bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring
Authors: DeLacey Emily , Hilberg Evan , Allen Elizabeth , Quiring Michael , Tann Cally J , Groce Nora Ellen , Vilus James , Bergman Ethan , Demasu-Ay Merzel , Dam Hang T , Kerac Marko 
Published: December 2021

ObjectivesThe aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.DesignA retrospective analysis with Shewhart control charts and funnel plots to explore intersite and over time variations in nutritional status.SettingWe conducted a retrospective analysis of records from Holt International’s Child Nutrition Programme from 35 sites in six countries; Mongolia, India, Ethiopia, Vietnam, China and the Philippines.ParticipantsDeidentified health records from Holt International’s online nutrition screening database included records from 2926 children, 0–18 years old. Data were collected from 2013 to 2020 and included demographic and health information.ResultsAt initial screening, 717 (28.7%) children were anaemic, 788 (34.1%) underweight, 1048 (37.3%) stunted, 212 (12.6%) wasted, 135 (12%) overweight or obese and 339 (31%) had small head circumference. Many had underlying conditions: low birth weight, 514 (57.5%); prematurity, 294 (42.2%) and disabilities, 739 (25.3%). Children with disabilities had higher prevalence of malnutrition compared with counterparts without disabilities at baseline and 1-year screenings. There was marked intersite variation. Funnel plots highlight sites with malnutrition prevalence outside expected limits for this specific population taking into consideration natural variation at baseline and at 1 year. Control charts show changes in site mean z-scores over time in relation to site control limits.ConclusionsMalnutrition is prevalent among children living within IBC, notably different forms of undernutrition (stunting, underweight, wasting). Underlying risk factors are also common: prematurity, low birth weight and disability. Nutrition interventions should take into account the needs of this vulnerable population, especially for infants and those with disabilities. Using control charts to present data could be especially useful to programme managers as sites outside control limits could represent: problems to be investigated; good practices to be shared.
Role of maintenance strategies in advanced epithelial ovarian cancer: a systematic review, network meta-analysis and cost-effectiveness analysis protocol
Authors: Hu Qiancheng , Kang Wenli , Wu Qiuji , Wang Xin , Wang Qingfeng , Luo Ting 
Published: December 2021

IntroductionDifferent maintenance strategies have shown efficacy in patients with advanced ovarian cancer, but without drawing any conclusion on which strategy is preferred. Therefore, we will conduct a network meta-analysis and cost-effectiveness analysis to investigate maintenance strategies containing chemotherapy, poly (ADP-ribose) polymerase (PARP) inhibitors and anti-angiogenesis therapy for patients with advanced ovarian cancer.Methods and analysisThe search strategy to identify potentially relevant studies will include hand searches in EMBASE, PubMed, Cochrane library and Web of science. The primary outcome is progression-free survival, defined as the date of randomisation to the date of progression or death. The secondary outcome is overall survival (calculated from the time from randomisation to death from any cause), grade 3–4 haematological and non-haematological toxicities, quality-adjusted life years and incremental cost-effectiveness ratios. Two steps of meta-analysis will be carried out, traditional pair-wise meta-analysis and network meta-analysis. Methodological quality, risk of bias and the strength of evidence from randomised controlled trials (RCTs) will be proposed to assess the quality of RCTs. Heterogeneity, publication bias, subgroup analysis and sensitivity analysis will be explored.Ethics and disseminationThe purpose of our study is to perform a comprehensive efficacy, safety and cost-effectiveness analysis of all maintenance strategies in patients with advanced ovarian cancer. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics approval is not required for network meta-analysis and cost-effectiveness analysis.PROSPERO registration numberCRD42021231814.
Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for theBuddyrandomised factorial trial
Authors: Åsberg Katarina , Lundgren Oskar , Henriksson Hanna , Henriksson Pontus , Bendtsen Preben , Löf Marie , Bendtsen Marcus 
Published: December 2021

IntroductionThe time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions.Methods and analysisA factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation.Ethics and disseminationThe study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study.Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023.Trial registration numberISRCTN23310640; Pre-results.
Age-specific correlation between thyroid hormone concentrations and ultrasound thyroid volume for diagnosing thyroid dysfunction in preterm infants: a single-centre, prospective, observational study protocol
Authors: Mikołajczak Aleksandra , Kufel Katarzyna , Bokiniec Renata 
Published: December 2021

IntroductionThyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to lack of gestational age-specific reference ranges and thyroid ultrasound nomograms. We aim to evaluate the age-specific correlation between circulating free thyroxine (FT4) and thyrotropin stimulating hormone (TSH) levels and ultrasound thyroid volume to assist identify infants requiring thyroid hormone replacement therapy.Methods and analysisThis is an observational, prospective, single-centre study that will include 200 preterm infants born between 24 and 32 weeks of gestational age, without any congenital diseases or malformation that may affect thyroid function. Venous blood will be obtained in infants at 14–21 days of life, and at 32 and 36 weeks of postconceptional age (PCA) to measure FT4 and TSH concentrations. Thyroid ultrasound will be performed at 32 and 36 weeks of PCA. Relevant outcomes will include determination of FT4 and TSH values and ultrasound thyroid volume for preterm infants born at 24–28 weeks of gestation and 29–32 weeks of gestation. Correlations among circulating hormone concentrations and thyroid volumes with the head circumference and body mass will also be determined.Ethics and disseminationThe Ethics Committee of the Medical University of Warsaw has approved the study protocol prior to recruitment (KB44/2019). Informed consent will be obtained from caretakers of preterm infants at the time of enrolment. Consent for participation in the study can be withdrawn at any time, without consequences and without obligation to justify the decision. All data will be stored in a secure, password-protected Excel file that is only accessible to researchers involved in the study. Findings will be published in a peer-reviewed journal and disseminated at relevant national and international conferences.Trial registration numberNCT04208503.
Inequities in childhood anaemia at provincial borders in Mozambique: cross-sectional study results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey
Authors: Muhajarine Nazeem , Adeyinka Daniel A , Matandalasse Mbate , Chicumbe Sergio 
Published: December 2021

ObjectivesThis study aims to identify the child-level, maternal-level, household-level and community-level determinants of anaemia among children aged 6–59 months, and determine the inequities of anaemia prevalence across communities in Mozambique.DesignCross-sectional study.SettingMozambique.ParticipantsThis study used data of a weighted population of 3946 children, 6–59 months, delivered by women between 15 and 49 years of age, from the 2018 Mozambique Malaria Indicator Survey.Primary outcome measureChild’s anaemic status, measured as altitude-adjusted haemoglobin concentration (in g/L); the severity of anaemia was categorised based on predefined threshold values. Multilevel Bayesian linear regressions identified key determinants of childhood anaemia. Based on data availability and policy implications, spatial analysis was used to determine geographical variation of anaemia at the community level and areas with higher risks.ResultsThe mean prevalence of childhood anaemia was 77.7% (SD: 5.5%). Provincially, Cabo Delgado province (86.2%) had the highest prevalence, Maputo province (70.2%) the lowest. Children with excess risk were mostly found in communities that had proximity to provincial borders: Niassa-Cabo Delgado-Nampula triprovincial border, Gaza-Inhambane border, Zambezia-Nampula border and provinces of Manica and Inhambane. Children with anaemia tended to be younger, males and at risk of having malaria because they were not sleeping under mosquito nets. In addition, children from poor families relative to children from wealthier households and those living in female-headed households were prone to anaemia.ConclusionFindings from this study provide evidence that spatial inequities in childhood anaemia exist in Mozambique, mostly concentrated in the communities living close to the provincial borders. Anaemia among children could be effectively reduced through malaria prevention, for example, bed netting. Interventions are needed that generate income for households, increase community support for households headed by women, improve malaria control, build capacity of healthcare workers to manage severely anaemic children and health education for mothers.
Patient-related healthcare disparities in the quality of acute hip fracture care: a 10-year nationwide population-based cohort study
Authors: Kristensen Pia Kjær , Falstie-Jensen Anne Mette , Madsen Morten , Johnsen Søren Paaske 
Published: December 2021

ObjectivesTo characterise and quantify possible patient-related disparities in hip fracture care including temporal changes.DesignPopulation-based cohort study.SettingAll Danish hospitals treating patients with hip fracture.Participants60 275 hip fracture patients from 2007 to 2016.InterventionsQuality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient’s probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients.Primary and secondary outcome measuresThe primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme.ResultsThe proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment.ConclusionsDisparity of care between best-off and worst-off patients remained substantial over time.
Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study
Authors: Shah Rahul , Raji Mukaila A , Westra Jordan , Kuo Yong-Fang 
Published: December 2021

ObjectiveExamine the association between the co-prescribing of opioids, benzodiazepines, gabapentinoids (pregabalin and gabapentin) and selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRI/SNRIs) in different combinations and the risk of falls and fractures.DesignRetrospective cohort study from 2015 to 2018.SettingMedicare enrolment and claims data.ParticipantsMedicare beneficiaries with both chronic pain and anxiety disorders in 2016 with continuous enrolments in Parts A and B from 2015 to 2016 who were prescribed any combination of opioid, benzodiazepine, gabapentinoid and SSRI/SNRI in 2017 for ≥7 days, as documented in their Medicare Part D coverage.InterventionsAny combination of use of seven drug regimens (benzodiazepine +opioid; benzodiazepine +gabapentinoid; benzodiazepine +SSRI/SNRI; opioid +gabapentinoid; opioid +SSRI/SNRI; gabapentinoid +SSRI/SNRI; ≥3 drug classes).Main outcomesFirst event of fall and the first event of fracture after the index date, which was the first day of combination drug use that lasted ≥7 days in 2017.ResultsA total of 47 964 patients (mean [SD] age, 75.9 [7.1]; 78.0% woman) with diagnoses of both chronic pain and anxiety were studied. The median (Q1–Q3) duration of drug combination use was 26 (14-30) days. After adjusting for demographic characteristics, chronic conditions and history of hospitalisation and fall or fracture, the co-prescribing of ≥3 drugs (adjusted HR [aHR], 1.38; 95% CI 1.14 to 1.67) and opioid plus gabapentinoid (aHR, 1.18; 95% CI 1.02 to 1.37) were associated with a high fall risk, compared with benzodiazepineplus opioid co-prescribing, findings consistent with the secondary analysis using inverse probability of treatment weighting with propensity scores. The co-prescribing of benzodiazepine plus gabapentinoid (aHR, 0.76; 95% CI 0.59 to 0.98) was associated with lower fracture risk compared with the co-prescribing of benzodiazepine plus opioid, though this finding was not robust.ConclusionsOur findings add to comparative toxicity research on different combinations of gabapentinoids and serotonergic agents commonly prescribed with or as substitutes for opioids and benzodiazepines in patients with co-occurring chronic pain and anxiety.
‘Screen and Treat for Anaemia Reduction (STAR)’ strategy: study protocol of a cluster randomised trial in rural Telangana, India
Authors: Kulkarni Bharati , Augustine Little Flower , Pullakhandam Raghu , Pradhan Anju Sinha , Dasi Teena , Palika Ravindranadh , Banjara Santosh Kumar , Sachdev Harshpal Singh 
Published: December 2021

IntroductionCurrent anaemia control programme focusing on prophylactic iron supplementation and facility-based screening with haemoglobin estimation is inadequate to reduce the high prevalence of anaemia in India. This study aims to examine the impact of community level ‘screen and treat’ strategy for increasing population mean haemoglobin and reducing anaemia prevalence in the rural population.Methods and analysisAn open-labelled cluster randomised controlled trial will be conducted in rural areas of Medchal district, Telangana, India. All individuals served by one Accredited Social Health Activist (ASHA) constitute one cluster and will be randomised in the ratio of 1:1 by covariate constrained randomisation. Eligible members aged between 6 months and 50 years (men, women, children and adolescents) will be included in the study. Intervention group will be screened for anaemia using a point of care haemoglobin estimation followed by treatment with iron–folic acid for 3 months. The intervention delivered by the ASHAs will be supported by an electronic decision support system and simplified medication regimen. Educational videos and interactive voice response system will be used to enhance compliance. The control group will continue to receive benefits of ongoing anaemia control programmes but there will be no active intervention by the study team. At 6 months, haemoglobin will be measured in participants from both arms. The primary outcome will be the difference in population mean haemoglobin in two arms and the secondary outcome will be the difference in the anaemia prevalence in two arms among 6–59 months old children. Multilevel models will be used for analysis accounting for data clustering.Ethics and disseminationThe study is approved by the institutional ethics committee of National Institute of Nutrition, Hyderabad. The results will be published in peer-reviewed journals and disseminated to policymakers. Findings will also be shared with study participants and community leaders.Trial registration numberCTRI/2019/01/016918.
Protocol for a diagnostic accuracy study to develop diagnosis algorithm for biliary atresia using MMP-7 (DIABA-7 study): a study recruiting from Chinese Biliary Atresia Collaborative Network
Authors: Jiang Jingying , Deng Jiale , Chen Gong , Dong Rui , Sun Song , Du Min , Yang Dake , Fang Zhuo , Zheng Shan 
Published: December 2021

IntroductionBiliary atresia is a severe liver disease in neonates, and the prognosis partially depends on the age at which infants undergo the Kasai procedure. Matrix metalloproteinase-7 (MMP-7) was confirmed to have significant value in the diagnosis of biliary atresia. However, so far, the reference range and its cut-off value for diagnosing biliary atresia have not been established yet.Methods and analysisDIagnosis Algorithm for Biliary Atresia (DIABA-7) is a prospective diagnostic test. Cholestatic infants and normal controls within 150 days of age are recruiting from the Chinese Biliary Atresia Collaborative Network. The serum samples and dried blood spot (DBS) samples are obtained to detect MMP-7 concentrations using an ELISA kit. The reference standard is the intraoperative exploration and subsequent histological examination of liver biopsies. Lambda-Mu-Sigma (LMS) method is used to calculate the normal range of serum MMP-7 of each age group. Receiver operating characteristics (ROC) curves are constructed to calculate the best cut-off point and area under the curve for the index test. The sensitivity, specificity, positive predictive value and negative predictive value are used to show the diagnostic accuracy. Pearson correlation coefficient test is applied to assess the correlation of serum MMP-7 and DBS MMP-7.Ethics and disseminationThis study was reviewed and approved by the Ethics Committee of Children’s Hospital of Fudan University (Number 2020–296). Dissemination will be guided by investigators and patients. The aim is to publish the study results in a high-quality peer-reviewed journal and present the findings at international academic meetings.Trial registration numberChiCTR2000032983.
Survival of mechanically ventilated ward patients and association with organisational factors: a multicentre prospective study
Authors: Wong Wai-Tat , Lee Anna , Gomersall Charles David , Shek Lam-hin , Chan Alfred , So Sheung-on , Sin Kai-cheuk , Tang Wai-ming , Sinn Maria , Ling Lowell 
Published: December 2021

ObjectivesDetermine 90-day mortality of mechanically ventilated ward patients outside the intensive care unit (ICU) and its association with organisational factors.DesignMulticentre prospective observational study of mechanically ventilated ward patients. Modified Poisson regression was used to assess association between nurse to patient ratio (NPR) and 90-day mortality, adjusted for designated medical team, Society of Critical Care Medicine (SCCM) triage priority and centre effect. NPR was divided into low (1:9.6 to 1:10), medium (1:6 to 1:8) and high (1:2.6). Sensitivity analysis was conducted for pneumonia with or without acute respiratory distress syndrome (ARDS) to assess magnitude of association.Setting7 acute public hospitals in Hong Kong.ParticipantsAll 485 mechanically ventilated patients in wards from participating hospitals between 18 January 2016 and 17 April 2016 were recruited. Three hundred patients were included after excluding patients with limitation of therapy within 24 hours of intubation.Main outcomes90-day mortality, Mortality Prediction Model III Standardised mortality ratio (MPMIII0SMR).Results201 patients died within 90 days after intubation (67.0%, 95% CI 61.5% to 72.1%), with MPMIII0SMR 1.88, 95% CI 1.63 to 2.17. Compared with high NPR, medium and low NPRs were associated with higher risk of 90-day mortality (adjusted relative risk (RRadj) 1.84, 95% CI 1.70 to 1.99 and 1.64, 95% CI 1.47 to 1.83, respectively). For 114 patients with pneumonia with or without ARDS, low to medium NPR, too sick to benefit from ICU (SCCM priority 4b), no ICU consultation and designated medical team were associated with risk of 90-day mortality (RRadj1.49, 95% CI 1.40 to 1.58; RRadj1.60, 95% CI 1.49 to 1.72; RRadj1.34, 95% CI 1.27 to 1.40; RRadj0.85, 95% CI 0.78 to 0.93, respectively).ConclusionThe 90-day mortality rates of mechanically ventilated ward patients were high. NPR was an independent predictor of survival for mechanically ventilated ward patients.