bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women with type 2 diabetes and coronary artery disease have a higher risk of heart failure than men, with a significant gender interaction between heart failure risk and risk factor management: a retrospective registry study
Authors: Fujita Yuko , Morimoto Takeshi , Tokushige Akihiro , Ikeda Masayuki , Shimabukuro Michio , Node Koichi , Ueda Shinichiro 
Published: May 2022

IntroductionWomen are generally perceived to have a lower risk of cardiovascular events than men, despite a lack of data, particularly among patients with diabetes. Here, we investigated gender differences in the risk of heart failure (HF) events in patients with type 2 diabetes and coronary artery disease (CAD). We also assessed the association between cardiovascular risk factor management and HF events.Research design and methodsThis retrospective registry study enrolled consecutive patients with both type 2 diabetes and CAD, based on angiography records and medical charts at 70 teaching hospitals in Japan, from January 2005 to December 2015.ResultsThe registry included 7785 patients with a mean follow-up period of 1328 days. The mean age of the patients was 67.6 years. The risk of hospitalization for HF in patients with both type 2 diabetes and CAD was significantly higher among women than among men (HR, 1.26, 95% CI 1.06 to 1.50). The relationship between HF risk and achieved low-density lipoprotein cholesterol (LDL-c) and systolic blood pressure, but not hemoglobin A1c, differed between women and men, with statistically significant interactions (p=0.009 and p=0.043, respectively).ConclusionsWomen with type 2 diabetes and CAD have a higher risk of HF than men. A significant gender interaction was observed in the association between HF risk and risk factor management, particularly regarding LDL-c and systolic blood pressure. The effectiveness of risk factor management may differ between men and women regarding HF prevention among patients with type 2 diabetes and CAD.
Reporting of patient-reported outcomes in trials on alcohol use disorder: a meta-epidemiological study
Authors: Douglas Alexander , Garrett Elizabeth , Staggs Jordan , Williams Cole , Shepard Samuel , Wise Audrey , Hillman Cody , Ottwell Ryan , Hartwell Micah , Vassar Matt 
Published: May 2022

ObjectivesCurrently, limited research exists to assess the extent of patient-reported outcome (PRO) reporting among randomised controlled trials (RCTs) evaluating alcohol use disorder (AUD). We sought to investigate the completeness of reporting of PROs using the Consolidated Standards of Reporting Trials-PRO (CONSORT-PRO) extension in AUD RCTs.Design settingMeta-epidemiological study.MethodsWe searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) on 29 June 2021 for published RCTs focused on AUD. Following these searches, title and abstract screening, and full-text screening were performed by two investigators. To be included, a study must have employed a randomised trial design, published in English, focused on treatment of AUD and included at least one PRO. Trials meeting inclusion criteria were evaluated for completeness of reporting using the CONSORT-PRO extension adaptation. These trials were also evaluated for risk of bias (RoB) using the Cochrane RoB V.2.0 tool. Additionally, an exploratory analysis of each RCT’s therapeutic area was extracted using the Mapi Research Trust’s ePROVIDE platform. Screening and data collection were all performed in masked, duplicate fashion.Main outcome measuresPRO completeness of reporting, identification of factors associated with completeness of reporting and PRO measures used in RCTs to evaluate patients with AUD.ResultsNineteen RCTs were evaluated in our analysis. Our primary outcome, the mean completion score for CONSORT-PRO, was 40.8%. Our secondary outcome—the identification of factors associated with completeness of reporting—found that trials published after 2014 (ie, 1 year after the publication of the CONSORT-PRO extension) were 15.0% more complete than trials published before 2014. We found no additional associations with better reporting.ConclusionsWe found that the completeness of PRO reporting in RCTs involving AUD was deficient. Complete reporting of PROs is instrumental in understanding the effects of interventions, encourages patient participation in their treatment and may increase clinician confidence in the value of PROs. High quality treatment strategies for AUD require properly reported PROs.
Multimorbidity and associations with clinical outcomes in a middle-aged population in Iran: a longitudinal cohort study
Authors: Odland Maria Lisa , Ismail Samiha , Sepanlou Sadaf G , Poustchi Hossein , Sadjadi Alireza , Pourshams Akram , Marshall Tom , Witham Miles D , Malekzadeh Reza , Davies Justine I 
Published: May 2022

BackgroundAs the populations of lower-income and middle-income countries age, multimorbidity is increasing, but there is little information on its long-term consequences. We aimed to show associations between multimorbidity and outcomes of mortality and hospitalisation in Iran, a middle-income country undergoing rapid economic transition.MethodsWe conducted a secondary analysis of longitudinal data collected in the Golestan Cohort Study. Data on demographics, morbidities and lifestyle factors were collected at baseline, and information on hospitalisations or deaths was captured annually. Logistic regression was used to analyse the association between baseline multimorbidity and 10-year mortality, Cox-proportional hazard models to measure lifetime risk of mortality and zero-inflation models to investigate the association between hospitalisation and multimorbidity. Multimorbidity was classified as ≥2 conditions or number of conditions. Demographic, lifestyle and socioeconomic variables were included as covariables.ResultsThe study recruited 50 045 participants aged 40–75 years between 2004 and 2008, 47 883 were available for analysis, 416 (57.3%) were female and 12 736 (27.94%) were multimorbid. The odds of dying at 10 years for multimorbidity defined as ≥2 conditions was 1.99 (95% CI 1.86 to 2.12, p<0.001), and it increased with increasing number of conditions (OR of 3.57; 95% CI 3.12 to 4.08, p<0.001 for ≥4 conditions). The survival analysis showed the hazard of death for those with ≥4 conditions was 3.06 (95% CI 2.74 to 3.43, p<0.001). The number of hospital admissions increased with number of conditions (OR of not being hospitalised of 0.36; 95% CI 0.31 to 0.52, p<0.001, for ≥4 conditions).ConclusionThe long-terms effects of multimorbidity on mortality and hospitalisation are similar in this population to those seen in high-income countries.
Cash, COVID-19 and aid cuts: a mixed-method impact evaluation among South Sudanese refugees registered in Kiryandongo settlement, Uganda
Authors: Stein Daniel , Bergemann Rico , Lanthorn Heather , Kimani Emma , Nshakira-Rukundo Emmanuel , Li Yulei 
Published: May 2022

ObjectivesIn this paper, we estimate the impact after 4–8 months of a large one-off unconditional cash transfer delivered to refugees during a time of dual shocks: the COVID-19 pandemic and cuts to monthly aid. We focus on four key outcomes: (1) health-seeking behaviour; (2) COVID-19 specific preventive health practices; (3) food security and (4) psychological well-being.MethodsWe use both quantitative and qualitative data to understand the impact of a cash transfer in this context. Quantitatively, we use a baseline survey of 1200 households (Q4 2019) and follow-up with three rounds of phone surveys in Q2 and Q3 2021, capturing at least half the sample in each round. We exploit an experimental variation in the timing of the cash transfer to assess the effect of the cash transfer through ordinary least squares regressions of intention to treat. Controlling for key baseline characteristics, we analyse the effect of the cash transfer on health access, COVID-19 health practices, food security and psychological well-being. Qualitatively, we make use of a longitudinal, small-n sample of refugee respondents, each of whom we interviewed up to 15 times between February and September 2020 to understand change over time and to go deeper into key topics.ResultsWe do not find a statistically significant effect (6.2%, p=0.188) of receiving the cash transfer on preventative measures against COVID-19. However, households receiving the cash transfer were more food secure, with a 14.4% (p=0.011) improvement on the food security index, have better psychological well-being (24.5%, p=0.003) and are more likely to seek healthcare in the private health facilities (10.4%, p=0.057) as compared with control households. We do not find significant results on the value of food consumption. Overall, we find stronger treatment effects for households that were the first to receive the cash transfers.ConclusionTaken together, we find significant support for the importance of cash transfers to refugee households mitigating against declines in food security and mental well-being in the face of shocks.
The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China
Authors: Chen Nan , Pan Jay 
Published: May 2022

ObjectiveFindings regarding the association between delivery volume and maternal health outcomes are mixed, most of which explored their correlation. This study aims to demonstrate the causal effect of delivery volume on severe maternal morbidity (SMM) in China.MethodsWe analysed all women giving birth in the densely populated Sichuan province with 83 million residents in China, during the fourth quarters of each of 4 years (from 2016 to 2019). The routinely collected discharge data, the health institutional annual report data and road network data were used for analysis. The maternal health outcome was measured by SMM. Instrumental variable (IV) methods were applied for estimation, while the surrounding average number of delivery cases per institution was used as the instrument.ResultsThe study included 4545 institution-years of data from 1456 distinct institutions with delivery services, reflecting 810 049 associated delivery cases. The average SMM rate was approximately 33.08 per 1000 deliveries during 2016 and 2019. More than 86% of delivery services were provided by a third of the institutions with the highest delivery volume (≥143 delivery cases quarterly). In contrast, less than 2% of delivery services were offered by a third of the institutions with the lowest delivery volume (<19 delivery cases quarterly). After adjusting the confounders in the IV-logistic models, the average marginal effect of per 1000 cases in delivery volume was −0.162 (95% CI −0.169 to –0.155), while the adjusted OR of delivery volume was 0.005 (95% CI 0.004 to 0.006).ConclusionIncreased delivery volume has great potential to improve maternal health outcomes, while the centralisation of delivery services might facilitate maternal health promotion in China. Our study also provides implications for other developing countries confronted with similar challenges to China.
The Kenya UK Breast Cancer Awareness Week: curriculum codesign and codelivery with direct and lived experience of breast cancer diagnosis and management
Authors: Riogi Bahaty , Ross Carlo , Mutebi Miriam , Dave Rajiv V 
Published: May 2022

Global health education holds a paradox: the provision of global health degrees focusing on challenges in low-income and middle-income countries has increased in high-income countries, while those in these low-income and middle-income countries lack access to contribute their expertise, creating an ‘information problem’. Breast cancer is a pressing global health priority, which requires curriculum design, implementation, ownership and leadership by those with direct and lived experience of breast cancer.The Kenya-UK Breast Cancer Awareness Week was conceptualised following the signing of the Memorandum of Understanding between the Kenyan and UK governments launching the Kenya UK Health Alliance. This alliance aims to promote health cooperation to address Kenya’s breast cancer challenge. Here, we present the first of the collaborative’s initiatives: a breast cancer global health education programme designed, implemented, owned and led by Kenyan stakeholders.We present the utilisation of the Virtual Roundtable for Collaborative Education Design for the design and implementation of a nationwide virtual breast cancer awareness week delivered across eleven Kenyan medical schools. By involving partners with lived and/or professional experience of breast cancer in Kenya in all stages of the design and delivery of the awareness week, the project experimented with disrupting power dynamics and fostered ownership of the initiative by colleagues with direct expertise of breast cancer in Kenya.This initiative provides a platform, precedent and playbook to guide professionals from other specialties in the design and implementation of similar global collaborative ventures. We have used this approach to continue to advocate for global health curricula design change, so that those with lived experiences of global health challenges in their contextualised professional and personal environments are given leadership, reward and ownership of their curricula and further to highlight breast cancer as a global heath priority.
News coverage of Mexico’s front-of-package food label policy
Authors: Ramírez A Susana , Garibay Kesia K , Payán Denise Diaz , Campos Gática Victoria , Merino Salmeron Yolanda 
Published: May 2022

ObjectivesTo examine news coverage of Mexico’s front-of-package food labelling policy.MethodsWe used Lexis Nexis to identify newspaper articles that mention the proposed law in four Mexican newspapers representing politically centre-left and centre-right perspectives. We coded for type and valence of arguments, sources and research evidence cited.ResultsWe identified N=361 relevant articles. Coverage of the front-of-package food label policy was primarily news (vs editorial/opinion). While most were neutral in tone, left-leaning newspapers had slightly more positive overall coverage compared with right-leaning newspapers, indicated by publishing more stories in favour of the policy, fewer in opposition, more propolicy arguments and more frequent inclusion of perspectives by government officials and public health advocates. Despite some evidence of bias, there was a general lack of credible opposition to the policy and mention of opponents across newspapers.Conclusions and policy implicationsThe relative absence of food and beverage industry stakeholders in news coverage of the food label policy is unexpected given their documented involvement in prior food policy debates. We discuss possible reasons for their conspicuous absence and lessons for public health advocates around the globe.
Ethnic disparities in immunisation: analyses of zero-dose prevalence in 64 countries
Authors: Cata-Preta Bianca O , Santos Thiago M , Wendt Andrea , Hogan Daniel R , Mengistu Tewodaj , Barros Aluisio J D , Victora Cesar G 
Published: May 2022

BackgroundThe Sustainable Development Goals (SDGs) recommend stratification of health indicators by ethnic group, yet there are few studies that have assessed if there are ethnic disparities in childhood immunisation in low-income and middle-income countries (LMICs).MethodsWe identified 64 LMICs with standardised national surveys carried out since 2010, which provided information on ethnicity or a proxy variable and on vaccine coverage; 339 ethnic groups were identified after excluding those with fewer than 50 children in the sample and countries with a single ethnic group. Lack of vaccination with diphtheria–pertussis–tetanus vaccine—a proxy for no access to routine vaccination or ‘zero-dose’ status—was the outcome of interest. Differences among ethnic groups were assessed using a χ2test for heterogeneity. Additional analyses controlled for household wealth, maternal education and urban–rural residence.FindingsThe median gap between the highest and lowest zero-dose prevalence ethnic groups in all countries was equal to 10 percentage points (pp) (IQR 4–22), and the median ratio was 3.3 (IQR 1.8–6.7). In 35 of the 64 countries, there was significant heterogeneity in zero-dose prevalence among the ethnic groups. In most countries, adjustment for wealth, education and residence made little difference to the ethnic gaps, but in four countries (Angola, Benin, Nigeria and Philippines), the high–low ethnic gap decreased by over 15 pp after adjustment. Children belonging to a majority group had 29% lower prevalence of zero-dose compared with the rest of the sample.InterpretationStatistically significant ethnic disparities in child immunisation were present in over half of the countries studied. Such inequalities have been seldom described in the published literature. Regular analyses of ethnic disparities are essential for monitoring trends, targeting resources and assessing the impact of health interventions to ensure zero-dose children are not left behind in the SDG era.
Emotional intelligence in military medical officers in the Defence Medical Services
Authors: MacEwan Dougal , Gibson A 
Published: May 2022

BackgroundEmotional intelligence (EI) is a concept describing an individual’s ability to understand, process and act accordingly on others’ and one’s own emotions. It is a desirable quality for people working in teams and is beneficial to the individual in many ways. It is increasingly recognised that understanding and developing EI are important to working in the healthcare environment. It becomes especially pertinent in the deployed Defence Medical Services (DMS), where clinicians often fulfil a significant leadership role in a small team.MethodsThis study was performed with the aim of exploring the role of EI in military doctors in the UK DMS. EI was measured in a cohort of 64 military doctors by way of a validated self-assessment questionnaire. Results were tested for differences in EI between different services and career stages.ResultsThe survey had an 83% return rate. There was roughly equal distribution between service, career groups and ages across the study population. There were more men than women. The population showed consistently high EI scores compared with control data. There were no statistical differences in EI scores between services or genders. Foundation doctors showed the highest EI scores and consultants the lowest (6.05 vs 5.3).ConclusionIt was demonstrated that military doctors have consistently high EI score, especially at the most junior level. This suggests that traits deemed desirable by the single service selection processes also pertain to high EI without it being specifically measured for. The dangers of having too high EI and the benefits of having a range of EI within a team were discussed. There were limitations of being unable to obtain qualitative data and not including primary healthcare staff. Several recommendations were set out as to how the DMS may use or further investigate EI with regard to training and recruitment.
Daily rhythms in right-sided and left-sided temporal lobe epilepsy
Authors: Latini Manuel Facundo , Oddo Silvia , Anzulovich Ana Cecilia , Kochen Silvia 
Published: May 2022

IntroductionEpilepsy is closely related to daily rhythms, such as the sleep–wake cycle. The objective of this study was to evaluate the relationship between drug-resistant temporal lobe epilepsy (TLE) and the parameters related to the sleep–wake cycle, seizure time and epilepsy laterality.MethodsConsecutive patients admitted to the video electroencephalogram unit with a diagnosis of TLE were enrolled. Patients were divided into two groups: those with left TLE (LTLE) and those with right TLE (RTLE). They then remained in the conditions of 12-hour light, 12-hour darkness. Demographic data, treatment, number and time of seizure occurrence, sleep diary, morningness–eveningness questionnaire, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were recorded.ResultsIn total, 74 patients with TLE, 43 with LTLE and 31 with RTLE, were studied. RTLE patients showed a significant preference for morningness. Patients treated with benzodiazepines showed worse sleep quality and greater daytime sleepiness. Patients who did not report any clear predominance and patients who reported seizures during wakefulness had significantly more seizures during wakefulness and patients who reported sleep predominance had more seizures during sleep (p>0.001). The LTLE group had a greater number of seizures from 8 to 16 hours, unlike the RTLE group, which had a uniform distribution (p=0.008).ConclusionsThis was a prospective study of patients with drug-resistant TLE performed in a controlled environment to study the impact of daily rhythms, seizure frequency and seizure distribution. Laterality seems to be a key factor in seizure distribution.
Association of multimorbidity and physical activity among older adults in India: an analysis from the Longitudinal Ageing Survey of India (2017–2018)
Authors: Boro Bandita , Saikia Nandita 
Published: May 2022

ObjectiveTo examine the association of multimorbidity and physical activity among older adults in India.DesignA cross-sectional study was conducted using large representative survey data.Setting and participantsThe study used data from the nationally representative ‘Longitudinal Ageing Study in India (LASI),’ conducted during 2017–2018. The study included a total sample of 65 336 older adults aged 45 years and above in India.MethodsModerate and vigorous physical activities were measured separately by self-reported questionnaires. Physical activity was calculated as minutes of metabolic equivalent tasks per week. The outcome variable was a categorical variable where 2=the prevalence of more than one morbidity, 1=presence of one morbidity and 0=none. Bivariate analysis and multinomial logistic regression were applied to fulfil the objectives.Results27.39% of older adults in India had multimorbidity. 31.02% of older adults did not engage in any moderate physical activities. Also, 59.39% of older adults did not engage in any vigorous physical activities. Older adults reporting low (adjusted relative risk ratio (A RRR): 1.10, 95% CI 1.03 to 1.18) and moderate (A RRR): 1.05, 95% CI 0.98 to 1.13) level of moderate physical activity were significantly more likely to suffer from multimorbidity compared with no involvement in moderate physical activity. However, older adults who reported high (A RRR: 0.79, 95% CI 0.75 to 0.84), moderate (A RRR: 0.88, 95% CI 0.80 to 0.98) and low level of vigorous physical activity (A RRR: 0.94, 95% CI 0.86 to 1.02) had significantly less multimorbidity in comparison to those who never engaged in vigorous physical activity.ConclusionLack of physical activity is associated with multimorbidity among older adults. Physical activity promotion should be adopted as a primary strategy in reducing the burden of morbidity and multimorbidity.