bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer risk according to fasting blood glucose trajectories: a population-based cohort study
Authors: Khong Thi Minh Thu , Bui Thi Tra , Kang Hee-Yeon , Lee Jinhee , Park Eunjung , Oh Jin-Kyoung 
Published: February 2024

IntroductionDiabetes mellitus is known to increase the risk of cancer. Fasting blood glucose (FBG) levels can be changed over time. However, the association between FBG trajectory and cancer risk has been insufficiently studied. This research aims to examine the relationship between FBG trajectories and cancer risk in the Korean population.Research design and methodsWe analyzed data from the National Health Insurance Service–National Health Screening Cohort collected between 2002 and 2015. Group-based trajectory modeling was performed on 256,271 Koreans aged 40–79 years who had participated in health examinations at least three times from 2002 to 2007. After excluding patients with cancer history before 2008, we constructed a cancer-free cohort. The Cox proportional hazards model was applied to examine the association between FBG trajectories and cancer incidence by cancer type, after adjustments for covariates. Cancer case was defined as a person who was an outpatient thrice or was hospitalized once or more with a cancer diagnosis code within the first year of the claim.ResultsDuring the follow-up time (2008–2015), 18,991 cancer cases were identified. Four glucose trajectories were found: low-stable (mean of FBG at each wave <100 mg/dL), elevated-stable (113–124 mg/dL), elevated-high (104–166 mg/dL), and high-stable (>177 mg/dL). The high-stable group had a higher risk of multiple myeloma, liver cancer and gastrointestinal cancer than the low-stable group, with HR 4.09 (95% CI 1.40 to 11.95), HR 1.68 (95% CI 1.25 to 2.26) and HR 1.27 (95% CI 1.11 to 1.45), respectively. In elevated-stable trajectory, the risk increased for all cancer (HR 1.08, 95% CI 1.02 to 1.16) and stomach cancer (HR 1.24, 95% CI 1.07 to 1.43). Significant associations were also found in the elevated-high group with oral (HR 2.13, 95% CI 1.01 to 4.47), liver (HR 1.50, 95% CI 1.08 to 2.08) and pancreatic cancer (HR 1.99, 95% CI 1.20 to 3.30).ConclusionsOur study highlights that the uncontrolled high glucose level for many years may increase the risk of cancer.
Use of machine learning to identify characteristics associated with severe hypoglycemia in older adults with type 1 diabetes: a post-hoc analysis of a case–control study
Authors: Freeman Nikki L B , Muthukkumar Rashmi , Weinstock Ruth S , Wickerhauser M Victor , Kahkoska Anna R 
Published: February 2024

IntroductionSevere hypoglycemia (SH) in older adults (OAs) with type 1 diabetes is associated with profound morbidity and mortality, yet its etiology can be complex and multifactorial. Enhanced tools to identify OAs who are at high risk for SH are needed. This study used machine learning to identify characteristics that distinguish those with and without recent SH, selecting from a range of demographic and clinical, behavioral and lifestyle, and neurocognitive characteristics, along with continuous glucose monitoring (CGM) measures.Research design and methodsData from a case–control study involving OAs recruited from the T1D Exchange Clinical Network were analyzed. The random forest machine learning algorithm was used to elucidate the characteristics associated with case versus control status and their relative importance. Models with successively rich characteristic sets were examined to systematically incorporate each domain of possible risk characteristics.ResultsData from 191 OAs with type 1 diabetes (47.1% female, 92.1% non-Hispanic white) were analyzed. Across models, hypoglycemia unawareness was the top characteristic associated with SH history. For the model with the richest input data, the most important characteristics, in descending order, were hypoglycemia unawareness, hypoglycemia fear, coefficient of variation from CGM, % time blood glucose below 70 mg/dL, and trail making test B score.ConclusionsMachine learning may augment risk stratification for OAs by identifying key characteristics associated with SH. Prospective studies are needed to identify the predictive performance of these risk characteristics.
Global approaches to tackling antimicrobial resistance: a comprehensive analysis of water, sanitation and hygiene policies
Authors: Weets Ciara M , Katz Rebecca 
Published: February 2024

BackgroundUnsafe water, sanitation and hygiene (WASH) contributes to a high burden of disease and exacerbates factors that promote the development of antimicrobial resistance (AMR). Enforceable policies are foundational to curbing inappropriate use of antimicrobials and providing safe WASH. While many countries have established National Action Plans for AMR that include provisions for WASH, few have codified these plans into legally enforceable policy. Here, we provide a comprehensive map and describe the current regulatory environment for WASH.MethodsWe conducted a comprehensive analysis of the WASH-related policies in 193 countries. Policies were identified, collated, and categorised into a publicly available repository.ResultsA total of 672 policies met the criteria for inclusion in the dataset. No category of WASH-related policies had been adopted by all countries included in the study. Policy categories that were potentially more difficult to enforce in light of economic and governance limitations tended to be more prevalent and diverse, whereas policies in categories that were highly resource intensive and specific were less universal. Countries with gaps in policy categories also tended to be regionally clustered. While countries in the South Asian and European WHO regions had nearly universal policy coverage across all countries, the presence of policies was inconsistent across countries in the African and Eastern Mediterranean regions.ConclusionWhile decision-makers should rely on knowing which policies work best to mitigate the burden of WASH-related disease and AMR development, they must first have a comprehensive understanding of the current regulatory environment. Researchers and decision-makers need to know which policies work best and under what circumstances. The global mapping of WASH policies, which may have implications for AMR development, serves as a foundation for future policy analysis for AMR.
Malaria trends in districts that were targeted and not-targeted for seasonal malaria chemoprevention in children under 5 years of age in Guinea, 2014–2021
Authors: Bisanzio Donal , Keita Mamadou Sitan , Camara Alioune , Guilavogui Timothée , Diallo Thierno , Barry Hamidou , Preston Adam , Bangoura Lamine , Mbounga Eliane , Florey Lia S , Taton Jean-Luc , Fofana Aissata , Reithinger Richard 
Published: February 2024

BackgroundSeasonal malaria chemoprevention (SMC) is a main intervention to prevent and reduce childhood malaria. Since 2015, Guinea has implemented SMC targeting children aged 3–59 months (CU5) in districts with high and seasonal malaria transmission.ObjectiveWe assessed the programmatic impact of SMC in Guinea’s context of scaled up malaria intervention programming by comparing malaria-related outcomes in 14 districts that had or had not been targeted for SMC.MethodsUsing routine health management information system data, we compared the district-level monthly test positivity rate (TPR) and monthly uncomplicated and severe malaria incidence for the whole population and disaggregated age groups (<5 years and ≥5 years of age). Changes in malaria indicators through time were analysed by calculating the district-level compound annual growth rate (CAGR) from 2014 to 2021; we used statistical analyses to describe trends in tested clinical cases, TPR, uncomplicated malaria incidence and severe malaria incidence.ResultsThe CAGR of TPR of all age groups was statistically lower in SMC (median=−7.8%) compared with non-SMC (median=−3.0%) districts. Similarly, the CAGR in uncomplicated malaria incidence was significantly lower in SMC (median=1.8%) compared with non-SMC (median=11.5%) districts. For both TPR and uncomplicated malaria incidence, the observed difference was also significant when age disaggregated. The CAGR of severe malaria incidence showed that all age groups experienced a decline in severe malaria in both SMC and non-SMC districts. However, this decline was significantly higher in SMC (median=−22.3%) than in non-SMC (median=−5.1%) districts for the entire population, as well as both CU5 and people over 5 years of age.ConclusionEven in an operational programming context, adding SMC to the malaria intervention package yields a positive epidemiological impact and results in a greater reduction in TPR, as well as the incidence of uncomplicated and severe malaria in CU5.
Prescriptions of antidepressants and anxiolytics in France 2012–2022 and changes with the COVID-19 pandemic: interrupted time series analysis
Authors: De Bandt David , Haile Sarah R , Devillers Louise , Bourrion Bastien , Menges Dominik 
Published: February 2024

BackgroundDepression and anxiety have increased in prevalence since the start of the COVID-19 pandemic.ObjectiveTo evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic’s potential impact in France.MethodsWe conducted an interrupted time series analysis of routine drug sales data (Medic'AM) from all French outpatient pharmacies from 2012 to 2022. We investigated trends in defined daily doses of antidepressants and anxiolytics sold per 1000 inhabitants (DDD/TID) and related expenditures before and after pandemic onset and in relation with stringency of pandemic mitigation measures. Analyses were performed descriptively and using segmented linear regression, autoregressive and autoregressive integrated moving average models.FindingsFrom 2012 to 2019, overall monthly antidepressant sales increased (+0.02 DDD/TID) while monthly anxiolytic sales decreased (−0.07 DDD/TID). With pandemic onset, there was a relevant and persisting trend increase (+0.20 DDD/TID per month) for antidepressant sales overall, with an estimated excess of 112.6 DDD/TID sold from May 2020 until December 2022. Anxiolytic sales were elevated from February 2020 throughout the pandemic but returned to expected levels by December 2022, with an estimated excess of 33.8 DDD/TID. There was no evident association between stringency and antidepressant or anxiolytic sales.ConclusionsThis study showed a protracted trend increase in the consumption of antidepressants since pandemic onset, while increases in anxiolytic consumption were temporary.Clinical implicationsWe provide evidence that the COVID-19 pandemic may have had long-lasting consequences on the prevalence and treatment of depression and anxiety disorders, requiring further actions by researchers and policy-makers to address this potential public mental health crisis.
Prescribing practices in the treatment of wasting: secondary analysis from a randomised trial
Authors: Rattigan Susan M , Grantz Kyra H , Hanson Kerstin , Langendorf Celine , Berthé Fatou , Grais Rebecca , Isanaka Sheila 
Published: February 2024

IntroductionCurrent guidelines for the outpatient treatment of severe acute malnutrition (SAM) recommend the provision of routine medications to all children at admission and prescribed medications as clinically indicated thereafter. The objective of this study was to describe the amount and purpose of medications prescribed during outpatient SAM treatment and explore the effect of routine antibiotics at admission on subsequent medication prescription.MethodsMedications prescribed during outpatient treatment were described by medication category, time from admission, and diagnoses among children with SAM in a placebo-controlled, double-blind trial of 7-day amoxicillin use. Total medications were compared by parent trial intervention arm (amoxicillin vs placebo) and differences assessed using Χ2and two-sample t-tests.ResultsOf the 2399 children enrolled, 74.6% of children received ≥1 prescribed medication during outpatient treatment. Antipyretics/analgesics (44.1% of children), antimalarials (56.6%) and antibiotics (30.0%) were prescribed most frequently. Children who received placebo in the parent trial received fewer total medications (mean difference: −0.80, 95% CI: −0.96 to –0.65) and oral antibiotics (mean difference: −0.96, 95% CI: −0.99 to –0.92) during treatment compared with children who received routine amoxicillin.ConclusionsWe found high rates of medication prescription during outpatient treatment for SAM, but fewer total medications and oral antibiotics prescribed to children receiving placebo in the parent trial. Our findings underscore the role of outpatient treatment programmes as an important source of medicine prescription and suggest that provision of antibiotics on a clinically indicated basis for outpatient SAM cases may be a strategy to support prudent antibiotic use in certain settings.Trial registration numberClinicalTrials.gov Registry (NCT01613547;https://clinicaltrials.gov/ct2/show/NCT01613547).
Evaluation of planned number of children, the well-being of the couple and associated factors in a prospective cohort in Yokohama (HAMA study): study protocol
Authors: Hara Koji , Kuroki Makoto , Shiraishi Sayuri , Matsumura Shingo , Ito Shuichi , Kurasawa Kentaro , Arimoto Azusa , Matsuzaki Yohei 
Published: February 2024

IntroductionMany developed countries including Japan are experiencing declining birth rates, particularly in urban areas. A gap between the planned number of children and the actual number of children exists, that is attributed to various factors such as: childcare leave and employment policies, childcare services, financial support, husbands’ contributions to household chores and childcare, marriage support, community, and couples’ well-being. Therefore, we propose HAMA study for having a baby, parenting, and marriage life (HAMA = ‘H’aving ‘A’ baby, parenting, and ‘MA’rriage life) in Yokohama (an urban area) to examine these issues.Methods and analysisIn this large-scale cohort study, we will elucidate the actual situation of families and child-rearing in Yokohama, evaluate the current policies and propose future measures to prevent a decline in the birth rate. Overall, 10 000 young married couples (wives aged 20–39 years as of 2022) will be randomly selected, and a survey form will be sent to them annually. They will be followed-up for 5 years to examine the factors associated with the planned number of children, well-being of the couple, childcare support policies, externalisation of housework and childcare, fathers’ participation in housework and childcare, wives’ free time, loneliness and social connectedness, relationship with the spouse and if they are working, questions regarding their work style and work-life balance will also be included. Ultimately, a conceptual model of the planned number of children and associated factors will be developed.Ethics and disseminationThis study has been approved by the Ethics Committee of Yokohama City University (reference number: 2022–10) and will be conducted following appropriate ethical guidelines. Opportunities to withdraw consent to participate in the survey are provided to participants. The results of this survey will be published as research papers in relevant journals and will be reported to the administration of Yokohama city and other agencies.
Evaluating a stepped care model of psychological support for adults affected by adversity: study protocol for a randomised controlled trial in Jordan
Authors: Keyan Dharani , Habashneh Rand , Akhtar Aemal , El-Dardery Hafsa , Faroun Muhannad , Abualhaija Adnan , Aqel Ibrahim Said , Dardas Latefa Ali , Bryant Richard 
Published: February 2024

BackgroundThe burden of common mental disorders in low and middle-income countries (LMICs) is growing with little known about how to allocate limited resources to reach the greatest number of people undergoing instances of significant psychological distress. We present a study protocol for a multicentre, parallel-group, superiority, randomised controlled trial.Methods and analysisAdults with significant psychological distress (K10 score ≥20) will be randomised to receive a stepped care programme involving a self-guided course (Doing What Matters) followed by a more intensive group programme (Problem Management Plus) or the self-guided course alone, both of which will take place in addition to enhanced treatment as usual comprising of a follow-up referral session to available services within the community. We will include 800 participants. An intent-to-treat and completer analysis will explore the impact of the stepped model of care on anxiety and depression symptoms (as measured by the Hopkins Symptom Checklist; HSCL-25) at 24 weeks from baseline. Secondary outcomes include positive psychological well-being, agency, changes in patient-identified problems, quality of life and cost-effectiveness. Linear mixed models will be used to assess the differential impact of the conditions over time. Analyses will focus on the primary outcome (HSCL-25) and secondary outcomes (agency subscale, WHO Well-Being Index, WHO Disability Assessment Schedule V.2.0, EQ-5D, Psychological Outcomes Profiles Scale) for both conditions, with the main outcome time point being the 3-month follow-up, relative to baseline.Ethics and disseminationThis will be the first randomised controlled trial to assess the benefits of a stepped model of care to addressing psychological distress in a LMIC setting. Results will provide important insights for managing limited resources to mental healthcare in these settings and will be accordingly disseminated to service providers and organisations via professional training and meetings, and via publication in relevant journals and conference presentations. We will also present these findings to the Jordanian Ministry of Health, where this institute will guide us on the most appropriate format for communication of findings, including written reports, verbal presentations and/or brochures. Ethical approval was obtained from the University of Jordan School of Nursing Research Ethics Committee (number: PF.22.10).Trial registration numberACTRN12621000189820p; Australian New Zealand Clinical Trials Registry.
Prototype development of the Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool): a protocol paper of a two-stage sequential and mixed methods codesign study
Authors: Brimelow Rachel , Brooks Deborah , Sriram Deepa , Burley Claire , Beattie Elizabeth , Byrne Gerard , Dissanayaka Nadeeka 
Published: February 2024

ObjectivesCurrent mental health practices for people living in residential aged care (RAC) facilities are poor. In Australia, there are no mechanisms to monitor and promote mental health for people living in RAC, including those who experience changed behaviours and psychological symptoms. The aim of this study is to improve current practices and mental health outcomes for people living in RAC facilities by codesigning a Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool).MethodsA two-stage sequential and mixed methods codesign methodology will be used. Stage 1 will include qualitative interviews and focus groups to engage with residents, family/care partners and RAC staff to ascertain mental healthcare practices and outcomes of greatest significance to them. Adapted concept mapping methods will be used to rank identified issues of concern in order of importance and changeability, and to generate draft quality indicators. Stage 2 will comprise a Delphi procedure to gain the wider consensus of expert panel views (aged care industry, academic, clinical) on the performance indicators to be included, resulting in the codesigned MHICare Tool.Ethics and disseminationThis study has been reviewed and approved by the University of Queensland Human Research Ethics Committee (HREC/2019002096). This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007). The study’s findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.ConclusionThis protocol reports structured methods to codesign and develop a mental health performance indicator tool for use in Australian RAC.
Great expectations? GPs’ estimations of time required to deliver BMJ’s ‘10 minute consultations’
Authors: Bradley Stephen Henry , Harper Alice M , Smith Lesley , Taylor Nigel , Delap Harriet , Pyke Helen , Girkin James , Sinnott Carol , Watson Jessica 
Published: February 2024

ObjectivesTo estimate the time required to undertake consultations according to BMJ’s 10-minute consultation articles.To quantify the tasks recommended in 10-minute consultation articles.To determine if, and to what extent, the time required and the number of tasks recommended have increased over the past 22 years.DesignAnalysis of estimations made by four general practitioners (GPs) of the time required to undertake tasks recommended inBMJ’s10-minute consultationarticles.SettingPrimary care in the UK.ParticipantsFour doctors with a combined total of 79 years of experience in the UK National Health Service following qualification as GPs.Main outcome measuresMedian minimum estimated consultation length (the estimated time required to complete tasks recommended for all patients) and median maximum estimated consultation length (the estimated time required to complete tasks recommended for all patientsandthe additional tasks recommended in specific circumstances). Minimum, maximum and median consultation lengths reported for each year and for each 5-year period.ResultsData were extracted for 44 articles. The median minimum and median maximum estimated consultation durations were 15.7 minutes (IQR 12.6–20.9) and 28.4 minutes (IQR 22.4–33.8), respectively. A median of 17 tasks were included in each article. There was no change in durations required over the 22 years examined.ConclusionsThe approximate times estimated by GPs to deliver care according to10-minute consultationsexceed the time available in routine appointments. ‘10 minute consultations’ is a misleading title that sets inappropriate expectations for what GPs can realistically deliver in their routine consultations. While maintaining aspirations for high-quality care is appropriate, practice recommendations need to take greater account of the limited time doctors have to deliver routine care.