bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing intervention prototypes to improve infant and young child nutrition in Peru: a participatory design study protocol
Authors: Rousham Emily , Pareja Rossina G , Creed-Kanashiro Hilary M , Bartolini Rosario , Pradeilles Rebecca , Ortega-Roman Deysi , Holdsworth Michelle , Griffiths Paula , Verdezoto Nervo 
Published: December 2023

IntroductionNutrition during the complementary feeding period (6–23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach.Methods and analysisThe study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6–23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6–23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities.Ethics and disseminationEthical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications.
Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries
Authors: Ruiz Brunner Maria de las Mercedes , Jahan Israt , Cuestas Eduardo , Cieri Maria Elisabeth , Escobar Zuluaga Johana , Condinanzi Ana Laura , Sanchez Federico , McIntyre Sarah , Smithers-Sheedy Hayley , Muhit Mohammad , Badawi Nadia , Díaz Raul , Diaz Agripina , Carranza Jorge , Durán Claudia , Quintero Valencia Carlos Alberto , Melaragno Mariana , Khandaker Gulam 
Published: December 2023

IntroductionCerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR).Methods and analysisThe LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared.Ethics and disseminationIndividual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.
Predictive value of machine learning on fracture risk in osteoporosis: a systematic review and meta-analysis
Authors: Wu Yanqian , Chao Jianqian , Bao Min , Zhang Na 
Published: December 2023

ObjectivesEarly identification of fracture risk in patients with osteoporosis is essential. Machine learning (ML) has emerged as a promising technique to predict the risk, whereas its predictive performance remains controversial. Therefore, we conducted this systematic review and meta-analysis to explore the predictive efficiency of ML for the risk of fracture in patients with osteoporosis.MethodsRelevant studies were retrieved from four databases (PubMed, Embase, Cochrane Library and Web of Science) until 31 May 2023. A meta-analysis of the C-index was performed using a random-effects model, while a bivariate mixed-effects model was used for the meta-analysis of sensitivity and specificity. In addition, subgroup analysis was performed according to the types of ML models and fracture sites.ResultsFifty-three studies were included in our meta-analysis, involving 15 209 268 patients, 86 prediction models specifically developed for the osteoporosis population and 41 validation sets. The most commonly used predictors in these models encompassed age, BMI, past fracture history, bone mineral density T-score, history of falls, BMD, radiomics data, weight, height, gender and other chronic diseases. Overall, the pooled C-index of ML was 0.75 (95% CI: 0.72, 0.78) and 0.75 (95% CI: 0.71, 0.78) in the training set and validation set, respectively; the pooled sensitivity was 0.79 (95% CI: 0.72, 0.84) and 0.76 (95% CI: 0.80, 0.81) in the training set and validation set, respectively; and the pooled specificity was 0.81 (95% CI: 0.75, 0.86) and 0.83 (95% CI: 0.72, 0.90) in the training set and validation set, respectively.ConclusionsML has a favourable predictive performance for fracture risk in patients with osteoporosis. However, most current studies lack external validation. Thus, external validation is required to verify the reliability of ML models.PROSPERO registration numberCRD42022346896.
Self-care behaviour and associated factors among heart failure patients in Ethiopia: a systematic review and meta-analysis
Authors: Wondmieneh Adam , Getie Addisu , Bimerew Melaku 
Published: December 2023

ObjectiveThis study aimed to estimate the pooled level of self-care behaviour among heart failure patients in Ethiopia.DesignSystematic review and meta-analysis.Data sourcePubMed/MEDLINE, HINARI, Web of Sciences, Scopus, Google Scholar, Science Direct, African journals online and University repositories were searched from 1 January 2000 to 1 November 2023.Eligibility criteriaWe include studies that examined self-care behaviour among heart failure patients, studies that report factors associated with self-care behaviour and observational studies (cross-sectional, case-control and cohort) with full text available.Data extraction and synthesisThe data were extracted with Microsoft Excel and analysed by using STATA V.11 software. The weighted inverse variance random-effects model at 95% CI was used to estimate the pooled level of self-care behaviour and its associated factors among heart failure patients. Tests of heterogeneity, test of publication bias and subgroup analyses were also employed.ResultsThirteen cross-sectional studies with 4321 study participants were included; and the pooled level of good self-care behaviour among heart failure patients in Ethiopia was found to be 38.3% (95% CI 31.46 to 45.13). Only 68.8% of heart failure patients were knowledgeable about heart failure. Knowledge about heart failure (Adjusted Odds Ratio (AOR)=3.39; 95% CI 2.42 to 4.74) and absence of comorbidity (AOR=2.69; 95% CI 1.35 to 5.37) were significantly associated with good self-care behaviour among heart failure patients in Ethiopia.ConclusionThe majority of heart failure patients in Ethiopia did not adhere to the recommended self-care behaviours. Nearly one-third of heart failure patients were not knowledgeable about heart failure. Knowledge about heart failure and the absence of comorbidities were significantly associated with good self-care behaviour. Therefore, efforts should be devoted to increasing knowledge and preventing comorbidities among heart failure patients.PROSPERO registration numberCRD42023394373.
Influence of physical fitness components on personality factors and risk perception of children and adolescents: a cross-sectional study
Authors: González-Gálvez Noelia , Vaquero-Cristobal Raquel , Maciá-Andreu María José , García-Tascon Marta , Soler-Marín Antonio , Gallardo-Guerrero Ana María 
Published: December 2023

ObjectivesTo examine the associations of cardiorespiratory fitness (VO2max) and muscular strength with indicators related to the risk scale, such as perceived competence, sensation seeking, competitiveness, risk taking and risk perception in sports.DesignCross-sectional study.SettingHigh schools from the Region of Murcia (Spain).ParticipantsThree-hundred-and-seventeen adolescents participated (mean age: 13.69±1.2 years old).Primary and secondary outcome measuresBody mass, body height, Course-Navette test, upper limb strength and psychoeducational factors that determine the propensity towards sports accidents in school children, the Sports Accident Propensity Scale were evaluated. It was performance t-test for independent samples, stepwise multiple linear regression models and a multiple mediation analysis.ResultsThe analysis showed significant differences with respect to sex in height, VO2max, handgrip strength and in all factors of the questionnaire (p=0.02-<0.01). Adolescents who presented greater VO2max, strength in the handgrip test and age showed a higher score in factors 1 and 3. Higher scores in factor 2 were associated with better VO2max and strength in handgrip test. Youngers and better values of strength in the handgrip showed higher score in factors 4 and 5. The mediation analysis with two mediating variables (handgrip strength and VO2max) showed a significant indirect effect. When handgrip strength and VO2max were included in the equations, the association between sex and each factor ceased to be significant.ConclusionThis study highlights the potential benefits of muscular strength (handgrip) and VO2max in the perceived risk scale, and the variable of age on this.Trial registration numberClinical trial:NCT05544370(pre-results).
How surgical Trainee Research Collaboratives achieve success: a mixed methods study to develop trainee engagement strategies
Authors: Clement Clare , Coulman Karen , Heywood Nick , Pinkney Tom , Blazeby Jane , Blencowe Natalie S , Cook Jonathan Alistair , Bulbulia Richard , Arenas-Pinto Alejandro , Snowdon Claire , Hilton Zoe , Magill Laura , MacLennan Graeme , Glasbey James , Nepogodiev Dmitri , Hardy Victoria , Lane J Athene 
Published: December 2023

ObjectivesThis study aimed to understand the role of surgical Trainee Research Collaboratives (TRCs) in conducting randomised controlled trials and identify strategies to enhance trainee engagement in trials.DesignThis is a mixed methods study. We used observation of TRC meetings, semi-structured interviews and an online survey to explore trainees’ motivations for engagement in trials and TRCs, including barriers and facilitators. Interviews were analysed thematically, alongside observation field notes. Survey responses were analysed using descriptive statistics. Strategies to enhance TRCs were developed at a workshop by 13 trial methodologists, surgical trainees, consultants and research nurses.SettingThis study was conducted within a secondary care setting in the UK.ParticipantsThe survey was sent to registered UK surgical trainees. TRC members and linked stakeholders across surgical specialties and UK regions were purposefully sampled for interviews.ResultsWe observed 5 TRC meetings, conducted 32 semi-structured interviews and analysed 73 survey responses. TRCs can mobilise trainees thus gaining wider access to patients. Trainees engaged with TRCs to improve patient care, surgical evidence and to help progress their careers. Trainees valued the TRC infrastructure, research expertise and mentoring. Challenges for trainees included clinical and other priorities, limited time and confidence, and recognition, especially by authorship. Key TRC strategies were consultant support, initial simple rapid studies, transparency of involvement and recognition for trainees (including authorship policies) and working with Clinical Trials Units and research nurses. A 6 min digital story on YouTube disseminated these strategies.ConclusionTrainee surgeons are mostly motivated to engage with trials and TRCs. Trainee engagement in TRCs can be enhanced through building relationships with key stakeholders, maximising multi-disciplinary working and offering training and career development opportunities.
Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study
Authors: Wang Wei , Jiang Jingfeng , Qi Lerong , Zhao Fanqi , Wu Jingying , Zhu Xiaoqi , Wang Bei , Hong Xiang 
Published: December 2023

ObjectiveOn 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students’ daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status.MethodsThis was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method.ResultsFinally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness.ConclusionDuring the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.
Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England
Authors: Smith Toby O , Khoury Reema , Hanson Sarah , Welsh Allie , Grant Kelly , Clark Allan B , Ashford Polly-Anna , Hopewell Sally , Pfeiffer K , Logan Phillipa , Crotty Maria , Costa Matthew L , Lamb Sarah 
Published: December 2023

ObjectivesTo assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery.DesignTwo-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study.SettingNational Health Service (NHS) providers in five English hospitals.ParticipantsCommunity-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers.InterventionUsual care: usual NHS care. Experimental: usual NHS careplusa caregiver–patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions.Randomisation and blindingCentral randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding.Main outcome measuresData collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals.Results102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable.ConclusionsThe HIP HELPER programme was acceptable to patient–caregiver dyads and health professionals. The COVID-19 pandemic impacting on site’s ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT.Trial registration numberISRCTN13270387.
Impact of smoking cessation on non-alcoholic fatty liver disease prevalence: a systematic review and meta-analysis
Authors: Zhang Shengan , Liu Zhidong , Yang Qinghua , Hu Zichun , Zhou Wenjun , Ji Guang , Dang Yanqi 
Published: December 2023

ObjectivesThe negative effects of smoking on numerous cardiovascular and metabolic diseases have been widely acknowledged. However, the potential effect of smoking cessation is relatively unelucidated. The objective of this study is to explore whether the prevalence of non-alcoholic fatty liver disease (NAFLD) in former smokers differs from the prevalence in current smokers.DesignSystematic review and meta-analysis.Data sourcesFour databases, that is, PubMed, Web of Science, Journal@Ovid and Scopus were searched from inception to 31 January 2023.Eligibility criteriaPopulation-based cross-sectional studies, including the baseline data of cohort studies with identified NAFLD diagnostic methods, and smoking status (current smoker or former smoker) of participants were included.Data extraction and synthesisTwo reviewers independently extracted the data including cigarette smoking status, country/region of studies, NAFLD diagnostic methods, sex, the average age and body mass index (BMI) of NAFLD participants and assessed the risk of bias with Agency for Healthcare Research and Quality (AHRQ) methodology checklist. Risk ratio (RR) of NAFLD prevalence in former smokers was pooled using the random-effects model.Results28 studies involving 4 465 862 participants were included. Compared with current smokers, the RR of overall NAFLD prevalence in former smokers was 1.13 (95% CI: 1.08 to 1.19, prediction interval: 0.92–1.39). This result persisted after adjustment for diagnostic methods, country/region, sex, age and BMI. Sensitivity analysis and risk of bias assessment indicated a stable conclusion.ConclusionsNAFLD prevalence in former smokers was at least not lower than that in current smokers and was partially related to increased BMI after smoking cessation, indicating that smoking cessation was possibly not a protective factor against NAFLD. Although the meta-analysis based on cross-sectional studies cannot conclude the causal relationships between smoking cessation and NAFLD onset, the potential onset of NAFLD associated with smoking cessation should be highlighted.PROSPERO registration numberCRD42023394944.
What is the current global health participation and future interest of healthcare students and National Health Service (NHS) staff? A cross-sectional research study of healthcare students and NHS staff in England
Authors: Goldstone Ross , Hinds Rachael , McCarthy Rose , Byrne Ged , Keen David 
Published: December 2023

ObjectivesThis research aimed to understand the prior and current global health participation, current availability of and future interest in participating in global health activities healthcare students and National Health Service (NHS) staff.DesignAn online survey was conducted on NHS staff and healthcare students in England between July and November 2021. The survey was disseminated to all secondary care providers in the English NHS and universities in England. A volunteer sample of 3955 respondents, including 2936 NHS staff, 683 healthcare students, 172 individuals combining NHS working and study and 164 respondents classified as other.ResultsMost (80%) respondents had not participated in a global health activity before, with 6% having previously participated, a further 3% currently participating and 11% unsure. Among those who had participated, the most common types of activity were attending global health events (75%). The most common reason for not participating was a limited knowledge of opportunities (78%). When asked about their future interest in global health participation, more than half of respondents (53%) indicated an interest and 8% were not interested. There was an significant proportion (39%) answering unsure, indicating a possible lack of understanding about global health participation.ConclusionsGlobal health has gathered increasing significance in recent years, both in policy and in education and training for healthcare professionals. Despite recognition of the role global learning plays in knowledge enhancement, skill development and knowledge exchange, this study suggests that global health participation remains low among NHS staff and healthcare students.