bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 lockdown and physical activity changes in Italy: a cross-sectional survey
Authors: Scacchi A , Bert F , Savatteri A , Lo Moro G , Catozzi D , Siliquini R 
Published: October 2021

Abstract

Background
The global pandemic of COVID-19 has caused radical changes in the structure of people's daily routines in most of the countries around the world and have had a big impact on physical activity (PA) and daily movement. Previous studies reported the increase of sedentary behaviours during movement restrictions. This study investigates the impact of the first Italian lockdown measures (9 march - 3 may 2020) on PA habits and factors potentially associated with starting or ceasing PA practice during home confinement.

Methods
A web-based cross-sectional survey was carried out using an online 40-item questionnaire spread in May 2020 in Italy. Multivariable regressions were performed.

Results
A total of 1865 people were enrolled. During lockdown, PA was performed by 65.5% of the sample. Overall, the number of physically active people increased by 8%, compared to the pre-pandemic period level (56%). A change in PA habits occurred in 34.1% of the sample (37.9% of them stopped PA and 62.1% started it). Starting PA during lockdown was related to being on a diet, whereas living with children and having poor psychological well-being were inversely related with starting PA. Conversely, unhealthy factors like being overweight or obese, having poor mental well-being and the occurrence of emotional overeating were related to stopping PA during lockdown.

Conclusions
The first Covid-19 Italian lockdown had a significant impact on healthy habits of the population, leading to an increase of physically active individuals. Furthermore, a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.

Key messages
Physical activity habits changed during lockdown due to Covid-19 pandemics and a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.
Algorithms and Artificial Intelligence in Primary Care for conscious drug use: a systematic review
Authors: Altamura G , Riccardi MT , Nurchis MC , Sapienza M , Sessa G , Damiani G , Ricciardi W 
Published: October 2021

Abstract

Primary care is a growing medical field willing to become a more integrated and technological asset. Although big changes already happened and more investments have been made, a limited amount of literature describes processes and technologies there applied or to be used. This paper aims to evaluate the efficacy and usability of different types of algorithms in primary care to improve drug safety by speeding up processes and achieving greater accuracy opening the path to providing better healthcare overall. The PICO model was adopted, three electronic databases (PubMed, Cochrane, Web of Science) were searched using appropriate keywords. Selected studies were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analysed using descriptive statistic, comparison of drug usage between algorithms or artificial intelligence application and usual care was performed using a χ2 test(α = 0.05). Out of 2207,19 studies were included,37% of them regarding error prevention,21% drug interactions,21% drug monitoring,16% drug prescription,5% drug administration. Results showed an easier and safer medication use in 74% of studies, a loss of safeness and accuracy in 16%; 10% of total studies did not come up with a valid esteem of results either for inadequate availability of the AI machine or because of the heterogeneity of the results in different settings. The evaluation of errors prevention, 40% of total studies, showed the most statistically significant results with 88% of positive outcomes from AI application. The results support that this technological approach to drugs management could contribute to the safety of treatment and to increase patients' and general practitioners' satisfaction. The application of AI or algorithms is significantly associated with a reduction of drug use errors (p &lt; 0.05). Future studies should work toward establishing a gold standard to measure AI performances.

Key messages
Artificial Intelligence and Algorithms in primary care have the potentiality to disrupt patient care with a safer and faster medication management. A comparison between Artificial Intelligence or algorithms and standard clinical practice may help finding the medication fields where a technological support could lead to better results.
Health for All: a health literate, culturally competent and participative approach
Authors: Banzola S , Bandello MA , Testi A , Az F , Clemente G , Piazza S , Mazza M , Chiapponi S , Costantino R , Berghenti F 
Published: October 2021

Abstract

Background
Three micro projects, planned by the multidisciplinary team in a Primary Care setting targeting refugees and asylum seekers, aim at migrants' health, building strategies together with the private and social sectors involved, for a culturally competent and Health Literate approach, within the ICARE Project activities. Three different areas of work were identified: detecting barriers to migrants' management of prevention and care of Covid-19; preventing domestic accidents in children; improving the participation to screening programs among refugees and women victims of human trafficking.

Objectives
The main objective is to improve migrants' engagement in health care and health promotion activities in a new context of living strongly influenced by the pandemic waves of Covid-19. The second objective is to enable a participative approach to migrants' health among intercultural mediators, nurses, paediatrician, infectious diseases specialist, psychologist, social workers and representatives of No Profit Organizations (NPOs) that support refugees and women victims of human trafficking within the “Oltre la Strada” Regional project.

Results
A closed questionnaire assessing knowledge about prevention and management of Covid-19 has been carried out among 100 refugees and asylum seekers. A video on prevention of domestic accidents was made and translated in eleven languages as a result of a cooperation with intercultural mediators, to encourage questions during the educational meetings. Finally, a focus group was performed with NPOs in order to identify common areas of work, enabling a participative approach to improve migrants' engagement.

Conclusions
The preliminary results reveal the need to approach migrants' health focusing on their participation through a multidimensional, person-centred, Health Literate and culturally competent cooperation. The outcomes from data analysis of the ongoing activities within the ICARE Project will be presented at the conference.

Key messages
A multidimensional approach to migrants’ health enables all stakeholders to learn from each others, improving the awareness about the relationship between health literacy and health outcomes. The cooperation between health, social and private sectors could be strategic for an organizational change towards a person-centred approach.
2020 healthcare workers flu vaccination during covid-19: the experience of Udine University Hospital
Authors: Chirico L , Moretti V , Valdi G , Varadi G , Da Ros R , Pozzi D , Brunelli L , Cocconi R 
Published: October 2021

Abstract

Background
To prevent flu spread, Italian healthcare workers (HCWs) are annually recommended and given free flu vaccination. This measure of healthcare system protection resulted to be fundamental during COVID-19 pandemic to prevent staff shortage issue. Being the minimum coverage target set at 75%, we decided to evaluate vaccination adherence among HCWs at Udine University hospital.

Methods
The 2020 vaccination campaign started 4 weeks earlier than usual and was based on a multiple offer strategy including a daily-dedicated clinic, in-ward administrations along with wide vaccination agenda promotion within hospital. The prevalence and the characteristics of vaccinated HCWs were compared with the same 2019 data.

Results
During 2020, 1868 out of 3839 (48.7%) of HCWs were vaccinated, compared to 29.1% in 2019 (p &lt; 0.0001). Doctors and residents were the most vaccinated categories in both years, being respectively 64.7% and 67.2% in 2020 vs 45.0% and 52.4% in 2019 (p &lt; 0.0001). Midwives showed the best improvement in coverage passing from 44.4% to 20.4% (p = 0.0096). HCWs working in emergency areas and intensive care unit reached the highest adherence in 2020 (61.3%) and the best improvement compared to 2019 as well (37.9%; p &lt; 0.0001).

Conclusions
Even if the target was not reached, strategies adopted for 2020 vaccination campaign significantly increased HCWs adherence. COVID-19 contribution in this achievement cannot be ruled out, possibly representing a strong reinforcing element for HCWs awareness towards infectious disease prevention.

Key messages
Despite the improvement in vaccination adherence, HCWs flu vaccination coverage still remains a concerning issue to be addressed. Increased flu shot adherence reached during COVID-19 pandemic should be not only a target to be maintained but even improved next year getting closer to herd immunity.
Factors of traffic incidents at University General Hospital of Heraklion, March-August 2018
Authors: Martimianaki A , Papadakaki M , Tosounidis T , Tsiligianni I 
Published: October 2021

Abstract

Background
Injury caused by a traffic accident is the leading cause of death in all age groups with a significant impact on public health expenditure. One of the highest accident rates in Greece is recorded in Crete

Methods
A retrospective archival study. It was carried out at the University General Hospital of Heraklion recording all the incidents in areas of the region of Heraklion and the transits of patients carried out from the rest of Crete.

Results
From March 2018 to August 2018, 493 cases were recorded in the Orthopedic Clinic by the Emergency Department. 89 incidents related to road accident injuries. Men were more involved in traffic accidents, with an average age of 42.5 years. The monthly allocation was roughly the same for all months. Insurance types were about 73.6% of the public provider, 5.7% of the private body, and 20.7% of the uninsured patients. The two-wheelers had the highest participation with 66.3%, cars with 38.8%, and 3.8% with pedestrians and cyclists. The highest incidence of injuries occurred by 22.7% was about fractures in legs and knees, pelvis, and spine fractures by 19.3%. Hip and thigh fractures followed by 14.8%. As caused factors were referred to the non-use of belts and helmets and alcohol in driving. The average hospitalization duration ranged from 7.6 days to 51 days. The average cost per patient ranged from €1,907 to €18,025. The largest total cost involved the fractures of the legs and knee with €52,315 and the spine and spine fractures with €41,459. The total cost in all three categories of insurance was approximately €25-26,000.

Conclusions
The percentage of road accidents in Crete remains at a high level. The highest incidence of injuries refers to legs and knee, pelvic and spinal fractures. Their hospitalization cost includes larger amounts in other European countries. Accompanied illnesses seem to have an impact on road behavior increasing the risk of a road accident.

Key messages
It is highlighted the implementation of more effective prevention programs aimed at youth. The proper management of the problem can bring huge financial relief to health expenditures.
Challenges of delivering reproductive health services to forced displaced populations
Authors: Varshney N , Budhathoki S , Omar M 
Published: October 2021

Abstract

Background
Of the 80 million forced displaced persons worldwide, women and children bear greater morbidity and mortality, especially in conflict-affected regions. This is due to disruption in health service provision, breakdown of social institutions and increase in sexual and gender-based violence. Reproductive health (RH) service delivery as part of humanitarian health cluster services is outlined in the Minimum Initial Service Package (MISP). This study explores the challenges of delivering RH services to forced-displaced populations, focussing on field level stakeholders in humanitarian settings.

Methods
Qualitative semi-structured interviews were conducted with stakeholders from non-governmental and United Nations agencies involved in delivering RH services to conflict-affected populations. Additionally, a scoping review, using the Arksey and O'Malley framework, of the literature was also conducted reviewing challenges of delivering RH programmes to women in forced displaced populations. An inductive and deductive thematic approach was used in data analysis.

Results
Eleven key informants (KIs) were interviewed from six conflict-affected countries including Syria, Afghanistan and Libya. Main emerging themes were: 1. Poor awareness of international guidelines (including the MISP) 2. Service provision barriers including lack of human resources 3. Attitudes towards SRH and women's rights 4. Disruption of health services due to COVID-19.

Conclusions
This study has highlighted the main challenges that the humanitarian actors delivering RH programmes in conflict-affected settings face. Implementation of international guidelines remains a key barrier. Key policy recommendations would be to standardise training for all RH providers, prioritise training in the MISP and address cultural attitudes towards RH. Further research exploring the use of WHO's essential medicines for RH and the long-term impact of COVID-19 on forced displaced females needs to be conducted.

Key messages
Providing basic essential reproductive health services to conflict affected populations remains a challenge, including implementation of standardised international guidance through the MISP. One key policy recommendation would be to prioritise training in MISP for conflict-affected humanitarian settings to ensure it is offered as part of the essential package.
Laboratory limits on the annihilation or decay of dark matter particles
Authors: Marrodán Undagoitia Teresa , Rodejohann Werner , Wolf Tim , Yaguna Carlos E 
Published: October 2021

Abstract
Constraints on the indirect detection of dark matter are usually obtained from observations of astrophysical objects—the Galactic Center, dwarf galaxies, M31, etc. Here we propose instead to look for the annihilation or decay of dark matter particles taking place inside detectors searching directly for dark matter or in large neutrino experiments. We show that the data from XENON1T and Borexino set limits on the annihilation and decay rates of dark matter particles with masses in the keV to few MeV range. All relevant final states are considered: annihilation into γγ and e−e+ and decays into γγ, γν, and e−e+. The expected sensitivities in XENONnT, DARWIN, JUNO, and THEIA are also computed. Though weaker than current astrophysical bounds, the laboratory limits (and projections) obtained are free from the usual astrophysical uncertainties associated with J-factors and unknown backgrounds, and may thus offer a complementary probe of the dark matter properties. We point out that current and future (astro)particle physics detectors might also be used to set analogous limits for different decays and dark matter masses above a few MeV.
Extracorporeal membrane oxygenation for coronavirus disease 2019-related acute respiratory distress syndrome
Authors: Short Briana , Abrams Darryl , Brodie Daniel 
Published: October 2021

Purpose of review
To understand the potential role of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), highlighting evolving practices and outcomes.

Recent findings
The role for ECMO in COVID-19-related ARDS has evolved throughout the pandemic. Early reports of high mortality led to some to advocate for withholding ECMO in this setting. Subsequent data suggested mortality rates were on par with those from studies conducted prior to the pandemic. However, outcomes are evolving and mortality in these patients may be worsening with time.

Summary
ECMO has an established role in the treatment of severe forms of ARDS. Current data suggest adherence to the currently accepted algorithm for management of ARDS, including the use of ECMO. However, planning related to resource utilization and strain on healthcare systems are necessary to determine the feasibility of ECMO in specific regions at any given time. Utilization of national and local networks, pooling of resources and ECMO mobilization units are important to optimize access to ECMO as appropriate. Reported complications of ECMO in the setting of COVID-19-related ARDS have been predominantly similar to those reported in studies of non-COVID-19-related ARDS. Further high-quality research is needed.
COVID-19 mRNA vaccine allergy
Authors: Risma Kimberly A. 
Published: October 2021

Purpose of review
A known history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is the only contraindication to coronavirus disease 2019 (COVID-19) mRNA vaccination. It is important for pediatricians to understand the likelihood of an allergic reaction to COVID-19 mRNA vaccines, including its excipients.

Recent findings
Episodes concerning for anaphylaxis were immediately reported following early administration of COVID-19 mRNA vaccines to adults. Although allergic type symptoms were reported equally in recipients of placebos and test vaccines in phase 3 clinical trials, post-authorization prospective studies state that 0.2–2% of vaccine recipients have experienced allergic reactions. Subsequent allergy testing of affected individuals has focused largely on evaluation of allergic sensitization to a novel vaccine excipient, polyethylene glycol (PEG). PEG is a polymer incorporated in numerous pharmaceutical products because of its favorable, inert properties. The results of allergy testing in adults to date indicate that IgE mediated anaphylaxis to PEG allergy is rarely identified after COVID-19 mRNA vaccine reactions. Numerous individuals with presumed anaphylaxis have tolerated a second vaccine after evaluation and testing by an allergist, suggesting either misdiagnosis or a novel immune mechanism.

Summary
Confirmed anaphylactic reactions to COVID-19 mRNA vaccines are rare, likely due to a lack of preexisting IgE against the vaccine components, including PEG.
Progress in understanding climate change's effects on children and youth
Authors: Brodie Nicola , Silberholz Elizabeth A. 
Published: October 2021

Purpose of review
Climate change remains a major threat to the health and well-being of children globally. This article reviews the myriad health effects of climate change on children throughout their lives and discusses ways in which the general pediatrician can be an advocate for climate solutions.

Recent findings
Rising atmospheric temperatures, increased air pollution, and destabilized weather patterns all lead to adverse health outcomes for children and adverse obstetric outcomes. However, the impact of climate change is not evenly distributed. Children living in poverty are more likely to be adversely impacted by the changing climate.

Summary
Ongoing and emerging research suggests that children are particularly vulnerable to the effects of climate change. The primary care pediatrician is encouraged to see this irrefutable evidence as a call to action for advocacy on behalf of our patients and the planet.
Photometric and Colorimetric Evaluation of Phototherapy Instruments for Syntonic Treatment of Visual Anomalies
Authors: López de la Fuente Carmen , Sánchez-Cano Ana Isabel 
Published: October 2021

SIGNIFICANCE
Ocular light exposure therapy has been used in optometric therapies to improve binocular anomalies such as accommodative or vergence dysfunctions, amblyopia therapy or to increase the visual field. Currently, syntonic phototherapy is used worldwide by behavioral optometrists, vision trainers, or occupational therapists, among others, although these treatments are supported by only a few research studies that lack consensus on the efficacy of this approach.

PURPOSE
In this article, we highlight the optical characteristics of lamps without evaluating the efficacy of their use in optometric procedures.

METHODS
Our work analyzes four devices often used in clinical practice in terms of spectral power distribution, illuminance levels at the corneal plane, and both theoretical photopic and melanopic contributions to the visual system.

RESULTS
First, illuminance levels reaching the corneal plane depend on the characteristics of each lamp and their distance from where the eye should be positioned; for example, delta-theta filter photopic illuminance is 13.1, 93.7, 22.7, or 41.6 lux with the four evaluated devices. Second, filters or modes named the same differ in terms of their spectral power distribution. Third, substantial difference in color appearance has been found among the same configurations.

CONCLUSIONS
The spectral and iluminance characteristics of syntonic systems used for vision therapy vary widely, including variations among filters with the same identifying characteristics. This provides significant sources of variability, which limit the ability to conduct evidence-based medicine clinical trials to assess the true efficacy of syntonic therapy. This study furthers our knowledge of syntonic phototherapy from a technical perspective; however, longitudinal research examining patients' evolution pre-lighting and post-lighting treatments is required to justify and understand the effects of light exposure and its impact on optometric and ocular parameters more clearly.
Extending Trauma Quality Improvement Beyond Trauma Centers
Authors: Jenkins Peter C. , Timsina Lava , Murphy Patrick , Tignanelli Christopher , Holena Daniel N. , Hemmila Mark R. , Newgard Craig 
Published: October 2021

Objective:
The American College of Surgeons (ACS) conducts a robust quality improvement program for ACS-verified trauma centers, yet many injured patients receive care at non-accredited facilities. This study tested for variation in outcomes across non-trauma hospitals and characterized hospitals associated with increased mortality.

Summary Background Data:
The study included state trauma registry data of 37,670 patients treated between January 1, 2013, and December 31, 2015. Clinical data were supplemented with data from the American Hospital Association and US Department of Agriculture, allowing comparisons among 100 nontrauma hospitals.

Methods:
Using Bayesian techniques, risk-adjusted and reliability-adjusted rates of mortality and interfacility transfer, as well as Emergency Departments length-of-stay (ED-LOS) among patients transferred from EDs were calculated for each hospital. Subgroup analyses were performed for patients ages >55 years and those with decreased Glasgow coma scores (GCS). Multiple imputation was used to address missing data.

Results:
Mortality varied 3-fold (0.9%–3.1%); interfacility transfer rates varied 46-fold (2.1%–95.6%); and mean ED-LOS varied 3-fold (81–231 minutes). Hospitals that were high and low statistical outliers were identified for each outcome, and subgroup analyses demonstrated comparable hospital variation. Metropolitan hospitals were associated increased mortality [odds ratio (OR) 1.7, P = 0.004], decreased likelihood of interfacility transfer (OR 0.7, P ≤ 0.001), and increased ED-LOS (coef. 0.1, P ≤ 0.001) when compared with nonmetropolitan hospitals and risk-adjusted.

Conclusions:
Wide variation in trauma outcomes exists across nontrauma hospitals. Efforts to improve trauma quality should include engagement of nontrauma hospitals to reduce variation in outcomes of injured patients treated at those facilities.