bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating the Period Prevalence of Publicly Funded Abortion to Space Live Births, 1999 to 2014
Authors: Studnicki James , Fisher John W. , Longbons Tessa , Reardon David C. , Craver Christopher , Harrison Donna J. 
Published: May 2021

Introduction/Objectives: Although a majority of women who have an abortion report having 1 or more children, there is no published research on the number of abortions which occur between live births, after a first child but before the last. The objectives of this research, therefore, were to estimate the period prevalence of an induced abortion separating live births in a population of Medicaid eligible enrollees and to identify the characteristics of enrollees significantly associated with the use of abortion to enable child spacing. Methods: A retrospective, cross-sectional, longitudinal analysis of the pregnancy outcome sequences of eligible enrollees over age 13 from the 17 states where Medicaid included coverage of all abortions, with at least one identifiable pregnancy outcome between 1999 and 2014. Eligibles with a defined sequence of birth-abortion-birth within up to 5 consecutive pregnancies were identified to estimate the number of eligibles who could have practiced birth spacing by abortion. Logistic regression was applied to identify the significant predictor variables of the birth-abortion-birth sequence. Results: There were 50 012 (1.02%) of 4 875 511 Medicaid eligible enrollees exhibited a birth-abortion-birth sequence. Eligibles with the birth-abortion-birth sequence are more likely to be Black than White (OR 2.641, CL 2.581-2.702), less likely to be Hispanic than White (OR 0.667, CL 0.648-0.687), and more likely to have received contraceptive counseling (OR 1.14, CL 1.118-1.163). Increases in months of Medicaid eligibility (OR 1.004, CL 1.003-1.004) and months from first pregnancy to second live birth (OR 1.015, CL 1.015-1.016) are associated with the likelihood of undergoing live births separated by one or more induced abortions. Increases in the age at first pregnancy are associated with a decreased likelihood of the birth-abortion-birth sequence (OR 0.962, CL 0.959-0.964). Conclusion: Birth spacing via abortion is uncommon among a low-income population for whom the financial barriers to abortion are somewhat alleviated.
Safe Extubation of Patients with COVID-19 for Minimizing Aerosolized Droplets
Authors: Akatsuka Masayuki , Yoshinaka Asami , Hagiwara Hiroya , Yamamoto Shuji 
Published: May 2021

Background: Healthcare workers must be protected during extubation of patients with coronavirus disease 2019 (COVID-19) owing to the presence of aerosolized droplets. Herein, we report a technique for extubating a patient with COVID-19 while minimizing aerosol dispersion. Case Report: We retrospectively identified a total of 79 patients admitted to our hospital from February 2020 to January 2021. Six of these patients were intubated for mechanical ventilation, 2 of whom had to be extubated. We prepared a clear vinyl sheet in the shape of a tent to place over the patient, and 2 staff members, both well experienced in airway management, stood outside the tent on either side of the patient. Before extubation, we confirmed that the patient’s consciousness level was good and the patient had no distress by adjusting the dose of sedative drugs. After extubation, a surgical mask was placed on the patient’s face. Conclusion: Our experience indicates that this method of extubation in a patient with COVID-19 could be safely implemented to protect healthcare workers.
Developing Risk Assessment Criteria and Predicting High- and Low-Dengue Risk Villages for Strengthening Dengue Prevention Activities: Community Participatory Action Research, Thailand
Authors: Suwanbamrung Charuai , Le Cua Ngoc , Kaewsawat Supreecha , Chutipattana Nirachon , Khammaneechan Patthanasak , Thongchan Supaporn , Nontapet Orratai , Thongsuk Cherd , Laopram Suphap , Niyomchit Chamaiporn , Sinthu Ruchira 
Published: May 2021

Background: Risk assessment criteria for predicting dengue outbreak must be appropriated at village levels. We aimed to develop risk dengue village prediction criteria, predict village dengue risk, and strengthen dengue prevention based on community participation. Methods: This participatory research conducted in Southern Thailand included the following 5 phases: (i) preparing communities in 3 districts; (ii) developing risk dengue village prediction criteria; (iii) applying computer program; (iv) predicting village dengue risk with 75 public health providers in 39 PCUs; and (v) utilizing findings to strengthen dengue prevention activities in 220 villages. Data collecting for prediction used secondary data from primary care units in the past 5 year and current year. Descriptive statistics used calculating criteria and comparing with standard level to adjust score of risk. Results: Risk dengue village assessment criteria had 2 aspects: dengue severity (3 factors) and dengue outbreak opportunity (3 factors). Total scores were 33 points and cut-off of 17 points for high and low dengue risks villages. All criteria were applied using computer program ( http://surat.denguelim.com ). Risk prediction involved stakeholder participation in 220 villages, and used for strengthening dengue prevention activities. The concept of integrated vector management included larval indices surveillance system, garbage management, larval indices level lower than the standard, community capacity activities for dengue prevention, and school-based dengue prevention. The risk prediction criteria and process mobilized villages for dengue prevention activities to decrease morbidity rate. Conclusion: Dengue risk assessment criteria were appropriated within the village, with its smallest unit, the household, included. The data can be utilized at village levels for evaluating dengue outbreak risks.
Perceived Barriers to Primary Care Services Utilization and its Associations with Overall Satisfaction of Patients in Saudi Arabia: A Cross-Sectional Questionnaire-Based Study
Authors: AlOmar Reem S. , AlShamlan Nouf A. , AlAmer Naheel A. , AlThumairi Arwa A. , Almir Bayan M. , Aldawood Heba A. , Bukhamsin Tuqa H. , Alqahtani Hatem A. , Al Shammari Malak A. 
Published: May 2021

Introduction: Primary care plays an integral role in modern healthcare systems. More so in a country that is currently undergoing a reform of its health system. Their remains barriers that hinder patients from seeking medical assistance from primary physicians. This study aims to examine the overall satisfaction of patients toward Primary Healthcare Centers (PHCs) in Saudi Arabia, as well as its association with potential barriers from a sample of patients who presented at the emergency department (ED) for non-urgent cases. Methods: This cross-sectional study sampled 403 patients from King Fahd Hospital of the University. A piloted questionnaire was utilized that included questions on sociodemographics, satisfaction of PHCs, as well as organizational, socioeconomic, access, and patient-doctor relationship barriers using a Likert-scale item response. Chi-squared and Fisher’s Exact tests were used to compare categorical variables, and multivariable logistic regression was used to assess the association between overall satisfaction and all factors and barriers. Results: The sample consisted of 48.1% males and 51.9% females. Only 5.2% of the patients were hospitalized. Of the total sample, 28.3% reported being always satisfied with PHC services. The most reported barriers were organizational barriers and socioeconomic barriers. The regression analysis found that being a female, highly educated, have high organizational, and patient-doctor relationship were independent predictors for low overall satisfaction with PHCs. Conclusion: Findings from this study should allow healthcare planners and policy makers to reduce the impact of these barriers by finding solutions that would target them. This may include strictly implementing policies such as proper implementing of triaging in EDs as well as promoting services that are being provided free of charge at these centers.
Enhanced Primary Health Care Intervention: Perceived Sustainability and Challenges Among Implementers
Authors: Perialathan Komathi , Johari Mohammad Zabri , Jaafar Norrafizah , Yuke Lin Kong , Lee Lan Low , Sodri Nur Aliyah , Mohd Yunus Siti Nur Nabilah 
Published: May 2021

Purpose: This study aimed to assess and explore perceived sustainability and challenges of the intervention among Health Care Providers (HCPs) who were involved. Methods: The study applied mixed-method embedded design to analyze both quantitative and qualitative data. Quantitative approach was used to evaluate sustainability perception from 20 intervention clinics via self-reported assessment form whereas qualitative data were obtained through in-depth interview (IDI) and focus group discussions (FGDs) 14 health care professionals participated in IDI session and were either care coordinators, liaison officers (LOs)/clinic managers, or medical officers-in-charge for the clinic’s intervention. Nine FGDs conducted comprised 58 HCPs from various categories. Results: HCPs from all the 20 clinics involved responded to each listed Enhanced Primary Healthcare (EnPHC) intervention components as being implemented but the perceived sustainability of these implementation varies between them. Quantitative feedback showed sustainable interventions included risk stratification, non-communicable disease (NCD) screening form, referral within clinics and hospitals, family health team (FHT), MTAC services and mechanisms and medical adherence status. Qualitative feedback highlighted implementation of each intervention components comes with its challenges, and most of it are related to inadequate resources and facilities in clinic. HCPs made initiatives to adapt based on clinical setting to implement the interventions at best level possible, whereby this seems to be one of the core values for sustainability. Conclusion: Overall perceptions among HCPs on sustainability of EnPHC interventions are highly influenced by current experiences with existing resources. Components perceived to have inadequate resources are seen as a challenge to sustain. It’s crucial for stakeholders to understand implications affecting implementation process if concerns raised are not addressed and allocation of needed resources to ensure overall successfulness and long term sustainability.
Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures
Authors: Gray Mitchell T. , Hidden Krystin A. , Malik Azeem T. , Khan Safdar N. , Phieffer Laura , Ly Thuan V. , Quatman Carmen E. 
Published: May 2021

Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.
The Influence of Cervical Spine Angulation on Symptoms Associated With Wearing a Rigid Neck Collar
Authors: Kelani Taiwo D. , Lee Annabelle , Walker Miny , Koizia Louis J. , Dani Melanie , Fertleman Michael B. , Kedgley Angela E. 
Published: May 2021

Introduction: Rigid cervical spine collars can be used to maintain the position of the cervical spine following injury or surgery. However, they have been associated with difficulty swallowing, pressure sores and pain, particularly in older patients. We aimed to investigate the relationship between cervical spine angulation, a rigid neck collar and neck pain in healthy young and older adults. Methods: Twenty healthy young adults aged 25 ± 3 years and 17 healthy older adults aged 80 ± 8 years were tested. Magnetic resonance imaging scans of their cervical spines were taken before and after the rigid neck collar was worn for 1 hour. Measurement of vertebral angulation involved digitization of the scans and joint angle calculations using image processing software. Pain was quantified before and after the collar was worn, using a visual analogue scale. Results: Pain scores increased in the young group after the collar was worn (p = 0.001). The older group showed no difference in pain score after the collar was worn. Statistical tests showed no significant correlations between the change in cervical angles and the change in pain scores after the collar was worn. Discussion: The aging process may contribute to the changing distribution of subcutaneous tissue and increase risk of symptoms associated with wearing a collar. Oesophageal compression is not a result of collar use. Conclusion: There is no correlation between cervical spine vertebrae angulation and symptoms associated with wearing a neck collar. Generally, older individuals have greater cervical lordosis angles, and more straight and lordotic neck shapes. Older individuals may be more prone to skin-interface pressures from the neck collar than younger individuals.
Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients
Authors: Loucas Marios , Loucas Rafael , Akhavan Nico Safa , Fries Patrick , Dietrich Michael 
Published: May 2021

Background: Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods: A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results: We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion: Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence: Level III, Therapeutic study.
A Clinical Evaluation of Scapular Dyskinesis Among Professional Bus Drivers With Unilateral Upper Quadrant Musculoskeletal Pain
Authors: Sattasuk Wipawee , Sitilertpisan Patraporn , Joseph Leonard , Paungmali Aatit , Pirunsan Ubon 
Published: May 2021

Background: Professional bus drivers report a high prevalence of upper quadrant musculoskeletal pain which could be associated with scapular dyskinesis (SD). However, the evidence for valid and reliable screening methods for this condition is limited as SD among bus drivers is an emerging area of research. Therefore, the main aim of the study was to investigate the reliability of dynamic scapular motion test (DSMT) using video analysis as an accurate method to evaluate SD and to identify patterns of SD among bus drivers. Methods: In total, 32 bus drivers from a private bus company with unilateral upper quadrant musculoskeletal pain participated in the study. The DSMT was conducted and the SD was captured in the video during shoulder flexion–abduction movements. Two investigators analyzed the video recordings and identified the patterns of SD. The intra- and interrater reliability were determined using the percentage of agreement and weighted Kappa coefficients (Kw). Descriptive analysis was used to examine the patterns of SD. Findings: The intra- and interrater reliability of DSMT using video analysis were excellent (Kw coefficient: 0.762–0.878 and 0.87–1.00, respectively). About 56.2% and 53.1% of bus drivers presented SD with the shoulder flexion and abduction movements during DSMT. Medial border prominence (Type II pattern of SD) was identified as the common pattern of SD. Conclusion/Application to practice: The DSMT using video analysis showed excellent intra- and interrater reliability to evaluate SD. Occupational health practitioners can consider DSMT using video analysis to identify SD among people with upper quadrant musculoskeletal pain at the workplace.
K-Line Tilt is a Predictor of Postoperative Kyphotic Deformity After Laminoplasty for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament
Authors: Sakai Kenichiro , Yoshii Toshitaka , Arai Yoshiyasu , Hirai Takashi , Torigoe Ichiro , Inose Hiroyuki , Tomori Masaki , Sakaki Kyohei , Yuasa Masato , Yamada Tsuyoshi , Matsukura Yu , Oyaizu Takuya , Morishita Shingo , Okawa Atsushi 
Published: May 2021

Study Design: Retrospective single-center study. Objectives: K-line is a decision-making tool to determine the appropriate surgical procedures for patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Laminoplasty (LAMP) is one of the standard surgical procedures indicated on the basis of K-line measurements (+: OPLL does not cross the K-line). We investigated the impact of K-line tilt, a radiographic parameter of cervical sagittal balance measured using the K-line, on surgical outcomes after LAMP. Methods: The study included 62 consecutive patients with K-line (+) C-OPLL who underwent LAMP. The following preoperative and postoperative radiographic measurements were evaluated: (1) the K-line, (2) K-line tilt (an angle between the K-line and vertical line), (3) center of gravity of the head –C7 sagittal vertical axis, (4) C2–C7 lordotic angle, (5) C7 slope, and (6) C2–C7 range of motion. Clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). Results: All the patients had non-kyphotic cervical alignment (CL ≥ 0°) preoperatively; however, kyphotic deformity (CL < 0°) was observed in 6 patients (9.7%) postoperatively. The recovery rate of the C-JOA scores was poor in the kyphotic deformity (+) group (7.8%) than in the kyphotic deformity (−) group (47.5%). The K-line tilt was identified to be a preoperative risk factor in the multivariate analysis, and the cutoff K-line tilt for predicting the postoperative kyphotic deformity was 20°. Conclusions: LAMP is not suitable for K-line (+) C-OPLL patients with K-line tilts >20°.
The Correlation Between Negative Nerve Root Sedimentation Sign and Gravity: A Study of Upright Lumbar Multi-Positional Magnetic Resonance Images
Authors: Zhang Qiwen , Mesregah Mohamed Kamal , Patel Kishan , Buser Zorica , Wang Jeffrey C. 
Published: May 2021

Study Design: Retrospective upright MRI study. Objective: To validate the presence of positive and negative nerve root sedimentation signs on multi-positional MRI in the upright position and explore the relationship between negative nerve root sedimentation and gravity. Methods: T2-weighted axial multi-positional images in the upright position at the intervertebral disc levels from L1–L2 to L4–L5 in 141 patients with non-specific low back pain were retrospectively assessed. A positive sedimentation sign was defined as the absence of nerve root sedimentation or the absence of dorsal conglomeration of nerve roots within the dural sac. A negative sedimentation sign was defined as nerve root sedimentation dorsally or dorso-laterally like a horseshoe. Intra-and inter-observer reliability was evaluated. The relationship between sedimentation sign and dural sac cross-sectional area (CSA), anterior-posterior (AP) diameter was also explored. Results: The kappa value of intra-observer reliability was 0.962 and inter-observer reliability was 0.925. Both positive and negative sedimentation signs did appear at all 4 lumbar levels, including L1/2, L2/3, L3/4 and L4/5. A positive sedimentation sign was associated with significantly decreased dural sac CSA and AP diameter at L2/3, L3/4 or L4/5 level when compared to negative sedimentation sign. Conclusions: Both negative and positive sedimentation signs appeared at the L1/2, L2/3, L3/4, and L4/5 levels on the upright MRI, which suggested that the presence of nerve roots sedimenting dorsally in patients may not be associated with gravity. Moreover, the current study supports that sedimentation signs on multi-positional MRI images could have the same diagnostic functions as on MRI images.