bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the national surveillance of Legionnaires’ disease in Norway, 2008-2017
Authors: Wolff Cecilia , Lange Heidi , Feruglio Siri , Vold Line , MacDonald Emily 
Published: November 2019

Abstract
Background In Norway, Legionnaires’ disease is reportable upon clinical suspicion to public health authorities and mandatorily notifiable through the Norwegian surveillance system for communicable diseases (MSIS) for both clinicians and laboratories. In the summer of 2017, several European countries reported high notification rates for Legionnaires’ disease, which was not observed in Norway. We evaluated MSIS to assess if it meets its objectives of detecting cases and trends in incidence of Legionnaires’ disease.Methods We retrieved MSIS data from 2008 to 2017 and calculated timeliness as days from sampling to notification, and internal completeness for key variables as the proportion of observations with a value. Where possible, we assessed internal validity on the presence of a plausible value. To estimate external completeness and validity we linked MSIS with hospital reimbursement claims in the Norwegian Patient Registry. To assess acceptability and representativeness, we surveyed doctors in 39 hospitals on their units’ diagnostic and notification procedures, and their use of MSIS.Results There were 438 notified cases. Internal completeness and internal validity were high for key variables (≥95%). The median delay from sampling to notification was 4 days. There were 73 patients in MSIS only, 70 in the Norwegian Patient Registry only, and 351 in both registers. The external completeness of MSIS was 83% (95% CI 80-86%). For external validity, the positive predictive value of MSIS was 83% (95% CI 79-86%). Forty-seven respondents from 28 hospitals described testing procedures. These were inconsistent: 29 (62%) reported no systematic application of criteria for requesting legionella testing. Eighteen (38%) reported testing all patients with suspected pneumonia and a travel history. Thirty-one (66%) found the notification criteria clear.Conclusions Our results suggest that the surveillance in MSIS can detect incidence changes for Legionnaires’ disease over time, by place and person, but likely does not detect every case diagnosed in Norway. We recommend wider investigation of diagnostic procedures in order to improve representativeness and awareness of MSIS notification criteria among clinicians in order to improve acceptability of the surveillance. We also recommend a more comprehensive assessment of whether patients only registered in the Norwegian Patient Registry were true Legionnaires’ disease cases.
Advocating an attack against severe malaria: a cost-effectiveness analysis
Authors: Greenhalgh Scott , Chandwani Veda 
Published: November 2019

Abstract
Background Recently a study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective.Methods Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings.Results Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries.Conclusion Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.
­­Lyme borreliosis in Finland: A register-based linkage study
Authors: Feuth Eeva , Virtanen Mikko , Helve Otto , Hytönen Jukka , Sane Jussi 
Published: November 2019

Abstract
Background: In Finland, the routine surveillance of Lyme borreliosis (LB) is laboratory-based. In addition, we have well established national health care registers where countrywide data from patient visits in public health care units are collected. In our previous study based on these registers, we reported an increasing incidence of both microbiologically confirmed and clinically diagnosed LB cases in Finland during the past years. Here, we evaluated our register data, refined LB incidence estimates provided in our previous study, and evaluated treatment practices considering LB in the primary health care. Methods: Three national health care registers were used. The Register for Primary Health Care Visits (Avohilmo) and the National Hospital Discharge Register (Hilmo) collect physician-recorded data from the outpatient and inpatient health care visits, respectively, whereas the National Infectious Diseases Register (NIDR) represents positive findings in LB diagnostics notified electronically by microbiological laboratories. We used a personal identification number in register-linkage to identify LB cases on an individual level in the study year 2014. In addition, antibiotic purchase data was retrieved from the Finnish Social Insurance Institution in order to evaluate the LB treatment practices in the primary health care in Finland.Results: Avohilmo was found to be useful in monitoring clinically diagnosed LB (i.e. EM infections), whereas Hilmo did not add much value next to existing laboratory-based surveillance of disseminated LB. However, Hilmo gave valuable information about uncertainties related to physician-based surveillance of disseminated LB and the total annual number of EM infections in our country. Antibiotic purchases associated with the LB-related outpatient visits in the primary health care indicated a good compliance with the recommended treatment guidelines. Conclusions: In 2018, Avohilmo was introduced in the routine surveillance of LB in Finland next to laboratory-based surveillance of disseminated LB.
Food insecurity during pregnancy in a maternal-infant cohort in Brazilian Western Amazon
Authors: Ramalho Alanderson Alves , Holanda Cibely Machado , Martins Fernanda Andrade , Rodrigues Bárbara Teles Cameli , Andrade Andréia Moreira , Koifman Rosalina Jorge 
Published: November 2019

Abstract

Background The aim of this study was to determine the prevalence and analyze the factors associated with food insecurity during gestation in a maternal-infant cohort in Rio Branco, Acre, Brazilian Western Amazon.Methods A population-based cross-sectional study was conducted with parturients from a maternal-infant cohort in Rio Branco, located in the western Brazilian Amazon. The dependent variable food insecurity was obtained through the Brazilian Scale of Food Insecurity, and associated factors were identified through multiple logistic regression.Results The prevalence of food insecurity in pregnancy was of 34.8% (IC95% = 32.2% - 37.5%). Regarding severity, the prevalence of mild food insecurity was 24.6% (95% CI = 22.3% - 27.0%), moderate food insecurity was 4.8% (95% CI = 3.6% - 6.0%), and severe food insecurity was 5.4% (95% CI = 4.3% - 6.8%). In the final multiple model, the factors directly associated with food insecurity were the presence of open sewage in the peridomestic environment (OR = 1.64; 95% CI: 1.21 - 2.22); belonging to economic classes C, D and E (OR = 1.99; 95% CI: 1.35 - 2.94); being an income transfer program beneficiary (OR = 1.65; 95% CI: 1.18 - 2.30), while the factors inversely associated with FI were schooling equal to or greater than 8 years (OR = 0.66; 95% CI: 0.49 - 0.90); having a partner (OR = 0.56; 95% CI: 0.39 - 0.79); primigestation (OR = 0.59; 95% CI: 0.44 - 0.78) and regular consumption of fruits and vegetables during pregnancy (OR = 0.63, 95% CI: 0.45 - 0.88).Conclusions Despite the existence of income transfer programs, regular consumption of fruits and vegetables is still relatively low and was associated with food insecurity in pregnant women. These findings reinforce the need for the ratification of actions aimed at the domestic economy in the income transfer programs and the development of actions of food and nutritional education in the gestational period.
Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda
Authors: Kigozi Simon P. , Kigozi Ruth N. , Epstein Adrienne , Mpimbaza Arthur , Sserwanga Asadu , Yeka Adoke , Nankabirwa Joaniter I. , Halliday Katherine , Pullan Rachel L , Rutazaama Damian , Sebuguzi Catherine M , Opigo Jimmy , Kamya Moses R , Staedke Sarah G , Dorsey Grant , Greenhouse Bryan , Rodriguez-Barraquer Isabel 
Published: November 2019

Abstract
Background: Malaria control using long-lasting insecticidal nets (LLINs) and indoor residual spraying of insecticide (IRS) has been associated with reduced transmission throughout Africa. However, the impact of transmission reduction on the age distribution of malaria cases remains unclear. Methods: Over a 10-year period (January, 2009 to July, 2018), outpatient surveillance data from four health facilities in Uganda were used to estimate the impact of control interventions on temporal changes in the age distribution of malaria cases using multinomial regression. Interventions included mass distribution of LLINs at all sites and IRS at two sites. Results: Overall, 896,550 patient visits were included in the study; 211,632 aged <5 years, 171,166 aged 5-15 years, and 513,752 >15 years. Over time, the age distribution of patients not suspected of malaria and those malaria negative either declined or remained the same across all sites. In contrast, the age distribution of suspected and confirmed malaria cases increased across all four sites for. In the two LLINs-only sites, the proportion of malaria cases in <5 years decreased from 31% to 16% and 35% to 25%, respectively. In the two sites receiving LLINs plus IRS, these proportions decreased from 58% to 30% and 64% to 47%, respectively. Similarly, in the LLINs-only sites, the proportion of malaria cases >15 years of age increased from 40% to 61% and 29% to 39%, respectively. In the sites receiving LLINs plus IRS, these proportions increased from 19% to 44% and 18% to 31%, respectively. Discussion: These findings demonstrate a shift in the burden of malaria from younger to older individuals following implementation of successful control interventions, which has important implications for malaria prevention, surveillance, case management and control strategies.
Multivariate joint modeling to identify markers of growth and lung function decline that predict cystic fibrosis pulmonary exacerbation onset
Authors: Andrinopoulou Eleni-Rosalina , Clancy John Paul , Szczesniak Rhonda 
Published: November 2019

Abstract
Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbation (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a multi-system disease and the extent to which simultaneously modeling growth and nutrition markers improves PE predictive accuracy is unknown. Furthermore, it is unclear which routinely collected clinical indicators of growth and nutrition in early life predict PE onset in CF. Methods: Using a longitudinal cohort of 17,100 patients aged 6-20 years (US Cystic Fibrosis Foundation Patient Registry; 2003-2015), we fit a univariate joint model of lung-function decline and PE onset and contrasted its predictive performance with a class of multivariate joint models that included combinations of growth markers as additional submodels. Outcomes were longitudinal lung function (forced expiratory volume in 1 s of % predicted), percentile measures of body mass index, weight-for-age and height-for-age and PE onset. Relevant demographic/clinical covariates were included in each submodel. We implemented a univariate joint model of lung function and time-to-PE and four multivariate joint models including growth outcomes. Results: All five joint models showed that declining lung function corresponded to slightly increased risk of PE onset (hazard ratio from univariate joint model: 0.97, P < 0.0001), and all had reasonable predictive accuracy (cross-validated area under the receiver-operator characteristic curve > 0.70). None of the growth markers alongside lung function as outcomes in multivariate joint modeling appeared to have an association with hazard of PE. Jointly modeling only lung function and PE onset yielded the most accurate (area under the receiver-operator characteristic curve = 0.75) and precise (narrowest interquartile range) predictions. Dynamic predictions were accurate across forecast horizons (0.5, 1 and 2 years) and precision improved with age. Conclusions: Including growth markers via multivariate joint models did not yield gains in prediction performance, compared to a univariate joint model with lung function. However, the joint-modeling approach itself may be useful for monitoring CF disease progression by providing a means of dynamic risk prediction.
Functional versus functional and anatomical criteria-guided ranibizumab treatment in patients with neovascular age-related macular degeneration – results from the randomized, phase IIIb OCTAVE study
Authors: Staurenghi Giovanni , Garweg Justus G. , Gerendas Bianca S. , Macfadden Wayne , Gekkiev Boris , Margaron Philippe , Dunger-Baldauf Cornelia , Kolář Petr 
Published: November 2019

Abstract
Background: To evaluate the efficacy and safety of two individualized ranibizumab retreatment schemes in neovascular age-related macular degeneration. Methods: Patients (N=671) were randomized (1:1) to receive three initial monthly ranibizumab 0.5 mg injections, then retreatment guided by either best-corrected visual acuity (BCVA) loss (Group I) or BCVA loss and/or signs of disease activity on optical coherence tomography (OCT; Group II). The study was terminated prematurely and the decision to discontinue the study was made by the sponsor. Efficacy analyses were performed on patients who completed 12 months of the originally planned 24-month study. Safety analyses are presented for all safety analyzable patients. Results: Of 671 randomized patients, 305 completed 12 months of the study. For the 12-month completers, baseline mean (standard deviation) BCVA and reading-center evaluated central subfield thickness (CSFT) were comparable [Group I: 60.9 (13.10) letters and 517.7(201.79) µm; Group II: 60.2 (12.21) letters and 515.3 (198.37) µm]. The change from baseline at Month 12 in BCVA was 6.7 (13.48) letters in Group I and 8.3 (13.53) letters in Group II and the change in CSFT was −161.3 (163.48) µm and −175.3 (170.45) µm, respectively. The mean number of ranibizumab injections was 8.2 in Group I and 8.4 in Group II. Conclusion: Ranibizumab treatment resulted in visual and anatomic gains at 12 months for both retreatment strategies, with a trend in favor of OCT-guided vs BCVA loss guided retreatment. No new safety signals were seen. Trial registration: www.ClinicalTrials.gov (NCT01780935). Registered 31January 2013 Keywords: Best-corrected visual acuity, neovascular age-related macular degeneration, optical coherence tomography, ranibizumab, retreatment criteria
Pemafibrate Tends to have Better Efficacy in Treating Dyslipidemia than Fenofibrate
Authors: Wang Haizhou , Li Haiou , Zhou Yunjiao , Liu Jing , Wang Fan , Zhao Qiu 
Published: November 2019

Aims:
To compare the efficacy of pemafibrate (PF) and fenofibrate (FF) in treating dyslipidemia.

Methods:
A comprehensive search was performed on the public database to identify relevant randomized controlled
trials (RCTs), which compared the effects of PF and FF treatment in lipid parameters among patients with
dyslipidemia. Mean difference (MD) and 95% confidence intervals (CI) were pooled for continuous outcomes,
whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes.

Results:
Three RCTs were included with a total of 744 patients (PF=547 and FF=197). Compared with the FF
group (100mg/day), PF group (0.05 to 0.4mg/day) had a better effect on reducing triglycerides (TGs) (MD, -8.66;
95%CI, -10.91 to -6.41), very low-density lipoprotein cholesterol (VLDL-C, MD, -12.19; 95%CI, -15.37 to -
9.01), remnant lipoprotein cholesterol (MD, -13.16; 95%CI, -17.62 to -8.69), apolipoprotein-B48 (ApoB48, MD,
-12.74; 95%CI, -17.71 to -7.76) and ApoCIII (MD, -6.25; 95%CI, -11.85 to -0.64). Although a slightly LDL-Cincreasing
effect was found in PF-treated group (MD, 3.10; 95%CI, -0.12 to 6.09), the levels of HDL-C (MD,
3.59; 95%CI, 1.65 to 5.53) and ApoAI (MD, 1.60; 95%CI, 0.38 to 2.82) were significantly increased in the PF
group. However, no significant difference was found in the level of total cholesterol (MD, 0.01; 95%CI, -1.37 to -
1.39), non-HDL-C (MD, -0.06; 95%CI, -1.75 to 1.63), ApoB (MD, 0.39; 95%CI, -1.37 to 2.15) and ApoAII (MD,
3.31; 95%CI, -1.66 to 8.29) between the two groups. In addition, the incidence of total adverse events (OR, 0.68;
95%CI, 0.53 to 0.86) and adverse drug reactions (OR, 0.36; 95%CI, 0.24 to 0.54) was lower in the PF group than
that in the FF group.

Conclusions:
Pemafibrate tends to have better efficacy in treating dyslipidemia than fenofibrate.
Comparison of Hypoglycemic and Antioxidant Activities of the Compounds Isolated from Ficus hispida Linn. and Ficus pomifera Wall
Authors: Nepram Ashalata , Wangkheirakpam Sujata , Laitonjam Warjeet S. 
Published: November 2019

Background:
Traditional knowledge has been a legacy of the past to the present. Barks of
Ficus hispida Linn. and leaves of Ficus pomifera Wall. (Moraceae) have been used traditionally for
the treatment of diabetes in North-east India and many other places. As many drugs have been developed
from traditional plants, the authors have taken up the plants for the study of hypoglycemic
activity.

Objective:
To investigate the hypoglycemic activities of the triterpenoids isolated from the plants
and their antioxidant activities.

Methods:
The bioactive compounds were determined by biochemical analysis, antioxidant activity
using DPPH method. Hypoglycemic activity was detected using glucose tolerance test in normal rats
and alloxan induced diabetic rats with Gliclazide as standard.

Results:
The biochemicals and trace elements were present in appreciable amounts. Triterpenoids,
(1-5), from F. pomifera and 19-hydroxyphlogacantholide (6), 3-O-[ß-D-glucopyranosyl-(1’→2’)-α-
L-rhamnopyranosyl-phlogacanthoside] (7) and galanolactone (8) along with stigmasterol (9), stigmasta-
5,22-dien-7-on-3ß-ol (10), 5-(decahydro-1,1,4a-trimethyl-6-methylene-5-yl)-3-methylpent-2-
enal (11), stigmasterol glucoside (12) and stigmast-4-en-3-one (13) from F. hispida Linn., respectively,
were isolated. The different extracts of the barks and leaves of these plants along with the isolated
compounds had antioxidant and hyploglycemic activities.

Conclusions:
The five triterpenoids (1-5) were isolated from the methanol extract of the leaves of F.
pomifera, and compounds (6-13) were isolated from the chloroform extract of the barks of F. hispida.
Methanol extract of the leaves of F. pomifera and the chloroform extract of the barks of F. hispida;
compounds (1-13) isolated from these two plants reduced DPPH free radicals in a concentrationdependent
manner. It was also observed that the methanol and chloroform extracts of the plants, F.
pomifera and F. hispida respectively, and the compounds (1, 6 & 7) exhibited anti-diabetic properties
and also caused a highly significant reduction in the blood glucose levels of normal rats.
Organocatalytic Regioselective [3+2] Annulation of Morita-Baylis-Hillman Carbonates with Azonaphthalenes: An Efficient Access to 3-Spiropyrazole- 2-oxindoles
Authors: Cheng Yuyu , Lu Zhongyue , Li Pengfei 
Published: November 2019

Background:A cheap and commercially available organocatalyst, 4-dimethylaminopyridine was successfully employed in the regioselective [3+2] cycloaddition of isatin-derived Morita-Baylis- Hillman carbonates with azonaphthalenes for the construction of 3-spiropyrazole-2-oxindoles in excellent yields under mild conditions.Methods:In the presence of 4-dimethylaminopyridine with a loading of 10 mol%, a series of isatinderived Morita-Baylis-Hillman carbonates reacted smoothly with azonaphthalenes in dichloromethane at room temperature to furnish 3-spiropyrazole-2-oxindoles in 72-98% yield.Result and Conclusion:In summary, we have developed reasonably cheap and commercially available 4-dimethylaminopyridine-mediated regioselective [3+2] annulations between isatin-derived Morita- Baylis-Hillman carbonates and azonaphthalenes for the construction of 3-spiropyrazole-2-oxindoles under mild conditions.
Ketamine Infusion in Post-Surgical Pain Management after Head and Neck Surgery: A Retrospective Observational Study
Authors: Pota Vincenzo , Passavanti Maria B. , Aurilio Caterina , Barbarisi Manlio , Giaccari Luca G. , Colella Umberto , Fiore Marco , Mangoni di Santostefano Giuseppe S. R. C. , Sansone Pasquale , Pace Maria C. 
Published: November 2019

Background:
Head and neck cancer affects approximately 382,000 new patients per year worldwide with a significant portion undergoing surgical treatment. During postoperative period key elements in the Intensive Care Unit (ICU) are airway management and pain control.

Objective:
We evaluated the average change of inpatient pain control using a Numerical Rating Score (NRS). We also evaluated the time of extubation after ICU admission recording the incidence of desaturation and the necessity of re-intubation. Secondary outcomes were the incidence of postoperative complications, included those narcotics-related, and the use of rescue analgesics.

Methods:
In this retrospective observational study, we analyzed data of registry before and after we have changed our postoperative analgesic protocol from remifentanil infusion to ketamine infusion.

Results:
Medical records of 20 patients were examined. 10 patients received 0.5 mg/kg ketamine bolus at the end of surgery, followed by a continuous infusion of 0.25 mg/kg/h. All patients presented a significant decrease in pain intensity from the 4th to 48th postoperative hour (p < 0.05), but statically not a significant difference in NRS score was recorded between the two groups. Time to extubation was shorter in ketamine group compared to the remifentanil group (112.30 min ± 16.78 vs. 78 min ± 14.17; p < 0.05). Desaturation rate was 10% in the remifentanil group, while no case was recorded in the ketamine group.

Conclusion:
The level of analgesia provided by ketamine and remifentanil was comparable. Ketamine was superior in ventilatory management of the patient with more rapid extubation and with no case of desaturation.