bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of COVID-19 in chronic kidney disease stage 5 patients on haemodialysis in Romania
Authors: Steriu A , Buhoara C , Penescu MN 
Published: October 2021

Abstract

Background
CKD 5 is a life threatening condition irrespective of cause. Most patients reach RRT. Predominant therapy is HD. Pandemic preparedness is an important pro-active public health function.

Objectives
1) to describe the incidence of COVID19 and IFR among CKD HD patients; 2) to evaluate the vaccination coverage among HD patients (Jan-Mar 2021); 3) to update a spreadsheet CKD5 HD 12-scenario treatment model by considering two new scenarios based on IFR: before and after vaccination.

Methods
First two objectives use secondary data: JHSU and ECDC (secondary sources of COVID19 data) for Apr 2020-Mar 2021. The 3 NPM periods are: Apr-May 2020 (state of emergency), Jun-Dec 2020 (state of alert; vaccination -), Jan-Mar 2021 (state of alert; vaccination +). Data are taken from the Romanian Renal Registry and population data from Eurostat (available July 2021). IFR was estimated with a modified Kaplan-Meier method (Ghani,2005). A calibrated and validated CKD5 treatment model has previously been defined (10.1093/eurpub/cku161.026). Scenarios are re-run with one parameter adjusted by IFR levels. Analyses used Excel, SPSS.

Results
n = 14300 adult HD patients in March 2020; highest incidence (risk) was recorded in Apr-May 2020: 4.5% (CI95% from 4.1 to 4.8) and 2.5% (CI95% from 2.2 to 2.7). Cumulative incidence was 6.9% vs 18.5 pmp in the general population (period 1). In the general pop COVID19 incidence was highest at 443 pmp in Nov 2020 (period 2). The IFR requires full data validation; CFR was 7.7% (CI95% from 5.97 to 9.46; period 1). It is estimated that by Mar 2021 the IFR has decreased by 50%. Vaccination coverage in HD patients reached 94% (Apr 2021). Preliminary results from the updated model are presented. The model upholds its validity as the IFR allows for a better fine tuning of one parameter (mortality).

Conclusions
treatment need and inequality in service provision can be addressed with a spreadsheet model by including pandemic preparedness measures.

Key messages
Haemodialysis patients had a very high COVID-19 incidence and CFR during the first two months of the COVID-19 pandemic when compared with the incidence in the general population. Pandemic preparedness must include protection measures for patients with chronic diseases. Renal patients are particularly vulnerable given their co-morbidity.
Predictive negative value of the COVID-19 rapid antigen test
Authors: Abroug H , Ben Hassine D , Ben Fredj M , Zemni I , Kacem M , Bouanene I , Belguith Sriha A 
Published: October 2021

Abstract

Background
Testing is a crucial tool in the pandemic response to identify and confirm COVID-19 in those who are symptomatic. The aim of the present study was to assess the negative predictive value (NPV) of COVID-19 Rapid Antigen Testing (RAT) according to the symptoms, test timing in relation to symptom onset and characteristics of the person.

Methods
We performed a prospective cohort study of patients attended the COVID-19 testing center at the university hospital of Monastir, between 23 November 2020 and 19 April 2021. In the first time we performed the COVID19 RAT. In the second time, if this result was negative we performed the reverse transcription polymerase chain reaction (rRT-PCR). The NPV was conducted with SPSS software, version 21.0. A logistic binary regression was performed to determine factors affected the NPV of COVID-19 RAT. A p value of &lt; 0.05 was considered statistically significant.

Results
A total of 855 tests were performed, of which 807 were RAT and 467 rRT-PCR. Positive RAT test was found in 336 cases (39%). False negative RAT was noted in 87 cases (10.2%). The NPV of RAT was 83.6%. The NPV ranged between 80% and 88% for the following symptoms: fever, cough, myalgia, dyspnea, dizziness, asthenia, headache, myalgia, odynophagia, flu_rhume. It varied from 64.2 to 77.8 for Ageusia, Anosmia, Arthralgia, chest pain, thrill, digestive signs. The NPV was equivalent according to age and gender. The NPV varied from 80 to 100% if the test was applied between the first and the 5th day for the onset of symptoms. Beyond this duration, it decreased to 50%. A long period of symptom onset (&gt;5 days) increased significantly the risk of false negative RAT (OR = 2.57 IC95%: [1.38-4.82], p = 0.003).

Conclusions
Many factors may affect the performance of COVID-19 Rapid Antigen Testing (RAT). In fact, negative RAT should be completed by a rRT-PCR according to the the type of symptoms and the time from illness onset.

Key messages
False negative RAT rate was high. Many factors must be taken into account in interpreting the RAT, in particular the type of symptoms and the time from illness onset.
Epidemiology of human alveolar echinococcosis in Armenia
Authors: Manukyan A , Avetisyan L , Sahakyan G , Paez A , Paronyan L , Vanyan A 
Published: October 2021

Abstract

Background
Since the 90s' E.multilocularis infection in foxes is rising and central-eastern European countries had seen first Alveolar echinococcosis (AE) human cases. AE is considered to be a very rare disease in Europe with average incidences of 0.03-0.20/100,000 inhabitants/year. Because of a suitable orography, this study aims to confirm whether there are human AE cases in Armenia, identify areas at risk, and also estimate AE annual incidence.

Methods
Retrospective AE case finding was carried out at main 6 multi-profile medical centers equipped with the most innovative diagnostic means. The medical records of all patients with liver surgery admitted between January 2008 and June 2020 were reviewed. A specific form was developed in EpiInfo v. 7.2. Annual national incidence was estimated using population denominators provided by the National Institute of Statistics (the population of Armenia is estimated at 2 963 243 people).

Results
From September 2019 until June 2020, overall 11 AE cases have been identified. All patients were diagnosed at advanced stages, with subsequent poor prognosis and costly treatment. Confirmation was based on tissue biopsy results. Age ranged from 19-59 years with a median of 39yrs. E. multilocularis was detected in rural communities, mostly in the Gegharkunik region (6 cases, 55%). Annual average incidence of AE was 0.033 varying between 0.032 in 2008 and 0.1 in 2017. For comparison with Armenia, an annual incidence in France was 0.026/100,000 in 2008 (the population of France is estimated at 65 273 511 people).

Conclusions
All cases were not notified by the surveillance system and the real prevalence of AE in the country is unknown. This young age could indicate widespread of infection in animals. Therefore, the burden of AE disease is difficult to estimate. The surveillance system in Armenia can be improved by the development of national guidelines for the prospective registry, AE awareness campaigns.

Key messages
First-time identification of human AE in Armenia calls for implementation of surveillance with a case definition and registry of all cases. AE is an emerging, and so far silent threat in Armenia.
Androgen deprivation therapy and cognitive decline in the NEON-PC study
Authors: Araujo N , Costa A , Conceição-Lopes L , Ferreira A , Carneiro F , Pacheco-Figueiredo L , Morais S , Tedim-Cruz V , Pereira S , Lunet N 
Published: October 2021

Abstract

Background/Objective
Androgen deprivation therapy (ADT) has been associated with cognitive decline, but results have been heterogenous. We describe changes in cognitive performance in patients with prostate cancer (PCa), according to treatment with ADT, during the 1st year after PCa diagnosis.

Methods
Between February 2018 and March 2021, 348 patients with PCa treated at the Instituto Português de Oncologia do Porto were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after one year (1y). ADT was used in 183 participants, and 165 were treated without ADT (total prostatectomy, radiotherapy, brachytherapy, active surveillance). Cognitive decline was defined as the decrease in MoCA from baseline to the 1y-evaluation below 1.5SD of the distribution of the MoCA variation in the whole cohort. Participants scoring below age- and education-based normative reference values in MoCA were considered to have probable cognitive impairment (PCI). Multivariate logistic regression was used to estimate age- and education-adjusted OR (aOR) of the association between ADT and cognitive decline/incident PCI.

Results/Discussion
PCI was observed in 12.4% of the patients at baseline. Mean MoCA scores increased from baseline to the 1y-evaluation (22.4 vs. 22.9, p = 0.001), and 51.2% of PCI cases at baseline had normal MoCA scores at 1y. Cognitive decline was most frequent in the ADT group (9.3% vs. 3.6%, p = 0.034), although the aOR was 2.44 (95%CI:0.89-6.71). The 1yr cumulative incidence of PCI was 10.4% (95%CI:6.2%-16.2%) in the ADT-group and 2.8% (95%CI:0.8-%-7.1%) in the non-ADT group [aOR=3.15 (95%CI:0.97-10.25)].

Conclusions
ADT was associated with a decrease in the cognitive performance of PCa patients during the 1st year after diagnosis. The completion of the 1y-evaluation in the whole cohort (n = 600) is needed to confirm these preliminary results.

Funding
POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017; UIDB/4750/2020;SFRH/BD/119390/2016

Key messages
Half of the cases with cognitive impairment at baseline improved at one-year. Patients treated with ADT seem to be affected by cognitive decline more frequently.
Vegetable gardening in slum homes for food security especially in COVID-19 and well-being in India
Authors: Agarwal S , Verma N , Verma S , Vishvakarma K , Kothiwal K 
Published: October 2021

Abstract

Issue
With livelihood loss, uncertain earning, slum families are often food insecure, at risk of undernutrition particularly during COVID-19 in Indian and other LMIC cities. While wheat flour was provided free during lockdown, later at subsidized costs and during non-COVID times, vegetables need to be bought at market price.

Methods
UHRC provided seeds, encouraged families to grow vegetables in slums of Indore, India for five years. In 2019-20 and 20-21, data was gathered through interviews, observations in 20 slums (where &gt;15 families grew vegetables).

Results
Uptake of seeds increased from 900 families in 2019-20 to 1200 in 20-21. With sharing of surplus harvest, 70,000 persons benefited in 2020-21. Families overcame food insecurity by arranging just wheat flour and cooked a vegetable for a meal. Used paint tubs, broken buckets and small spaces were used. Creepers were made to climb on roofs, walls, trees. Green cover increased to &gt; 8 acres in 2021. The practice saves valuable family resources particularly in COVID-19 distress through provision of vegetables for family consumption.

Lessons
Perseverant efforts are key and help build a ‘fairer, healthier world'. Yield per family increased as they grow with incremental confidence. Despite small spaces slum families creatively grew vegetables. Children and youth help overcome constraints and are key actors. Early adopters serve as motivators and champions for subsequent adopters who begin growing vegetables on observing neighbours, friends grow vegetables and share with them. Nurturing plants, seeing vegetables grow fostered positivity, hope, motivation to grow every year, enhanced self-worth, and a positive feeling about their abode. People particularly children and youth learn how eating home-grown vegetables reduces carbon footprint of purchased vegetables transported to urban markets, save cost and overcome food insecurity. They reduce ambient air temperature to cool urban spaces.

Key messages
Despite small spaces, slum families grow, share vegetables, feel accomplished, enable food security, social cooperation, all crucial to well-being of slum populations. Methods used and lessons learnt of perseveringly motivating slum families have the potential of replication/adaptation in cities of India and other LMICs.
Household pharmaceutical waste (example from Serbia)
Authors: Paut Kusturica M , Ostojic T , Kresoja M , Horvat O , Tomas A , Jevtic M 
Published: October 2021

Abstract

Background
Proper disposal of household pharmaceutical waste can reduce the negative influence of medicines on the environment. Environmental awareness do not necessarily equate with proper behavior, as other issues, such as the availability of an organized disposal system, play an important role. The aim was to examine the current disposal methods of unused medicines from households, and the willingness of Serbian residents to participate and bear the costs of an organized collection program. Also, we wanted to define factors contributing to an individual's willingness to participate and pay for a disposal program.

Methods
The survey included randomly selected patients older than 18 years visiting private pharmacies in the four largest Serbian cities. The questionnaire included information on the presence of unwanted medicines in the household, general medicine disposal practices, the likelihood to participate in a medicine takeback program, willingness to pay for a disposal program, importance to the environment, and demographic variables.

Results
The majority of Serbian people dispose unused medicines into household garbage. 80% of respondents are likely to participate, however less than half are willing to pay for the collection of unused medicines. The factors that influenced willingness to participate are environmental awareness and income, while the factors affecting willingness to pay, are previously received advice about proper disposal, education level, number of unwanted medicines in the household and gender.

Conclusions
Awareness campaigns advising the general public on proper medicine disposal and well-organized and easily accessible collection programs are essential in order to enable the general public to return unused medicines for proper disposal.

Key messages
Household pharmaceutical waste is a major public health issue in Serbia. Residents in Serbia are willing to participate in collection programs, thus building legislative into practice is urgent.
A2CT Assessment Alzheimer Centre Tool: evaluation tool of structures for people with dementia
Authors: Mangili S , Brambilla A , Capolongo S 
Published: October 2021

Abstract

Background
The increasing number of elderly population (17,4% over 65 in Europe in 2009 and 20,3% in 2019) is following by the progressive growth in diseases related to age. One of them is dementia that afflicts 8% of over 65s, of which 60% with Alzheimer. Patients with progressive cognitive deterioration often need to leave their houses and move to nursing homes but in many cases, these aren't suitable for hosting them because based on regulations and standards that are exceeded. Aim of the study is to evaluate if those territorial structures are suitable for patients.

Methods
The study addressed a systematic literature review, in the relationship between built environment and patients with dementia, different case studies, and existing evaluation tools. The evidence that emerged allowed to develop of a rating tool divided into 4 macro-areas (quality, spaces, activities, and wayfinding) and composed by different criteria and indicators. The tool was applied in 5 facilities in Northern Italy and strategies were provided.

Results
The facilities differ in type and age of construction and the results of the evaluation tool show that 2 are inadequate (&lt;60%) 2 sufficient (&lt;80%) and 1 excellent (&gt;80%). The best one is the newest and is conceived based on analysis of evidence in the relationship between Alzheimer's and built environment and facts this scored the maximum (100%) for spaces than the other older structures, made by the reuse of existing spaces, results as inadequate (every structure obtained &lt;65%). For each criticality found implementation strategies were provided.

Conclusions
The investigation highlights that the design of territorial structures must be based on evidence to create better spaces for the well-being of patients. It also shows that existing buildings are not able to respond to the need of patients affected by dementia. To get a broader view of the situation, the tool could be applied in other structures both in other regions and abroad.

Key messages
This research is the first that use assessment methodologies for the quality evaluation of territorial structures dedicated for Alzheimer patients in the Italian context. Evaluating a structure and adapting it to the needs of the specific patient must become the practice in a constantly evolving field such as the medical-health one.
Urgency and emergency process for ambulance regulation during the COVID-19 pandemic
Authors: Mafra ACCN , Gomes WPP , Domingues J , Oliveira IE , Trufelli AM , Brito KLD , Bottaro PV , Palácio DC , Martins ACF 
Published: October 2021

Abstract

Issue
Severe acute respiratory syndrome (SARS) caused by SARS-CoV-2 proved to be a global public health problem. Critical ill patients attended in Primary Health Care (PHC) often require fast transportation to the Urgency and Emergency Network (UEN). Controlling an ambulance fleet requires technical skill, discipline, organization and emotional care. During the pandemic, there was an increase in ambulances requests, including removing patients from PHC to the UEN. In this context, ambulances were occasionally lost or not directed to PHC facilities, resulting in worsening the patient clinical situation, dropout or long waiting periods.

Description of the problem
To strengthen the removals process and patients referrals, PHC and UEN professionals of services in São Paulo designed and implemented a strategy according to patient severity criteria. We used a 5W2H matrix to discuss relevant topics, skills, actions and indicators and develop a tool to prioritize diagnoses or clinical conditions requiring immediate removal. Besides, we standardized the request flows and drivers contact. The team trained professionals to manage ambulances. We monitor the quantity, destination and release time of ambulances.

Results
We defined acute myocardial infarction, stroke, sepsis, SARS and pregnancy as a priority for removal. During implantation, removals volume increased from 18 to 50 per week. Despite this, there was no change in the average waiting time: about 82 minutes. The dropout rate and release time slightly increase, from 2.4% to 3.0% and from 28 minutes to 43 minutes per request, respectively. Besides technical issues, professionals were oriented to manage anxiety. It was possible to evaluate the demand for hiring more vehicles and save resources.

Lessons
This experience strengthened PHC as an access point and organizer of the healthcare network. Early detection of UEN referral necessity contributes to providing adequate, equity and timely care.

Key messages
In the face of the COVID-19 pandemic scenario, a strategy to organize and optimize removal to UEN is needed to assure adequate and timely care. Cooperation between different services in the health care network promotes safety and quality of patient care.
Rabies surveillance in the central region of Tunisia: A 15-year observational study
Authors: Ben Nasrallah C , Ben Fredj M , Kacem M , Grira S , Dhouib W , Zemni I , Abroug H , Bouanene I , Belguith Sriha A 
Published: October 2021

Abstract

Background
Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. In Tunisia, the National Rabies Control Program was initiated in 1982 based on dog's annual vaccination campaign. The aim of our study was to describe the epidemiological profile and management of rabies exposure in the Monastir governorate, Tunisia.

Methods
We included in our study all cases of animal aggression reported between 2004 and 2018 in the Monastir governorate. The source of the data was the directorate of primary health care in Monastir.

Results
A total of 27,277 bites were reported with an annual average of 1,817 cases per year. Most of victims were in the 5-14 age group (25%, n = 6,902). The culprit animal was the dog in 64% of cases followed by rats and cats. Only 42% of attacking dogs were vaccinated. A significant increase in dog bites was noted from 2004 to 2018 (β = 16.5; p = &lt;10-3). The number of bites increased significantly (β = 23.2; p = &lt;10-3) by vaccinated dogs and decreased significantly by unvaccinated dogs (β = -12; p = &lt;10-3). During our study period, a total of 146 cases of animal rabies was confirmed. Only one case of human rabies was reported, the aggressor animal was a cat and post-exposure prophylaxis was not received.

Conclusions
In Tunisia, human exposure to rabies by a dog has been on the rise. Future interventions should focus on mass dog vaccination campaigns and contraception in order to eliminate this disease.

Key messages
A significant increase in dog bites was noted from 2004 to 2018. It is crucial to reinforce appropriate preventive strategies, such as mass dog vaccination programs.
Falls among older general practice patients: risk factors and fall prevention in Belgium, 2019-2020
Authors: Moreels S , Boffin N , De Schreye R 
Published: October 2021

Abstract

Background
Around 30% of people aged 65 years and older living in the community fall every year. Falling among older persons is a multifactorial health condition needing multifactorial care. General practitioners (GPs) are well placed to implement a multifactorial management. Therefore a surveillance study of accidental falls was carried out to study characteristics of falls, fallers and fall risks; prevalence of risk factors and fall prevention by GPs.

Methods
A 2-year retrospective population-based study based on data collected by the Belgian network of Sentinel General Practices (SGP) on all community-dwelling patients aged ≥65 years consulting their GP for new fall-related injuries. Data of 2019-20 were pooled because of no significant difference. Factors associated with a multifactorial risk profile were analyzed by multivariate logistic regression.

Results
During 2019-20, 759 accidental falls were registered. For 24% of fallers, medical and/or nursing intervention was required and 22% had a severe injury. During consult, 31% was referred to the hospital. 59% of patients showed at least one of the four most prevalent fall risks, i.e. deficits of mobility or balance, polypharmacy, cognitive impairment or psychotropic medication. A multifactorial risk profile was observed in 46% of patients and was associated with age, recurrent falling, falling in residential care center and during activities of daily living. Addressing surrounding and walking problems were most taken as preventive measures. For 28% of fallers, other healthcare providers (mainly nurse and physiotherapist) were involved in preventive care.

Conclusions
This study yields recent data on risk factors and preventive fall interventions in general practice in Belgium. Collaborative preventive fall measures are taken in about one in four patients, although previous SGP research (2009-10) showed that interventions were better implemented when specialized caregivers had been involved concurrently.

Key messages
Multifactorial interventions are crucial for preventing accidental falls in older general practice patients in Belgium. More collaboration between GPs and other caregivers is needed when taking preventive fall measures.