bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Influenza Virus on Human Skin: Importance of Hand Hygiene in Coronavirus Disease 2019 (COVID-19)
Authors: Hirose Ryohei , Ikegaya Hiroshi , Naito Yuji , Watanabe Naoto , Yoshida Takuma , Bandou Risa , Daidoji Tomo , Itoh Yoshito , Nakaya Takaaki 
Published: October 2020

Abstract

Background
The stability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on human skin remains unknown, considering the hazards of viral exposure to humans. We generated a model that allows the safe reproduction of clinical studies on the application of pathogens to human skin and elucidated the stability of SARS-CoV-2 on human skin.

Methods
We evaluated the stability of SARS-CoV-2 and influenza A virus (IAV), mixed with culture medium or upper respiratory mucus, on human skin surfaces and the dermal disinfection effectiveness of 80% (weight/weight) ethanol against SARS-CoV-2 and IAV.

Results
SARS-CoV-2 and IAV were inactivated more rapidly on skin surfaces than on other surfaces (stainless steel/glass/plastic); the survival time was significantly longer for SARS-CoV-2 than for IAV (9.04 hours [95% confidence interval, 7.96– 10.2 hours] vs 1.82 hours [1.65–2.00 hours]). IAV on other surfaces was inactivated faster in mucus versus medium conditions, while SARS-CoV-2 showed similar stability in the mucus and medium; the survival time was significantly longer for SARS-CoV-2 than for IAV (11.09 hours [10.22–12.00 hours] vs 1.69 hours [1.57–1.81 hours]). Moreover, both SARS-CoV-2 and IAV in the mucus/medium on human skin were completely inactivated within 15 seconds by ethanol treatment.

Conclusions
The 9-hour survival of SARS-CoV-2 on human skin may increase the risk of contact transmission in comparison with IAV, thus accelerating the pandemic. Proper hand hygiene is important to prevent the spread of SARS-CoV-2 infections.
Advancing Digital Health Equity: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association
Authors: Wood Brian R , Young Jeremy D , Abdel-Massih Rima C , McCurdy Lewis , Vento Todd J , Dhanireddy Shireesha , Moyer Kay J , Siddiqui Javeed , Scott John D 
Published: October 2020

Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revolutionized the practice of ambulatory medicine, triggering rapid dissemination of digital healthcare modalities, including synchronous video visits. However, social determinants of health, such as age, race, income, and others, predict readiness for telemedicine and individuals who are not able to connect virtually may become lost to care. This is particularly relevant to the practice of infectious diseases (ID) and human immunodeficiency virus (HIV) medicine, as we care for high proportions of individuals whose health outcomes are affected by such factors. Furthermore, delivering high-quality clinical care in ID and HIV practice necessitates discussion of sensitive topics, which is challenging over video without proper preparation. We describe the “digital divide,” emphasize the relevance to ID and HIV practice, underscore the need to study the issue and develop interventions to mitigate its impact, and provide suggestions for optimizing telemedicine in ID and HIV clinics.
Cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden
Authors: Landmesser Ulf , Lindgren Peter , Hagström Emil , van Hout Ben , Villa Guillermo , Pemberton-Ross Peter , Arellano Jorge , Svensson Maria Eriksson , Sibartie Mahendra , Fonarow Gregg C 
Published: October 2020

Abstract

Aims
To assess the cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to standard-of-care lipid-lowering treatment [maximum tolerated dose (MTD) of statin and ezetimibe] in Swedish patients with a history of myocardial infarction (MI).

Methods and results
Cost-effectiveness was evaluated using a Markov model based on Swedish observational data on cardiovascular event rates and efficacy from the FOURIER trial. Three risk profiles were considered: recent MI in the previous year; history of MI with a risk factor; and history of MI with a second event within 2 years. For each population, three minimum baseline low-density lipoprotein cholesterol (LDL-C) levels were considered: 2.5 mmol/L (≈100 mg/dL), based on the current reimbursement recommendation in Sweden; 1.8 mmol/L (≈70 mg/dL), based on 2016 ESC/EAS guidelines; and 1.4 mmol/L (≈55 mg/dL), or 1.0 mmol/L (≈40 mg/dL) for MI with a second event, based on 2019 ESC/EAS guidelines. Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab was associated with increased quality-adjusted life-years and costs vs. standard-of-care therapy. Incremental cost-effectiveness ratios (ICERs) were below SEK700 000 (∼€66 500), the generally accepted willingness-to-pay threshold in Sweden, for minimum LDL-C levels of 2.3 (recent MI), 1.7 (MI with a risk factor), and 1.7 mmol/L (MI with a second event). Sensitivity analyses demonstrated that base-case results were robust to changes in model parameters.

Conclusion
Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to MTD of statin and ezetimibe may be considered cost-effective at its list price for minimum LDL-C levels of 1.7–2.3 mmol/L, depending on risk profile, with ICERs below the accepted willingness-to-pay threshold in Sweden.
Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient’s reported outcome measures
Authors: Nieri Michele , Paoloni Valeria , Lione Roberta , Barone Valeria , Marino Merlo Matilde , Giuntini Veronica , Cozza Paola , Franchi Lorenzo 
Published: October 2020

SummaryObjectiveThe objective of this study was to compare an expansion screw of the maxilla that generates moderate and continuous forces versus a conventional screw for rapid maxillary expansion (RME) on patient-reported outcome measure during the first 12 weeks of treatment.Trial designThis is a superiority, multicenter, two-arm parallel balanced randomization trial.MethodsPatients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group, treated with an expansion screw with Ni–Ti springs) was compared to a conventional RME screw that generates intermittent heavy forces (RME group). The primary response variable was the visual analogue scale (VAS) on pain calculated in the first 12 weeks of therapy. The VAS on difficulty on speaking and oral hygiene, patient satisfaction, and complications were also evaluated. A computer-generated block randomization was used with allocation concealed in sequentially numbered opaque-sealed envelopes. Blinding was not applicable. Linear models were used for statistical analysis.ResultsTwenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. The mean of the VAS for pain was 0.3 ± 0.4 in the Leaf group and 0.6 ± 0.5 in the RME group. The difference was −0.3 (95 per cent CI from −0.5 to −0.0; P = 0.017) in favour of the Leaf group. The difference in pain was marked in the first week (Leaf group 2.2 ± 2.3; RME group 3.7 ± 2.6; difference −1.5; 95 per cent CI from −2.7 to −0.3; P = 0.019).ConclusionsPatients in the Leaf group experienced a lower degree of pain, especially during the first week following the application of the expander. For the other variables, no significant differences were reported between the two treatments.RegistrationThe study was registered in the ISRCTN register on 8 November 2016 with the number ISRCTN18263886.
Deconstructing the patient pathway to (in)effective care for hypertension: an application to the Philippines
Authors: Balabanova D 
Published: October 2020

Abstract
Patient pathways for hypertension care are clinically-determined and depicted as a linear process: from diagnosis and initiation of treatment, to subsequent follow-up. However, increasing evidence suggests that patient journeys are more complex, involving different points of diagnosis; starting, stopping and changing treatment-in the formal and informal sectors-and multiple re-entries into the system. This longitudinal qualitative study sought to obtain in depth knowledge of these pathways over time.
We thematically analysed data from 40 interviews with hypertensive Filipino patients of low socio-economic status, repeated after 12 months to capture health events and actions taken. Data was also collected using mobile phone-based digital diaries in the interim.
Low-income hypertensive patients in the Philippines navigate a complex terrain to manage their condition. Barriers facing patients and their coping strategies differ at each stage. The pluralistic health system affects pathway through conflicting and alternative information from outside the formal health sector, social networks and commercial bodies. Patients proactively make decisions on how to manage their condition in relation to these formal and informal systems. Barriers to adherence include factors beyond the health system, notably precarious work contexts which require patients to compromise their livelihoods to follow provider-proscribed treatment. Families act as enables of care, motivating patients to follow or modify their pathway.
The concept of an optimal ‘patient pathway' is normative and often ignores the complex reality of patients' lives as they manage multiple priorities. In reality, pathways are cyclical and iterative. Advocating rigid pathways that patients must follow for life is unrealistic, especially for the poor. Instead, health systems need to adapt to reflect patients' fluid life trajectories and expectations to enable them to effectively manage their condition alongside other demands.
Is the firearm epidemic in the US getting worse?
Authors: Tedesco D , Adja K Y C , Rallo F , Reno C , Fantini M P , Hernandez-Boussard T 
Published: October 2020

Abstract

Background
The US is the least regulated firearm market in the Western world and firearm violence is a major public health issue. Firearms account for 40,000 deaths in the US annually, which is higher than other high-income countries. Although most of the gun-related deaths in the US are the result of suicide attempts and self-inflicted injuries, nearly 40% of them come from accidents, assaults, or police intervention.

Methods
We measured the number of non-self-inflicted firearm-related ED visits, by including patients discharged with diagnostic ICD-9-CM (ICD-10 for 2016) codes of accidents, assaults or legal intervention resulting in firearm injuries between 2006-2016. We used data from the Healthcare Cost and Utilization Project (HCUPnet). From the CDC Wide-ranging Online Data for Epidemiologic Research we obtained data on non-suicidal firearm-related deaths over the period 2006-2017. To identify the cause of death we used the ICD-10 codes. Temporal changes of rates of ED visits and deaths were evaluated using Joinpoint Software.

Results
In 2006 there were a total of 79,998 ED visits with a diagnostic code of firearm-related injury, and this number showed a non-significant 2.7% annual decline between 2006-2013 (p = 0.06) followed by a significant 19.4% annual increase between 2013-2016 (p &lt; 0.05), resulting in 111.305 visits in 2016. The number of non-suicidal firearm-related deaths showed a significant 2.2% annual decline between 2006-2014 (p &lt; 0.05), followed by a significant 10.3% APC (p &lt; 0.05) between 2014-2017.

Conclusions
Data showed steady rates until 2013 and a striking increasing trend starting from 2013. Firearm-related deaths followed the same trends. Our data show that in the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities. Analysis limitations: we used national-level aggregate data and coding accuracy may be not consistent nationwide.

Key messages
In the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities nationwide. The US firearm related deaths epidemic urges for new policies and preventive measures, such as stricter background checks and restrictions on guns ownership.
The role of the trainer in adapted physical activity for osteoporosis to improve quality of life
Authors: Marini S , Masini A , Maietta Latessa P , Sanna T , Raggi A , Buffa A , Malavolta N , Barone G , Leoni E , Dallolio L 
Published: October 2020

Abstract

Background
Osteoporosis is a major health burden worldwide and require a multi-modal approach including exercise. Fractures have a substantial impact on quality of life (QoL) so exercise programs may to be conducted by trainers able to deal with this condition, because exercise alone, even if in the right dosage, seems to be not enough to improve QoL. A quasi-experimental pilot study performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol specifically designed for osteoporotic women with vertebral fractures and its effect on QoL, with a specific focus on trainer's role.

Methods
The Experimental Group (EG) performed APA protocol 1hour twice a week for 6 months, while the Control Group (CG) received standard care. QoL was assessed at baseline and follow-up with ECOS-16 questionnaire and semi structured interviews to understand women perceptions regarding trainer's role. Using mixed-methods quantitative and qualitative data were analyzed using SPSS 5 and NVivo 12, respectively.

Results
40 post-menopausal women (mean age: 67.6±4.6) divided in 2 groups EG = 22 and CG = 18, completed the study. At follow-up, EG improved significantly QoL (EG: -0.5±0.5 vs CG: 0.0±0.3 p = 0.02). The APA intervention had a significant effect on all the components of QoL, as measured by the disease-specific ECOS-16 questionnaire: Physical Component Summary (PCS) (EG: -0.4±0.5 vs CG: 0.0±0.4 p = 0.06) and Mental Component Summary (MCS) (EG: -0.5±0.6 vs CG: 0.1±0.5 p = 0.02). The interviews confirmed this result, emphasizing the key role of the trainer in improving their QoL. The adherence calculated as number of sessions performed compared to the sessions proposed was 75.8%. No injuries were observed.

Conclusions
The feasibility, the safety, and the positive effect of the proposed exercise protocol on QoL confirmed also by the interviews, show that principles of exercise education applied by trainers should be extended also to patients with other chronic condition.

Key messages
Trainers specifically educated, could be a means of achieving the goal improving people’s QoL, as they occupy the role of exercise experts and also an educational, relational and support role. The management of osteoporosis is multi-modal and includes exercise, often recommended as a beneficial non-pharmacological treatment to slow the rate of bone loss and improve quality of life.
Future visions for medical education, the importance of public health themes in education and beyond
Authors: Ghazal Asswad A , Fundano N , Holm S , Khan H , Petráková A 
Published: October 2020

Abstract
Steps for the future improvement of competencies evaluation and fulfilment were studied, with the eventual goal of the unification of guidelines internationally to ensure the standardisation and uniformity of the quality of medical education. The future vision for the integration of public health into medical education curriculums, highlighting the importance of public health in medical education and its application in a wide variety of situations across medical education and beyond in practise as a medical professional in a range of specialities. The need for ways to increase engagement of medical students within public health issues will also be discussed.
Burden of breast cancer in Serbia 2007-2017
Authors: Todorovic J , Santric-Milicevic M , Stamenkovic Z , Bjegovic-Mikanovic V , Terzic-Supic Z , Vasic M 
Published: October 2020

Abstract

Background
Breast cancer is the third highest incidence of cancer globally. It is the leading cause of cancer-associated mortality among females in the world. In Serbia, the incidence rate of breast cancer in 2015 was 61.0/100000 and breast cancer attributed to 18.9% of total cancer mortality among females. The aim of this study was to examine the incidence rate, years lived with disability (YLD) and disability-adjusted life-years (DALY) in Serbia in the ten-year period, from 2007 to 2017.

Methods
We analyzed data from the global burden of disease study (GBD) 2017. The data for the breast cancer incidence, prevalence, YLD, DALY counts and DALY rates per 100,000 were used for analyses.

Results
The prevalence of breast cancer in Serbia (in thousands) in 2017 was 44.6 (95% CI: 39.9-50.6), the incidence (in thousands) was 5.6 (95% CI: 5.0-6.4), YLD (in thousands) in 2017 was 3.5 (95% CI: 2.5-4.9). In the period between 2007 and 2017, YLD counts increased by 11.7%, while the age-standardized rates increased by 5.8%. Total all age DALY counts for both sexes were 51.8 (95% CI: 49- 55.3) in 2007 and 51.5 (95% CI: 45.7-58.3) in 2017. Age-standardized DALY rates per 100,000 decreased from 388.8 (95% CI: 368.3-415.7) in 2007 to 366.3 (95% CI: 323.8-415.4) in 2017.

Conclusions
The data from the GBD study show that the total YLD counts in Serbia increased by more than 10% in the past decade. However, the total DALY counts did not change significantly and the age-standardized DALY rate per 100,000 decreased in the period between 2007 and 2017.

Key messages
The total years-lived with disability as a consequence of the breast cancer increased for 10% in Serbia between 2007 and 2017. The decrease in age-standardized DALYs may reflect aging and depopulation effects in Serbia.
Why provision of clinical decision support (CDS) is not enough? Factors influencing the CDS adoption
Authors: Laka M , Milazzo A , Merlin T 
Published: October 2020

Abstract

Background
Clinical decision support (CDS) can improve the quality and efficiency of care by increasing access to evidence-based data at the point-of-care. However, CDS adoption is limited in clinical settings. The focus on the technical design have overlooked end-users’ perceptions, social and organisational factors that may influence uptake. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) model, we aimed to identify different challenges and opportunities for CDSS adoption in clinical settings.

Methods
A cross-sectional online survey was conducted from June-October 2019 with general practitioners, physicians and surgeons in Australia. To measure the impact of UTAUT moderators (age, gender and experience) and care settings (primary care vs. hospitals) on perceived barriers and facilitators to CDS implementation, multivariate logistic regression was carried out. Qualitative data was thematically analysed for emerging patterns and themes.

Results
Many respondents indicated that CDS can promote evidence-based care (79%) and improve quality and safety (52%). Overall CDS adoption is dependent on factors such as effort expectancy (ease of use), performance expectancy and a facilitating environment for system use. Clinician perceptions of barriers and facilitators to uptake are associated with type of care setting. There was higher likelihood of perceiving ease of use (OR 1.39, 95% CI 1.15-2.07), time limitations (OR 1.95, 95%CI 1.10-3.77), patient' preferences (OR 2.17, 95% CI 1.14-3.37) and threat to professional autonomy (OR 2.15, 95%CI 1.39-3.41) as factors that influence adoption in primary care. Providing relevant information in right format at right time is critical for successful CDS use.

Conclusions
CDS implementation requires a holistic approach addressing users' perceptions and preferences determined through stakeholder consultation. The system design must be easy to use but also facilitated through the provision of on-site training and support.

Key messages
CDS adoption is determined by systems’ ease of use and provision of enabling environment. Users and setting characteristics are important moderators and must be considered in CDS implementation.
Evaluation of policy measures to promote a healthy diet and physical activity: The PEN Project
Authors: Ahrens W 
Published: October 2020

Abstract

Issue
There is a knowledge gap regarding the effectiveness of policies to change the upstream drivers of health-related behaviours like physical activity (PA) and food choice in a favourable direction.

Description of the problem
No systematic evaluation of policy interventions across Europe is currently being conducted, thus little information on the merit or utility of policy interventions is available and no guidance on how to address this gap exists.

Expected Results
PEN will provide tools to evaluate and benchmark policies addressing PA, unhealthy diets and sedentary behaviour (SB) while accounting for existing health inequalities. From February 2019 to January 2022, a multi-disciplinary research network from Europe and New Zealand will interact with policy makers and experts in policy development, implementation and evaluation to (1) assess public policies with potential influence on food and PA environments, (2) foster a harmonised pan-European surveillance system, (3) model the population level impact of policies, (4) evaluate facilitators and barriers of policy implementation processes, (5) give recommendations for an equity and diversity perspective in these policies. It will refine appropriate research designs and methods for the quantification of policy impact.

Lessons
PEN has adopted the INFORMAS approach to monitor, benchmark and support public and private sector actions in selected European countries to increase healthy food environments and reduce obesity and NCDs and their related inequalities. PEN has expanded this approach to develop a PA policy environment index. It has advanced the roadmap for a harmonized European surveillance system and derived a set of indicators for dietary, physical activity and sedentary behaviours including their upstream drivers.

Key messages
PEN strives to achieve implementation of evidence-based policies in different cultural or socio-economic settings with focus on vulnerable groups. PEN will give recommendations on how research designs and methods for the quantification of policy impact can be improved.