bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of blindness and its determinants in Bangladeshi adult population: results from a national cross-sectional survey
Authors: Shakoor Shawkat Ara , Rahman Mustafizur , Hossain A H M Enayet , Moniruzzaman Mohammad , Bhuiyan Mahfuzur Rahman , Hakim Ferdous , Zaman M Mostafa 
Published: April 2022

ObjectiveThe objective of this study was to determine the prevalence of blindness and its determinants in Bangladeshi adult population.Study designA cross-sectional population-based survey conducted at household level with national representation. Samples were drawn from the 2011 national census frame using a multistage stratified cluster sampling method.Setting and participantsThe survey was done in urban and rural areas in 2013 using a probability proportionate to size sampling approach to locate participants from 72 primary sampling units. One man or one woman aged ≥40 years was randomly selected from their households to recruit 7200. In addition to sociodemographic data, information on medication for hypertension and diabetes was obtained. Blood pressure and capillary blood glucose were measured. Eyelids, cornea, lens, and retina were examined in addition to visual acuity and refraction testing.Primary outcome measuresThe following definition was used to categorise subjects having (1) blindness: visual acuity <3/60, (2) low vision: ≥3/60 to <6/60 and (3) normal vision: ≥6/12 after best correction.ResultsWe could recruit 6391 (88.8%) people among whom 2955 (46.2%) were men. Among them, 1922 (30.1%) were from urban and 4469 (69.9%) were from rural areas. The mean age was 54.3 (SD 11.2) years. The age-standardised prevalence, after best correction, of blindness and low vision was 1.0% (95% CI 0.5% to 1.4%) and 12.1% (95% CI 10.5% to 13.8%), respectively. Multivariable logistic regression indicated that cataract, age-related macular degeneration and diabetic retinopathy were significantly associated with low vision and blindness after adjustment for age and sex. Population attributable risk of cataract for low vision and blindness was 79.6%.ConclusionsLow vision and blindness are common problems in those aged 40 years or older. Extensive screening and eye care services are necessary for wider coverage engaging all tiers of the healthcare system especially focusing on cataract.
Assessment of mental health trajectories before and after myocardial infarction, atrial fibrillation or stroke: analysis of a cohort study in Tromsø, Norway (Tromsø Study, 1994–2016)
Authors: Lorem Geir Fagerjord , Opdal Ida Marie , Wilsgaard Tom , Schirmer Henrik , Løchen Maja-Lisa , Olsen Ingrid Petrikke , Steigen Terje , Rognmo Kamilla 
Published: April 2022

ObjectivesThe increased survival rate of cardiovascular disease (CVD) implies a higher proportion of individuals who live with CVD. Using data from the Tromsø Study, we aimed to investigate mental health symptom trajectories before and after myocardial infarction, atrial fibrillation or stroke in a general population and to explore factors that contribute to the association.DesignCohort study.SettingSample drawn from inhabitants of the municipality of Tromsø, Norway, who participated in the Tromsø Study (1994–2016).ParticipantsA total of 18 719 participants (52.3% women) were included, and of these 2098 (32.9% women) were diagnosed with myocardial infarction, 1896 (41.9% women) with atrial fibrillation and 1263 (42.9% women) with stroke.Primary outcome measuresMental health symptoms were assessed using the Hopkins Symptom Checklist-10 and the Conor Mental Health Index.ResultsThe participants who were diagnosed with either myocardial infarction or stroke had a significant monotonous increase in mental health symptoms before myocardial infarction (p=0.029) and stroke (p=0.029) that intensified at the time of diagnosis. After the event, the study found a higher prevalence of mental health symptoms with a decline in symptom levels over time for myocardial infarction (p<0.001) and stroke (p=0.004), but not for atrial fibrillation (before: p=0.180, after: p=0.410). The risk of elevated mental health symptoms with myocardial infarction, atrial fibrillation and stroke was associated with sex (p<0.001), age (p<0.01), physical activity (p<0.001), diabetes (p<0.05) and other comorbidities (p<0.001).ConclusionThe study indicates that mental health problems among individuals with myocardial infarction, atrial fibrillation and stroke may have started to develop several years before the cardiovascular event and suggests that successful CVD rehabilitation may need to consider previous life factors. Future research is recommended to examine whether health promotion measures in a general population also create mental health resilience after a CVD event.
Approaches and outcomes of community health worker’s interventions for hypertension management and control in low-income and middle-income countries: systematic review
Authors: Mbuthia Grace Wambura , Magutah Karani , Pellowski Jennifer 
Published: April 2022

ObjectivesTo critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs).MethodWe performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables.ResultsOf the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level.Discussion and conclusionThe current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.
Optimising diagnostics to discriminate complicated from uncomplicated appendicitis: a prospective cohort study protocol
Authors: Bom Wouter J , Scheijmans Jochem C G , Ubels Sander , van Geloven Anna A W , Gans Sarah L , Tytgat Kristien M A J , van Rossem Charles C , Koens Lianne , Stoker Jaap , Bemelman Willem A , Dijkgraaf Marcel G W , Boermeester Marja A 
Published: April 2022

IntroductionGrowing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary.Methods and analysisThe SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient’s preferences for different treatment options will be assessed.Ethics and disseminationEthical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.
Sex differences in neurology: a scoping review protocol
Authors: Moores Ginette , Wolff Elena , Pikula Aleksandra , Bui Esther 
Published: April 2022

IntroductionSex and gender are independently important in health and disease but have been incompletely explored in neurology. This is in part contributed to by the pre-existing male bias in scientific literature that results in fewer females being included in clinical research and the often interchangeable use of sex and gender in the literature. This scoping review intends to identify the advances as well as under-explored aspects of this field to provide a road map for future research. This paper outlines the methods for a scoping review of published, peer-reviewed literature on sex and gender differences in four subspecialty areas of neurology: demyelination, stroke, epilepsy and headache.Methods and analysisA detailed search strategy will be used to search five databases pertaining only to sex differences. Specific inclusion and exclusion criteria will be applied to capture relevant literature published from 2014 to 2020. Data will be collected and synthesised to provide an overview of information retrieved, a narrative synthesis of each subspecialty area and map of results.Ethics and disseminationResearch ethics board approval was not required for this study. This study will aid in mapping recent trends in sex differences in four major neurological conditions and will help identify areas for further research. A manuscript will be compiled for publication and presentations of findings.Registration detailsThe final protocol is registered with the Open Science Framework (https://osf.io/n937x/).
Associations between fibrinogen levels and the risk of cardiovascular disease and all-cause death: a cohort study from the Chin-Shan community in Taiwan
Authors: Hsieh Cheng-Tzu , Chien Kuo-Liong , Hsu Hsiu-Ching , Lin Hung-Ju , Su Ta-Chen , Chen Ming-Fong , Lee Yuan-Teh 
Published: April 2022

ObjectivesAlthough several studies have investigated the association between fibrinogen level and the risk of cardiovascular disease (CVD), few studies have been conducted in Asia.SettingWe conducted a community-based prospective cohort study in the Chin-Shan community, Taiwan.ParticipantsA total of 2222 participants (54.6±11.9 years, 53.4% women, and 22.4 years of follow-up) who underwent plasma fibrinogen measurements and were without CVD at baseline were recruited, among which 735 participants with available C reactive protein (CRP) were included in the joint analysis of the association of fibrinogen and CRP levels with the risk of CVD.Primary and secondary outcome measuresFibrinogen and CRP levels were measured by clotting and high-sensitivity immunoturbidimetric assays, respectively. The study outcomes were CVD events and all-cause death. Our definition of CVD included both coronary artery disease (CAD) and stroke cases. Cox proportional hazards regression models were used to estimate the HRs and 95% CIs.ResultsCompared with the lowest quartile, participants with higher fibrinogen levels tended to have a higher risk of CAD (adjusted HR for the highest quartile=1.48 (95% CI 0.90 to 2.44); test for trend p=0.037) regardless of CRP level (adjusted HR=2.12 (95% CI 1.24 to 3.63) and 2.17 (95% CI 1.06 to 4.44) for high fibrinogen/low CRP and high fibrinogen/high CRP, respectively). The association was not observed for stroke (adjusted HR for the highest quartile=0.99 (95% CI 0.62 to 1.60); test for trend p=0.99) and was only observed for all-cause death among participants <65 years of age (adjusted HR for the highest quartile=1.47 (95% CI 1.11 to 1.95); test for trend p=0.004).ConclusionsFibrinogen may be a potential risk factor for CAD but not for stroke. Further studies are necessary to clarify the differences in the role of fibrinogen levels on the risk of CVD between Asian and Western countries.
Trends in outcomes following COVID-19 symptom onset in Milan: a cohort study
Authors: Jackson Christopher H , Grosso Francesca , Kunzmann Kevin , Corbella Alice , Gramegna Maria , Tirani Marcello , Castaldi Silvana , Cereda Danilo , De Angelis Daniela , Presanis Anne 
Published: April 2022

BackgroundFor people with symptomatic COVID-19, the relative risks of hospital admission, death without hospital admission and recovery without admission, and the times to those events, are not well understood. We describe how these quantities varied with individual characteristics, and through the first wave of the pandemic, in Milan, Italy.MethodsA cohort study of 27 598 people with known COVID-19 symptom onset date in Milan, Italy, testing positive between February and June 2020 and followed up until 17 July 2020. The probabilities of different events, and the times to events, were estimated using a mixture multistate model.ResultsThe risk of death without hospital admission was higher in March and April (for non-care home residents, 6%–8% compared with 2%–3% in other months) and substantially higher for care home residents (22%–29% in March). For all groups, the probabilities of hospitalisation decreased from February to June. The probabilities of hospitalisation also increased with age, and were higher for men, substantially lower for healthcare workers and care home residents, and higher for people with comorbidities. Times to hospitalisation and confirmed recovery also decreased throughout the first wave. Combining these results with our previously developed model for events following hospitalisation, the overall symptomatic case fatality risk was 15.8% (15.4%–16.2%).ConclusionsThe highest risks of death before hospital admission coincided with periods of severe burden on the healthcare system in Lombardy. Outcomes for care home residents were particularly poor. Outcomes improved as the first wave waned, community healthcare resources were reinforced and testing became more widely available.
Intended versus actual delivery location and factors associated with change in delivery location among pregnant women in Southern Province, Zambia: a prespecified secondary observational analysis of the ZamCAT
Authors: Solomon Hiwote , Henry Elizabeth G , Herlihy Julie , Yeboah-Antwi Kojo , Biemba Godfrey , Musokotwane Kebby , Bhutta Afsah , Hamer Davidson H , Semrau Katherine E A 
Published: April 2022

ObjectivesThis prespecified, secondary analysis of the Zambia Chlorhexidine Application Trial (ZamCAT) aimed to determine the proportion of women who did not deliver where they intended, to understand the underlying reasons for the discordance between planned and actual delivery locations; and to assess sociodemographic characteristics associated with concordance of intention and practice.DesignPrespecified, secondary analysis from randomised controlled trial.SettingRecruitment occurred in 90 primary health facilities (HFs) with follow-up in the community in Southern Province, Zambia.ParticipantsBetween 15 February 2011 and 30 January 2013, 39 679 pregnant women enrolled in ZamCAT.Secondary outcome measuresThe location where mothers gave birth (home vs HF) was compared with their planned delivery location.ResultsWhen interviewed antepartum, 92% of respondents intended to deliver at an HF, 6.1% at home and 1.2% had no plan. However, of those who intended to deliver at an HF, 61% did; of those who intended to deliver at home, only 4% did; and of those who intended to deliver at home, 2% delivered instead at an HF. Among women who delivered at home, women who were aged 25–34 and ≥35 years were more likely to deliver where they intended than women aged 20–24 years (adjusted OR (aOR)=1.31, 95% CI=1.11 to 1.50 and aOR=1.32, 95% CI=1.12 to 1.57, respectively). Women who delivered at HFs had greater odds of delivering where they intended if they received any primary schooling (aOR=1.34, 95% CI=1.09 to 1.72) or more than a primary school education (aOR=1.54, 95% CI=1.17 to 2.02), were literate (aOR=1.33, 95% CI=1.119 to 1.58), and were not in the lowest quintile of the wealth index.ConclusionDiscrepancies between intended and actual delivery locations highlight the need to go beyond the development of birth plans and exposure to birth planning messaging. More research is required to address barriers to achieving intentions of a facility-based childbirth.Trial registration numberClinicalTrials.gov Registry (NCT01241318).
‘Striving for freedom or remaining with what is well-known’: a focus-group study of self-management among people with type 1 diabetes who have suboptimal glycaemic control despite continuous subcutaneous insulin infusion
Authors: Persson Margareta , Leksell Janeth , Ernersson Åsa , Rosenqvist Ulf , Hörnsten Åsa 
Published: April 2022

IntroductionContinuous subcutaneous insulin infusion (CSII) treatment is beneficial for obtaining glycaemic control for many persons with type 1 diabetes mellitus (T1DM). Still, some individuals do not obtain improved HbA1C levels despite CSII treatment, and there is a lack of evidence regarding how psychosocial factors may influence glycaemic control. Thus, we aimed to explore the attitudes and experiences of self-management among people with T1DM and suboptimal glycaemic control despite CSII treatment.Research design and methodsA qualitative inductive design was applied, and four FGDs were performed with 37 adult men and women of various ages and duration of T1DM. All participants had suboptimal glycaemic control despite CSII treatment. Transcripts were analysed using qualitative manifest and latent content analysis.Results and conclusionThe themesSearching for freedom and flexibilityandPreferring safety and the well-knownillustrated the divergent psychosocial strategies adapted, which both resulted in suboptimal glycaemic control. The technical devices and their effects on glycaemic levels may be challenging to understand and adjust to fit people’s lifestyles. The rapid advances of technology devices in diabetes care can potentially change peoples’ lives, but is the educational support developing as fast? Multifaceted web-based education of high quality, including tailored support with a person-centred focus, is more important than ever before as the need for technical knowledge and understanding may put further disease burdens to patients with T1DM on CSII treatment.
Antibiotic use attributable to specific aetiologies of diarrhoea in children under 2 years of age in low-resource settings: a secondary analysis of the MAL-ED birth cohort
Authors: Brennhofer Stephanie A , Platts-Mills James A , Lewnard Joseph A , Liu Jie , Houpt Eric R , Rogawski McQuade Elizabeth T 
Published: April 2022

ObjectiveTo quantify the frequency of antibiotic treatments attributable to specific enteric pathogens due to the treatment of diarrhoea among children in the first 2 years of life in low-resource settings.DesignSecondary analysis of a longitudinal birth cohort study, Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED).SettingThis study was conducted at eight sites in Bangladesh, Brazil, India, Nepal, Peru, Pakistan, South Africa and Tanzania.ParticipantsWe analysed 9392 reported diarrhoea episodes, including 6677 with molecular diagnostic test results, as well as 31 408 non-diarrhoeal stools from 1715 children aged 0–2 years with 2 years of complete follow-up data.Primary and secondary outcome measuresWe estimated incidence rates and the proportions of antibiotic use for diarrhoea and for all indications attributable to the top 10 aetiologies of diarrhoea. We estimated associations between specific aetiologies and antibiotic treatment, and assessed whether clinical characteristics of the diarrhoea episodes mediated these relationships.ResultsShigella and rotavirus were the leading causes of antibiotic treatment, responsible for 11.7% and 8.6% of diarrhoea treatments and 14.8 and 10.9 courses per 100 child-years, respectively. Shigella and rotavirus-attributable diarrhoea episodes were 46% (RR: 1.46; 95% CI: 1.33 to 1.60), and 19% (RR: 1.19; 95% CI: 1.09 to 1.31) more likely to be treated with antibiotics, respectively, compared with other aetiologies. Considering antibiotic uses for all indications, these two pathogens accounted for 5.6% of all antibiotic courses, 19.3% of all fluoroquinolone courses and 9.5% of all macrolide courses. Among indicated treatments for dysentery, Shigella and Campylobacter jenjui/Campylobacter coli were responsible for 27.5% and 8.5% of treated episodes, respectively.ConclusionsThe evidence that Shigella and rotavirus were disproportionately responsible for antibiotic use due to their high burden and severity further strengthens the value of interventions targeted to these pathogens. Interventions against Campylobacter could further prevent a large burden of indicated antibiotic treatment for dysentery, which could not be averted by antibiotic stewardship interventions.