bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021
Authors: Lomas J , Brown N , Fitzpatrick J , Fryers P , Barnard S 
Published: October 2021

Abstract

Background
Assessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics.

Methods
The study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time.

Results
Preliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect.

Conclusions
The burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events.

Key messages
Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups. COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.
A scoping review of the EU's impact on access to medicines in low- and middle-income countries
Authors: Perehudoff K , Durán C , Demchenko I , Mazzanti V , Parwani P , Suleman F , de Ruijter A 
Published: October 2021

Abstract

The European Union (EU) has a potential major influence on patients' global access to medicines. Historically, this influence most notably came through the EU's trade and aid agendas that intentionally targeted foreign markets. Now, the EU's own internal pharmaceutical policy appears to indirectly shape global access to medicines (ex. EU's large-scale Covid-19 vaccine procurement and export bans). To understand the ways the EU's internal and external policies impact on global access to medicines, this Scoping Review synthesises evidence of the EU's global regulatory influence and its impacts on access to medicines in non-EU low- and middle-income countries (LMICs). By searching 8 databases and grey literature, documents published in English, Spanish, Portuguese, or Russian between 1995-2021 that addressed an EU law, regulation, or policy in relation to access to medicines in LMICs were included. This review identifies three mechanisms through which EU action impacts on medicines in LMICs. One, the EU's external, treaty-based agreements with LMICs can affect their pharmaceutical trade, sales, and use. Two, EU's internal market regulation, standards, and methods are used as models or sources of inspiration for pharmaceutical governance in LMICs. Three, ‘soft' forms of EU influence manifest through the EU's technical assistance, its research and development (aid) funding, and its ‘capacity building' activities towards LMIC actors in the field of pharmaceuticals. Examples of impacts of EU action ranged from the development of new medicines primarily for LMICs, to changes in the availability of generics and on medicines spending in LMICs, and the potential for a more efficient yet less autonomous local market approval process. Most evidence of impact was not peer reviewed. This study raises the question of how to support resilient and efficient global pathways for drug development and regulation while still being responsive and accountable to the local public interest.

Key messages
There are 3 mechanisms through which EU action impacts on medicines in LMICs: treaty-based agreements, EU internal market regulation, and ‘soft' EU influence. EU decision makers need a reliable understanding of how the EU’s internal and external policies impact on pharmaceuticals globally.
In Silico Preliminary evaluation of Cx601 as new therapeutic approach in hospital clinical paths
Authors: Rubba F , Luglio G , Castiglione F , Rispo A , Tropeano FP , Pagano G , Vozzella EA , De Palma GD 
Published: October 2021

Abstract

Crohn's disease is a chronic inflammatory bowel disease characterized by transmural inflammation and fistula formation. Perianal fistulas are a common complication of Crohn's disease and are estimated to affect up to 28% of patients in the first two decades after diagnosis, particularly those with colonic disease and rectal involvement. Complex perianal fistulas in Crohn's disease are challenging to treat, severely impair patients' quality of life and cause substantial morbidity. Allogeneic, expanded, adipose-derived stem cells (Cx601) are a promising new therapeutic approach, although their high cost is often discouraging. We aimed at assessing the safety and efficacy of this treatment in patients with complex perianal fistulas in patients with Crohn's disease. Therefore, we conducted a meta-analysis in order to evaluate this new therapeutic approach before introducing it as standard of care. We examined 8 studies published in the last 10 years, 5 of which were selected for the final analysis. The primary outcome assessed was the combined fistula remission (clinical + imaging) assessed through the clinical examination and MRI, the control being the traditional medical strategies (ie, antibiotics, immunomodulators and anti-tumour necrosis factor agents). We registered a total of 128 events (lack of remission) in the control group vs 94 in the experimental one (Confidence Interval for OR of 0,12-0,31, P &lt; 0,001). Our “in silico” assessment is reliable, being the introduction of (Cx601) an innovative and effective treatment. Further insights will be provided by the INSPIRE registry, a multinational post-marketing study whose main objective is the evaluation of the real-world clinical effectiveness and safety of (Cx601) in patients affected by Crohn's disease with complex perianal fistulas for a duration of 36 months, to which our University “Federico II” is actively taking part.

Key messages
Disability reduction is an important goal in cronh therapeutic path of care. Our “in silico” assessment may support the introduction of (Cx601) an innovative and effective treatment.
Health Technology Assessment for COVID19: an approach for the Horizon Scanning of health innovations
Authors: Cadeddu C , Ruggeri M , Roazzi P , Mandolini D , Grigioni M , Marchetti M 
Published: October 2021

Abstract

Background
The COVID-19 pandemic definitely changed the approach to technologies evaluation, firstly in terms of timeliness. In order to answer to this need, a new methodology was proposed, joining the elements of horizon scanning with the Multi-Criteria Decision Analysis (MCDA). In this work we describe the results of 2 case studies of application.

Methods
By means of an assessment matrix, a multidisciplinary expert panel gave a score based on a Likert scale and related to potential value and perceived risk for each technology. Economic, clinical and ethical criteria were considered as a summary of Health Technology Assessment (HTA) main domains. The final scores were then weighted by the MCDA and a scatter plot defined 4 positioning scenarios according to the balance of values and risks resulted, each conducting to an appropriate recommendation (full HTA report or reject). A Monte Carlo simulation was also carried out for the assessment of variability of results.

Results
An individual protection device for COVID-19 and a contact tracing app were assessed. The first technology was placed in the “Danger Zone” of the graph, because of its high costs and organizational complexity. The second one was placed in the “Comfort Zone” of the graph, due to low costs and easiness of implementation and management. For this innovation a recommendation for a full HTA and a pilot testing was given. In both cases, the Monte Carlo simulation confirmed the results of previous analyses.

Conclusions
The implementation of this new tool presented for the large amount of innovations created in response to COVID-19 could be supportive for decision makers, especially in pandemic times when a rapid answer is necessary. Improvements in the subjective judgement process, by introducing an objective approach, is now ongoing as it could enhance the strength of the final decision.

Key messages
In a pandemic time as the current, HTA should be as rapid as possible without losing scientific robustness. The methodology described could be an answer in support to the decision-making process, allowing an adequate and quick priority setting.
Tumescent liposuction for lipoedema: A systematic review of clinical effectiveness and safety
Authors: Walter M , Goetz G , Gassner L 
Published: October 2021

Abstract

Background
Tumescent liposuction is an established method for surgical therapy of lipoedema - a chronic, progressive, and painful fat distribution disorder. We aimed to assess the clinical effectiveness and safety of liposuction in patients with lipoedema (stage I-III) compared to any conservative treatment, concerning patient-relevant outcomes, such as reduction of pain, reduction in the size of extremities, improvement in quality of life (QoL), and safety events.

Methods
A systematic review was conducted, and five databases were searched. In-/exclusion criteria were predefined according to the PICOS scheme. The internal validity of the included studies was assessed using the IHE checklist; strength of evidence for safety outcomes by the GRADE approach.

Results
Six prospective uncontrolled trials (467 patients) were included for assessment of clinical effectiveness. Pain outcomes (patient-reported) statistically significantly improved at six-months follow-up and up to 12 years after liposuction (six studies). Reduced sizes of patients' extremities before-and-after liposuction were reported in three studies regarding reduced leg volume and circumference of lower extremities. Statistically significant improvements in lipoedema-related QoL outcomes were reported in four studies. Seventeen post-operative adverse events occurred overall (492 patients, one additional retrospective study), including five serious adverse events. Other reported procedure-related adverse events comprise, e.g., post-operative wound infections and bleedings. Studies were judged with moderate/high risk of bias. Strength of evidence for safety outcomes was judged to be very low.

Conclusions
The current evidence is insufficient to prove that tumescent liposuction as safe as und more effective than conservative therapy for lipoedema. However, based on the limited evidence of the included uncontrolled studies, liposuction may potentially reduce lipoedema-associated clinical symptoms and improve the QoL.

Key messages
Based on the limited evidence of identified uncontrolled studies, liposuction may potentially reduce lipoedema-associated clinical symptoms and improve the quality of life of affected females. High-quality comparative studies need to be awaited. The results may support and influence the effect estimates considerably.
Implementation of Mental adjustment to cancer scale in psycho-oncology practice in Bulgaria
Authors: Tzvetkova S , Tschilingirova N 
Published: October 2021

Abstract

Background
Theoretically there are several insufficiently confirmed statements based on evidences that underline the important role of psychological assistance to patients with malignant neoplasms. Since April, 2021, Mental Adjustment to Cancer Scale (MAC) is translated into Bulgarian and it was introduced to psycho-oncologic practice in Bulgaria.

Methods
The concise variant of MAC - Mini Mental Adjustment to Cancer Scale (Mini-MAC) has been implemented evaluating the degree when the patients perceive their adaptation to the diagnosis and cancer treatment. It comprises 29 items and measures four inner scales: determination, helplessness, anxiety, cognitive negligence and fatalism. It has been applied in compliance with strict confidentiality, voluntary principle and objectivity to 30 patients - 14 male and 16 female.

Results
MAC scales have good consistency - alpha coefficient from 0.56 to 0.74. The age correlates moderately with disease type (r=.35, p = 0.05). Helplessness is in positive relation to anxiety (r=.63, p = 0.000) and fatalism (r=.30, p = 0.05), and in negative one to determination (r=-.35, p = 0.05). The determination is in statistic positive relation to cognitive negligence (r=.44, p = 0.02).

Conclusions
The malignant disease type does not influence the scale results. They are influenced by inner factors as morbid experience, sensitivity to the disease, psychological protections that are frequently demonstrated by cognitive negligence and determination. MAC has been successfully implemented in the clinical psychological counseling in Bulgaria.

Key messages
Mental Adjustment to Cancer Scale identifies patients' adaptation to cancer and is introduced in Bulgaria. The methodology shows the established cognitive mechanisms for personal understanding and behavior in the course of treatment.
Suberosis at Public Health Unit (PHU) of Santa Maria da Feira/Arouca (F/A) (Portugal)
Authors: Fernandes D , Paiva Monteiro G , Barroso Travassos S , Miguel Carvalho J 
Published: October 2021

Abstract

Introduction
Santa Maria da Feira (SMF) is currently one of the largest producers of cork in Portugal. Suberosis is an occupational disease of workers in the cork processing industry, associated with repeated exposure to moldy cork dust, usually presenting itself as a disease of the pulmonary interstitium (Hypersensitivity Pneumonitis). This study aims to assess the impact of occupational health interventions on the cork industry, in terms of health promotion and risk prevention.

Methods
We assessed 10 different cork companies distributed in 10 parishes of SMF.

Results
With regard to health promotion, we highlight the development of healthy workplaces and the strong commitment to training health professionals with regard to the correct use of personal protective equipment (PPE). Regarding the prevention of risks, emphasis is placed on the two areas that imply greater professional risks: storage and the process of drilling and boring. The storage of cork is done most of the time in dark and humid places, providing ideal conditions for the development of mold and the process of drilling and boring exposes workers to large amounts of moldy cork dust. In these settings, investing in PPE namely protective gloves and mask, as well as collective prevention measures, namely effective ventilation systems and regular control of humidity conditions, are essential to health protection of workers.

Conclusions
SMF has a prevalence of Suberosis well above the national average. In order to respond to this issue, the cork industry must reinforce the investment in terms of PPE, with the use of uniform, cuffs, safety shoes and visor, variable with the specific production process. In terms of collective protection, the signaling of the main hazards and the information available in the workstations regarding mandatory/recommended PPE, isolation of the areas with the most dangerous tasks as well as the maximum possible turnover between tasks are essential in terms of Occupational Health.

Key messages
Suberosis is an occupational disease of workers in the cork industry, associated with repeated exposure to moldy cork dust, usually presenting itself as a disease of the pulmonary interstitium. The development of healthy workplaces, the correct use of PPE and the investment in effective ventilation systems and control of humidity, are essential to health protection of cork workers.
Occupational prestige and sickness absence inequality in Sweden: a registry-based study
Authors: Nwaru C , Berglund T , Hensing G 
Published: October 2021

Abstract

Background
Socioeconomic position has been linked to sickness absence (SA). However, less is known about the role of occupational prestige, a measure of social status afforded by one's occupation, in SA. To expand knowledge on socioeconomic determinants of SA and on gender differences in SA, this study aimed to investigate the association between occupational prestige and SA and the distribution of the association in women and men. The study also aimed to analyze the effects of intersections of gender and occupational prestige on SA.

Methods
The study was based on data of 97 397 employed individuals aged 25-59 years selected from the 2004, 2007 and 2010 waves of the Swedish Labour Force Survey. Baseline occupational prestige was measured with the Standard International Occupational Prestige Scale. Information on SA was retrieved from the national register. Two measures of SA were defined: the number of SA days in any particular year during a 3-year follow-up and long-term (&gt;120 days) SA based on data of participants with at least one sick leave spell during the follow-up.

Results
Working in lower prestige occupations was associated with increased SA among women and men. The association was independent of other socioeconomic indicators, such as income, education, and occupational class. In the intersectional analysis, women regardless of prestige level and men in lower prestige occupations had higher probability of SA compared with men in high prestige occupations. Women in high prestige occupations had the highest absenteeism rates (IRR, 2.25, 95%CI, 2.20-2.31), while men in medium prestige occupations had the lowest rates (IRR, 1.17, 95%CI, 1.13-1.20). Compared with the rest of the groups, men in low and medium prestige occupations had higher odds for long-term absence.

Conclusions
Women, regardless of occupational prestige level, and men in lower occupational prestige had an increased risk of sickness absence.

Key messages
Occupational prestige was associated with sickness absence in women and men. There is need to pay close attention to occupational prestige as a factor that may influence health and labor market participation.
Can a UV-C box help cinema industry by hygienizing video-cameras?
Authors: Messina G , Limaj S , Amodeo D , De Palma I , Petri C , Cevenini G 
Published: October 2021

Abstract

Background
UV-C has proven to be an effective microbiocide method for disinfecting objects in domestic and work environments. Aim of this study was to test the biocidal efficiency of an UVC box on a real video-camera.

Methods
In February 2021, a descriptive study on a parallelepiped-shaped UVC box, produced by Cartoni S.p.a., was conducted at the University of Siena. The box has 10 UV-C lamps (254 nm at 0.9 Watt/each) and all six mirrored reflective walls. It was specifically engineered for disinfecting equipments for film makers. A real professional camera was used to assess the level of disinfection. Contamination was obtained inoculating 1.5x107CFU/mL of S. Aureus ATCC 43300 on five 20 cm2 plastic carriers positioned in five different spots (referred as spots A, B, C, D, E), both directly (spot A), and indirectly (by reflected light, spots B, C, D, E) exposed to a UV-C light source. After a cycle of 3 minutes' exposition to UV-C: all carriers were transferred on empty Petri dishes; 10 mL D/E medium was added, transferred into a 50 ml Falcon and spun for 40 minutes at 4500 rpm; the supernatant was then removed and 100 µl of it was incubated into a Petri dish (with a generic growth medium) at 36 °C for 48 h. The experiment was run in triplicate. The mean logarithmic reduction and its 95% confidence interval were calculated from the replicates data and compared with positive controls (1.5x107CFU/mL).

Results
Mean logarithmic reduction compared to positive control was in spot A: 6.33 log10(C.I. 5.90-6.75), spot B: 4.74 log10(C.I. 4.11-5.33), spot C: 4.83 log10(C.I. 4.75-4.91), spot D: 4.89 log10(C.I. 4.12-5.65), spot E: 5.00 log10(C.I. 4.79-5.21).

Conclusions
These experiments showed that after 3 minutes of UV-C exposure there is a significant reduction in the bacterial load, 4 to 6 log10 (99.99% to 99.9999% reduction), on the carriers. The results also highlight the ability of the UV-C box to disinfect all infected spots, including those irradiated by reflected light.

Key messages
UV-C Box devices are effective in decreasing bacterial contamination on shared work tools in cinema industries, regardless of the direct or indirect exposition to the UV-C source. UV-C box's speed in hygienizing shared work tools can help cinema industry professionals to work in a safer and cleaner environment.
What motivates patients to change general practitioners in the Pleven region, Bulgaria?
Authors: Karcheva M , Vasileva B 
Published: October 2021

Abstract

Problem
The World Health Organization's 2008 World Health Report, entitled ‘Primary care now more than ever,' clearly states the need of knowledge about primary care not as one of the ordinary structures of the national health system, but as its leading priority.

Description of the problem
Since the start of health reform in Bulgaria, the choice and change of a GP by patients is most often spontaneous, random, and without enough specific information about the qualities of the GP. This reduces the effectiveness of the free choice of a doctor. The purpose of this study was to analyze the patient's motives for changing their GP. A survey was conducted among respondents in the period from September 1st to 30th, 2018 in the Pleven Region, Bulgaria. Patients who visited their GPs during the study period were interviewed. The results were processed using Microsoft Office Excel 2007.

Results
It was established that 830 (78.8%) of the 1053 respondents in the territory of Pleven Region have changed their personal doctor. The three leading motives were: long waiting times in front of the GP's office - 30.2%, change of residence - 19%, and lack of sufficient referrals from a physician to the specialist - 11.7%. Most of the surveyed patients assessed their GP as having a positive attitude toward them. 132 (12.6%) of the participants rate their personal doctor as rude, always being in a hurry, and nervous or not giving them any answers at all.

Lessons
When choosing a GP, the patient's prior information about the qualities and competencies of the personal physician of his\her choice is very low. It is necessary to create a system for the informed choice of a personal physician which will have a double effect, 1) a more adequate and more critically justified choice of a GP by the patient, and 2) a clearer, more stable commitment and responsibility of the GPs to the patients who chose them.

Key messages
It is necessary to improve the overall organization of the work of GPs. Healthcare is a type of interaction between the doctor and the patient during the diagnostic and treatment process.