bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study
Authors: Chen Xiaohua , Zha Shun , Shui Tie-Jun 
Published: November 2021

Background
Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis.

Methodology/Principal findings
In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms.

Conclusions
Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.
Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic
Authors: Johnson Claire , Dupuis Jérémie B. , Goguen Pierre , Grenier Gabrielle 
Published: November 2021

Background
During the COVID-19 pandemic, telehealth technologies were used in the primary health care setting in New Brunswick as a means to continue providing care to patients while following public health guidelines. This study aimed to measure these changes and examine if they improved timely access to primary care. A secondary goal was to identify which telehealth technologies were deemed sustainable by primary care providers.

Methods
This was a comparative study on the use of telehealth technology before and during the COVID-19 pandemic. Between April 2020 and November 2020, 114 active primary care providers (family physicians or nurse practitioners) responded to the online survey.

Results
The findings illustrated an increase in the use of telehealth technologies. The use of phone consultations increased by 122%, from 43.9% pre-pandemic to 97.6% during the pandemic (p < 0.001). The use of virtual consultation (19.3% pre-pandemic vs. 41.2% during the pandemic, p < 0.001), emails and texts also increased during the pandemic. Whereas the more structural organizational tools (electronic medical charts and reservation systems) remained stable. However, those changes did not coincide with a significant improvement to timely access to care during the pandemic. Many participants (40.1%) wanted to keep phone consultations, and 21.9% of participants wanted to keep virtual consultations as part of their long-term practice.

Interpretation
The observed increase in the use of telehealth technologies may be sustainable, but it has not significantly improved timely access to primary care in New Brunswick.
Comprehensive occupational health services for healthcare workers in Zimbabwe during the SARS-CoV-2 pandemic
Authors: Kavenga Fungai , Rickman Hannah M. , Chingono Rudo , Taruvinga Tinotenda , Marembo Takudzwa , Manasa Justen , Marambire Edson , McHugh Grace , Gregson Celia L. , Bandason Tsitsi , Redzo Nicol , Maunganidze Aspect , Magure Tsitsi , Ndhlovu Chiratidzo , Mujuru Hilda , Rusakaniko Simbarashe , Manangazira Portia , Ferrand Rashida A. , Kranzer Katharina 
Published: November 2021

Background
Healthcare workers are disproportionately affected by COVID-19. In low- and middle- income countries, they may be particularly impacted by underfunded health systems, lack of personal protective equipment, challenging working conditions and barriers in accessing personal healthcare.

Methods
In this cross-sectional study, occupational health screening was implemented at the largest public sector medical centre in Harare, Zimbabwe, during the “first wave” of the country’s COVID-19 epidemic. Clients were voluntarily screened for symptoms of COVID-19, and if present, offered a SARS-CoV-2 nucleic acid detection assay. In addition, measurement of height, weight, blood pressure and HbA1c, HIV and TB testing, and mental health screening using the Shona Symptom Questionnaire (SSQ-14) were offered. An interviewer-administered questionnaire ascertained client knowledge and experiences related to COVID-19.

Results
Between 27th July and 30th October 2020, 951 healthcare workers accessed the service; 210 (22%) were tested for SARS-CoV-2, of whom 12 (5.7%) tested positive. Clients reported high levels of concern about COVID-19 which declined with time, and faced barriers including lack of resources for infection prevention and control.
There was a high prevalence of largely undiagnosed non-communicable disease: 61% were overweight or obese, 34% had a blood pressure of 140/90mmHg or above, 10% had an HbA1c diagnostic of diabetes, and 7% had an SSQ-14 score consistent with a common mental disorder. Overall 8% were HIV-positive, with 97% previously diagnosed and on treatment.

Conclusions
Cases of SARS-CoV-2 in healthcare workers mirrored the national epidemic curve. Implementation of comprehensive occupational health services during a pandemic was feasible, and uptake was high. Other comorbidities were highly prevalent, which may be risk factors for severe COVID-19 but are also important independent causes of morbidity and mortality. Healthcare workers are critical to combatting COVID-19; it is essential to support their physical and psychological wellbeing during the pandemic and beyond.
Differentiating transient from persistent diabetic range hyperglycemia in a cohort of people completing tuberculosis treatment in Dhaka, Bangladesh
Authors: Alkabab Yosra M. A. , Biswas Samanta , Ahmed Shahriar , Paul Kishor , Nagajyothi Jyothi , Banu Sayera , Heysell Scott 
Published: November 2021

Background
In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment.

Methods
Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion.

Results
429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23–26.04, p<0.05).

Conclusion
HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.
Changes in choroidal vascular structure from vitreoretinal lymphoma and the intraocular cytokine level associated with clinical resolution after intravitreal methotrexate treatment
Authors: Kim Rae-Young , Park Jae Hyun , Kim Mirinae , Park Young-Geun , Cho Seok-Goo , Park Young-Hoon 
Published: November 2021

Purpose
To evaluate changes in choroidal vascular structure and aqueous cytokine levels in eyes with vitreoretinal lymphoma (VRL) after intravitreal methotrexate (MTX) treatment.

Methods
In this retrospective study, VRL patients who visited our hospital between October 2018 and July 2020 were reviewed. Aqueous samples were obtained before treatment and at clinical resolution after intravitreal MTX therapy. Interleukin (IL)-6 and IL-10 levels and the IL-10-to-IL-6 ratio were evaluated. Swept-source optical coherence tomographic images were obtained along with the aqueous samples. Subfoveal choroidal thickness (SFCT), total vascular area of the choroid (TCA), stromal area (SA), luminal area (LA), and choroidal vascularity index (CVI) were assessed.

Results
Twelve patients were enrolled (female:male—5:7). The mean age (± standard deviation) at diagnosis was 60.9±8.5 years. In the 16 eyes diagnosed with VRL, values of SFCT, TCA, LA, and SA significantly decreased after treatment (all p-values <0.05). Additionally, the aqueous cytokine IL-10 level and IL-10-to-IL-6 ratio were significantly decreased (p = 0.001 and p = 0.003, respectively). The choroidal structure in the non-treated fellow eyes did not show any significant difference. There were no further changes in SFCT, TCA, LA, or CVI that occurred during maintenance therapy. For clinical remission, the patients received 7.7±5.5 intravitreal MTX injections. The required number of injections for clinical remission was positively correlated with best-corrected visual acuity, IL-10, and IL-6 levels in the active phase (p = 0.035, p = 0.009, and p = 0.031, respectively).

Conclusion
Eyes with active VRL exhibited choroidal thickening with increased vascular and stromal areas that decreased after remission following MTX treatment. Higher aqueous IL-10 and IL-6 levels and lower visual acuity in the active phase may indicate the number of injections required for remission; this should be considered in the treatment of patients with VRL.
Improving patient flow during infectious disease outbreaks using machine learning for real-time prediction of patient readiness for discharge
Authors: Bishop Jennifer A. , Javed Hamza A. , el-Bouri Rasheed , Zhu Tingting , Taylor Thomas , Peto Tim , Watkinson Peter , Eyre David W. , Clifton David A. 
Published: November 2021

Background
Delays in patient flow and a shortage of hospital beds are commonplace in hospitals during periods of increased infection incidence, such as seasonal influenza and the COVID-19 pandemic. The objective of this study was to develop and evaluate the efficacy of machine learning methods at identifying and ranking the real-time readiness of individual patients for discharge, with the goal of improving patient flow within hospitals during periods of crisis.

Methods and performance
Electronic Health Record data from Oxford University Hospitals was used to train independent models to classify and rank patients’ real-time readiness for discharge within 24 hours, for patient subsets according to the nature of their admission (planned or emergency) and the number of days elapsed since their admission. A strategy for the use of the models’ inference is proposed, by which the model makes predictions for all patients in hospital and ranks them in order of likelihood of discharge within the following 24 hours. The 20% of patients with the highest ranking are considered as candidates for discharge and would therefore expect to have a further screening by a clinician to confirm whether they are ready for discharge or not. Performance was evaluated in terms of positive predictive value (PPV), i.e., the proportion of these patients who would have been correctly deemed as ‘ready for discharge’ after having the second screening by a clinician. Performance was high for patients on their first day of admission (PPV = 0.96/0.94 for planned/emergency patients respectively) but dropped for patients further into a longer admission (PPV = 0.66/0.71 for planned/emergency patients still in hospital after 7 days).

Conclusion
We demonstrate the efficacy of machine learning methods at making operationally focused, next-day discharge readiness predictions for all individual patients in hospital at any given moment and propose a strategy for their use within a decision-support tool during crisis periods.
Predictors of return to work among women with long-term neck/shoulder and/or back pain: A 1-year prospective study
Authors: Rashid Mamunur , Kristofferzon Marja-Leena , Nilsson Annika 
Published: November 2021

Background
Sick leave due to musculoskeletal pain, particularly in the neck/shoulders and back, is one of the major public health problems in Western countries such as Sweden. The aim of this study was to identify predictors of return to work (RTW) among women on sick leave due to long-term neck/shoulder and/or back pain.

Methods
This was a prospective cohort study with a 1-year follow-up. The study participants were recruited from a local Swedish Social Insurance Agency register and had all been on sick leave for ≥ 1 month due to long-term (≥ 3 months) neck/shoulder and/or back pain. Data on predictors and outcome were collected using a self-administered questionnaire. A total of 208 women aged 23–64 years were included at baseline, and 141 responded at the 1-year follow-up. Cluster analyses were performed to identify one predictor from each cluster for use in the regression model.

Results
At the 1-year follow-up, 94 of the 141 women had RTW and 47 had not. Women who engaged in more coping through increasing behavioral activities (OR: 1.14, 95% CI: 1.03–1.25) and those who more strongly believed they would return to the same work within 6 months (OR: 1.22, 95% CI: 1.10–1.37) had an increased probability of RTW. Receiving more social support outside work (OR: 0.50, 95% CI: 0.28–0.92) decreased the odds of RTW at the 1-year follow-up.

Conclusions
Behavioral activities, beliefs about returning to the same work, and social support outside work were predictors of RTW at the 1-year follow-up. Healthcare professionals should consider these predictors in their efforts to prevent prolonged sick leave and to promote RTW in this population.
D1/D5 Dopamine Receptors and mGluR5 Jointly Enable Non-Hebbian Long-Term Potentiation at Sensory Synapses onto Lamina I Spinoparabrachial Neurons
Authors: Li Jie , Price Theodore J. , Baccei Mark L. 
Published: November 2021

Highly correlated firing of primary afferent inputs and lamina I projection neurons evokes synaptic long-term potentiation (LTP), a mechanism by which ascending nociceptive transmission can be amplified at the level of the spinal dorsal horn. However, the degree to which neuromodulatory signaling shapes the temporal window governing spike-timing-dependent plasticity (STDP) at sensory synapses onto projection neurons remains unclear. The present study demonstrates that activation of spinal D1/D5 dopamine receptors (D1/D5Rs) creates a highly permissive environment for the production of LTP in male and female adult mouse spinoparabrachial neurons by promoting non-Hebbian plasticity. Bath application of the mixed D1/D5R agonist SKF82958 unmasked LTP at STDP pairing intervals that normally fail to alter synaptic efficacy. Furthermore, during D1/D5R signaling, action potential discharge in projection neurons became dispensable for LTP generation, and primary afferent stimulation alone was sufficient to induce strengthening of sensory synapses. This non-Hebbian LTP was blocked by the D1/D5R antagonist SCH 39166 or genetic deletion of D5R, and required activation of mGluR5 and intracellular Ca2+release but was independent of NMDAR activation. D1/D5R-enabled non-Hebbian plasticity was observed across multiple neuronal subpopulations in the superficial dorsal horn but was more prevalent in spinoparabrachial neurons than interneurons. Interestingly, the ability of neonatal tissue damage to promote non-Hebbian LTP in adult projection neurons was not observed in D5R knock-out mice. Collectively, these findings suggest that joint spinal D1/D5R and mGluR5 activation can allow unfettered potentiation of sensory synapses onto the output neurons responsible for conveying pain and itch information to the brain.SIGNIFICANCE STATEMENTSynaptic LTP in spinal projection neurons has been implicated in the generation of chronic pain. Under normal conditions, plasticity at sensory synapses onto adult mouse spinoparabrachial neurons follows strict Hebbian learning rules, requiring coincident presynaptic and postsynaptic firing. Here, we demonstrate that the activation of spinal D1/D5Rs promotes a switch from Hebbian to non-Hebbian LTP so that primary afferent stimulation alone is sufficient to evoke LTP in the absence of action potential discharge in projection neurons, which required joint activation of mGluR5 and intracellular Ca2+release but not NMDARs. These results suggest that D1/D5Rs cooperate with mGluR5 receptors in the spinal dorsal horn to powerfully influence the amplification of ascending nociceptive transmission to the brain.
Social justice in education from the perspective of the Roma in the Czech Republic – A case study
Authors: Levínská Markéta , Bittnerová Dana 
Published: November 2021

AbstractThis paper addresses the current educational rights of the Roma community (in the Czech Republic). The aim of the paper is to present the educational system, its advantages and disadvantages and the ways in which the legal system supports educational rights. The second part of the paper focuses on the exercising and negotiation of rights in the contemporary social context. The work is based on ethnographic research conducted since 2005 by the Levínská, Bittnerová, & Doubek team in socially excluded localities. The data analysis is based on the theoretical concept of cognitive anthropology and the cultural models theory (D’Andrare, & Strauss, 1992). Cultural models and the ways in which parents, students and teachers negotiate rights are presented. The tension between rationality and morality (Bateson, 1958) is demonstrated by the models’ endurance; communication, cognitive and material support; and independence. Although the system itself provides equal opportunities, the prospects that education affords are a fundamental problem. One obstacle is racial bias, which influences members of the dominant group. Another significant obstacle is poverty and the costs of higher education, which are beyond the financial capacity of poor families. A third obstacle is knowledge, which is insufficient in excluded localities and poor families, and that families are unable to give students adequate support in navigating the full scope of student responsibilities.
SAĞLIK ÇALIŞANLARINA YÖNELİK ŞİDDET VE İLİŞKİLİ FAKTÖRLER: ARAŞTIRMA UYGULAMA HASTANESİ ÖRNEĞİ
Authors: BATMAZ Kıymet , USKUN Ersin , AYDIN Gamze 
Published: November 2021

Amaç
Bu çalışmada bir Araştırma ve Uygulama Hastanesi’nde
çalışan sağlık personelinin şiddet ile karşılaşma
sıklığı ve ilişkili etmenlerin saptanması amaçlanmıştır.
Gereç ve Yöntem
Örneklem seçilmeden Süleyman Demirel Üniversitesi
Araştırma ve Uygulama Hastanesi’nde çalışan tüm
sağlık personeli çalışma kapsamına alınmış, 481 personele
(%70.6) ulaşılmıştır. Verilerin toplanmasında
Şiddet Olay Formu’ndan (The Violent Incident Form-
VIF) faydalanılmıştır. İstatistiksel değerlendirmede tanımlayıcı
istatistikler ve ki-kare testi kullanılmıştır.
Bulgular
Çalışanların %30.2 ’sinin meslek hayatlarının herhangi
bir döneminde şiddete uğradığı; son bir yıl içinde
şiddete uğrayanların ise %19.6 olduğu tespit edildi.
Saldırganların büyük çoğunluğu hasta (%58.7) ve
hasta yakınlarından (%60.2) oluşmaktaydı ve %75.5’i
erkekti. Şiddete maruz kalanların olaydan sonra
%19.6’sı tepki vermezken; sadece %16.1’i şikâyetçi
olmuştu. Beyaz kod uygulamasını 474 sağlık çalışanının
sadece %11.8’inin doğru olarak bildiği tespit edildi.
Şiddet sonrası %68.5’inin nereye başvurulacağını
ya hiç bilmediği ya da eksik/yanlış bildiği tespit edildi.
Şiddete uğradıktan sonra %30.1’i işi bırakmayı düşünmüştü
ve sadece %22.4’ü şikâyetçi olmuştu. Şiddete
uğrayan 143 sağlık çalışanının sadece %5.6’sı
darp raporu almış; sadece 1 (%0.7) olayda şiddet nedeniyle
iş kazası raporu alınmıştı.
Sonuç
Her 3 sağlık çalışanından birinin meslek hayatının bir
döneminde şiddete maruz kaldığı, maruziyetin kadın
sağlık çalışanlarında anlamlı yüksek olduğu görülmüştür.
Şiddet olaylarının ülke genelinde ve çalışılan
kurumda arttığını düşünmenin, şiddet olayına şahit
olma ve hasta hakları birimine şikâyet edilmenin sağlık
çalışanlarının şiddete uğrama riskini arttırdığı tespit
edilmiştir. Buna karşın şiddet olayı sonrasında çalışanların
büyük çoğunluğunun nereye başvurulacağını
ve beyaz kod uygulamasını ise hiç, eksik veya yanlış
bildikleri tespit edilmiştir.
Index of the natural killer cells cytotoxic activity and values in patients with uterine myoma
Authors: Shevchukova N. , Selkov S. , Kramareva N. , Pigina T. , Shiriayeva Ya. 
Published: November 2021

State of the system of immunobiological control is of great importance for pathogenesis of uterine myoma as of any process of tumorous growth.
56 patients were examined to study their clinical and laboratory data, total serum interferon, the ability of peripheral blood leucocytes to synthesize a/b- and g -interferons, cytotoxic activity of natural killer cells.
The ability of peripheral blood leucocytes to synthesize a/b -interferon was found to be low in 89,5% of patients, g -interferon - in 51,6%. In women with very low g -interferon level (max 28, min 14) the size of myomatic nodes exceeded 5 cm in diameter, fast growth of tumors was noted. Cytotoxic activity of natural killers was low in 27% of women, and all of them had either fast growth of the uterine myoma (with nodes more than 5 cm in diameter) or myoma recurrence after myomectomy.
High positive correlation was found between the patients age and the ability of peripheral blood leucocytes to produce g -interferon (correlation coefficient = 0,44), between the size of a myomatic node and indices of the functional activity of natural killers (c.c. = 0,35), between the ability of peripheral blood leucocytes to produce a/b -interferon and functional activity of natural killer cells (c.C. 0,32).
So, the growth of uterine myoma can be predicted indirectly by the showings of cytotoxic activity of natural killer cells and by the ability of peripheral blood leucocytes to produce g-interferon.