bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with birthweight and adverse pregnancy outcomes among children in rural Guinea-Bissau - a prospective observational study
Authors: Stjernholm Alexander Dahl , Thysen Sanne Marie , Borges Igualdino Da Silva , Fisker Ane Bærent 
Published: June 2021

Abstract
Background
Low birthweight (LBW) is associated with higher mortality and morbidity, but there is limited data on the prevalence of LBW in rural Africa, where many births occur at home. The Bacillus Calmette-Guérin (BCG) vaccine has non-specific effects. Studies suggest that maternal BCG-vaccination may affect the health of the child.

Methods
The present study is nested within a randomised trial in rural Guinea-Bissau: Pregnancies were registered at two-monthly village visits, where information on BCG scar status and other background factors were obtained. Children were enrolled in the trial and weighed at home within 72 h after birth. In this prospective observational study, we assessed factors associated with adverse pregnancy outcomes and birthweight in binomial and linear regression models.

Results
Among 1320 women who had their BCG scar status assessed, 848 (64%) had a scar, 472 (36%) had no scar. The risk of adverse pregnancy outcomes (miscarriages, stillbirths, early neonatal deaths) tended to be higher among BCG scar-negative women (13%) than among women with a BCG scar (10%), adjusted prevalence ratio = 1.29 (0.99–1.68). Birthweight was assessed for 628 (50%) of the 1232 live born children. The mean birthweight was 2.89 kg (SD 0.43) and the proportion of LBW children was 17% (104/628). Sex, twinning, region of birth, maternal age, maternal mid-upper arm circumference (MUAC), antenatal consultations, parity and possession of a mobile phone were associated with birthweight, while maternal BCG scar status was not.

Conclusions
This study provides the first birthweight data for home-born children in rural Guinea-Bissau, with a mean birthweight of 2.89 kg (SD 0.43) and a LBW prevalence of 17%. We found a tendency for higher risk of adverse pregnancy outcomes among BCG scar-negative women. Birthweight was similar in children of mothers with and without BCG scar.
Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study
Authors: Donkers Moniek A. , Gilissen Vincent J. H. S. , Candel Math J. J. M. , van Dijk Nathalie M. , Kling Hans , Heijnen-Panis Ruth , Pragt Elien , van der Horst Iwan , Pronk Sebastiaan A. , van Mook Walther N. K. A. 
Published: June 2021

Abstract
Background
The COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.

Methods
An extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19.

Results
Three hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.

Conclusion
Levels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care.
Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings
Authors: Gorham Gillian , Howard Kirsten , Cunningham Joan , Barzi Federica , Lawton Paul , Cass Alan 
Published: June 2021

Abstract
Background
Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations.

Objective
To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) associated with different dialysis models in urban, rural and remote locations.

Methods
Using cost weights attributed to diagnostic codes in the NT Department of Health’s hospital admission data set (2008–2014), we calculated the mean (SD) total annual health service costs by dialysis model for 995 dialysis patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between different explanatory variables to estimate ‘best casemix’/‘worst casemix’ cost scenarios.

Results
The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and $43 440 (SD $5 048) and lowest for remote at $19 584 (SD $4 394). When combined with the observed maintenance dialysis costs, expenditure was the highest for urban models at $148 510 (SD $19 774). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person from a remote area, was $5 648 more and increased further for those from remote and very remote areas to $10 785 and $15 118 respectively.

Conclusions
This study demonstrates that dialysis treatment in urban areas for relocated people has health and cost implications that maybe greater than the cost of remote service delivery. The study emphasises the importance of considering all health service costs and cost consequences of service delivery models.

Key points for decision makers
Relocation for dialysis treatment has serious health and economic consequences. Relocated people have low dialysis attendance and high hospital costs in urban areas. While remote dialysis service models are more expensive than urban models, the comparative cost differences are significantly reduced when all health service costs are included. The delivery of equitable and accessible dialysis service models requires a holistic approach that incorporates the needs of the patient; hence dialysis cost studies must consider the full range of cost impacts beyond the dialysis treatments alone.
The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine
Authors: Shi Zewen , Shi Lin , Chen Xianjun , Liu Jiangtao , Wu Haihao , Wang Chenghao , Chen Zeming , Yang Fang , Yu Sheng , Pang Qingjiang 
Published: June 2021

Abstract
Background
The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty.

Methods
Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded.

Results
The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base.

Conclusion
In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base.

Level of evidence
Level IV
Weight and mid-upper arm circumference gain velocities during treatment of young children with severe acute malnutrition, a prospective study in Uganda
Authors: Kamugisha Jolly G. K. , Lanyero Betty , Nabukeera-Barungi Nicolette , Nambuya-Lakor Harriet , Ritz Christian , Mølgaard Christian , Michaelsen Kim F. , Briend André , Mupere Ezekiel , Friis Henrik , Grenov Benedikte 
Published: June 2021

Abstract
Background
Weight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM). However, changes in weight and mid-upper arm circumference (MUAC) gain velocities over time are scarcely described. We assessed weight and MUAC gain velocities in 6–59 mo-old children with complicated SAM by treatment phase and edema status.

Methods
This was a prospective study, nested in a randomized/probiotic trial (ISRCTN16454889). Weight and MUAC gain velocities were assessed by treatment phase and edema at admission using linear mixed-effects models.

Results
Among 400 children enrolled, the median (IQR) age was 15.0 (11.2;19.2) months, 58% were males, and 65% presented with edema. During inpatient therapeutic care (ITC), children with edema vs no edema at admission had negative weight gain velocity in the stabilization phase [differences at day 3 and 4 were − 11.26 (95% CI: − 20.73; − 1.79) g/kg/d and − 13.09 (95% CI: − 23.15; − 3.02) g/kg/d, respectively]. This gradually changed into positive weight gain velocity in transition and eventually peaked at 12 g/kg/d early in the rehabilitation phase, with no difference by edema status (P > 0.9). During outpatient therapeutic care (OTC), overall, weight gain velocity showed a decreasing trend over time (from 5 to 2 g/kg/d), [difference between edema and non-edema groups at week 2 was 2.1 (95% CI: 1.0;3.2) g/kg/d]. MUAC gain velocity results mirrored those of weight gain velocity [differences were − 2.30 (95% CI: − 3.6; − 0.97) mm/week at week 1 in ITC and 0.65 (95% CI: − 0.07;1.37) mm/week at week 2 in OTC].

Conclusions
Weight and MUAC gain velocities among Ugandan children with complicated SAM showed an increasing trend during transition and early in the rehabilitation phase, and a decreasing trend thereafter, but, overall, catch-up growth was prolonged. Further research to establish specific cut-offs to assess weight and MUAC gain velocities during different periods of rehabilitation is needed.
Lymphangioma of popliteal fossa masquerading as Baker’s cyst
Authors: Padmanaban Elamparidhi , Suryawanshi Sanika , Amirthalingam Umamageswari , Keloth Thara , George Rintu 
Published: June 2021

Abstract
Background
Lymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection.

Case presentation
A 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells.

Conclusion
Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.
Reporting Incidences of Neuroblastoma in Various Resource Settings
Authors: van Heerden Jaques , Abraham Natasha , Schoeman Judy , Reynders David , Singh Elvira , Kruger Mariana 
Published: June 2021

PURPOSE The incidences of neuroblastoma (NB) differ significantly between various resource settings because of varying quality of cancer registries and underdiagnoses. This study aimed to evaluate current regional variations as reported by international cancer registries and the theoretical and reported differences in international NB incidences and to evaluate South Africa (SA) as a case for variable reporting. METHODS A comprehensive literature review on registries reporting on NB was performed to construct incidence tables. The SEER Program incidence of 10.5/million children was used to calculate the expected number of NB cases for each country. Registry data of NB cases between 2000 and 2016 were requested from The South African National Cancer registry (SA-NCR) and the South African Children's Tumour Registry (SACTR) for comparison and to perform a probabilistic linkage study. RESULTS Internationally, incidences varied between –97.1% and +80% compared with the SEER program. SA under-reported NB cases by an estimated 74.2%. Between 2000 and 2016, the SA-NCR reported between 23 and 51 cases/year, whereas the SACTR reported between 18 and 57 cases/year for the same period. The incidence reported by the SA-NCR varied between 1.5 and 2.8/million children under 15-year per year, whereas the SACTR reported 1.74-2.6 cases/million children. Both registries reported incidences less than high-income country. A probabilistic record linkage of the two registries resulted in a combined incidence of 2.9 cases/million children. CONCLUSION As with most low- and middle-income countries, SA has either a lower incidence or underdiagnoses of NB cases. The reasons for under-reporting are not clear, but can be due to undiagnosed NB cases with spontaneous regression, missed possible cases because of lack of autopsies, and diagnosed cases not recorded in registries.
Birth Cohort Trends in Health Disparities by Sexual Orientation
Authors: Liu Hui , Reczek Rin 
Published: June 2021

Abstract
Lesbian, gay, and bisexual-identified (LGB) people experience worse mental and physical health than their straight-identified counterparts. Given remarkable social and legal changes regarding LGB status in recent decades, we theorize that this profound health disadvantage may be changing across cohorts. Using data from the 2013–2018 National Health and Interview Surveys, we analyze five mental and physical health outcomes—psychological distress, depression, anxiety, self-rated physical health, and activity limitation—across three birth cohorts colloquially known as (1) Millennials, (2) Generation Xers, and (3) Baby Boomers and pre-Boomers. We find no evidence of reduced health disparities by sexual orientation across cohorts. Instead, relative to straight-identified respondents, the health disadvantages of gay, lesbian, and—most strikingly—bisexual-identified people have increased across cohorts. Findings highlight the importance of identifying the causes of increased health disparities as well as designing and implementing moredirect public policies and programs to eliminate health disparities among more recent LGB cohorts.
Added Value of Radiotherapy Following Neoadjuvant FOLFIRINOX for Resectable and Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis
Authors: Janssen Quisette P. , van Dam Jacob L. , Kivits Isabelle G. , Besselink Marc G. , van Eijck Casper H. J. , Homs Marjolein Y. V. , Nuyttens Joost J. M. E. , Qi Hongchao , van Santvoort Hjalmar J. , Wei Alice C. , de Wilde Roeland F. , Wilmink Johanna W. , van Tienhoven Geertjan , Groot Koerkamp Bas 
Published: June 2021

Abstract
Background
The added value of radiotherapy following neoadjuvant FOLFIRINOX chemotherapy in patients with resectable or borderline resectable pancreatic cancer ((B)RPC) is unclear. The objective of this meta-analysis was to compare outcomes of patients who received neoadjuvant FOLFIRINOX alone or combined with radiotherapy.

Methods
A systematic literature search was performed in Embase, Medline (ovidSP), Web of Science, Scopus, Cochrane, and Google Scholar. The primary endpoint was pooled median overall survival (OS). Secondary endpoints included resection rate, R0 resection rate, and other pathologic outcomes.

Results
We included 512 patients with (B)RPC from 15 studies, of which 7 were prospective nonrandomized studies. In total, 351 patients (68.6%) were treated with FOLFIRINOX alone (8 studies) and 161 patients (31.4%) were treated with FOLFIRINOX and radiotherapy (7 studies). The pooled estimated median OS was 21.6 months (range 18.4–34.0 months) for FOLFIRINOX alone and 22.4 months (range 11.0–37.7 months) for FOLFIRINOX with radiotherapy. The pooled resection rate was similar (71.9% vs. 63.1%, p = 0.43) and the pooled R0 resection rate was higher for FOLFIRINOX with radiotherapy (88.0% vs. 97.6%, p = 0.045). Other pathological outcomes (ypN0, pathologic complete response, perineural invasion) were comparable.

Conclusions
In this meta-analysis, radiotherapy following neoadjuvant FOLFIRINOX was associated with an improved R0 resection rate as compared with neoadjuvant FOLFIRINOX alone, but a difference in survival could not be demonstrated. Randomized trials are needed to determine the added value of radiotherapy following neoadjuvant FOLFIRINOX in patients with (B)PRC.
LGBTQI+, vidas precárias e necropolítica em tempos da Covid-19: a interseccionalidade e a teoria queer em cena
Authors: Duarte Marco José De Oliveira , Oliveira Dandara Felícia Silva 
Published: June 2021

Tomar o rebatimento da pandemia da Covid-19 na população de lésbicas, gays, bissexuais, transexuais, travestis, transgêneros, não binários, intersexos e mais (LGBTQI+) é um desafio que vem pautando um conjunto de pesquisadoras/es, ativistas, gestoras/es etc. para seu enfrentamento. Particularmente, nesse artigo analisa-se esses efeitos a partir dos conceitos de necropolítica, vidas precárias e interseccionalidade de sexualidade, gênero, raça e classe. Os efeitos do cisheterossexismo, do racismo, da LGBTQIfobia são, em referência à lógica do capital, estruturantes e estruturais, refletindo, portanto, nas particularidades das vidas de LGBTQI+. Essa análise nos revela a importância de debater os impactos das vulnerabilidades e precariedades desses sujeitos, pois se antes já sofriam no seu cotidiano os efeitos das discriminações, preconceitos e mortes, com mais radicalidade esses elementos se impõem em contexto pandêmico. Os dados aqui tratados apontam para as condições dessas vidas precárias com mais agravamentos, principalmente, tomados pela perspectiva da interseccionalidade entre sexualidade, gênero, raça e classe social, nos marcos das desigualdades e das relações sociais necrocapitalistas e ultraliberais. Neste sentido, o artigo pretende problematizar essas questões que marcam a população LGBTQI+, como as violações, violências, opressões e mortes, a fim de apontar formas de enfrentamento e resistência em tempos de ascensão da política antidemocrática. Palavras-Chave: LGBTQIfobia; pandemia; precariedade; vulnerabilidade; necropolítica.
Pandæmonium educacional? – Para um manifesto docente contra a “distância social"
Authors: Varela Raquel , Della Santa Roberto 
Published: June 2021

O ano de 2020 começou com duas convulsões socio-metabólicas (MÉSZÁROS, 2009) fulcrais: o aprofundamento da crise capitalista global e, desde meados de janeiro, a difusão planetária do novo coronavírus. Desde então, a partir de meados de março, escolas, institutos e universidades de educação básica, profissional e superior suspenderam as suas actividades e diferentes sectores estão sendo obrigados a interromper parte de seus processos produtivos e serviços, ainda que de forma desigual, no planeta. Qual deve ser a posição dos professores diante de todos esses processos e eventos histórico-mundiais? A instrução remota emergencial e a digitalização dos processos de aprendizagem estarão escritas nas estrelas de nosso destino colectivo? Será que o desenvolvimento físico e psíquico de crianças e jovens passará incólume? Podem os saberes objectivos serem reduzidos a descriptores de competências? Qual dever ser o papel das tecnologias de informação na educação pública? Existe alguma alternativa hegemônica viável a esta nova distopia educacional 4.0? O que fazer? E por onde começar? Palavras-Chave: pedagogia histórico-crítica; o ato docente na era de sua reprodutibilidade técnica; educação a distância; educação como mercadoria; pandemia do novo coronavírus.
Assistentes Sociais na vanguarda da pandemia da COVID-19: tensionamentos e resistências
Authors: Da Silva Ana Paula Cardoso , Rangel Luciane Barbosa do Amaral 
Published: June 2021

O presente texto se propõe precipuamente a homenagear aos/às Assistentes Sociais que estão na linha de frente de atuação nas diversas políticas públicas no cenário de crise estrutural do capital, acentuado com os limites e os desafios trazidos diante da conjuntura pandêmica do novo coronavírus, em especial, às profissionais que perderam a vida neste período no exercício de suas funções. Serão abordados alguns tensionamentos e estratégias de resistência enfrentados nos cotidianos dos espaços sócio-ocupacionais, sobretudo, nas políticas de Saúde e de Assistência Social. Palavras-chave: Exercício Profissional; Resistência; Pandemia; Políticas Públicas.