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    Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: a retrospective observational study.
    BMJ Open 2017 Nov 15;7(11):e019478. Epub 2017 Nov 15.
    Nuffield Department of Medicine, University of Oxford, Oxford, UK.
    Objectives: Kenyan guidelines for antibiotic treatment of pneumonia recommended treatment of pneumonia characterised by indrawing with injectable penicillin alone in inpatient settings until early 2016. At this point, they were revised becoming consistent with WHO guidance after results of a Kenyan trial provided further evidence of equivalence of oral amoxicillin and injectable penicillin. This change also made possible use of oral amoxicillin for outpatient treatment in this patient group. Read More

    What is the relationship between physical activity and cardiovascular risk factors in stroke survivors post completion of rehabilitation? Protocol for a longitudinal study.
    BMJ Open 2017 Nov 15;7(11):e019193. Epub 2017 Nov 15.
    Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia.
    Introduction: Physical activity (PA) can modify cardiovascular and other health risks in people with stroke, but we know little about long-term PA in this group. This study aims to describe PA levels and investigate relationships between PA, cardiovascular risk factors, mobility and participant characteristics (eg, age, mood and fatigue) in the 2 years following rehabilitation discharge after first stroke.

    Methods And Analysis: This is a longitudinal observational study with follow-up at 6, 12 and 24 months after rehabilitation discharge. Read More

    Changing physical activity behaviour for people with multiple sclerosis: protocol of a randomised controlled feasibility trial (iStep-MS).
    BMJ Open 2017 Nov 15;7(11):e018875. Epub 2017 Nov 15.
    Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK.
    Introduction: Although physical activity may reduce disease burden, fatigue and disability, and improve quality of life among people with multiple sclerosis (MS), many people with MS are physically inactive and spend significant time in sedentary behaviour. Behaviour change interventions may assist people with MS to increase physical activity and reduce sedentary behaviour. However, few studies have investigated their effectiveness using objective measures of physical activity, particularly in the long term. Read More

    Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort.
    BMJ Open 2017 Nov 15;7(11):e018746. Epub 2017 Nov 15.
    Division of Primary Care, University of Nottingham, University Park, Nottingham, UK.
    Objectives: Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women's smoking and quitting behaviour throughout pregnancy and after delivery.

    Design: Longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. Read More

    Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review.
    BMJ Open 2017 Nov 15;7(11):e018606. Epub 2017 Nov 15.
    The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
    Objective: To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice.

    Design: A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data.

    Data Sources: An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials. Read More

    A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus.
    BMJ Open 2017 Nov 15;7(11):e018598. Epub 2017 Nov 15.
    Department of Gastroenterology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
    Introduction: The prevalence of obesity and obesity-related diseases, including type 2 diabetes mellitus (T2DM), is increasing. Exclusion of the foregut, as occurs in Roux-en-Y gastric bypass, has a key role in the metabolic improvements that occur following bariatric surgery, which are independent of weight loss. Endoscopically placed duodenal-jejunal bypass sleeve devices, such as the EndoBarrier (GI Dynamics, Lexington, Massachusetts, USA), have been designed to create an impermeable barrier between chyme exiting the stomach and the mucosa of the duodenum and proximal jejunum. Read More

    Prevalence of diabetic retinopathy in children and young people living with diabetes: protocol for a systematic review.
    BMJ Open 2017 Nov 15;7(11):e018578. Epub 2017 Nov 15.
    GOS Institute of Child Health, University College London, London, UK.
    Introduction: The frequency of diabetes mellitus in childhood is increasing. Thus, more children and young people are at risk of developing diabetic retinopathy and diabetes related visual impairment. However, there is no consensus on optimal screening strategies for the paediatric population reflecting the lack of clarity about the current burden of disease in this group. Read More

    Qualitative evaluation of a deferred consent process in paediatric emergency research: a PREDICT study.
    BMJ Open 2017 Nov 15;7(11):e018562. Epub 2017 Nov 15.
    College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
    Background: A challenge of conducting research in critically ill children is that the therapeutic window for the intervention may be too short to seek informed consent prior to enrolment. In specific circumstances, most international ethical guidelines allow for children to be enrolled in research with informed consent obtained later, termed deferred consent (DC) or retrospective consent. There is a paucity of data on the attitudes of parents to this method of enrolment in paediatric emergency research. Read More

    Diagnostic and laboratory test ordering in Northern Portuguese Primary Health Care: a cross-sectional study.
    BMJ Open 2017 Nov 15;7(11):e018509. Epub 2017 Nov 15.
    MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
    Objectives: To characterise the test ordering pattern in Northern Portugal and to investigate the influence of context-related factors, analysing the test ordered at the level of geographical groups of family physicians and at the level of different healthcare organisations.

    Design: Cross-sectional study.

    Setting: Northern Primary Health Care, Portugal. Read More

    Identifying bioethical issues in biostatistical consulting: findings from a US national pilot survey of biostatisticians.
    BMJ Open 2017 Nov 16;7(11):e018491. Epub 2017 Nov 16.
    Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York, USA.
    Objectives: The overall purposes of this first US national pilot study were to (1) test the feasibility of online administration of the Bioethical Issues in Biostatistical Consulting (BIBC) Questionnaire to a random sample of American Statistical Association (ASA) members; (2) determine the prevalence and relative severity of a broad array of bioethical violations requests that are presented to biostatisticians by investigators seeking biostatistical consultations; and (3) establish the sample size needed for a full-size phase II study.

    Design: A descriptive survey as approved and endorsed by the ASA.

    Participants: Administered to a randomly drawn sample of 112 professional biostatisticians who were ASA members. Read More

    Dynamic treatment selection and modification for personalised blood pressure therapy using a Markov decision process model: a cost-effectiveness analysis.
    BMJ Open 2017 Nov 15;7(11):e018374. Epub 2017 Nov 15.
    Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Stanford, California, USA.
    Objective: Personalised medicine seeks to select and modify treatments based on individual patient characteristics and preferences. We sought to develop an automated strategy to select and modify blood pressure treatments, incorporating the likelihood that patients with different characteristics would benefit from different types of medications and dosages and the potential severity and impact of different side effects among patients with different characteristics.

    Design, Setting And Participants: We developed a Markov decision process (MDP) model to incorporate meta-analytic data and estimate the optimal treatment for maximising discounted lifetime quality-adjusted life-years (QALYs) based on individual patient characteristics, incorporating medication adjustment choices when a patient incurs side effects. Read More

    Prevalence of pregnancy-related pelvic girdle pain and associated factors in Australia: a cross-sectional study protocol.
    BMJ Open 2017 Nov 15;7(11):e018334. Epub 2017 Nov 15.
    School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia.
    Introduction: Pregnancy-related pelvic girdle pain (PPGP) is a common musculoskeletal disorder. Women with PPGP report difficulty performing everyday functional activities, such as standing and walking. However, the magnitude of the problem remains unknown in Australia. Read More

    Benefits and risks of Iron interventions in children (BRISC): protocol for a three-arm parallel-group randomised controlled field trial in Bangladesh.
    BMJ Open 2017 Nov 15;7(11):e018325. Epub 2017 Nov 15.
    Department of Medicine, The Royal Melbourne Hospital, Melbourne, Australia.
    Introduction: Anaemia is a major global health problem affecting about 43% of preschool children globally and 60% of 6-24-month-old children in rural Bangladesh, half of which is attributed to iron deficiency (ID). Although WHO recommends universal supplementation with iron or home fortification with iron-containing multiple micronutrient powders (MMPs) to children under 2 years, evidence for benefits of these interventions on childhood development (a key rationale for these interventions) and harms (especially infection) remains limited. This study aims to evaluate the impact of iron or MMPs supplementation compared with placebo on (a) children's development, (b) growth, (c) morbidity from infections and (d) haematological and iron indices. Read More

    What are older smokers' attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study.
    BMJ Open 2017 Nov 15;7(11):e018150. Epub 2017 Nov 15.
    School of Social and Community Medicine, University of Bristol, Bristol, UK.
    Objectives: To investigate whether age is associated with access to smoking cessation services.

    Design: Data from the Smoking Toolkit Study 2006-2015, a repeated multiwave cross-sectional household survey (n=181 157).

    Setting: England. Read More

    Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases who receive intraocular anti-VEGF injections (E-PsEYE): protocol for a randomised controlled trial.
    BMJ Open 2017 Nov 15;7(11):e018149. Epub 2017 Nov 15.
    Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
    Introduction: Because of the great potential of vascular endothelial growth factor inhibitors (anti-VEGF) for retinal exudative diseases, an increased number of patients receives this treatment. However, during this treatment, patients are subjected to frequent invasive intravitreal injections, and the effects on reversing the process of vision loss are uncertain, which may have negative consequences for patients' mental health. One in three patients experience at least mild symptoms of depression/anxiety. Read More

    Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial).
    BMJ Open 2017 Nov 15;7(11):e018145. Epub 2017 Nov 15.
    Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands.
    Introduction: Based on epidemiological, immunological and pathology data, the idea that appendicitis is not necessarily a progressive disease is gaining ground. Two types are distinguished: simple and complicated appendicitis. Non-operative treatment (NOT) of children with simple appendicitis has been investigated in several small studies. Read More

    Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland.
    BMJ Open 2017 Nov 15;7(11):e018086. Epub 2017 Nov 15.
    Association of Surgeons in Training, London, UK.
    Objectives: Applications for surgical training have declined over the last decade, and anecdotally the costs of training at the expense of the surgical trainee are rising. We aimed to quantify the costs surgical trainees are expected to cover for postgraduate training.

    Design: Prospective, cross-sectional, questionnaire-based study. Read More

    Logistic regression analysis of factors influencing the effectiveness of intensive sound masking therapy in patients with tinnitus.
    BMJ Open 2017 Nov 15;7(11):e018050. Epub 2017 Nov 15.
    Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
    Objectives: To investigate factors influencing the effectiveness of intensive sound masking therapy on tinnitus using logistic regression analysis.

    Design: The study used a retrospective cross-section analysis.

    Participants: 102 patients with tinnitus were recruited at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, China. Read More

    A national cohort study evaluating infant and fetal mortality caused by birth defects in Korea.
    BMJ Open 2017 Nov 15;7(11):e017963. Epub 2017 Nov 15.
    Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
    Objective: To analyse the prevalence of fetal and infant deaths due to birth defects in Korea and those trends according to maternal age.

    Design: Retrospective national cohort study SETTING: Korean Vital Statistics database of the Korean Statistical Information Service, between 2009 and 2015.

    Participants: 2176 infant deaths and 4343 fetal deaths caused by birth defects, among 3 181 145 total live births and 43 385 fetal deaths during the study periods. Read More

    Are IL18RAP gene polymorphisms associated with body mass regulation? A cross-sectional study.
    BMJ Open 2017 Nov 15;7(11):e017875. Epub 2017 Nov 15.
    Department of Genomic and Genetic Diagnosis Unit, Hospital Clínico Research Foundation (INCLIVA), Valencia, Spain.
    Objectives: To investigate the association between IL18RAP and body mass index (BMI) and obesity and to verify the effect of a polymorphism in the microRNA136 (MIR136) IL18RAP binding region.

    Design: We analysed samples from two Spanish cross-sectional studies, VALCAR (Spanish Mediterranean coast) and Hortega (Spanish centre). These studies aimed at analysing cardiovascular risk and development of cardiovascular disease in the general population. Read More

    'When it goes back to my normal I suppose': a qualitative study using online focus groups to explore perceptions of 'control' among people with eczema and parents of children with eczema in the UK.
    BMJ Open 2017 Nov 15;7(11):e017731. Epub 2017 Nov 15.
    Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
    Objective: To inform the development of a core outcome set for eczema by engaging with people with eczema and parents of children with eczema to understand their experiences and understanding of the concept 'eczema control'.

    Design: 37 participants took part in a total of six semi-structured online focus groups held in a typed chatroom with 5-7 participants per group. Three groups involved adults with eczema and three groups involved parents of children with eczema. Read More

    Menopausal hormone therapy and colorectal cancer: a linkage between nationwide registries in Norway.
    BMJ Open 2017 Nov 15;7(11):e017639. Epub 2017 Nov 15.
    Department of Research, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway.
    Objectives: With the present study, we aimed to investigate the association between menopausal hormone therapy (HT) and risk of colorectal cancer (CRC).

    Setting: Cohort study based on the linkage of Norwegian population-based registries.

    Participants: We selected 466822 Norwegian women, aged 55-79, alive and residing in Norway as of 1 January 2004, and we followed them from 2004 to 2008. Read More

    Lipid profiles and determinants of total cholesterol and hypercholesterolaemia among 25-74 year-old urban and rural citizens of the Yangon Region, Myanmar: a cross-sectional study.
    BMJ Open 2017 Nov 15;7(11):e017465. Epub 2017 Nov 15.
    Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Objective: The first is to estimate the prevalence of dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia, high low-density lipoprotein (LDL) level and low high-density lipoprotein (HDL) level), as well as the mean levels of total cholesterol, triglyceride, LDL and HDL, in the urban and rural Yangon Region, Myanmar. The second is to investigate the association between urban-rural location and total cholesterol.

    Design: Two cross-sectional studies using the WHO STEPS methodology. Read More

    Impact of informal caregiving on older adults' physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO's Study on global AGEing and adult health (SAGE).
    BMJ Open 2017 Nov 15;7(11):e017236. Epub 2017 Nov 15.
    Faculty of Health, Deakin University, Geelong, Australia.
    Objectives: A high proportion of care stemming from chronic disease or disability in low-income and middle-income countries is provided by informal caregivers. The goal of this study was to determine the level of burden experienced by these caregivers, explore associated factors and assess whether caregivers' and non-caregivers' health differed.

    Design And Setting: This cross-sectional study was a secondary analysis of data on caregivers' burden, health and health risk factors in Ghana, India and the Russian Federation collected as part of the WHO's Study on global AGEing and adult health (SAGE) Wave 1. Read More

    Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes.
    BMJ Open 2017 Nov 15;7(11):e017184. Epub 2017 Nov 15.
    Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK.
    Objective: Explore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals.

    Design: Systematic review of economic evaluations.

    Data Sources And Eligibility Criteria: Database searches (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. Read More

    Unequal cluster sizes in stepped-wedge cluster randomised trials: a systematic review.
    BMJ Open 2017 Nov 15;7(11):e017151. Epub 2017 Nov 15.
    Department of Health Sciences, University of Leicester, Leicester, UK.
    Objectives: To investigate the extent to which cluster sizes vary in stepped-wedge cluster randomised trials (SW-CRT) and whether any variability is accounted for during the sample size calculation and analysis of these trials.

    Setting: Any, not limited to healthcare settings.

    Participants: Any taking part in an SW-CRT published up to March 2016. Read More

    Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries.
    BMJ Open 2017 Nov 15;7(11):e017122. Epub 2017 Nov 15.
    Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
    Objectives: Antenatal care (ANC) is an essential part of primary healthcare and its provision has expanded worldwide. There is limited evidence of large-scale cross-country studies on the impact of ANC offered to pregnant women on child health outcomes. We investigate the association of ANC in low-income and middle-income countries with short- and long-term mortality and nutritional child outcomes. Read More

    Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study.
    BMJ Open 2017 Nov 15;7(11):e016221. Epub 2017 Nov 15.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Objectives: To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs).

    Design: Ecological time-trend analysis and a prospective cohort study.

    Setting: Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. Read More

    Knowledge, attitudes and intention regarding mHealth in generation Y: evidence from a population based cross sectional study in Chakaria, Bangladesh.
    BMJ Open 2017 Nov 15;7(11):e016217. Epub 2017 Nov 15.
    Partners in Population and Development, Dhaka, Bangladesh.
    Background And Objectives: mHealth offers a new opportunity to ensure access to qualified healthcare providers. Therefore, to better understand its potential in Bangladesh, it is important to understand how young people use mobile phones for healthcare. Here we examine the knowledge, attitudes and intentions to use mHealth services among young population. Read More

    Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial: a protocol for the pragmatic randomised study of appendicitis treatment.
    BMJ Open 2017 Nov 15;7(11):e016117. Epub 2017 Nov 15.
    Department of Emergency Medicine, Olive-View UCLA Medical Center, Sylmar, California, USA.
    Introduction: Several European studies suggest that some patients with appendicitis can be treated safely with antibiotics. A portion of patients eventually undergo appendectomy within a year, with 10%-15% failing to respond in the initial period and a similar additional proportion with suspected recurrent episodes requiring appendectomy. Nearly all patients with appendicitis in the USA are still treated with surgery. Read More

    Effects of health and social care spending constraints on mortality in England: a time trend analysis.
    BMJ Open 2017 Nov 15;7(11):e017722. Epub 2017 Nov 15.
    Department of Applied Health Research, University College London, London, UK.
    Objective: Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates.

    Methods: We collected data on health and social care resources and finances for England from 2001 to 2014. Read More

    What Happens After Menopause? (WHAM): protocol for a prospective, multicentre, age-matched cohort trial of risk-reducing bilateral salpingo-oophorectomy in high-risk premenopausal women.
    BMJ Open 2017 Nov 14;7(11):e018758. Epub 2017 Nov 14.
    Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
    Introduction: Women at high inherited risk of ovarian cancer are advised to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 40-45 years or when their families are complete. Most women are premenopausal at this age, so RRBSO will induce surgical menopause. Despite the clear benefits of RRBSO for cancer risk reduction, much less is known about the impact on non-cancer outcomes that contribute to health and well-being and inform surveillance and management strategies. Read More

    Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study.
    BMJ Open 2017 Nov 14;7(11):e018527. Epub 2017 Nov 14.
    Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
    Objective: To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes.

    Design: Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews.

    Participants: Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings. Read More

    Validation of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale Dutch language version in patients with hindfoot fractures.
    BMJ Open 2017 Nov 14;7(11):e018314. Epub 2017 Nov 14.
    Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Objectives: The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most used questionnaires for measuring functional recovery after a hindfoot injury. Recently, this instrument was translated and culturally adapted into a Dutch version. In this study, the measurement properties of the Dutch language version (DLV) were investigated in patients with a unilateral hindfoot fracture. Read More

    Impact of improved insulation and heating on mortality risk of older cohort members with prior cardiovascular or respiratory hospitalisations.
    BMJ Open 2017 Nov 14;7(11):e018079. Epub 2017 Nov 14.
    Public Health Department, University of Otago, Wellington, New Zealand.
    Objectives: We carried out an evaluation of a large-scale New Zealand retrofit programme using administrative data that provided the statistical power to assess the effect of insulation and/or heating retrofits on cardiovascular and respiratory-related mortality in people aged 65 and over with prior respiratory or circulatory hospitalisations.

    Design: Quasi-experimental cohort study based on administrative data.

    Setting: New Zealand. Read More

    MONITOR-IC study, a mixed methods prospective multicentre controlled cohort study assessing 5-year outcomes of ICU survivors and related healthcare costs: a study protocol.
    BMJ Open 2017 Nov 14;7(11):e018006. Epub 2017 Nov 14.
    Department of Intensive Care Medicine, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands.
    Introduction: Due to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors' HRQoL, is mostly unknown. Read More

    Long-term prognosis of young breast cancer patients (≤40 years) who did not receive adjuvant systemic treatment: protocol for the PARADIGM initiative cohort study.
    BMJ Open 2017 Nov 14;7(11):e017842. Epub 2017 Nov 14.
    Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands.
    Introduction: Currently used tools for breast cancer prognostication and prediction may not adequately reflect a young patient's prognosis or likely treatment benefit because they were not adequately validated in young patients. Since breast cancers diagnosed at a young age are considered prognostically unfavourable, many treatment guidelines recommend adjuvant systemic treatment for all young patients. Patients cured by locoregional treatment alone are, therefore, overtreated. Read More

    Health literacy in Italy: a cross-sectional study protocol to assess the health literacy level in a population-based sample, and to validate health literacy measures in the Italian language.
    BMJ Open 2017 Nov 14;7(11):e017812. Epub 2017 Nov 14.
    Departement of Health Science, University of Florence, Florence, Italy.
    Introduction: Health literacy (HL) concerns the knowledge and competences necessary for people to meet complex health demands. The aims of this study are to assess the level of HL in a sample using the Italian version of the Newest Vital Sign and the association of HL and selected antecedents with health outcomes, and to develop and validate the Italian version of the three Brief Health Literacy Screeners, two subjective numeracy items and the short form and the short-short form of the European Health Literacy Survey Questionnaire.

    Methods And Analysis: The study adopts a cross-sectional design and is being conducted in Florence, with information collected through telephone interviews. Read More

    Does the impact of a plant-based diet during pregnancy on birth weight differ by ethnicity? A dietary pattern analysis from a prospective Canadian birth cohort alliance.
    BMJ Open 2017 Nov 14;7(11):e017753. Epub 2017 Nov 14.
    Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
    Objective: Birth weight is an indicator of newborn health and a strong predictor of health outcomes in later life. Significant variation in diet during pregnancy between ethnic groups in high-income countries provides an ideal opportunity to investigate the influence of maternal diet on birth weight.

    Setting: Four multiethnic birth cohorts based in Canada (the NutriGen Alliance). Read More

    Development of a discussion tool to enable well-being by providing choices for people with dementia: a qualitative study incorporating codesign and participatory action research.
    BMJ Open 2017 Nov 14;7(11):e017672. Epub 2017 Nov 14.
    RDNS Research Institute, Royal District Nursing Service, St Kilda, Victoria, Australia.
    Objective: To codesign a discussion tool to facilitate negotiation of risk between health professionals, people with dementia and carers.

    Methods: A qualitative approach using codesign. Thematic analysis was used to analyse interviews and focus groups with people with dementia, carers, healthcare staff and healthy older people exploring the issue of risk in dementia, the acceptability and development of a discussion tool. Read More

    Effect of iron and zinc-biofortified pearl millet consumption on growth and immune competence in children aged 12-18 months in India: study protocol for a randomised controlled trial.
    BMJ Open 2017 Nov 14;7(11):e017631. Epub 2017 Nov 14.
    Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
    Introduction: Biofortified crops represent a sustainable agricultural solution for the widespread micronutrient malnutrition in India and other resource-limited settings. This study aims to investigate the effect of the consumption of foods prepared with iron- and zinc-biofortified pearl millet (FeZn-PM) by children on biomarkers of iron and zinc status, growth, and immune function.

    Methods And Analysis: We will conduct a randomised controlled feeding trial in identified slums of Mumbai, India among 200 children aged between 12 and 18 months. Read More

    Assessing the consequences of gestational diabetes mellitus on offspring's cardiovascular health: MySweetHeart Cohort study protocol, Switzerland.
    BMJ Open 2017 Nov 14;7(11):e016972. Epub 2017 Nov 14.
    Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
    Introduction: Gestational diabetes mellitus (GDM) is a state of glucose intolerance with onset during pregnancy. GDM carries prenatal and perinatal risks as well as long-term risks for the mother and her child. GDM may be involved in the foetal programming of long-term cardiovascular health. Read More

    Electrosclerotherapy for capillary malformations: study protocol for a randomised within-patient controlled pilot trial.
    BMJ Open 2017 Nov 14;7(11):e016401. Epub 2017 Nov 14.
    Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Noord-Holland, Netherlands.
    Introduction: The current state-of-the-art treatment modality for hypertrophic capillary malformations (CMs), laser therapy, has a considerable rate of non-responders and recurrence. Intralesional bleomycin injections (or 'sclerotherapy') are commonly used to treat venous and lymphatic malformations with an excellent effect, but these intravascular injections are not possible in CMs due to the small diameter of the vessels. Electroporation-an electric field applied to the tissue-could increase the permeability of endothelial cells, which could theoretically facilitate targeted localised bleomycin delivery. Read More

    Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014.
    BMJ Open 2017 Nov 14;7(11):e016210. Epub 2017 Nov 14.
    Division of Emergencies and Critical Care, The Intervention Centre, Oslo University Hospital, Oslo, Norway.
    Objective: The numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important.

    Methods: This retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. Read More

    Incidence of shoulder dislocations in the UK, 1995-2015: a population-based cohort study.
    BMJ Open 2017 Nov 14;7(11):e016112. Epub 2017 Nov 14.
    Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
    Objective: This cohort study evaluates the unknown age-specific and gender-specific incidence of primary shoulder dislocations in the UK.

    Setting: UK primary care data from the Clinical Practice Research Datalink (CPRD) were used to identify patients aged 16-70 years with a shoulder dislocation during 1995-2015. Coding of primary shoulder dislocations was validated using the CPRD general practitioner questionnaire service. Read More

    Cross-sectional study evaluating data quality of the National Cancer Registration and Analysis Service (NCRAS) prostate cancer registry data using the Cluster randomised trial of PSA testing for Prostate cancer (CAP).
    BMJ Open 2017 Nov 14;7(11):e015994. Epub 2017 Nov 14.
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Objectives: To compare the completeness and agreement of prostate cancer data recorded by the National Cancer Registration and Analysis Service (NCRAS) with research-level data specifically abstracted from medical records from the Cluster randomised triAl of prostate specific antigen (PSA) testing for Prostate cancer (CAP) trial.

    Design: Cross-sectional comparison study.

    Participants: We included 1356 men from the CAP trial cohort who were linked to the NCRAS registry. Read More

    Current status of postnatal depression smartphone applications available on application stores: an information quality analysis.
    BMJ Open 2017 Nov 14;7(11):e015655. Epub 2017 Nov 14.
    Institute of Mental Health, Singapore, Singapore.
    Objectives: It is the aim of the current research to identify some common functionalities of postnatal application, and to determine the quality of the information content of postnatal depression application using validated scales that have been applied for applications in other specialties.

    Settings And Participants: To determine the information quality of the postnatal depression smartphone applications, the two most widely used smartphone application stores, namely Apple iTunes as well as Google Android Play store, were searched between 20May and 31 May. No participants were involved. Read More

    The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England.
    BMJ Open 2017 Nov 14;7(11):e015594. Epub 2017 Nov 14.
    Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland.
    Objectives: To estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents.

    Study Design: To estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a 'de novo' analysis was performed. Read More

    Stoic beliefs and health: development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale.
    BMJ Open 2017 Nov 14;7(11):e015137. Epub 2017 Nov 14.
    Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA.
    Introduction: We developed and validated a new parsimonious scale to measure stoic beliefs. Key domains of stoicism are imperviousness to strong emotions, indifference to death, taciturnity and self-sufficiency. In the context of illness and disease, a personal ideology of stoicism may create an internal resistance to objective needs, which can lead to negative consequences. Read More

    Prospective daily diary study reporting of any and all symptoms in healthy adults in Pakistan: prevalence and response.
    BMJ Open 2017 Nov 14;7(11):e014998. Epub 2017 Nov 14.
    University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
    Objectives: Prevalence of symptoms in everyday life and how people respond to these symptoms is little studied outside Western culture and developed countries. We sought to use modified diary methods to explore the prevalence of and responses to symptoms in Pakistan.

    Design: Prospective daily survey of symptoms and response. Read More

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