bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training the public health emergency response workforce: a mixed-methods approach to evaluating the virtual reality modality
Authors: Bugli Dante , Dick Leah , Wingate Kaitlin C , Driscoll Scott , Beck Dave , Walsh Bridget , Greiner Ashley Lauren 
Published: May 2023

ObjectivesTo produce and evaluate a novel virtual reality (VR) training for public health emergency responders.DesignFollowing a VR training designed to test key public health emergency responder competencies, a prospective cohort of participants completed surveys rating self-assessed skill levels and perceptions of training methods.SettingThe VR training sessions were administered in a quiet room at the US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.ParticipantsAll participants volunteered from a list of CDC emergency international surge responders.Outcome measuresPerceived impact of the training on responder skills was self-reported via a Likert 5-point scale questionnaire. Assessments were modelled according to the Expanded Technology Acceptance Model measuring participantperceived usefulness ofandintention to usethe new technology. Inductive coding of qualitative feedback resulted in the identification of central themes.ResultsFrom November 2019 to January 2020, 61 participants were enrolled. Most (98%) participants self-rated above neutral for all skills (mean 4.3; range 1.21–5.00). Regression modelling showed that theperceived ease of use ofthe VR and ability to producedemonstrable resultsas likely drivers of further use. Participants agreed that others would benefit from the training (97%), it was representative of actual response scenarios (72%) and they would use lessons learnt in the field (71%). Open-response feedback highlighted feeling being immersed in the training and its utility for public health responders.ConclusionsAt a time when a trained emergency public health workforce is a critical need, VR may be an option for addressing this gap. Participants’ impressions and feedback, in the setting of their high skill level and experience, highlighted the utility and benefit of using VR to deliver training. Further research is needed to determine skill acquisition through VR training among a pool of future responders with limited to no response experience.
Association between bilirubin levels and risk of stroke: a systematic review and meta-analysis
Authors: Wang Gege , Qiao Luyao , Tang Zhenyu , Zhou Siqi , Min Jun , Li Min 
Published: May 2023

ObjectiveTo evaluate the association between bilirubin levels and stroke risk.DesignSystematic review and meta-analysis, reported in accordance with Meta-analysis Of Observational Studies in Epidemiology guidelines.Data sourcesThe PubMed, Embase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure Databases were searched from inception up to 27 February 2022.Eligibility criteriaCohort studies assessing the dose–response relationship between bilirubin levels and risk of stroke were eligible for inclusion. There were no language restrictions.Data extraction and synthesisAll data from eligible studies were collected and assessed by two independent investigators. We generated pooled relative risks (RRs) with 95% CIs. We used a restricted cubic spline model for the dose–response analyses. Subsequent subgroup analyses were conducted according to stroke outcomes, follow-up duration, geographical area and size of the cohort.ResultsNine articles including results from 11 cohort studies with 7835 cases of stroke and 263 596 participants met the inclusion criteria. The summarised RR of stroke comparing the highest and lowest bilirubin level was 0.85 (95% CI 0.72 to 0.99). The dose–response analysis indicated that a 15 µmol/L increment of bilirubin level was associated with an 18% lower risk of stroke (RR=0.82, 95% CI 0.67 to 0.99). For ischaemic stroke, the RR was 0.76 (95% CI 0.58 to 0.99). Significant publication bias was not detected.ConclusionsElevated bilirubin levels were associated with a decreased risk of stroke among adults.PROSPERO registration numberCRD42017071497.
Evaluation of health utility in trial-based cost–utility analyses for major cardiovascular disease: protocol for a systematic review
Authors: Nakao Yasuhisa , Kawakami Hiroshi , Miyazaki Shigehiro , Saito Makoto , Luo Yan , Yamamoto Kazumichi , Yamaguchi Osamu 
Published: May 2023

IntroductionThe global incidence of cardiovascular disease (CVD) is high, and the medical costs associated with its management have been increasing. Cost–utility analyses (CUAs) are essential for understanding the value of healthcare interventions and for decision-making. A majority of the CUAs for CVD are model based and have cited health utilities from previously published data; standard health utilities for the CUAs of CVD have not been established yet. Thus, we aim to identify the standard utilities according to the patients’ condition and disease severity in patients with major CVDs.Methods and analysisWe will search Medline and Evidence-Based Medicine Reviews for trial-based CUA studies that have reported on quality-adjusted life-years using original health utilities for patients with three major forms of CVD (coronary artery disease, heart failure and atrial fibrillation). Papers on trial-based CUAs will be included, while those on model-based CUAs will be excluded. No restrictions will be made in terms of intervention type. The main outcome comprises the health utilities calculated on a scale of 0–1 (irrespective of the measurement methods) at baseline and after treatment. Two independent investigators will screen the eligibility of articles; they will extract data, including health utilities, from the eligible articles for further analysis. The quality of the included studies will be assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. We will describe the means and SDs of the health utilities from all the included studies. The mean utility weights for individual studies will be combined through meta-analyses using a random-effects model to obtain the representative health utility value for each disease. Subgroup analyses will be conducted according to the severity and duration of each disease.Ethics and disseminationEthical approval is not required. The review will be submitted to an appropriate peer-reviewed journal.PROSPERO registration numberCRD42022316278.
Study protocol: how does parental stress measured by clinical scales and voice acoustic stress markers predict children’s response to PTSD trauma-focused therapies?
Authors: Zeghari Radia , Gindt Morgane , König Alexandra , Nachon Ophelie , Lindsay Hali , Robert Philippe , Fernandez Arnaud , Askenazy Florence 
Published: May 2023

IntroductionPost-traumatic stress disorder (PTSD) symptoms in youth are influenced by parental anxiety and stress. When parents have high levels of stress or have developed PTSD themselves, children tend to show more anxiety symptoms. Parental stress can affect the severity of children’s PTSD and lower the success of recovery. However, the influence of parental stress on the effectiveness of trauma-focused therapies (eye movement desensitisation and reprocessing and cognitive behavioural therapy) has not yet been investigated to our knowledge. Hence, we will measure parental stress (using both validated scales and vocal acoustic markers) and investigate how it influences children’s PTSD recovery.Method and analysisSixty children between the ages of 7 and 15 years who experienced type 1 trauma will be recruited at the Nice Pediatric Psychotrauma Center in France. We plan to measure stress using two different approaches. We will ask parents to answer validated scales of stress and mood in general. Stress will also be measured using vocal acoustic markers. Parents will be recorded while narrating their child’s trauma and during the narrative of a positive and neutral recall of events. Child participants will have to complete anxiety, PTSD and depression scales before the beginning of the trauma-focused therapy and after 3 months of treatment.Linear mixed effects models and differential statistics, such as significance testing corrected for multiple testing, will be used to determine the validity of speech features for the proposed hypotheses. Repeated measures analysis of variance will be performed on the clinical scales scores according to parental stress. Correlations will be performed between clinical scales of parents and children according to time of assessment.Ethics and disseminationThis study was approved by the Committee for the Protection of Individuals of the University of Nice Sophia Antipolis (CERNI) on 21 February 2022, under the number CER2022-015.All participants will be informed that this is an observational study and their consent taken prior to the experiment. Participants will be informed that they can withdraw from the study at any time and that it would not affect the care provided.Trial registration numberCER AVIS n° 2022-015.
Epidemiological study on gender bias and low-value practices in primary care: a study protocol
Authors: Carrillo Irene , Lopez-Pineda Adriana , Pérez-Jover Virtudes , Guilabert Mercedes , Vicente María Asunción , Fernández César , Gil-Guillen Vicente F , Orozco-Bletrán Domingo , Chilet-Rosell Elisa , Luzon Oliver Lourdes , Astier-Peña Maria Pilar , Tella Susanna , Carratalá-Munuera Concepción , Mira José Joaquín 
Published: May 2023

IntroductionEvidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.Methods and analysisA Delphi study will be performed to reach a consensus on the ‘Do Not Do’ recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected ‘Do Not Do’ recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.Ethics and disseminationThe study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.Trial registration numberThe study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022.
Compliance and patient satisfaction with treatment settings recommended by the medical on-call service 116117 in Germany using computer-assisted structured initial assessment: a cross-sectional observational study accompanying the demand intervention
Authors: Schäfer Ingmar , Menzel Agata , Herrmann Tobias , Willms Gerald , Oltrogge Jan Hendrik , Lühmann Dagmar , Scherer Martin 
Published: May 2023

ObjectivesIn order to reduce the use of emergency departments, computer-assisted initial assessment was implemented at the medical on-call service 116117. Our study assessed compliance and patient satisfaction.DesignCross-sectional observational postal survey.SettingMedical on-call service 116117 by eight Associations of Statutory Health Insurance Physicians in Germany.ParticipantsThe intervention was observed between January 2020 and March 2021. Minors and patients with invalid contact data were excluded. A random sample of eligible patients received standardised questionnaires by mail.Outcome measuresWe analysed associations of sociodemographic data, health status, previous service use, health literacy, and recommended settings with compliance and patient satisfaction by multivariable, multilevel logistic regression.InterventionsBased on symptoms and context factors, the computer software suggested service levels. Staff and patient discussed if higher levels were indicated, services were available and self-transport was possible. They then agreed on recommendations for treatment settings.ResultsOf 9473 contacted eligible patients, 1756 patients (18.5%) participated. Median age was 66 years (IQR=50–79), and 986 (59.0%) were women. At least one recommended setting was used by 1397 patients (85.4%). General practitioner (GP) practices were used by 143 patients (68.4%). Generally, better compliance was associated with lower depression levels (OR 1.59, 95% CI 1.17 to 2.17, p=0.003), fewer previous hospital stays (OR 2.02, 95% CI 1.27 to 3.23, p=0.003) and recommendations for any setting other than GP practices (OR 0.13, 95% CI 0.06 to 0.29, p<0001, to OR 0.37, 95% CI 0.19 to 0.72, p=0.003). A total of 606 patients (50.7%) were completely satisfied. Patient satisfaction was associated with higher age (OR 1.30, 95% CI 1.13 to 1.49, p<0.001), better self-rated health (OR 1.30, 95% CI 1.10 to 1.53, p=0.002), not having musculoskeletal disorders (OR 0.68, 95% CI 0.49 to 0.94, p=0.021), better health literacy (OR 0.69, 95% CI 0.54 to 0.89, p=0.005, and OR 0.49, 95% CI 0.36 to 0.67, p<0.001) and receiving no recommendation for GP practices (OR 0.61, 95% CI 0.43 to 0.87, p=0.006).ConclusionsMost patients were compliant and satisfied. Lowest compliance and satisfaction were found in GP practices, but nonetheless, two of three patients with respective recommendations were willing to use this setting.Trial registration numberGerman Clinical Trials Register DRKS00017014.
Polycyclic aromatic hydrocarbons and risk of rheumatoid arthritis: a cross-sectional analysis of the National Health and Nutrition Examination Survey, 2007–2016
Authors: Beidelschies Michelle , Lopez Rocio , Pizzorno Joseph , Le Phuc , Rothberg Michael B , Husni M E , D'Adamo Christopher 
Published: May 2023

ObjectiveWhile there are several well-established environmental risk factors for rheumatoid arthritis (RA), a paucity of evidence exists linking environmental toxicants with RA prevalence. We aimed to examine the associations between various environmental toxicants and RA among adults in the U.S. general population while adjusting for non-heritable risk factors.DesignCross-sectional study.SettingNational Health and Nutrition Examination Survey conducted from 2007 to 2016.ParticipantsThe study included 21 987 adult participants (no RA: 20 569; RA: 1418). Participants were excluded (n=7214) if they did not answer questions related to self-reporting of RA, had another or unknown type of arthritis, or did not have interview or biospecimen data.Primary and secondary outcome measuresAssociation between individual toxicants and body burden scores for polycyclic aromatic hydrocarbons (PAH), phthalates and plasticisers (PHTHTEs) metabolites or volatile organic compounds (VOCs) and participant self-reported RA based on multivariable logistic regression models while adjusting for age, sex, urine creatinine, body mass index, smoking, race, education, family poverty income ratio, any vigorous or moderate activity and dietary fibre.ResultsWhile increased prevalence of RA was observed in participants with the highest quartile of various individual PAHs, only 1-hydroxynaphthalene (OR: 1.8 (1.1 to 3.1); p=0.020) remained associated in a fully adjusted model. PAH body burden was found to be associated with RA (Q4 vs Q1, OR: 2.2 (1.09 to 4.2); p=0.028) in a fully adjusted model. Interestingly, after accounting for PAH body burden, smoking was not associated with RA (OR: 1.4 (0.89 to 2.3); p=0.13). A mediation analysis demonstrated that PAH body burden accounted for 90% of the total effect of smoking on RA. PHTHTE and VOC metabolites were not associated with RA in fully adjusted models.Conclusions and relevancePAHs are associated with RA prevalence, mediate the majority of the effects of smoking on RA, and are associated with RA independent of smoking status.
Experience of induction of labour: a cross-sectional postnatal survey of women at UK maternity units
Authors: Harkness Mairi , Yuill Cassandra , Cheyne Helen , McCourt Christine , Black Mairead , Pasupathy Dharmintra , Sanders Julia , Heera Neelam , Wallace Chlorice , Stock Sarah Jane 
Published: May 2023

ObjectivesThis study explored women’s views and experiences of key elements of the induction of labour (IOL) process, including at home or in hospital cervical ripening (CR).DesignA questionnaire-based postnatal survey undertaken as part of the CHOICE Study process evaluation. The questionnaire was administered online and included fixed response and free-text options.SettingNational Health Service maternity units in the UK.Participants309 women who had an IOL.Outcome measuresThe primary outcome measure was experience of IOL. Few women returned home during CR, meaning that statistical comparison between those who experienced home-based and hospital-based CR was not possible. Findings are reported as descriptive statistics with content analysis of women’s comments providing context.ResultsInformation to support choice and understand what to expect about IOL is often inadequate or unavailable. Having IOL can create anxiety and remove options for birth that women had hoped would enhance their experience. Although it can provide a more comfortable environment, home CR is not always an acceptable solution. Women described maternity care negatively impacted by staffing shortages; delays to care sometimes led to unsafe situations. Women who had a positive experience of IOL described supportive interaction with staff as a significant contribution to that.ConclusionsWomen do not experience IOL as a benign and consequence free intervention. There is urgent need for research to better target IOL and optimise safety and experience for women and their babies. Relatively few women were offered CR at home and further research is needed on this experience.
Single-arm, open-labelled, safety and tolerability of intrabronchial and nebulised bacteriophage treatment in children with cystic fibrosis andPseudomonas aeruginosa
Authors: Singh Jagdev , Fitzgerald Dominic A , Jaffe Adam , Hunt Sharon , Barr Jeremy J , Iredell Jonathan , Selvadurai Hiran 
Published: May 2023

IntroductionCystic fibrosis (CF) is a multisystem condition that is complicated by recurrent pulmonary infections requiring aggressive antibiotic treatment. This predisposes the patient to complications such as sensorineural hearing loss, renal impairment, hypersensitivity and the development of antibiotic resistance.Pseudomonas aeruginosais one of the more common organisms which cause recurrent infections and result in greater morbidity and mortality in people living with CF. Bacteriophages have been identified as a potential alternative or adjunct to antibiotics. We hypothesise that bacteriophage therapy is a safe and well-tolerated treatment in children with CF infected withP. aeruginosainfection in their airways.MethodsThis single-arm, open-labelled, non-randomised trial will run for a maximum period of 36 months with up to 10 participants. Adolescents (≥12 years and <18 years of age) who continue to shedP.aeruginosa(within 3 months of enrolment) despite undergoing eradication therapy previously, will be considered for this trial. Non-genetically modified bacteriophages that have demonstrated obligate lytic activity against each of the study participants’P. aeruginosastrains will be selected and prepared according to a combination of established protocols (isolation, purification, sterility testing and packaging) to achieve close to good manufacturing practice recommendations. The selected bacteriophage will be administered endo-bronchially first under direct vision, followed by two times a day nebulisation for 7 days in addition to standard CF treatment (intravenous antibiotics, physiotherapy to be completed as inpatient for 10–14 days). Safety and tolerability will be defined as the absence of (1) fever above 38.5°C occurring within 1 hour of the administration of the nebulised bacteriophage, (2) a 10% decline in spirometry (forced expiratory volume in 1 s %) measured preadministration and postadministration of the first dose of nebulised bacteriophage. Clinical reviews including repeat sputum cultures and spirometry will be performed at 3, 6, 9 and 12 months following bacteriophage treatment.Ethics and disseminationOur clinical trial is conducted in accordance with (1) good clinical practice, (2) Australian legislation, (3) National Health and Medical Research Council guidelines for the ethical conduct of research.Trial registration numberAustralia and New Zealand Clinical Trial Registry (ACTRN12622000767707).
The Canadian Food Intake Screener for assessing alignment of adults’ dietary intake with the 2019 Canada’s Food Guide healthy food choices recommendations: scoring system and construct validity
Authors: Hutchinson Joy M. , Dodd Kevin W. , Guenther Patricia M. , Lamarche Benoit , Haines Jess , Wallace Angela , Perreault Maude , Williams Tabitha E. , Louzada Maria Laura da Costa , Jessri Mahsa , Lemieux Simone , Olstad Dana Lee , Prowse Rachel , Simpson Janis Randall , Vena Jennifer E. , Szajbely Kathleen , Kirkpatrick Sharon I. 
Published: May 2023

The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults’ dietary intake over the past month with the 2019 Canada’s Food Guide’s healthy food choices recommendations. From July to December 2021, adults ( n = 154) aged 18–65 years completed the screener and up to two 24 h dietary recalls. The screener scoring system was aligned with the Healthy Eating Food Index-2019 (HEFI-2019), to the extent possible. Analysis of variance compared screener scores among subgroups with known differences in diet quality. Using the recall data, the National Cancer Institute multivariate method was used to model HEFI-2019 components, with the screener score as a covariate, and the correlation coefficient between screener and total HEFI-2019 scores was estimated. The mean screener score was 35 points (SD = 4.7; maximum 65), ranging from 26 (1st percentile) to 45 (99th percentile). Differences in scores in hypothesized directions were evident by gender identity ( p = 0.06), perceived income adequacy ( p = 0.07), education ( p = 0.02), and smoking status ( p = 0.003). The correlation between screener and HEFI-2019 scores was 0.53 (SE = 0.12). The screener’s moderate construct validity supports its use for rapid assessment of alignment of adults’ intake with the healthy food choices recommendations when comprehensive dietary assessment is not possible. Novelty The Canadian Food Intake Screener was developed to rapidly assess alignment of dietary intake with the Canada’s Food Guide-2019 healthy food choices recommendations. Scoring is aligned with the Healthy Eating Food Index-2019 to the extent possible. Among a sample of adults, reasonable variation in screener scores was noted, mean screener scores differed between some subgroups with known differences in diet quality, and a moderate correlation between screener scores and total Healthy Eating Food Index-2019 scores based on repeat 24 h dietary recalls was observed. The Canadian Food Intake Screener has moderate construct validity for rapid assessment of overall alignment of adults’ dietary intake with the Canada’s Food Guide-2019 healthy food choices recommendations.