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    What is the effect of secondary (high) schooling on subsequent medical school performance? A national, UK-based, cohort study.
    BMJ Open 2018 May 23;8(5):e020291. Epub 2018 May 23.
    Department of Health Sciences, University of York, Heslington, UK.
    Objectives: University academic achievement may be inversely related to the performance of the secondary (high) school an entrant attended. Indeed, some medical schools already offer 'grade discounts' to applicants from less well-performing schools. However, evidence to guide such policies is lacking. Read More

    Reporting quality of randomised controlled trial abstracts on age-related macular degeneration health care: a cross-sectional quantification of the adherence to CONSORT abstract reporting recommendations.
    BMJ Open 2018 May 22;8(5):e021912. Epub 2018 May 22.
    Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58448 Witten, Germany.
    Objective: To assess the reporting quality of randomised controlled trial (RCT) abstracts on age-related macular degeneration (AMD) healthcare, to evaluate the adherence to the Consolidated Standards of Reporting Trials (CONSORT) statement's recommendations on minimum abstract information and to identify journal characteristics associated with abstract reporting quality.

    Design: Cross-sectional evaluation of RCT abstracts on AMD healthcare.

    Methods: A PubMed search was implemented to identify RCT abstracts on AMD healthcare published in the English language between January 2004 and December 2013. Read More

    Development and validation of two clinical prediction models to inform clinical decision-making for lumbar spinal fusion surgery for degenerative disorders and rehabilitation following surgery: protocol for a prospective observational study.
    BMJ Open 2018 May 22;8(5):e021078. Epub 2018 May 22.
    Scientific Institute for Quality of Healthcare, Radboud UMC, Nijmegen, The Netherlands.
    Introduction: Potential predictors of poor outcome will be measured at baseline: (1) preoperatively to develop a clinical prediction model to predict which patients are likely to have favourable outcome following lumbar spinal fusion surgery (LSFS) and (2) postoperatively to predict which patients are likely to have favourable long-term outcomes (to inform rehabilitation).

    Methods And Analysis: Prospective observational study with a defined episode inception of the point of surgery. Electronic data will be collected through the British Spine Registry and will include patient-reported outcome measures (eg, Fear-Avoidance Beliefs Questionnaire) and data items (eg, smoking status). Read More

    Improving predictive asthma algorithms with modelled environment data for Scotland: an observational cohort study protocol.
    BMJ Open 2018 May 20;8(5):e023289. Epub 2018 May 20.
    Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, The University of Edinburgh, Edinburgh, UK.
    Introduction: Asthma has a considerable, but potentially, avoidable burden on many populations globally. Scotland has some of the poorest health outcomes from asthma. Although ambient pollution, weather changes and sociodemographic factors have been associated with asthma attacks, it remains unclear whether modelled environment data and geospatial information can improve population-based asthma predictive algorithms. Read More

    Public attitudes in England towards the sharing of personal data following a mass casualty incident: a cross-sectional study.
    BMJ Open 2018 May 20;8(5):e022852. Epub 2018 May 20.
    Department of Psychological Medicine, King's College London, London, UK.
    Objectives: To assess public attitudes towards data sharing to facilitate a mental health screening programme for people caught up in a mass casualty incident.

    Design: Two, identical, cross-sectional, online surveys, using quotas to ensure demographic representativeness of people aged 18-65 years in England. Participants were randomly allocated to consider a scenario in which they witness a terrorism-related radiation incident or mass shooting, after which a police officer records their contact details. Read More

    Severe outcomes associated with respiratory viruses in newborns and infants: a prospective viral surveillance study in Jordan.
    BMJ Open 2018 May 20;8(5):e021898. Epub 2018 May 20.
    Department of Pediatrics, Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
    Objective: To assess virus-specific hospitalisation rates, risk factors for illness severity and seasonal trends in children hospitalised with acute respiratory infections (ARI).

    Design: Prospective cohort study.

    Setting: A government hospital serving low-income and middle-income population in Amman, Jordan. Read More

    Adolescent self-consent for vaccinations: protocol for a mixed methods systematic review.
    BMJ Open 2018 May 20;8(5):e021335. Epub 2018 May 20.
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Introduction: The recent global expansion of routine adolescent vaccination programmes has the potential to protect young people against the acquisition of infectious disease and improve their health. Although in many countries the legal framework supports young people to provide consent for medical interventions if they are considered competent, written parental consent can act as a barrier to uptake as it is frequently a condition of adolescent vaccination programmes. The aim of this systematic review protocol is to document the methods which will be used to identify, appraise and synthesise the available qualitative and quantitative evidence to address: (1) whether implementation of adolescent self-consent procedures can increase vaccination uptake and (2) the barriers and facilitators to implementation of adolescent self-consent procedures. Read More

    Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore.
    BMJ Open 2018 May 20;8(5):e021291. Epub 2018 May 20.
    Health Services and Outcomes Research, National Healthcare Group, Singapore.
    Objective: Multimorbidity in patients with heart failure (HF) results in poor prognosis and is an increasing public health concern. We aim to examine the effect of multimorbidity focusing on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) on all-cause and cardiovascular disease (CVD)-specific mortality among patients diagnosed with HF in Singapore.

    Design: Retrospective cohort study. Read More

    Evaluation of an intervention programme addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a feasibility trial (ABLE).
    BMJ Open 2018 May 20;8(5):e020812. Epub 2018 May 20.
    The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.
    Introduction: The number of persons living with a chronic condition is increasing worldwide. Conditions are considered chronic when lasting 1 year or more and requiring ongoing medical attention and/or limiting activities of daily living (ADL). Besides medical treatment, physical exercise to improve body functions is recommended and prescribed. Read More

    Induced endometrial trauma (endometrial scratch) in the mid-luteal menstrual cycle phase preceding first cycle IVF/ICSI versus usual IVF/ICSI therapy: study protocol for a randomised controlled trial.
    BMJ Open 2018 May 20;8(5):e020755. Epub 2018 May 20.
    Fertility Unit - Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
    Introduction: Endometrial trauma commonly known as endometrial scratch (ES) has been shown to improve pregnancy rates in women with a history of repeated implantation failure undergoing in vitro fertilisation (IVF), with or without intracytoplasmic sperm injection (ICSI). However, the procedure has not yet been fully explored in women having IVF/ICSI for the first time. This study aims to examine the effect of performing an ES in the mid-luteal phase prior to a first-time IVF/ICSI cycle on the chances of achieving a clinical pregnancy and live birth. Read More

    Relationships between functional fitness and cognitive impairment in Chinese community-dwelling older adults: a cross-sectional study.
    BMJ Open 2018 May 20;8(5):e020695. Epub 2018 May 20.
    Chronic disease prevention and control, Wuhan Centers for Disease Prevention and Control, Wuhan, China.
    Objective: The aim of this study was to investigate the associations between each functional fitness (FF) domain and cognitive impairment (CI) in Chinese community-dwelling older adults.

    Design: A community-based, cross-sectional study was conducted.

    Setting: Participants were selected by multistage stratified random sampling in Wuhan City, Hubei Province, Central China, during December 2015-May 2016. Read More

    Teaching the relationship between health and climate change: a systematic scoping review protocol.
    BMJ Open 2018 May 20;8(5):e020330. Epub 2018 May 20.
    Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
    Introduction: The observed and projected impacts of climate change on human health are significant. While climate change has gathered global momentum and is taught frequently, the extent to which the relationships between climate change and health are taught remains uncertain. Education provides an opportunity to create public engagement on these issues, but the extent to which historical implementation of climate health education could be leveraged is not well understood. Read More

    Neighbourhood socioeconomic position and risks of major chronic diseases and all-cause mortality: a quasi-experimental study.
    BMJ Open 2018 May 20;8(5):e018793. Epub 2018 May 20.
    Department of Economics, University of Toronto, Toronto, Ontario, Canada.
    Objectives: This study estimated the health impacts of neighbourhood socioeconomic position (SEP) among public housing residents. Because applicants to public housing were assigned to housing projects primarily based on factors other than personal choice, we capitalised on a quasirandom source of variation in neighbourhood of residence to obtain more valid estimates of the health impacts of neighbourhood SEP.

    Design: Quasiexperimental study. Read More

    Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.
    BMJ Open 2018 May 18;8(5):e019865. Epub 2018 May 18.
    Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
    Objectives: To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk.

    Methods: Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). Read More

    Determining the pneumococcal conjugate vaccine coverage required for indirect protection against vaccine-type pneumococcal carriage in low and middle-income countries: a protocol for a prospective observational study.
    BMJ Open 2018 May 18;8(5):e021512. Epub 2018 May 18.
    Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
    Introduction: Pneumococcal conjugate vaccines (PCVs) prevent disease through both direct protection of vaccinated individuals and indirect protection of unvaccinated individuals by reducing nasopharyngeal (NP) carriage and transmission of vaccine-type (VT) pneumococci. While the indirect effects of PCV vaccination are well described, the PCV coverage required to achieve the indirect effects is unknown. We will investigate the relationship between PCV coverage and VT carriage among undervaccinated children using hospital-based NP pneumococcal carriage surveillance at three sites in Asia and the Pacific. Read More

    Determinants of return at work of breast cancer patients: results from the OPTISOINS01 French prospective study.
    BMJ Open 2018 May 18;8(5):e020276. Epub 2018 May 18.
    Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France.
    Introduction: Return to work (RTW) after breast cancer (BC) is still a new field of research. The factors determining shorter sick leave duration of patients with BC have not been clearly identified. The aim of this study was to describe work during BC treatment and to identify factors associated with sick leave duration. Read More

    Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis.
    BMJ Open 2018 May 18;8(5):e019912. Epub 2018 May 18.
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
    Objective: To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices.

    Design: Systematic review and meta-analysis.

    Setting, Participants, Interventions: Seven electronic databases were searched to January 2018. Read More

    Vapour, gas, dust and fume occupational exposures in male patients with rheumatoid arthritis resident in Cornwall (UK) and their association with rheumatoid factor and anti-cyclic protein antibodies: a retrospective clinical study.
    BMJ Open 2018 May 17;8(5):e021754. Epub 2018 May 17.
    Rheumatology Department, Royal Cornwall Hospital, Truro, Cornwall, UK.
    Objectives: To quantify exposure to vapour, gas, dust and fumes (VGDF) and smoking in male rheumatoid arthritis (RA) and investigate impact on rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) levels.

    Design: A retrospective observational study.

    Setting: The Royal Cornwall Hospital Trust, UK. Read More

    Effect of dietary omega-3 fatty acid supplementation on frailty-related phenotypes in older adults: a systematic review and meta-analysis protocol.
    BMJ Open 2018 May 17;8(5):e021344. Epub 2018 May 17.
    NIHR Nottingham BRC, Nottingham, UK.
    Introduction: The beneficial effect of dietary omega-3 supplementation in younger adults or older people with acute or chronic disease is established. Knowledge is now needed about the effect in medically stable older people. The objective of this study is to examine and assess the evidence for a role of dietary omega-3 polyunsaturated fatty acid (PUFA) supplementation in older adults on (1) muscle mass and muscle strength, (2) inflammatory biomarkers and (3) physical activity. Read More

    Investigating admitted patients' satisfaction with nursing care at Debre Berhan Referral Hospital in Ethiopia: a cross-sectional study.
    BMJ Open 2018 May 17;8(5):e021107. Epub 2018 May 17.
    Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia.
    Objectives: The aims of the study were (1) to assess the level of patient satisfaction with nursing care and (2) to identify factors influencing patient satisfaction.

    Design: A hospital-based, cross-sectional study was conducted with 252 admitted patients in the medical, surgical and paediatric wards.

    Setting: Debre Berhan Referral Hospital, Debre Berhan, Ethiopia, with a catchment population of 2. Read More

    Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey.
    BMJ Open 2018 May 17;8(5):e021006. Epub 2018 May 17.
    Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
    Objective: Understanding the factors that influence human papillomavirus (HPV) vaccination uptake is critically important to the design of effective vaccination programmes. In Switzerland, HPV vaccination uptake (≥1 dose) by age 16 years among women ranges from 31% to 80% across 26 cantons (states). Our objective was to identify factors that are associated with the spatial variation in HPV vaccination uptake. Read More

    Accuracy of lung cancer ICD-9-CM codes in Umbria, Napoli 3 Sud and Friuli Venezia Giulia administrative healthcare databases: a diagnostic accuracy study.
    BMJ Open 2018 May 17;8(5):e020628. Epub 2018 May 17.
    Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy.
    Objectives: To assess the accuracy of International Classification of Diseases 9th Revision-Clinical Modification (ICD-9-CM) codes in identifying subjects with lung cancer.

    Design: A cross-sectional diagnostic accuracy study comparing ICD-9-CM 162.x code (index test) in primary position with medical chart (reference standard). Read More

    Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study.
    BMJ Open 2018 May 17;8(5):e020566. Epub 2018 May 17.
    Swiss Patient Safety Foundation, Zürich, Switzerland.
    Objectives: In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians.

    Design: Qualitative study with semistructured interviews. Read More

    Comparison of the effect of immediate versus delayed transfer following a stimulated IVF cycle on the ongoing pregnancy rate of frozen-thawed embryo transfer cycles: a study protocol for a randomised controlled trial.
    BMJ Open 2018 May 17;8(5):e020507. Epub 2018 May 17.
    Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong.
    Introduction: Frozen-thawed embryo transfer (FET) has become an increasingly important part of in-vitro fertilisation (IVF) treatment. Currently, there is still no good scientific evidence to support when to perform FET following a stimulated IVF cycle. Since all published studies are retrospective and the findings are contradictory, a randomised controlled study is needed to provide Level 1 evidence to guide the clinical practice. Read More

    Protocol for the validation of sensitivity and specificity of the Cow's Milk-related Symptom Score (CoMiSS) against open food challenge in a single-blinded, prospective, multicentre trial in infants.
    BMJ Open 2018 May 17;8(5):e019968. Epub 2018 May 17.
    Children's Hospital Zhejiang, University School of Medicine, Hangzhou, China.
    Introduction: The symptoms of cow's milk protein allergy (CMPA) in infancy can be non-specific which may delay a correct diagnosis and cause adverse clinical outcomes. The diagnosis of non-IgE-mediated CMPA is particularly complex as it involves a 2 to 4 week elimination diet followed by oral food challenge (OFC). The Cow's Milk-related Symptom Score (CoMiSS) is a clinical resource for primary healthcare providers which aims to increase awareness of CMPA symptoms to facilitate an earlier diagnosis. Read More

    Which anthropometric measures best indicate type 2 diabetes among Russian, Somali and Kurdish origin migrants in Finland? A cross-sectional study.
    BMJ Open 2018 May 17;8(5):e019166. Epub 2018 May 17.
    Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
    Objectives: To compare the performance of body mass index (BMI), waist-to-height ratio (WHtR), waist circumference (WC) and waist-to-hip ratio (WHR) in detecting type 2 diabetes among Russian, Somali and Kurdish (born in Iraq/Iran) origin migrants and Finns.

    Design And Participants: Cross-sectional study comparing health examination survey data of Russian, Somali and Kurdish origin migrants (n=917) aged 30-64 years who took part in the Migrant Health and Wellbeing Survey with the general Finnish population in the Health 2011 Survey (n=887). Participants were randomly selected from the National Population Register. Read More

    Electroacupuncture as a complement to usual care for patients with non-acute low back pain after back surgery: a pilot randomised controlled trial.
    BMJ Open 2018 May 17;8(5):e018464. Epub 2018 May 17.
    Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, The Republic of Korea.
    Objectives: The aim of this pilot study was to estimate the sample size for a large pragmatic study of the comparative effectiveness of electroacupuncture (EA) for low back pain (LBP) after back surgery.

    Design: A randomised, active-controlled, assessor-blinded trial.

    Participants: Patients with recurrent or persistent LBP, defined as a Visual Analogue Scale (VAS) score of ≥50 mm, with or without leg pain after back surgery. Read More

    Automated, computer-guided PASI measurements by digital image analysis versus conventional physicians' PASI calculations: study protocol for a comparative, single-centre, observational study.
    BMJ Open 2018 May 17;8(5):e018461. Epub 2018 May 17.
    Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
    Introduction: Reliable and accurate assessment of severity in psoriasis is very important in order to meet indication criteria for initiation of systemic treatment or to evaluate treatment efficacy. The most acknowledged tool for measuring the extent of psoriatic skin changes is the Psoriasis Area and Severity Index (PASI). However, the calculation of PASI can be tedious and subjective and high intraobserver and interobserver variability is an important concern. Read More

    Optimum hospice at home services for end-of-life care: protocol of a mixed-methods study employing realist evaluation.
    BMJ Open 2018 May 16;8(5):e021192. Epub 2018 May 16.
    Centre for Health Services Studies, University of Kent, Canterbury, UK.
    Introduction: Hospice at home (HAH) services aim to enable patients to be cared for and die in their place of choice, if that is at home, and to achieve a 'good death'. There is a considerable range of HAH services operating in England. The published evidence focuses on evaluations of individual services which vary considerably, and there is a lack of consistency in terms of the outcome measures reported. Read More

    Early use of Antibiotics for at Risk CHildren with InfluEnza (ARCHIE): protocol for a double-blind, randomised, placebo-controlled trial.
    BMJ Open 2018 May 16;8(5):e021144. Epub 2018 May 16.
    Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
    Introduction: Influenza and influenza-like illness (ILI) create considerable burden on healthcare resources each winter. Children with pre-existing conditions such as asthma, diabetes mellitus and cerebral palsy are among those at greatest risk of clinical deterioration from influenza/ILI. The Antibiotics for at Risk CHildren with InfluEnza (ARCHIE) trial aims to determine whether early oral treatment with the antibiotic co-amoxiclav reduces the likelihood of reconsultation due to clinical deterioration in these 'at risk' children. Read More

    White matter hyperintensities and their subtypes in patients with carotid artery stenosis: a systematic review and meta-analysis.
    BMJ Open 2018 May 16;8(5):e020830. Epub 2018 May 16.
    Department of Neurology, Cerebrovascular Disease Center, People's Hospital, China Medical University, Shenyang, People's Republic of China.
    Objective: We aimed to perform a systematic review and meta-analysis to clarify the association between white matter hyperintensities (WMHs) and carotid artery (CA) stenosis.

    Study Design: Systematic review and meta-analysis.

    Participants: CA stenosis was set at ≥50%, and WMHs were assessed by MRI and evaluated quantitatively or semiquantitatively. Read More

    Long-term effects of bariatric surgery on acute kidney injury: a propensity-matched cohort in the UK Clinical Practice Research Datalink.
    BMJ Open 2018 May 16;8(5):e020371. Epub 2018 May 16.
    Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
    Objective: Bariatric surgery is an effective method of weight reduction and has been associated with acute kidney injury (AKI) as a perioperative event. However, the long-term effects of the weight reduction after surgery on AKI are unknown. The objective of this study is to quantify the association of bariatric surgery with later risk of AKI. Read More

    Effectiveness of 23-valent pneumococcal polysaccharide vaccine on elderly long-term cancer survivors: a population-based propensity score matched cohort study.
    BMJ Open 2018 May 16;8(5):e019364. Epub 2018 May 16.
    Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Objective: The Advisory Committee on Immunization Practices in 2012 recommended the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults with high risk of pneumonia. However, its effectiveness in cancer survivors has not been investigated. Our aim was to investigate the effectiveness of PPSV23 in these patients. Read More

    Frequency of non-motor symptoms in Parkinson's disease presenting to tertiary care centre in Pakistan: an observational, cross-sectional study.
    BMJ Open 2018 May 16;8(5):e019172. Epub 2018 May 16.
    School of Biological Sciences, University of the Punjab, Lahore, Punjab, Pakistan.
    Objective: To determine the frequency of non-motor symptoms (NMS) in patients of Parkinson's disease (PD) presenting to a movement disorder clinic at a tertiary care centre in Pakistan, and how frequency of NMS is different in male and female patients.

    Study Design: Observational, cross-sectional study.

    Setting: Tertiary care centre. Read More

    Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol.
    BMJ Open 2018 May 14;8(5):e022899. Epub 2018 May 14.
    Department of Urology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada.
    Introduction: Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).

    Methods And Analysis: Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Read More

    Developing a complex intervention to support timely engagement with palliative care for patients with advanced cancer in primary and secondary care in the UK: a study protocol.
    BMJ Open 2018 May 14;8(5):e022835. Epub 2018 May 14.
    Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
    Introduction: For patients with advanced cancer, timely access to palliative care can improve quality of life and enable patients to participate in decisions about their end-of-life care. However, in a UK population of 2500 patients who died from cancer, one-third did not receive specialist palliative care, and of those who did, the duration of involvement was too short to maximise the benefits. Initiating a conversation about palliative care is challenging for some health professionals and patients often have unmet information needs and misconceptions about palliative care. Read More

    Marathon Kids UK: study design and protocol for a mixed methods evaluation of a school-based running programme.
    BMJ Open 2018 May 14;8(5):e022176. Epub 2018 May 14.
    National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
    Introduction: Schools are promising settings for physical activity promotion; however, they are complex and adaptive systems that can influence the quality of programme implementation. This paper presents an evaluation of a school-based running programme (Marathon Kids). The aims of this study are (1) to identify the processes by which schools implement the programme, (2) identify and explain the contextual factors affecting implementation and explications of effectiveness and (3) examine the relationship between the level of implementation and perceived outcomes. Read More

    Autologous Stem Cells in Achilles Tendinopathy (ASCAT): protocol for a phase IIA, single-centre, proof-of-concept study.
    BMJ Open 2018 May 14;8(5):e021600. Epub 2018 May 14.
    Royal Veterinary College, Hatfield, UK.
    Introduction: Achilles tendinopathy (AT) is a cause of pain and disability affecting both athletes and sedentary individuals. More than 150 000 people in the UK every year suffer from AT.While there is much preclinical work on the use of stem cells in tendon pathology, there is a scarcity of clinical data looking at the use of mesenchymal stem cells to treat tendon disease and there does not appear to be any studies of the use of autologous cultured mesenchymal stem cells (MSCs) for AT. Read More

    Assessment of thyroid cancer risk associated with radiation dose from personal diagnostic examinations in a cohort study of US radiologic technologists, followed 1983-2014.
    BMJ Open 2018 May 14;8(5):e021536. Epub 2018 May 14.
    Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA.
    Objective: To assess whether personal medical diagnostic procedures over life, but particularly those associated with exposure in adulthood, were associated with increased thyroid cancer risk.

    Design: Participants from the US Radiologic Technologists Study, a large, prospective cohort, were followed from the date of first mailed questionnaire survey completed during 1983-1989 to the earliest date of self-reported diagnosis of thyroid cancer or of any other cancer than non-melanoma skin cancer (NMSC) in any of three subsequent questionnaires up to the last in 2012-2014.

    Setting: US nationwide, occupational cohort. Read More

    How effective and cost-effective are behaviour change interventions in improving the prescription and use of antibiotics in low-income and middle-income countries? A protocol for a systematic review.
    BMJ Open 2018 May 14;8(5):e021517. Epub 2018 May 14.
    Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, London, UK.
    Introduction: Antibiotic resistance endangers effective prevention and treatment of infections, and places significant burden on patients, families, communities and healthcare systems. Low-income and middle-income countries (LMICs) are especially vulnerable to antibiotic resistance, owing to high infectious disease burden, and limited resources for treatment. High prevalence of antibiotic prescription and use due to lack of provider's knowledge, prescriber's habits and perceived patient needs further exacerbate the situation. Read More

    Association between dipstick proteinuria and hearing impairment in health check-ups among Japanese workers: a cross-sectional study.
    BMJ Open 2018 May 14;8(5):e021427. Epub 2018 May 14.
    Department of Public Health, Dokkyo Medical University, Tochigi, Japan.
    Objective: Prevention of hearing impairment is important because it is difficult to recover from it. Epidemiological studies have examined the risk factors for hearing impairment; however, the association between dipstick proteinuria and hearing impairment has not been previously examined. This study aimed to clarify the association between dipstick proteinuria and hearing impairment. Read More

    Compliance with current VTE prophylaxis guidelines and risk factors linked to complications of VTE prophylaxis in medical inpatients: a prospective cohort study in a Spanish internal medicine department.
    BMJ Open 2018 May 14;8(5):e021288. Epub 2018 May 14.
    Internal Medicine Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
    Objectives: To evaluate the degree of compliance with the current guidelines regarding venous thromboembolism (VTE) prophylaxis in medical patients during admission and to identify risk factors linked to complications of VTE prophylaxis.

    Design: Prospective cohort study.

    Setting: The Internal Medicine Department of the University Hospital of Santiago de Compostela (tertiary referral hospital). Read More

    Association between secondhand smoke exposure and hypertension in never smokers: a cross-sectional survey using data from Korean National Health and Nutritional Examination Survey V, 2010-2012.
    BMJ Open 2018 May 14;8(5):e021217. Epub 2018 May 14.
    Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea.
    Objectives: Secondhand smoke (SHS) exposure is associated with cardiovascular disease. This study aims to determine the association between SHS exposure estimated by questionnaire and hypertension in Korean never smokers.

    Setting: Korean National Health and Nutrition Examination Survey (KNHANES) V was conducted from 2010 to 2012. Read More

    Comparison of indoor temperatures of homes with recommended temperatures and effects of disability and age: an observational, cross-sectional study.
    BMJ Open 2018 May 14;8(5):e021085. Epub 2018 May 14.
    UCL Energy Institute, University College London, London, UK.
    Objectives: We examine if temperatures in winter in English homes meet the recommendation of being at least 18°C at all times. We analyse how many days meet this criterion and calculate the hours per day and night being at/above 18°C. These metrics are compared between households with occupants aged above 64 years or having a long-term disability (LTD) and those younger and without disability. Read More

    Postnatal depression and intimate partner violence: a nationwide clinic-based cross-sectional study in Malaysia.
    BMJ Open 2018 May 14;8(5):e020649. Epub 2018 May 14.
    Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
    Introduction: An estimated 13% of women in the postnatal period suffer from postnatal depression (PND) worldwide. In addition to underprivileged women, women who are exposed to violence are at higher risk of PND. This study aimed to investigate the relationship between intimate partner violence (IPV) and PND in Malaysia. Read More

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