bluuebunny/crossref_metadata_2025_split huggingface dataset:
The potential impact of novel tuberculosis vaccines on health equity and financial protection in low-income and middle-income countries
Authors: Portnoy Allison , Clark Rebecca A , Weerasuriya Chathika K , Mukandavire Christinah , Quaife Matthew , Bakker Roel , Garcia Baena Inés , Gebreselassie Nebiat , Zignol Matteo , Jit Mark , White Richard G , Menzies Nicolas A 
Published: July 2023

IntroductionOne in two patients developing tuberculosis (TB) in low-income and middle-income countries (LMICs) faces catastrophic household costs. We assessed the potential financial risk protection from introducing novel TB vaccines, and how health and economic benefits would be distributed across income quintiles.MethodsWe modelled the impact of introducing TB vaccines meeting the World Health Organization preferred product characteristics in 105 LMICs. For each country, we assessed the distribution of health gains, patient costs and household financial vulnerability following introduction of an infant vaccine and separately for an adolescent/adult vaccine, compared with a ‘no-new-vaccine’ counterfactual. Patient-incurred direct and indirect costs of TB disease exceeding 20% of annual household income were defined as catastrophic.ResultsOver 2028–2050, the health gains resulting from vaccine introduction were greatest in lower income quintiles, with the poorest 2 quintiles in each country accounting for 56% of total LMIC TB cases averted. Over this period, the infant vaccine was estimated to avert US$5.9 (95% uncertainty interval: US$5.3–6.5) billion in patient-incurred total costs, and the adolescent/adult vaccine was estimated to avert US$38.9 (US$36.6–41.5) billion. Additionally, 3.7 (3.3–4.1) million fewer households were projected to face catastrophic costs with the infant vaccine and 22.9 (21.4–24.5) million with the adolescent/adult vaccine, with 66% of gains accruing in the poorest 2 income quintiles.ConclusionUnder a range of assumptions, introducing novel TB vaccines would reduce income-based inequalities in the health and household economic outcomes of TB in LMICs.
Effect of bilirubin and Gilbert syndrome on health: cohort analysis of observational, genetic, and Mendelian randomisation associations
Authors: Hamilton Fergus W , Abeysekera KWM , Hamilton Willie , Timpson Nicholas J 
Published: July 2023

ObjectivesTo compare associations between the Gilbert syndrome genotype in European populations, measured bilirubin concentrations, genetically predicted bilirubin using this genotype, and a wide range of health outcomes in a large cohort.DesignCohort study including observational, genetic, and Mendelian randomisation analyses.Setting22 centres across England, Scotland, and Wales in UK Biobank (2006-10), with replication in a national Finnish cohort (FinnGen).Participants463 060 participants in the UK Biobank were successfully genotyped for a genetic variant (rs887829) that is strongly associated with Gilbert syndrome and 438 056 participants had measured bilirubin concentrations with linked electronic health record data coded using the tenth edition of the International Classification of Diseases. Replication analyses were performed in FinnGen (n=429 209) with linked electronic health record data.Main outcome measuresOdds ratios for the association between serum bilirubin concentrations, rs887829-T homozygosity (the risk genotype for Gilbert syndrome), genetically predicted bilirubin using rs887829-T allele carriage alone, and a wide range of health outcomes recorded in primary and secondary care.Results46 189 participants in UK Biobank (about 10%) were homozygous for rs887829-T defining them as having the genotype characterising Gilbert syndrome. However, only 1701 (3%) of this group had a coded diagnosis of Gilbert syndrome. Variation at this locus explained 37.1% of all variation in measured serum bilirubin. In the observational analyses, higher bilirubin concentrations had strong inverse associations with a wide range of outcomes including overall health status, chronic obstructive pulmonary disease, myocardial infarction, and cholesterol measures. These associations were not identified in people with the Gilbert genotype. We identified associations with genetically predicted bilirubin concentrations and biliary and liver pathology (eg, odds ratio for cholelithiasis 1.16 (95% confidence interval 1.12 to 1.20); P=5.7×10-16) and a novel association with pityriasis rosea (1.47 (1.27 to 1.69), P=1.28×10-7).ConclusionsOnly 3% of participants who are homozygous for rs887829-T have a recorded diagnosis of Gilbert syndrome. Carriers of this genotype have modest increases in the odds of developing biliary pathology and pityriasis rosea. Evidence from the analyses of genetic data suggests that bilirubin has no likely causal role in protection from cardiovascular disease, chronic obstructive pulmonary disease, or other key healthcare outcomes and therefore represents a poor target for therapeutic intervention for these outcomes.
Mind-body exercise interventions for prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic review and meta-analysis
Authors: Tan Leona , Strudwick Jessica , Deady Mark , Bryant Richard , Harvey Samuel B 
Published: July 2023

ObjectiveMind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations.DesignSystematic review and meta-analysis.MethodsA systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges’gand 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses.ResultsSix studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD (g=−0.25, 95% CI −0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms.ConclusionLimited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias.PROSPERO registration numberCRD42020180375
Factors associated with graduation examination results from standardised residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020
Authors: Gao QiSheng , Li Ruoqi , Xia Zhijun , Qu Xianguo , Jiang Ling 
Published: July 2023

ObjectiveStandardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the quality of residency training. This study aimed to analyse the results and associated factors of the graduation examination of standardised residency training in Zhejiang Province in 2020.DesignCross-sectional analysis of examination results data.SettingMedical and health institutions and universities in Zhejiang Province.ParticipantsA total of 5555 examinees took the graduation examination of standardised residency training in Zhejiang Province in 2020.Primary outcomesPass rates of the practical skill examination and written examination.ResultsThe pass rates for the practical skill examination and written examination were 91.8% and 96.5%, respectively. Examinees aged 30 and above (adjusted OR (AOR)=0.48, 95% CI 0.26 to 0.89), those with 3 years (AOR=0.19, 95% CI 0.09 to 0.43) and 2 years (AOR=0.61, 95% CI 0.40 to 0.96) of training, those who retook the examination (AOR=0.28, 95% CI 0.20 to 0.391) and those from primary healthcare institutions (AOR=0.56, 95% CI 0.40 to 0.77) were less likely to pass the practical skill examination. Examinees with a postgraduate degree and those from colleges and universities had higher pass rates in the written examination (AOR=6.37, 95% CI 1.95 to 23.34; AOR=2.87, 95% CI 1.40 to 6.65, respectively). Examinees aged 30 and above (AOR=0.08, 95% CI 0.01 to 0.30), those aged between 25 and 30 (AOR=0.22, 95% CI 0.03 to 0.80), those who retook the examination (AOR=0.04, 95% CI 0.03 to 0.07), those from second-level hospitals (AOR=0.58, 95% CI 0.39 to 0.87) and those who failed the practical skill examination (AOR=0.17, 95% CI 0.12 to 0.25) were less likely to pass the written examination.ConclusionsThe pass rate of the graduation examination of standardised residency training was associated with the individual characteristics of the examinees. The results of practical skill examination were related to the results of the written examination.
Concordance and determinants of mothers’ and children’s diets in Nigeria: an in-depth study of the 2018 Demographic and Health Survey
Authors: Akseer Nadia , Tasic Hana , Adeyemi Olutayo , Heidkamp Rebecca 
Published: July 2023

ObjectivesImproving the diversity of the diets in young children 6–23 months is a policy priority in Nigeria and globally. Studying the relationship between maternal and child food group intake can provide valuable insights for stakeholders designing nutrition programmes in low-income and middle-income countries.DesignWe examined the relationship between maternal and child dietary diversity among 8975 mother–child pairs using the Nigeria 2018 Demographic and Health Survey (DHS). We assessed concordance and discordance between maternal and child food group intake using the McNemar’s χ2test, and the determinants of child minimum dietary diversity (MDD-C) including women MDD (MDD-W) using hierarchical multivariable probit regression modelling.SettingNigeria.Participants8975 mother–child pairs from the Nigeria DHS.Primary and secondary outcome measuresMDD-C, MDD-W, concordance and discordance in the food groups consumed by mothers and their children.ResultsMDD increased with age for both children and mothers. Grains, roots and tubers had high concordance in mother–child dyads (90%); discordance was highest for legumes and nuts (36%), flesh foods (26%), and fruits and vegetables (39% for vitamin-A rich and 57% for other). Consumption of animal source food (dairy, flesh foods, eggs) was higher for dyads with older mothers, educated mothers and more wealthy mothers. Maternal MDD-W was the strongest predictor of MDD-C in multivariable analyses (coef 0.27; 95% CI 0.25 to 0.29, p<0.000); socioeconomic indicators including wealth (p<0.000), mother’s education (p<0.000) were also statistically significant in multivariable analyses and rural residence (p<0.000) was statistically significant in bivariate analysis.ConclusionProgramming to address child nutrition should be aimed at the mother–child dyad as their food consumption patterns are related and some food groups appear to be withheld from children. Stakeholders including governments, development partners, non-governmental organizations, donors and civil society can act on these findings in their efforts to address undernutrition in the global child population.
Global use of electronic patient-reported outcome systems in nephrology: a mixed methods study
Authors: Anderson Nicola Elizabeth , Kyte Derek , McMullan Christel , Cockwell Paul , Aiyegbusi Olalekan Lee , Verdi Rav , Calvert Melanie 
Published: July 2023

ObjectivesThe use of electronic patient-reported outcome (ePRO) systems to support the management of patients with chronic kidney disease is increasing. This mixed-methods study aimed to comprehensively identify existing and developing ePRO systems, used in nephrology settings globally, ascertaining key characteristics and factors for successful implementation.Study designePRO systems and developers were identified through a scoping review of the literature and contact with field experts. Developers were invited to participate in a structured survey, to summarise key system characteristics including: (1) system objectives, (2) population, (3) PRO measures used, (4) level of automation, (5) reporting, (6) integration into workflow and (7) links to electronic health records/national registries. Subsequent semistructured interviews were conducted to explore responses.Setting and participantsEligible systems included those being developed or used in nephrology settings to assess ePROs and summarise results to care providers. System developers included those with a key responsibility for aspects of the design, development or implementation of an eligible system.Analytical approachStructured survey data were summarised using descriptive statistics. Interview transcripts were analysed using Codebook Thematic Analysis using domains from the Consolidated Framework for Implementation Research.ResultsFifteen unique ePRO systems were identified across seven countries; 10 system developers completed the structured survey and 7 participated in semistructured interviews. Despite system heterogeneity, reported features required for effective implementation included early and sustained patient involvement, clinician champions and expanding existing electronic platforms to integrate ePROs. Systems demonstrated several common features, with the majority being implemented within research settings, thereby affecting system implementation readiness for real-world application.ConclusionsThere has been considerable research investment in ePRO systems. The findings of this study outline key system features and factors to support the successful implementation of ePROs in routine kidney care.Cite Now
Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol
Authors: Capdevila Mathieu , De Jong Audrey , Aarab Yassir , Vonarb Aurelie , Carr Julie , Molinari Nicolas , Capdevila Xavier , Brochard Laurent , Jaber Samir 
Published: July 2023

IntroductionReadiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient’s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient’s illness.Methods and analysisThis will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH2O with positive end expiratory pressure (PEEP) level of 0 cmH2O, PSV 0 cmH2O with PEEP 0 cmH2O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease).Ethics and disseminationThe study project was approved by the appropriate ethics committee (2019-A01063-54, Comité de Protection des Personnes TOURS - Région Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent.Trial registration numberNCT04222569.
General practitioners ending their practice and impact on patients’ health, healthcare use and mortality: a protocol for national registry cohort studies in Norway, 2008 to 2021
Authors: Vinjerui Kristin Hestmann , Sarheim Anthun Kjartan , Asheim Andreas , Carlsen Fredrik , Mjølstad Bente Prytz , Nilsen Sara Marie , Pape Kristine , Bjorngaard Johan H 
Published: July 2023

IntroductionContinuous general practitioner (GP) and patient relations associate with positive health outcomes. Termination of GP practice is unavoidable, while consequences of final breaks in relations are less explored. We will study how an ended GP relation affects patient’s healthcare utilisation and mortality compared with patients with a continuous GP relation.Methods and analysisWe link national registries data on individual GP affiliation, sociodemographic characteristics, healthcare use and mortality. From 2008 to 2021, we identify patients whose GP stopped practicing and will compare acute and elective, primary and specialist healthcare use and mortality, with patients whose GP did not stop practicing. We match GP–patient pairs on age and sex (both), immigrant status and education (patients), and number of patients and practice period (GPs). We analyse the outcomes before and after an ended GP–patient relation, using Poisson regression with high-dimensional fixed effects.Ethics and disseminationThis study protocol is part of the approved project Improved Decisions with Causal Inference in Health Services Research, 2016/2159/REK Midt (the Regional Committees for Medical and Health Research Ethics) and does not require consent. HUNT Cloud provides secure data storage and computing. We will report using the STROBE guideline for observational case–control studies and publish in peer-reviewed journals, accessible in NTNU Open and present at scientific conferences. To reach a broader audience, we will summarise articles in the project’s web page, regular and social media, and disseminate to relevant stakeholders.
Cost–benefit analysis of partnership working between fire and rescue and health services across England and Wales during the COVID-19 pandemic
Authors: Waring Sara , Jones Alaw 
Published: July 2023

ObjectivesFire and rescue services undertook a range of additional activities to support the National Health Service (NHS) in managing extreme service demand during the COVID-19 pandemic. This study aims to examine the cost–benefit of partnership work between fire and rescue services and the NHS during the COVID-19 pandemic.SettingEngland and Wales.DesignA cost–benefit approach was used. Data relating to resources and outcomes was accessed from a National Data Portal commissioned by the National Fire Chiefs Council to record fire and rescue service responses throughout the pandemic. Literature-based economic estimates were applied to establish the potential cost–benefit of fire and rescue services undertaking support activities.ResultsFire and rescue services commonly undertook eight activities to support ambulance services and hospitals in three key areas: (1) driving ambulances, (2) provision of personal protective equipment for healthcare workers and (3) mass testing and mass vaccination. Benefits outweighed costs for all activities. Total costs were estimated at £93.26 million and total benefits were between £171.46 million and £1.10 billion.ConclusionsThis is the first economic evaluation of partnership working between fire and rescue and health services during a pandemic. Findings highlight the social and economic value of co-operation between fire and rescue services and the NHS and provides important evidence for informing public sector decisions regarding the allocation of resources in future public health crises.
Relationships of illness perception, symptoms response and social support with acute myocardial infarction patients’ prehospital delay in rural China: protocol for a cross-sectional study
Authors: Jin Jingfen , Yang Haifeng , Guo Zhiting , L V Xuebing , Jiang Xiuju , Ding Chuanqi 
Published: July 2023

IntroductionThe timely treatment of acute myocardial infarction (AMI) patients is of utmost importance, and yet, there remains a significant disparity between urban and rural areas in China due to the unequal distribution of medical resources. The manifestation of symptoms and psychosocial factors play a crucial role in shaping medical decisions for AMI patients. It is well established that minimising prehospital delay (PHD) is crucial for the successful implementation of recanalisation therapy and reducing mortality in out-of-hospital settings. However, there remains a paucity of studies investigating the correlation between illness perception, symptom response, social support, and PHD in AMI patients.AimThe aim of this study was to analyse the relationship pathways between symptom response, illness perception, social support and PHD time in patients with AMI in rural areas of China.MethodsA primary care-based cross-sectional study was designed to investigate the inpatients initially diagnosed with AMI in the emergency department of three tertiary care hospitals in three counties in northern Zhejiang Province by convenience sampling method from January 2023 to December 2023. A minimum of 286 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using logistic regression and structural equation model with PHD as main outcome parameter.DiscussionThis is the first study of the factors influencing PHD in AMI in rural China using structural equation model. Our study will address this gap in the available research. The implementation and findings of this study may provide a reliable basis for reducing PHD in AMI patients in rural areas and establish a relevant theoretical foundation for the implementation of targeted interventions and risk prevention measures in primary care hospitals.