bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Olfactory Dysfunction and Critical Illness and Mortality in COVID‐19: A Meta‐analysis
Authors: Goshtasbi Khodayar , Pang Jonathan , Lehrich Brandon M. , Vasudev Milind , Birkenbeuel Jack L. , Abiri Arash , Kuan Edward C. 
Published: May 2021

The emerging literature regarding the novel coronavirus disease 2019 (COVID‐19) suggests that patients with olfactory dysfunction (OD) have a milder disease course with improved clinical symptomatology and outcomes. This study utilized the National Library of Medicine’s PubMed/MEDLINE database to query for articles describing major outcomes in patients with COVID‐19 with or without OD. Of the 1284 examined studies, 26 were included for a total of 11,408 patients (35.9% with OD). When compared with patients with OD, patients without OD were 5.3 times more likely to experience hospitalization (odds ratio, 5.28 [95% CI, 4.64‐6.01]; P <. 001), 7.0 times more likely to undergo intubation or ventilation (7.01 [5.52‐8.90], P <. 001), and 7.0 times more likely to die (6.97 [3.54‐13.74], P <. 001). This association between OD and COVID‐19 outcomes may play an important role in patient risk stratification and counseling and early identification of potentially severe cases, and it may encourage future investigations regarding the infectivity and immune response to SARS‐CoV‐2.Level of evidence4.
Risk of peritonitis after gastroscopy in peritoneal dialysis patients
Authors: Chan Gordon Chun-Kau , Wong Sunny Hei , Ng Jack Kit-Chung , Li Philip Kam-Tao , Szeto Cheuk-Chun , Chow Kai-Ming 
Published: May 2021

Background: Peritonitis is a common and serious complication of peritoneal dialysis (PD). Translocation of gut bacteria to peritoneum is an important mechanism, which may be enhanced by gastrointestinal endoscopy. Methods: In this retrospective observational cohort study, we identified 450 gastroscopies performed in PD patients within a single centre between 2014 and 2019. Gastroscopy-related peritonitis was defined by peritonitis within 1 week after endoscopy. Results: A total of 408 endoscopic episodes in 216 patients were analysed after excluding 42 cases with either pre-existing peritonitis before endoscopy, or concomitant biliary, small bowel or large bowel endoscopy. There were 16 episodes of peritonitis within 1 week of endoscopy (3.9%). One-quarter of cases were polymicrobial (four episodes, 25.0%). Logistic regression model showed that patient’s age, number of endoscopic biopsies, and histamine-2 receptor blocker use were independently associated with peritonitis, while prior antibiotics exposure was associated with lower risk of peritonitis, odds ratio 0.23 (95% confidence interval 0.06–0.95; p = 0.04). Conclusion: Peritonitis can complicate gastroscopy in PD patients and occurs more often in elderly or after repeated biopsy procedures.
Patterns of Health Care Services During Pediatric Concurrent Hospice Care: A National Study
Authors: Lindley Lisa C. , Svynarenko Radion , Mooney-Doyle Kim , Mendola Annette , Naumann Wendy C. , Keim-Malpass Jessica 
Published: May 2021

Background: Children at end of life have unique and complex care needs. Although there is increasing evidence about pediatric concurrent hospice care, the health care services received while in hospice have not received sufficient attention. Objectives: To examine the health care services, unique clusters of health care services, and characteristics of the children in the clusters. Methods: Multiple data sources were used including national Medicaid claims data. Children under 21years in pediatric concurrent hospice care were included. Using Medicaid categories assigned to claims, health care services were distributed across 20 categories. Latent class analysis was used to identify clusters of health care services. Demographic profiles of the clusters were created. Results: The 6,243 children in the study generated approximately 500,0000 non-hospice, health care service claims while enrolled in hospice care. We identified 3 unique classes of health care services use: low (61.1%), moderate (18.1%), and high (20.8%) intensity. The children in the 3 classes exhibited unique demographic profiles. Conclusions: Health care services cluster together in unique fashion with distinct patterns among children in concurrent hospice care. The findings suggest that concurrent hospice care is not a 1-size-fit all solution for children. Concurrent hospice care may be customized and require attention to care coordination to ensure high-quality care.
Treatment of Cleft Lip and Palate in the Amazon Region in Brazil: Speech Results and Sociodemographic Aspects
Authors: de Araújo Laryssa Lopes , Alonso Nivaldo , Fukushiro Ana Paula 
Published: May 2021

Objective: To investigate the speech outcomes in individuals with cleft lip and palate (CLP) from the Amazon region and determine their correlation with sociodemographic factors. Design: Cross-sectional, prospective, single-blind study. Setting: Tertiary care institute in Manaus, Amazonas, Brazil. Patients: Four hundred twenty individuals with CLP, aged 4 to 57 years. Main Outcome Measures: The samples were judged by 3 speech pathologists experienced in the speech assessment of individuals with CLP. Hypernasality was scored using a 4-point scale, being 1 = absent, 2 = mild, 3 = moderate, and 4 = severe, and the active speech symptoms were classified as absent or present. The final score for each speech symptom was reached by consensus among the 3 examiners Descriptive analysis of sociodemographic data included origin, socioeconomic status, type of cleft, surgical technique employed, the age they underwent primary and secondary palatoplasty, and palatal fistula. Results: Absence of hypernasality was observed in 41% of the individuals, 18% had mild, 28% moderate, and 13% severe hypernasality. Active speech symptoms were observed in 57% of the individuals. Significant correlations were found between speech outcomes and the variables such as origin, socioeconomic status, age at primary and secondary palatoplasty, and presence of fistula. Conclusions: Most individuals with repaired CLP from the Amazon region presented speech disorders, characterized by hypernasality and active errors. Patients living outside the state capital, of low socioeconomic level, underwent palatoplasty late and with presence of palatal fistula tended to have the worst speech outcomes.
Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD
Authors: Ercan Eyup Sabri , Unsel-Bolat Gul , Tufan Ali Evren , Karakoc Demirkaya Sevcan , Bilac Oznur , Celik Goncagul , Kılıç Birim Günay , Akyol Ardic Ulku , Yalin Sapmaz Sermin , Aksu Hatice , Yolga Tahiroglu Aysegul , Karacetin Gul , Tural Umit , Aktepe Evrim , Rodopman Arman Ayşe , Başgül Senem , Coşkun Murat , Dursun Onur Burak , Durukan İbrahim , Perdahli Fiş Neşe , Gençoğlan Salih , Gökçen Cem , Sarı Gokten Emel , Görker Işık , Görmez Vahdet , Yıldız Gündoğdu Özlem , Hesapçioğlu Selma Tural , Kandemir Hasan , Mutluer Tuba , Nasiroğlu Serhat , Özcan Özlem , Şahin Nilfer , Toros Fevziye , Perçinel Yazici İpek , Yazici Kemal Utku , Yulaf Yasemin , Yüksel Tuğba , Bilgic Ayhan , Altun Hatice , Akdemir Devrim , Mazlum Betül , Çakın Memik Nursu , Foto Özdemir Dilşad , Üneri Özden , Ünal Fatih 
Published: May 2021

Objective: This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children. Method: The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants. Results: The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses. Conclusion: Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD.
CNVs in the 22q11.2 Chromosomal Region Should Be an Early Suspect in Infants with Congenital Cardiac Disease
Authors: Pineda Tatiana , Zarante Ignacio , Paredes Angela Camila , Rozo Juan Pablo , Reyes Martha C. , Moreno-Niño Olga María 
Published: May 2021

Background: Congenital heart disease (CHD) is the most common congenital malformation, it is frequently found as an isolated defect, and the etiology is not completely understood. Although most of the cases have multifactorial causes, they can also be secondary to chromosomal abnormalities, monogenic diseases, microduplications or microdeletions, among others. Copy number variations (CNVs) at 22q11.2 are associated with a variety of symptoms including CHD, thymic aplasia, and developmental and behavioral manifestations. We tested CNVs in the 22q11.2 chromosomal region by MLPA in a cohort of Colombian patients with isolated CHD to establish the frequency of these CNVs in the cohort. Methods: CNVs analysis of 22q11.2 by MLPA were performed in 32 patients with apparently isolate CHD during the neonatal period. Participants were enrolled from different hospitals in Bogotá, and they underwent a clinical assessment by a cardiologist and a clinical geneticist. Results: CNVs in the 22q11.2 chromosomal region were found in 7 patients (21.9%). The typical deletion was found in 6 patients (18.75%) and atypical 1.5 Mb duplication was found in 1 patient (3.1%). Conclusions: CNVs in 22q11.2 is a common finding in patients presenting with isolated congenital cardiac disease, therefore these patients should be tested early despite the absence of other clinical manifestations. MLPA is a very useful molecular method and provides an accurate diagnosis.
COVID-19 and disconnected youth: Lessons and opportunities from OECD countries
Authors: Palmer Ashley N. , Small Eusebius 
Published: May 2021

Aims: This paper highlights how the novel coronavirus pandemic (COVID-19) has amplified economic instability and health risks for disconnected youth and young adults (YYA). We offer a brief review of governmental policy responses in four OECD countries and how they may impact the disconnect YYA within those countries. Methods: Literature was reviewed utilizing Cochrane Library, ERIC, PsychINFO, PubMed/MEDLINE and Web of Science to outline existing inequities among disconnected YYA and COVID-19 economic and health impacts. Government responses to COVID-19 from four OECD countries were reviewed. Using the social protection model, we highlighted significant policy changes and developments that influence the protection of vulnerable populations and evaluated the potential effect of long-term economic dislocations prompted by the COVID-19 pandemic. Results: Disconnected YYA suffered significant financial and health burdens with no social protection floor in place. Lessons learned prior to and during the pandemic indicate that initiatives aimed at improving health and well-being among vulnerable YYA and their communities must be adequately funded, flexible, and comprehensive. Attempts to connect or reconnect YYA who were disconnected prior to the COVID-19 pandemic will require a re-envisioning of policy. Conclusions: Globally, governments must invest in social safety net programs that focus on supporting those most at-risk. A concentrated focus on job creation, education and training, and paid work experience, investments in early childhood care and education, housing, health and mental health care is necessary to not only offset the pandemic’s effects but also support thriving in the future for YYA.
Impact of Primary Tumor Size on Prognosis in Patients With Metastatic Renal Cell Carcinoma Receiving Cytoreductive Nephrectomy: A Population Study of a Chinese Center and the US SEER Database
Authors: Jiang Weixing , Shou Jianzhong , Shi Hongzhe , Wen Li , Zhang Huijuan , Zheng Shan , Li Changling , Ma Jianhui 
Published: May 2021

Background: The relationship between the size of the primary tumor and the prognosis of patients with metastatic renal cell carcinoma (mRCC) is unclear. In this study, we aimed to investigate the significance of the size of the primary tumor in mRCC. Methods: We retrospectively reviewed the data of patients with mRCC who underwent cytoreductive nephrectomy (CN) from 2006 to 2013 in a Chinese center (n = 96) and those in the Surveillance, Epidemiology, and End Results (SEER) database (from 2004 to 2015, n = 4403). Tumors less than 4 cm in size were defined as small. Prognostic factors were analyzed using univariate and multivariate Cox proportional hazards regression analyses. Results: Patients with small tumors had a longer overall survival than other patients, both in the Chinese cohort (median, 30.0 vs 24.0 months, P = 0.026) and the SEER cohort (median, 43.0 vs 23.0 months, P < 0.001). After adjusting for other significant prognostic factors, small tumor size was still an independent protective factor in the Chinese cohort (adjusted hazard ratio [HR], 0.793; 95% confidence interval [CI]: 0.587–0.998, P = 0.043). In the SEER cohort, multivariate analysis showed that small tumor size was also an independent protective factor (HR, 0.880; 95% CI: 0.654–0.987, P = 0.008). In addition, as a continuous variable, a 1 cm elevation in tumor size translated into a 3.8% higher risk of death (HR, 1.038; 95% CI, 1.029–1.046; P < 0.001). Conclusion: Patients with small tumors may have a favorable prognosis after CN for mRCC. Although CN is not a standard protocol in mRCC, small tumor size may be a candidate when we are deciding to perform CN because of the potential benefit for OS.
Cervical pap smears and pandemics: The effect of COVID-19 on screening uptake & opportunities to improve
Authors: Masson Hannah 
Published: May 2021

Background: The Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented upheaval within global healthcare systems and resulted in the temporary pausing of the National Health Service (NHS) Scotland Cervical Screening Programme. With several months of backlogs in appointments, there has not only been a reduction in primary samples being taken for human papilloma virus (HPV) testing but there have also been fewer women referred to colposcopy for investigation and treatment of precancerous or cancerous changes as a result. Encouraging uptake for cervical screening was always a priority before the pandemic, but it is even more important now, considering that the fears and barriers to screening that women may have are now exacerbated by COVID-19. Objectives: This article explores the impact of the pandemic on the uptake of cervical screening within NHS Ayrshire & Arran and evaluates potential strategies to improve uptake now and in future such as self-sampling and telemedicine. Methods: This article presents evidence-based literature and local health board data relating to cervical screening during the pandemic. Results: Human papilloma virus self-sampling carried out by the woman in her home has been shown to improve uptake, especially in non-attenders, whilst maintaining a high sensitivity and, crucially, reducing the need for face-to-face contact. Increased education is key to overcoming barriers women have to screening and telemedicine can strengthen engagement with women during this time. Conclusion: There are lessons to be learned from the pandemic, and we must use this opportunity to improve cervical screening uptake for the future.
Serum neurofilament levels reflect outer retinal layer changes in multiple sclerosis
Authors: Seitz Caspar B. , Steffen Falk , Muthuraman Muthuraman , Uphaus Timo , Krämer Julia , Meuth Sven G. , Albrecht Philipp , Groppa Sergiu , Zipp Frauke , Bittner Stefan , Fleischer Vinzenz 
Published: May 2021

Background: Serum neurofilament light chain (sNfL) and distinct intra-retinal layers are both promising biomarkers of neuro-axonal injury in multiple sclerosis (MS). We aimed to unravel the association of both markers in early MS, having identified that neurofilament has a distinct immunohistochemical expression pattern among intra-retinal layers. Methods: Three-dimensional (3D) spectral domain macular optical coherence tomography scans and sNfL levels were investigated in 156 early MS patients (female/male: 109/47, mean age: 33.3 ± 9.5 years, mean disease duration: 2.0 ± 3.3 years). Out of the whole cohort, 110 patients had no history of optic neuritis (NHON) and 46 patients had a previous history of optic neuritis (HON). In addition, a subgroup of patients ( n = 38) was studied longitudinally over 2 years. Support vector machine analysis was applied to test a regression model for significant changes. Results: In our cohort, HON patients had a thinner outer plexiform layer (OPL) volume compared to NHON patients ( B = −0.016, SE = 0.006, p = 0.013). Higher sNfL levels were significantly associated with thinner OPL volumes in HON patients ( B = −6.734, SE = 2.514, p = 0.011). This finding was corroborated in the longitudinal subanalysis by the association of higher sNfL levels with OPL atrophy ( B = 5.974, SE = 2.420, p = 0.019). sNfL levels were 75.7% accurate at predicting OPL volume in the supervised machine learning. Conclusions: In summary, sNfL levels were a good predictor of future outer retinal thinning in MS. Changes within the neurofilament-rich OPL could be considered as an additional retinal marker linked to MS neurodegeneration.
Challenges Faced by Female Out-of-School Adolescents in Accessing and Utilizing Sexual and Reproductive Health Service: A Qualitative Exploratory Study in Southwest, Ethiopia
Authors: Hailemariam Shewangizaw , Gutema Lidiya , Agegnehu Wubetu , Derese Msganaw 
Published: May 2021

Introduction Due to the limited access to sexual and reproductive health service, out-of-school-adolescents become at a higher risk for early marriage, early pregnancy early parenthood, and poor health outcomes over their life course. Hence, the aim of this study was to explore the challenges faced by female out-of-school adolescents in accessing sexual and reproductive health service in Bench-Sheko zone. Methods A community-based qualitative exploratory study was carried out from November 01/2020 to December 01/2020 among selected out-of-school adolescents residing in rural and urban districts of Bench-Sheko Zone, and healthcare professionals working in the local health centers. FGD participants and healthcare providers were purposely selected for this study. Eight focus group discussions and 8 in-depth interviews were conducted among female out-of-school adolescents, and health care professionals, respectively. Result The study revealed that out-of-school adolescents encounter several challenges in accessing sexual reproductive health service which includes socio-cultural barriers, health system barriers, perceived legal barrier, inadequate information regarding sexual reproductive health service, and low parent-adolescent communication. Conclusion The finding suggests the need to engage community influencers (religious leaders, community leaders, and elders) in overcoming the socio-cultural barriers. Program planners and policy makers have better make an effort to create adolescent friendly environments in SRH service areas. Furthermore, implementing community-based awareness raising programs, parental involvement in sexual reproductive health programs, and encouraging parent-adolescent communication on sexual reproductive health issues could improve sexual reproductive health service utilization by out-of-school adolescents in the study area.
House Officers’ Choice of Family Medicine Specialty amid the Implementation of the New Universal Health Insurance Law
Authors: Ahmed Marwa Mostafa , Fares Samar , Sayed Asmaa Ahmed , ElSayed Inas Talat , Soliman Saeed S. A. 
Published: May 2021

Background The new Egyptian Universal Health Insurance Law is introduced through family-oriented primary health care. Increasing the number of recent graduates who specialized in family medicine is considered a national need to overcome family physicians’ shortage. Aim To explore the factors affecting the house officers’ choice of Family Medicine as a future career amid the implementation of the new Universal Health Insurance Law in Egypt. Methods This is a cross-sectional study conducted on house officers during their training in Cairo university hospitals from the first of March 2020 to February 2021. The researchers offered an anonymous self-administered questionnaire to all house officers at the beginning of their 2-week family medicine training (1170 house officers). Results A total of 1052 completed the questionnaire (response rate 90%). Family medicine as a specialty was considered by 53.6% (n = 564) of participants, while only 23.4% (n = 246) of participants had an obvious intention to choose family medicine. Multivariate (adjusted) logistic regression model revealed that factors significantly associated with intention to choose family medicine were marital status, knowledge about governmental advantages for family medicine offered to the specialized recent graduates, and previously encountered with family practice as customers. Conclusions The choice of family medicine specialty is increasing among house officers. This could be attributed to the growing interest in family medicine in Egypt, especially after implementing the new insurance law’s first phase in several Egyptian governorates.
Leg Stiffness, Joint Stiffness, and Running-Related Injury: Evidence From a Prospective Cohort Study
Authors: Davis John J. , Gruber Allison H. 
Published: May 2021

Background: The spring-like behavior of the leg and the joints of the lower body during running are thought to influence a wide range of physiologic and mechanical phenomena, including susceptibility to overuse injury. If leg and joint stiffness are associated with running-related injuries, altering joint or leg stiffness may be a useful avenue for injury rehabilitation and injury prevention programs. Purpose: To test the associations between running-related injury and leg stiffness, knee stiffness, and ankle stiffness in a prospective study of recreational runners. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 49 healthy recreational runners took part in a year-long study. Participants completed a 3-dimensional kinematic and kinetic biomechanical assessment at baseline and reported training volume and injury status in a weekly survey during the follow-up period. Relationships between stiffness and injury were assessed at the level of individual legs (n = 98) using spline terms in Cox proportional hazards models. Results: During follow-up, 23 participants (29 legs) sustained injury. The median time to injury was 27 weeks (53.27 hours of training). Relative injury rate as a function of knee stiffness displayed a weak and nonsignificant U-shaped curve ( P = .187-.661); ankle and leg stiffness displayed no discernable associations with relative injury rate (leg stiffness, P = .215-.605; ankle stiffness, P = .419-.712). Conclusion: Leg and joint stiffness may not be important factors in the development of running-related injuries. Moderate changes in leg and joint stiffness are unlikely to substantially alter injury risk.