bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concussion and depressive symptoms in high school students: impact of physical activity and substance use
Authors: Wingerson Mathew J , Carry Patrick , Mannix Rebekah , Meier Timothy , Smulligan Katherine L , Wilson Julie C , Howell David R 
Published: January 2025

ObjectiveTo investigate the association between concussion history and depressive symptoms after adjusting for physical activity, substance use, and illicit drug use.MethodsWe analysed data from the Adolescent Behaviour and Experiences Survey, a nationally representative survey of adolescents in the USA. Our independent variables were history of concussion in the 12 months preceding survey completion; self-reported weekly physical activity (days per week with >60 min of physical activity, 0–7 scale); substance use over the past 30 days (yes vs no) and illicit drug use throughout lifetime (yes vs no). Our dependent variable was participant-reported sadness/hopelessness over the past 12 months (yes vs no).ResultsAmong 7499 adolescents (9th–12th grade, 50.4% female), reporting one or more concussions over the past year was not associated with the odds of depressive symptoms (OR: 1.13, 95% CI: 0.93 to 1.37, p=0.21). Each additional day of physical activity per week was associated with a lower odds of depressive symptoms (OR: 0.91; 95% CI: 0.89 to 0.94; p<0.0001). Illicit drug use (OR ever vs never: 2.48; 95% CI: 1.96 to 3.13; p<0.0001) and substance use (OR yes vs no: 2.77; 95% CI: 2.34 to 3.29; p<0.001) were associated with a higher odds of depressive symptoms.ConclusionsAdjusting for physical activity, substance use and illicit drug use, concussion was not significantly associated with depressive symptoms. This novel discovery informs clinicians as they counsel adolescents with concussion; future research should examine physical activity and avoidance of substance/illicit drug use as postinjury recommendations in an effort to lower the risk of depressive symptoms.
To what extent do the prevalence of sickness presence and reasons for sickness presence vary between school classes in upper secondary schools? A cross-sectional survey in Trøndelag county, Norway
Authors: Johansen Vegard 
Published: January 2025

ObjectivesThis paper investigated sickness presence (SP) among students in academic upper secondary schools (USS). The research question asked was: To what extent do the prevalence of SP and reasons for SP vary between school classes in USS in Norway?DesignA cross-sectional survey was done in the final year of USS. Multilevel modelling was used to estimate school class-level effects.Setting71 school classes from 13 Norwegian schools participated in the study in April 2018.Participants1955 students in academic education programmes were invited to participate in the survey, and 1511 completed it. The response rate was 77%. 58% of the respondents were female students.Outcome measuresThe outcome measures were the number of SP incidents and reasons for practising SP in school. The analysis examined factors that influenced the prevalence of and reasons for SP.Results54% of the students reported two or more incidents of SP. The primary reason for reporting SP was attendance pressure, including factors such as not wanting to exceed the absence limit (90%), concerns that high school absences could negatively affect grades (65%) or reduce chances of getting a job (61%). Some students reported positive reasons for SP, such as maintaining social connections (32%). Multilevel modelling indicated that the class-level effect on the prevalence of SP incidents and positive attendance reasons accounted for 5% of the variance. Some of the class-level effect was due to contextual factors (eg, student relations) and less was due to compositional factors (eg, gender distribution).ConclusionsThe study discovered significant variations in SP between school classes, suggesting that students’ attitudes and behaviours towards SP can influence their peers. Moreover, attendance pressure factors for SP were more frequently reported than positive attendance factors.
Breastfeeding empowerment and its relationship with health literacy and spousal support among breastfeeding mothers in Tabriz, Iran: a cross-sectional study
Authors: Targhaq Shaqayeq , Hosseinzadeh Mina , Mirghafourvand Mojgan , Mousavi Zahra 
Published: January 2025

BackgroundBreast milk is crucial for the health and survival of infants, but exclusive breastfeeding often fails due to various reasons such as lack of breastfeeding empowerment.ObjectivesThis study aimed to determine the status of breastfeeding empowerment and its relationship with health literacy and perceived spousal support among breastfeeding mothers while recognising that other related factors also contribute to breastfeeding empowerment.DesignCross-sectional study.SettingPrimary health centres of Tabriz city, Iran.ParticipantsIncluded 342 breastfeeding mothers with infants aged 6 months or younger in Tabriz, Iran.ResultsThe mean (SD) scores for breastfeeding empowerment, health literacy and partner support were 141.98 (33.92) out of a possible range of 37 to 185, 126.08 (21.27) out of a possible range of 33 to 165 and 64.95 (12.62) out of a possible range of 20 to 100, respectively. Based on the adjusted general linear model, for every unit increase in perceived spousal support, women’s breastfeeding empowerment score increased significantly (B=0.546; 95% CI 0.29 to 0.79; p<0.001). Additionally, working mothers had a significantly higher breastfeeding empowerment score compared with housewives (B=13.91; 95% CI 0.88 to 27.73; p=0.04), and currently, breastfeeding mothers had a significantly higher score compared with mothers who were not currently breastfeeding (B=72.26; 95% CI 60.42 to 84.10; p<0.001).ConclusionsThe findings of this study underscore the critical role of perceived spousal support in enhancing breastfeeding empowerment among mothers. By encouraging spousal involvement, families can create a supportive environment that values and facilitates breastfeeding. Healthcare providers also can play an essential role in offering guidance and resources to both mothers and their partners. By emphasising the importance of spousal support in breastfeeding, a supportive culture can be fostered that values breastfeeding as a natural aspect of motherhood.
Is first-line treatment with polatuzumab vedotin–rituximab–cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) for previously untreated diffuse large B-cell lymphoma cost-effective in China? A cost-effectiveness analysis using a Markov model
Authors: Dong Liangliang , Zhong Wanfu , Chen Ting , Zhao Qiuling , Liu Wenbin , Qiu Xiuliang , Huang Ruyi , Huang Shengqiang , Xie Ruixiang , Yang Lin 
Published: January 2025

ObjectiveTo evaluate the cost-effectiveness of polatuzumab vedotin–rituximab–cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) in CD20-positive patients with previously untreated diffuse large B-cell lymphoma (DLBCL) in China.DesignA Markov model was constructed to analyse the cost-effectiveness of two strategies in CD20-positive patients with previously untreated DLBCL over a lifetime horizon: (1) pola-R-CHP and (2) rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). The clinical outcomes were obtained from the POLARIX(NCT03274492), SCHOLAR-1, ZUMA-7(NCT03391466) and TRANSFORM(NCT03575351) trials. Costs were derived from the Chinese official websites and published literature, and utility values were obtained from the published literature. The willingness-to-pay (WTP) threshold was set at triple the 2023 Chinese per capita gross domestic product of US$38 042.49/quality-adjusted life year (QALY). Uncertainty was addressed using sensitivity analyses. The scenario analyses were also conducted.SettingChinese healthcare system perspective.ParticipantsA hypothetical cohort of adult patients presenting with CD20-positive, patients with previously untreated DLBCL.InterventionsPola-R-CHP versus R-CHOP.Main outcome measuresThe main outcomes of the study were QALYs, incremental cost-effectiveness ratio (ICER) and incremental net-health benefit (INHB).ResultsIn China, the ICER and INHB of pola-R-CHP compared with R-CHOP were US$77 036.33/QALY and −1.11 QALYs, respectively. The ICER was above the WTP threshold. Outcomes were most responsive to the price of pola. Probabilistic sensitivity analyses indicated that pola-R-CHP had a low probability of being cost-effective under the current WTP threshold. The scenario analyses demonstrated that when the price of pola fell by more than 32.5% to less than US$33.19/mg, the economic probability of pola-R-CHP was greater than 50% in previously untreated CD20-positive patients with DLBCL in China.ConclusionsPola-R-CHP is not cost-effective in the first-line treatment for previously untreated CD20-positive DLBCL in China. A value-based price for the cost of pola is less than US$33.19/mg.
Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study
Authors: Yin Christina Y , Scott Mary M , Talarico Robert , Hakimjavadi Ramtin , Kierulf Jackie , Webber Colleen , Hawken Steven , Moledina Aliza , Manuel Doug , Hsu Amy , Tanuseputro Peter , Fung Celeste , Kaasalainen Sharon , Molnar Frank , Shamon Sandy , McIsaac Daniel I , Kobewka Daniel 
Published: January 2025

IntroductionLong-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the resident’s wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents.Method and analysisWe will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders.Ethics and disseminationEthics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars.Trial registrationOpen Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY).
Barriers and facilitators to the implementation of the Assessment of Burden of Chronic Conditions tool in Dutch primary care: a context analysis
Authors: Claessens Danny , Boudewijns Esther A , Vervloet Marcia , Keijsers Lotte C E M , Gidding-Slok Annerika H M , van Schayck Onno C P , van Dijk Liset 
Published: January 2025

ObjectivesThe Assessment of Burden of Chronic Conditions (ABCC) tool is developed to facilitate a personalised approach to care through assessment and visualisation of a patient’s experienced burden of disease, and integrating this in the conversation based on shared decision-making and individualised care plans. An indispensable step in the implementation process is an understanding of the context. The aim of this study is to perform a context analysis to identify barriers and facilitators to the implementation of the ABCC tool by healthcare providers (HCPs) in Dutch primary care.DesignA qualitative context analysis was performed among HCPs prior to using the ABCC tool. The Consolidated Framework for Implementation Research was used to map contextual influences through semistructured interviews. A deductive coding process and content analysis was applied to identify barriers and facilitators for the implementation of the ABCC tool.ParticipantsHCPs who participated as interventionists in an effectiveness study were recruited for this study.Results17 HCPs (16 practice nurses and 1 general practitioner) participated. Data saturation was reached at the 11th interview. HCPs expected several major barriers to the implementation of the ABCC tool:too many different digital environments, high complexity in access, lack of time, no integration of the ABCC tool in guidelines and care standards, and patients not willing to adopt an active role in their care process. The major facilitators for implementation were a clear perception of the ABCC tool’s benefits, high compatibility with and relative advantage over current practices and being part of a progressive work culture that stimulates innovation.ConclusionsThis study provides insight in the barriers and facilitators to the implementation of an intervention in the patient–HCP conversation. Barriers were present in complexity, available resources, patient needs and resources, and external policies and incentives while facilitators were present in knowledge and beliefs, implementation climate and culture. These barriers and facilitators provide opportunities for the selection and tailoring of implementation strategies for the ABCC tool.
High-intensive physical rehabilitation approach in children and adolescents with acquired brain injury during subacute phase (REHABILITY): a feasibility study protocol
Authors: Gmelig Meyling Christiaan , Verschuren Olaf , Rentinck Ingrid , van der Steen Irene , Engelbert Raoul , Gorter Jan Willem 
Published: January 2025

IntroductionWhile principles of neuroplasticity and motor learning emphasise the potential of high dosage of physical rehabilitation in children and adolescents with acquired brain injury (ABI) during the subacute phase, we lack empirical evidence to demonstrate its impact in terms of meaningful outcomes. Clinical research is needed to investigate adequate dosage of physical rehabilitation and its effects on outcomes with reliable and validated outcome measurements. In this study we will investigate the feasibility of a highly intensive physical rehabilitation intervention and outcomes with reliable and valid outcome measurements.Methods and analysisOur study with a prospective case-series design will evaluate (1) The safety and feasibility of a high-intensive physical rehabilitation programme to improve functioning and participation in children and adolescents with ABI, and (2) The feasibility of a core set of clinical outcome measures to assess recovery on relevant International Classification of Functioning, Disability, and Health domains during the subacute phase. We aim to include 10–15 children and adolescents aged 6–20 years with moderate-severe ABI during subacute rehabilitation in a specialised youth department for inpatient rehabilitation in The Netherlands. In the rehabilitation programme, we aim at a highly intensive approach of 3–5 hours physical rehabilitation per day during inpatient rehabilitation. Frequent and systematic assessment (baseline, each consecutive 6 weeks -if applicable- and at discharge) through a core set of outcome measures will provide insights into the degree of recovery of motor and cognitive functioning. We use descriptive and inferential statistics and thematic content analysis for analysis of the data.Ethics and disseminationThe study has been approved by the Medical Ethics Research Committee of the University Medical Hospital, Utrecht (reference number: 23U-0628). We aim to disseminate our findings in peer-reviewed journals and present at national and international conferences.
Exploring the quality of end-of-life care in the intensive care unit: a qualitative multiple case study approach with family members of Muslim patients
Authors: Nayfeh Ayah , Conn Lesley Gotlib , Dale Craig , Fowler Robert 
Published: January 2025

ObjectiveMuslim patients are an underrepresented community in end-of-life care research, with little evidence around factors that influence the quality and experience of care. The aim of this study was to explore the quality of end-of-life care in the intensive care unit (ICU) from the perspective of next-of-kin family members of Muslim patients.DesignA qualitative multiple case study design using semistructured interviews with family members of Muslim patients. Healthcare providers’ notes from the patient medical record were also used to contextualise the patient care experience and medical journey. Data were analysed using deductive content analysis.SettingA large academic tertiary care hospital in Toronto, Canada.ParticipantsNext-of-kin family members of Muslim patients (≥18 years) who were admitted to the ICU and died in hospital between October 2019 and December 2021.ResultsFamily members of five Muslim patients of South Asian descent were recruited for this study. Four central themes were identified: (1) trust and confidence in the healthcare team overseen by medical experts; (2) quality communication with medical experts; (3) achieving patient goals of care; and (4) dignity of care through cultural respect and emotional support. Culture, religion and religiosity did not appear to have a major influence on the medical decision-making process. Communication, emotional and psychological well-being for patients, and cultural respect were identified as possible areas for quality improvement.ConclusionsOur findings identified central themes in the quality of end-of-life care for families of seriously ill Muslim patients. These insights can inform clinical processes and interventions to improve the quality of care and reduce psychological and emotional burden at the end of life.
Evaluating the implementation and impact of a volunteer navigation oncology support programme: study protocol for a pragmatic, real-world hybrid type 2 study
Authors: Rocque Gabrielle B , Dent D'Ambra N , Waugh Charlotte , Hill Emily K , Federman Noah , Bostock Rosenzweig Ian , Morris Bonny , Kamal Arif 
Published: January 2025

IntroductionPatient navigation is recommended by accrediting bodies such as the Commission on Cancer and is a key element in payment reform demonstration projects, due to the established benefits in reducing barriers to healthcare, improving care coordination and reducing healthcare utilisation. However, oncology practices are often resource constrained and lack the capacity to extend navigation services at the desired intensity for their patient population. The American Cancer Society (ACS) developed the ACS Community Access to Resources, Education, and Support (CARES) programme to expand navigation capacity through the training of students from local universities as volunteers to serve as non-clinical navigators to support cancer patients. Although this approach has great potential for scalability, the best approach to early implementation and impact of volunteer navigation remains unclear.Methods and analysisThis pragmatic single-arm pre–post study evaluates the implementation and effectiveness of volunteer navigation for patients participating in the 2023–2024 pilot. This study will use data collected during routine care for quantitative implementation and patient outcomes. The Updated Consolidated Framework for Implementation Research will guide evaluation of early programme implementation with three initial pilot sites. This pragmatic evaluation of real-world implementation of volunteer navigation in the oncology setting will support future efforts to scale-up this intervention across US health systems.Ethics and disseminationThis study was approved by University of Morehouse School of Medicine Social and Behavioral (IRB), which served as the IRB for record for this project (IRB-2025819–2). No consent required for this study protocol. ACS CARES plans to disseminate this model and include additional sites as participants in future years.
Measuring the patient safety climate in community pharmacies: an updated national survey
Authors: Ljungberg Persson Christina , Nordén Hägg Annika , Södergård Björn 
Published: January 2025

BackgroundThe patient safety climate in community pharmacies was measured nationally in Sweden in 2008. Since that time the Swedish pharmacy market has undergone a re-regulation which probably has affected the patient safety climate in pharmacies.ObjectivesThe aim was to evaluate the patient safety climate among pharmacists working in Swedish community pharmacies and compare it with historical data.DesignThe patient safety climate among pharmacists was analysed in two cross-sectional surveys. Historical data from 2008 and data collected in 2022 were compared. The Safety Attitudes Questionnaire (SAQ), containing items on safety culture arranged in six dimensions, was used in both surveys. It uses a 5-point Likert scale to create a quantitative description of the respondents’ perception of patient safety climate.SettingCommunity pharmacies in Sweden.ParticipantsThese surveys were census studies because all pharmacists working in community pharmacies in Sweden were invited to participate and no sampling occurred.ResultsThe number of respondents was 2738 in 2008 and 1931 in 2022. The patient safety climate in Swedish community pharmacies appears to have worsened between 2008 and 2022 according to the pharmacists. All values of the dimensions included in the SAQ have decreased, except for the dimension of Stress Recognition, where an increase indicated a larger awareness among the pharmacists of how stress impacts their work. The overall negative trend in SAQ values seen between 2008 and 2022 was consistent, irrespective of the respondent’s level of education, their role in the pharmacy or the number of years since their education was completed.ConclusionsThe patient safety climate in community pharmacies in Sweden seems to have deteriorated. With an increasingly strained healthcare system, community pharmacists must be reliable defenders of patient safety, and it is essential to ensure that the climate in their workplace supports the important work being carried out.