bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor psychological health and 8-year mortality: a population-based prospective cohort study stratified by gender in Scania, Sweden
Authors: Fridh Maria , Pirouzifard Mirnabi , Rosvall Maria , Lindstrom Martin 
Published: November 2022

ObjectivesWe investigated gender differences in the association between mortality and general psychological distress (measured by 12-item General Health Questionnaire, GHQ-12), as an increased mortality risk has been shown in community studies, but gender differences are largely unknown.SettingWe used data from a cross-sectional population-based public health survey conducted in 2008 in the Swedish region of Skåne (Scania) of people 18–80 years old (response rate 54.1 %). The relationship between psychological distress and subsequent all-cause and cause-specific mortality was examined by logistic regression models for the total study population and stratified by gender, adjusting for age, socioeconomic status, lifestyle (physical activity, smoking, alcohol consumption), and chronic disease.ParticipantsOf 28 198 respondents, 25 503 were included in analysis by restrictive criteria.Outcome measuresOverall and cause-specific mortality by 31 December 2016.ResultsMore women (20.2 %) than men (15.7 %) reported psychological distress at baseline (GHQ ≥3). During a mean follow-up of 8.1 years, 1389 participants died: 425 (30.6%) from cardiovascular diseases, 539 (38.8%) from cancer, and 425 (30.6%) from other causes. The overall association between psychological distress and mortality risk held for all mortality end-points except cancer after multiple adjustments (eg, all-cause mortality OR 1.8 (95 % CI 1.4 to 2.2) for men and women combined. However, stratification revealed a clear gender difference as the association between GHQ-12 and mortality was consistently stronger and more robust among men than women.ConclusionMore women than men reported psychological distress while mortality was higher among men (ie, the morbidity-mortality gender paradox). GHQ-12 could potentially be used as one of several predictors of mortality, especially for men. In the future, screening tools for psychological distress should be validated for both men and women. Further research regarding the underlying mechanisms of the gender paradox is warranted.
Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants
Authors: Ji Ying , Zhang Yan , Yun Qingping , Chang Chun 
Published: November 2022

ObjectivesTo identify clues for women’s tobacco control, this study analyses the gender differences in social environmental changes associated with smoking and the interaction between the environment and individuals’ social integration.Design, setting and participantsA cross-sectional design and secondary analysis were used among Chinese internal migrants. Data were from the 2012 Migrant Dynamics Monitoring Survey in China with participants aged 15–59 years old (75 416 women and 83 140 men) who resided in cities for more than 1 month.Primary and secondary outcome measuresSocial environmental changes were measured by differences in smoking prevalence and women’s empowerment between the migrant-receiving province (MRP) and migrant-sending province (MSP). Social participation and duration of stay (DOS) were adopted as indicators of social integration. Stratified analysis and binary logistic regression models were used to determine the dependent variable (smoking status) and environmental changes after controlling for age, education, income and happiness.ResultsDifferences in the smoking prevalence environment (lower in MRP, OR 0.70, 95% CI 0.60 to 0.83; higher rate in MRP, OR 1.79, 95% CI 1.35 to 2.37) and women’s empowerment (lower rate in MRP, OR 0.80, 95% CI 0.68 to 0.97; higher rate in MRP, OR 1.15, 95% CI 1.00 to 1.33) between MRP and MSP were positively correlated with women’s smoking. In men, however, migrating to an area with lower smoking prevalence could not reduce smoking risk, whereas moving to an area with higher women’s empowerment could. A long DOS was an independent risk factor for smoking in women (ranged from 1.20 to 2.00 in various environmental changes scenarios) but a protective factor for men. An interaction between environmental changes and social integration could not be verified.ConclusionsTobacco control strategies should consider gender differences, especially women who are experiencing social environmental changes.
Cross-sectional online survey of clinicians’ knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use
Authors: Gorukanti Anu L , Kimminau Kim S , Tindle Hilary A , Klein Jonathan D , Gorzkowski Julie , Kaseeska Kristen , Ali Raabiah , Singh Lavisha , David Sean P , Halpern-Felsher Bonnie 
Published: November 2022

ObjectiveTo examine adolescent healthcare clinicians’ self-reported screening practices as well as their knowledge, attitudes, comfort level and challenges with screening and counselling adolescents and young adults (AYA) for cigarette, e-cigarette, alcohol, marijuana, hookah and blunt use.DesignA 2016 cross-sectional survey.SettingAcademic departments and community-based internal medicine, family medicine and paediatrics practices.ParticipantsAdolescent healthcare clinicians (N=771) from 12 US medical schools and respondents to national surveys. Of the participants, 36% indicated male, 64% female, mean age was 44 years (SD=12.3); 12.3% of participants identified as Asian, 73.7% as white, 4.8% as black, 4.2% as Hispanic and 3.8% as other.Primary and secondary outcome measuresSurvey items queried clinicians about knowledge, attitudes, comfort level, self-efficacy and challenges with screening and counselling AYA patients about marijuana, blunts, cigarettes, e-cigarettes, hookah and alcohol.ResultsParticipants were asked what percentage of their 10–17 years old patients they screened for substance use. The median number of physicians reported screening 100% of their patients for cigarette (1st, 3rd quartiles; 80, 100) and alcohol use (75, 100) and 99.5% for marijuana use (50,100); for e-cigarettes, participants reported screening half of their patients and 0.0% (0, 50), (0, 75)) reported screening for hookah and blunts, respectively. On average (median), clinicians estimated that 15.0% of all 10–17 years old patients smoked cigarettes, 10.0% used e-cigarettes, 20.0% used marijuana, 25.0% drank alcohol and 5.0% used hookah or blunts, respectively; yet they estimated lower than national rates of use of each product for their own patients. Clinicians reported greater comfort discussing cigarettes and alcohol with patients and less comfort discussing e-cigarettes, hookah, marijuana and blunts.ConclusionsThis study identified low rates of screening and counselling AYA patients for use of e-cigarettes, hookahs and blunts by adolescent healthcare clinicians and points to potential missed opportunities to improve prevention efforts.
Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review
Authors: Kazibwe Joseph , Shah Hiral A , Kuwawenaruwa August , Schell Carl Otto , Khalid Karima , Tran Phuong Bich , Ghosh Srobana , Baker Tim , Guinness Lorna 
Published: November 2022

ObjectivesCritical care is essential in saving lives of critically ill patients, however, provision of critical care across lower resource settings can be costly, fragmented and heterogenous. Despite the urgent need to scale up the provision of critical care, little is known about its availability and cost. Here, we aim to systematically review and identify reported resource use, availability and costs for the provision of critical care and the nature of critical care provision in Tanzania.DesignThis is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMedline, Embase and Global Health databases were searched covering the period 2010 to 17 November 2020.Eligibility criteriaWe included studies that reported on forms of critical care offered, critical care services offered and/or costs and resources used in the provision of care in Tanzania published from 2010.Data extraction and synthesisQuality assessment of the articles and data extraction was done by two independent researchers. The Reference Case for Estimating the Costs of Global Health Services and Interventions was used to assess quality of included studies. A narrative synthesis of extracted data was conducted. Costs were adjusted and reported in 2019 US$ and TZS using the World Bank GDP deflators.ResultsA total 31 studies were found to fulfil the inclusion and exclusion criteria. Critical care identified in Tanzania was categorised into: intensive care unit (ICU) delivered critical care and non-ICU critical care. The availability of ICU delivered critical care was limited to urban settings whereas non-ICU critical care was found in rural and urban settings. Paediatric critical care equipment was more scarce than equipment for adults. 15 studies reported on the costs of services related to critical care yet no study reported an average or unit cost of critical care. Costs of medication, equipment (eg, oxygen, personal protective equipment), services and human resources were identified as inputs to specific critical care services in Tanzania.ConclusionThere is limited evidence on the resource use, availability and costs of critical care in Tanzania. There is a strong need for further empirical research on critical care resources availability, utilisation and costs across specialties and hospitals of different level in low/middle-income countries like Tanzania to inform planning, priority setting and budgeting for critical care services.PROSPERO registration numberCRD42020221923.
The kindness COVID-19 toolkit: a mixed-methods evaluation of a programme designed by doctors in training for doctors in training
Authors: Ward Madeleine C , Crinall Karen , McDonald Rebecca , Crinall William , Aridas James , Leung Cheryl , Quittner Danielle , Hodges Ryan J , Rolnik Daniel L 
Published: November 2022

ObjectivesThe impact of a coronavirus disease (COVID-19)-specific professional development programme on the well-being of obstetrics and gynaecology (O&G) doctors in training (DiT) working during the pandemic.DesignA mixed-method evaluation of a single group pre–post test design study.SettingMelbourne, Australia between September 2020 and April 2021.Participants55 O&G DiT working across four healthcare sites of a major tertiary hospital in Victoria, Australia, were included in the programme.InterventionsThe delivery of a codesigned peer-to-peer programme, which identified and addressed the well-being goals of O&G DiT. Seven interactive workshops were run alongside the implementation of a number of participant-led wellness initiatives.Main outcome measuresRepeated-measures analysis of WHO Well-being Index (WHO-5) and Copenhagen Burnout Innovatory (CBI) scores across three time points during the programme. Multilevel generalised linear mixed-effects models with random intercept were fit to the data, both in the entire population (intention-to-treat) and restricted to those who attended the workshop (‘per-protocol’ analysis). Participatory experiences and programme learning were captured using the Most Significant Change (MSC) technique, which included inductive thematic analysis.ResultsWe demonstrated an overall 31.9% improvement in well-being scores (p=0.006). The MSC evaluation captured a shift in workplace culture as a result of the programme, with improvement across the domains of connection, caring, communication, confidence and cooperation.ConclusionsWe have successfully used a mixed-method approach to contextualise a productive programme to improve the well-being of COVID-19 front-line healthcare workers.
How client criminalisation under end-demand sex work laws shapes the occupational health and safety of sex workers in Metro Vancouver, Canada: a qualitative study
Authors: McDermid Jennifer , Murphy Alka , McBride Bronwyn , Wu Sherry , Goldenberg Shira M , Shannon Kate , Krüsi Andrea 
Published: November 2022

ObjectivesIn 2014, Canada implemented end-demand sex work legislation that criminalises clients and third parties (eg, managers, security personnel, etc) involved in sex work. The focus of this analysis is to explore how the criminalisation of clients shapes the occupational health and safety of sex workers.DesignAs part of a longstanding community-based study (An Evaluation of Sex Workers’ Health Access), this analysis draws on 47 in-depth qualitative interviews with indoor sex workers and third parties. Informed by an intersectional lens and guided by a structural determinants of health framework, this work seeks to characterise the impact of client criminalisation in shaping the occupational health and safety of indoor sex workers.SettingIndoor sex work venues (eg, massage parlour, in-call, brothel, etc) operating in Metro Vancouver, Canada.Participants47 predominately racialised sex workers and third parties working in indoor environments between 2017 and 2018.ResultsWhile participants highlighted that the majority of their client interactions were positive, their narratives emphasised how end-demand criminalisation impeded their occupational safety. The criminalisation of clients was linked to reduced ability to negotiate the terms of sexual transactions, including type of service, price and sexual health. Client preference for cash payments to maintain anonymity led to increased risk of robbery and assault due to knowledge of high cash flow in sex work venues and a reluctance to seek police protection. Workers also noted that client fear of being prosecuted or ‘outed’ by police enhanced feelings of shame, which was linked to increased aggression by clients.ConclusionPolicies and laws that criminalise clients are incompatible with efforts to uphold the occupational health and safety and human rights of sex workers. The decriminalisation of sex work is urgently needed in order to support the well-being and human rights of all those involved in the Canadian sex industry.
Selling one’s future: over-indebtedness and the risk of poor mental health and the role of precarious employment – results from the Scania Public Health Cohort, Sweden
Authors: Östergren Per-Olof , Bodin Theo , Canivet Catarina , Moghaddassi Mahnaz , Vilhelmsson Andreas 
Published: November 2022

ObjectivesThe credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment.MethodsThis is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women.ResultsOver-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men.ConclusionsOver-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.
Knowledge, attitude and behaviour of general practitioners in Shanghai during the pandemic of COVID-19: a cross-sectional study
Authors: Tang Huiyun , Wang Jian , Fang Jialiang , Tu Boxiang 
Published: November 2022

ObjectivesTo understand the knowledge, attitude and behaviour of general practitioners (GPs) towards COVID-19 and to provide evidence for improved prevention and control measures against the pandemic.Study designA cross-sectional study was conducted with 1018 GPs in Shanghai from 21 February to 2 March 2020 using the WeChat platform.MethodsStratified random cluster sampling was performed according to the regional division of urban, urban–rural fringe and rural areas. This study used a self-designed mobile questionnaire. The questionnaire collected information on knowledge, attitudes and behaviours regarding COVID-19 prevention and control.ResultsA total of 989 questionnaires were declared valid. The average scores of GPs’ knowledge, attitude and behaviour towards COVID-19 were 6.14±1.42 (range 0–10), 13.59±4.42 (range 0–25) and 7.82±1.53 (range 0–10), respectively. Multiple linear regression analysis showed that the knowledge score of male GPs was lower than that of female GPs (p=0.002). In addition, the ‘attitude’ score of female GPs was higher than that of male GPs (p=0.004). The ‘behaviour’ score of GPs in urban areas was lower than that of GPs in urban–rural fringe areas (p<0.001). The higher the knowledge score, the higher the behavioural score was observed to be (p<0.001).ConclusionsThe scores of knowledge, attitude and behaviour of Shanghai GPs towards COVID-19 were limited at the beginning of the COVID-19 outbreak. As a hopeful measure, the early implementation of proper training programmes for GPs in times of crisis will contribute to disease control and prevention. Lessons learnt from the current pandemic will hopefully help GPs handle similar future challenges and potential novel pandemics.
Self-medication with ophthalmic drugs and its associated factors among ophthalmic patients attending three hospitals in Asmara, Eritrea: a cross-sectional study
Authors: Tesfay Hayleab , Fiseha Kibrom , Abera Simon , Mihreteab Siele Senai , Tesfamariam Eyasu H , Abdu Nuru 
Published: November 2022

ObjectiveTo assess the prevalence and practice of self-medication and its associated factors among ophthalmic patients.DesignAn analytical cross-sectional study design was employed.SettingThree hospitals inAsmara, Eritrea.ParticipantsSamples of ophthalmic outpatients aged >18 years who visited the three hospitals in Asmara, Eritrea. Systematic random sampling was used to select the study participants.Data collection and analysisData were collected from September 2021 to October 2021 in a face-to-face interview using a structured questionnaire. The collected data were double entered and analysed using CSPro (V.7.2) and SPSS (V.26), respectively. Descriptive statistics and logistic regression were performed. P values less than 0.05 were considered as significant.Primary and secondary outcome measuresMain outcome variable was practice of self-medication with ophthalmic drugs (SMOD). Secondary outcome measure was the determinants of self-medication practice.ResultsA total of 351 participants were recruited with a response rate of 97.7%. The prevalence of SMOD was found to be 14.9% (95% CI (11.1% to 18.7%)). The most frequently preferred ophthalmic drug groups were antibiotics (63.6%), followed by corticosteroids (22.7%). The main reasons for SMOD were easy accessibility (52.9%) and previous familiarity of the eye medication (27.5%). Eye redness (n=19/51) and foreign body sensation (n=18/51) were the most self-recognised complaints that required self-medication. The most common source of information for SMOD was pharmacy professionals (41.1%). Only attitude score (Crude odds ratio (COR)= 1.25, 95% CI 1.12, 1.39) was significantly associated with the practice of SMOD at bivariate logistic regression.ConclusionThough the majority of respondents considered self-medication with ophthalmic drugs as inappropriate, a significant number of them practising it. This mandates relevant bodies to take stricter measures to protect the public from the misuse of eye medications.
Physical therapy for the management of motor symptoms in amyotrophic lateral sclerosis: protocol for a systematic review
Authors: Silva Stephano Tomaz , Souza Aline Alves de , Pondofe Karen , Melo Luciana Protásio de , Resqueti Vanessa R , Valentim Ricardo Alexsandro de Medeiros , Ribeiro Tatiana Souza 
Published: November 2022

IntroductionThe prescription of an intervention plan can be challenging for the physical therapist, considering clinical phenotypes, individual prognosis and the rapid, progressive and deteriorating nature of amyotrophic lateral sclerosis (ALS). In this context, therapeutic exercises (eg, resistance and aerobic exercises) for patients with ALS remain controversial and may influence the treatment plan. Therefore, this review aims to critically assess whether physical therapy interventions are effective for improving functional capacity, quality of life and fatigue of individuals with ALS.Methods and analysisStudies will be selected according to eligibility criteria, and language, geographical area or publication date will not be restricted. Four databases will be used: MEDLINE, EMBASE, Cochrane Library (CENTRAL) and Physiotherapy Evidence Database (PEDro). Searches will also be conducted on ClinicalTrials.gov and references from included studies. We plan to conduct the searches between October and December 2022. Two independent authors will examine titles and abstracts and exclude irrelevant studies and duplicates. We will assess the quality of studies and quality of evidence, and disagreements will be resolved with a third researcher. The findings will be presented in the text and tables; if possible, we will perform meta-analyses.Ethics and disseminationNo ethical approval is required because this study does not involve human beings. We will publish our findings in peer-reviewed journals.PROSPERO registration numberCRD42021251350.