bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gaps in antihypertensive and statin treatments and benefits of optimisation: a modelling study in a 1 million ethnically diverse urban population in UK
Authors: Wu Runguo , Rison Stuart Christopher Gorthorn , Raisi-Estabragh Zahra , Dostal Isabel , Carvalho Chris , Robson John , Mihaylova Borislava 
Published: December 2021

ObjectivesTo characterise gaps in antihypertensive treatment in people with hypertension and statin treatment in people with cardiovascular diseases (CVD) in a large urban population and quantify the health and economic impacts of their optimisation.DesignA cross-sectional population study and a long-term CVD decision model.SettingPrimary care, UK.ParticipantsAll adults with diagnosed hypertension or CVD in a population of about 1 million people, served by 123 primary care practices in London, UK in 2019.InterventionsFollowing UK clinical guidelines, all adults with diagnosed hypertension were categorised into optimal, suboptimal and untreated groups with respect to their antihypertensive treatment, and all adults with diagnosed CVD were categorised in the same manner with respect to their statin treatment.OutcomesProportion of patients suboptimally treated or untreated. Projected cardiovascular events avoided, years and quality-adjusted life years (QALYs) gained and healthcare costs saved with optimised treatments.Results21 954 of the 91 828 adults with hypertension (24%; mean age 59 years; 49% women) and 9062 of the 23 723 adults with CVD (38%; mean age 69 years; 43% women) were not optimally treated with antihypertensive or statin treatment, respectively. Per 1000 additional patients optimised over 5 years, hypertension treatment is projected to prevent 25 (95% CI 16 to 32) major vascular events (MVEs) and 7 (3 to 10) vascular deaths, statin treatment, 28 (22 to 33) MVEs and 6 (4 to 7) vascular deaths. Over their lifespan, a patient with uncontrolled hypertension aged 60–69 years is projected to gain 0.64 (95% CI 0.36 to 0.87) QALYs with optimised hypertension treatment, and a similarly aged patient with previous CVD not optimally treated with statin is projected to gain 0.3 (0.24 to 0.37) QALYs with optimised statin treatment. In both cases, the hospital cost savings minus extra medication costs were about £1100 per person over remaining lifespan.ConclusionsOptimising cardiovascular treatments can cost-effectively reduce cardiovascular risk and improve life expectancy.
Short-term oestrogen as a strategy to prevent postpartum depression in high-risk women: protocol for the double-blind, randomised, placebo-controlled MAMA clinical trial
Authors: Høgh Stinne , Hegaard Hanne Kristine , Renault Kristina Martha , Cvetanovska Eleonora , Kjærbye-Thygesen Anette , Juul Anders , Borgsted Camilla , Bjertrup Anne Juul , Miskowiak Kamilla Woznica , Væver Mette Skovgaard , Stenbæk Dea Siggaard , Dam Vibeke Høyrup , Binder Elisabeth , Ozenne Brice , Mehta Divya , Frokjaer Vibe G 
Published: December 2021

IntroductionPostpartum depression affects 10%–15% of women and has a recurrence rate of 40% in subsequent pregnancies. Women who develop postpartum depression are suspected to be more sensitive to the rapid and large fluctuations in sex steroid hormones, particularly estradiol, during pregnancy and postpartum. This trial aims to evaluate the preventive effect of 3 weeks transdermal estradiol treatment immediately postpartum on depressive episodes in women at high risk for developing postpartum depression.Methods and analysisThe Maternal Mental Health Trial is a double-blind, randomised and placebo-controlled clinical trial. The trial involves three departments of obstetrics organised under Copenhagen University Hospital in Denmark. Women who are singleton pregnant with a history of perinatal depression are eligible to participate. Participants will be randomised to receive either transdermal estradiol patches (200 µg/day) or placebo patches for 3 weeks immediately postpartum. The primary outcome is clinical depression, according to the Diagnostic and Statistical Manual of Mental Disorders-V criteria of Major Depressive Disorder with onset at any time between 0 and 6 months postpartum. Secondary outcomes include, but are not limited to, symptoms of depression postpartum, exclusive breastfeeding, cortisol dynamics, maternal distress sensitivity and cognitive function. The primary statistical analysis will be performed based on the intention-to-treat principle. With the inclusion of 220 participants and a 20% expected dropout rate, we anticipate 80% power to detect a 50% reduction in postpartum depressive episodes while controlling the type 1 error at 5%.Ethics and disseminationThe study protocol is approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Centre for Data Protection Compliance in the Capital Region of Denmark. We will present results at scientific meetings and in peer-reviewed journals and in other formats to engage policymakers and the public.Trial registration numberNCT04685148.
Health-related quality of life in postcardiac interventional catheterization patients with congenital heart disease: a mixed-methods study protocol from Pakistan
Authors: Ali Fatima , Ladak Laila Akbar , Usmani Asra Abeer , Raza Hussain Ahmed , Siddiqui Marium Tariq , Hasan Babar 
Published: December 2021

IntroductionImprovement in health-related quality of life (HRQoL) has been reported in patients with congenital heart disease treated with interventional cardiac catheterization; however, there is a significant dearth of literature from low/middle-income countries (LMICs) about this aspect. Multiple factors like sociodemographic and cultural differences, variable procedural outcomes due to lack of technical expertise and limited resources and inconsistent postprocedure follow-up may affect HRQoL in LMICs. This protocol paper aims to describe the study methodology to determine the HRQoL and its predictors in patients who have undergone interventional cardiac catheterization. Conclusions from this protocol study will help prepare a holistic approach to delivering care to patients in low-resource settings.Methods and analysisA mixed-methods study design will be used. The quantitative arm will compare the HRQoL of these postcardiac interventional catheterization patients with their age-matched healthy siblings to identify the HRQoL predictors, whereas the qualitative arm will further explore the experiences of these patients and parents. A minimum number of 108 patients of age 2 years and above, at least 6 months postinterventional catheterization follow-up and ability to understand Urdu/English will be enrolled. PedsQL 4.0 Generic Core Scales, PedsQL Cognitive Functioning Scale and PedsQL 3.0 Cardiac Module will be used. The Student’s t-test will analyse the difference in the means of HRQoL between patients and siblings. Multiple regression will identify HRQoL predictors. A subsample of enrolled patients and parents will be interviewed and analysed using directed content analysis (a qualitative component of the study).Ethics and disseminationEthics approval has been obtained from Ethics Review Committee of The Aga Khan University, Pakistan (ERC #2020-3456-11808). Study findings will be published in peer-reviewed journals and presented at conferences.
Maternal use of cough medications during early pregnancy and selected birth defects: a US multisite, case–control study
Authors: Cao Yanyan , Rhoads Anthony , Burns Trudy , Carnahan Ryan M , Conway Kristin M , Werler Martha M , Mitchell Allen , Romitti Paul 
Published: December 2021

ObjectiveTo examine associations between maternal use of cough medications containing dextromethorphan (DM) without guaifenesin (glyceryl guaiacolate (GG)) (‘DM alone’), GG without DM (‘GG alone’) or DM +GG and major birth defects in offspring.DesignPopulation-based case–control study.SettingThe multisite, US National Birth Defects Prevention Study.ParticipantsMothers of 1644 children with neural tube defects (NTDs), 15 110 with non-NTDs, and 10 671 control children without a birth defect diagnosis.Main outcome measuresORs and 95% CIs.ResultsFor NTD analysis, 1.7% of mothers of case children and 1.2% of mothers of control children reported using DM alone, 1.1% and 0.6% GG alone, and 0.4% and 0.2% DM +GG. Respective percentages for non-NTD analysis were 2.2% and 1.9% for DM alone, 1.7% and 1.6% for GG alone, and 0.5% and 0.4% for DM +GG. For all NTDs and subtypes, adjusted OR estimates for DM alone were near the null with 95% CIs that included 1.0. Estimates (95% CI) were 1.8 (1.0 to 3.3) for GG alone and 1.8 (0.6 to 4.8) for DM +GG with all NTDs and 2.2 (1.1 to 4.3) for GG alone with spina bifida. Of the 45 adjusted OR estimates for non-NTDs, 39 ranged from 0.5 to 1.6 with 95% CIs that included 1.0. Near twofold or higher estimates (95% CI) were observed for the remainder and included 1.9 (1.0 to 3.7) for hydrocephalus, 2.9 (1.3 to 6.5) for atrioventricular septal defect and 1.8 (1.1 to 3.0) for transverse limb deficiency with DM alone; 2.1 (1.1 to 4.0) for small intestinal atresia/stenosis and 2.1 (0.9 to 4.5) for omphalocele with GG alone; and 3.2 (1.5 to 6.9) for gastroschisis with DM +GG.ConclusionsMaternal use of medications containing DM alone, GG alone or DM +GG showed positive associations with a small number of birth defects. These observations, which should be interpreted with caution due to small proportions of exposed mothers, may represent true signals or chance findings and warrant evaluation in future studies.
Can a pathological model improve the abilities of the paretic hand in hemiplegic children? The PAM-AOT study protocol of a randomised controlled trial
Authors: Verzelloni Jessica , Errante Antonino , Beccani Laura , Filippi Mariacristina , Bressi Barbara , Cavuto Silvio , Ziccarelli Settimio , Bozzetti Francesca , Costi Stefania , Pineschi Elena , Fogassi Leonardo , Ferrari Adriano 
Published: December 2021

IntroductionAction Observation Treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by subsequent repetition. In children with unilateral cerebral palsy (UCP), it improves upper limb function in daily activities. The standard paradigm of AOT requires the observation of healthy models; however, it has been demonstrated that the mirror neuron system of children with UCP is more activated by observation of pathological models, showing a similar motor repertoire, than by the healthy model, suggesting that AOT based on pathological models is superior to the standard paradigm of AOT in the functional rehabilitation of the affected upper limb of children with UCP.Methods and analysisThis protocol describes an active two-arm randomised controlled evaluator-blinded trial. Twenty-six children with UCP will participate in 3 weeks of intensive AOT: the experimental group will observe a pathological model, while the control group will observe a typically developed model. The primary outcome is the spontaneous use of the paretic hand, measured with the Assisting Hand Assessment. Secondary outcome measures are the Melbourne Assessment of Unilateral Upper Limb Function, the ABILHAND-Kids and the Activities Scale for Kids-performance. Assessments will be performed at baseline (T0), at the end of intensive AOT (T1), at 8–12 weeks (T2) and at 24–28 weeks (T3) after the end of intensive AOT.Ethics and disseminationThe trial was approved by the Area Vasta Emilia Nord Ethics Committee (AVEN prot. n. 133117, 29 November 2018), and it was prospectively registered on ClinicalTrials.gov. The results will be submitted for publication to a peer-reviewed journal, discussed with parents of children participating in the trial and disseminated at suitable conferences.Trial registration numberNCT04088994; Pre-results.
Readiness of health facilities and determinants to manage diabetes mellitus: evidence from the nationwide Service Provision Assessment survey of Afghanistan, Bangladesh and Nepal
Authors: Huda Md Durrul , Rahman Mosiur , Rahman Md Mosfequr , Islam Md Jahirul , Haque Syed Emdadul , Mostofa Md Golam 
Published: December 2021

ObjectivesUsing nationally representative surveys, the study’s aims were to: (1) evaluate healthcare facilities’ readiness to provide diabetes mellitus (DM) services and (2) identify the factors that affect DM service readiness.Data sourceData from Service Provision Assessment surveys conducted in three low-resource South Asian (SA) countries: Afghanistan, Bangladesh and Nepal, were used in this study.DesignCross-sectional nationally representative surveyParticipantsA total of 117, 317 and 397 public and private health facilities in Afghanistan, Bangladesh and Nepal, respectively were analysed.Primary outcomeA total of 12 items/indicators were used to measure a health facility’s readiness to provide DM services across four domains.ResultsFor DM management, about 39.3%, 58.4% and 58.2% of health facilities in Afghanistan, Bangladesh and Nepal centred around 7–8, 3–6 and 4–6 items. Only 12.8%, 5.0% and 4.8% of healthcare facilities in Afghanistan, Bangladesh and Nepal reported having at least % (9/12) of the necessary items for DM management, and no one reported having all 12 important items for DM management. According to the negative binomial regression models, the factors associated with higher readiness scores vary among the three countries analysed. Regression models also showed that increases in the number of DM care providers and facility types are similar factors linked to increased readiness scores in all three countries.ConclusionsIn order to increase a health facility’s readiness to offer DM care, country-specific factors must be addressed in addition to common factors found in all three countries. Further research is required to determine the cause of country-level differences in tracer item availability in order to develop targeted and effective country-specific strategies to improve care quality in the SA region.
Cross-sectional study of chronic hepatitis B virus infection in Rwandan high-risk groups: unexpected findings on prevalence and its determinants
Authors: Umutesi Justine , Klett-Tammen Carolina , Nsanzimana Sabin , Krause G , Ott J J 
Published: December 2021

ObjectivesUsing secondary data from 208 079 Rwandans, we determined the prevalence of chronic hepatitis B virus (HBV) infection among high-risk groups and its demographic, geographical and health-related determinants.DesignIn this cross-sectional study, we obtained and analysed data from a national hepatitis B vaccination and screening campaign conducted in Rwanda in 2017. We performed logistic regression to examine associations between chronic HBV infection and related factors such as risk status and geographical characteristics.SettingIndividuals were sampled nationally in all 30 districts across 4 provinces and the city of Kigali and all prisons in Rwanda.ParticipantsThe study involves 208 079 individuals at high risk including prisoners and other high-risk groups (oHRG).Main outcomeThe primary outcome for our study was hepatitis B surface antigens (HBsAg) prevalence.FindingsFrom 208 079 adults participants, 206 517 (99.2%) had valid HBsAg results, 4.3% of 64 944 prisoners and 4.0% of 140 985 oHRG were HBV positive. The prevalence was higher in Northern Province 5.1%, (95% CI 4.8 to 5.4). In multivariate analysis, the odds of infection decreased with increasing age, and hepatitis C antibody positivity reduced the odds for chronic HBV (OR 0.58, 95% CI 0.52 to 0.66 and OR 0.74, 95% CI 0.62 to 0.89 among oHRG and prisoners, respectively). In addition, being female was associated with lower odds of HBV (OR 0.70, 95% CI 0.66 to 0.74 and OR 0.80, 95% CI 0.65 to 0.98 among oHRG and prisoners, respectively).ConclusionWe found that individuals below 55 years of age and individuals who belong to high-risk groups (ie, sex workers, injection drug users, men who have sex with men, etc) have a higher probability of chronic HBV infection. Infection with chronic hepatitis C virus was not correlated with chronic HBV infection in our study population. Potential explanations include differential routes of transmission, specific immunological and pathophysiological factors or different effects of health prevention and control programmes.
Vision-specific risk factors impacting self-rated health among older men in urban China: a population-based cross-sectional study
Authors: Yang Wei , Han Jinsong , Wang Bowen , Zhang Tianjiao , Sun Wei 
Published: December 2021

BackgroundSelf-rated health (SRH) has been well documented as an important assessment of health status among the older adults. Interestingly, visual ability has been reported to have a considerable impact on the quality of life of the older adults. This study clarified vision-specific risk factors impacting SRH among older men without cognitive impairment in order to optimise healthcare for the older adults.MethodsA population-based cross-sectional study was conducted in urban areas of Liaoning Province. A stratified sampling method was used and all men aged ≥65 years and living in sampled communities without dementia were interviewed between March and November 2012. SRH, visual ability and factors including demographic characteristics, physical conditions, lifestyle factors, social psychological factors and social activities, were measured. 1884 effective responses were received (effective response rate, 84.8%) and 1724 individuals were enrolled after further cognitive screening.ResultsThe mean age was 72.9±5.9 (mean±SD). Of individuals with good and poor visual ability, 38.3% and 33.0% reported good SRH, respectively. The characteristics between different visual ability groups were significantly different. Interactions between visual ability and four items had significant effects on SRH. In good visual ability group, chronic disease had the strongest association with good SRH followed by participating in entertainment, taking a walk, filial piety and alcohol consumption. In poor visual ability group, taking a walk had the strongest association with good SRH followed by participating in entertainment, hearing ability, smoking, quality of sleep, going out alone to distant places and alcohol consumption.ConclusionsA good SRH status, even among the individuals with good visual ability, had a low prevalence among older men in urban areas. The risk factors impacting SRH was vision-specific. Physical conditions were crucial for SRH among those with good visual ability. In contrast, lifestyle factors were prominent for those with poor visual ability.
HPV vaccination uptake among Somali American patients at an urban primary care clinic in Minnesota, USA: identifying and testing interventions to improve uptake using video reflexive ethnography
Authors: Pratt Rebekah , Ndagire Channelle , Oyenuga Abayomi , Xiong Serena , Carroll Katherine , Adam Patricia 
Published: December 2021

ObjectivesWhile there have been efforts to address common and culturally informed barriers to healthcare, Somali Americans have low rates of human papillomavirus (HPV) vaccination. This study aimed to use video reflexive ethnography (VRE) to identify primary care health inequities, derive interventions aimed at improving HPV vaccination rates in Somali Americans, and then test their impact on vaccination rates.DesignThe VRE methodology involves three sequential steps: data collection, reflexive discussion and identifying intervention in practice. Preintervention and postintervention vaccination uptake data were collected for Somali patients.SettingVRE was conducted with medical assistants (MAs) and Somali patients for 3 months (June–August 2018) in an urban primary care clinic in Minnesota, USA. HPV vaccination rates were collected and analysed pre-VRE and for a period of 6 months post the implementation of the interventions identified by VRE.Participants14 MAs participated in the VRE which designed the study intervention, which was tested on 324 Somali patients eligible for HPV vaccination.Primary outcome measureHPV vaccination uptake among Somali patients.ResultsMAs identified three practice challenges related to HPV vaccination: provider fatigue related to ongoing patient vaccine hesitancy or refusal, MAs misinterpretation of patient’s vaccination dissent language, and missed opportunities to respond to unique patient concerns as a result of following standard work procedures. Using VRE, MAs identified and developed several interventions to address these practice challenges. Adjusted for age at clinic visit (years), the difference in preintervention and postintervention HPV immunisation rates was 10.1 per 100 patient-visits (95% CI 2.97 17.3; p=0.0057).ConclusionVRE can engage MAs in an innovative, participatory process to identify and address concerns about health inequities. In this study, MAs designed and implemented interventions that improved HPV vaccination rates in Somali Americans. Further research is needed to more fully assess the impact of such interventions.
Financial risks of care seeking for malaria by rural households in Jimma Zone, Oromia Region, Southwest Ethiopia: a cross-sectional study
Authors: Assebe Lelisa Fekadu , Dillu Dereje , Tiru Gemu , Johansson Kjell Arne , Bolongaita Sarah , Chakrabarti Averi , Hendrix Nathaniel 
Published: December 2021

ObjectivesDespite major progress in the prevention and control of malaria in recent years, the disease remains a major cause of morbidity in Ethiopia. Malaria also imposes substantial socioeconomic costs on households. The aim of this study is to estimate the financial risk of seeking malaria service for rural households across socioeconomic statuses in the Jimma Zone, Oromia Region.DesignA facility-based cross-sectional survey.SettingJimma Zone, Oromia Region, Southwest Ethiopia.ParticipantsA total of 221 patients with malaria from 10 public health facilities were interviewed between September 2018 and December 2019.Primary and secondary outcome measuresThe main outcome measures capture the financial risks associated with malaria services, specifically catastrophic and impoverishing health expenditures. Catastrophic health expenditure (CHE) occurs when healthcare costs reach 10% of a household’s monthly income, whereas impoverishment occurs when a household’s monthly income falls below the national poverty level after paying for health service. Descriptive statistics were used to summarise the expenditure patterns associated with malaria services. All costs were gathered in Ethiopian birr and reported in 2019 US$.ResultsThe average cost of receiving malaria services was US$4.40 (bootstrap 95% CI: 3.6 to 5.3), with indirect costs accounting for 52% of total costs. Overall, at the 10% threshold, 12% (bootstrap 95% CI: 8.1% to 16.7%) of patients with malaria incurred CHE: 40% (bootstrap 95% CI: 26.7% to 55.6%) of the household in the poorest quintile experienced CHE, but none from the richest quintile did. The proportion of households living in poverty increased by more than 2-3% after spending on malaria-specific health services.ConclusionHealthcare seeking for malaria imposes a substantial financial risk on rural households, particularly for the poorest and most vulnerable. Malaria policies and interventions should therefore seek to alleviate both the direct costs and productivity losses associated with the disease, especially among the poor.