bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in COVID-19 mortality between pandemic phases in a southern Italian region
Authors: Meo F , Di Giovanni P , Cedrone F , D'Addezio M , Di Martino G , Scampoli P , Torzi G , Di Girolamo A , Staniscia T
Published: October 2021

Background

Overall mortality is a relevant indicator of the population burden during COVID-19 pandemic, reflecting the overload and preparedness of the healthcare system. This study aimed to analyse the distribution of deaths in SARS-CoV-2 positive patients between pandemic phases and to evaluate the characteristics of COVID-19 patients deceased during the year.

Methods

Data on confirmed COVID-19 cases were collected from the recording system of the Department of Prevention of the Local Health Authority of Abruzzo Region, Italy. The course of the epidemic was stratified in 4 phases: the first wave (March-May 2020), the low incidence phase (June-September 2020), the second wave (October 2020-December 2021), and the variants spread phase in our region (January-March 2021).

Results

From March 2020 to March 2021 we registered 17,082 cases of SARS-CoV-2 infection, of these patients 571 (3.35%) had a fatal outcome. The mortality was the highest during the first ‘peak' phase, interesting the 14.20% of the notified cases, and the lowest during the last phase (2.50%). Mortality due to COVID-19 mainly affected men (54.99%) and geriatric patients (median age: 84; IQR: 75-90). Women dying for SARS-CoV-2 infection had a more advanced median age (87; IQR: 79-92) than men (81; IQR: 73-87). The lowest median age was registered in patients deceased during the low incidence phase (75.5; IQR: 71-82). The median time span, in days, from a SARS-CoV-2 positive test to death was significant lower in the phase 1 (days:10; IQR:4-20) then in phase 4 (days:14; IQR:8-22) (p < 0.001).

Conclusions

Our results showed that mortality markedly decreased during the COVID-19 epidemic, and this could be likely related to an improved organisation and delivery of care, in addition to a better knowledge of disease treatment. Elderly patients were more likely to progress toward fatal outcome. The healthcare systems should pay special attention to them in order to effectively manage possible future pandemics.

Key messages

The COVID-19 mortality reduction highlights an improvement of health care; the elderly remains at major risk of death. Providing pandemic prevention and care models focused also on vulnerable groups is a major public health challenge.
Health system saturation in managing COVID-19 patients in Monastir, Tunisia
Authors: Ben Hassine D , Zemni I , Dhouib W , Ben Fredj M , Bennasrallah C , Kacem M , Abroug H , Chriaa C , Bouanene I , Belguith Sriha A
Published: October 2021

Background

COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aimed to determine the average length of stay, occupancy bed rate and bed turnover rate for COVID-19 patients in Monastir university hospital between the 1st October 2020 and 28th february 2021.

Methods

This is a cross-sectional study that enrolled all hospitalizations for COVID19 in Monastir University hospital, the unique third level healthcare in this region, between the 1st October 2020 and 28th february 2021. The following indicators: the average length of stay, the occupancy bed rate and the bed turnover rate were calculated during the study period.

Results

We included 762 hospitalizations for COVID-19 during the study period. The average age of our population was 64,22 years (standard deviation= 14,17). Male predominance was noted with sex ratio=1,63. The median length of stay was significantly longer in the intensive care unit (ICU) than in the other departments (11 (7;16) days, versus 7(2;14) days), p = 0.008. The average number of beds available for COVID-19 patients during the study period was 13 in the ICU and 65 in the other wards. The bed turnover rate and the bed occupancy rate per month were respectively 2,66 patient/bed/month and 96,26% in the ICU versus 1,74 patient/bed/month and 62,26% in the other wards. The occupancy bed rate in the ICU exceeded the 100% during the outbreak of January and February 2021 (129,72% and 120,66% respectively).

Conclusions

Despite the efforts by the health services and social isolation measures in Tunisia, this study highlighted the saturation of our health system with an overload in intensive care units.

Key messages

Length of stay for patients with Covid-19 was significantly the longest in ICU. The occupancy bed rate, exceeding 100% in ICU, highlighted the health system collapse in managing COVID-19 patients.
Addictive behaviours during the COVID-19 pandemic: results from a nationwide study in Portugal
Authors: Virgolino A , Santos O , Fialho M , Heitor MJ , Costa A , Rasga C , Martiniano H , Costa J , Vicente A , Caldas de Almeida T
Published: October 2021

Background

Evidence shows that individuals can engage in maladaptive behaviours as a response to a pandemic context, which can compromise their health and wellbeing. This project aims to characterize self-reported changes in addiction-related behaviours and associated factors in the adult population during the first COVID-19 lockdown, in Portugal.

Methods

Cross-sectional study, with an online survey conducted between May 22 and July 20, 2020, targeting a non-probabilistic sample of adults (18 years of age or more) dwelling in Portugal (mainland and autonomous regions). The following data were collected: alcohol drinking, smoking, use of cannabis and other substances, gambling, and sugar-sweetened food intake, work-related variables, and sociodemographics. After data cleaning and weighting (by sex, age group, NUTS II and educational level), logistic regression models were conducted to assess potential determinants of addiction-related behaviours.

Results

Overall, 3.982 individuals participated in the study (79.1% women; mean age of 45.15 years). Women, young adults (18-34 years) and individuals with difficulties in work-life balance had higher odds for self-reported increase of sweets intake. Men, young adults (18-34 years) and those with work-life balance difficulties presented higher odds for alcohol drinking increase. Those unemployed (or with suspended activity or in layoff) and those with lower income had higher odds for gambling behaviour increase.

Conclusions

Some segments of the Portuguese population reported to have increased their engagement in addictive-related behaviours, during the COVID-19 lockdown, which can have negative consequences for mental health. The study of the correlates of maladaptive responses under this scenario is pivotal to inform public health interventions and alleviate the potential deleterious impacts of this pandemic.

Key messages

COVID-19 pandemic can increase maladaptive coping behaviours in some segments of the population. Public health interventions are needed to mitigate the negative consequences of this pandemic.
Risky sexual behaviors reported by patients in a free sexual health center in Paris (2017-2020)
Authors: Husson M , Piron P , Duteil C , de La Rochebrochard E , Segouin C , Troude P
Published: October 2021

Background

In France, a national network of free sexual health centers offers prevention, diagnosis and treatment for STI and HIV. These centers help socially disadvantaged and high-risk populations to access STI/HIV testing but few detailed data are available on patients' sexual behaviors. This study aims to describe sexual behaviors among attendees of a Parisian free sexual health center for STI/HIV screening.

Methods

This observational study included 5130 patients who attended the center for STI/HIV testing from August 2017 through January 2020 and completed a self-administered electronic questionnaire. Data obtained from the consultation database and the questionnaire included STI results, sociodemographic characteristics and sexual behaviors. Criteria reported in the literature to define “high-risk sexual behavior (HRSB)” were used to describe sexual practices.

Results

Median age of patients was 26 years [Q1-Q3:23-32] and 8% had no health insurance. Slightly less than one third of patients were women who had sex with men, 37% were men who had sex exclusively with women and 18% were men who had sex with men; 22% had never had HIV testing before the consultation. Regarding sexual practices, 76% reported unprotected sexual intercourse, 3% transactional sex and 8% a history of sexual violence. Depending on the threshold used to define multiple partners (≥6 vs ≥ 2 partners during the previous year), the proportion of patients varied from 31% to 81%. Globally, the proportion of patients reporting at least one HRSB ranged from 87% to 95%. Eleven percent of patients had at least one STI (mostly chlamydia).

Conclusions

Our sexual health center fulfills its missions as most patients consulting for STI/HIV testing reported HRSB and almost one quarter had never previously had an HIV test. The next step will be to explore profiles including sexual behavior, sociodemographic characteristics and HIV knowledge to adapt our prevention strategy to patients' needs.

Key messages

Our sexual health center fulfills its missions as most patients consulting for STI/HIV testing reported HRSB and almost one quarter had never previously had an HIV test. The next step will be to explore profiles including sexual behavior, sociodemographic characteristics and HIV knowledge to adapt our prevention strategy to patients’ needs.
Pap-smear and cervical cancer in Estonia: a population-based case-control study
Authors: Nõmm O , Veerus P , Innos K
Published: October 2021

Backround

Studies have shown the ineffectiveness of Estonian cervical cancer (CC) screening programme. To examine the reasons for high CC incidence in Estonia, a study was conducted, linking individual Pap-smear history to CC incidence.

Methods

In this population-based case-control study, cases were women aged ≥25 years with an in situ/invasive CC diagnosed in Estonia in 2011-2017, derived from cancer registry. Three controls per case were randomly selected from population registry using a density sampling scheme. Exposure was defined as no Pap-smears during seven years prior to diagnosis or index date compared to at least one smear. Multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Age, place of residence, citizenship, education, marital status and interruption in health insurance were also analysed. The analysis was done separately in screening age group (35-60 years).

Results

Among 1439 cases and 4317 controls, the proportion of women with no Pap-smears was 53% and 35%, respectively. In multivariate analysis, women with no Pap-smears were at a higher risk for CC (OR = 2.42; 95% CI: 1.97-2.97). In screening age group, the impact of no Pap-smears was stronger (OR = 2.62; 95% CI: 2.12-3.24). CC risk decreased with age, was two to three times higher in other regions compared to Northern Estonia; was higher for lower-educated women; and for divorced/widowed women compared to married women. Interruption in health insurance caused a 25% increase in risk. However in screening age group, women with no Pap-smears and an interruption in health insurance experienced a four-fold increase in CC risk.

Conclusions

The study confirmed the importance of screening in preventing CC, also revealing the independent effect of several social factors on CC risk. To reduce CC incidence in Estonia, immediate efforts are necessary to increase the effectiveness of screening, particularly among high-risk and hard-to-reach women.

Key messages

This case-control study of cervical cancer in Estonia identified high-risk groups: women with no Pap-smears, interruptions in health insurance, low education, and living outside the capital city area. Reduction in cervical cancer incidence in Estonia can be achieved through more effective screening and communication, tailored to the needs of different population groups, mainly high-risk women.
COVID-19 control measures and the response rate in the organized breast cancer screening in Croatia
Authors: Kovačević J , Musil V , Sovic S , Kosic Bibic N , Zombori D , Juresa V
Published: October 2021

Background

In order to reduce breast cancer mortality, decades of effort have been dedicated to continuous improvements of the organized breast cancer screening program (BCSP). The aim of this research was to analyse effect of the pandemic control measures on BCSP in Croatia, by comparing first (before the pandemic) and the second half of the sixth invitation round (during the pandemic). The implementation of the BSCP in Croatia was paused from March 16th- May 5th 2020). It is challenging to return the BSCP to the pre-pandemic rates.

Methods

Data on 699,877 women who were scheduled to be invited in the sixth invitation round in BCSP were analysed. Measure of government policy response, Stringency Index (SI) was analysed along with number of women invited in BCSP, responded to invitation and response rate.

Results

Of all women invited in the sixth invitation round of BCSP, response rate was 5.7% lower than in the fifth round. Fewer mammograms in the BCSP program and on the doctor's referral were recorded. In comparison of the monthly data, pause of the BCSP and the usual oscillations during the year, such as summer and winter holidays, were observed. Increase in response rate was occurred after the restart of the BCSP (May/June 2019, 41.0%/42.8% vs. May/June 2020, 67.2%/60.1%).

Conclusions

The number of monthly invited and responded women in BCSP did not return to the pre-pandemic values yet, but better response rate after the restart of the program (40% vs. 60%) was observed. Women were less motivated to respond to the invitation during the period of strict measures. Fear of COVID-19 could be addressed with an intensive public health campaign and vaccination of women invited to BCSP.

Key messages

The response rate in the BCSP was 5.7% lower during the COVID-19 pandemic measures. Vaccination against COVID-19 of women involved in the BCSP could improve the response rate.
Epidemiology of New Delhi Enterobacterales in Tuscany during the COVID- 19 pandemic
Authors: Porretta AD , Forni S , Tavoschi L , Righi L , Gemmi F
Published: October 2021

In Tuscany, Italy, colonisation or infection by New Delhi metallo- beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalised patients has increasingly been observed since 2018, leading in 2019 to the introduction of enhanced control measures successfully reducing transmission. We describe here the impact of the COVID epidemic on the underlying NDM-CRE prolonged outbreak in Tuscany. Data on patients colonised or infected by NDM-CRE reported by Tuscan laboratory surveillance among hospitalised patients in four Tuscan hospitals were collected from 07/2019 to 10/2020. Since February 2020 COVID-19 diagnosis was recorded. Monthly rates of NDM-CRE cases on hospital days in medical and critical care wards were calculated. In March-October 2020 NDM-CRE rates were calculated and stratified by COVID-19 diagnosis. The number of NDM-CRE cases/hospital days in 2019 decreased due to control interventions, however since March 2020 an increase was observed, temporally associated with COVID-19 admissions. In March-October 2020, compared to previous period, NDM-CRE cases had lower median age (73 yrs vs 75), were less likely to have previous hospitalisation episodes (59% vs 75%) and more likely to be admitted to ICU (32% vs 20%). We observed, in the period March-October 2020 a significantly higher rate of NDM-CRE cases per hospital days (256.71/100,000) in COVID-19 patients, compared to non-COVID-19 ones (452.9/100,000). Our data suggest a resurgence in NDM-CRE spread among hospitalised patients in Tuscany during COVID pandemic, despite evidence of effective control measures in 2019. Risk of NDM-CRE transmission was significantly higher among COVID patients. Several factors may have contributed to this occurrence, including patients case mix, performance of risk-prone procedures (including antibiotic prescriptions), extended length of stay, availability and usage of personal protective equipment and compliance with infection prevention procedures.

Key messages

We observed a relation between admission for COVID-19 and the risk of a hospital acquisition of NDM-CRE. There is the need to conciliate Health Care Associated Infections control measured with COVID-19 protection ones.
Community Health Centers for Resilient Communities in the post-COVID-19 era
Authors: Buffoli M , Gola M , Mosca EI , Ugolini M , Lettieri E , Capolongo S
Published: October 2021

Background

The synergy between territorial services and hospital organizations plays a crucial role for health promotion. Starting from the recent pandemic, the Community Health Centers (CHCs) could turn out particularly efficient in cases of high emergencies, avoiding the overflow of users in the hospital thanks to health home care management or low and medium-care facilities. The aim of the research is to identify evidence based experiences that supports the efficacy of design and management of CHCs, also during pandemics.

Methods

The methodology is based on the analysis of several European case studies, selected by an extensive analysis of the main EU countries, through a comparative matrix with different criteria related to: a) general information; b) urban relationship with the healthcare territorial network; c) number of inhabitants and population basins; d) building typology, dimensions, flexibility and layout issues; e) healthcare staff involved, the number of workers and volumes of activities; f) sanitary and not sanitary functions before and during the COVID-19 pandemic, and transformations applied.

Results

The analysis gives rise to several correlations due the localization of CHCs and the healthcare territorial network, dimensions and staff involved, sanitary and not sanitary functions -before and during the pandemic- and the flexibility of the CHCs, that permits to list experience based best practices for the design and management of resilient CHCs, as useful strategic lines for professionals in public health and healthcare design. The survey highlights the strategic role of CHCs for the healthcare territorial network with particular evidence during pandemics.

Conclusions

The strategies aim to encourage the introduction of CHCs for the access to care for the population. The outcomes of the analysis are related to the research project Cities and Health Community Centers for Resilient Communities funded by PoliSocial Award 2020 of Politecnico di Milano.

Key messages

definition of design and organizational strategies for Community Health Centers for Resilient Communities in the post-COVID-19 era. qualitative and quantitative data analysis of European Community Health Centers before and during the COVID-19 pandemic.
Co-occurring addiction problems among high school students in Sousse (Tunisia)
Authors: Ben Nasrallah C , Maatoug J , Ghammem R , Mbarki O , Zammit N , Ben Fredj S , Misbah R , Ghannem H
Published: October 2021

Background

Adolescence is a transitory period characterized by psychological, physical and emotional changes. Teenagers seek new experiences and engage in a range of risky behaviors, including the consumption of psychoactive substances that lead to addiction problems. Adolescent addiction represents a major public health and safety issue. Addictions co-occur in the same individual, increasing the risk of negative outcomes and health problems.

We aimed to determine the prevalence of occurring and co-occurring addiction behaviors among high school students in the region of Sousse and to specify the risk factors.

Methods

A cross-sectional study was conducted from February 5 to March 14, 2018 in public high schools in the governorate of Sousse. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 10.

Results

A total of 1399 high school students were included in our study. An average age of 17±2.28 years and a female predominance (60.5%) were noted. The prevalence of tobacco product use and alcohol consumption was 20.9% and 10.1% respectively. The prevalence of illicit substance use was 7%. Facebook and video game addiction were reported among 36.1% and 35.3% high school students respectively. The analysis of co-occurring addiction problems showed that 12.2% and 4.5% had two and three addiction problems, respectively. Almost 3% of included adolescents had the maximum number of four addiction problems. Multivariate analysis showed that co-occurring addiction increases among boys, participants that repeated the grade and among those with moderate or severe depression, anxiety and alexithymia.

Conclusions

The findings have implications for identifying the risk factors of co-occurring addictive behaviors, and the development of primary prevention strategies resulting from such factors

Key messages

The prevalence of addictive behavior is very high in middle school students. Understanding the risk factors of co-occurrence addictive problems is important for prevention program planning.
COVID-19 - pandemic effect on Human Papilloma Virus Vaccination of eighth grade students in Croatia
Authors: Rajn V , Vuljak-Vulić J , Kos Milkić A , Jureša V
Published: October 2021

Issue/problem

Vaccination at the time of the Covid-19 pandemic is a challenge for vaccinators. The consequences of not vaccinating against human papilloma virus (HPV) of youngs for their future reproductive health are far-reaching. In Croatia, HPV vaccination is voluntary and free for all school children and students.

Description of the problem

Rate of HPV vaccination in eighth grade students before the epidemic school year 2018/19, at the onset of the epidemic 2019/20 and 2020/21 in the midst of the epidemic, Croatia in the city of Koprivnica and 11 municipalities in the Koprivničko-križevačka County. The research included 1530 children of eighth grade during three school years in the city of Koprivnica and 11municipalities. Data were collected by the School Health Service. Before the panidemic, vaccinations took place at school, and during the epidemic exclusively in school medicine practices. Completely vaccinated are considered those vaccinated with two or three doses depending the student age.

Results

Fully vaccinated students 2018/2019 is 54.2% (277/511), urban area 48.0% (133/277) and rural area 61.5% (144/234). 2019/2020 62.0% (330/532) of students were vaccinated, urban area 56.3% (160/284) and rural area 68.6% (170/248). Coverage of girls with full vaccination 2018/2019 is 63.4% and boys 46.6%. In 2019/2020 71.8% girls and 52.3% boys were fully vaccinated. In 2020/2021 the first dose received 53.4% (260/487), girls 65.3% and boys 43.4%. The second dose did not received in 2018/2019 5.2% students and 2019/2020 8.8%. The main reason in the rural area is the distance from school clinics and the inability to vaccinate children at school.

Lessons

In the school year 2019/2020 there was an increase in vaccination compared to 2018/2019 of 7.8%, despite difficult conditions.

Key messages

Unexpectedly during the epidemic the response to vaccination increased. HPV vaccination should remain a priority in adolescent health protection.
Monitoring the health status of the elderly in an urban area in Athens, Greece
Authors: Stamatopoulos Z , Bakola M , Kitsou KS , Kallianezos P , Charalambous G , Jelastopulu E
Published: October 2021

Background

Aging of population brings changes in needs and capacities. People live longer and chronic diseases appear to be a potential risk of major causes of disability and functional dependency. The aim of this study was to investigate the physical and mental health of the elderly residing in an urban area in Athens,Greece.

Methods

In this population-based study using a convenience sampling, seniors aged ≥65 years old, under no medical treatment were selected from Korydalos area, Athens, Greece. A translated version of the General Health Questionnaire (GHQ-28) was used and associations with other parameters were performed. Higher GHQ-28 scores indicate higher levels of distress.

Results

A total of 100 seniors participated in the study, 64% females, mean age 71.4 years. 51% were married, 40% lived alone and 82% had primary or secondary education. 59% received a pension from the state, out of them 42% between 601-1000 euros and 33% between 301-600 euros, monthly. The mean GHQ-28 score, for a potential mental disorder in the somatization, anxiety, social dysfunction, and depression factors, was 24.3, 29.1, 42.9 and 10.2, respectively. Females presented higher scores in total GHQ score (p = 0.018), in somatization (p = 0.019) and in social dysfunction (p = 0.001). Higher age was associated with higher total GHQ score (p = 0.001), higher anxiety (p = 0,006) and higher dysfunction (p = 0.006). Seniors with lower educational level had higher total GHQ score (p = 0.032) and higher social dysfunction (p < 0.001). Low financial status was associated with higher social dysfunction (p = 0.005).

Conclusions

The study revealed an overall moderate emotional distress in elderly. However, a high risk in social dysfunction is obvious, whereas risk of depression is very low. Age, educational level and financial status are associated with various dimensions of distress and psychiatric disorders. GHQ-28 is a suitable screening tool and can be used to prevent chronic disease and mental disorder

Key messages

GHQ-28 can be used as a screening tool in elderly in urban communities to assess psychological well-being and detect possible psychiatric morbidity and to improve their overall health.
Insulin resistance and sleep complains in ten years follow-up
Authors: Podlipskyte A , Mickuviene N , Kazukauskiene N , Varoneckas G
Published: October 2021

Background

The serious health consequence that comes from disrupted and poor sleep quality is an increased risk for cardiac diseases and diabetes. The goal was to investigate the association of insulin resistance with sleep complains in ten years follow-up.

Methods

A randomized epidemiological follow up study with 835 subjects: 300 (35.9%) men and 535 (64.1%) women was performed in 2003 and in 2013. The Basic Nordic Sleep Questionnaire was used to assess the frequency of sleep complaints in the first and the follow up survey. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). The contingent was divided into 2 groups: insulin resistance group (HOMA-IR> 2.7) 33% and No- insulin resistance group (HOMA-IR ≤2.7) 67%.

Results

A statistically significantly increased number of persons with diabetes mellitus and high body mass index was seen in both groups after 10-year period; however, in insulin resistance group an increase was more expressed. A statistically significant change of sleep complains after 10-year period was seen in insulin resistance group; while in no-insulin resistance group there were no significant modifications. Individuals with insulin resistance were more likely to complain of difficulty falling asleep (from 11.2% to 17.8%, p = 0.031) and early wake up in the morning (from 12.6% to 24.5%, p = 0.003) after 10-year period. Daytime sleepiness was also more frequently observed among persons with insulin resistance (from 9.0% to 14.7, p = 0.037). They were more likely to use sleeping pills (from 4.0% to 8.3%, p = 0.034) and, not surprisingly, were more likely to use alcohol to improve sleep (from 1.1% to 4.4%, p = 0.012).

Conclusions

A statistically significant increase in body mass index and diabetes as well as difficulty to fall asleep, early waking up in the morning, severe drowsiness in the morning and daytime sleepiness was found in ten years follow-up in insulin resistance group.

Key messages

A statistically significant increase of sleep complains after ten years follow-up was seen in insulin resistance group. Insulin resistance and metabolic syndrome in parallel with disturbed sleep may lead to the development of diabetes in follow-up.
Accuracy of identifcation of traumatic brain injuries in routine hospital data
Authors: Staines A , O'Farrell A , Healy A , O'Donnell K , McGettrick G , Bourke T , Johnson H , Corrigan C
Published: October 2021

Background

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Much work on the epidemiology of TBI uses routinely collected health care data. There is no separate code for TBI in ICD-10, a common coding system for acute care. One reason for reported variations in TBI prevalence between countries is differences in the identification of TBI from routine data. This study assessed the performance of an Australian classification system (Pozzatto et al 2019), using a standardised approach to ICD-10 codes to identify cases of likely TBI in routine hospital discharge data.

Methods

The original study was done on hospital data from New South Wales. We replicated their approach using Irish hospital data, held by Health Intelligence, from 2013 to 2020. Cases not classified as TBI by this system, but with codes, such as loss-of-consciousness, skull fracture or intra-cranial injury were manually reviewed.

Results

All 98,419 discharges with any code in S00 to S99 were reviewed. 27,851 (28.3%) had a skull fracture or intracranial injury. 12,106 (12.3%) had loss-of-consciousness and/or post-traumatic amnesia. 11,976 (98.9%) of these (12.2% of the total) had either a skull fracture or an intra-cranial injury reported. 26,085 (26.5%) of the original 98,419 cases were classified as TBI using the NSW classification. Manual review of 1.3% (1,356) cases added a maximum of 0.32% (321) further possible cases of TBI, suggesting a sensitivity of the classification of 98.8% (95% CI 98.6% - 98.9%).

Discussion

The main limitation is that it is not possible to identify false positive cases - those coded as TBI, but where no TBI was present. This approach to identifying TBI works well, and is feasible for wider implementation. It provides comparability between different studies.

Pozzato I et al. (2019), Epidemiology of hospitalised traumatic brain injury in the state of New South Wales, Australia: a population-based study. Australian and New Zealand Journal of Public Health. 2019

Key messages

There are problems comparing data on TBI between different countries because no single code for TBI exists in ICD-10, and this is a real challenge for epidemiologists and health services researchers. The use of an agreed system, developed in Australia, for recoding injury data to identify TBI has promise, and shows excellent sensitivity in two countries.
SSI and antibiotic prophylaxis adequacy in hysterectomy surgery in Murcia, Spain
Authors: Monteagudo JF , Pérez-Romero SB , Arana-Aragón B , Rueda-Nieto S , Román-Sánchez J , Podio-Martínez M , Yepes-García P , Sánchez-Rodríguez D
Published: October 2021

Background

Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs). Our objective was to describe incidence of SSI and adequacy of surgical antibiotic prophylaxis (SAP) in abdominal hysterectomy (HYST) interventions in our center.

Methods

A prospective study was carried out in Hospital General Universitario Reina Sofia, Murcia. Patients subjected to HYST between May 1st and November 30th of 2020 were included. No exclusion criteria were established. SSI surveillance was done following CDC -NNIS guidelines. Data were obtained from clinical documents and electronic records, evaluated following local antimicrobial stewardship program (ASP) guidelines and classified as adequate or inadequate. Inadequate SAP was divided into five categories: “Length of administration”, “Antibiotic election”, “Inadequate Timing”, “Antibiotic indication” and “Other”.

Results

A total of 57 interventions were recorded. Mean age was 52,7 y (sd = 11,4y). 3 SSI were found: 1 superficial and 2 deep. Total cumulative incidence was 5,3%. Grouping by NNIS risk score, cumulative incidence in NNIS 2-3 patients was 33,3%, while in NNIS 0 and NNIS 1 was 2,6% and 6,2%. Median hospitalization length was 3 days (IQR = 1). Median time from surgery to infection was 5 days (IQR =0.5). SAP was found to be adequate in 71% of interventions. Main causes of inadequacy were inadequate timing (77,7%), indication (11,1%), election (5,5%) and length of administration (5,5%).

Conclusions

SSI incidence in HYST in our center was found to be slightly higher than other studies found in the literature. Moreover, our findings show that 29% of abdominal hysterectomy surgeries received inadequate SAP, being inadequate timing the main cause of inadequacy.

Key messages

SSI surveillance is crucial when it comes to monitoring and preventing HAI. Monitoring SAP adequacy is a helpful resource to assure compliance and improve our patients surgery-related safety.
Automata theory approach to predicate intuitionistic logic
Authors: Zielenkiewicz Maciej , Schubert Aleksy
Published: October 2021

Predicate intuitionistic logic is a well-established fragment of dependent types. Proof construction in this logic, as the Curry–Howard isomorphism states, is the process of program synthesis. We present automata that can handle proof construction and program synthesis in full intuitionistic first-order logic. Given a formula, we can construct an automaton such that the formula is provable if and only if the automaton has an accepting run. As further research, this construction makes it possible to discuss formal languages of proofs or programs, the closure properties of the automata and their connections with the traditional logical connectives.
A road-map to white dwarf pollution: Tidal disruption, eccentric grind-down, and dust accretion
Authors: Brouwers Marc G , Bonsor Amy , Malamud Uri
Published: October 2021

A significant fraction of white dwarfs show metal lines indicative of pollution with planetary material but the accretion process remains poorly understood. The main aim of this paper is to produce a road-map illustrating several potential routes for white dwarf pollution and to link these paths to observational outcomes. Our proposed main road begins with the tidal disruption of a scattered asteroid and the formation of a highly eccentric tidal disc with a wide range of fragment sizes. Accretion of these fragments by Poynting-Robertson (PR) drag alone is too slow to explain the observed rates. Instead, in the second stage, several processes including differential apsidal precession cause high-velocity collisions between the eccentric fragments. Large asteroids produce more fragments when they disrupt, causing rapid grind-down and generating short and intense bursts of dust production, whereas smaller asteroids grind down over longer periods of time. In the final stage, the collisionally produced dust circularises and accretes onto the white dwarf via drag forces. We show that optically thin dust accretion by PR drag produces large infrared (IR) excesses when the accretion rate exceeds 107 g/s. We hypothesise that around white dwarfs accreting at a high rate, but with no detected infrared excess, dust circularisation requires enhanced drag - for instance due to the presence of gas near the disc’s pericentre.
Supernova induced processing of interstellar dust: impact of interstellar medium gas density and gas turbulence
Authors: Kirchschlager Florian , Mattsson Lars , Gent Frederick A
Published: October 2021

Quantifying the efficiency of dust destruction in the interstellar medium (ISM) due to supernovae (SNe) is crucial for the understanding of galactic dust evolution. We present 3D hydrodynamic simulations of an SN blast wave propagating through the ISM. The interaction between the forward shock of the remnant and the surrounding ISM leads to destruction of ISM dust by the shock-heated gas. We consider the dust processing due to ion sputtering, accretion of atoms/molecules, and grain–grain collisions. Using 2D slices from the simulation time series, we apply post-processing calculations using the paperboats code. We find that efficiency of dust destruction depends strongly on the rate of grain shattering due to grain–grain collisions. The effective dust destruction is similar to previous theoretical estimates when grain–grain collisions are omitted, but with grain shattering included, the net destruction efficiency is roughly one order of magnitude higher. This result indicates that the dust-destruction rate in the ISM may have been severely underestimated in previous work, which only exacerbates the dust-budget crises seen in galaxies at high redshifts.
The magnetized white dwarf + helium star binary evolution with accretion-induced collapse
Authors: Ablimit Iminhaji
Published: October 2021

Accretion-induced collapse (AIC) from oxygen/neon/magnesium composition white dwarf (ONeMg WD) + stripped helium (He) star binaries is one promising channel to form peculiar neutron star objects. It has been discussed that the WD’s magnetic field may alter the accretion phase in the WD binary evolution. By considering non-magnetic and sufficiently magnetized WDs, we investigate the evolution of ONeMg WD + He star binaries with detailed stellar evolution and binary population synthesis simulations. The role of the magnetically confined accretion in the possible formation pathway for like millisecond pulsars (MSPs) and magnetars is also studied. Comparing with the case of spherically symmetric accretion, the mass accumulation efficiency of the WDs is enhanced at low mass-transfer rate under the magnetic confinement model. The initial parameter space of the potential AIC progenitor systems moves toward shorter orbital period and lower donor mass (but not so significantly) due to the effect of the magnetic confinement. This also allows final MSPs to have lower mass WD companions and shorter orbital periods. There is no significant difference between the Galactic birth rates of the AIC derived with and without the magnetic confinement, which implies that the magnetic field of the WD does not dramatically change the number of ONeMg WD + He star binaries which can produce AIC. It is worth noting that these conclusions can be applied for the carbon/oxgen (CO) WD + He star binaries as progenitors of type Ia supernovae, because the accretion phases of ONeMg WDs and CO WDs are similar. The Galactic rate of magnetars possibly formed via AIC of highly magnetized WDs is $0.34\times 10^{-4}\, {\rm yr}^{-1}$.
The Copernican principle in light of the latest cosmological data
Authors: Camarena David , Marra Valerio , Sakr Ziad , Clarkson Chris
Published: October 2021

We pursue a program to confront observations with inhomogeneous extensions of the FLRW metric. The main idea is to test the Copernican principle (CP) rather than assuming it a priori. We consider the ΛCDM model endowed with a spherical ΛLTB inhomogeneity around us, that is, we assume isotropy and test the hypothesis of homogeneity. We confront the ΛLTB model with the latest available data from cosmic microwave background, BAO, type Ia supernovae, local H0, cosmic chronometers, Compton y-distortion, and kinetic Sunyaev–Zeldovich effect. We find that these data can constrain tightly this extra inhomogeneity, almost to the cosmic variance level: on scales ≳ 100 Mpc structures can have a small non-Copernican effective contrast of just δL ∼ 0.01. Furthermore, the constraints on the standard ΛCDM parameters are not weakened after marginalizing over the parameters that model the local structure, to which we assign ignorance priors. In other words, dropping the CP assumption does not imply worse constraints on the cosmological parameters. This positive result confirms that the present and future data can be meaningfully analyzed within the framework of inhomogeneous cosmology.
Evolution of accretion disc reflection spectra due to a Type I X-ray burst
Authors: Speicher J , Ballantyne D R , Fragile P C
Published: October 2021

Irradiation of the accretion disc causes reflection signatures in the observed X-ray spectrum, encoding important information about the disc structure and density. A Type I X-ray burst will strongly irradiate the accretion disc and alter its properties. Previous numerical simulations predicted the evolution of the accretion disc due to an X-ray burst. Here, we process time-averaged simulation data of six time intervals to track changes in the reflection spectrum from the burst onset to just past its peak. We divide the reflecting region of the disc within r ≲ 50 km into six to seven radial zones for every time interval and compute the reflection spectra for each zone. We integrate these reflection spectra to obtain a total reflection spectrum per time interval. The burst ionizes and heats the disc, which gradually weakens all emission lines. Compton scattering and bremsstrahlung rates increase in the disc during the burst rise, and the soft excess at <3 keV rises from ≈4 to ≈38 per cent of the total emission at the burst peak. A soft excess is expected to be ubiquitous in the reflection spectra of X-ray bursts. Structural disc changes such as inflation because of heating or drainage of the inner disc due to Poynting–Robertson drag affect the strength of the soft excess. Further studies on the dependence of the reflection spectrum characteristics to changes in the accretion disc during an X-ray burst may lead to probes of the disc geometry.
Symptomatic Oculomotor Nerve Cyst in a 3-Year-Old Child: Case Report With Emphasis on Surgical Management
Authors: Müther Michael , Bruns Ann-Katrin , Fortmann Thomas , Brentrup Angela , Grenzebach Ulrike , Stummer Walter
Published: October 2021

BACKGROUND AND IMPORTANCE

Third nerve palsies in the pediatric population are most commonly caused by trauma, tumors, or vascular abnormalities. Cystic oculomotor nerve neuropathies, however, are rare. We report the case of a symptomatic cyst along and within the oculomotor nerve, which has not been described previously.

CLINICAL PRESENTATION

Here, we report a case of a 3-yr-old girl presenting with a progressive painless oculomotor nerve palsy. A magnetic resonance imaging revealed a cystic formation along the cisternal and cavernous course of the nerve. Due to lack of alternative treatment options, surgery was offered. Intraoperative direct nerve stimulation allowed for identification of a non-functional part of the cyst wall and open fenestration and biopsy were executed. Histopathology revealed neuritis. Serology was negative for various pathogens. The oculomotor palsy rapidly resolved. At a follow-up 5 yr after surgery, the girl is asymptomatic and the cisternal part of the cyst remains collapsed.

CONCLUSION

This is the first report of a symptomatic cyst along and within the oculomotor nerve treated effectively with open fenestration and decompression highlighting the importance of intraoperative neuromonitoring in cranial nerve surgery. Uncertainty remains regarding the etiology of this disease.
Demand for Factory-Made Cigarettes and Roll-Your-Own Tobacco and Differences Between Age and Socioeconomic Groups: Findings From the International Tobacco Control Netherlands Survey
Authors: Geboers Cloé , Shang Ce , Nagelhout Gera E , de Vries Hein , van den Putte Bas , Fong Geoffrey T , Candel Math J J M , Willemsen Marc C
Published: October 2021

Introduction

Macroeconomic studies have shown that young individuals who smoke, and have a low socioeconomic status respond more strongly to price increases. Most of this evidence stems from research on factory-made (FM) cigarettes. With the rising popularity of roll-your-own (RYO) tobacco, there is a need for studies on cigarette demand that distinguish between both.

Aims and Methods

This study examined whether individual demand differed for FM and RYO tobacco, and across age, and socioeconomic (income and education) groups. Purchase tasks for FM and RYO cigarettes were included in the 2020 International Tobacco Control (ITC) Netherlands Survey. Adults who smoke daily (n = 1620) stated how many cigarettes they would smoke in 24 hours across eight prices. Four demand indices were derived: intensity (consumption at zero costs), alpha (rate of change in elasticity), Pmax (turning point elasticity), and breakpoint (lowest price where consumption equals zero). The indices were tested for subgroup differences.

Results

Individuals who smoke RYO tobacco indicated higher intensity, and greater alpha than individuals who smoke FM cigarettes. Participants aged 25–39 had lower Pmax, and 18–24 year olds displayed higher breakpoints. Participants with low income displayed higher intensity, and lower Pmax than other income groups. No associations were found with education.

Conclusions

Individuals who smoke RYO tobacco indicated higher price sensitivity than those smoking FM cigarettes, supporting the need to harmonize tobacco taxation. Taxation may be especially beneficial to reducing consumption among individuals with a low income or smoke RYO tobacco. Substantially higher prices are needed in the Netherlands to achieve the desired results.

Implications

Individuals who smoke daily were willing to pay substantially higher prices than the current market prices, indicating the room and need for much higher taxation levels. Demand for RYO tobacco was more sensitive to price changes than demand for FM cigarettes. Taxation should be raised at equivalent rates for FM and RYO cigarettes. Taxation appears to be especially effective in reducing consumption among people who smoke RYO tobacco and low-income individuals. It remains important to combine increased taxation with other tobacco control measures.
Ultrasound Lancet-aided Translaminar Posterior Lumbar Approach to the Recesso-Foraminal Area
Authors: Rustia Alessandro , Pesce Alessandro , Palmieri Mauro , D’Andrea Giancarlo , Frati Alessandro
Published: October 2021

Extrusion and sequestration of the nucleus pulposus involving the spinal canal or the foramina/recesses complicates up to 28% of the lumbar disc herniations. The transpars/translaminar anatomical approach is well described and its advantages when handling with a lateral, foraminal extruded disc herniation are appreciated and recognized. Nevertheless, this approach presents several pitfalls such as the risk of disconnecting the pars interarticularis, which may cause segmental instability. This particular eventuality is because of the particular anatomical conformation of the pars interarticularis. Although already part of the modern surgical armamentarium for general, orthopedic, cranial and spinal surgeons, the use of the ultrasonic scalpel technique for such approach has never been discussed to date, to the best of our knowledge. The purpose of the present paper is therefore to introduce and describe the stepwise technique along with an extensive discussion of the facilitating role of the ultrasonic scalpel in the translaminar/transpars approach in the management of extruded disc herniation of the lumbar spine.