bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Neck Pain and Its Impact on Quality-of-Life—A Population-Based, Cross Sectional Study in Singapore
Authors: Hey Hwee Weng Dennis , Lim Joel Xue Yi , Ong Jing Zhi , Luo Nan 
Published: August 2021

Study Design.
Cross-sectional, epidemiological study.

Objective.
This study aims to describe the prevalence, risk factors, disability, and quality of life (QoL) burden of neck pain.

Summary of Background Data.
Neck pain is an increasingly common symptom that results in significant disability and loss of QoL to the individual, and imposes a considerable economic burden to developed countries.

Methods.
A cross-sectional, questionnaire-based study was conducted via multistage random sampling of public households in Singapore on individuals aged 21 and older. Questionnaires were administered face-to-face by trained interviewers. Data analyzed included the prevalence and characteristics of neck pain, its relationship with sociodemographic factors, and its association on QoL and disability via validated questionnaires: EQ5D questionnaire and Neck Disability Index (NDI), respectively.

Results.
A total of 626 individuals with a median age of 52.0 years (interquartile range 37.0–67.0), and even sex distribution of males (54.0%) and females (46.0%) were included in this study. A total of 144 individuals reported neck pain over the past 6 months, giving a 6-month period prevalence of 23.0%. Among them, nine (6.3%) had chronic, whereas 12 (8.3%) had severe neck pain. Female sex was the only significant risk factor for neck pain on multivariate analysis, with a risk ratio of 1.34 (95% confidence interval [CI] 1.00–1.80, P = 0.049). Individuals with neck pain had mean raw NDI scores of 4.91 ± 6.25, with higher disability seen with increasing pain duration and intensity (P < 0.001 and P = 0.002 respectively). Compared to individuals without neck pain, those with neck pain had poorer QoL with lower EQ5D-Index scores (0.84 ± 0.25 vs. 0.93 ± 0.15; 95% CI 0.046–0.132, P < 0.001) and EQ5D-VAS scores (68.76 ± 14.59 vs. 73.86 ± 13.64; 95% CI 2.510–7.697, P < 0.001).

Conclusion.
Our findings show that neck pain is a prevalent condition with chronicity and severity of symptoms associated with reduced QoL and increased disability. Population sample health scores can serve as potential reference targets in disease management and aid national health care policy-making.

Level of Evidence: 3
Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study
Authors: Kasch Richard , Truthmann Julia , Hancock Mark J. , Maher Christopher G. , Otto Markus , Nell Christopher , Reichwein Niklas , Bülow Robin , Chenot Jean-François , Hofer Andre , Wassilew Georgi , Schmidt Carsten Oliver 
Published: August 2021

Study Design.
Population-based cohort study.

Objective.
We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP).

Summary of Background Data.
The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse.

Methods.
Participants (n = 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain.

Results.
MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50–1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04–2.37), but not in those with baseline pain (−0.30; −0.99 to 0.38).

Conclusion.
Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.

Level of Evidence: 3
Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis*
Authors: Wang Yi Tian , Lang Jenna K. , Haines Kimberley J. , Skinner Elizabeth H. , Haines Terry P. 
Published: August 2021

OBJECTIVES:
Significant variability exists in physical rehabilitation modalities and dosage used in the ICU. Our objective was to investigate the effect of physical rehabilitation in ICU on patient outcomes, the impact of task-specific training, and the dose-response profile.

DATA SOURCES:
A systematic search of Ovid MEDLINE, Cochrane Library, EMBASE, and CINAHL plus databases was undertaken on the May 28, 2020.

STUDY SELECTION:
Randomized controlled trials and controlled clinical trials investigating physical rehabilitation commencing in the ICU in adults were included. Outcomes included muscle strength, physical function, duration of mechanical ventilation, ICU and hospital length of stay, mortality, and health-related quality of life. Two independent reviewers assessed titles, abstracts, and full texts against eligibility criteria.

DATA EXTRACTION:
Details on intervention for all groups were extracted using the template for intervention description and replication checklist.

DATA SYNTHESIS:
Sixty trials were included, with a total of 5,352 participants. Random-effects pooled analysis showed that physical rehabilitation improved physical function at hospital discharge (standardized mean difference, 0.22; 95% CI, 0.00–0.44), reduced ICU length of stay by 0.8 days (mean difference, –0.80 d; 95% CI, –1.37 to –0.23 d), and hospital length of stay by 1.75 days (mean difference, –1.75 d; 95% CI, –3.03 to –0.48 d). Physical rehabilitation had no impact on the other outcomes. The intervention was more effective in trials where the control group received low-dose physical rehabilitation and in trials that investigated functional exercises.

CONCLUSIONS:
Physical rehabilitation in the ICU improves physical function and reduces ICU and hospital length of stay. However, it does not appear to impact other outcomes.
Comparison of antimuscarinic drugs to beta adrenergic agonists in overactive bladder: A literary review
Authors: Wani Mudassir M. , Sheikh Mohammad I. , Bhat Tahir , Bhat Zubair , Bhat Arshad 
Published: August 2021

Abstract

Background:
The purpose of this study was to carry an extended literature review to compare antimuscarnics with beta adrenergic agonists (mirabegron) in treatment of overactive bladder.

Materials and methods:
A literature review was carried out, using key words in different databases including MEDLINE, PUBMED, and EMBASE. All relevant published articles during last 5 years with full texts available were included in this review for critical analysis and evaluation. In total, there were 20 studies including 7 systemic reviews, 6 retrospective cohort, 3 prospective cohort, 2 randomized controlled trials, and 2 cross sectional studies.

Results:
After critical evaluation the results were considered under parameters of efficacy, adverse effects, adherence and persistence, tolerability, cost-effectiveness. In 9 studies efficacy was evaluated, 5 studies dealt with adverse effects, same number evaluated adherence and persistence. Cost effectiveness was compared in 3 and same number of studies also compared tolerability.

Conclusions:
To conclude, we found mirabegron is as efficacious as any other antimuscarnics, has better tolerability (including elderly), has better adverse effect profile, is cost effective, has better persistence and adherence rates at 12 months.
Effect of Linked-color Imaging on the Detection of Adenomas in Screening Colonoscopies
Authors: dos Santos Carlos E.O. , Malaman Daniele , Arciniegas Sanmartin Ivan D. , Onófrio Fernanda d.Q. , Pereira-Lima Júlio C. 
Published: August 2021

Objectives:
Linked-color imaging (LCI) is a new image-enhancement option that emphasizes mucosal surface contrast, facilitating the differentiation between colorectal lesions and normal mucosa. This study aimed to evaluate the potential of LCI to increase the detection of colorectal adenomas in screening colonoscopies.

Methods:
A prospective randomized study was conducted using white-light imaging (WLI), blue-laser imaging (BLI)-bright and LCI. The outcome measures were adenoma detection rate (ADR), mean number of adenomas per patient, and withdrawal time. Lesion characteristics such as size, morphology, location, and histology were also evaluated.

Results:
A total of 205 patients were randomized, and 251 adenomas were detected. The overall ADR was 62%. The ADR was 52.9% for WLI, 62.1% for BLI-bright, and 71% for LCI, and was significantly higher in the LCI group than in the WLI group (P=0.04). No significant difference was observed between LCI and BLI-bright (P=0.28) or BLI-bright and WLI (P=0.30). The mean number of adenomas per patient was 1.01, 1.03, and 1.62 for WLI, BLI-bright, and LCI, respectively, with a significant difference (P=0.02). Withdrawal time did not differ among the groups. A total of 71 adenomas were detected by WLI, 68 by BLI-bright, and 112 by LCI. There was no difference in the size and morphology of the adenomas detected, nor in the diagnosis of sessile serrated adenomas/polyps.

Conclusion:
LCI significantly increased the detection of adenomas in screening colonoscopies.
Risk of Severe COVID-19 Increased by Metabolic Dysfunction-associated Fatty Liver Disease
Authors: Tao Ziwen , Li Yueyue , Cheng Baoquan , Zhou Tao , Gao Yanjing 
Published: August 2021

Background:
The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) in coronavirus disease-2019 (COVID-19) patients and whether it affects the outcomes of COVID-19 requires investigation.

Goals:
The aim was to determine the prevalence of MAFLD among COVID-19 patients and its influence on the outcomes of COVID-19 by meta-analysis.

Methods:
Our study protocol has been registered on PROSPERO (CRD42021242243). The studies published on PubMed, Embase, Cochrane Library, and Web of Science before March 11, 2021 were screened. The Newcastle-Ottawa scale (NOS) and Agency for Healthcare Research and Quality scale were used to assess the quality of the studies. Pooled analysis was conducted using the software RevMan version 5.3 and Stata version 15.0 SE. The stability of the results was assessed by sensitivity analysis. Publication bias was evaluated using funnel plots, Egger test, and trim-and-fill analysis.

Results:
Seven studies covering 2141 COVID-19 patients were included. It was confirmed that MAFLD increased the risk of severe COVID-19 (odds ratios: 1.80, 95% confidence interval: 1.53-2.13, P<0.00001). No association was found between the presence of MAFLD and the occurrence of COVID-19 death. The pooled prevalence of MAFLD among COVID-19 patients was 36% (95% confidence interval: 0.23-0.49, P<0.00001). Sensitivity analysis confirmed that the initial results were stable.

Conclusions:
MAFLD can increase the incidence of severe COVID-19, but the correlation between MAFLD and COVID-19 death has not been confirmed. Further investigation is needed to explore the possible mechanism of this association. Since MAFLD is common among patients infected with SARS-CoV-2, more care should be given to COVID-19 patients with underlying MAFLD.
Experience of a smartphone ambulatory ECG clinic for emergency department patients with palpitation: a single-centre cohort study
Authors: Cullen Julia , Reed Matthew J. , Muir Alexandra , Murphy Ross , Pollard Valery , Zangana Goran , Krupej Sean , Askham Sylvia , Holdsworth Patricia , Davies Lauren 
Published: August 2021

Background and importance
Palpitation is one of the commonest presenting complaints to the emergency department (ED). Diagnosis depends on capturing an ECG during the episode. Unlike syncope, patients retain consciousness and therefore their ability to activate an ECG event recorder. The Investigation of Palpitation in the ED study demonstrated Food and Drug Administration approved AliveCor/Kardia device that links to a smartphone app was safe and effective. A Smartphone Palpitation and Pre-syncope Ambulatory Care Clinic was therefore established.

Objective(s)
To review the first year of patients attending the service to determine the number and cost-effectiveness of cardiac dysrhythmias diagnoses.

Design
Single-center cohort study.

Settings and participants
Royal Infirmary of Edinburgh, UK. All patients (over 16 years) presenting consecutively to ED with palpitation or pre-syncope, whose ECG was normal, had a compatible device and where an underlying cardiac dysrhythmia was possible were enrolled.

Intervention
Ambulatory Care Clinic utilizing the AliveCor/Kardia device.

Outcome measures and analysis
Number diagnosed with cardiac dysrhythmia and mean cost per diagnosis.

Main results
Between 24 July 2019 and 23 July 2020, 290 consecutive patients were referred of age 16–80 years (mean 43.3, SD 15.0). One hundred twenty (41.4%) were male. Two hundred thirty-seven (81.7%) were fitted with the device and 220 (75.9%) underwent full investigation. Seventeen of 237 (7.2%) patients had a cardiac diagnosis (12 atrial fibrillation/flutter, 5 supraventricular tachycardia and 1 atrial tachycardia).

Conclusions
There were 17 cardiac diagnoses (7.2%). The cost per symptomatic rhythm diagnosis was 358 GBP (~415 Euro) and the cost per cardiac dysrhythmia diagnosis was 4570 GBP (~5298 Euro). A smartphone-based event recorder clinic should be considered for ED palpitation patients.
The association between presenting complaints and clinical outcomes in emergency department patients of different age categories
Authors: Raven Wouter , van den Hoven Elisa M.P. , Gaakeer Menno I. , Ter Avest Ewoud , Sir Ozcan , Lameijer Heleen , Hessels Roger A.P.A. , Reijnen Resi , van Zwet Erik , de Jonge Evert , Nickel Christian H. , de Groot Bas 
Published: August 2021

Background and importance
Although aging societies in Western Europe use presenting complaints (PCs) in emergency departments (EDs) triage systems to determine the urgency and severity of the care demand, it is unclear whether their prognostic value is age-dependent.

Objective
To assess the frequency and association of PCs with hospitalization and mortality across age categories.

Methods
An observational multicenter study using all consecutive visits of three EDs in the Netherlands Emergency department Evaluation Database. Patients were stratified by age category (0–18; 19–50; 51–65; 66–80; >80 years), in which the association between PCs and case-mix adjusted hospitalization and mortality was studied using multivariable logistic regression analysis (adjusting for demographics, hospital, disease severity, comorbidity and other PCs)

Results
We included 172  104 ED-visits. The most frequent PCs were ‘extremity problems’ [range across age categories (13.5–40.8%)], ‘feeling unwell’ (9.5–23.4%), ‘abdominal pain’ (6.0–13.9%), ‘dyspnea’ (4.5–13.3%) and ‘chest pain’ (0.6–10.7%). For most PCs, the observed and the case-mix-adjusted odds for hospitalization and mortality increased the higher the age category. The most common PCs with the highest adjusted odds ratios (AORs, 95% CI) for hospitalization were ‘diarrhea and vomiting’ [2.30 (2.02–2.62)] and ‘feeling unwell’ [1.60 (1.48–1.73)]. Low hospitalization risk was found for ‘chest pain’ [0.58 (0.53–0.63)] and ‘palpitations’ [0.64 (0.58–0.71)].

Conclusions
Frequency of PCs in ED patients varies with age, but the same PCs occur in all age categories. For most PCs, (case-mix adjusted) hospitalization and mortality vary across age categories. ‘Chest pain’ and ‘palpitations,’ usually triaged ‘very urgent’, carry a low risk for hospitalization and mortality.
Effectiveness of the modified Valsalva manoeuvre in adults with supraventricular tachycardia: a systematic review and meta-analysis
Authors: Lodewyckx Eric , Bergs Jochen 
Published: August 2021

Background and importance
Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node’s refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion. There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard VM has already been systematically reviewed, there has been no such analysis for the modified VM.

Objective(s)
Compare the effectiveness of the modified VM versus the standard VM in restoring the normal sinus rhythm in adult patients with supraventricular tachycardia.

Design
Systematic review with meta-analysis of published randomised controlled trials.

Outcome measures
The primary outcome was the reconversion to a sinus rhythm. Secondary outcomes included: medication use, adverse events, length of stay in the emergency department and hospital admission.

Main results
Five randomised controlled trials were included, with a combined total of 1181 participants. The meta-analysis demonstrated a significantly higher success rate for reconversion to sinus rhythm when using the modified VM compared to the standard VM in patients with an SVT (odds ratio = 4.36; 95% confidence interval, 3.30–5.76; P < 0.001). More adverse events were reported in the modified VM group, although this difference is NS (risk ratio = 1.48; 95% confidence interval, 0.91–2.42; P = 0.11). The available evidence suggests that medication use was lower in the modified VM group than the standard VM group. However, medication use could not be generalised across the different studies. None of the included studies showed a significant difference in length of stay in the emergency department. Only one study reported on hospital admission, with no significant difference between the two groups.

Conclusions
The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. Meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.
Body Composition of Infants With Congenital Gastroschisis
Authors: McNelis Kera , Poindexter Anne , Goddard Gillian , Riddle Stefanie , Wessel Jacqueline , Helmrath Michael 
Published: August 2021

ABSTRACTInfants born with congenital gastroschisis are at risk for intrauterine growth restriction, small for gestational size at birth, and growth failure during the newborn period despite advanced care. Body composition provides a more complete picture of proportional growth than weight and length alone. Fat‐free mass (FFM) represents organ growth, and in preterm infants without gastroschisis, improved FFM deposition is associated with improved neurodevelopmental outcomes. There is limited literature regarding the body composition of infants with gastroschisis. This case series describes the body composition of 10 infants with gastroschisis.
Outcomes of Traditional and Enhanced Gonorrhea Partner Services in the Strengthening the US Response to Resistant Gonorrhea Project, 2017 to 2019
Authors: Learner Emily R. , Schlanger Karen , Mauk Kerry , Pham Cau D. , Mukai Rachel , Mulleavey Lacy , Kerani Roxanne P. , Albano Terilyn , Sessoms Brandy , Holderman Justin L. , Toro Brian , Sankaran Madeline , Kirkcaldy Robert D. ,   for the SURRG Working Group
Published: August 2021

Introduction
The Centers for Disease Control and Prevention implemented Strengthening the US Response to Resistant Gonorrhea (SURRG) to build local detection and response capacity and evaluate responses to antibiotic-resistant gonorrhea outbreaks, including partner services for gonorrhea. We evaluated outcomes of traditional partner services conducted under SURRG, which involved (1) counseling index patients and eliciting sexual partners; (2) interviewing, testing, and treating partners; and (3) providing partner services to partners newly diagnosed with gonorrhea. We also evaluated outcomes of enhanced partner services, which additionally involved interviewing and testing partners of persons who tested negative, and social contacts of index patients and partners.

Methods
We analyzed partner services investigation data from 8 jurisdictions participating in SURRG from 2017 to 2019. We summed total index patients, partners from traditional partner services, and partners and contacts from enhanced partner services, and calculated partner services outcomes among partners and contacts. We also visualized sexual networks from partner services data.

Results
Of 1242 index patients identified, 506 named at least 1 sexual partner. Traditional partner services yielded 1088 sexual partners, and 105 were newly diagnosed with gonorrhea. Enhanced partner services yielded an additional 59 sexual partners and 52 social contacts. Of those partners and contacts, 3 were newly diagnosed with gonorrhea. Network visualization revealed sparse networks with few complex partnership clusters.

Conclusions
Traditional partner services for gonorrhea may be useful for eliciting, notifying, and diagnosing partners of index patients in an outbreak setting. Enhanced partner services are unlikely to be effective for eliciting, notifying, and diagnosing a substantial number of additional people.
Targeting Culture Criteria to Maximize Culture Positivity of Neisseria gonorrhoeae in 3 Sexual Health Clinic Settings
Authors: Nguyen Trang Quyen , Jamison Kelly , Pfister John , Sankaran Madeline , Amsterdam Lori , Siemetzk-Kapoor Ulrike , Pathela Preeti 
Published: August 2021

Background
Although most gonorrhea (GC) cases in the United States are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the Centers for Disease Control and Prevention demonstration project (Strengthening the US Response to Resistant Gonorrhea [SURRG]) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility.

Methods
For sexually transmitted infection clinics in New York City, NY; San Francisco, CA; and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across 3 groups: (1) sex partners of persons with GC, (2) patients with symptoms (e.g., urethral or cervical discharge), (3) patients who had tested positive and were returning for GC treatment and compared it with positivity among all other patients. We then examined SURRG-period NAAT positivity among patients from whom a culture was or was not collected, and culture positivity, by specimen site and jurisdiction.

Results
Pre-SURRG, NAAT positivity across the 3 select groups was at least twice that of patients who did not meet any criteria. SURRG-period NAAT positivity was higher among patients from whom a culture was also collected. Overall culture positivity was relatively high (New York City, 34.8%; San Francisco, 26.7%; Milwaukee, 24.8%); the proportion of specimens tested varied widely (range, 5.7%–26.5%) by jurisdiction.

Conclusions
Evaluation of NAAT data can inform the establishment of criteria for culture collection for AST. Routine evaluation and quality improvement activities related to culture collection/isolation techniques could increase NG isolation for AST.