bluuebunny/crossref_metadata_2025_split huggingface dataset:
Process evaluation of a multicentre randomised clinical trial of substituting surgical excisions of low-risk basal cell carcinomas from secondary to primary care
Authors: Noels Eline , Lugtenberg Marjolein , Wakkee Marlies , Ramdas Kirtie H R , Bindels Patrick J E , Nijsten Tamar , van den Bos Renate R 
Published: February 2022

ObjectivesIn 2016, the SKINCATCH Trial, a clustered multi-centre randomised trial, was initiated to assess whether low-risk basal cell carcinomas (BCCs) can be treated by general practitioners (GPs) without loss of quality of care. The trial intervention consisted of a tailored 2-day educational course on skin cancer management. The aim of this process evaluation was to investigate GPs’ exposure to the intervention, implementation of the intervention and experiences with the intervention and trial.Research design and methodsData on exposure to the intervention, implementation and experiences were obtained at several points during the trial. Complementary quantitative components (ie, surveys, database analysis, medical record analysis) and qualitative components (ie, interviews and focus groups) were used. Quantitative data were analysed using descriptive statistics; qualitative data were summarised (barrier interviews) or audiorecorded, transcribed verbatim and thematically analysed using Atlas.Ti (focus groups).ResultsFollowing a 100% intervention exposure, results concerning the implementation of the trial showed that aside from the low inclusion rate of patients with low-risk BCCs (n=54), even less excisions of low-risk BCCs were performed (n=40). Although the intervention was experienced as highly positive, several barriers were mentioned regarding the trial including administrative challenges, lack of time and high workload of GPs, low volume of BCC patients and patients declining to participate or requesting a referral to a dermatologist.ConclusionsAlthough GPs’ participation in the highly valued training was optimal, several barriers may have contributed to the low inclusion and excision rate of low-risk BCCs. While some of the issues were trial-related, other barriers such as low patient-volume and patients requesting referrals are applicable outside the trial setting as well. This may question the feasibility of substitution of surgical excisions of low-risks BCCs from secondary to primary care in the current Dutch setting.Trial registration numberTrial NL5631 (NTR5746).
Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital: the results of a mixed-method phase-II study
Authors: Stuber Felicitas , Seifried-Dübon Tanja , Tsarouha Elena , Rahmani Azad Zahra , Erschens Rebecca , Armbruster Ines , Schnalzer Susanne , Mulfinger Nadine , Müller Andreas , Angerer Peter , Helaß Madeleine , Maatouk Imad , Nikendei Christoph , Ruhle Sascha , Puschner Bernd , Gündel Harald , Rieger Monika A , Zipfel Stephan , Junne Florian 
Published: February 2022

ObjectivesHospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership.DesignThis is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants’ change in everyday work.SettingA tertiary hospital in Germany.ParticipantsN=93 leaders of different professions.InterventionAn interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource ‘team’, (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention.Outcome measuresFeasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership.ResultsAfter the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants’ self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work.ConclusionsThis intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre—randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus).
Effects of socioeconomic status on the control of hypertension in patients <65 and ≥65 years of age in Taiwan: a nationwide cross-sectional study
Authors: Lin Sheng-Feng , Kuo Tzu-Tung , Pan WH , Bai Chyi Huey 
Published: February 2022

ObjectiveImplementation of National Health Insurance in 1995 improved the control of hypertension due to comprehensive coverage of medical costs for all residents in Taiwan. However, the role of individual socioeconomic status (iSES), namely, education and personal income, in awareness, treatmen, and control of blood pressure, has not been well studied in Taiwan.DesignA nationwide cross-sectional survey was executed in this study.SettingA systematic, multistage sampling scheme from a nationwide cohort in Taiwan was adopted to select adult participants. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or the use of antihypertensive medications.ParticipantsA total of 4599 subjects completed door-to-door household interviews and physical examinations.Primary and secondary outcome measuresA summing z score of iSES was constructed by two domains of the iSES, namely, income and education, through which participants were classified into three SES levels. Logistic regression models were used to assess associations of awareness, treatment, and control in younger (<65 years) and older (≥65 years) participants with hypertension.ResultsYounger people in the highest tertile of iSES were less likely to be aware of their hypertension (OR: 0.48, 95% CI: 0.37 to 0.64, p<0.0001) or to have it treated (OR: 0.49, 95% CI 0.37 to 0.64, p<0.0001) but more likely to have their hypertension controlled (OR: 1.52, 95% CI 1.19 to 1.94, p=0.0009). We did not detect an association in people aged >65 years.ConclusionHealth education to improve awareness and treatment of hypertension should focus on younger people with higher iSES in Taiwan.
Outcomes in hospitalised patients with sepsis, severe sepsis or septic shock and reported penicillin allergy: a retrospective cohort study
Authors: Beddow David , Patel Love , Smith Claire S , Kirven Justin , Schmidt Christine , Ruppman Daniel , Kethireddy Rajesh , Wankum Michael , Dawud Barite , St. Hill Catherine A 
Published: February 2022

ObjectiveTo determine outcomes in hospitalised patients with sepsis and reported penicillin allergy (PcnA).DesignObservational retrospective cohort study using data from electronic health records.SettingA large single health system with 11 hospitals of small, medium and large sizes including a 630-bed tertiary care teaching hospital.ParticipantsPatients (n=5238) ≥18 years of age, hospitalised with sepsis, severe sepsis or septic shock between 1 January 2016 and 31 December 2018, received antibacterial agents, and had documented PcnA status. Patients <18 years of age at admission were excluded.Outcome measuresPrimary outcomes evaluated were inpatient mortality and 30-day mortality posthospital discharge. Secondary outcomes were hospital length of stay, 30-day readmissions, duration of antibiotic use, rate of Clostridium difficile infection and total cost of care.ResultsThere was no difference in outcomes including inpatient or 30-day mortality, hospital length of stay, in-hospital antibiotic duration, C. difficile infection, total cost of care and 30-day readmission rate between patients labelled with a PcnA vs patients who did not report PcnA (non-PcnA).ConclusionIn this retrospective single health system study, there was no difference in key outcomes including inpatient or 30-day mortality in patients admitted with sepsis and reported PcnA compared with patients who reported no PcnA.
Analysis of eGFR index category and annual eGFR slope association with adverse clinical outcomes using real-world Japanese data: a retrospective database study
Authors: Zhang Ling , Hauske Sibylle , Ono Yasuhisa , Kyaw Moe H , Steubl Dominik , Naito Yusuke , Kanasaki Keizo 
Published: February 2022

ObjectivesReal-world clinical outcome data of patients with an above-normal estimated glomerular filtration rate (eGFR) and increasing eGFR over time (eGFR slope) are scarce. Although eGFR is commonly recorded, eGFR slopes are rarely used for adverse outcome risk categorisation in clinical practice. We investigated the association of above-normal/below-normal eGFR ranges and increasing/declining eGFR slopes with clinical outcomes in Japan.DesignObservational cohort study.SettingPrimary and acute care hospitals; 423 centres.Participants57 452 patients aged ≥16 years with ≥3 eGFR values (latest available January 2013–December 2016) from the Japanese Medical Data Vision database were stratified into six index eGFR and six eGFR slope groups (slopes calculated using a linear mixed model).Primary and secondary outcome measuresTime-to-event analyses of cardiovascular mortality, all-cause mortality (ACM), all-cause hospitalisation (ACH) and cardiovascular and major kidney events. eGFR and slope groups were analysed by Cox proportional hazard models with multivariable adjustment, using normal eGFR/little-to-no slope groups as reference.ResultsHigher risk of clinical outcomes was observed with declining eGFR slope groups versus the reference group; the HR (95% CI) for slope ≤−5 mL/min/1.73 m2/year: cardiovascular events 1.8 (1.4 to 2.2), ACH 1.8 (1.5 to 2.1), and ACM 2.8 (1.9 to 4.2) and was non-significant for kidney events 1.5 (0.9 to 2.5). A similar, but non-significant, pattern was observed with increasing slope groups (slope >3 mL/min/1.73 m2/year HR (95% CI): cardiovascular events 1.2 (0.9 to 1.5), ACH 1.1 (0.9 to 1.4) and ACM 1.5 (0.9 to 2.3)).Above-normal and below-normal eGFR groups were associated with poorer outcomes versus the reference group, but kidney events were associated with below-normal eGFR only.ConclusionPoorer clinical outcomes were observed not only for below-normal eGFR and declining eGFR slope groups but also for certain above-normal eGFR and increasing slope groups. eGFR and eGFR slope may, therefore, be useful for identifying patients at high risk of adverse clinical outcomes.
Metabolic syndrome, associated factors and optimal waist circumference cut points: findings from a cross-sectional community-based study in the elderly population in Asmara, Eritrea
Authors: Achila Oliver Okoth , Araya Mathewos , Berhe Arsema Brhane , Haile Niat Habteab , Tsige Luwam Kahsai , Shifare Bethelihem Yemane , Bitew Tesfaalem Abel , Berhe Israel Eyob , Abraham Isayas Afewerki , Yohaness Eyob Garoy 
Published: February 2022

ObjectiveThe aim of the study was to investigate the prevalence of metabolic syndrome (MetSyn), associated factors, and optimal waist circumference (WC) cut points in a subset of the elderly population in Asmara, Eritrea.DesignA community-based cross-sectional study conducted between January and June 2018.SettingAsmara, Eritrea.ParticipantsDemographic, clinical biochemistry and anthropometric information were collected from a total of 319 elderly participants of African lineage (54.5% men vs 45.5% women).Main outcome measuresLipid profiles, fasting plasma glucose (FPG), anthropometric data, clinical profiles and demographic characteristic of patients were described. MetSyn was defined according to the International Diabetes Federation harmonised criteria.ResultsThe median age (IQR) of study participants was 67 (IQR: 63–72 years)—men 68 (IQR: 64–74) years versus women 65 (IQR: 62–70) years, p=0.002. The prevalence of MetSyn was 90 (28.4%). Abnormal values in MetSyn components were as follows: systolic blood pressure/diastolic blood pressure ≥130/85 mm Hg or use of hypertension medication 133 (41.7%); overweight/obesity, 55 (25.1%); abdominal obesity 129 (40.4); low-density lipoproptein cholesterol (LDL-C) >130 mg/dL, 139 (43.6%); total cholesterol >200 mg/dL, 152 (47.6%); non-high-density lipoproptein cholesterol (HDL-C)>130 mg/dL, 220 (69.0%) and FPG (≥100–125 mg/dL), 35 (12.7%) and FPG>125.17 (6.2%). Multivariate logistic regression analysis indicated that sex (females) (adjusted OR (aOR) 4.69, 95% CI 2.47 to 8.92); non-HDL-C (aOR 1.09, 95% CI 1.05 to 1.14); LDL-C >130 mg/dL (aOR 2.63, 95% CI 1.09 to 6.37) and body mass index (aOR 1.20, 95% CI 1.10 to 1.32) were independently associated with the presence of MetSyn. Optimal cut points for WC in men yielded a value of 85.50 cm, a sensitivity of 76.0%, a specificity of 61.0% and an area under receiver operating characteristics curve (AUROC) value of 74.0, 95% CI (65.7 to 82.4). For women, the WC at a cut point value of 80.50 cm yielded the highest Youden index (0.41) with a sensitivity of 80%, a specificity of 39%, and an AUROC of 73.4, 95% CI (64.8 to 82.5).ConclusionsThe MetSyn is highly prevalent in a subset of apparently healthy elderly population in Asmara, Eritrea. The findings support opportunistic and/or programmatic screening for CVD risk in the elderly during outpatient visits.
Association of social isolation, loneliness and genetic risk with incidence of dementia: UK Biobank Cohort Study
Authors: Elovainio Marko , Lahti Jari , Pirinen Matti , Pulkki-Råback Laura , Malmberg Anni , Lipsanen Jari , Virtanen Marianna , Kivimäki Mika , Hakulinen Christian 
Published: February 2022

BackgroundSocial isolation and loneliness have been associated with increased risk of dementia, but it is not known whether this risk is modified or confounded by genetic risk of dementia.MethodsWe used the prospective UK Biobank study with 155 070 participants (mean age 64.1 years), including self-reported social isolation and loneliness. Genetic risk was indicated using the polygenic risk score for Alzheimer’s disease and the incident dementia ascertained using electronic health records.ResultsOverall, 8.6% of participants reported that they were socially isolated and 5.5% were lonely. During a mean follow-up of 8.8 years (1.36 million person years), 1444 (0.9% of the total sample) were diagnosed with dementia. Social isolation, but not loneliness, was associated with increased risk of dementia (HR 1.62, 95% CI 1.38 to 1.90). There were no interaction effects between genetic risk and social isolation or between genetic risk and loneliness predicting incident dementia. Of the participants who were socially isolated and had high genetic risk, 4.4% (95% CI 3.4% to 5.5%) were estimated to developed dementia compared with 2.9% (95% CI 2.6% to 3.2%) of those who were not socially isolated but had high genetic risk. Comparable differences were also in those with intermediate and low genetic risk levels.ConclusionsSocially isolated individuals are at increased risk of dementia at all levels of genetic risk.
Understanding facilitators and barriers to follow-up after abnormal cervical cancer screening examination among women living in remote areas of Romania: a qualitative study protocol
Authors: Nyanchoka Linda , Damian Andreea , Nygård Mari 
Published: February 2022

IntroductionIn 2020 in Europe, Romania had the second highest incidence and mortality rates of cervical cancer, after Montenegro. To address cervical cancer in the country, the Romanian government established a national cervical cancer screening programme in 2012. The programme provides free testing as well as free treatment in the event of cervical precancer diagnosis for women 25–64 years old with health insurance who are referred from a programme-registered general practitioner. Participation in screening, retesting and follow-up for detected precancerous lesions is suboptimal, thus reducing the overall effectiveness of the programme.AimThe overall aim of the study is to examine facilitators and barriers to cervical cancer screening follow-up after an abnormal cervical cancer screening examination among underserved women living in remote areas of Romania. We have the following specific research questions: (1) what are the knowledge, perspectives and experiences of women living in remote areas of Romania with cervical cancer screening and (2) what are the knowledge, perspectives and experiences of women living in remote areas of Romania with follow-up information and services after abnormal cervical cancer screening results.MethodWe will conduct an exploratory qualitative study using semi-structured interviews. Data analysis will be based on the thematic analysis outlined by Braun and Clarke. We will use QSR International’s NVivo V.12 as the qualitative data analysis software for both data management and analysis.Ethics and disseminationStudy findings will inform recommendations for the Romania national policy for the cervical cancer screening programme, with a particular focus on underserved women living in remote areas with limited access to healthcare services. They will also be disseminated to relevant conferences and meetings. Ethics approval was obtained from Romania (Ref. 199/1501.2021 application no. 661/15.01.2021) and Norway (Ref. 12929853).
Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: a retrospective cohort study
Authors: Leniz Javiera , Henson Lesley A , Potter Jean , Gao Wei , Newsom-Davis Tom , Ul-Haq Zia , Lucas Amanda , Higginson Irene J , Sleeman Katherine E 
Published: February 2022

ObjectiveTo examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life.DesignRetrospective cohort study.SettingWe used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK).ParticipantsPeople registered in general practices, with a diagnosis of cancer who died between 2016 and 2019.Primary and secondary outcome measures≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life.ResultsOf 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47).ConclusionsExpanding community nursing could reduce acute hospital use at the end of life and improve quality of care.
Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review
Authors: Fleitas Alfonzo Ludmila , King Tania , You Emily , Contreras-Suarez Diana , Zulkelfi Syafiqah , Singh Ankur 
Published: February 2022

ObjectiveTo document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity.DesignScoping review.MethodsA search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results.ResultsA total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity.ConclusionGiven the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.