bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study
Authors: Ben Hassen Céline , Fayosse Aurore , Landré Benjamin , Raggi Martina , Bloomberg Mikaela , Sabia Séverine , Singh-Manoux Archana 
Published: February 2022

AbstractObjectiveTo examine the association of midlife and late life multimorbidity, including severity of multimorbidity, with incident dementia.DesignProspective cohort study.SettingCivil service departments in London (Whitehall II study, study inception in 1985-88).Participants10 095 participants, aged 35 to 55 at baseline.Main outcome measureIncident dementia at follow-up between 1985 and 2019. Cause specific Cox proportional hazards regression was used to examine the association of multimorbidity overall and at age 55, 60, 65, and 70 with subsequent dementia, taking into account the competing risk of death.ResultsThe prevalence of multimorbidity (≥2 chronic diseases) was 6.6% (655/9937) at age 55 and 31.7% (2464/7783) at age 70; 639 cases of incident dementia occurred over a median follow-up of 31.7 years. After adjustment for sociodemographic factors and health behaviours, multimorbidity at age 55 was associated with subsequent risk of dementia (difference in incidence rate per 1000 person years 1.56, 95% confidence interval 0.62 to 2.77; hazard ratio 2.44, 95% confidence interval 1.82 to 3.26). The association weakened progressively with older age at onset of multimorbidity. At age 65, onset of multimorbidity before age 55 was associated with 3.86 (1.80 to 6.52) per 1000 person years higher incidence of dementia (hazard ratio 2.46, 1.80 to 2.26) and onset between 60 and 65 was associated with 1.85 (0.64 to 3.39) per 1000 person years higher incidence (1.51, 1.16 to 1.97). Severity of multimorbidity (≥3 chronic diseases) at age 55 was associated with a 5.22 (1.14 to 11.95) per 1000 person years higher incidence of dementia (hazard ratio 4.96, 2.54 to 9.67); the same analyses at age 70 showed 4.49 (2.33 to 7.19) per 1000 person years higher incidence (1.65, 1.25 to 2.18).ConclusionMultimorbidity, particularly when onset is in midlife rather than late life, has a robust association with subsequent dementia. The increasingly younger age at onset of multimorbidity makes prevention of multimorbidity in people with a first chronic disease important.
EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial
Authors: Persson Anders , Atroshi Isam , Tyszkiewicz Thomas , Hailer Nils , Lazarinis Stergios , Eisler Thomas , Brismar Harald , Mukka Sebastian , Kernell Per-Juan , Mohaddes Maziar , Sköldenberg Olof , Gordon Max 
Published: February 2022

IntroductionThere is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not.Methods and analysisMulticentre, double-blind, cluster-randomised, placebo-controlled trial conducted at seven hospitals in 2017–2022. All patients that undergo orthopaedic surgery for minimum 30 min are included. Intervention group: patients operated in OR with PAP devices turned on. Control group: patients operated in OR with PAP devices turned off. Randomisation: each OR will be randomised in periods of 4 weeks, 6 weeks or 8 weeks to either have the devices on or off. Primary outcome: any SSI postoperatively defined as a composite endpoint of any of the following: use of isoxazolylpenicillin, clindamycin or rifampicin for 2 days or more, International Classification of Diseases codes or Nordic Medico-Statistical Committee codes indicating postoperative infection. In a second step, we will perform a chart review on those patients with positive indicators of SSI to further validate the outcome. Secondary outcomes are described in the Methods section. Power: we assume an SSI rate of 2%, an SSI reduction rate of 25% and we need approximately 45 000 patients to attain a power of 80% at a significance level of 0.05.Ethics and disseminationThe study is approved by the Swedish Ethical Review Authority. The interim analysis results from the study will be presented only to the researchers involved unless the study thereafter is interrupted for whatever reason. Publication in a medical journal will be presented after inclusion of the last patient.Trial registration numberNCT02695368.
Study protocol of the ACCESS trial: a randomised trial to evaluate the effectiveness of human papillomavirus testing by self-sampling in cervical cancer screening uptake and precancer detection
Authors: Fujita Misuzu , Shimazu Minobu , Nagashima Kengo , Suzuki Misae , Tauchi Ichiro , Sakuma Miwa , Yamamoto Setsuko , Shozu Makio , Hanaoka Hideki , Tsuruoka Nobuhide , Kasai Tokuzo , Hata Akira 
Published: February 2022

IntroductionRecently, the incidence of cervical cancer has increased in Japan, probably because of an interruption in human papillomavirus (HPV) vaccination and a low cervical cancer screening rate. There is a lack of evidence for self-sampling HPV testing as a cervical cancer screening tool in Japan. The Accelerating Cervical Cancer Elimination by Self-Sampling test trial aims to compare the effectiveness of screening using the self-sampling HPV test with that of routine screening concerning screening uptake and precancer detection.Methods and analysisThis trial has a single-municipality, open-label, parallel, superiority and randomised design. Approximately 20 000 women who have not undergone cervical cancer screening for at least 3 years will be assigned randomly to the self-sampling arm and the control arm using a 1:1 ratio. Participants assigned to the control arm will undergo routine cervical cancer screening (cytology test) provided by Ichihara City, while those assigned to the self-sampling arm will choose the routine screening or self-sampling HPV test. HPV tests will be performed using the cobas 8800 system (Roche Diagnostics, Rotkreuz, Switzerland). Participants who will undergo the self-sampling HPV testing will be recommended to undergo routine screening. The results of the cytology test and further tests, such as colposcopy and biopsy, will be collected and used for this trial. The risk ratio and risk difference in the proportion of participants with cervical intraepithelial neoplasia two or worse between the two arms will be calculated. The test for the null hypothesis (the detection rates are equal between the two arms) will be performed using Pearson’s χ2 test.Ethics and disseminationThis trial was approved by the Research Ethics Committees of the Chiba Foundation for Health Promotion and Disease Prevention and the collaborating research institutes. The results will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberjRCT1030200276. Pre-results.
Factors associated with recruitment success in the phase 2a study of aztreonam–avibactam development programme: a descriptive qualitative analysis among sites in Spain
Authors: Jimenez-Rodriguez Rosa M , Martín-Gutiérrez Guillermo , Jiménez-Jorge Silvia , Rosso-Fernández Clara M , Tallón-Aguilar Luis , Roca-Oporto Cristina , Padillo Javier , Luckey Alison , Cano Angela , López-Ruiz José , Gómez-Zorrilla Silvia , Bonnín-Pascual Jaime , Boix-Palop Lucía , Montejo José Miguel , Torre-Cisneros Julian , Cisneros José Miguel 
Published: February 2022

ObjectiveSuccessful clinical trials are subject to recruitment. Recently, the REJUVENATE trial, a prospective phase 2a open-label, single-arm interventional clinical trial conducted within the Innovative Medicines Initiative-supported Combatting Bacterial Resistance in Europe-Carbapenem Resistance project, was published, with 85% of the recruitment performed in Spain. We analysed the recruitment success in this trial by establishing a model of recruitment practice.MethodsA descriptive qualitative study was performed from May 2016 to October 2017 at 10 participating Spanish centres. Data were extracted from: (1) feasibility questionnaires to assess the centre’s potential for patient enrolment; (2) delegation of responsibility records; (3) pre-screening records including an anonymised list of potentially eligible and (4) screening and enrolment records. A descriptive analysis of the features was performed by the participating centre. Pearson’s and Spearman’s correlation coefficients were calculated to determine factors of recruitment success.ResultsThe highest recruitment rate was observed in Hospitals 3 and 6 (58.8 and 47.0 patients per month, respectively). All the study teams were multidisciplinary with a median of 15 members (range: 7–22). Only Hospitals 3, 5 and 6 had dedicated nursing staff appointed exclusively to this study. Moreover, in those three hospitals and in Hospital 9, the study coordinator performed exclusive functions as a research planner, and did not assume these functions for the other hospitals. The univariate analysis showed a significant association between recruitment success and months of recruitment (p=0.024), number of staff (p<0.001), higher number of pharmacists (p=0.005), infectious disease specialists (p<0.001), the presence of microbiologist in the research team (p=0.018) and specifically dedicated nursing staff (p=0.036).ConclusionsThe existence of broad multidisciplinary teams with staff dedicated exclusively to the study as well as the implementation of a well-designed local patient assessment strategy were the essential optimisation factors for recruitment success in Spain.Trial registration numberNCT02655419; EudraCT 2015-002726-39; analysis of pre-screened patients.
Causes of death and characteristics of non-survivors rescued during recreational mountain activities in Japan between 2011 and 2015: a retrospective analysis
Authors: Oshiro Kazue , Murakami Tomikazu 
Published: February 2022

ObjectivesThis study aimed to describe the cause of death and characteristics at the prehospital setting associated with care and rescue processes of non-survivors rescued in the mountain of Japan.DesignRetrospective analysis.SettingPrehospital setting of mountain searches and rescues in Japan. A total of 10 prefectural police headquarters with >10 cases of mountain death from 2011 to 2015.ParticipantsData were generated from the existing records. Of the total 6159 rescued subjects, 548 mountain deaths were caused by recreational activities.ResultsAmong the 548 mountain deaths, 83% were men, and major causes of death were trauma (49.1%), hypothermia (14.8%), cardiac death (13.1%) and avalanche-related death (6.6%). The alive rate at rescue team arrival in all non-survivors was 3.5%, with 1, 4 and 14 cases of cardiac, hypothermia and trauma, respectively. Cardiac deaths occurred in 93.1% (67/72) of men and individuals aged >41 years, and 88.7% (63/71) were found on mountain trails. In hypothermia, callouts were made between 17:00 and 6:00 at 49% (40/81) and by persons not on-site in 59.7% (46/77). People with >6 hours in trauma or >1 hour in cardiac death already died on rescue team arrival, but some with hypothermia after 6 hours were alive.ConclusionThis study is one of the first large-scale retrospective analyses of prehospital non-survivors in mountain emergencies. The alive rate at rescue arrival in all mountain deaths was only 3.5%. These data showed that the circumstances related to onset and the process until the rescue team arrives have different characteristics, depending on the cause of death. Survival may be enhanced by targeting better use of the time before rescue team arrival and by providing further education, particularly mountain rescue-related medical problems to rescuers including bystanders.
Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review
Authors: Xanthopoulou Penny , Thomas Ciara , Dooley Jemima 
Published: February 2022

ObjectiveTo review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders.DesignA systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants’ experiences were included.Data sourcesMEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed.Data extraction and synthesisTwo reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed.ResultsWe identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where ‘frequent attenders’ are repeatedly let down by mental health services.ConclusionLack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.
Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: a cross-sectional study in eastern Nepal
Authors: Ghimire Saruna , Shrestha Aman , Yadav Uday Narayan , Mistry Sabuj Kanti , Chapadia Bunsi , Yadav Om Prakash , Ali ARM Mehrab , Rawal Lal B , Yadav Priyanka , Mehata Suresh , Harris Mark 
Published: February 2022

BackgroundCOVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic.MethodsA cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ2 tests and binary logistic regressions determined inferences.ResultsNearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds.ConclusionsOlder adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.
Type 2 diabetes in Scottish military veterans: a retrospective cohort study
Authors: Bergman Beverly P , Mackay Daniel , Pell J P 
Published: February 2022

ObjectivesType 2 diabetes is an important public health problem but the risk in UK military veterans is unknown. We used data from the Trends in Scottish Veterans' Health study to investigate the risk in comparison with people with no record of service.DesignRetrospective cohort study of a large national sample in Scotland, with up to 37 years follow-up.SettingPseudoanonymised extract of computerised Scottish National Health Service records, including a disease register and national vital records.Participants78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence.Outcome measuresCox proportional HRs for first record of type 2 diabetes in veterans compared with non-veterans, overall and by sex and birth cohort. Long-term trend, comorbidity with specific mental health outcomes and risk of limb loss.ResultsOverall, 7.2% of veterans were diagnosed with type 2 diabetes, and were at slightly increased risk compared with non-veterans, Cox proportional HR 1.08, 95%CIs 1.04 to 1.11, p<0.001. The increased risk was confined to men, and to veterans born prior to 1960. There has been no change in HR over the last 25 years. Among veterans with post-traumatic stress disorder (PTSD), 12.1% had been diagnosed with type 2 diabetes, compared with 9.4% of non-veterans with PTSD. The difference was statistically significant, OR 1.29, 95% CI 1.04 to 1.59, p=0.021. Risk of limb loss was increased among the oldest veterans.ConclusionsOlder veterans in Scotland have an increased risk of type 2 diabetes in comparison with non-veterans, but there is no difference in respect of younger veterans, and the pattern of risk shows no evidence that it is changing. There is a positive association between type 2 diabetes and PTSD, especially in the presence of comorbid mood disorder, an important finding which should be noted by care providers.
Development of machine learning prediction models to explore nutrients predictive of cardiovascular disease using Canadian linked population-based data
Authors: Morgenstern Jason D. , Rosella Laura C. , Costa Andrew P. , Anderson Laura N. 
Published: February 2022

Machine learning may improve use of observational data to understand the nutritional epidemiology of cardiovascular disease (CVD) through better modelling of non-linearity, non-additivity, and dietary complexity. Our objective was to develop machine learning prediction models for exploring how nutrients are related to CVD risk and to evaluate their predictive performance. We established a population-based cohort from the Canadian Community Health Survey and measured CVD incidence and mortality from 2004 to 2018 using administrative databases of national hospital discharges and deaths. Predictors included 61 nutrition variables and fourteen socioeconomic, demographic, psychological, and behavioural variables. Conditional inference forest models were interpreted and evaluated by permutation feature importance, accumulated local effects, and predictive discrimination and calibration. A total of 12 130 individuals were included in the study. Use of supplements, caffeine, and alcohol were the most important nutrition variables for prediction of CVD. Supplement use was associated with decreased risk, caffeine was associated with increasing risk, and alcohol had a u-shaped association with risk. The model had an out-of-sample c-statistic of 0.821 (95% confidence interval = 0.801–0.842). Exploratory findings included both known and novel associations and predictive performance was competitive, suggesting that further application of machine learning to nutritional epidemiology may help elucidate risks and improve predictive models. Novelty: Machine learning prediction models were developed for CVD using dietary data. Models were interpreted with interpretable machine learning techniques, revealing diverse associations between diet and CVD. Models achieved comparable or superior predictive performance to existing CVD risk prediction models.
Responsive feeding values and practices among families across the Canadian Maritime provinces
Authors: Rossiter Melissa D. , Richard Brenna , Whitfield Kyly C. , Mann Linda , McIsaac Jessie-Lee D. 
Published: February 2022

Children benefit from responsive feeding practices where their internal signals of hunger and satiety are valued and met with prompt, emotionally supportive, and developmentally appropriate responses. Using an online survey, this study describes responsive feeding values and practices among parents of young children (0–5 years) (n = 1039) across 3 Canadian Maritime provinces. Independent-samples t-tests and 1-way ANOVA were performed to determine the differences in survey questions related to the responsive feeding practices and values. First-time parents and parents with younger children report implementing more consistently some of the challenging responsive feeding practices, such as avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3–5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices with food such as pressuring, rewarding, and restriction. These coercive practices may be ineffective and counterproductive as they reinforce reasons to eat unrelated to appetite and self-regulation. Preschool and early feeding interventions that support parents in understanding normal child development, including typical eating behaviours and self-regulation, could help to equip them for challenging feeding experiences and encourage long-term responsive feeding practices.Novelty: First-time parents and parents with younger children report more consistently avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3–5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices such as pressuring, rewarding, and restriction.
Gauge invariance and localization of vector Kaluza–Klein modes
Authors: Fu Chun-E. , Zhao Zhen-hua , Sun Ming-Hui 
Published: February 2022

AbstractWe investigate the gauge invariance and localization of vector KK modes for a bulk U(1) gauge field under three kinds of localization mechanism on a brane with one extra dimension. By a general KK decomposition for the bulk U(1) gauge field, there are both vector and scalar KK modes on the brane, which couple with each other. We demonstrate that for a localization mechanism with a gauge invariant bulk action of the U(1) gauge field, the effective action of the KK modes on the brane can be formalized to gauge invariant form. However, only the massive vector KK modes and their accompanying scalar ones can be both localized on the brane, which depends on the solution of the brane, the gauge invariance of the massive vector field is finally preserved. For a localization mechanism with a broken gauge invariant bulk action of the field, it is impossible to rebuild the gauge invariance on the brane.