bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation
Authors: Bouwsma Esther V A , Huirne Judith A F , van de Ven Peter M , Vonk Noordegraaf Antonie , Schaafsma Frederieke G , Schraffordt Koops Steven E , van Kesteren Paul J M , Brölmann Hans A M , Anema Johannes R 
Published: March 2023

ObjectiveTo evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.DesignStepped-wedge cluster randomised controlled trial.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Participants433 employed women aged 18–65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery.InterventionsAn internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice.Main outcome measuresThe primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers.ResultsMedian time until RTW was 49 days (IQR 27–76) in the intervention group and 62 days (42–85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%).ConclusionsImplementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries.Trial registration numberNTR2933; Results.
Impact of Obesity on Postoperative Outcomes following cardiac Surgery (The OPOS study): rationale and design of an investigator-initiated prospective study
Authors: Aguiar Christie , MacLeod Jeffrey , Yip Alexandra , Melville Sarah , Légaré Jean-Francois , Pulinilkunnil Thomas , Kienesberger Petra , Brunt Keith , Hassan Ansar 
Published: March 2023

IntroductionIncreasing levels of obesity worldwide have led to a rise in the prevalence of obesity-related complications including cardiovascular risk factors such as diabetes, hypertension and dyslipidaemia. Healthcare providers believe that overweight and obese cardiac surgery patients are more likely to experience adverse postoperative outcomes. The body mass index (BMI) is the primary measure of obesity in clinical practice, without accounting for a patient’s level of cardiopulmonary fitness or muscle mass. The objective of this study is to determine whether fitness capacity of obese cardiac surgical patients and biomarkers, alone or in combination, will help identify patients at risk for adverse outcomes when undergoing cardiac surgery.Methods and analysisPatients between the ages of 18 and 75 years undergoing elective cardiac surgery are consented to participate in this prospective observational study. Patients will be invited to participate in measures of obesity, functional capacity and exercise capacity assessments, quality of life questionnaires, and blood and tissue sampling for biomarker analysis. The endpoints evaluated are measures other than BMI that could be predictive of short-term and long-term postoperative outcomes. Clinical outcomes of interest are prolonged ventilation, hospital length of stay, renal failure and all-cause mortality. Biomarkers of interest will largely focus on metabolism (lipids, amino acids) and inflammation (adipokines, cytokines and chemokines).Ethics and disseminationThis study has been approved by the institutional review board at the Horizon Health Network. On completion of the study, the results shall be disseminated through conference presentations and publications in peer-reviewed journals. Additionally, the report shall also be diffused more broadly to the general public and the cardiovascular community.Trial registration numberNCT03248921.
‘Secretly, it’s a competition’: a qualitative study investigating what helped employees quit smoking during a workplace smoking cessation group training programme with incentives
Authors: Van den Brand Floor A , Dohmen Lisa M E , Van Schayck Onno C P , Nagelhout Gera E 
Published: March 2023

ObjectivesSmoking cessation programmes in combination with financial incentives have shown to increase quit rates in smokers, but it is not clear which elements of this intervention help smokers to succeed in their quit attempt. The aim of this study was to explore the view of successful and unsuccessful quitters about which factors had affected their ability to quit smoking.DesignSemistructured qualitative interviews were conducted and analysed using the Framework method.SettingInterviews were conducted in 2017 with employees from nine different Dutch companies.Participants24 successful and unsuccessful quitters from the intervention group of a cluster randomised controlled trial (RCT) who participated in a workplace smoking cessation group training programme in which smoking abstinence was rewarded with financial incentives.ResultsThemes that emerged were the workplace setting, quitting with colleagues, motivation, family support, strategies and the financial incentives. The interviewees reported that the smoking cessation programme was appreciated in general, was convenient, lowered the threshold to sign up, stimulated peer support and competition and provided strategies to resist smoking. Personal motivation and a mind set to never smoke again were regarded as important factors for quit success. The financial incentives were not considered as a main motivator to quit smoking, which contradicts the results from the RCT. The financial incentives were considered as more attractive to smokers with a low income.ConclusionsAccording to participants, contributors to quitting smoking were the workplace cessation programme, personal motivation and peer support, but not the incentives. More research is needed on the contradiction between the perceived effects of financial incentives on quit success and the actual difference in quit rates.Trial registration numberNTR5657.
Premorbid risk factors influencing labour market attachment after mild traumatic brain injury: a national register study with long-term follow-up
Authors: Graff Heidi Jeannet , Siersma Volkert , Møller Anne , Kragstrup Jakob , Andersen Lars L , Egerod Ingrid , Malá Rytter Hana 
Published: March 2023

ObjectivesSome patients with mild traumatic brain injury (mTBI) experience persistent postconcussive symptoms, influencing the ability to work. This study assessed associations between mTBI and labour market attachment (up to 5 years postinjury) in patients with different premorbid characteristics.Design and settingDanish national cohort study with 5-year register follow-up.ParticipantsWe included hospital admitted patients between 18 and 60 years diagnosed with mTBI (International Classification of Diseases, version 10 diagnosis S06.0) (n=19 732). For each patient, one control was selected matched on age, gender and municipality (n=18 640).Primary outcome measurePrimary outcome was ‘not attending ordinary work’, and premorbid risk factors were cohabitation status, education, ethnicity, gender, age and comorbidities.ResultsThe odds of not attending ordinary work increased from 6 months to 5 years. The highest increased odds (approximately twice as high for patients) of not attending ordinary work at 5 years were found in the highest educational group (OR 2.15, 95% CI 1.78 to 2.59), for patients of non-Danish origin (OR 1.98, 95% CI 1.52 to 2.57), for patients between 30 and 39 years (OR 1.93, 95% CI 1.68 to 1.23) and for patients with somatic comorbidities (OR 1.81, 95% CI 1.38 to 2.37). Contrary to expectations, we did not find higher odds in patients with psychiatric diagnoses (OR 1.12, 95% CI 0.76 to 1.60).ConclusionsImportant premorbid characteristics for lower labour market participation after mTBI were higher education, non-Danish origin, age 30–39 years and having somatic comorbidities. Demographic and health-related variables should be considered when assessing patients with mTBI at risk of long-term sickness absence.Trial registration numberNCT03214432; Results.
Prevalence of risk factors of non-communicable diseases in Kerala, India: results of a cross-sectional study
Authors: Sarma P S , Sadanandan Rajeev , Thulaseedharan Jissa Vinoda , Soman Biju , Srinivasan Kannan , Varma R P , Nair Manju R , Pradeepkumar A S , Jeemon Panniyammakal , Thankappan K R , Kutty Raman V 
Published: March 2023

ObjectiveTo estimate the prevalence of non-communicable disease (NCD) risk factors in Kerala.DesignA community-based, cross-sectional survey.ParticipantsIn 2016–2017 a multistage, cluster sample of 12 012 (aged 18–69 years) participants from all 14 districts of Kerala were studied.Main outcome measuresNCD risk factors as stipulated in the WHO’s approach to NCD risk factors surveillance were studied. Parameters that were studied included physical activity score, anthropometry, blood pressure (BP), and fasting blood glucose (FBG) and morning urine sample to estimate dietary intake of salt.ResultsThe mean age was 42.5 years (SD=14.8). Abdominal obesity was higher in women (72.6%; 95% CI 70.7 to 74.5) compared with men (39.1%; 95% CI 36.6 to 41.7), and also higher among urban (67.4%; 95% CI 65.0 to 69.7) compared with rural (58.6%; 95% CI 56.6 to 60.5) residents. Current use of tobacco and alcohol in men was 20.3% (95% CI 18.6 to 22.1) and 28.9% (95% CI 26.5 to 31.4), respectively. The estimated daily salt intake was 6.7 g/day. The overall prevalence of raised BP was 30.4% (95% CI 29.1 to 31.7) and raised FBG was 19.2% (95% CI 18.1 to 20.3). Raised BP was higher in men (34.6%; 95% CI 32.6 to 36.7) compared with women (28%; 95% CI 26.4 to 29.4), but was not different between urban (33.1%; 95% CI 31.3 to 34.9) and rural (29.8%; 95% CI 28.3 to 31.3) residents. Only 12.4% of individuals with hypertension and 15.3% of individuals with diabetes were found to have these conditions under control. Only 13.8% of urban and 18.4% of rural residents did not have any of the seven NCD risk factors studied.ConclusionMajority of the participants had more than one NCD risk factor. There was no rural–urban difference in terms of raised BP or raised FBG prevalence in Kerala. The higher rates of NCD risk factors and lower rates of hypertension and diabetes control call for concerted primary and secondary prevention strategies to address the future burden of NCDs.
Socioeconomic and behavioural determinants of overweight/obesity among adults in Botswana: a cross-sectional study
Authors: Keetile Mpho , Navaneetham Kannan , Letamo Gobopamang , Bainame Kenabetsho , Rakgoasi Serai Daniel , Gabaitiri Lesego , Masupe Tiny , Molebatsi Robert 
Published: March 2023

ObjectiveTo undertake a comprehensive assessment of socioeconomic and behavioural determinants of overweight/obesity among adult population in Botswana.DesignThe study adopted a cross-sectional design by selecting adult respondents in 3 cities and towns, 15 urban villages and 15 rural areas across Botswana using a multistage probability sampling technique.SettingThe study was conducted in selected rural and urban areas of Botswana.ParticipantsThe study sample consisted of 1178 adult males and females aged 15 years and above.Primary outcome measuresObjectively measured overweight/obesity.ResultsPrevalence of overweight/obesity in the study population was estimated at 41%. The adjusted OR (AOR) of overweight/obesity were highest among women (AOR=2.74, 95% CI 1.92 to 3.90), in ages 55–64 years (AOR=5.53, 95% CI 2.62 to 11.6), among individuals with secondary (AOR=1.70, 95% CI 1.11 to 2.61) and tertiary education (AOR=1.99, 95% CI 1.16 to 3.38), smokers (AOR=2.16, 95% CI 1.22 to 3.83) and people with poor physically activity (AOR=1.46, 95% CI 1.03 to 3.24). These were statistically significant at 5% level.ConclusionWomen, older adults, people with high education level, smokers and people who reported poor physical activity were found to have higher odds of being overweight/obesity. These findings suggest the need for broad based strategies encouraging physical activity among different socioeconomic groups.
Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: retrospective cohort study
Authors: Elimian Kelly Osezele , Ochu Chinwe Lucia , Ebhodaghe Blessing , Myles Puja , Crawford Emily E , Igumbor Ehimario , Ukponu Winifred , Olayinka Adobola , Aruna Olusola , Dan-Nwafor Chioma , Olawepo Olatayo Ayodeji , Ogunbode Oladipo , Atteh Rhoda , Nwachukwu William , Venkatesan Sudhir , Obagha Chijioke , Ngishe Samuel , Suleiman Kabir , Usman Muhammad , Yusuff Hakeem Abiola , Nwadiuto Ifeoma , Mohammed Abbas Aliyu , Usman Rabi , Mba Nwando , Aderinola Olaolu , Ilori Elsie , Oladejo John , Abubakar Ibrahim , Ihekweazu Chikwe 
Published: March 2023

ObjectiveDespite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria.DesignRetrospective cohort study.SettingCOVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control.ParticipantsIndividuals who were investigated for SARS-CoV-2 using real-time PCR testing during the study period 27 February–8 June 2020.MethodsCOVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs.ResultsA total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trend<0.0001), male sex (aOR 1.11, 95% CI 1.04 to 1.18) and the following presenting symptoms: cough (aOR 1.23, 95% CI 1.13 to 1.32), fever (aOR 1.45, 95% CI 1.45 to 1.71), loss of smell (aOR 7.78, 95% CI 5.19 to 11.66) and loss of taste (aOR 2.50, 95% CI 1.60 to 3.90). An increased risk of mortality following COVID-19 was observed in those aged ≥51 years, patients in farming occupation (aOR 7.56, 95% CI 1.70 to 33.53) and those presenting with cough (aOR 2.06, 95% CI 1.41 to 3.01), breathing difficulties (aOR 5.68, 95% CI 3.77 to 8.58) and vomiting (aOR 2.54, 95% CI 1.33 to 4.84).ConclusionThe significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals.
Qualitative study exploring heterogeneity in caregiving experiences post-stroke in Singapore
Authors: Tyagi Shilpa , Luo Nan , Tan Chuen Seng , Tan Kelvin Bryan , Tan Boon Yeow , Menon Edward , Venketasubramanian N , Loh Wei Chin , Fan Shu Hui , Yang Kenneth Lam Thuan , Swee Ling Chan Audrey , Farwin Aysha , Lukman Zunairah Binti , Koh Gerald Choon-Huat 
Published: March 2023

ObjectiveStroke, a common illness in older adults, accounts for up to 4% of direct medical costs in developed nations. Informal caregiving contributing a significant proportion of economic burden post-stroke warrants a deeper understanding of the caregiving context to sustain caregiving arrangement. While literature exists describing differences in motivation and preferences of caregivers, limited literature explores differences in caregiving experiences of different types of caregivers (ie, spouse, adult-child, sibling or others). Addressing this gap, our study aimed to explore the caregiving experience of stroke survivors and their family caregivers across different caregiver identities in an Asian setting.DesignQualitative descriptive study.SettingCommunity setting.ParticipantsWe conducted semi-structured interviews with 26 stroke survivors and 35 caregivers purposively sampled from an outpatient rehabilitation setting, an outpatient clinic and a support organisation. Data were analysed using thematic analysis.Outcome measuresThemes including caregiving experience of stroke survivors and their family caregivers across different caregiver identities.ResultsFollowing five themes were reported: caregiver reserve, coping strategies, caregiver burden, competing commitments and role of foreign domestic worker (FDW) in family caregiving. Spouse caregivers were less willing to ask for help, commonly adopted faith-based, and spacing or recharging types of coping, reported emotional strain and shared limited accounts of FDWs. Adult-child caregivers were more willing to ask for help, engaged in alternative care arrangements involving FDWs, commonly adopted action-focussed coping and reported multidimensional caregiver burden.ConclusionOur findings illustrated the heterogeneity in factors affecting caregiving experience across spouse and adult-child caregivers. Practical implications include conducting a needs assessment for caregiver-stroke survivor dyads and providing tailored support, training and information to help caregivers cope better.
‘A war of a different kind’: local municipalities’ experiences in managing the COVID-19 pandemic in Israel–a qualitative study
Authors: Nehushtan Hilla , Barel Hila , Donchin Milka , Bar-Zeev Yael 
Published: March 2023

ObjectivesIn Israel, in 2020, 57/257 local municipalities were part of the Healthy Cities Network (HCN). HCN municipalities have a strong political commitment to health promotion and reducing health inequalities. This research aimed to (1) explore local municipalities’ management of the pandemic and (2) assess whether belonging to the HCN impacted this management.Design, setting and participantsFourteen municipalities were chosen—seven HCN municipalities, matched to seven non-HCN municipalities. In each municipality, semistructured telephone interviews were conducted with three to four officials. Interviews were recorded, transcribed and analysed using inductive thematic coding, both in general and specifically to compare HCN and non-HCN municipalities.ResultsForty-two interviews were conducted, with five main themes: (1) relationship with the government; with the transference of information to the local municipalities found to be challenging and a strong need for more independence at the local level; (2) contact with residents which was divided into several actions, such as mapping the city population, supporting vulnerable populations and managing volunteers; (3) relationships within the municipality which included a sense of collaboration and community but also a feeling of wear out; (4) difference between the first lockdown compared with following lockdowns; within these themes, no significant differences were found between HCN municipalities and non-HCN municipalities and (5) the role of the Healthy City (HC) coordinator which was critical in several municipalities. They served as brokers, had a pre-existing intersectoral network and held a broader vision of health.ConclusionsLocal municipalities in Israel played an important role in the pandemic response. Municipalities requested a central information source and more independence at the local level. Challenges and responses were similar across municipalities and residents, regardless of their HCN status. However, in some municipalities, the role of the HC coordinator was crucial for the pandemic response due to pre-existing interprofessional and intersectoral networks.
High continuous positive airway pressures versus non-invasive positive pressure ventilation in preterm neonates: protocol for a multicentre pilot randomised controlled trial
Authors: Mukerji Amit , Rempel Emily , Thabane Lehana , Johnson Heather , Schmolzer Georg , Law Brenda Hiu Yan , Jani Pranav , Tracy Mark , Rottkamp Catherine , Keszler Martin , Kirpalani Haresh , Shah Prakesh S 
Published: March 2023

IntroductionLow pressure nasal continuous positive airway pressure (nCPAP) has long been the mainstay of non-invasive respiratory support for preterm neonates, at a constant distending pressure of 5–8 cmH2O. When traditional nCPAP pressures are insufficient, other modes including nasal intermittent positive pressure ventilation (NIPPV) are used. In recent years, high nCPAP pressures (≥9 cmH2O) have also emerged as an alternative. However, the comparative benefits and risks of these modalities remain unknown.Methods and analysisIn this multicentre pilot randomised controlled trial, infants <29 weeks’ gestational age (GA) who either: (A) fail treatment with traditional nCPAP or (B) being extubated from invasive mechanical ventilation with mean airway pressure ≥10 cmH2O, will be randomised to receive either high nCPAP (positive end-expiratory pressure 9–15 cmH2O) or NIPPV (target mean Paw 9–15 cmH2O). Primary outcome is feasibility of the conduct of a larger, definitive trial as assessed by rates of recruitment and protocol violations. The main secondary outcome is failure of assigned treatment within 7 days postrandomisation. Multiple other clinical outcomes including bronchopulmonary dysplasia will be ascertained. All randomised participants will be analysed using intention to treat. Baseline and demographic variables as well as outcomes will be summarised and compared using univariate analyses, and a p<0.05 will be considered significant.Ethics and disseminationThe trial has been approved by the respective research ethics boards at each institution (McMaster Children’s Hospital: Hamilton integrated REB approval #2113; Royal Alexandra Hospital: Health Research Ethics Board approval ID Pro00090244; Westmead Hospital: Human Research Ethics Committee approval ID 2022/ETH01343). Written, informed consent will be obtained from all parents/guardians prior to study enrolment. The findings of this pilot study will be disseminated via presentations at national and international conferences and via publication in a peer-reviewed journal. Social media platforms including Twitter will also be used to generate awareness.Trial registration numberNCT03512158.