bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends of Obesity Rates Between Patients Undergoing Primary Total Knee Arthroplasty and the General Population from 2013 to 2020
Authors: Muthusamy Nishanth , Singh Vivek , Sicat Chelsea S. , Rozell Joshua C. , Lajam Claudette M. , Schwarzkopf Ran 
Published: December 2021

Background:
Obesity is a recognized risk factor for severe knee osteoarthritis. However, it remains unclear how obesity prevalence trends in the current population undergoing total knee arthroplasty (TKA) compare with those seen in individuals not undergoing this procedure. In this study, we assessed the yearly trends in body mass index (BMI) and obesity rates between patients who have undergone primary TKA and those in the general population.

Methods:
We retrospectively reviewed all patients ≥18 years of age from January 2013 through December 2020 who underwent primary, elective TKA and those who had an annual routine physical examination at our institution within the same period. Baseline demographic characteristics were collected. The independent samples t test was used to compare means and the chi-square test was used to compare proportions between the 2 cohorts, and a linear regression was used to determine the significance of the yearly trends.

Results:
A total of 11,333 patients who underwent primary TKA and 1,158,168 patients who underwent an annual physical examination were included in this study. After adjusting for age, we found the mean BMI for the TKA group to be significantly greater (p < 0.001) every year compared with the annual physicals group. The proportion of patients who were categorized into any obesity class (BMI, ≥30 kg/m2), Class-I obesity (BMI, 30 to 34.9 kg/m2), Class-II obesity (BMI, 35 to 39.9 kg/m2), and Class-III obesity (BMI, ≥40 kg/m2) was significantly higher for the TKA group each year compared with the annual physicals group. An analysis of trends over time showed a significantly increasing trend (p < 0.001) in BMI and obesity rates for the annual physicals group, but a stable trend for patients undergoing TKA.

Conclusions:
Patients who underwent TKA continued to have higher BMI than the general population, which showed a steady increase over time. Physicians need to continue in their efforts to educate patients on weight management and healthy lifestyles to potentially delay the need for a surgical procedure.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Paradigm Shift in Osteonecrosis Treatment with Bisphosphonates
Authors: D(Orth) Sanjay Agarwala , Vijayvargiya Mayank 
Published: December 2021

Background:
Bisphosphonates are proven to be effective in obviating the need for surgical intervention in osteonecrosis of the femoral head. However, the late onset of pain relief hampers compliance. We present the clinical and radiographic outcome of a combination therapy compared with alendronate-only therapy for the management of osteonecrosis of the femoral head.

Methods:
The data of patients diagnosed with osteonecrosis of the femoral head from January 2001 to January 2017 were retrospectively analyzed. The first group, the alendronate treatment group, comprised 432 hips (358 patients) diagnosed from January 2001 to January 2009 and treated with 10-mg oral alendronate daily for 3 years. The second group, the combination treatment group, comprised 442 hips (386 patients) diagnosed from February 2009 to January 2017 and treated with a combination therapy of 35-mg oral alendronate twice weekly and 5-mg intravenous zoledronic acid once annually for 3 years. Clinical assessment was performed using the Harris hip score, the visual analog scale (VAS) pain score, and the clinical failure rate. Radiographic assessment was performed for progression and collapse.

Results:
In the alendronate treatment group, at a mean follow-up of 129.6 months (range, 60 to 220 months), 74.5% did not require a surgical procedure, and, in the combination treatment group, at a mean follow-up of 69 months (range, 37 to 105 months), 88.9% did not require a surgical procedure. The clinical failure rate at 3 years was 4% for stage I, 11% for stage II, and 29% for stage III in the alendronate treatment group, and it was 5% for stage I, 9% for stage II, and 32% for stage III in the combination treatment group. Patients in the combination treatment group had a significantly better improvement in VAS score at 6 weeks (from 7.10 to 3.66) compared with patients in the alendronate treatment group (from 7.93 to 7.00).

Conclusions:
Our study shows that both oral alendronate-only therapy and bisphosphonate combination therapy retard the progression of disease, reduce the rate of collapse, and, hence, reduce the need for joint replacement surgery. However, bisphosphonate combination therapy offers earlier improvement in pain and functional scores compared with oral alendronate therapy only.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implementation of Medicines Pricing Policies In Sub-Saharan Africa: Systematic Review
Authors: Koduah Augustina , Baatiema Leonard , de Chavez Anna Cronin , Danso-Appiah Anthony , Kretchy Irene A , Agyepong Irene Akua , King Natalie , Ensor Tim , Mirzoev Tolib 
Published: December 2021

Abstract
Background: High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA), are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability. However, evidence on the experiences of implementations of these policies in SSA settings appears limited. To bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? Methods: We identified policies, examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines.Results: Of the 5595 studies identified, 32 met the inclusion criteria. The results showed fourteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were: limited awareness about policies, lack of regulatory capacity, and lack of price transparency in external reference pricing process. Key facilitators were: favourable policy environment on essential medicines, strong political will, and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines were mixed. Reductions in prices were reported occasionally and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines.Conclusions: Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications: avoiding ‘one-size-fits-all’ approach, engaging both private and public sector policy actors in policy implementation and continuously monitor implementation and effects of policies. Systematic review protocol registration: PROSPERO registration number CRD42020178166.
Pregnancy-Associated Listeriosis in a Tertiary Hospital in Ningbo, Zhejiang, China: A Retrospective Study
Authors: Ke Yefang , Ye Lina , Zhu Pan , Sun Ying , Zhu Zhe 
Published: December 2021

Abstract
Background

Pregnancy-associated listeriosis is a severe infectious disease and potentially leading to fetal/neonatal fatal. Limited information on pregnancy-associated listeriosis is available in China.
Methods

We performed a retrospective study on maternal and neonatal patients with pregnancy-associated listeriosis. The clinical characteristics of pregnancy-associated listeriosis were studied, and the outcome determinants of neonatal listeriosis were explored.
Results

14 cases of pregnancy-associated listeriosis were identified. The incidence of pregnancy-associated listeriosis in our hospital was 16.69/100,000 births. All of the 14 maternal patients eventually recovered after delivery shortly with no sequelae. None of the 12 mothers who delivered in this hospital received antepartum first-line empirical treatment. Among the 14 neonatal cases, 1 was late onset listeriosis and 13 were early onset cases; 11 survived and 3 died. Fatality rates were significantly higher in outborn neonates (P=0.005). Besides, higher mortality rates were observed in neonates with lower birth weight (P=0.038), gestational age<28 weeks (P=0.056), and Apgar score (5th min) <5 (P=0.056), with marginally significant differences.
Conclusions

There is a neglected burden of pregnancy-associated listeriosis in our hospital. Timely and optimal resuscitative measures are considered to be important to reduce mortality of neonatal listeriosis. Listeriosis should be considered in the differential diagnosis of pregnancy-associated infections.
Trauma and Posttraumatic Stress in Unaccompanied Young Refugees During Their Flight: A Longitudinal Cross-Country Study
Authors: Pfeiffer Elisa , Behrendt Malte , Adeyinka Sarah , Devlieger Ines , Rota Marina , Uzureau Océane , Verhaeghe Floor , Lietaert Ine , Derluyn Ilse 
Published: December 2021

Abstract
Background: Unaccompanied young refugees (UYRs) constitute an especially vulnerable population who report high rates of trauma and mental health problems. There is a significant gap in the literature on trauma and symptoms of posttraumatic stress disorder (PTSD) in UYRs who are still on the move and live in precarious circumstances such as refugee camps. This study therefore aimed at investigating pre- and peri-migration trauma of UYRs, longitudinal trajectories of PTSD, and the impact of gender, trauma, and daily stressors on PTSD over time. Methods: This longitudinal, mixed-method, and multi-country study was conducted in various settings (e.g. refugee camps) across nine European countries. A representative and heterogeneous sample of N = 187 UYRs (78.4% male) from 29 different countries was assessed via interviews at 3 time-points during a period of 27 months. Data was analyzed via growth curve modelling.Results: Prevalence rates of traumatic experiences ranged between 29.5-91.9%. PTSD scores were high but significantly decreased over time (b = -0.98; p = .004). Females reported higher PTSD compared with males at baseline (p = .002), but gender did not influence the longitudinal trajectory of PTSD. Pre-migration trauma had a significant effect on PTSD at baseline (b = 0.48; p = .042). More daily stressors resulted in higher PTSD across time (b = 0.13-0.26; p ≤ .001). Conclusions: The number of traumatic events pre- and peri- migration, daily stressors and PTSD in this heterogeneous sample are to say the least alarming. Humanitarian and political assistance is urgently needed to curb the oftentimes life-threatening conditions UYRs face during their migration.
Racial Disparities in Triple Negative Breast Cancer: Toward a Causal Architecture Approach
Authors: Siegel Scott D. , Brooks Madeline M. , Lynch Shannon M. , Sims-Mourtada Jennifer , Schug Zachary T. , Curriero Frank C. 
Published: December 2021

Abstract
Background: Triple negative breast cancer (TNBC) is an aggressive subtype of invasive breast cancer that disproportionately affects Black women and contributes to racial disparities in breast cancer mortality. Prior research has suggested that neighborhood effects may contribute to this disparity beyond individual risk factors.Methods: The sample included a cohort of 3,316 breast cancer cases diagnosed between 2012 and 2020 in New Castle County, Delaware, a geographic region of the US with elevated rates of TNBC. Multilevel methods and geospatial mapping evaluated whether the race, income, and race/income versions of the neighborhood Index of Concentration at the Extremes (ICE) metric could efficiently identify census tracts (CT) with higher odds of TNBC relative to other forms of invasive breast cancer. Odds ratios (OR) and 95% confidence intervals (CI) were reported; p-values <0.05 were significant. Additional analyses examined area-level differences in exposure to metabolic risk factors, including unhealthy alcohol use and obesity.Results: The ICE-Race, -Income-, and Race/Income metrics were each associated with greater census tract odds of TNBC on a bivariate basis. However, only ICE-Race was significantly associated with higher odds of TNBC after adjustment for patient-level age and race (most disadvantaged CT: OR= 2.09; 95%CI=1.40-3.13), providing support for neighborhood effects. Higher counts of alcohol and fast-food retailers, and correspondingly higher rates of unhealthy alcohol use and obesity, were observed in CTs that were classified into the most disadvantaged ICE-Race quintile and had the highest odds of TNBC. Conclusion: The use of ICE can facilitate the monitoring of cancer inequities and advance the study of racial disparities in breast cancer.
Characteristics And Outcomes of Sepsis Patients With And Without COVID-19
Authors: Heubner Lars , Hattenhauer Sarah , Güldner Andreas , Petrick Paul , Roessler Martin , Schmitt Jochen , Schneider Ralph , Held Hanns Christoph , Mehrholz Jan , Bodechtel Ulf , Ragaller Maximilian , Koch Thea , Spieth Peter Markus 
Published: December 2021

Abstract
Background: The aim of this study was to describe and compare clinical characteristics and outcomes in critically ill septic patients with and without COVID-19.Methods: From February 2020 to March 2021, patients from surgical and medical ICUs at the University Hospital Dresden were screened for sepsis. Patient characteristics and outcomes were assessed descriptively. Patient survival was analyzed using the Kaplan-Meier estimator. Associations between in-hospital mortality and risk factors were modeled using robust Poisson regression, which facilitates derivation of adjusted relative risks.Results: In 177 ICU patients treated for sepsis, COVID-19 was diagnosed and compared to 191 septic ICU patients without COVID-19. Age and sex did not differ significantly between sepsis patients with and without COVID-19, but SOFA score at ICU admission was significantly higher in septic COVID-19 patients. In-hospital mortality was significantly higher in COVID-19 patients with 59% compared to 29% in Non-COVID patients. Statistical analysis resulted in an adjusted relative risk for in-hospital mortality of 1.74 (95%-CI=1.35-2-24) in the presence of COVID-19 compared to other septic patients. Age, procalcitonin maximum value over 2 ng/ml, need for renal replacement therapy, need for invasive ventilation and septic shock were identified as additional risk factors for in-hospital mortality.Conclusion: COVID-19 was identified as independent risk factor for higher in-hospital mortality in sepsis patients. The need for invasive ventilation and renal replacement therapy as well as the presence of septic shock and higher PCT should be considered to identify high-risk patients.
Consumer Awareness and Perception on Mineral and Vitamin Supplements to Boost Immunity Against COVID-19
Authors: Dimaano Francesca , Alog Marimar , Diez Nica Anne , Barcelon Eufemio 
Published: December 2021

COVID-19 have been widespread all over the world. Mineral supplementation and Vitamin intake may help to reduce the severity of the common cold. This study determines the Knowledge, Attitude, And Practices of Consumers About Mineral and Vitamin Supplementation to boost immune system for COVID-19. 178 Participants who lived in the NCR Bubble particularly Metro Manila, Laguna, Cavite, Rizal, and Bulacan., 18-years old and above were chosen by convenience sampling. To get the appropriate data needed, the researchers divided the questionnaire into 4 parts such as Demographics, Knowledge, Attitude, and Practices using likert scale. Descriptive analysis of frequencies and percentages for demographic characteristics, KAP assessment and likewert interpretation was applied. The respondents' knowledge, attitude, and practices toward micronutrient supplementation were evaluated. Results showed that the respondents have a very good understanding, belief, and practice of mineral supplementation and vitamin intake to boost the immune system. Before the pandemic, 178 respondents did not take mineral supplements; nevertheless, 58 respondents (32.58 percent) took vitamins, and 117 respondents (65.73%) took both mineral and multivitamin supplements. On the other hand, 61 (34.27%) respondents took vitamins, while 120 (67.42%) respondents took both mineral and vitamin supplements during the pandemic. In addition, the intake of these supplements increased during pandemic. Self-willingness (28.65%) was the most common response to factors linked with mineral and vitamin consumption prior to the pandemic, whereas doctor's prescription was the most common response during the pandemic (44.94%). The level of micronutrient supplementation practiced by the respondents was also applied because they knew and believed that it could reduce the risk of COVID-19 infection.
Aprendizaje-servicio para la formación en atención farmacéutica, enfrentando los retos de la pandemia COVID-19
Authors: Carmona Mata Vanesa , Vázquez-Velasco Miguel , Del Campo Pérez Carmen , Giorgi Poletti Giorgio 
Published: December 2021

En la actualidad, tanto la sociedad como las entidades gubernamentales buscan la humanización del sistema sanitario, en especial para el tratamiento de los pacientes más vulnerables, como los pertenecientes al colectivo LGTBI+. Para ello, se requieren profesionales sanitarios altamente cualificados y comprometidos, por lo que el método de Aprendizaje-Servicio (ApS) puede ser una valiosa herramienta.
El presente artículo describe el proyecto de formación basado en la metodología ApS llevado a cabo por la Facultad de Farmacia de la UCM junto con COGAM, ONG especializada en proyectos y programas orientados a sensibilizar y visibilizar la diversidad del colectivo LGTBI+. Aunque inicialmente diseñado para su realización presencial, la crisis sanitaria y social ocasionada por la pandemia COVID-19 obligó a la virtualización del proyecto: Los alumnos recibieron formación específica a distancia y realizaron actividades de difusión y divulgación científica, así como de asesoramiento farmacéutico, con muy buena aceptación por parte de los usuarios.
Los resultados aún son preliminares, pero la actividad formativa desempeñada parece ejercer un efecto beneficioso tanto para los estudiantes como para la comunidad, incluso en las condiciones sanitarias y sociales más desafiantes, y puede ser fácilmente trasladada a cualquier otra disciplina académica.
Aprendizaje-Servicio Virtual y Pedagogía Social. El proyecto ProAcción Social
Authors: Sotelino-Losada Alexandre , Brea Castro Millán 
Published: December 2021

El uso de la red social Instagram abre un amplio espacio a propuestas educativas que no sólo tienen que ver con la difusión de imágenes y vídeos, la relación casual a través de “likes” o las conversaciones privadas. Ofrece también la posibilidad de intercambio de conocimientos e información académica desde una perspectiva asíncrona, dinámica y no paternalista.
Este trabajo presenta los resultados de una experiencia de aprendizaje-servicio virtual donde el alumnado del Grado de Educación Social ha incluido esta plataforma en su dinámica de trabajo académico. El objetivo es visibilizar el perfil profesional de las/los educadoras/es sociales, al tiempo que investigan sobre diferentes necesidades circundantes para sensibilizar y reclamar de manera pública una intervención ajustada.
Para el análisis de los datos hemos utilizado una metodología mixta con datos cualitativos (informes de trabajo y reflexiones grupales) y cuantitativos (impacto de publicaciones) tomados longitudinalmente. Finalmente podemos destacar que el uso de Instagram en las aulas universitarias promueve la consolidación de una identidad profesional en Educación Social y también contribuye a la participación e inclusión de todo el alumnado en el grupo aula. Por último, también se cubre una necesidad social, base en el ApS, contrarrestando prejuicios vinculados a colectivos vulnerables.
Water resources east: An integrated water resource management exemplar
Authors: Smith Nancy , Price Robin , Moncaster Steve 
Published: December 2021

Abstract
Water Resources East (WRE) is a 180 strong and growing membership organisation established in 2014 to learn from international best practice on how to develop a more collaborative approach to water resource management planning to the 2050s and beyond. This is happening now in a unique region of England under significant pressure due to population growth, economic ambition, the need for enhanced environmental protection, and significant climate change impacts.
The lesson of this chapter is the power of multi-sector water resource planning through collaborative and adaptable mechanisms led by integrated water resource management (IWRM). Through using active project case studies to gain insight into how we work with our members: Future Fenland Adaptation; Regional Natural Capital Planning through Systematic Conservation Planning (Water Resources East is teaming up with Biodiversify and WWF-UK, with financial support from the Coca-Cola Foundation, to develop a natural capital plan for Eastern England through Systematic Conservation Planning); and exploration of multi-sector finance of nature-based solutions through the creation of Water Funds, we hope to provide a strong evidence base for our sustainable and resilient methodologies and approaches that can be used, or be an influence on, other water management systems globally.
Lastly, the WRE team and longest standing contributors reflect on lessons and recommendations from the past seven years of work.
Bathing water quality analysis, management and policy: an integrated assessment for Ireland
Authors: Alamanos Angelos , Rolston Alec , Linnane Suzanne , McGrath Triona 
Published: December 2021

Abstract
Every bathing season in Ireland several bathing sites are closing and receiving warnings against bathing. In this report, their water quality status is assessed, and the broader picture of each case is investigated. A database is formed including location-maps, the restrictions they were/are subject to, the official justification, past and current annual water quality status, (sub)catchment where they are located, main water bodies flowing in, the closest wastewater treatment plants with their characteristics and performance based on EU treatment standards, the closest meteorological stations and the rainfall data related with stormwater overflow events (correlation analyses) and the surrounding land cover. For each case, possible causes were discussed; the actions so far and the relevant literature are analyzed to provide key policy recommendations which are useful for the review of the European Bathing Water Directive.