bluuebunny/crossref_metadata_2025_split huggingface dataset:
A study to assess current approaches of allergists in European countries diagnosing and managing children and adolescents with peanut allergy
Authors: Sharma Vibha , Jobrack Jennifer , Cerenzia Wendy , Tilles Stephen , Ryan Robert , Sih-Meynier Regina , Zeitler Stefan , Manning Michael 
Published: December 2020

Rationale
Food allergy is documented to result in considerable morbidity, negative impact on quality of life, and substantial medical care costs. Although anecdotal data suggest widely varying practices in the diagnosis and management of food allergies, the diversity and relative frequency of these practices have not been documented.

Methods
A questionnaire was developed evaluating allergists’ management approaches of individuals with peanut allergy (PA) in Germany (DE), France (FR), and the United Kingdom (UK).

Results
Here, we report the survey results from a total of 109 allergists from DE, FR and the UK. They reported to confirm PA at initial diagnosis using skin prick test (≥60%), while allergists from DE and FR reported using allergen-specific IgE testing more (>86%) compared to the UK (<50%). At initial diagnosis, oral food challenge was used less in DE (13%) and FR (14%) and very rarely in the UK (3%) to confirm diagnosis. Recognition of acute reactions, use of adrenaline auto-injectors and allergen avoidance were reported to be discussed with the patient/caregiver at the initial office visit by most allergists (>75%). Half of the responders reported assessing the patient’s quality of life. 63% allergists reported retesting for PA resolution at a later date, with 45% allergists indicated to recommend ingestion of a normal serving of peanut regularly upon resolution. Lack of effective PA treatment was reported to be a ‘very significant’ barrier for optimal PA treatment, with allergists being less than ‘moderately familiar’ with data from clinical trials testing new treatments options for PA. Lastly, allergists stated that the severity of patient’s PA ranked as the most important factor in their decision to recommend oral immunotherapy for PA treatment.

Conclusions
This survey provides essential insights into the practice of allergists and highlights some areas that would inform strategies for education and improving PA healthcare.
TST conversions and systemic interferon-gamma increase after methotrexate introduction in psoriasis patients
Authors: de Medeiros Vanessa Lucília Silveira , Santos Fabiana Cristina Fulco , Montenegro Lílian Maria Lapa , Silva Maria da Conceição , Souza Valdênia Maria Oliveira de , Lima Neto Reginaldo Gonçalvez de , Moura Líbia Cristina Rocha Vilela , Magalhães Vera 
Published: December 2020

Background
Tuberculosis screening in psoriasis patients is complex due to the immunological alterations associated with psoriasis, the presence of comorbidities, and the effect of immunosuppressive treatment. However, it is not established whether the results of screening tests are affected by these factors in psoriasis patients.

Objectives
To determine whether there is a change in the results of the tuberculin skin test (TST) or the interferon-gamma release assay (IGRA) in psoriasis patients living in tuberculosis (TB)-endemic area after 12 weeks of methotrexate (MTX) treatment and to investigate the association of the test results with clinical and inflammatory markers.

Methods
Forty-five patients were selected for a prospective single-arm self-controlled study and followed for at least 18 months. The TST, IGRA, Psoriasis Area and Severity Index (PASI), and inflammatory factors (erythrocyte sedimentation rate (ESR), C-reactive protein, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha levels), were determined before and after 12 weeks of oral 15 mg per week MTX administration and compared. The associations between the IGRA and TST results were verified before and after treatment according to inflammatory factors and clinical characteristics (age, blood glucose, weight, body mass index, disease duration, and PASI).

Results
We collected data on 25 patients who completed the full course of therapy and the follow-up. None of the patients developed TB. TST positivity was significantly elevated at week 12 (25% baseline vs 44% at week 12, P < 0.037). Three IGRAs followed the TST conversions. There was no difference between TST and IGRA pre- or posttreatment. Serum IFN-γ increased significantly in week 12 (15.95 pg/ml baseline vs 18.82 pg/ml at week 12, P < 0.005) and tended to be higher among TST-positive patients (P = 0.072). The baseline IGRA was associated with a higher ESR (P = 0.038). None of the test results were associated with clinical characteristics.

Conclusions
In addition to the classic booster effect, TST conversions in patients using MTX can occur due to an increase in IFN-γ. However, it is not possible to exclude true TST conversions. Therefore, other diagnostic methods, like IGRA or chest tomography, should be used when the TST has intermediate results.
Factors influencing pregnancy planning of multi-ethnic Asian women with diabetes: A qualitative study
Authors: Z. I. Irmi , C. J. Ng , P. Y. Lee , N. Hussein 
Published: December 2020

IntroductionPregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women’s pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women’s pregnancy planning.MethodsThis qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis.ResultsFrom the 33 interviews that were analysed, four important factors influencing participants’ decisions regarding pregnancy planning were identified. Participants’ perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious ‘up to God’ beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care.ConclusionsThis study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.
Prevalence of prelacteal feeding and associated risk factors in Indonesia: Evidence from the 2017 Indonesia Demographic Health Survey
Authors: Rahmartani Lhuri D. , Carson Claire , Quigley Maria A. 
Published: December 2020

BackgroundPrelacteal feeding (PLF) is a recognised challenge to optimal breastfeeding but remains common in Indonesia. Meanwhile, PLF-related epidemiological research is limited, particularly in this setting. This study examines the prevalence and determinants of overall PLF as well as common PLF types (formula, other milk, and honey) in Indonesia.MethodsData from 6127 mothers whose last child was ≤23-month-old were drawn from the 2017 Indonesia Demographic and Health Survey. Multivariable modified Poisson regression was used to measure the prevalence ratio (PR) for selected PLF risk factors. PLF was defined as anything to drink other than breast milk within three days after birth, before breastmilk flows. Additional analyses were performed on mothers who gave formula, other milk, and honey.ResultsAbout 45% babies in Indonesia received PLF with formula being the most frequent (25%), followed by other milk (14%), plain water (5%), and honey (3%). Factors associated with higher prevalence of any PLF were higher wealth quintiles in rural area (PR 1.07; 95% CI 1.03–1.11 per increase in quintile), baby perceived to be small at birth (PR 1.23; 95% CI 1.12–1.35), caesarean deliveries at either public (PR 1.27; 95% CI 1.13–1.44) or private facilities (PR 1.15; 95% CI 1.01–1.31), and not having immediate skin-to-skin contact after birth (PR 1.32; 95% CI 1.23–1.42). PLF was less prevalent among mothers who gave birth to second/subsequent child (PR 0.82; 95% CI 0.76–0.88) and who had an antenatal card (PR 0.89; 95% CI 0.80–0.99). These patterns did not apply uniformly across all PLF types. For example, honey was more common among home births than deliveries at health facilities, but formula and other milk were more common among caesarean deliveries.ConclusionsMapping risk factors for PLF, especially by types, could help to design more targeted interventions to reduce PLF and improve breastfeeding practices in Indonesia.
Epidemiology, outcomes, and the use of intensive care unit resources of critically ill patients diagnosed with COVID-19 in Sao Paulo, Brazil: A cohort study
Authors: Socolovithc Rachel Lane , Fumis Renata Rego Lins , Tomazini Bruno Martins , Pastore Laerte , Galas Filomena Regina Barbosa Gomes , de Azevedo Luciano Cesar Pontes , Costa Eduardo Leite Vieira 
Published: December 2020

Background
The coronavirus disease (COVID-19) pandemic has brought significant challenges worldwide, with high mortality, increased use of hospital resources, and the collapse of healthcare systems. We aimed to describe the clinical outcomes of critically ill COVID-19 patients and assess the impact on the use of hospital resources and compare with critically ill medical patients without COVID-19.

Methods and findings
In this retrospective cohort study, we included patients diagnosed with COVID-19 admitted to a private ICU in Sao Paulo, Brazil from March to June 2020. We compared these patients with those admitted to the unit in the same period of the previous year. A total of 212 consecutive patients with a confirmed diagnosis of COVID-19 were compared with 185 medical patients from the previous year. Patients with COVID-19 were more frequently males (76% vs. 56%, p<0.001) and morbidly obese (7.5% vs. 2.2%, p = 0.027), and had lower SAPS 3 (49.65 (12.19) vs. 55.63 (11.94), p<0.001) and SOFA scores (3.78 (3.53) vs. 4.48 (3.11), p = 0.039). COVID-19 patients had a longer ICU stay (median of 7 vs. 3 days, p<0.001), longer duration of mechanical ventilation (median of 9 vs. 4 days, p = 0.003), and more frequent tracheostomies (10.8 vs. 1.1%, p<0.001). Survival rates until 28 days were not statistically different (91% vs. 85.4%, p = 0.111). After multivariable adjustment for age, gender, SAPS 3, and Charlson Comorbidity Index, COVID-19 remained not associated with survival at 28 days (HR 0.59, 95% CI 0.33–1.06, p = 0.076). Among patients who underwent invasive mechanical ventilation, the observed mortality at 28-days was 16.2% in COVID-19 patients compared to 34.6% in the previous year.

Conclusions
COVID-19 required more hospital resources, including invasive and non-invasive ventilation, had a longer duration of mechanical ventilation, and a more prolonged ICU and hospital length of stay. There was no difference in all-cause mortality at 28 and 60 days, suggesting that health systems preparedness be an important determinant of clinical outcomes.
The disease burden of multimorbidity and its interaction with educational level
Authors: Chen Yi Hsuan , Karimi Milad , Rutten-van Mölken Maureen P. M. H. 
Published: December 2020

IntroductionPolicies to adequately respond to the rise in multimorbidity have top-priority. To understand the actual burden of multimorbidity, this study aimed to: 1) estimate the trend in prevalence of multimorbidity in the Netherlands, 2) study the association between multimorbidity and physical and mental health outcomes and healthcare cost, and 3) investigate how the association between multimorbidity and health outcomes interacts with socio-economic status (SES).MethodsPrevalence estimates were obtained from a nationally representative pharmacy database over 2007–2016. Impact on costs was estimated in a fixed effect regression model on claims data over 2009–2015. Data on physical and mental health and SES were obtained from the National Health Survey in 2017, in which the Katz-10 was used to measure limitations in activities of daily living (ADL) and the Mental Health Inventory (MHI) to measure mental health. SES was approximated by the level of education. Generalized linear models (2-part models for ADL) were used to analyze the health data. In all models an indicator variable for the presence or absence of multimorbidity was included or a categorical variable for the number of chronic conditions. Interactions terms of multimorbidity and educational level were added into the previously mentioned models.ResultsOver the past ten years, there was an increase of 1.6%-point in the percentage of people with multimorbidity. The percentage of people with three or more conditions increased with +2.1%-point. People with multimorbidity had considerably worse physical and mental health outcomes than people without multimorbidity. For the ADL, the impact of multimorbidity was three times greater in the lowest educational level than in the highest educational level. For the MHI, the impact of multimorbidity was two times greater in the lowest than in the highest educational level. Each additional chronic condition was associated with a greater worsening in health outcomes. Similarly, for costs, where there was no evidence of a diminishing impact of additional conditions either. In patients with multimorbidity total healthcare costs were on average €874 higher than in patients with a single morbidity.ConclusionThe impact of multimorbidity on health and costs seems to be greater in the sicker and lower educated population.
El corazón frágil. El doloroso despertar moral del Dr. Edgar Pascoe
Authors: D’ottavio Callegari María Eugenia , D’ottavo Callegari María Silvia , D’ottavio Cattani Alberto Enrique 
Published: December 2020

El corazón frágil es una miniserie británica, estrenada en 1996. Dado que este drama médico ofrece, entre otras, una variedad de posibilidades de debate sobre facetas deontológicas y actitudinales para médicos en particular y profesionales del área de la salud en general resulta más que recomendable apreciar las varias lecturas que permite.
El objetivo de este trabajo es abordarla y presentar algunas de tales posibilidades.
Evaluation of biosimilarity of RinGlar® (GEROPHARM LLC, Russia) and Lantus® (Sanofi-Aventis Deutschland GmbH, Germany) using the euglycemic hyperinsulinemic clamp technique in patients with type 1 diabetes: double-blind randomized clinical trial
Authors: Mayorov Alexander Y. , Drai Roman V. , Karonova Tatiana L. , Avdeeva Olga I. , Makarenko Igor E. , Koksharova Ekaterina O. , Mishina Ekaterina Е. , Sevastyanova Yulia А. , Afonkina Olena V. 
Published: December 2020

Background: Prevention of the development of micro-and macrovascular complications in patients with diabetes melli-tus (DM) encouraged the search for insulin analogues that allow imitating, as close as possible, a normal physiological insulin secretion in healthy people. Biosimilars (bioanalogues of reference products) play an important role in the full provision with high-quality insulin medications throughout patients. The program of clinical trials of insulin bioanalogues includes pharmacology studies: pharmacokinetics (PK), pharmacodynamics (PD) and clinical safety research.Aims: To test whether RinGlar® (GEROPHARM LLC, Russia) and Lantus® (Sanofi-Aventis Deutschland GmbH, Germany) have similar PK and PD profiles in a hyperinsulinemic euglycaemic clamp (HEC) setting in patients with type 1 diabetes mellitus. Permission of the Ministry of Health of the Russian Federation No. 150 of 03/03/2016.Materials and methods: The study was conducted in 42 patients with type 1 diabetes aged 18 to 65 years. A doubleblind, randomized, crossover study of comparative PK and PD of drugs was chosen as a study design. The investigational products were injected after achieving a state of euglycemia before the HEC in a single dose of 0.6 U/kg subcutaneously into the subcutaneous fat of the anterior abdominal wall. During the study, regular blood sampling was performed, the amount of insulin glargine in the samples was determined by ELISA. The results are used to calculate the PK parameters and generate the concentration-time curves. The glucose infusion rate was corrected based on the measurement of glycemia. These data are used to calculate the PD parameters.Results: RinGlar® and Lantus® interventions have comparable PK and PD profiles in HEC setting in patients with type 1 diabetes. This is confirmed by the similarity of the main PK/PD parameters, PK/PD curves, and comparable safety. The confidence intervals of the geometric mean ratio were 81.02% - 120.62% for the PK parameter AUCins0-T, and 85.43% - 115.64% for the PD-parameter AUCGIR0_T, which fall within the specified limits of 80% - 125% to establish comparability between drugs.Conclusions: Results of the clinical trial demonstrate the biosimilarity of the products RinGlar® and Lantus®.
Environmental Components and Mechanism of Public-Private Partnership in the Area of Risk Insurance in Crop
Authors: BAIMAGAMBETOVA Zamzagul , ISMAILOVA Rymkul , KULMAGANBETOVA Aisulu , KASSIMBEKOVA Meiramkul , OMARKHANOVA Zhibek 
Published: December 2020

Crop risk insurance in Kazakhstan is an urgent problem for agricultural producers and insurers, since agriculture is in the zone of constant natural and economic risks, where the main share of risks is associated with weather events affecting the production of agricultural crops. In order to reduce natural risks in agriculture, to ensure the protection of the property interests of farmers in crop production from the consequences of adverse natural phenomena, measures are being taken by the state and business, however, there are problems that both agricultural producers and insurers face.
Public-private partnership has established itself as a successful tool for interaction between business and the state, and now in Kazakhstan a lot of work is being done for the qualitative growth and development of the PPP mechanism, which requires more active interaction between the state and business in the field of crop production.
Legal Regulation of Agricultural Cooperation: New Approaches and Prospects for Developing Rural Areas
Authors: BAKYTZHAN Kalymbek , YERKINBAYEVA Lazzat , NURMUKHANKYZY Daniya , ZHUSUPBEKOVA Madina , NESIPBAYEVA Indira 
Published: December 2020

Throughout the post-independence period, the development of agriculture and rural areas has been among the main priorities of Kazakhstan's economic policy.
This study considers new approaches and prospects for the legal regulation of agricultural cooperation and the development of rural areas.
The article analyzes the legal regulation of agricultural cooperation in the Republic of Kazakhstan and foreign countries. The authors have identified the main constraining factors to the development of agricultural cooperative societies, in particular, and rural areas, in general. They have also determined the key measures for developing agricultural cooperation and rural areas, as well as provided a detailed overview of such measures.
The study results prove that the formation of a multi-level system of agricultural cooperative societies, functioning in collaboration with state (local) authorities, contributes to the development of rural areas.
Environmental Innovations as a Factor of Increasing the Economic Efficiency of Production. Study Case: Pavlodar Region
Authors: ARYNOVA Zylfiya Amangeldinovna , KAIDAROVA Lyazzatkenovna , SARTOVA Rysty Bozmanaevna , BAYANDINA Gulmira Duisenbaevna , RAKHMETULLINA Shynar Zhakanovna , ZHETESSOVA Mariyam Turashevna 
Published: December 2020

The relevance of the research topic is that the world has turned its face to the environmental problem, which is the created real threat of a global environmental catastrophe. The aggravation of relations between society and the environment is facilitated by a technogenic type of economic development, of a nature-destructive nature, based on the use of natural resources and means of production without taking into account environmental restrictions.
Environmental innovations as a factor in increasing the economic efficiency of production in order to improve products and services require the development of technologies, which include environmentally friendly biotechnology, waste processing technologies, low-polluting technologies, etc. There is a need for radical changes in the methods and means of environmental protection, which reduce the technogenic impact on the biosphere of the Earth, and contribute to the preservation of human health.
The Effect of Circuit Training on Concentration of Medical Students in Diponegoro University
Authors: Hastari Tiwik Budi , Bakhtiar Yuriz , Wibisono Dimas Sindhu , Muttaqin Zainal 
Published: December 2020

Background. Concentration has an important role that influences the success of the learning process. The higher the concentration of students in learning, the more effective learning and teaching processes are carried out. One of the benefits of exercise is the improvement of concentration. Lack of time and motivation to do physical exercise are some reasons why people do less exercise. Circuit Training is an exercise that does not require a lot of time and is becoming a trend now.Objective: To find out the effect of the Circuit Training on the concentration level of students at Medical Faculty of Diponegoro University.Method. This research was a quasi-experimental study with pre and post-test design, where research subjects were divided into two groups, there are the control group and the treatment group. The research subjects were 28 male students at Medical Faculty of Diponegoro University. The treatment group had given Circuit Training for 6 weeks. In one week there were 3 meetings where each training session was done in 3 circuits/cycle and each circuit consisted of 8 movements. The indicator assessed in this study was the level of concentration measured using the Digit Symbol Substitution Test (DSST) before and after Circuit Training for 6 weeks. The results were analyzed using SPSS.Results. The score of concentration in the treatment group increased with a pre-test score 64,93 ± 6,38 and post-test score 76,29 ± 5,74. Significant results (p = 0.001) were obtained in the pre and post-test treatment groups.Conclusion. Circuit training for 6 weeks can increase the concentration score of students at Medical Faculty of Diponegoro University.