bluuebunny/crossref_metadata_2025_split huggingface dataset:
De-labelling penicillin allergy in acutely hospitalized patients: a pilot study
Authors: Steenvoorden Linde , Bjoernestad Erik Oeglaend , Kvesetmoen Thor-Agne , Gulsvik Anne Kristine 
Published: October 2021

Abstract
Background
Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. Few patients undergo evaluation, which leads to overuse of broad-spectrum antibiotics. The objective of this study was to monitor prevalence and implement screening and testing of hospitalized patients.

Methods
All patients admitted to the medical department in a local hospital in Oslo, Norway, with a self-reported penicillin allergy were screened using an interview algorithm to categorize the reported allergy as high-risk or low-risk. Patients with a history of low-risk allergy underwent a direct graded oral amoxicillin challenge to verify absence of a true IgE-type allergy.

Results
257 of 5529 inpatients (4.6%) reported a penicillin allergy. 191 (74%) of these patients underwent screening, of which 86 (45%) had an allergy categorized as low-risk. 54 (63%) of the low-risk patients consented to an oral test. 98% of these did not have an immediate reaction to the amoxicillin challenge, and their penicillin allergy label could thus be removed. 42% of the patients under treatment with antibiotics during inclusion could switch to treatment with penicillins immediately after testing, in line with the national recommendations for antibiotic use.

Conclusions
The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. Screening and testing of hospitalized patients with self-reported penicillin allergy is a feasible and easy measure to de-label a large proportion of patients, resulting in immediate clinical and environmental benefit. Our findings suggest that non-allergist physicians can safely undertake clinically impactful allergy evaluations.
Primary gross tumor volume is prognostic and suggests treatment in upper esophageal cancer
Authors: Chen Yuanmei , Huang Qiuyuan , Chen Junqiang , Lin Yu , Huang Xinyi , Wang Qifeng , Yang Yong , Chen Bijuan , Ye Yuling , Zheng Binglin , Qi Rong , Chen Yushan , Xu Yuanji 
Published: October 2021

Abstract
Background
To aid clinicians strategizing treatment for upper esophageal squamous cell carcinoma (ESCC), this retrospective study investigated associations between primary gross tumor volume (GTVp) and prognosis in patients given surgical resection, radiotherapy, or both resection and radiotherapy.

Methods
The population comprised 568 patients with upper ESCC given definitive treatment, including 238, 216, and 114 who underwent surgery, radiotherapy, or combined radiotherapy and surgery. GTVp as a continuous variable was entered into the multivariate Cox model using penalized splines (P-splines) to determine the optimal cutoff value. Propensity score matching (PSM) was used to adjust imbalanced characteristics among the treatment groups.

Results
P-spline regression revealed a dependence of patient outcomes on GTVp, with 30 cm3 being an optimal cut-off for differences in overall and progression-free survival (OS, PFS). GTVp ≥30 cm3 was a negative independent prognostic factor for OS and PFS. PSM analyses confirmed the prognostic value of GTVp. For GTVp < 30 cm3, no significant survival differences were observed among the 3 treatments. For GTVp ≥30 cm3, the worst 5-year OS rate was experienced by those given surgery. The 5-year PFS rate of patients given combined radiotherapy and surgery was significantly better than that of patients given radiotherapy. The surgical complications of patients given the combined treatment were comparable to those who received surgery, but radiation side effects were significantly lower.

Conclusion
GTVp is prognostic for OS and PFS in upper ESCC. For patients with GTVp ≥30 cm3, radiotherapy plus surgery was more effective than either treatment alone.
Screening for post-traumatic stress disorder among adolescents following floods- a comparative study from private and public schools in Kerala, India
Authors: Mathew Geethu , Varghese Aby Dany , Sabu Ans Mary , Joseph Aleena 
Published: October 2021

Abstract
Introduction
Disasters can have deep physical and psychological impact among survivors. An extraordinary southwest monsoon has unleashed floods and landslides in Kerala state in 2018. Adolescents are more vulnerable to psychological impairment after a disaster and trauma during initial stages of life can etch an indelible signature in the individual’s development and may lead to future disorders.

Objectives
1. To screen for PTSD and associated factors among adolescents 8 months post floods in selected schools in flood-affected areas of Alleppey district of Kerala 2. To compare the proportion of adolescents screened positive for PTSD in public and private schools.

Methodology
A 3-month, Cross-sectional study was done among 670 adolescents in private and public schools using stratified sampling in Alleppey district. The study tool included a structured questionnaire that collected information on sociodemographics, flood-related variables, Trauma screening questionnaire and academic performance.

Results
The mean age of the participants was 16.03 ± 0.73 years with almost equal gender distribution. One-third of students reported flood-related damage to house/property, and a few lost their pets. Nearly 50% of the students reported that they still re-experience and get upsetting memories about flood events. The prevalence of probable PTSD noted to be 34.9%. We observed that 31% of students in public school screened positive for PTSD compared to 38.8% of private school students. (odds ratio = 1.409, CI 1.024–1.938). Male gender (Odds ratio = 1.503, CI 1.093–2.069), higher age (Odds ratio = 1.701, CI 1.120–2.585), damage during floods (Odds ratio = 2.566, CI 1.814–3.630), presence of morbidity (Odds ratio = 3.568, CI 1.888–6.743), camp stay (Odds ratio = 3.788, CI 2.364–6.067) and loss of pets (Odds ratio = 3.932, CI 2.019–7.657) were the factors significantly associated with PTSD. We noted a deterioration in academic performance in 45.9% of students who screened positive for PTSD.

Conclusion and recommendations
High prevalence of stress disorder highlights the need for early identification and intervention for PTSD and including trained counsellors as a part of the disaster management team in future.
Factors related to HIV testing frequency in MSM based on the 2011–2018 survey in Tianjin, China: a hint for risk reduction strategy
Authors: Liu Zhongquan , Chen Yang , Yao Tingting , Zhang Tiantian , Song Desheng , Liu Yuanyuan , Yu Maohe , Xu Jie , Li Zhijun , Yang Jie , Cui Zhuang , Li Changping , Ma Jun 
Published: October 2021

Abstracts
Background
In recent years, HIV testing has become one of the effective strategies to reduce the risk of the infection. Frequent quarterly HIV testing can be cost effective. Therefore, an in-depth study of factors related to the testing behavior of men who have sex with men (MSM) were analyzed to optimize intervention strategies.

Methods
From March 2011 to October 2018, the project was implemented in a Tianjin (China) bathhouse, and 5165 MSM were surveyed using snowball sampling. Factors related to HIV testing behavior were analyzed by ordinal logistic regression analysis after grouping according to testing frequency, and comprehensive analysis was performed.

Results
The multivariate logistic analysis showed that 6 variables including young MSM (OR = 0.67, 95% CI: 0.49–0.92, p = 0.01), low-educated MSM (OR = 0.60, 95% CI: 0.48–0.77, p < 0.0001), low HIV/AIDS knowledge (95% CI: 0.57–0.83, p < 0.0001), marital status (OR = 1.30, 95% CI: 1.07–1.57, p = 0.007), acceptance of condom promotion and distribution (OR = 14.52, 95% CI: 12.04–17.51, p < 0.0001), and frequency of condom use (p < 0.05) could link to HIV testing behaviors.

Conclusions
In order to achieve the 95–95-95 goal, target publicity, HIV/AIDS education and promotion of HIV self-testing kits should be carried out to encourage frequent HIV testing among MSM who are young (especially students), married to women, poorly educated and who are reluctant to always use condoms.
Usefulness of intraoperative C-arm image intensifier in reducing errors of acetabular component during primary total hip arthroplasty: an application of Widmer’s method
Authors: Song Joo-Hyoun , Kim Yong-Sik , Kwon Soon-Yong , Lim Young-Wook , Jung Jiyoung , Oh Seungbae 
Published: October 2021

Abstract
Background
Acetabular prosthesis positioning in total hip arthroplasty (THA) is crucial in reducing the risk of dislocation. There has been minimal research on the proper way to put the acetabular components into the safe zone intraoperatively. Assessment of version by intraoperative imaging intensifier is very valuable. The value of Widmer’s method, using the intraoperative C-arm available to determine cup anteversion was assessed.

Methods
One hundred one hips in 91 patients who underwent primary THA were eligible for inclusion. Utilizing intraoperative C-arm images, measurement was performed using the technique described by Widmer. The values obtained using 3D computed tomography postoperatively, which determined the anteversion of the acetabular component, were regarded as the reference standard.

Results
The method of Widmer obtained values similar to those obtained using 3D computed tomography and was considered accurate (n.s.). All 101 hips were positioned in the set target zone. Among the 101 hips, the cup position in nine hips (8.9%) was changed. The dislocation rate in our study was 1.0% with all dislocations occurring in hips placed in the target zone. The mean Harris hip score after THA in 1 year was 94.2 (82-98).

Conclusions
The method of Widmer was accurate using intraoperative imaging intensifier for the measurement of the anteversion of the acetabular component during THA, with reference to the anteversion obtained from the 3D computed tomography. Also, utilizing intraoperative C-arm imaging was very useful because it allowed for correction of the position of the acetabular cup.
Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study
Authors: Bawoke Giziew , Kejela Segni , Alemayehu Abebe , Bogale Girmaye Tamirat 
Published: October 2021

Abstract
Background
Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries.

Methods
This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent.

Results
A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30–49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5–8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2–14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1–5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3–3.9)). No in-hospital mortality occurred during the course of the study.

Conclusion
Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.
Impact of the Affordable Care Act Medicaid expansion on oral surgery delivery at community health centers: an observational study
Authors: Goldstein Evan V. , Xu Wendy Yi , Seiber Eric E. 
Published: October 2021

AbstractBackgroundUnmet oral health needs routinely affect low-income communities. Lower-income adults suffer a disproportionate share of dental disease and often cannot access necessary oral surgery services. The Affordable Care Act (ACA) Medicaid expansion created new financial opportunities for community health centers (CHCs) to provide mission-relevant services in low-income areas. However, little is understood in the literature about how the ACA Medicaid expansion impacted oral surgery delivery at CHCs. Using a large sample of CHCs, we examined whether the ACA Medicaid expansion increased the likelihood of oral surgery delivery at expansion-state CHCs compared to non-expansion-state CHCs.MethodsExploiting a natural experiment, we estimated Poisson regression models examining the effects of the Medicaid expansion on the likelihood of oral surgery delivery at expansion-state CHCs relative to non-expansion-state CHCs. We merged data from multiple sources spanning 2012–2017. The analytic sample included 2054 CHC-year observations.ResultsCompared to the year prior to expansion, expansion-state CHCs were 13.5% less likely than non-expansion-state CHCs to provide additional oral surgery services in 2016 (IRR = 0.865;P = 0.06) and 14.7% less likely in 2017 (IRR = 0.853;P = 0.02). All else equal, and relative to non-expansion-state CHCs, expansion-state CHCs included in the analytic sample were 8.7% less likely to provide oral surgery services in all post-expansion years pooled together (IRR = 0.913;P = 0.01).ConclusionsMedicaid expansions can provide CHCs with opportunities to expand their patient revenue and services. However, whether because of known dental treatment capacity limitations, new competition, or coordination with other providers, expansion-state CHCs in our study sample were less likely to provide oral surgery services on the margin relative to non-expansion-state CHCs following Medicaid expansion.
Factors associated with prolonged post-operative acute care length of stay in limb amputation patients in Saskatchewan, Canada
Authors: Essien Samuel Kwaku , Zucker-Levin Audrey 
Published: October 2021

Abstract
Background
The effect of predisposing factors on post-operative acute care length of stay (POALOS) after lower extremity amputation (LEA) has been sparsely studied with reports largely focused on major (through/proximal to the ankle) LEA specifically due to diabetes mellitus (DM). Although valuable, the narrow focus disregards the impact of other causes and minor levels (distal to the ankle) of LEA. To address this gap, this study aimed to identify predisposing factors associated with prolonged POALOS after index LEA stratified by amputation level in Saskatchewan.

Methods
The study used Saskatchewan’s provincial linked administrative health data and demographic factors between 2006 and 2019. Amputation levels, identified as major or minor, were derived from the amputation procedure codes. POALOS was calculated by subtracting patients’ intervention date from discharge date, recorded in days, and categorized as short (< 7 days) or prolonged (> 7 days). Multivariable logistic regression was performed to identify predictors associated with prolonged POALOS.

Results
Of the 3123 LEA cases 1421 (45.5%) had prolonged POALOS. The median POALOS for the entire cohort was 7 days (IQR 3 to 16 days); 5 days (IQR 1 to 10 days) for minor LEA and 11 days (IQR 5 to 23 days) for major LEA. Predictors of prolonged POALOS after minor LEA were diabetes (AOR = 2.47, 95% CI: 1.87–3.27) and general surgeon (AOR = 1.52, 95% CI: 1.21–1.91). Minor LEA performed by orthopedic surgeons were half (AOR = 0.49, 95% CI: 0.35–0.70) as likely to experience prolonged POALOS. Predictors of prolonged POALOS after major LEA were diabetes (AOR = 1.34, 95% CI: 1.04–1.71), general surgeon (AOR = 1.91, 95% CI: 1.45–2.49), urban residence (AOR = 1.58, 95% CI: 1.25–1.99), Resident Indian (RI) status (AOR = 1.57, 95% CI: 1.15–2.15), and age with the likelihood of prolonged POALOS after LEA attenuating with increasing age: 35–54 years (AOR = 2.73, 95% CI: 1.56–4.76); 55–69 years (AOR = 2.65, 95% CI: 1.54–4.58); and 70+ years (AOR = 1.81, 95% CI: 1.05–3.11).

Conclusion
This study identified only diabetes and surgical specialty predicted prolonged POALOS after both major and minor LEA in Saskatchewan while residence, RI status, and age were predictors of POALOS after major LEA. These findings shed light on the need for further research to identify confounding factors. It is not clear if general surgeons care for more unplanned, emergent cases with poor entry-level health while specialty surgeons perform more scheduled procedures.
Estimating intervention effectiveness in trials of malaria interventions with contamination
Authors: Multerer Lea , Vanobberghen Fiona , Glass Tracy R. , Hiscox Alexandra , Lindsay Steven W. , Takken Willem , Tiono Alfred , Smith Thomas 
Published: October 2021

Abstract
Background
In cluster randomized trials (CRTs) or stepped wedge cluster randomized trials (SWCRTs) of malaria interventions, mosquito movement leads to contamination between trial arms unless buffer zones separate the clusters. Contamination can be accounted for in the analysis, yielding an estimate of the contamination range, the distance over which contamination measurably biases the effectiveness.

Methods
A previously described analysis for CRTs is extended to SWCRTs and estimates of effectiveness are provided as a function of intervention coverage. The methods are applied to two SWCRTs of malaria interventions, the SolarMal trial on the impact of mass trapping of mosquitoes with odor-baited traps and the AvecNet trial on the effect of adding pyriproxyfen to long-lasting insecticidal nets.

Results
For the SolarMal trial, the contamination range was estimated to be 146 m ($$95\%$$

95
%

credible interval $$[0.052,\,0.923]$$

[
0.052
,

0.923
]

km), together with a $$31.9\%$$

31.9
%

($$95\%$$

95
%

credible interval $$[15.3,\,45.8]\%$$

[
15.3
,

45.8
]
%

) reduction of Plasmodium infection, compared to the $$30.0\%$$

30.0
%

reduction estimated without accounting for contamination. The estimated effectiveness had an approximately linear relationship with coverage. For the AvecNet trial, estimated contamination effects were minimal, with insufficient data from the cluster boundary regions to estimate the effectiveness as a function of coverage.

Conclusions
The contamination range in these trials of malaria interventions is much less than the distances Anopheles mosquitoes can fly. An appropriate analysis makes buffer zones unnecessary, enabling the design of more cost-efficient trials. Estimation of the contamination range requires information from the cluster boundary regions and trials should be designed to collect this.
The contributions of public health policies and healthcare quality to gender gap and country differences in life expectancy in the UK
Authors: Allel Kasim , Salustri Franceso , Haghparast-Bidgoli Hassan , Kiadaliri Ali 
Published: October 2021

Abstract
Background
In many high-income countries, life expectancy (LE) has increased, with women outliving men. This gender gap in LE (GGLE) has been explained with biological factors, healthy behaviours, health status, and sociodemographic characteristics, but little attention has been paid to the role of public health policies that include/affect these factors. This study aimed to assess the contributions of avoidable causes of death, as a measure of public health policies and healthcare quality impacts, to the GGLE and its temporal changes in the UK. We also estimated the contributions of avoidable causes of death into the gap in LE between countries in the UK.

Methods
We obtained annual data on underlying causes of death by age and sex from the World Health Organization mortality database for the periods 2001–2003 and 2014–2016. We calculated LE at birth using abridged life tables. We applied Arriaga’s decomposition method to compute the age- and cause-specific contributions into the GGLE in each period and its changes between two periods as well as the cross-country gap in LE in the 2014–2016 period.

Results
Avoidable causes had greater contributions than non-avoidable causes to the GGLE in both periods (62% in 2001–2003 and 54% in 2014–2016) in the UK. Among avoidable causes, ischaemic heart disease (IHD) followed by injuries had the greatest contributions to the GGLE in both periods. On average, the GGLE across the UK narrowed by about 1.0 year between 2001–2003 and 2014–2016 and three avoidable causes of IHD, lung cancer, and injuries accounted for about 0.8 years of this reduction. England & Wales had the greatest LE for both sexes in 2014–2016. Among avoidable causes, injuries in men and lung cancer in women had the largest contributions to the LE advantage in England & Wales compared to Northern Ireland, while drug-related deaths compared to Scotland in both sexes.

Conclusion
With avoidable causes, particularly preventable deaths, substantially contributing to the gender and cross-country gaps in LE, our results suggest the need for behavioural changes by implementing targeted public health programmes, particularly targeting younger men from Scotland and Northern Ireland.
Prevalence, characteristics, and distribution of HPV genotypes in women from Zhejiang Province, 2016–2020
Authors: Yan Xiaotian , Shen Lingwei , Xiao Yufei , Wang Qi , Li Fugang , Qian Yun 
Published: October 2021

Abstract
Objective
To evaluate and understand the prevalence of HPV genotypes and characteristics of female populations in specific areas and the relationship with cervical lesions, which can effectively guide cervical cancer screening and formulate HPV vaccine prevention strategies.

Methods
A total of 77,443 women who visited gynecological clinics and underwent health examinations in the Second Affiliated Hospital of Zhejiang University School of Medicine during 2016–2020 were enrolled in this survey. Cervical samples were collected for HPV DNA genotyping and cervical cytology testing. Cervical biopsies were performed for patients with visible cervical abnormality or abnormal cytological results.

Results
The results showed the 5-year overall positive rate was 22.3%, of which the gynecology clinic group had significantly more positive results compared with the health examination group (P < 0.001). The five most common genotypes in Zhejiang Province were HPV 52, 58, CP8304, 16, and 51 (23.9%, 12.7%, 11.7%, 11.7% and 9.3%). HPV infection was age-specific, with the highest infection rate in the age group ≤ 20 compared to other age groups (P < 0.001). HPV infection was also season-specific, with the highest infection rate in spring or winter. The main HPV infection mode was single infection (P = 0.004), but patients ≤ 20 years old were more likely to develop multiple infections (51.0%). HPV 16, 52 and 58 were the main genotypes that caused cytological abnormalities and HPV16, 18, 56, 58 and 66 were independent risk factors for cervical lesions (OR = 2.352, 1.567, 2.000, 1.694, 1.889; all P < 0.05). Further analysis found HPV 16 and 18 were the main genotypes that cause cervical cancer histological abnormalities and were independent risk factors for cervical cancer (OR = 5.647, P < 0.001; OR = 3.495, P = 0.036).

Conclusion
This article analyzed the prevalence of distribution characteristics of HPV infection and revealed the corelation between HPV infection and cytological and histological abnormalities. Comprehensive results of this survey will help Zhejiang Province to formulate public health policies and provide evidence for future selection of specific HPV vaccines.