bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educator perspectives on concussion management in the college classroom: a grounded theory introduction to collegiate return-to-learn
Authors: Bevilacqua Zachary , Cothran Donetta J , Rettke Devin J , Koceja David M , Nelson-Laird Thomas F , Kawata Keisuke 
Published: April 2021

ObjectivesTo gather the perspectives of collegiate instructors regarding how concussion is managed within the college classroom. To introduce the themes surrounding collegiate return-to-learn (RTL) and the classroom management of students with concussion.DesignQualitative grounded theory.SettingLarge, public university in the Midwest.ParticipantsTwenty-three college instructors participated in a private, semistructured, audio-recorded, one-on-one interview. Participants included 12 males and 11 females. Interview recordings were transcribed verbatim, followed by an iterative process of open-coding and axial-coding, performed by two researchers.ResultsThree themes emerged from the coded data: (1) awareness—external knowledge of concussion and previous experiences, (2) legitimacy—medical note provided and no note provided and (3) accommodating the student—instructor’s role and feasibility of the accommodation. Psychosocial factors such as small class sizes, graduate-level students and an instructor’s empathy appeared to influence an instructor’s decision making when accommodating a student recovering from concussion.ConclusionThese novel data provide foundational evidence regarding how college instructors perceive and subsequently manage concussion within the classroom, while also offering accuracy to aims of subsequent collegiate RTL investigationsArticle summaryRTL is an emerging field within concussion management, yet is grossly underexplored within the college setting. By utilising a grounded theory approach, this article introduces the themes that dictate the landscape of RTL for a college student.
Perspectives and experiences of people who were randomly assigned to wait-and-see approach in a gluteal tendinopathy trial: a qualitative follow-up study
Authors: Plinsinga Melanie Louise , Mellor Rebecca , Setchell Jenny , Ford Kelsie , Lynch Leonard , Melrose Joshua , Polansky Clare , Vicenzino Bill 
Published: April 2021

ObjectiveTo explore participants’ perspectives on, and experiences of, being assigned to a wait-and-see arm of a gluteal tendinopathy trial.DesignDescriptive qualitative.SettingGeneral community in Brisbane and Melbourne, Australia.ParticipantsFifteen participants who had been randomly allocated to the wait-and-see group in a recent parallel group superiority clinical trial. That trial compared the wait-and-see approach to a physiotherapist-led education plus exercise approach, and an ultrasound-guided corticosteroid injection. The wait-and-see approach involved one physiotherapy session in which participants received reassurance, general advice and encouragement to stay active for the management of gluteal tendinopathy.Data collection and analysisSemistructured interviews were conducted by four interviewers in person or over the internet, audio recorded and transcribed verbatim. Transcripts were coded and data analysed using an inductive thematic approach.ResultsFive themes were extracted from the interview transcripts: (1) Feeling disenfranchised by being assigned to a wait-and-see approach; (2) the importance of having a clinical and imaging diagnosis during screening for inclusion into the clinical trial; (3) feelings regarding the effectiveness of the approach; (4) the convenient and easy to follow nature of the wait-and-see approach and (5) the connotation of wait-and-see not always being perceived as an intervention.ConclusionsParticipants found the wait-and-see approach convenient and easy to follow, yet almost always felt disenfranchised that nothing was being done. Participants highlighted the importance of a definite clinical and imaging diagnosis.Trial registration numberACTRN12612001126808; Post-results.
Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis
Authors: Parmar Parveen K , Rawashdah Fatma , Al-Ali Nahla , Abu Al Rub Raeda , Fawad Muhammad , Al Amire Khaldoun , Al-Maaitah Rowaida , Ratnayake Ruwan 
Published: April 2021

ObjectivesGlobally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies.Setting and participantsA participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan.Primary outcomeThis causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan.ResultsDuring the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring.ConclusionsCHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.
Unmet care needs of community-dwelling stroke survivors: a systematic review of quantitative studies
Authors: Lin Bei-lei , Mei Yong-xia , Wang Wen-na , Wang Shan-shan , Li Ying-shuang , Xu Meng-ya , Zhang Zhen-xiang , Tong Yao 
Published: April 2021

ObjectivesUnderstanding the unmet needs of community-dwelling stroke survivors is essential for further intervention. This systematic review was performed to summarise their unmet needs from a quantitative viewpoint.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesA comprehensive search of six databases was conducted from inception to February 2020: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and CBM. The methodological quality of the studies was assessed. Unmet needs were categorised, and a pooled analysis of the main outcomes was conducted.Eligibility criteria for selecting studiesWe included quantitative studies focused on the unmet needs of stroke survivors who live at homes rather than in any other institutionalised organisation.ResultsIn total, 32 of 2660 studies were included, and 1980 unmet needs were identified. The prevalence of patients with unmet needs ranged from 15.08% to 97.59%, with a median of 67.20%; the median number of unmet needs per patient ranged from 2 to 8 (0–31). The prevalence of unmet needs was high at 6 months post-stroke (62.14%) and 2 years post-stroke (81.37%). After categorisation, the main concerns among these patients were revealed to be information support, physical function and mental health; a few studies reported unmet needs related to leisure exercise, return to work and so on. Additionally, differences in the measurement tools used across studies affect what unmet needs participants report.ConclusionsSufficient, accurate, individualised and dynamic information support is a priority among community-dwelling stroke survivors. Physical function and mental health are also the most significant concerns for re-achieving social participation. It is essential to design and disseminate standard, effective and time-saving tools to assess unmet needs.Trial registration numberCRD42018112181.
Impact of neighbourhood walkability on the onset of multimorbidity: a cohort study
Authors: Moin John Sina , Glazier Richard H , Kuluski Kerry , Kiss Alex , Upshur Ross 
Published: April 2021

Multimorbidity has become highly prevalent around the globe and been associated with adverse health outcomes and cost of care. The built environment has become an important dimension in response to obesity and associated chronic diseases by addressing population sedentariness and low physical activity.ObjectiveThe aim of the following study was to examine whether there was an increased risk for multimorbidity for those living in less walkable neighbourhoods. It was hypothesised that participants residing in less walkable neighbourhoods would have a higher risk for multimorbidity.SettingCity of Toronto and 14 neighbouring regions/municipalities within Ontario, Canada.ParticipantsStudy participants who had completed the Canadian Community Health Survey between the year 2000 and 2012, between 20 and 64 and 65 and 95 years of age, residing within a neighbourhood captured in the Walkability Index, and who were not multimorbid at the time of interview, were selected.InterventionThe Walkability Index was the key exposure in the study, which is divided into quintiles (1—least, 5—most walkable neighbourhoods). Participants were retrospectively allocated to one of five quintiles based on their area of residency (at the time of interview) and followed for a maximum of 16 years.Primary outcome measureBecoming multimorbid with two chronic conditions.Secondary outcome measureBecoming multimorbid with three chronic conditions.ResultsRisk for multimorbidity (two chronic conditions) was highest in least compared with most walkable neighbourhoods with an HR of 1.14 (95% CI: 1.02 to 1.28, p=0.0230). While results showed an overall gradient response between decreased walkability and increased risk for multimorbidity, they were not statistically significant across all quintiles or in the older-adult cohort (65–95 years of age).ConclusionStudy results seem to suggest that low neighbourhood walkability may be a risk factor for multimorbidity over time. More studies are needed to examine whether neighbourhood walkability is a potential solution for multimorbidity prevention at the population level.
How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR
Authors: O'Doherty Alasdair F , Humphreys Helen , Dawkes Susan , Cowie Aynsley , Hinton Sally , Brubaker Peter H , Butler Tom , Nichols Simon 
Published: April 2021

ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.
Effects of traditional qigong exercise on ankylosing spondylitis: a protocol for systematic reviews and meta-analysis
Authors: Liu Wei , Fan Yihua , Wan Renhong , Zhao Longmei , Lu Hang , Liao Rongjun , Zhuang Zhining , Guo Xiaoping 
Published: April 2021

IntroductionAnkylosing spondylitis (AS) is a recurrent autoimmune disease that is associated with a high disability rate, which has a profound negative impact on daily life. It has been clinically reported that traditional qigong exercise has certain therapeutic advantages in treating AS; however, this postulation is not evidence-based. Therefore, this study will aim at systematically appraising the validity and safety of traditional qigong exercise in treating AS.Methods and analysisWe searched the English (PubMed, Embase, Web of Science and the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, Wan fang, VIP and Chinese biomedical database) for relevant information. Additionally, the Baidu Academic and Google Academic databases were manually searched to mine relevant information. Randomised controlled clinical trials of traditional qigong exercise in treating AS were searched from the establishment of the database to September 2020. Quality articles were extracted and independently evaluated by two researchers before inclusion in this study. Meta-analysis of the included articles was performed using the RevMan V.5.3 software.Ethics and disseminationThis study will not involve primary data collection, and formal ethics approval will, therefore, not be required. We aim to publish this systematic review in a peer-reviewed journal.Trial registration numberCRD42020207057.
Impact of COVID-19 on household food insecurity and interlinkages with child feeding practices and coping strategies in Uttar Pradesh, India: a longitudinal community-based study
Authors: Nguyen Phuong Hong , Kachwaha Shivani , Pant Anjali , Tran Lan M , Ghosh Sebanti , Sharma Praveen Kumar , Shastri Vishal Dev , Escobar-Alegria Jessica , Avula Rasmi , Menon Purnima 
Published: April 2021

ObjectivesThe COVID-19 pandemic has profound negative impacts on people’s lives, but little is known on its effect on household food insecurity (HFI) in poor setting resources. This study assessed changes in HFI during the pandemic and examined the interlinkages between HFI with child feeding practices and coping strategies.DesignA longitudinal survey in December 2019 (in-person) and August 2020 (by phone).SettingCommunity-based individuals from 26 blocks in 2 districts in Uttar Pradesh, India.ParticipantsMothers with children <2 years (n=569).Main outcomes and analysesWe measured HFI by using the HFI Access Scale and examined the changes in HFI during the pandemic using the Wilcoxon matched-pairs signed-rank tests. We then assessed child feeding practices and coping strategies by HFI status using multivariable regression models.ResultsHFI increased sharply from 21% in December 2019 to 80% in August 2020, with 62% households changing the status from food secure to insecure over this period. Children in newly or consistently food-insecure households were less likely to consume a diverse diet (adjusted OR, AOR 0.57, 95% CI 0.34 to 0.95 and AOR 0.51, 95% CI 0.23 to 1.12, respectively) compared with those in food-secure households. Households with consistent food insecurity were more likely to engage in coping strategies such as reducing other essential non-food expenditures (AOR 2.2, 95% CI 1.09 to 4.24), borrowing money to buy food (AOR 4.3, 95% CI 2.31 to 7.95) or selling jewellery (AOR 5.0, 95% CI 1.74 to 14.27) to obtain foods. Similar findings were observed for newly food-insecure households.ConclusionsThe COVID-19 pandemic and its lockdown measures posed a significant risk to HFI which in turn had implications for child feeding practices and coping strategies. Our findings highlight the need for further investment in targeted social protection strategies and safety nets as part of multisectoral solutions to improve HFI during and after COVID-19.
Prevalence of keratoconus in persons with Down syndrome: a review
Authors: Kristianslund Olav , Drolsum Liv 
Published: April 2021

PurposeKeratoconus is a vision-threatening condition, and there is a need for knowledge about the occurrence in subgroups of the population. The progression of the disease can be effectively stopped, and vision may be restored, if keratoconus is diagnosed at an early stage. The purpose of this review was to evaluate the literature of the prevalence of keratoconus in persons with Down syndrome.MethodsWe conducted a literature review of keratoconus prevalence in persons with Down syndrome. A thorough search was performed in Pubmed (Medline), and the quality of evidence was evaluated.ResultsThe literature review identified 20 relevant studies, which reported keratoconus in 0%–71% of persons with Down syndrome. These studies varied greatly in design, patient selection, sample sizes and mean age, and the quality of evidence concerning estimates for the prevalence of keratoconus was generally evaluated as low. Most studies that included adults reported high prevalences of keratoconus–in many studies more than 10-fold the prevalence in the general population. No large screening studies in persons with Down syndrome were identified.ConclusionsThe present review showed that the prevalence of keratoconus in persons with Down syndrome is higher than in the general population. However, estimates from previous studies vary widely. Screening for keratoconus in this group should be considered.
Feasibility of intra-amniotic digoxin administration by obstetrics and
gynecology trainees to induce fetal demise prior to medical abortion beyond
20 weeks
Authors: Tufa Tesfaye Hurissa , Lavelanet Antonella Francheska , Belay Lemi , Seboka Berhanu , Bell Jason 
Published: April 2021

Background
Transient fetal survival is one issue that providers may face while
managing late second-trimester abortion. Induction of fetal demise using
digoxin and other means has been widely performed by maternal–fetal
medicine and family planning subspecialists worldwide. However, there
are no data available in Ethiopia as regards preventing transient fetal
survival in late second-trimester medical termination of
pregnancy.

Objective
The objective of the study was to document the feasibility of
intra-amniotic digoxin administration for inducing fetal demise prior to
medical abortion beyond 20 weeks of gestational age. Additionally, we
aimed to demonstrate that this skill could be transferred to obstetrics
and gynaecology residents at St Paul’s Hospital Millennium Medical
College in Addis
Ababa, Ethiopia.

Methods
A retrospective cross-sectional study design was conducted to
document the feasibility, safety and effectiveness of intra-amniotic
digoxin. A structured questionnaire was used to collect selected
sociodemographic data and clinical characteristics. Data were entered
and analysed using SPSS statistical package version 20.

Results
During the study period, 49 women received intra-amniotic digoxin.
The success rate of intra-amniotic digoxin in this study was 95.9%.
Thirty-seven (75.5%) procedures were performed by obstetrics and
gynaecology residents and 12 (24.5%) were performed by family planning
faculties. There were two out of hospital expulsions with no signs of
life, and no other serious maternal complications were
observed.

Conclusion
It is feasible for obstetrics and gynaecology trainees in Ethiopia
to learn how to safely administer intra-amniotic digoxin to induce fetal
demise for induced medical terminations.
Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland
Authors: Laukkanen Lauri , Lahtinen Sanna , Raatiniemi Lasse , Ehrola Ari , Kaakinen Timo , Liisanantti Janne 
Published: April 2021

ObjectivesA high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.MethodsData from EMS missions with a registered non-transportation code during 1 January 2018–31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.ResultsA total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code ‘abdominal pain’, clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.ConclusionIn this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.