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6 ["What\u2019s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland"] 10.1136/bmjopen-2017-018023 http://dx.doi.org/10.1136/bmjopen-2017-018023 2017-10-16T22:16:03Z [] 0 19 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Irish publicly funded hospitals and residential institutions.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extremely severe symptoms of depression, anxiety and stress were evident in 7.2%, 6.1% and 9.5% of participants (Depression, Anxiety, Stress Scale 21). Symptoms of distress, depression, anxiety and stress were significantly higher and levels of well-being were significantly lower in trainees compared with consultants, and this was not accounted for by differences in sociodemographic variables. Self-stigma was present in 68.4%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The work hours of doctors working in Irish hospitals were in excess of European Working Time Directive’s requirements. Just over half of hospital doctors in Ireland had positive well-being. Compared with international e… 5 [] ["Bl\u00e1naid Hayes", "Lucia Prihodova", "Gillian Walsh", "Frank Doyle", "Sally Doherty"] [""] [""] [""]
9 ["Season and region of birth as risk factors for coeliac disease a key to the aetiology?"] 10.1136/archdischild-2015-310122 http://dx.doi.org/10.1136/archdischild-2015-310122 2016-08-16T01:13:27Z ["Pediatrics, Perinatology, and Child Health"] 39 11 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0–14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at &lt;2 years had an increased CD risk if born in spring while those diagnosed at 2–14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991–1996 had increased CD risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.</jats:p></jats:sec> 5 [] ["Fredinah Namatovu", "Marie Lindkvist", "Cecilia Olsson", "Anneli Ivarsson", "Olof Sandstr\u00f6m"] [""] [""] [""]
12 ["Exploring the potential chemopreventative effect of aspirin and rofecoxib on hereditary nonpolyposis colorectal cancer\u2013like endometrial cancer cells in vitro through mechanisms involving apoptosis, the cell cycle, and mismatch repair gene expression"] 10.1111/j.1525-1438.2007.00867.x http://dx.doi.org/10.1111/j.1525-1438.2007.00867.x 2007-02-21T17:45:30Z [] 34 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Women in hereditary nonpolyposis colorectal cancer (HNPCC) families have up to a 71% lifetime risk for developing endometrial cancer (EC). This compares to the female lifetime risk for colorectal cancer (CRC) in HNPCC of 60%. The basis of HNPCC is an inherited mutation in a mismatch repair gene (MMR). Aspirin and COX2 inhibitors seem to have a chemoprotective effect on CRC in the general population and are the subject of prospective clinical studies in patients at high risk for CRC including HNPCC. There is no evidence that these agents have any protective effect against EC in the general population. This study investigated the effect of aspirin and a COX2 inhibitor (rofecoxib) on an HNPCC EC cell line model (Ishikawa) by assessing the effect on proliferation, apoptosis, the cell cycle, and MMR gene expression. Aspirin inhibits EC cell proliferation by inducing apoptosis and changes in the cell cycle. This effect is not mediated by changes in MMR gene (hMSH2) expression as assessed by quantitative reverse transcription–polymerase chain reaction. Rofecoxib inhibits EC cell proliferation; this did not appear to be mediated by induction of apoptosis, by alterations of the cell cycle, or by changes in MMR gene expression</jats:p> 5 [] ["N. J. Wood", "N. A. Quinton", "S. Burdall", "E. Sheridan", "S. R. Duffy"] [""] [""] [""]
13 ["Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation"] 10.1136/emermed-2012-201737 http://dx.doi.org/10.1136/emermed-2012-201737 2013-03-29T00:49:44Z ["Critical Care and Intensive Care Medicine", "Emergency Medicine", "General Medicine"] 19 10 ["1472-0205", "1472-0213"] Emergency Medicine Journal <jats:sec><jats:title>Objectives</jats:title><jats:p>Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinee's answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbach's α) and its ability to discriminate between the different groups (ANOVA followed by Tukey's post hoc test).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbach's α=0.80). Statistically significant differences were found between the groups (F<jats:sub>0.271</jats:sub>=21.07; p&lt;0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p&lt;0.001), students and experts (p&lt;0.001), and residents and experts (p=0.017).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise.</jats:p></jats:sec> 5 [] ["Caroline Boulouffe", "Bruno Doucet", "Xavier Muschart", "Bernard Charlin", "Dominique Vanpee"] [""] [""] [""]
25 ["Using Q-methodology to guide the implementation of new healthcare policies"] 10.1136/bmjqs-2017-007380 http://dx.doi.org/10.1136/bmjqs-2017-007380 2018-04-12T16:20:06Z [] 25 5 ["2044-5415", "2044-5423"] BMJ Quality & Safety <jats:p>There are many challenges in the development, implementation and evaluation of healthcare policy. One challenge is understanding how different stakeholders view a particular policy and what impact these views may have during implementation. Q-methodology is one approach that can be used to help policy makers and researchers actively engage with those who are important in policy implementation, and anticipate their responses. Q-methodology combines qualitative and quantitative research methods to systematically explore and describe the range of viewpoints about a topic. Participants are required to rank a set of predefined statements relating to the topic, according to their own viewpoint. Factor analytic techniques then identify people who are like-minded in the way they view the topic and enable areas of consensus and divergence in viewpoint to be clearly defined. This mapping of viewpoints allows those working in policy implementation to anticipate likely barriers and levers in implementing new policies.</jats:p> 5 ["http://orcid.org/0000-0002-5418-0495", "http://orcid.org/0000-0001-8721-8026"] ["Sarah Alderson", "Robbie Foy", "Louise Bryant", "Shenaz Ahmed", "Allan House"] [""] [""] [""]
29 ["Ovarian fibrosarcoma with long-term survival: A case report"] 10.1136/ijgc-00009577-200107000-00016 http://dx.doi.org/10.1136/ijgc-00009577-200107000-00016 2019-03-05T12:15:23Z ["Obstetrics and Gynaecology", "Oncology"] 0 3 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Abstract.</jats:title><jats:p>Huang Y-C, Hsu K-F, Chou C-Y, Dai Y-C, Tzeng C-C. Ovarian fibrosarcoma with long-term survival.</jats:p><jats:p>Primary ovarian fibrosarcoma is an exceedingly rare malignant ovarian stromal tumor which has a poor prognosis. We report here a 46-year-old woman who suffered from irregular vaginal bleeding for 2 months. She received hysterectomy and salpingo-oophorectomy due to a provisional diagnosis of uterine and ovarian tumors. At surgery, an 8-cm ovarian solid multilobular tumor was found. Frozen section examination revealed an ovarian fibrosarcoma. She then underwent staging procedures including intraperitoneal washing, cytology, and pelvic and para-aortic lymph node sampling. Final pathologic examination revealed that the tumor exhibited densely packed spindle cells in storiform configuration with obvious increased mitotic activity. In addition, the flow cytometric study showed marked elevated percentage of tumor cells in the S phase (13.1%). After surgery, the patient received six courses of combination chemotherapy with epirubicin, ifosfamide, and dacarbazine (DTIC). The patient stood the treatment well and is free from disease 6 years later.</jats:p></jats:sec> 5 [] ["Y.-C. Huang", "K.-F. Hsu", "C.-Y. Chou", "Y.-C. Dai", "C.-C. Tzeng"] [""] [""] [""]
30 ["Inter-rater reliability of published flow diversion occlusion scales"] 10.1136/neurintsurg-2015-012193 http://dx.doi.org/10.1136/neurintsurg-2015-012193 2016-01-20T23:04:34Z ["Surgery", "Clinical Neurology", "General Medicine"] 14 3 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>With increasing use of flow-diverting stents for the treatment of intracranial aneurysms, standardized methods and a common language to evaluate angiographic outcomes are needed. Multiple grading scales have been developed for this purpose but none has been widely adopted.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To analyze these scales to determine interobserver reliability.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Four independent assessors scored the intraprocedural angiograms of patients who underwent flow-diverting stent deployment for an intracranial saccular or fusiform aneurysm at our institution between October 2012 and June 2015. Angiographic outcome immediately after flow-diverting stent deployment was scored using three grading scales (Kamran–Byrne (KB), Simple Measurement of Aneurysm Residual after Treatment (SMART), and O'Kelley, Krings, Marotta (OKM)). Statistical analysis was performed using Light's κ for multiple raters (κ), Kendall's coefficient of concordance (W), and intraclass correlation (ICC).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included the angiograms of 50 consecutive patients (mean age 58 years, range 30–79) who underwent flow-diverting stent deployment for an intracranial aneurysm (40 saccular, 10 fusiform). Six aneurysms were located in the posterior circulation. The inter-rater reliability was typically poor or fair: SMART aneurysm filling (κ=0.30, W=0.36, ICC=0.12), SMART parent vessel stenosis (κ=0.07, W=0.33, ICC=0.12), KB axis I (κ=0.24, W=0.50, ICC=0.25), KB axis II (κ=0.07, W=0.30, ICC=0.06), OKM aneurysm filling (κ=0.23, W=0.45, ICC=0.13), OKM contrast stasis (κ=0.36,W=0.71, ICC=0.54).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Existing flow-diverting stent grading scales have low inter-rater reliability for most categories.</jats:p></jats:sec> 5 [] ["Marcus D Mazur", "Philipp Taussky", "Lubdha M Shah", "Blair Winegar", "Min S Park"] [""] [""] [""]
38 ["A case of protrusion of an intraperitoneal chemotherapy catheter through rectum"] 10.1136/ijgc-00009577-200501000-00026 http://dx.doi.org/10.1136/ijgc-00009577-200501000-00026 2019-03-06T16:30:38Z ["Obstetrics and Gynaecology", "Oncology"] 0 1 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Bowel penetration of an intraperitoneal catheter occurred in a patient who had received a course of uncomplicated intraperitoneal chemotherapy for a persistent ovarian carcinoma. One month after the termination of chemotherapy, she presented with protrusion of a catheter through anus. At operation, the catheter was removed, the rectum was repaired primarily, and a cytoreductive surgery was performed.</jats:p> 5 [] ["Y. Bilsel", "E. Balik", "D. Bugra", "S. Yamaner", "A. Akyuz"] [""] [""] [""]
51 ["A challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma"] 10.1136/bcr-2018-226168 http://dx.doi.org/10.1136/bcr-2018-226168 2019-07-09T10:09:12Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.</jats:p> 5 ["http://orcid.org/0000-0002-9143-8942"] ["Alexander Yao", "Haroon Saeed", "Gavin Udall", "Vivek Kaushik", "Lip Wai Lee"] [""] [""] [""]
54 ["PO 8417\u2005RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY"] 10.1136/bmjgh-2019-edc.89 http://dx.doi.org/10.1136/bmjgh-2019-edc.89 2019-04-24T15:32:16Z [] 0 0 ["2059-7908"] BMJ Global Health <jats:sec><jats:title>Background</jats:title><jats:p>Despite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (P<jats:sub>trend</jats:sub> &lt;0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (P<jats:sub>trend</jats:sub>=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p&lt;0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) &lt;18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early dea… 5 [] ["Moses Ngari", "Osman Abdullahi", "Deche Sanga", "Geoffrey Katana", "Annie Willetts"] [""] [""] [""]
56 ["High-grade astrocytoma with ventricular invasion in a dog"] 10.1136/vetreccr-2019-000958 http://dx.doi.org/10.1136/vetreccr-2019-000958 2019-12-03T10:42:48Z ["General Veterinary"] 22 0 ["2052-6121"] Veterinary Record Case Reports <jats:p>A 13-year-old female German Shepherd dog was euthanised and submitted to necropsy after a 7-month history of prolonged recumbency and vocalisation. Gross anatomical changes consisted of a well-demarcated, 3.5×1.5 cm, soft red mass that effaced the right lateral ventricle and compressed the adjacent neuroparenchyma. Histologically, elongate neoplastic cells with astrocytic morphology were arranged in short bundles and streams supported by a neuropil-like stroma. Neoplastic cells were immunopositive for glial fibrillar acidic protein (GFAP) and oligodendrocyte transcription factor 2 (Olig2), and immunonegative for e-cadherin and pancytokeratin. Histological and immunohistochemical features were consistent with a high-grade astrocytoma with ventricular invasion, a rare feature of astrocytic tumours in dogs.</jats:p> 5 ["http://orcid.org/0000-0002-7128-8756"] ["Rayane Chitolina Pupin", "Daniel R Rissi", "Danilo Carloto Gomes", "Amanda Gimelli", "Mariana Isa Poci Palumbo"] [""] [""] [""]
58 ["Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands"] 10.1136/bmjdrc-2019-000767 http://dx.doi.org/10.1136/bmjdrc-2019-000767 2020-01-08T10:45:11Z [] 0 0 ["2052-4897"] BMJ Open Diabetes Research & Care <jats:sec><jats:title>Rationale and objectives</jats:title><jats:p>Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patients only received BIGUs, 19.1% of all patients started on BIGUs but switched to BIGU +SU. 13.5% of patients with T2DM initiated insulins, on average 532 days (almost 18 months) after the index date.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings showed that in the Netherlands, medication treatment in patients with T2DM is mainly consistent with the clinical guidelines in the Netherlands during the study period.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0003-2775-7276", "http://orcid.org/0000-0002-2957-5436"] ["Jan Maurik van den Heuvel", "Niloufar Farzan", "Mandy van Hoek", "Anke-Hilse Maitland-van der Zee", "Fariba Ahmadizar"] [""] [""] [""]
76 ["O5A.1\u2005Definition of case management for return-to-work in the approach of workers with musculoskeletal disorders: an update using a scoping review"] 10.1136/oem-2019-epi.110 http://dx.doi.org/10.1136/oem-2019-epi.110 2020-05-08T06:57:14Z ["Public Health, Environmental and Occupational Health"] 0 0 ["1351-0711", "1470-7926"] Occupational and Environmental Medicine <jats:sec><jats:title>Purpose</jats:title><jats:p>We aim to identify the elements and functions that define the case management in the individual approach of workers with musculoskeletal disorders for return to work and to propose an updated definition.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Relevant articles were identified through a computerized search up to 1 December 2017 in the bibliographic databases PubMed, Web of Science, Scopus, Cochrane Library, IBECS, EMBASE, and LILACS. Language filter (English and Spanish) was included in the search. The inclusion criteria were working age population with musculoskeletal disorders, studies that described or evaluated case management interventions, and return to work interventions. Military personnel, and rheumatic and surgical pathologies were excluded. Independent pairs reviewed all cites and articles and extracted data, and narrative synthesis was carried out.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Our searches identified 1950 possible relevant articles, of which 27 were included for data extraction. Of these, 15 papers included definitions of case management, and 14 common elements were identified. Twenty two explained the role of case manager and in 18 a description of tasks was found. In 25 articles referral services were mentioned. The most common defining elements were ‘return to work intervention’, ‘multidisciplinary assessment’ and ‘interdisciplinary intervention’ (53.8%). The 40% of the articles emphasized the ’coordination’, ‘to influence multiple factors’ (33.3%) and ‘individual approach’ (26.7%). The tasks included ’to establish goals and plan the rehabilitation for return to work’ (50%), and ’supervise or coordinate return to work process and to offer/refer the employee to services/adaptations or therapeutic workplaces’ (36.4%) The most common offered services were mental health (64.0%), and rehabilitation (48.0%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Despite… 5 [] ["Merc\u00e8 Soler Font", "Jos\u00e9 Maria Ramada Rodilla", "Jos\u00e9 Maria Gonzalez", "Francisco Palencia Sanchez", "Consol Serra Pujadas"] [""] [""] [""]
61 ["At the speed of Juul: measuring the Twitter conversation related to ENDS and Juul across space and time (2017\u20132018)"] 10.1136/tobaccocontrol-2019-055427 http://dx.doi.org/10.1136/tobaccocontrol-2019-055427 2020-03-20T21:16:55Z ["Public Health, Environmental and Occupational Health", "Health(social science)"] 0 0 ["0964-4563", "1468-3318"] Tobacco Control <jats:sec><jats:title>Background</jats:title><jats:p>Electronic nicotine delivery systems (ENDS) are the most-used tobacco product by adolescents, and Juul has rapidly become the most popular ENDS brand. Evidence indicates that Juul has been marketed heavily on social media. In light of recent lawsuits against the FDA spurred by claims that the agency responded inadequately to this marketing push, measuring the social media conversation about ENDS like Juul has important public health implications.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We employed search filters to collect Juul-related and other ENDS-related data from Twitter in 2017–2018 using Gnip Historic PowerTrack. Trained coders labelled random samples for Juul and ENDS relevance, and the labelled samples were used to train a supervised learning classifier to filter out irrelevant tweets. Tweets were geolocated into US counties and their <jats:italic>fitness for use</jats:italic> was assessed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The amount of Juul-related tweets increased 67 times over the study period (from 18 849 in the first quarter of 2017 to 1 287 028 in the last quarter of 2018), spreading widely across US counties. By the last quarter 2018, 34% of US counties had more than 6 Juul-related posts per 10 000 people, up from 0% in the first quarter 2017. However, during the same period, the total of non-Juul ENDS-related tweets decreased by 25%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Juul-related content grew exponentially on Twitter and spread across the entire country during the time when the brand was gaining market share. This social media buzz continued to increase even after FDA’s multiple interventions to curb promotions targeting minors.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0002-1685-1753", "http://orcid.org/0000-0002-3425-9155"] ["Yoonsang Kim", "Sherry L Emery", "Lisa Vera", "Bryn David", "Jidong Huang"] ["R01CA194681-04S1"] ["National Cancer Institute"] ["10.13039/100000054"]
67 ["Risk and protective factors associated with BV chronicity among women in Rakai, Uganda"] 10.1136/sextrans-2019-054145 http://dx.doi.org/10.1136/sextrans-2019-054145 2019-10-10T21:16:02Z ["Infectious Diseases", "Dermatology"] 0 0 ["1368-4973", "1472-3263"] Sexually Transmitted Infections <jats:sec><jats:title>Objectives</jats:title><jats:p>To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0001-9267-4384", "http://orcid.org/0000-0001-8762-6214"] ["Marie E Thoma", "Rebecca M Brotman", "Ronald H Gray", "Nelson K Sewankambo", "Maria J Wawer"] ["R01AI47608"] ["Eunice Kennedy Shriver National Institute of Child Health and Human Development", "Centers for Disease Control and Prevention", "National Institute of Allergy and Infectious Diseases"] ["10.13039/100009633", "10.13039/100000030", "10.13039/100000060"]
69 ["Cell therapy for the preterm infant: promise and practicalities"] 10.1136/archdischild-2019-317896 http://dx.doi.org/10.1136/archdischild-2019-317896 2020-04-06T21:15:32Z ["Obstetrics and Gynaecology", "Pediatrics, Perinatology, and Child Health", "General Medicine"] 0 0 ["1359-2998", "1468-2052"] Archives of Disease in Childhood - Fetal and Neonatal Edition <jats:p>Recent decades have seen the rapid progress of neonatal intensive care, and the survival rates of the most preterm infants are improving. This improvement is associated with changing patterns of morbidity and new phenotypes of bronchopulmonary dysplasia and preterm brain injury are recognised. Inflammation and immaturity are known contributors to their pathogenesis. However, a new phenomenon, the exhaustion of progenitor cells is emerging as an important factor. Current therapeutic approaches do not adequately address these new mechanisms of injury. Cell therapy, that is the use of stem and stem-like cells, with its potential to both repair and prevent injury, offers a new approach to these challenging conditions. This review will examine the rationale for cell therapy in the extremely preterm infant, the preclinical and early clinical evidence to support its use in bronchopulmonary dysplasia and preterm brain injury. Finally, it will address the challenges in translating cell therapy from the laboratory to early clinical trials.</jats:p> 5 ["http://orcid.org/0000-0001-6742-7314"] ["Elizabeth K Baker", "Susan E Jacobs", "Rebecca Lim", "Euan M Wallace", "Peter G Davis"] ["Research Training Program Scholarship"] ["University of Melbourne", "National Health and Medical Research Council"] ["10.13039/501100001782", "10.13039/501100000925"]
79 ["Processes and contexts influencing health inequalities among women who are mothers"] 10.1136/jech-2019-212229 http://dx.doi.org/10.1136/jech-2019-212229 2019-06-10T21:19:16Z ["Public Health, Environmental and Occupational Health", "Epidemiology"] 20 0 ["0143-005X", "1470-2738"] Journal of Epidemiology and Community Health <jats:p>This paper presents a conceptual framework that aims to conceptualise the different processes and contexts influencing health inequalities among women who are mothers. On the one hand, four processes are shown: (1) social stratification; (2) route into motherhood; (3) exposure and vulnerability to risk factors; and (4) generation of health inequalities. On the other hand, the role of the socioeconomic and political context, the labour market context, and the social, community and family context, as well as their inter-relationships, are presented. In addition, different family policy models, social values and cultural imperatives are considered.</jats:p> 5 ["http://orcid.org/0000-0001-6653-3393", "http://orcid.org/0000-0002-1170-2505"] ["Sara Trujillo-Alem\u00e1n", "Gloria Perez", "Jillian Reynolds", "Silvia Rueda", "Carme Borrell"] ["278173-2"] ["SOPHIE Project - Evaluating the Impact of Structural Policies on Health Inequalities and their Social Determinants and Fostering Change"] [[""]]

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