bluuebunny/crossref_metadata_2025 huggingface dataset:
Parenteral Long-Acting Antiseizure Medications Are Used More Often to Treat Seizure Clusters Than Convulsive Status Epilepticus in the Pediatric Emergency Department
Authors: Pfeiffer Christina K. , Mackay Mark T. , Long Elliot , Stephens David , Dalziel Stuart R. , Babl Franz E. ,   on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT)
Published: February 2022

Objective:Recent trials provide high-quality evidence for second-line treatment of convulsive status epilepticus (CSE) in children. However, the most effective medications for other seizure emergencies are poorly understood without established treatment algorithms. We investigated children presenting to the emergency department with repetitive or prolonged convulsions who required intravenous long-acting antiseizure medications, to determine the relative importance and treatment responsiveness of status epilepticus and seizure clusters. Methods: Retrospective observational study in the emergency department, Royal Children's Hospital, Melbourne, Australia (annual census 90 000) using hospital electronic medical records data of patients presenting with seizures in 2018. For patients receiving parenteral long-acting antiseizure medications, seizures were categorized as convulsive status epilepticus, nonconvulsive status epilepticus, and seizure clusters. Results: 1468 patients (2% of all visits) presented with seizures to the emergency department in 2018. Long-acting antiseizure medications were administered to 97 (7%) children for the emergency management of seizures. The majority presented with seizure clusters (n = 69; 71%). Only 11 (11%) were in convulsive status epilepticus and 17 (18%) in nonconvulsive status epilepticus. In convulsive status epilepticus, nonconvulsive status epilepticus, and seizure clusters, phenytoin was used in 27%, 53%, and 58% and levetiracetam in 73%, 47%, and 32%, respectively. Conclusions:Convulsive status epilepticus represents a small portion of patients requiring parenteral long-acting antiseizure medications. Seizure clusters accounted for >6 times the number of convulsive status epilepticus, yet evidence and treatment algorithms are lacking.
Body Image Dissatisfaction, Breastfeeding Experiences, and Self-Efficacy in Postpartum Women with and Without Eating Disorder Symptoms
Authors: Kapa Hillary M. , Litteral Jennifer L. , Keim Sarah A. , Jackson Jamie L. , Schofield Kyle A. , Crerand Canice E.
Published: February 2022

Background:

Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy.

Research Aims:

To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms.

Methods:

A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2–6 months old who had breastfed their infant at least once ( N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum.

Results:

Clinical eating disorder symptoms were reported by 9.8% ( n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations ( B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction ( B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy ( B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences.

Conclusions:

Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.
Unpacking Super-Exploitation in the 21st Century: The Struggles of Haitian Workers in Brazil
Authors: Portes Virginio Francis , Stewart Paul , Garvey Brian
Published: February 2022

Emerging patterns of south–south migration and rapid economic growth in developing countries have highlighted the need for new conceptual contributions accounting for the experiences of migrant workers in the Global South. The concept of super-exploitation has been among those contributions with reference to appalling working conditions and the dependence of developing countries on the export of commodities. However, this article argues that the understanding of contemporary forms of super-exploitation experienced by migrant workers remains underdeveloped. Drawing upon 42 semi-structured interviews with Haitian workers in Brazil, this study makes an innovative contribution to the conceptualisation of super-exploitation in the 21st century, particularly from the perspective of social reproduction theory. This article argues that super-exploitation can be defined more accurately as a combination of economic and non-economic forces that entangle productive–reproductive–exploitative relationships, thereby shaping the dependence of workers on wages below the value necessary for their social reproduction.
Principles for Responsible Management Education: An Axiological Approach
Authors: Audebrand Luc K. , Pepin Matthias
Published: February 2022

In this article, we rely on the development of a Massive Open Online Course (MOOC) to show the relevance of a values-based approach to responsible management. To clarify the notion of values, we draw on Heinich’s axiological sociology, which presents values as principles of judgment and action. Building on this approach, we interviewed 35 management scholars to understand the values they attribute to responsible management. Our analysis led to the identification of seven actionable values that can be used to circumscribe responsible management. We also show how three interrelated levels of analysis—namely, individual (micro), organizational (meso), and societal (macro)—allowed us to further organize the interview data to produce rich content for the MOOC. Our contribution is twofold: first, our values-based approach helps overcome the axiological ambiguity of the Principles for Responsible Management Education (PRME), which invoke the importance of incorporating “the values of global social responsibility” (Principle 2), but fail to define and operationalize these values. Second, we provide a rationale and guidance for implementing values-based responsible management education in Business Schools.
An Exploratory Study of an Online Vaccine Education Program in Middle-School Students to Promote Vaccine Acceptance
Authors: Lewin Edward B. , Bellanti Dawn M. , Boyd Courtney C. , Orenstein Walter A. , Bellanti Joseph A.
Published: February 2022

Background: While vaccines have reduced the incidence of vaccine-preventable diseases, vaccine hesitancy threatens the re-emergence of childhood infectious diseases. Purpose: This randomized controlled study evaluated an online vaccine education program to advance vaccine acceptance among middle-school students. Methodology: Study participants were randomly assigned to an intervention group who viewed the VEP videos or to a comparison group who viewed a science-based video unrelated to vaccines. Results: Knowledge scores improved in both groups and more favorable shifts in vaccine-related beliefs and attitudes occurred in the intervention than in the comparison group. Conclusions: This program can be feasibly delivered via an online platform to middle school students, resulting in shifts in vaccine-related knowledge, beliefs and attitudes. Implications: Delivering evidence-based content to instruct about vaccine effectiveness and safety is an area in which school nurses have demonstrated an important role as a resource for patient education to promote vaccine advocacy.
Vitamin E and levocarnitine as prophylaxis against doxorubicin-induced cardio toxicity in the adult cancer patient: A review
Authors: Moustafa Iman , Saka Sule , Viljoen Michelle , Oosthuizen Frasia
Published: February 2022

Objective

Doxorubicin, a component of the anthracycline group, is a highly effective in the treatment of hematologic and solid malignancies. Because of the cardiotoxic adverse effects, use is limited. Antioxidants may negate this anthracycline-induced cardiotoxicity, although the literature is not conclusive with regards to the cardioprotective benefits of antioxidants. This review assessed and mapped evidence of the efficacy of vitamin E and levocarnitine against doxorubicin-induced cardiotoxicity in adult cancer patients.

Data Sources

This review was based on the Arksey and O’Malley methodology. Potentially relevant literature in English published between January 1960 and April 2021 was identified through a database search. Oxford Quality Scoring System and AMSTR2 were used to assess the quality of trials and systematic reviews respectively, as well as the risks of potential bias.

Data Summary

Nineteen of the 10 268 (0.2%) articles from the initial search were included in the final analysis (12 clinical trials and 7 systematic reviews). Vitamin E was included in seven prospective clinical trials. Levocarnitine was included in five clinical trials as an individual agent and a single trial as a combination treatment. No trials could be found investigating the combination of vitamin E and levocarnitine in humans.

Conclusions

This review found that levocarnitine trials showed some cardioprotective effects but the results from vitamin E trials were controversial and inconclusive. Most of the trials reviewed had some shortcomings. Further investigations are therefore needed to determine the efficacy of vitamin E and levocarnitine in preventing doxorubicin-induced cardiotoxicity in adult cancer patients.
Temporal trends in cause-specific mortality in a rural-provincial area of Denmark, Lolland-Falster, 1970–2018
Authors: Holmager Therese Lucia Friis , Nymand Lophaven Søren , Mortensen Laust Hvas , Lynge Elsebeth
Published: February 2022

Aim:

In Denmark, rural-provincial Lolland-Falster currently has the highest mortality, caused mainly by the high mortality of in-migrating people. To identify possible preventive measures to combat this excess mortality insight into the underlying diseases is needed.

Methods:

We used data from Danish registers to calculate cause-specific mortality for 1970–1979, 1980–1989, 1990–1999, 2000–2009 and 2010–2018 divided into cancer, cardiovascular diseases, respiratory diseases, external causes and other causes (all remaining causes). We calculated age-standardised mortality rates for Lolland-Falster and the rest of Denmark: mortality rate ratios and excess number of deaths per 100,000 person-years for Lolland-Falster distinguishing between long-term residents (10+ years) and in-migrants.

Results:

In 1970–1979, the age-standardised mortality rates for Lolland-Falster resembled those for rest of Denmark. Over time, age-standardised mortality rates for cardiovascular diseases decreased but more so for the rest of Denmark than for Lolland-Falster. Age-standardised mortality rates for other diseases increased but more so for Lolland-Falster than for the rest of Denmark. The excess mortality in Lolland-Falster derived in particular from in-migrants: in 2010–2018 the mortality rate ratios for this population reached 2.29 (95% confidence interval 1.96–2.69) for external causes and 2.12 (95% confidence interval 1.97–2.29) for other diseases. In-migrants had in total 411 excess deaths per 100,000 person-years. Of these 27% came from tobacco smoking-related causes of death. However, another 25% came from ill-defined, unspecified and a broad range of other, minor causes of deaths.

Conclusions:

The excess mortality of in-migrants to Lolland-Falster was attributable to all main causes of deaths, which stresses the complexity in combatting geographical disparities in mortality.
LGBTQ+ non-discrimination and religious freedom in the context of government-funded faith-based education, social welfare, health care, and aged care
Authors: Ezzy Douglas , Beaman Lori , Dwyer Angela , Fielder Bronwyn , McLeay Angus , Rice Simon , Richardson-Self Louise
Published: February 2022

Anti-discrimination laws around the world have explicitly protected LGBTQ+ people from discrimination with various levels of exceptions for religion. Some conservative religious organisations in Australia are advocating to be allowed to discriminate against LGBTQ+ people in certain organisations they manage. The political debate in Australia has focused on religiously affiliated organisations that provide services in education, social welfare, health care, and aged care. We argue that religious exceptions allowing discrimination should be narrow because they cause considerable harm, reinforce, disadvantage and because LGBTQ+ people are deserving of respect and rights. We draw on a national representative survey to demonstrate that the views of some conservative religious lobby groups do not represent the views of the majority of religious people in Australia or the views of the majority of Christian people.
Dementia and its impacts on the intimate, sexual couple relationship: A systematic review of qualitative research studies
Authors: Albert Susan Carol , Eduardo Martinelli José , Costa Pessoa Maria Silvia
Published: February 2022

Objective

There is growing evidence for the need to recognize persons with dementia as sexual beings who wish to continue expressing their sexuality, including within their couple relationship. The aim of this literature review was to investigate empirical qualitative studies that examined sexuality and sexual intimacy in the couple relationship when one spouse has dementia.

Method

A systematic literature review was performed in January 2021, five data bases were searched: Pubmed, MedLine, Lilacs, Scopus, and SciELO. The references of articles included in the review were screened together with the references of other relevant reviews.

Results

Nine studies were identified that investigated sexuality and sexual intimacy from the perspective of the couple living with dementia or from the perspective of the spouse. The analysis identified four key themes: addressing dementia and sexuality; challenges to maintaining sexuality within the couple relationship; forms of sexual expression; and the desire to be seen as a sexual being.

Conclusion

Despite evidence of the importance of sexuality in later life and the positive effects it has on the quality of the couple relationship, research has identified the difficulty of destigmatizing sexuality and older persons, particularly when considering couples affected by dementia. Further research is required to better understand how living with the illness impacts sexual expression and the intimacy of the couple relationship.
Transformative Learning in Fijian Primary Schools: A Case Study of Australian University Students’ International Experiences
Authors: Chandra Vinesh , Lassig Carly , Tangen Donna
Published: February 2022

Service-learning is used by universities to promote community engagement thatbenefits both the students and the recipient community; however, evidence largely demonstrates only the shortterm effects of such experiences. This paper presents ananalysis of the transformational learning of a group of Australian students who travelled to Fiji in an organised service-learing project. Using Kiely's model oftransformational learning, this case study describes the dissonance felt by a sub-groupof three (n = 3) students, from a cohort of thirteen (n = 13), who subsequently used this transformational learning to make major changes in their career and life goals. Rather than being adversely affected by the dissonance they experienced, these students used this learning as an opportunity for personal and professional growth. These findings support the notion that service-learning has the potential to provide students with challenging, life-changing opportunities that can have long-lasting effects.
Consent Requirements for Testing Health Policies: An Intercontinental Comparison of Expert Opinions
Authors: Berner-Rodoreda Astrid , McMahon Shannon , Eyal Nir , Hossain Puspita , Rabbani Atonu , Barua Mrittika , Sarker Malabika , Metta Emmy , Mmbaga Elia , Leshabari Melkizedeck , Wikler Daniel , Bärnighausen Till
Published: February 2022

Individual informed consent is a central requirement for clinical research on human subjects, yet whether and how consent requirements should apply to health policy experiments (HPEs) remains unclear. HPEs test and evaluate public health policies prior to implementation. We interviewed 58 health experts in Tanzania, Bangladesh and Germany on informed consent requirements for HPEs. Health experts across all countries favored a strong evidence base, prior information to the affected populations, and individual consent for ‘risky’ HPEs. Differences pertained to individual risk perception, how and when consent by group representatives should be obtained and whether HPEs could be treated as health policies. The study adds to representative consent options for HPEs, yet shows that more research is needed in this field – particularly in the present Covid-19 pandemic which has highlighted the need for HPEs nationally and globally.
Clinical Challenges of Acute Porphyria in the Young Adult
Authors: Burns Shannon , Harmel Allison , Miller Sally , Pucci Gabriela Figueiredo , Greco Jonathan , Pulley Michael , Pizzi Michael
Published: February 2022

Porphyria is a metabolic disorder caused by a mutation in the heme biosynthetic pathway, with vague symptomatology and rare prevalence. A triad of hyponatremia, intermittent seizures, and abdominal pain should raise suspicion for porphyria. The diagnosis is based on increased blood porphobilinogen levels and genetic mutations. Treatment involves Dextrose-10 administration followed by hematin infusions as soon as possible. A maintenance dose of hematin is required in some cases. Here, we report a delayed diagnosis of acute intermittent porphyria (AIP) in an 18-year-old female, who first presented with severe anemia attributed to iron deficiency from menstrual blood loss. After discharge, she was readmitted with bilateral lower extremity and abdominal pain, hyponatremia, and seizure attributed to polypharmacy. During this second hospitalization, she was transferred to our hospital complaining of chest pain, shortness of breath, markedly decreased weakness, dysphagia, and hallucinations. After an extensive workup, she was diagnosed with AIP, and Dextrose-10 and hemin infusion were started. Our patient was found to have a missense mutation in the Hydroxymethylbilane synthase gene. She recovered after an extended ICU stay of 45 days and was discharged with a moderate improvement of weakness. Early diagnosis is necessary to prevent severe manifestations and long-term sequelae, such as axonal neuropathy, which occurred in the presented case.
Progressive Myelopathy With Acute Worsening After Steroids and Lumbar Puncture
Authors: Thebault Simon , Kim WooJin , Hadwen Jeremiah , Walker Gregory B. , Drake Brian , Fantaneanu Tadeu A.
Published: February 2022

We present the case of a 73-year-old woman with a 3-month history of non-traumatic thoracic myelopathy. Initial MRI showed a T6-conus T2 signal hyperintensity. Based on this presentation, and given a personal and family history of autoimmune disease, our patient was first managed as an inflammatory transverse myelitis. Subsequent worsening after lumbar puncture and steroids prompted re-evaluation, ultimately identifying the cause as a thoracic spinal dural AV fistula. Both investigation of possible transverse myelitis with lumbar puncture and empiric treatment with steroids may not only result in diagnostic delays but also precipitate venous infarction and irreversible harm. While the MRI often provides the initial diagnosis, clinical suspicion for this under-diagnosed cause of myelopathy should be raised in older patients with a more progressive thoracic myelopathy with worsening after lumbar puncture and/or steroids. Definitive and time-sensitive treatment by interventional neuroradiology or neurosurgery results in stabilization or improvement of disability in most cases.
Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review
Authors: Jaiswal Vikash , Nepal Gaurav , Dijamco Patricia , Ishak Angela , Dagar Mehak , Sarfraz Zouina , Shama Nishat , Sarfraz Azza , Lnu Kriti , Mitra Saloni , Agarwala Preeti , Naz Sidra , Song David , Jaiswal Akash
Published: February 2022

Introduction:

COVID-19 vaccines became available after being carefully monitored in clinical trials with safety and efficacy on the human body. However, a few recipients developed unusual side effects, including cerebral venous sinus thrombosis (CVST). We aim to systematically review the baseline features, clinical characteristics, treatment, and outcomes in patients developing CVST post-COVID-19 vaccination.

Methods:

This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) 2020 guideline. Investigators independently searched PubMed, Embase, and Google Scholar for English language articles published from inception up until September 10, 2021, reporting the incidence of CVST post-COVID-19 vaccines. We analyzed CVST patients’ baseline data, type of vaccines, clinical findings, treatment, and outcomes. Our systematic review process yielded patient-level data.

Result:

The final analysis included 25 studies that identified 80 patients who developed CVST after the COVID-19 vaccination. Of the 80 CVST cases, 31 (39.24%) patients died. There was no significant relationship between mortality and age ( P = .733), sex ( P = .095), vaccine type ( P = .798), platelet count ( P = .93), and comorbidities such as hypertension ( P = .734) and diabetes mellitus ( P = .758). However, mortality was associated with the duration of onset of CVST symptoms after vaccination ( P = .022). Patients with CVST post-COVID-19 vaccination were more likely to survive if treated with an anticoagulant ( P = .039). Patients who developed intracranial hemorrhage ( P = .012) or thrombosis in the cortical vein ( P = .021) were more likely to die.

Conclusion:

COVID-19 vaccine-associated CVST is associated with high mortality rate. Timely diagnosis and management can be lifesaving for patients.
Update on Performance and Return to Sport After Biceps Tenodesis in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter N. , D’Angelo John , Ma Kevin , Rowe Dana , Ciccotti Michael G. , Romeo Anthony A.
Published: February 2022

Background:

Bicipital disorders are common among overhead athletes, especially professional baseball players. The ideal treatment for bicipital problems in professional baseball players is unknown.

Purpose/Hypothesis:

The purpose was to determine the return-to-sport (RTS) rate and performance after RTS in professional baseball players who underwent biceps tenodesis. It was hypothesized that there will be a high RTS rate in this population, with no difference between the biceps tenodesis and control groups in the RTS rate or performance.

Study Design:

Case series; Level of evidence, 4.

Methods:

All professional Major League Baseball players who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between players with biceps tenodesis and matched controls (no history of biceps tenodesis).

Results:

Included were 14 players (mean age, 27 ± 4 years; 12 pitchers, 2 position outfielders). Most surgeries (79%) were open subpectoral tenodeses, 2 were arthroscopic biceps transfers, and 1 was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%), and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent superior labral anterior-posterior repairs). While 86% (12/14) were able to RTS, 50% (7/14) returned at the same or a higher level, and 50% of the whole study were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did RTS, it took 245 ± 84 days, and their performance after RTS was unchanged and did not differ from that of matched controls.

Conclusion:

Open subpectoral tenodesis was the most common tenodesis technique performed on professional baseball players. While 86% of players returned to sport after biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who returned successfully.
Antibodies against Periodontal Microorganisms and Cognition in Older Adults
Authors: Merchant A.T. , Yi F. , Vidanapathirana N.P. , Lohman M. , Zhang J. , Newman-Norlund R.D. , Fridriksson J.
Published: February 2022

Introduction:

Markers of poor oral health are associated with impaired cognition and higher risk of Alzheimer disease (AD) and thus may help predict AD.

Objectives:

The aim of this study was to evaluate the cross-sectional association between empirically derived groups of 19 IgG antibodies against periodontal microorganisms and cognition in middle-aged and older adults.

Methods:

The study population consisted of participants of the third National Health and Nutrition Examination Survey (NHANES III) (1988 to 1994), who were 60 y and older, among whom cognition and IgG antibodies against 19 periodontal microorganisms were measured (N = 5,162).

Results:

In multivariable quantile regression analyses, the Orange-Red (Prevotella melaninogenica, Prevotella intermedia, Prevotella nigrescens, Porphyromonas gingivalis) and Yellow-Orange (Staphylococcus intermedius, Streptococcus oralis, Streptococcus mutans, Fusobacterium nucleatum, Peptostreptococcus micros, Capnocytophaga ochracea) cluster scores were negatively associated with cognition. A 1-unit higher cluster score for the Orange-Red cluster was associated on average with a lower cognitive score (β for 30th quantile = −0.2640; 95% confidence interval [CI], −0.3431 to −0.1848). Similarly, a 1-unit higher score for the Yellow-Orange cluster was associated with a lower cognitive score (β for 30th quantile = −0.2445; 95% CI, −0.3517 to −0.1372).

Conclusion:

Groups of IgG antibodies against periodontal microorganisms were associated with lower cognition among free living adults 60 years and older, who were previously undiagnosed with cognitive impairment. Though poor oral health precedes the development of dementia and AD, oral health information is currently not used, to our knowledge, to predict dementia or AD risk. Combining our findings with current algorithms may improve risk prediction for dementia and AD.

Knowledge Translation Statement:

IgG antibodies against periodontal microorganisms were associated with lower cognition among adults 60 years and older previously undiagnosed with cognitive impairment. Periodontal disease may predict cognition among older adults.
Risk-based bridge component importance measures under seismic loads
Authors: Vishnu Navya , Padgett Jamie E , Dueñas-Osorio Leonardo
Published: February 2022

This article formulates risk-based component importance measures (RCIMs) to identify critical components for a bridge subjected to earthquakes. RCIM, unlike traditional reliability-based importance measures, is well suited for complex systems like bridges as it uses a flexible system failure definition using bridge level risk consequences or performance objectives. Contrasting traditional notions of risk and reliability related to structural system failures, the RCIMs embrace a broader definition of risk which includes consequences of system failure to society and the environment. System failure is defined as exceedance of a user-defined threshold of system risk (e.g. based on cost, emissions, embodied energy, or other metrics). Our definition of system failure using global performance metrics helps relating component to system reliability explicitly and offers an alternative perspective to aggregate joint failure events of bridge components into relevant damage states. RCIM combines information about the reliability of a component and its contribution to the system performance and hence the importance measures developed offer risk mitigation indicators for decision makers as to which components may require upgrade to achieve a given performance objective. The proposed RCIMs generalize existing importance measures through analytical exploration of the entire space of system configurations with correlated component failures, while also considering multiple risk-based criteria beyond reliability. These RCIMs, demonstrated through a seismic bridge system case study, further show that as the bridge components age and the hazard intensity varies, the relative contribution of the components to system risk also shifts.
Historical expectations with DNA methyltransferase inhibitor monotherapy in MDS: when is combination therapy truly “promising”?
Authors: Brunner Andrew M. , Fell Geoffrey , Steensma David P.
Published: February 2022

DNA methyltransferase inhibitors (DNMTIs) for patients with higher risk myelodysplastic syndromes (HR-MDS) have low complete remission rates and are not curative. Early DNMTI combination clinical trials in HR-MDS are often termed “promising,” but many randomized trials subsequently failed to show benefit. Clearer understanding of when a combination is likely to improve upon DNMTI monotherapy would inform randomized studies. We reviewed MDS azacitidine or decitabine monotherapy studies. We collected baseline demographics including International Prognostic Scoring System (IPSS) risk, DNMTI, disease characteristics; and response variables including survival and marrow and hematologic responses. Aggregate estimates across studies were calculated using meta-analyses techniques. Using a binomial design, we estimated the necessary operating characteristics to design a phase 2 study showing improved efficacy of a combination over monotherapy. Among 1908 patients, the overall response rate (ORR) was 24% (n = 464; 95% confidence interval [CI], 0.22-0.26): 267 complete response (CR, 14%), 68 partial response (4%), and 129 marrow complete remission (7%). Among 1604 patients for whom a hematologic response was reported, 476 (30%; 95% CI, 0.27-0.32) reported hematologic improvement (HI). More patients treated with azacitidine achieved HI (38%; 95% CI, 0.35-0.41) compared with decitabine (15%; 95% CI, 0.13-0.19), whereas the marrow ORR rate was higher with decitabine (29%; 95% CI, 0.26-0.33) compared with azacitidine (21%; 95% CI, 0.19-0.23). CR rates were similar between DNMTIs: 13% with azacitidine and 16% with decitabine. Variables that influence MDS response include the specific DNMTI backbone and the distribution of IPSS risk of patients enrolled on a trial. Considering these factors can help identify which early combination approaches are worth assessing in larger randomized trials.
The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study
Authors: Xie Xin , Ren Kaijie , Zhou Zhangjian , Dang Chengxue , Zhang Hao
Published: February 2022

Background

Peptic ulcer disease (PUD) is a common digestive disorder, of which the prevalence decreased in the past few decades. However, the decreasing tendency has plateaued in recent years due to changes in risk factors associated with the etiology of PUD, such as non-steroidal anti-inflammatory drug use. In this study, we investigated the epidemiological and the sociodemographic characteristics of PUD in 204 countries and territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study.

Methods

Demographic characteristics and annual prevalence, incidence, mortality, disability-adjusted life years (DALYs) and age-standardized death rate (ASR) data associated with PUD were obtained and analyzed. According to the sociodemographic index (SDI), the numbers of patients, ASRs, estimated annual percentage changes and geographical distributions were assessed with a generalized linear model and presented in world maps. All evaluations of numbers and rates were calculated per 100,000 population with 95% uncertainty intervals (UIs).

Results

In 2019, the global prevalence of PUD was approximately 8.09 [95% UI 6.79–9.58] million, representing a 25.82% increase from 1990. The age-standardized prevalence rate was 99.40 (83.86–117.55) per 100,000 population in 2019, representing a decrease of 143.37 (120.54–170.25) per 100,000 population from 1990. The age-standardized DALY rate in 2019 was decreased by 60.64% [74.40 (68.96–81.95) per 100,000 population] compared to that in 1990. In both sexes, the numbers and ASRs of the prevalence, incidence, deaths and DALYs were higher in males than in females over 29 years. Regionally, South Asia had the highest age-standardized prevalence rate [156.62 (130.58–187.05) per 100,000 population] in 2019. A low age-standardized death rate was found in the high-income super-region. Among nations, Kiribati had the highest age-standardized prevalence rate [330.32 (286.98–379.81) per 100,000 population]. Regarding socioeconomic status, positive associations between the age-standardized prevalence, incidence, death rate, DALYs and SDI were observed globally in 2019.

Conclusions

Morbidity and mortality due to PUD decreased significantly from 1990 to 2019, while a gradual upward inclination has been observed in recent 15 years, which might be associated with changes in risk factors for PUD. Attention and efforts by healthcare administrators and society are needed for PUD prevention and control.
Graves’ disease overlapping with chronic hepatitis B and methimazole-induced liver injury and autoimmune hepatitis: a case report
Authors: Zheng Meifang , Cui Shiyuan , Zhang Wei , Brigstock David R. , Gao Runping
Published: February 2022

Background

Liver injury related to Graves’ Disease (GD) includes hepatotoxicity of thyroid hormone excess, drug-induced liver injury, and changes resulting from concomitant liver disease. Methimazole (MMI) has been shown to induce several patterns of liver injury. However, the diagnosis and treatment of autoimmune hepatitis (AIH) overlapping with either GD or chronic hepatitis B are challenging.

Case presentation

A 35-year-old man from China presented with a two-year history of GD and a 10-day history of progressive jaundice. He had taken MMI for two months and discontinuing treatment due to liver toxicity 1 year ago and for another 6 days 20 days prior to hospitalization. The patient was diagnosed with GD overlapping with chronic hepatitis B and MMI-induced liver injury with early stage of acute-on-chronic liver failure on admission. However, the elevated aminotransferase and bilirubin levels could not be controlled after correction of liver failure and effective control of HBV replication and hyperthyroidism by daily oral entecavir and one-time oral administration of 131-iodine. The patient underwent liver biopsy on the 43rd day of hospitalization, showing HBsAg expression on the membrane of hepatocytes and typical histopathological characteristics of AIH. He was finally diagnosed with GD overlapping with chronic hepatitis B and MMI-induced liver injury and AIH. The elevated aminotransferase and bilirubin completely returned to normal by 3-month glucocorticoid therapy and continuous entecavir treatment and there was no recurrence during a 6-month follow-up, suggesting that AIH in this patient is different from classical AIH or GD-associated AIH.

Conclusions

GD together with AIH is a complex and difficult subject. It needs to be clarified whether MMI or HBV can act as a trigger for AIH in this patient.
Effect of artificial tears on dynamic optical quality in patients with dry eye disease
Authors: Wei Zhenyu , Su Yuandong , Su Guanyu , Baudouin Christophe , Labbé Antoine , Liang Qingfeng
Published: February 2022

Background

In clinical practice, fluctuating vision or decreased quality of vision is a common complaint in DED patients. Our study was designed to investigate the change in dynamic optical quality in dry eye patients after the use of artificial tears.

Methods

Fifty-nine patients with dry eye disease (DED) and 31 control subjects were included in this prospective case-control study. There was no significant difference in age and sex between these two groups (P = 0.342, P = 0.847, respectively). Clinical evaluation of the ocular surface included Ocular Surface Disease Index (OSDI), tear film break-up time (TBUT), lipid layer thickness (LLT), and Schirmer I test. DED patients were divided into two groups, mild (31 patients) and severe (28 patients). The optical quality of the tear film was measured with the Optical Quality Analysis System (OQAS) using the mean objective scatter index (mean OSI), standard deviation of objective scatter index (SD-OSI) and modulation transfer function cut-off (MTF cut-off). After baseline examinations, one drop of artificial tears (ATs, carboxymethylcellulose ophthalmic solution, 0.5%) was instilled in both eyes, and optical quality parameters were measured again at 5 and 30 min following application of ATs.

Results

At baseline, the mean OSI was higher in the DED group (0.95 ± 0.54) than in controls (0.54 ± 0.23, P < 0.001). The SD-OSI was also significantly increased in DED patients (0.44 ± 0.71) compared to control subjects (0.12 ± 0.06, P = 0.003). Five minutes after AT instillation, mean OSI and SD-OSI decreased significantly in severe DED patients (P = 0.044; P = 0.018), remained unchanged in mild DED patients, and increased in the control group (P = 0.019; P < 0.001). Thirty minutes after AT instillation, no significant difference in optical quality parameters was observed among the three groups.

Conclusion

The effect of ATs on optical quality in patients with DED may differ according to the severity of the disease. Measurement of optical quality might be a promising tool to evaluate the effects of various ATs and possibly individualize treatment in DED patients.
Epidemiology of floods in sub-Saharan Africa: a systematic review of health outcomes
Authors: Suhr Friederike , Steinert Janina Isabel
Published: February 2022

Background

Floods have affected 2.3 billion people worldwide in the last 20 years, and are associated with a wide range of negative health outcomes. Climate change is projected to increase the number of people exposed to floods due to more variable precipitation and rising sea levels. Vulnerability to floods is highly dependent on economic wellbeing and other societal factors. Therefore, this systematic review synthesizes the evidence on health effects of flood exposure among the population of sub-Saharan Africa.

Methods

We systematically searched two databases, Web of Science and PubMed, to find published articles. We included studies that (1) were published in English from 2010 onwards, (2) presented associations between flood exposure and health indicators, (3) focused on sub-Saharan Africa, and (4) relied on a controlled study design, such as cohort studies, case-control studies, cross-sectional studies, or quasi-experimental approaches with a suitable comparator, for instance individuals who were not exposed to or affected by floods or individuals prior to experiencing a flood.

Results

Out of 2306 screened records, ten studies met our eligibility criteria. We included studies that reported the impact of floods on water-borne diseases (n = 1), vector-borne diseases (n = 8) and zoonotic diseases (n = 1). Five of the ten studies assessed the connection between flood exposure and malaria. One of these five evaluated the impact of flood exposure on malaria co-infections. The five non-malaria studies focused on cholera, scabies, taeniasis, Rhodesian sleeping sickness, alphaviruses and flaviviruses. Nine of the ten studies reported significant increases in disease susceptibility after flood exposure.

Conclusion

The majority of included studies of the aftermath of floods pointed to an increased risk of infection with cholera, scabies, taeniasis, Rhodesian sleeping sickness, malaria, alphaviruses and flaviviruses. However, long-term health effects, specifically on mental health, non-communicable diseases and pregnancy, remain understudied. Further research is urgently needed to improve our understanding of the health risks associated with floods, which will inform public policies to prevent and reduce flood-related health risks.
Do the issues of religious minority and coastal climate crisis increase the burden of chronic illness in Bangladesh?
Authors: Hossain Altaf , Alam Md. Jahangir , Mydam Janardhan , Tareque Mohammad
Published: February 2022

Background

Chronic illness with disability and its out-of-pocket expenditure (OOPE) remains a big financial challenge in Bangladesh. The purpose of this study was to explore how religious minority problem and coastal climate crisis with other common risk factors determined chronic illness with a disability and its financial burden in Bangladesh. Existing policy responses, especially, social safety net programs and their governance were analyzed for suggesting better policy options that avoid distress financing.

Methods

Binary logistic and multiple linear regression models were respectively used to identify the factors of disability, and high OOPE based on Bangladesh Household Income and Expenditure Survey 2016 data.

Results

We found that disable people had relatively higher OOPE than their non-disabled counterparts and this OOPE further surges when the number of disabilities increases. In addition to the common factors, the novelty of our findings indicated that the religious minority problem as well as the coastal climate crisis have bearing on the disability burden in Bangladesh. The likelihood of having a chronic illness with a disability was 13.2% higher for the religious minorities compared to the majorities (Odds ratio (OR): 1.132, 95% confidence interval (CI): 1.033–1.241) and it was 21.6% higher for the people who lived in the exposed coast than those who lived in the non-exposed area (OR: 1.216, 95% CI: 1.107–1.335). With disabilities, people from the exposed coast incurred higher OOPE than those from the non-exposed areas. Although receiving assistance from social safety net programs (SSNPs) seemed to reduce their high OOPE and financial distress such as selling assets and being indebted, the distribution was not equitably and efficiently managed to confirm the process of inclusion leakage-free. On average, those who enrolled from the minority group and the exposed coast paid the relatively higher bribes.

Conclusions

To reduce burden, the government should strengthen and specify the existing SSNPs more for disable people, especially from the minority group and the exposed coast, and ensure the selection process more inclusive and leakage-free.
Radiological and functional assessment in patients with lumbar spinal stenosis
Authors: Huang Chuan-Ching , Jaw Fu-Shan , Young Yi-Ho
Published: February 2022

Background

Although patients with lumbar spinal stenosis (LSS) may have impaired postural control, current diagnosis of LSS depends mainly on clinical manifestation and radiological assessment, while functional assessment of postural balance remains less investigated. This study thus correlated radiological assessment via MR imaging with functional assessment using foam posturography in LSS patients.

Methods

Forty-seven LSS patients aged 50–85 years were enrolled. All patients received subjective outcome measures first, followed by plain radiography of whole spine and lumbosacral spine, MR imaging, and foam posturography under four conditions. Then, these results were analyzed using stepwise multiple regression analysis. Another 47 age- and sex-matched healthy controls also underwent foam posturography for comparison.

Results

The LSS group revealed significant increases in the sway area of foam posturography than the control group regardless of various conditions. Advanced age, poor walking endurance, and neural compression at the L2/3 level on MR images were significantly correlated with the characteristic parameters of foam posturography (p < 0.05). In contrast, subjectively reported pain and plain radiography did not correlate with posturographic results (p > 0.05).

Conclusions

Patients with LSS who exhibit less severe symptoms do not ensure normal postural balance. Functional assessment (foam posturography) on postural balance significantly correlated with radiological assessment (MR imaging) in LSS patients. The use of foam posturography may help assess postural control in LSS patients. It takes a short time and costs less, and would be practical to make this a routine examination in LSS patients.