bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in dementia diagnoses in Sweden during the COVID-19 pandemic
Authors: Axenhus Michael , Schedin-Weiss Sophia , Tjernberg Lars , Wimo Anders , Eriksdotter Maria , Bucht Gustaf , Winblad Bengt
Published: April 2022

Introduction

The COVID-19 pandemic has caused large disruptions to healthcare systems. Refocus on COVID-19 related care might have contributed to indirect effects on other healthcare areas. Care focused on acute conditions have been negatively affected although research into the effects on chronic and care intensive patient groups such as patients with dementia diseases is lacking. In this study we evaluated dementia diagnosis trends in Sweden during 2015–2020 according to International Classification of Disease version 10 coding of common dementia diseases.

Methods

Regional and national statistics in the form of International Classification of Disease version 10 coding, COVID-19 incidence, mortality data, and population census data were collected from the National Institute of Health and Welfare. Logistic regression analysis was performed to identify trends of dementia diagnosis during 2015–2020. Correlation test was performed between COVID-19 incidence, mortality rates, and dementia coding.

Results

Dementia diagnosis incidence has been declining since 2015 and further decline was noted in many regions in Sweden during 2020. As COVID-19 incidence increased, fewer cases of dementia were diagnosed, a decrease that differentially impacted women and those who were advanced in age.

Conclusions

Dementia diagnosis incidence in Sweden has been on a decline since 2015. The COVID-19 pandemic caused a further larger decline in dementia diagnosis incidence during 2020. COVID-19 incidence, but not mortality, was associated with decrease in dementia diagnosis incidence. There might be a large number of undiagnosed patients with dementia and healthcare reforms should be enacted to address this. Women and elderly are particularly vulnerable groups.
Exploration of attitudes regarding uptake of COVID-19 vaccines among vaccine hesitant adults in the UK: a qualitative analysis
Authors: Denford Sarah , Mowbray Fiona , Towler Lauren , Wehling Helena , Lasseter Gemma , Amlôt Richard , Oliver Isabel , Yardley Lucy , Hickman Matthew
Published: April 2022

Background

The aim of this work was to explore barriers and facilitators to uptake of COVID-19 vaccines and to explore views and reactions to efforts to improve vaccine uptake among vaccine hesitant individuals.

Methods

Semi-structured interviews were conducted with people between the age of 18–29 years who had not had a COVID-19 vaccine, and those between 30 and 49 years who had not had a second dose of a COVID-19 vaccine.

Results

A total of 70 participants took part in the study, 35 participants had received one dose, and 35 had not been vaccinated. Participants described a willingness to be vaccinated to keep themselves and those around them safe and to avoid restrictions. Barriers to uptake included: (1) perceived lack of need for COVID-19 vaccinations, (2) concerns about the efficacy of vaccinations, (3) concerns about safety, and (4) access issues. Uptake appeared to be influenced by age and health status, trust in government, and knowledge and understanding of science. Introduction of vaccine passes may provide a motive for having a vaccine but may be viewed as coercive.

Conclusion

Participants were hesitant, rather than opposed, and had questions about their need for, and the safety and efficacy of the vaccine. Young people did not consider themselves to be at risk of becoming ill from COVID-19, did not think the vaccination was effective in preventing transmission, and did not think sufficient research had been conducted regarding possible long-term side-effects. Concerns were exacerbated by a lack of trust in government, and misunderstanding of science. To promote uptake, public health campaigns should focus on the provision of information from trusted sources that explains the benefits of vaccination and addresses safety concerns more effectively. To overcome inertia in people with low levels of motivation to be vaccinated, appointments must be easily accessible.
Risk factors for healthcare-associated infection among children in a low-and middle-income country
Authors: Murni Indah K. , Duke Trevor , Kinney Sharon , Daley Andrew J. , Wirawan Muhammad Taufik , Soenarto Yati
Published: April 2022

Background

Healthcare-associated infections (HAI) are one of significant causes of morbidity and mortality. Evaluating risk factors associated with HAI are important to improve clinical outcomes. We aimed to evaluate the risk factors of HAI in children in a low-to middle-income country.

Methods

A prospective cohort study was conducted during 43 months at a teaching hospital in Yogyakarta, Indonesia. All consecutive patients admitted to pediatric ICU and pediatric wards > 48 h were eligible. Those eligible patients were observed daily to identify the presence of HAI based on CDC criteria. The risk factors of HAI were identified. Multivariable logistic regression was used to identify independent risk factors.

Results

Total of 2612 patients were recruited. Of 467 were diagnosed as HAI. The cumulative incidence of HAI was 17.9%. In the multivariable analysis; length of stay > 7 days, severe sepsis, use of urine catheter, central venous catheter (CVC), non-standardized antibiotics, and aged < 1 year were independently associated with increased risk of HAI with adjusted OR (95%CI): 5.6 (4.3–7.3), 1.9 (1.3–2.9), 1.9 (1.3–2.6), 1.8 (1.1–2.9), 1.6 (1.2–2.0), and 1.4 (1.1–1.8), respectively.

Conclusions

This study found that length of stay > 7 days, use of urine catheter and CVC, non-standardized antibiotic use, aged < 1 year, and had a diagnosis of severe sepsis increased risk of HAI.
Prevalence of dry eye disease among Chinese high school students during the COVID-19 outbreak
Authors: Lin Feng , Cai Yuying , Fei Xinfeng , Wang Yimin , Zhou Minwen , Liu Yan
Published: April 2022

Purpose

The study aimed to investigate the prevalence of dry eye disease (DED) and relevant risk factors among Chinese high school students during the COVID-19 outbreak.

Methods

A cross-sectional study was conducted from November to December 2020, and 4825 high school students from nine high schools in Shanghai were recruited. All students completed ocular surface disease index (OSDI) and perceived stress scale (PSS) questionnaires and answered other questions designed to ascertain information on the risk factors related to DED. DED was diagnosed when OSDI scores were greater than or equal to 13. The prevalence of symptomatic DED was determined. A T-test, Kruskal-Wallis test, Chi-square test, and logistic regression analysis were used to examine the possible risk factors.

Results

The prevalence of symptomatic DED among Chinese high school students was 70.5%. In univariate analysis, higher PSS scores (P<0.001), prolonged video display terminal (VDT) use (P<0.001), wearing contact lenses (P=0.001), poor sleep quality (P<0.001), and being female (P<0.001) were significantly correlated with dry eyes. In multivariate logistic regression analysis, higher PSS scores (P<0.001, OR=1.20), prolonged VDT use (P<0.001, OR=1.07), poor sleep quality (P<0.001, OR=1.84), and being female (P=0.001, OR=1.25) were significant risk factors associated with DED.

Conclusions

Due to the epidemic, most Chinese high school students are in a high-risk environment in which they are more likely to suffer from DED, such as long online courses and heavy stress from school. Relevant preventive measures that may have a positive impact on public health and quality of life for high school students should be brought to the forefront.
Determining the effect of air quality on activities of daily living disability: using tracking survey data from 122 cities in China
Authors: Liu Huan
Published: April 2022

Background

Current research on activities of daily living (ADLs) disability has mostly focused on the analysis of demographic characteristics, while research on the microcharacteristics of individuals and the macroenvironment is relatively limited, and these studies solely concern the impact of air quality on individual health.

Methods

This study innovatively investigated the impact of air quality on ADL disability by matching micro data of individuals from the China Health and Retirement Longitudinal Study with data of urban environmental quality from 122 cities. In this study, an ordered panel logit model was adopted for the benchmark test, and the two-stage ordered probit model with IV was used for endogenous treatment.

Results

This innovative study investigated the impact of air quality on ADL disability by matching individual micro data from the China Health and Retirement Longitudinal Study with urban environmental quality data for 122 cities. The results showed that air quality significantly increased the probability of ADL disability. The positive and marginal effect of air quality on moderate and mild disability was higher. Generally, the marginal effect of air quality on residents’ health was negative. In terms of group heterogeneity, the ADL disability of individuals aged over 60 years, those in the high Gross Domestic Product (GDP) group, females, and those in the nonpilot long-term care insurance group was more affected by air quality, and the interaction between air quality and serious illness showed that the deterioration of air quality exacerbated the ADL disability caused by serious illness; that is, the moderating effect was significant.

Conclusions

According to the equilibrium condition of the individual health production function, the ADL disability caused by a 1% improvement in air quality is equivalent to the ADL disability caused by an 89.9652% reduction in serious illness, indicating that the effect of improved air quality is difficult to replace by any other method. Therefore, good air quality can not only reduce ADL disability directly but also reduce serious illness indirectly, which is equivalent to the reduction of ADL disability. This is called the health impact.
Restaurant managers’ readiness to maintain people’s healthy weight and minimise food waste in Japan
Authors: Akamatsu Rie , Tonsho Nozomi , Saiki Mika , Komatsu Mihono
Published: April 2022

Background

People who consume high amounts of ready-to-eat meals have a higher body mass index than those who do not. However, if customers adhere to eating proper amounts without restaurants reducing the portions, plate waste may occur. It is therefore incumbent upon restaurants to serve suitable meal portions to customers in the interests of their health and the environment. This study examined whether restaurants support Japan’s national goals of minimising food loss and waste and maintaining healthy body weight. Additionally, the characteristics of restaurant managers who display a willingness to meet these goals, were identified.

Methods

An internet-based nationwide cross-sectional survey was conducted among restaurant managers in Japan in May 2019. The main outcome measured was readiness to take action toward maintaining healthy weight and minimising food loss and waste. Chi-square tests were performed to examine the characteristics of three groups, divided on the basis of their readiness to take action toward achieving these two goals. The group that displayed a higher readiness toward attaining both goals was examined using logistic regression analyses.

Results

Of the 412 restaurant managers who responded, 387 (93.9%) were analysed. Few managers reported taking action toward maintaining healthy weight (n = 13, 3.4%) and minimising food loss and waste (n = 45, 11.6%). Two variables, ‘medium- or big-sized company’ and ‘referring to the United Nations’ Sustainable Development Goals for running their business’, were related to both higher readiness for maintaining healthy weight and minimising food loss and waste (odds ratio [OR] = 2.27, confidence interval [CI]: 1.11–4.62; OR = 4.06, CI: 2.39–6.88, respectively).

Conclusions

Increasing recognition of the Sustainable Development Goals among restaurant managers is needed to increase their cooperation toward meeting Japan’s national goals.
The role of synovial fluid aspiration in shoulder joint infections
Authors: Streck Laura Elisa , Forster Johannes , von Hertzberg-Boelch Sebastian Philipp , Reichel Thomas , Rudert Maximilian , Rueckl Kilian
Published: April 2022

Background

Joint aspiration with analysis of synovial fluid white blood cell count (WBC) and microbiological culture is a widely established aspect in the diagnosis of shoulder joint infections (SJI). In case of a two stage revision for SJI, joint aspiration before re−/implantation of a total shoulder arthroplasty (TSA) was used to rule out persistent infection for years but its value is under debate. Shoulder specific data on all aspects is rare. The current study aims to answer the following research questions: Does joint aspiration have an insufficient predictive value in the diagnosis of SJI in (1) initial workup and (2) before definite arthroplasty with polymethylmethacrylate (PMMA)-Spacer in place?

Methods

This retrospective evaluation investigates 35 patients that were treated for SJI with a two staged implantation of a TSA after debridement and implantation of an PMMA-Spacer. Joint aspirations were performed preoperatively (PA) and before re−/implantation of the prosthesis while spacer was in place (interstage aspiration, IA). Samples were taken for microbiological culture and analysis of WBC. Sensitivity and specificity were calculated with reference to intraoperative microbiological samples. Receiver Operating Characteristic (ROC), Area-Under-Curve analysis (AUC) and calculation of the Youden index were performed to find optimum cut-off for WBC.

Results

The sensitivity of microbiological cultures from PA was 58.3% and the specificity was 88.9%. The mean WBC was 27,800 leucocytes/mm3 (range 400-96,300). The maximum Youden index (0.857) was a cut-off of 2600 leucocytes/mm3 with a sensitivity of 85.7% and a specificity of 100.0%. The sensitivity and specificity of IA were 0.0% and 88.5%, respectively.

Conclusions

Preoperative aspiration is likely to miss Cutibacteria spp. and CoNS and cannot rule out infection for sure. However, we recommend it for its advantages of targeted antibiotic therapy in case of germ identification. Empiric antibiotic therapy should cover Cutibacteria and CoNS even if aspiration showed negative microbiological cultures. In contrast, the diagnostic value of interstage aspiration does not qualify for its routine use.
Hypereosinophilia is a predictive biomarker of immune checkpoint inhibitor-induced hypopituitarism in patients with renal cell carcinoma
Authors: Yamada Hodaka , Washino Satoshi , Suzuki Daisuke , Saikawa Rika , Tonezawa Shiori , Hagiwara Rie , Funazaki Shunsuke , Yoshida Masashi , Konishi Tsuzumi , Saito Kimitoshi , Miyagawa Tomoaki , Hara Kazuo
Published: April 2022

Background

This study aimed to evaluate whether hypereosinophilia is a clinical biomarker of immune checkpoint inhibitor-induced hypopituitarism in patients with renal cell carcinoma treated with nivolumab plus ipilimumab.

Methods

This was a retrospective cohort study conducted at Jichi Medical University Saitama Medical Center between January 2018 and December 2020. In total, 12 patients with renal cell carcinoma who presented with immune checkpoint inhibitor-induced hypopituitarism were enrolled in this study. The clinical parameters and symptoms at baseline, last visit, and onset of hypopituitarism were analyzed.

Results

The median period from the initial treatment with immune checkpoint inhibitors to the onset of hypopituitarism was 82.5 (range: 56–196) days. Most patients developed hypopituitarism within 6 months. One patient presented with hypophysitis and 11 patients presented with isolated adrenocorticotropic hormone deficiency. The major symptoms noted at onset were fatigue (66.7%) and loss of appetite (41.7%). None of the patients had symptoms during the last visit. However, four developed hypereosinophilia. Eosinophil fraction (%) and eosinophil count (/µL) increased during the last visit and at the onset of hypopituitarism, respectively. The serum sodium and plasma glucose levels were similar.

Conclusions

The eosinophil count increased before the onset of hypopituitarism. Thus, hypereosinophilia can be an early predictor of hypopituitarism.
Administrative data analysis of student attrition in hungarian medical training
Authors: Pusztai Gabriella , Demeter-Karászi Zsuzsanna , Alter Emese , Marincsák Rita , Dabney-Fekete Ilona Dóra
Published: April 2022

Background

There is numerous empirical evidence supporting that college students studying in fields with rigorous curriculum and high requirements, such as medical training, are characterized by a higher risk of attrition than their peers. Since Hungarian medical training attracts more and more international students every year, the issue of dropout can have a global impact. Our study aimed to examine attrition risks of local and international students in Hungarian medical training.

Methods

In our study, we examined the dropout behaviour of all medical students who started their studies in 2010 in Hungary (N = 2391) by analysing longitudinal administrative data of those who studied between 2010 and 2017. Doing this, we conducted descriptive statistics and uncovered the risks of dropout using binary logistic regression.

Results

Our results indicate that the danger is primarily increased by factors directly linked to or indicating poor academic performance (slow pace of credit accumulation, tuition-based forms of finance). Individual characteristics, namely gender, and citizenship, also have a moderate but significant effect on the latter.

Conclusions

Thus a policy proposal can be formulated consisting of making the training network less rigid, devoting more educational attention to and providing targeted mentoring for students with learning difficulties and academic hardships. Foreign medical students studying in Hungary comprise a large group that has a high attrition rate, making it a prime target for dropout-reducing programs.
The educational value of an audience response system use in an Iraqi medical school
Authors: Tuma Faiz , Majeed Husam , Blebea John , Nassar Aussama , Durchholz William C. , Schofield Susie
Published: April 2022

Background

Medical education is continually evolving particularly through the modern implementation of educational technology. Enhancing interactive learning in the classroom or lecture settings is one of the growing uses of educational technology. The role and potential benefits of such technology may not be as evident in developing educational systems like the one in Iraq. The purpose of this study was to examine the effect and perception of the use of an audience response system (ARS) on interactive medical education in Iraq. A mixed quantitative and qualitative research methodology approach was used to study the effects and users’ perceptions (both student and tutor) of the ARS.

Method

The study was conducted in an Iraqi medical school in the Head and Neck course during the spring semester for third-year medical students. The course involved fifteen one-hour lectures over fifteen weeks. Users’ perceptions were evaluated by survey and focus group discussions (FGD). Descriptive statistics were used for quantitative measures and thematic analysis for the qualitative data.

An ARS system was installed and integrated into the course lectures throughout the course period of three months to enhance interactive learning. Three to five interactive questions were used in each lecture. Anonymous participation and answers were maintained. The appropriate discussion was initiated when pertinent depending on students’ answers.

Result

Most students (77% of survey, 85% of FGD) perceived the use of ARS as impactful on their learning.

They found the ARS engaging (70%), motivating (76%), promoting interactions (73%), and augment learning through better understanding and remembering (81%). Through the FGD, students expressed improved focus, enhanced thinking and reflection, and joyful learning. The educator perceived the ARS use as practical, interactive, thinking-stimulator, and reflective of student’s understanding. The required technology skills were reasonable; however, it demanded extra non-insignificant time to learn the use.

Conclusion

The perception of the ARS in this study was overall positive, providing encouragement for wide application of this technology in medical education in the developing world. Further studies are needed to validate and prioritize ARS usage in medical education in Iraq.
Association between dispensing of low-value oral albuterol and removal from Medicaid preferred drug lists
Authors: Volerman Anna , Pelczar Alison , Conti Rena , Ciaccio Christina , Chua Kao-Ping
Published: April 2022

Background

Oral albuterol has worse efficacy and side effects compared with inhaled albuterol, and thus its use has been discouraged for decades. Drug inclusion or exclusion on formularies have been associated with reductions in low-value care. This study examines dispensing of oral albuterol and inclusion of oral albuterol on state Medicaid drug formularies--Preferred Drug Lists (PDLs). It also evaluates the association between removal of oral albuterol from the PDL and dispensing levels.

Methods

This quasi-experimental study determined oral albuterol inclusion on PDLs and dispensing between 2011 and 2018, using Medicaid program websites and the State Drug Utilization Database. Using a difference-in-differences model, we examine the association between removal of oral albuterol from Arkansas’ Medicaid PDL in 2014 and dispensing of this drug through Medicaid, with Iowa as a control state. The outcome measure was the percent of all albuterol prescriptions that were for oral albuterol.

Results

A total of 28 state Medicaid PDLs included at least one formulation of oral albuterol in 2018. In 2018, 179,446 oral albuterol prescriptions were dispensed to Medicaid beneficiaries nationally. Medicaid programs paid approximately $3.0 million for oral albuterol prescriptions in 2018. Removal of oral albuterol syrup from the Arkansas PDL in March 2014 was associated with a more rapid decline in dispensing compared with Iowa which maintained this medication on their PDL.

Conclusions

Findings suggest that removal of low-value medications, such as oral albuterol, from PDLs may be one avenue by which state Medicaid programs can reduce wasteful spending while improving guideline-based care.
Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review
Authors: Gartner Jean-Baptiste , Abasse Kassim Said , Bergeron Frédéric , Landa Paolo , Lemaire Célia , Côté André
Published: April 2022

Background

Confusion exists over the definition of the care pathway concept and existing conceptual frameworks contain various inadequacies which have led to implementation difficulties. In the current global context of rapidly changing health care systems, there is great need for a standardized definition and integrative framework that can guide implementation. This study aims to propose an accurate and up-to-date definition of care pathway and an integrative conceptual framework.

Methods

An innovative hybrid method combining systematic review, concept analysis and bibliometric analysis was undertaken to summarize qualitative, quantitative, and mixed-method studies. Databases searched were PubMed, Embase and ABI/Inform. Methodological quality of included studies was then assessed.

Results

Forty-four studies met the inclusion criteria. Using concept analysis, we developed a fine-grained understanding, an integrative conceptual framework, and an up-to-date definition of patient-centered care pathway by proposing 28 subcategories grouped into seven attributes. This conceptual framework considers both operational and social realities and supports the improvement and sustainable transformation of clinical, administrative, and organizational practices for the benefit of patients and caregivers, while considering professional experience, organizational constraints, and social dynamics. The proposed attributes of a fluid and effective pathway are (i) the centricity of patients and caregivers, (ii) the positioning of professional actors involved in the care pathway, (iii) the operation management through the care delivery process, (iv) the particularities of coordination structures, (v) the structural context of the system and organizations, (vi) the role of the information system and data management and (vii) the advent of the learning system. Antecedents are presented as key success factors of pathway implementation. By using the consequences and empirical referents, such as outcomes and evidence of care pathway interventions, we went beyond the single theoretical aim, proposing the application of the conceptual framework to healthcare management.

Conclusions

This study has developed an up-to-date definition of patient-centered care pathway and an integrative conceptual framework. Our framework encompasses 28 subcategories grouped into seven attributes that should be considered in complex care pathway intervention. The formulation of these attributes, antecedents as success factors and consequences as potential outcomes, allows the operationalization of this model for any pathway in any context.
Developing contraceptive services for immigrant women postpartum – a case study of a quality improvement collaborative in Sweden
Authors: Kilander Helena , Weinryb Maja , Vikström Malin , Petersson Kerstin , Larsson Elin C.
Published: April 2022

Background

Immigrant women use less effective contraceptive methods and have a higher risk of unintended pregnancies. Maternal health care services offer a central opportunity to strengthen contraceptive services, especially among immigrants. This study aimed to evaluate a Quality Improvement Collaborative QIC. Its objective was to improve contraceptive services for immigrant women postpartum, through health care professionals’ (HCPs) counselling and a more effective choice of contraceptive methods.

Methods

The pilot study was designed as an organisational case study including both qualitative and quantitative data collection and analysis. Midwives at three maternal health clinics (MHCs) in Stockholm, Sweden participated in a QIC during 2018–2019. In addition, two recently pregnant women and a couple contributed user feedback. Data on women’s choice of contraceptive method at the postpartum visit were registered in the Swedish Pregnancy Register over 1 year.

Results

The participating midwives decided that increasing the proportion of immigrant women choosing a more effective contraceptive method postpartum would be the goal of the QIC. Evidence-based changes in contraceptive services, supported by user feedback, were tested in clinical practice during three action periods. During the QIC, the proportion of women choosing a more effective contraceptive method postpartum increased at an early stage of the QIC. Among immigrant women, the choice of a more effective contraception increased from 30 to 47% during the study period. Midwives reported that their counselling skills had developed due to participation in the QIC, and they found using a register beneficial for evaluating women’s choice of contraceptive methods.

Conclusions

The QIC, supported by a register and user feedback, helped midwives to improve their contraceptive services during the pregnancy and postpartum periods. Immigrant women’s choice of a more effective contraceptive method postpartum increased during the QIC. This implies that a QIC could increase the choice of a more effective contraception of postpartum contraception among immigrants.
Telerehabilitation during the COVID-19 pandemic in Sweden: a survey of use and perceptions among physiotherapists treating people with neurological diseases or older adults
Authors: Bezuidenhout Lucian , Joseph Conran , Thurston Charlotte , Rhoda Anthea , English Coralie , Conradsson David Moulaee
Published: April 2022

Background 

Telerehabilitation, i.e. rehabilitation at a distance using Information and Communication Technology (ICT), is a promising avenue for improving health among people with neurological diseases or older adults who often experience limited access to services. Still, little is known about physiotherapists’ use, perceptions and needs with regards to telerehabilitation services.

Aims

To describe physiotherapists use and perceptions of, as well as needs for, telerehabilitation services for the rehabilitation of people with neurological diseases or older adults in Sweden.

Methods

In this cross-sectional study, an author-created survey was sent out to members of the Swedish Association of Physiotherapists including questions about the use and perceptions of existing telerehabilitation services (e.g. telephone, internet-based applications and mobile applications) as well as needs of future telerehabilitation services. The results were presented descriptively as numbers and percentages.

Results

Three hundred seven physiotherapists were included in this study with 139 (45%) treating people with neurological diseases and 168 (55%) treating older adults. Most respondents did not provide telerehabilitation before (74%) or during (51%) the COVID-19 pandemic. Telephone, which was predominantly used for administrative tasks, was the most frequent utilised ICT used by 68% of the physiotherapist using ICTs several days/week. Few respondents used internet-based applications (12%), mobile applications (3%) or SMS services (8%) and videoconferencing (3%). A majority of the respondents were interested in ICT (78%), felt comfortable using ICT (57%) and were interested in learning how ICT can be used in rehabilitation (92%). Still, few respondents perceived that people with neurological diseases or older adults can use existing ICTs for rehabilitation purposes (18%) and that existing reimbursement system within health care facilitates remote rehabilitation (16%). Important functionality of future ICT perceived by physiotherapists covered patient communication (e.g. chat, SMS and video), assessments (e.g. digital surveys and assessment of physical activity) and treatment (e.g. exercise prescription).

Conclusion

While physiotherapists had an overall positive perception to use and willingness to learn about telerehabilitation, few used telerehabilitation services before nor during the COVID-19 pandemic and they also perceived multilevel barriers for implementation, ranging from patients ability to use ICT to existing reimbursement systems within health care. Our findings emphasize the need to strengthen the expertise regarding remote services among physiotherapists.
Prevalence and risk factors of preoperative venous thromboembolism in patients with malignant musculoskeletal tumors: an analysis based on D-dimer screening and imaging
Authors: Hayashida Kenta , Kawabata Yusuke , Saito Keiju , Fujita Shintaro , Choe Hyonmin , Kato Ikuma , Takeyama Masanobu , Inaba Yutaka
Published: April 2022

Background

Venous thromboembolism (VTE) is a major complication in patients with malignant tumors and orthopedic disorders. Although it is known that patients undergoing surgery for malignant musculoskeletal tumor are at an increased risk of thromboembolic events, only few studies have investigated this risk in detail. Therefore, the aim of this study was to determine the prevalence and risk factors for preoperative VTE in malignant musculoskeletal tumors patients.

Methods

We retrospectively reviewed the medical records of 270 patients who underwent surgical procedures, including biopsy for malignant musculoskeletal tumor, have undergone measurements of preoperative D-dimer levels, and were subsequently screened for VTE by lower extremity venous ultrasonography and/or contrast-enhanced computed tomography scans. Statistical analyses were performed to examine the prevalence and risk factors for VTE. Receiver operating characteristic (ROC) analysis was performed to verify the D-dimer cutoff value for the diagnosis of VTE.

Results

Overall, 199 patients (103 with primary soft tissue sarcomas, 38 with primary bone sarcomas, 46 with metastatic tumors, and 12 with hematologic malignancies) were included. D-dimer levels were high in 79 patients; VTE was detected in 19 patients (9.5%). Multivariate analysis indicated that age ≥ 60 years (P = 0.021) and tumor location in the lower limbs (P = 0.048) were independent risk factors for VTE. ROC analysis showed that the D-dimer cutoff value for the diagnosis of VTE was 1.53 µg/mL; the sensitivity and specificity were 89.5% and 79.4%, respectively.

Conclusions

Our study indicated that age and tumor location in the lower limbs were independent risk factors for preoperative VTE in malignant musculoskeletal tumors patients. D-dimer levels were not associated with VTE in the multivariate analysis, likely because they are affected by a wide variety of conditions, such as malignancy and aging. D-dimer is useful for exclusion diagnosis because of its high sensitivity, but patients with high age and tumor location in the lower limbs are a high-risk group and should be considered for imaging evaluation such as ultrasonography regardless of D-dimer levels.

Trial registration

Our study was approved by the institutional review board. The registration number is B200600056. The registration date was July 13, 2020.
Inverse relation of body weight with short-term and long-term mortality following hip fracture surgery: a meta-analysis
Authors: Yang Tzu-I , Chen Yu-Hang , Chiang Ming-Hsiu , Kuo Yi-Jie , Chen Yu-Pin
Published: April 2022

Background

The obesity paradox, which suggests that high body weight is positively associated with survival in some diseases, has not been proven in patients with hip fracture. In this study, meta-analysis of previous studies on the impacts of body weight on postoperative mortality following hip fracture surgery in older adults was conducted.

Methods

PubMed, Embase, and Cochrane library were searched for studies investigating the correlation between mortality after hip fracture surgery and body weight. The search main items included: (“Body mass index” OR “BMI” or “body weight”) and (“hip fracture” or “hip fractures”). Studies contained data on short-term (≤ 30-day) and long-term (≥ 1 year) mortality after hip fracture and its association with distinct body weight or BMI groups were reported as full-text articles were included in this meta-analysis.

Results

Eleven separate studies were included. The definitions of underweight and obesity differed among the included studies, but the majority of the enrolled studies used the average body weight definition of a BMI of 18.5 to 24.9 kg/m2; underweight referred to a BMI of < 18.5 kg/m2; and obesity pertained to a BMI of > 30 kg/m2. Based on the generalized definitions of body-weight groups from the enrolled studies, the group with obesity had lower long-term (odds ratio [OR]: 0.63, 95% CI: 0.50–0.79, P < 0.00001) and short-term (OR: 0.63, 95% CI: 0.58–0.68, P ≤ 0.00001) mortality rates after hip fracture surgery when compared with patients with average-weight group. However, compared with the average-weight group, the underweight group had higher long-term (OR: 1.51, 95% CI: 1.15-1.98, P=0.003) and short-term (OR: 1.49, 95% CI: 1.29-1.72, P<0.00001) mortality rates after hip fracture surgery.

Conclusions

Current evidence demonstrates an inverse relation of body weight with long-term and short-term mortality after hip fracture surgery in older adults.
First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques
Authors: Kang Yang S. , Bridgen Andy
Published: April 2022

Background

First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end‐stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis.

Methods

The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded.

Results

Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively.

Conclusions

Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester‐Oxford Foot Questionnaire and EuroQol‐5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis.
A machine learning approach to identify risk factors for running-related injuries: study protocol for a prospective longitudinal cohort trial
Authors: Rahlf A. L. , Hoenig T. , Stürznickel J. , Cremans K. , Fohrmann D. , Sanchez-Alvarado A. , Rolvien T. , Hollander K.
Published: April 2022

Background

Running is a very popular sport among both recreational and competitive athletes. However, participating in running is associated with a comparably high risk of sustaining an exercise-related injury. Due to the often multifactorial and individual reasons for running injuries, a shift in thinking is required to account for the dynamic process of the various risk factors. Therefore, a machine learning approach will be used to comprehensively analyze biomechanical, biological, and loading parameters in order to identify risk factors and to detect risk patterns in runners.

Methods

The prospective longitudinal cohort study will include competitive adult athletes, running at least 20 km per week and being free of injuries three months before the start of the study. At baseline and the end of the study period, subjective questionnaires (demographics, injury history, sports participation, menstruation, medication, psychology), biomechanical measures (e.g., stride length, cadence, kinematics, kinetics, tibial shock, and tibial acceleration) and a medical examination (BMI, laboratory: blood count, creatinine, calcium, phosphate, parathyroid hormone, vitamin D, osteocalcin, bone-specific alkaline phosphatase, DPD cross-links) will be performed. During the study period (one season), continuous data collection will be performed for biomechanical parameters, injuries, internal and external load. Statistical analysis of the data is performed using machine learning (ML) methods. For this purpose, the correlation of the collected data to possible injuries is automatically learned by an ML model and from this, a ranking of the risk factors can be determined with the help of sensitivity analysis methods.

Discussion

To achieve a comprehensive risk reduction of injuries in runners, a multifactorial and individual approach and analysis is necessary. Recently, the use of ML processes for the analysis of risk factors in sports was discussed and positive results have been published. This study will be the first prospective longitudinal cohort study in runners to investigate the association of biomechanical, bone health, and loading parameters as well as injuries via ML models. The results may help to predict the risk of sustaining an injury and give way for new analysis methods that may also be transferred to other sports.

Trial registration: DRKS00026904 (German Clinical Trial Register DKRS), date of registration 18.10.2021.
Social media text analytics of Malayalam–English code-mixed using deep learning
Authors: Thara S. , Poornachandran Prabaharan
Published: April 2022

Zigzag conversational patterns of contents in social media are often perceived as noisy or informal text. Unrestricted usage of vocabulary in social media communications complicates the processing of code-mixed text. This paper accentuates two major aspects of code mixed text: Offensive Language Identification and Sentiment Analysis for Malayalam–English code-mixed data set. The proffered framework addresses 3 key points apropos these tasks—dependencies among features created by embedding methods (Word2Vec and FastText), comparative analysis of deep learning algorithms (uni-/bi-directional models, hybrid models, and transformer approaches), relevance of selective translation and transliteration and hyper-parameter optimization—which ensued in F1-Scores (model’s accuracy) of 0.76 for Forum for Information Retrieval Evaluation (FIRE) 2020 and 0.99 for European Chapter of the Association for Computational Linguistics (EACL) 2021 data sets. A detailed error analysis was also done to give meaningful insights. The submitted strategy turned in the best results among the benchmarked models dealing with Malayalam–English code-mixed messages and it serves as an important step towards societal good.
Time-series analysis with smoothed Convolutional Neural Network
Authors: Wibawa Aji Prasetya , Utama Agung Bella Putra , Elmunsyah Hakkun , Pujianto Utomo , Dwiyanto Felix Andika , Hernandez Leonel
Published: April 2022

CNN originates from image processing and is not commonly known as a forecasting technique in time-series analysis which depends on the quality of input data. One of the methods to improve the quality is by smoothing the data. This study introduces a novel hybrid exponential smoothing using CNN called Smoothed-CNN (S-CNN). The method of combining tactics outperforms the majority of individual solutions in forecasting. The S-CNN was compared with the original CNN method and other forecasting methods such as Multilayer Perceptron (MLP) and Long Short-Term Memory (LSTM). The dataset is a year time-series of daily website visitors. Since there are no special rules for using the number of hidden layers, the Lucas number was used. The results show that S-CNN is better than MLP and LSTM, with the best MSE of 0.012147693 using 76 hidden layers at 80%:20% data composition.
Analysis of acute sinusitis-related early failed implant surface: a combined histological, electron microscopy, and X-ray spectroscopy approach
Authors: Nguyen Truc Thi Hoang , Eo Mi Young , Seo Mi Hyun , Kim Soung Min
Published: April 2022

Background

Even though dental implants are a reliable choice for dental rehabilitation, implant failures due to various etiologies have been reported. Early implant failures account for 2 to 6% of installed implants and are reported to have a higher rate than late failures, regardless of loading time. We herein report three cases of acute sinusitis and early implant failure with implants that failed within 1 month after installation. The aim of this study was to evaluate the surface properties of early failed implants and peri-implant tissue to determine the early osseointegration pattern in acute sinusitis-related failed implants as well as the possible role of surface contamination in the failure of osseointegration.

Results

A combined histological, electron microscopy, and X-ray spectroscopy approach was used to characterize the surface of non-osseointegrated titanium implants and the surrounding biological tissues. Morphologic scanning electron microscopy revealed a heterogeneous surface and irregular osseointegration. The implant surface was covered mostly by carbon- and oxygen-rich organic matter. Energy-dispersive X-ray spectroscopy surface analysis of three implants showed the incorporation of some contaminants in both the upper and apical regions. Carbon, nitrogen, sodium, silicon, chlorine, sulfur, gold, and zirconium were detected on the surface of one or more failed implants. Fibrosis, lymphocytic, and macrophage infiltrates and a high activation of osteoclasts surrounding the bone graft particles were detected in the surrounding tissues.

Conclusions

The etiology and mechanism of early implant failure, especially in sinus-related cases, as well as the proper management interventions to minimize the rate of early implant failures, are of great concern. No matter how confident and accurate the surgeon’s operation, there may be unknown errors in the whole procedure that no one knows about. Rather than errors related to the implant surface, it is expected that there were invisible problems during the evaluation of the patient’s own unique sinus mucosal inflammation or the operator’s own procedure. Furthermore, well-designed researches are necessary to reveal the effect of material-related factors on acute sinus complication and early implant failure.
Influence of replacement of wheat flour by rice flour on rheo-structural changes, in vitro starch digestibility and consumer acceptability of low-gluten pretzels
Authors: Jan Nusrat , Naik H. R. , Gani Gousia , Bashir Omar , Amin Tawheed , Wani Sajad Mohd , Sofi Shakeel Ahmad
Published: April 2022

This study aimed to access the influence of rice flour incorporation on various quality attributes of low-gluten wheat-based pretzels viz., functional, rheological, starch digestibility, color, textural and sensorial properties. Significant increase in swelling power (18.33 ± 0.51) and bulk density (0.58 ± 0.04) was observed in flour blend upon incorporation of rice flour, whereas, significant decrease in oil absorption capacity (0.62 ± 0.09), solubility index (6.72 ± 0.17), foaming capacity (9.67 ± 0.34), and foaming stability (3.39 ± 0.15) was recorded. Pasting properties of samples were studied using a Rapid Visco Analyser which indicated that all the pasting properties increased with an increase in rice flour incorporation. Fourier transform infrared spectroscopic studies revealed no difference in the basic functional groups of flour blend upon the incorporation of rice flour, however, it had a pronounced effect on elastic modulus (G′) of flour blend. In vitro starch digestion characteristics revealed 7.23% surge in slowly digestible starch and 13.36% reduction in rapidly digestible starch of developed low-gluten pretzels upon the incorporation of rice flour. Apparent amylose content (27.3 ± 1.45) and resistant starch content (6.12 ± 0.97) increased and starch digestibility index (69.87 ± 1.72) decreased in developed low-gluten pretzels. In conclusion, the developed low-gluten pretzels had significantly (p < 0.05) higher mineral profile and lightness (L*) and lower breaking strength in addition to having better overall acceptability. This study indicated that substituting wheat flour with rice flour up to a level of 35% affected the quality attributes of developed low-gluten pretzels.

Graphical abstract