medsci-skills 4.1.0

package/skills/write-paper/references/paper_types/case_report.md

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+# Paper Type: Case Report
+
+## Overview
+
+- **Reporting guideline:** CARE 2016 (mandatory)
+- **Typical word count:** 1000–1500 words (short-form) or 2000–3000 words (extended with literature review)
+- **Default mode:** Short-form (1000-1500 words). Use `--extended` for longer format.
+- **Structure:** Title → Abstract → Introduction → Case Presentation → Discussion → Conclusions → Patient Perspective (optional) → Informed Consent
+- **Key requirement:** Patient consent/anonymization documented
+
+---
+
+## CARE 2016 Checklist Quick Reference
+
+| # | Item | Section | Description |
+|---|------|---------|-------------|
+| 1 | Title | Title | Diagnosis or main symptom AND "case report" |
+| 2 | Key words | Abstract | 2-5 keywords covering the case |
+| 3 | Abstract | Abstract | Structured: Introduction, Case Presentation, Conclusion |
+| 4 | Introduction | Introduction | Background with references, why this case is reportable |
+| 5 | Patient information | Case Presentation | Demographics, main symptoms, medical history |
+| 6 | Clinical findings | Case Presentation | Physical examination, key clinical findings |
+| 7 | Timeline | Case Presentation | Important dates and events in table or figure |
+| 8 | Diagnostic assessment | Case Presentation | Methods, pathological findings, challenges, reasoning |
+| 9 | Therapeutic intervention | Case Presentation | Types, administration, duration, changes |
+| 10 | Follow-up and outcomes | Case Presentation | Clinician-assessed and patient-assessed outcomes, adherence, adverse events |
+| 11 | Discussion | Discussion | Strengths, limitations, relevant literature, rationale for conclusions |
+| 12 | Patient perspective | Optional | Patient's own views when available |
+| 13 | Informed consent | End | Documentation that consent was obtained |
+
+> Full CARE checklist: https://www.care-statement.org/checklist
+
+---
+
+## When to Write a Case Report
+
+Case reports are appropriate when the case demonstrates:
+- A rare or previously unreported condition or presentation
+- An unusual complication of a known condition or procedure
+- A novel diagnostic approach or therapeutic intervention
+- An important teaching point with clinical relevance
+- A paradoxical or unexpected finding
+
+---
+
+## Title
+
+Format: "[Condition/Diagnosis]: [What makes it unusual]" or "[Unusual presentation/complication] of [condition]"
+
+Example: "Cerebral Venous Sinus Thrombosis Presenting as Isolated Neck Pain: A Case Report and Literature Review"
+
+Keep ≤ 15 words. Include "Case Report" in the title or subtitle.
+
+---
+
+## Structured Abstract (150–250 words)
+
+```
+Introduction: [Why this case is being reported — one sentence on rarity or teaching value]
+
+Case Presentation: [Age, sex, key presenting complaint, key imaging/lab findings, diagnosis]
+
+Clinical Findings: [Key examination and investigation results]
+
+Treatment/Intervention: [What was done]
+
+Outcome: [Follow-up duration, outcome at last follow-up]
+
+Conclusion: [Take-home message — what this case adds to the literature]
+```
+
+---
+
+## Introduction (200–400 words)
+
+1. Clinical background: Briefly describe the condition (2–3 sentences; cite key references).
+2. Why this case is unusual: State the rarity explicitly. If known epidemiology: "The reported incidence is [X per 100,000 person-years]."
+3. Objective: "We report a case of [condition] presenting with [unusual feature] and discuss [management strategy/diagnostic approach/teaching point]."
+
+---
+
+## Case Presentation (600–1200 words)
+
+### Patient Information
+
+- Age and sex (no name or specific dates — protect anonymity)
+- Chief complaint
+- Relevant medical history, medications, allergies, family history, social history
+- Any relevant prior treatments or procedures
+
+### Clinical Findings
+
+- Physical examination findings
+- Vital signs (if relevant)
+
+### Diagnostic Assessment (Imaging — Key Section for Radiology Cases)
+
+Structure imaging descriptions as:
+
+```
+[Modality and technique]: [Acquisition parameters if relevant]
+  → Findings: [Location, size, morphology, signal/density characteristics,
+               enhancement pattern, associated findings]
+  → Impression: [Radiological diagnosis or differential]
+```
+
+Example:
+"Contrast-enhanced MRI of the brain (1.5 T, gadolinium 0.1 mmol/kg) demonstrated a 2.3 × 1.8 cm extra-axial mass in the right cerebellopontine angle with hypointense T1, hyperintense T2 signal, and homogeneous enhancement. Mass effect on the ipsilateral facial and vestibulocochlear nerves was evident."
+
+List relevant laboratory findings in a table.
+
+### Clinical Timeline Table
+
+| Date | Event |
+|------|-------|
+| Day 0 | Symptom onset — [description] |
+| Day 3 | Emergency department presentation |
+| Day 5 | Imaging: [key finding] |
+| Day 7 | Diagnosis established / Procedure performed |
+| Day 14 | Discharge |
+| Month 3 | Follow-up: [outcome] |
+
+### Therapeutic Intervention
+
+Describe exactly what was done:
+- Medical management: drug names, doses, duration
+- Surgical/procedural management: technique, approach, materials used, any intraoperative findings
+- Multidisciplinary involvement
+
+### Follow-up and Outcome
+
+- Follow-up duration (e.g., "At 6-month follow-up")
+- Functional outcome (use validated scales where applicable: mRS, GCS, NIHSS, Karnofsky)
+- Imaging outcome (if follow-up imaging available)
+- Any complications of treatment
+
+---
+
+## Discussion (400–800 words)
+
+1. **Literature context:** How does this case compare to previously reported cases? Cite key papers. Include a brief systematic search if cases are very rare ("A PubMed search using the terms '[terms]' identified [N] previously reported cases").
+2. **Pathophysiology:** Explain the underlying mechanism if relevant.
+3. **Diagnostic challenge:** Why was this case difficult to diagnose, or what did imaging add?
+4. **Management rationale:** Why was this treatment chosen? What are the alternatives?
+5. **Learning points:** What should clinicians take from this case?
+
+---
+
+## Learning Points Box (Required)
+
+3–5 concise, specific, clinically actionable statements:
+
+```
+Learning Points
+• [Specific diagnostic or management insight]
+• [Imaging finding or pattern to recognize]
+• [Management principle or pitfall to avoid]
+• [When to consider this diagnosis]
+```
+
+---
+
+## Conclusion (100–200 words)
+
+"We report a case of [condition] with [unusual feature]. [Key diagnostic or management point]. This case highlights the importance of [clinical lesson]. [Any implications for practice or future research]."
+
+---
+
+## Patient Perspective (Optional)
+
+If the patient consented to provide a statement about their experience, include a brief paragraph in their own words. This is increasingly encouraged by CARE guidelines and some journals.
+
+---
+
+## Informed Consent Statement
+
+At the end of the case report, include one of these statements:
+
+**Option A (patient consented):**
+"Written informed consent was obtained from the patient for publication of this case report and any accompanying images."
+
+**Option B (patient deceased/consent waiver):**
+"The institutional review board waived the requirement for informed consent for this retrospective case report. All identifying information has been removed."
+
+**Option C (minor patient):**
+"Written informed consent was obtained from the patient's legal guardian for publication of this case report."
+
+---
+
+## Required Figures
+
+| Item | Content |
+|------|---------|
+| Figure 1 | Key imaging findings (annotated; typically 3–6 panels) |
+| Figure 2 | Timeline figure or pathology if relevant |
+| Table 1 | Clinical and laboratory data at presentation |
+| Table 2 | Comparison with published similar cases (if ≥5 exist) |
+
+---
+
+## Similar Case Literature Search
+
+When writing the Discussion, systematically search for previously reported similar cases:
+
+**Search strategy:**
+1. Primary: PubMed — `"[condition]"[Title] AND "case report"[Publication Type]`
+2. If <5 results, broaden: `"[condition]"[Title/Abstract] AND (case report[ti] OR case series[ti])`
+3. Optional: Google Scholar for non-indexed case reports
+
+**Data extraction from each similar case:**
+- Author and year
+- Patient age and sex
+- Key presenting features
+- Diagnostic method
+- Treatment approach
+- Outcome at follow-up
+
+**Comparison table (include if >=5 similar cases found):**
+
+| Author (Year) | Age/Sex | Key Presentation | Diagnosis Method | Treatment | Outcome |
+|---------------|---------|-----------------|-----------------|-----------|---------|
+| Current case | ... | ... | ... | ... | ... |
+| [Prior case 1] | ... | ... | ... | ... | ... |
+
+If <5 similar cases exist, state explicitly: "To our knowledge, only [N] similar cases have been reported in the English literature [citations]."
+
+---
+
+## Common Case Report Pitfalls
+
+1. **Failing to explain why the case is unusual** — state rarity explicitly with epidemiological data.
+2. **Missing patient consent statement** — most journals will reject without this.
+3. **Identifying information in images** — check DICOM metadata, remove patient labels from figures.
+4. **Vague imaging descriptions** — give exact size, location, signal characteristics, and enhancement pattern.
+5. **Overclaiming in Discussion** — case reports cannot establish causality; use "may," "suggest," "is consistent with."
+6. **Insufficient literature context** — do a PubMed search for similar cases; cite all relevant ones.
+7. **Too long a Discussion** — case reports are not reviews; keep Discussion focused on this case's lessons.

package/skills/write-paper/references/paper_types/cross_national.md

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+# Cross-National Comparison Study — Paper Type Template
+
+## Overview
+
+Template for cross-national (binational) comparative studies using nationally representative datasets from two or more countries. Covers three study architectures: (A) Parallel Survey Analysis using cross-sectional surveys (e.g., KNHANES + NHANES), (B) Discovery/Validation Cohort using claims databases (e.g., NHIS + JMDC), and (C) Binational Birth/Longitudinal Cohort with sibling comparison. Applicable to prevalence comparisons, association studies, trend analyses, and composite health metric evaluations.
+
+---
+
+## Title
+
+- Include "Cross-National," "Binational," or country names.
+- Specify the study design in a subtitle.
+- Under 20 words preferred.
+
+### Title Templates
+
+| Pattern | Example |
+|---------|---------|
+| `Cross-national comparison of {X} and {Y} in {Country A} and {Country B}: a nationwide representative comparative study` | Depression and diabetes in Korea and the US |
+| `Binational association between {X} and {Y} in {Country A} and {Country B}: a nationally representative cross-sectional study` | PUFA and depression in Korea and the US |
+| `Maternal {exposure} and {outcome} in offspring: a binational cohort study` | Pregestational diabetes and neuropsychiatric risk |
+| `Burden of {outcome} after {exposure} in {Country A} and {Country B}: a binational population-based cohort study` | Cardiovascular outcomes after infection |
+| `Trends in {outcome} among {population}, {year range}: a nationwide representative study` | Physical activity trends (single-country variant) |
+
+Notes:
+- "Binational" is increasingly preferred over "Cross-national" for two-country studies.
+- Always include the year range for trend studies.
+- The subtitle pattern is consistent: "a nationwide representative {comparative/cross-sectional/cohort} study."
+
+---
+
+## Abstract (Structured, 250 words max)
+
+### Background
+- State the known relationship and the cross-national evidence gap.
+- Template: "Although {known relationship} has been suggested, evidence remains limited across cultural contexts. This study {compared/examined} {association} in {Country A} and {Country B}."
+
+### Methods
+- Name both datasets with years and sample sizes.
+- State that datasets were analyzed independently.
+- Name the harmonization approach and statistical methods.
+
+### Results
+- Report sample sizes from each dataset.
+- Key findings with weighted odds ratios (wOR) or aHRs and 95% CIs from each country.
+- Highlight convergent or divergent findings across countries.
+
+### Conclusion
+- Main conclusion emphasizing cross-national consistency or divergence.
+- Implication for policy or future research.
+
+#### Discovery/Validation Variant
+- Results structure: "In the {weighted} discovery cohort, {N} individuals were included... Similar patterns were observed in the validation cohort."
+
+---
+
+## Introduction (3-4 paragraphs, ~400-500 words)
+
+### Paragraph 1: Global Burden Statement
+- Cite GBD or WHO prevalence figures with projections.
+- Template: "{Condition} remains a {highly prevalent / growing} global health {threat/challenge}."
+
+### Paragraph 2: Prior Evidence (Single-Country Limitations)
+- Summarize existing single-country evidence.
+- Flag limitations: "were limited to single-country cohorts," "did not adjust for key confounders," "have not taken broad population approaches."
+- If relevant, cite Mendelian randomization evidence showing ancestral or population differences.
+
+### Paragraph 3: Cross-National Gap and Study Aim
+- Template: "To our knowledge, no prior study has evaluated {association} within a cross-national comparative framework."
+- Template: "To address this gap, we analyzed nationally representative data from {Dataset A} and {Dataset B} collected between {years} to compare {outcome} in {Country A} and {Country B}."
+- Optional: justify the country pairing with cultural, genetic, or healthcare system differences.
+
+### Variation: Trend Studies
+- Replace the cross-national gap with a temporal gap: "there is a lack of large-scale studies examining how {X} patterns have evolved across pre-, intra-, and post-pandemic periods."
+
+---
+
+## Materials and Methods (~1000-1400 words)
+
+### 3.1 Data Sources
+
+Describe each dataset separately with parallel structure:
+
+Template:
+> This study utilized {Dataset A} for {years} and {Dataset B} for {years}.
+>
+> {Dataset A} is a {population-based, cross-sectional / cohort} survey conducted by {Agency A} using a stratified, multistage probability sampling design to assess the health and nutritional status of the noninstitutionalized {Country A} population.
+>
+> {Dataset B}, administered by {Agency B}, is a {biennial / annual} survey designed to represent the noninstitutionalized {Country B} population using a similar multistage probability sampling approach.
+>
+> Both surveys include standardized health interviews, physical examinations, and laboratory tests, and collect extensive information on sociodemographic characteristics, health behaviors, and medical conditions.
+
+#### Common Dataset Pairings
+
+| Country A Dataset | Country B Dataset | Use Case |
+|-------------------|-------------------|----------|
+| KNHANES (Korea) | NHANES (US) | Nutrition, metabolic, mental health, composite score comparisons |
+| NHIS (Korea) | JMDC (Japan) | Claims-based cohort and birth cohort studies |
+| K-COV-N (NHIS+KDCA) | JMDC (Japan) | Disease-specific cohort (discovery/validation) |
+| KCHS (Korea) | — (single-country) | National trend studies with temporal phases |
+
+Notes:
+- Survey years may be non-consecutive if specific variables are only collected in certain cycles. Always explain excluded years.
+- For claims-based binational studies, shift the description to: "This binational cohort study included {N} individuals from {Country A} and {N} from {Country B}, from {start} to {end}."
+
+### 3.2 Ethics Approval
+
+- Separate IRB approvals per country, listed together.
+- Template: "The {Dataset A} protocol was approved by {IRB A} ({numbers}), and the {Dataset B} protocol was approved by {IRB B} ({numbers}). All participants provided written informed consent. Both surveys comply with the ethical principles outlined in the Declaration of Helsinki, and their de-identified data are publicly accessible for research purposes."
+
+### 3.3 Variable Harmonization
+
+Three-layer harmonization framework:
+
+#### Layer 1: Identical Instruments
+- Variables measured with the same validated instrument in both datasets (e.g., PHQ-9 for depression, fasting glucose + HbA1c for diabetes).
+- Template: "{Instrument} was used in both {Dataset A} and {Dataset B}."
+
+#### Layer 2: Country-Specific Cutoffs with Clinical Justification
+- Variables where clinical thresholds differ by national guidelines.
+- Template: "{Variable} was defined using country-specific standards: {cutoff A} in {Country A} and {cutoff B} in {Country B}, reflecting established national guidelines."
+- Common example: BMI >=25 in East Asia (Asia-Pacific cutoff) vs. BMI >=30 in US/Europe (WHO Western cutoff).
+
+#### Layer 3: Operationally Different Variables Mapped to Equivalent Categories
+- Variables measured differently but mappable to equivalent categories.
+- Common examples:
+  - Income: quintiles (Korea) vs. poverty-income ratio (US) → binary high/low.
+  - Smoking/alcohol: mapped to equivalent categorical levels.
+
+#### Key Harmonization Decisions (Reference Table)
+
+| Variable | Typical Resolution |
+|----------|-------------------|
+| Obesity | Country-specific BMI cutoffs with justification |
+| Income | Equivalent binary or tertile split |
+| Depression | Identical instrument (PHQ-9) with same cutoff |
+| Diabetes | Identical lab criteria (FG >=126 or HbA1c >=6.5%) |
+| Physical activity | Identical framework (IPAQ-SF → MET-min/week) |
+
+#### Core Principle
+> "We applied harmonized variable definitions and conducted weighting and preprocessing separately for each dataset to preserve internal validity."
+
+**Never pool raw data across countries.** Each dataset is analyzed independently.
+
+#### ICD-10-Level Harmonization (Claims-Based Studies)
+For binational cohort studies using claims databases, harmonization is done at the ICD-10 code level rather than questionnaire items. Apply the same code definitions, exposure/outcome assessments, and analytical approaches to both cohorts.
+
+### 3.4 Study Population
+
+- State inclusion/exclusion criteria applied to each dataset separately.
+- For composite score studies (e.g., Life's Essential 8): calculate the score identically in both countries.
+- For cohort studies: apply parallel exclusion cascades to each country's dataset.
+
+### 3.5 Statistical Analysis
+
+#### Architecture A: Parallel Survey Analysis
+
+```
+Step 1 — Separate analysis per country
+  "Data from {Dataset A} and {Dataset B} were analyzed separately."
+  Complex survey design: "appropriate stratification, clustering, and sampling weights were applied."
+
+Step 2 — Sequential model building
+  Model 1: adjusted for age and sex
+  Model 2: additionally adjusted for {income, education, smoking, alcohol, BMI, comorbidities}
+  Results as weighted odds ratios (wOR) with 95% CI
+
+Step 3 — Subgroup / interaction analyses
+  Stratified by: sex, age group, education, income, alcohol, smoking, obesity, comorbidities
+  "Weighted odds ratios are adjusted for all covariates except the stratification variable."
+
+Step 4 — Advanced modeling (choose as appropriate)
+  - Restricted cubic spline (RCS) with 3 knots for nonlinear dose-response
+  - Weighted quantile sum (WQS) regression for composite exposure component contribution
+  - Beta-coefficient comparison across time periods (trend studies)
+```
+
+Notes:
+- Never pool datasets into a single regression.
+- Compare results side-by-side in the same table.
+- Multicollinearity: check via VIF; values <2.0 acceptable.
+- Missing data: variables with <5% missingness → complete case; higher → multiple imputation (5 datasets).
+
+#### Architecture B: Discovery/Validation Cohort
+
+```
+Step 1 — Full analysis in discovery cohort
+  PS-based balancing (overlap weighting, SIPTW, or matching)
+  Cox proportional hazards → aHR with 95% CI
+  Stratification and time-dependent analyses
+
+Step 2 — Replication in validation cohort
+  "The study applied similar methodologies to the {validation cohort} as those used for the discovery cohort."
+  Same ICD-10 codes, exposure/outcome definitions, follow-up duration, and PS approach.
+
+Step 3 — Subgroup analyses
+  Disease severity, treatment dosage, temporal era stratification
+```
+
+#### Architecture C: Binational Birth/Longitudinal Cohort
+
+```
+Step 1 — Full-cohort SIPTW-weighted Cox regression (primary)
+Step 2 — Sibling comparison analysis (addresses unmeasured familial confounding)
+Step 3 — Independent validation in second country (sibling pairs or full cohort)
+```
+
+For multiple primary outcomes: apply Bonferroni correction (p < 0.05/K).
+
+#### Software and Significance
+- SAS for survey-weighted analyses and Cox regression.
+- R for WQS regression and advanced modeling.
+- Python for ML components if applicable.
+- "A two-sided p value of less than 0.05 was considered statistically significant."
+
+---
+
+## Results (~800-1200 words)
+
+### 4.1 Study Population
+- Report sample sizes from each dataset: "{N_A} from {Dataset A} and {N_B} from {Dataset B}."
+- Demographics table (Table 1) with columns per country.
+
+### 4.2 Primary Findings
+- Present results from each country in parallel.
+- For parallel survey studies: wORs from both countries in the same table.
+- For discovery/validation: primary results from discovery, confirmation from validation.
+
+### 4.3 Subgroup and Advanced Analyses
+- Stratification results by country.
+- Dose-response (RCS) or component contribution (WQS) results.
+- Time-dependent or era-specific results if applicable.
+
+### 4.4 Sensitivity Analyses
+- Confirm findings with alternative definitions, negative controls, or sibling comparisons.
+
+### Rules
+- Same as original article: no interpretation, no causal language.
+- Present both countries' results for every analysis.
+
+---
+
+## Discussion (4-5 paragraphs, ~800-1200 words)
+
+### Paragraph 1: Summary of Key Findings
+- Highlight cross-national consistency or divergence.
+- State whether findings were replicated across countries.
+
+### Paragraphs 2-3: Comparison with Prior Literature
+- Compare with prior single-country and cross-national studies.
+- Discuss population-specific factors (cultural, genetic, healthcare system) that may explain differences.
+
+### Paragraph 4: Clinical and Policy Implications
+- Policy relevance across different healthcare systems.
+- Public health recommendations.
+
+### Paragraph 5: Limitations
+
+Standard limitation categories for cross-national studies:
+
+| # | Category | Template |
+|---|----------|----------|
+| 1 | Cross-sectional design | "The cross-sectional design precludes inference of causality." Mitigation: "the dose-response relationship and consistency across subgroups support plausibility." |
+| 2 | Dataset differences | "Differences exist between {Dataset A} and {Dataset B} in data collection methods, diagnostic criteria, and survey protocols." Mitigation: "we applied harmonized variable definitions and conducted weighting and preprocessing separately for each dataset to preserve internal validity." |
+| 3 | Temporal coverage mismatch | "{Dataset A} included selected survey years, whereas {Dataset B} provided continuous data." Mitigation: "appropriate sampling weights and consistent analytic criteria." |
+| 4 | Self-report bias | "The use of self-reported data may introduce recall bias." Mitigation: "both surveys utilize validated instruments administered by trained personnel." |
+| 5 | Country-specific definitions | "Obesity and income were defined using country-specific standards." Mitigation: "these definitions reflect established national guidelines and were applied consistently within each dataset, allowing for valid within-country comparisons." |
+| 6 | Multiple comparisons | "Subgroup analyses were not adjusted for multiple comparisons." Mitigation: "based on prespecified variables of clinical and epidemiological relevance." |
+| 7 | Unmeasured confounders | "Differences in healthcare systems, cultural factors, and unmeasured confounders may influence the relationship." |
+| 8 | Population representativeness | "Both cohorts are from East Asian and Western populations; extrapolation to other regions requires caution." |
+
+Each limitation followed by mitigation. End with strength-as-buffer: "our use of large, nationally representative samples allows for a broad understanding of population-level trends."
+
+### Conclusion
+- Citable statement emphasizing cross-national convergence or divergence.
+- Specific policy or clinical recommendation.
+
+---
+
+## Tables
+
+- **Table 1**: Baseline characteristics by country (separate columns per dataset).
+- **Table 2**: Primary association results (wOR or aHR with 95% CI) from both countries in parallel columns.
+- **Table 3**: Subgroup analyses by country.
+- **Table S1+**: Variable harmonization details, ICD-10 codes, sensitivity analysis results.
+
+## Figures
+
+- **Figure 1**: Study flow diagram (per country or combined with country-specific branches).
+- **Figure 2**: Forest plot of primary associations by country and subgroup.
+- **Figure 3**: Restricted cubic spline dose-response curves (if applicable).
+- Optional: Trend plots for temporal studies, WQS component weight bar charts.
+
+---
+
+## Boilerplate Sentences (Reusable)
+
+### Survey Design
+> "To account for the complex survey designs and ensure nationally representative estimates, appropriate stratification, clustering, and sampling weights were applied."
+
+### Ethical
+> "Both surveys comply with the ethical principles outlined in the Declaration of Helsinki, and their de-identified data are publicly accessible for research purposes."
+
+### Separate Analysis Justification
+> "For cross-national comparisons, data from {Dataset A} and {Dataset B} were analyzed separately."
+
+### Within-Country Validity Defense
+> "These definitions reflect established national guidelines and were applied consistently within each dataset, allowing for valid within-country comparisons and minimizing potential bias in the overall findings."
+
+### Data Availability
+> "Study protocol and statistical code: available from the corresponding author. Dataset: {public access URLs}."
+
+---
+
+## Checklist Before Submission
+
+- [ ] Both datasets described with sampling design, years, and agency
+- [ ] Separate IRB approvals per country listed
+- [ ] Harmonization approach explicitly stated for all key variables
+- [ ] Country-specific cutoffs justified with national guideline references
+- [ ] Datasets analyzed independently (never pooled)
+- [ ] Survey weights applied for cross-sectional surveys
+- [ ] Results presented in parallel for both countries
+- [ ] Subgroup analyses consistent across both datasets
+- [ ] Limitations address dataset differences and temporal mismatch
+- [ ] Within-country validity defense included
+- [ ] Numbers consistent between text, tables, and figures
+- [ ] Reporting guideline (STROBE) items addressed