bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case of recurrence of adult-onset Still’s disease in the third trimester: a case report and literature review
Authors: Hosoya Satoshi , Sadatsuki Miyuki , Izuka Shinji , Yamashita Hiroyuki , Oishi Hajime 
Published: February 2021

Abstract
Background
Adult-onset Still’s disease (AOSD) is a self-inflammatory disease showing macrophage and neutrophil activation by inflammatory cytokines such as TNF-α, IL-6, and IL-18. Although some cases with the flare of AOSD during pregnancy have been reported, most had flares in the first or second trimester and few had flares in the third trimester. In this report, we present the case of a patient with recurrent flare of AOSD in the third trimester and discuss the management of AOSD in the third trimester with the review of previous literatures.

Case presentation
A 38-year-old woman in complete AOSD remission without medication presented with impaired liver function, low platelet count, mild fever, abdominal pain, splenomegaly, and elevated ferritin and IL-18 levels at 30 gestational weeks. Although the laboratory data and physical examination finding suggested HELLP syndrome or acute fatty liver of pregnancy and we considered the termination of her pregnancy, her fetus was in a reactive status. Considering her fetal status, some specific findings of AOSD, and her AOSD history, we and rheumatologists diagnosed her with AOSD recurrence and started systemic steroid therapy. In her clinical course, three flares of AOSD occurred, twice in the third trimester and once in postpartum; twice systemic steroid pulse therapies were then needed. Ultimately, a healthy infant was delivered transvaginally at 36 gestational weeks spontaneously.

Conclusions
Specific findings of the flare of AOSD such as fever, splenomegaly, elevated ferritin and IL-18 levels, and fetal status could be useful findings for differentiation from HELLP syndrome and AFLP in the third trimester. With the careful management supported by rheumatologists, patients complicated with the flare of AOSD may continue their pregnancy longer than we expected.
Nutritional education during rehabilitation of children 6–24 months with acute malnutrition, under unavailability of therapeutic/supplementary foods: a retrospective study in rural Angola
Authors: Pietravalle Andrea , Scilipoti Martina , Cavallin Francesco , Lonardi Magda , Tshikamb Ivo Makonga , Robbiati Claudia , Trevisanuto Daniele , Putoto Giovanni 
Published: February 2021

Abstract
Background
Dietary counseling can play an important role in managing child malnutrition but is often inadequate or absent. Moreover, little emphasis is given to the usefulness of local available foods in the rehabilitation of malnourished children. This study aimed to evaluate the adherence and effectiveness of nutritional education during rehabilitation of children (6–24 months) with acute malnutrition, in a setting of unavailability of therapeutic/supplementary foods.

Methods
Retrospective observational study on the adherence to dietary counseling and the impact on growth in children 6–24 months who were referred for acute malnutrition at the Catholic Mission Hospital of Chiulo (Angola) from August 2018 to January 2019. Main outcome measures were change in dietary habits and growth gain.

Results
Sixty-four out of 120 children returned at first follow-up visit (default rate 47%). A change in dietary habits was reported in 32/64 (50%) children. Changing dietary habits was associated with an improved change in weight gain (MD 9.3 g/kg/day, 95%CI 4.2 to 14.3; p = 0.0005) and in weight/height ratio (MD 1.1 SD, 95%CI 0.7 to 1.4; p < 0.0001).

Conclusions
A change in dietary habits after discharge was noted in only half of the patients who returned at first follow up visit, but it provided some advantages in term of weight gain and weight/height ratio. Further studies are needed to identify children at risk of low adherence to follow-up visits and low compliance to the nutritional recommendations, in order to increase the effectiveness of rehabilitation programs.
Associations between occupation and heavy alcohol consumption in UK adults aged 40–69 years: a cross-sectional study using the UK Biobank
Authors: Thompson Andrew , Pirmohamed Munir 
Published: February 2021

Abstract
Background
Understanding the relationship between occupation and alcohol use offers opportunities to provide health promotion programmes based on evidence of need. We aimed to determine associations between occupation and heavy alcohol consumption in working individuals aged 40–69 years.

Methods
A cross-sectional study was conducted using 100,817 people from the UK Biobank: 17,907 participants categorised as heavy drinkers, defined as > 35 units/week for women and > 50 units/week for men, and 82,910 drinking controls. Prevalence ratios (PRs) and 95% CIs were calculated for gender-specific heavy drinking in 353 occupations using Standard Occupational Classification, V.2000.

Results
Seventy-seven occupations were associated with level of alcohol consumption in drinkers. The largest ratios for heavy drinkers were observed for publicans and managers of licenced premises (PR = 2.81, 95%CI 2.52–3.14); industrial cleaning process occupations (PR = 2.09, 1.33–3.28); and plasterers (PR = 2.07, 1.66–2.59). Clergy (PR = 0.20, 0.13–0.32); physicists, geologists and meteorologists (PR = 0.40, 0.25–0.65); and medical practitioners (PR = 0.40, 0.32–0.50) were least likely to be heavy drinkers. There was evidence of gender-specific outcomes with the proportion of jobs associated with heavy drinking accounted for by skilled trade occupations being 0.44 for males and 0.05 for females, and 0.10 for males and 0.40 for females when considering managers and senior officials.

Conclusions
In the largest study of its kind, we found evidence for associations between a wider variety of occupations and the risk of heavy alcohol consumption than identified previously, particularly in females, although causality cannot be assumed. These results help determine which jobs and broader employment sectors may benefit most from prevention programmes.
Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development
Authors: Arias-Casais Natalia , Garralda Eduardo , Sánchez-Cárdenas Miguel Antonio , Rhee John Y. , Centeno Carlos 
Published: February 2021

Abstract
Background
Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology.

Aim
To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above.

Methods
A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy.

Results
The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines.

Conclusion
Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.
MEBO versus topical Diltiazem versus a combination of both ointments in the treatment of acute anal fissure: a randomized clinical trial protocol
Authors: El Charif Mohamad Hadi , Doughan Samer , Kredly Rawya , Kassas Sara , Azab Rayan , Sbaity Eman 
Published: February 2021

Abstract
Background
Anal fissure is a common complication of the anorectal region and one of the most reported causes of anal pain. Acute anal fissure can be cured by surgery or medical treatment. There is an increase in the use of topical therapy for the treatment of anal fissures. A common topical drug used is Diltiazem (DTZ), a calcium-channel blocker, which relaxes the anal sphincter and thus promotes healing of the anal fissure. Moist exposed burn ointment (MEBO) is an ointment that is effective for the treatment of burns and wound healing and is becoming popular in the treatment of anal fissures.

Methods
This is a 1:1:1 randomized, controlled, parallel design, with endpoint measures of change in pain score, wound healing, defecation strain score and patient’s global impression of improvement. The study will be conducted at AUBMC over a 10-week period. Patients will be randomized to three treatment arms: MEBO, Diltiazem, and a combination of MEBO and Diltiazem ointments.

Discussion
The results of this study will allow physicians to assess the efficacy and safety of MEBO in the treatment of acute anal fissure, and also in comparison to Diltiazem. This trial will generate evidence-based conclusions regarding the use of a herbal/natural-based product (MEBO ointment) for the treatment of anal fissures.

Trial registration
ClinicalTrials.gov Identifier NCT04153032. Clinical Trial Registration Date: 06-NOVEMBER-2019.
Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis
Authors: Leaune Edouard , Rey-Cadilhac Violette , Oufker Safwan , Grot Stéphanie , Strowd Roy , Rode Gilles , Crandall Sonia 
Published: February 2021

Abstract
Background
Experts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved.

Method
We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved.

Results
Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome.

Conclusions
Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.
Sexual violence in medical students and specialty registrars in Flanders, Belgium: a population survey
Authors: Geldolf M. , Tijtgat J. , Dewulf L. , Haezeleer M. , Degryse N. , Pouliart N. , Keygnaert I. 
Published: February 2021

Abstract
Background
Sexual violence has globally been recognized as harmful to young people’s health. In medical school, which is a highly competitive environment, the risk is supposedly even bigger. In this study we firstly aimed to investigate the magnitude and precipitating factors of sexual violence in medical students and specialty registrars in Flanders, Belgium. Secondly, we wanted to assess the reactive behaviours as well as the knowledge of possible types of bystander reactions as well as potential support resources for victims of sexual violence.

Methods
This study was initiated and coordinated by the Flemish medical student representation organisation (VGSO). A survey containing demographic and behaviour-specific questions based on the UNMENAMAIS and SAS-V questionnaire was sent to all undergraduate, graduate and postgraduate students of the 5 medical schools in Flanders. Participants were asked to limit their responses to internship-related events. Further questions concerning reactions to sexual violence, assailants, bystander reactions and general knowledge concerning support after sexual violence were asked.

Results
We received 3015 valid responses to our survey, obtaining a response rate of 29% in the potential target population. Within the total study population, 1168 of 3015 participants (38,73%) reported having been victim of at least one type of sexual violence as explored by our survey. This percentage was the highest in GP specialty registrars (53%), followed by specialty registrars (50%) and master students (39%). Assailants of sexual violence varied, most often they were medical staff members, students or patients. In most types of sexual violence, nobody reacted to this behaviour. Women (57.3%) talked about what happened afterwards more often than men (39.7%). When asked about their knowledge of possible bystander reactions and support services for sexual violence, 60% of the respondents did not know about their existence.

Conclusions
Sexual violence is still a relatively frequent issue in medical students and specialty registrars. Patients form an important part of the assailants. In a third of reported sexual violence cases, nobody reacted. In addition, male victims seem to underreport. There is still much need for sensitisation on support mechanisms and centres for victims and witnesses of sexual violence.
Clinical data mining on network of symptom and index and correlation of tongue-pulse data in fatigue population
Authors: Shi Yulin , Hu Xiaojuan , Cui Ji , Cui Longtao , Huang Jingbin , Ma Xuxiang , Jiang Tao , Yao Xinghua , Lan Fang , Li Jun , Bi Zijuan , Li Jiacai , Wang Yu , Fu Hongyuan , Wang Jue , Lin Yanting , Bai Jingxuan , Guo Xiaojing , Tu Liping , Xu Jiatuo 
Published: February 2021

AbstractBackgroundFatigue is a kind of non-specific symptom, which occurs widely in sub-health and various diseases. It is closely related to people's physical and mental health. Due to the lack of objective diagnostic criteria, it is often neglected in clinical diagnosis, especially in the early stage of disease. Many clinical practices and researches have shown that tongue and pulse conditions reflect the body's overall state. Establishing an objective evaluation method for diagnosing disease fatigue and non-disease fatigue by combining clinical symptom, index, and tongue and pulse data is of great significance for clinical treatment timely and effectively.MethodsIn this study, 2632 physical examination population were divided into healthy controls, sub-health fatigue group, and disease fatigue group. Complex network technology was used to screen out core symptoms and Western medicine indexes of sub-health fatigue and disease fatigue population. Pajek software was used to construct core symptom/index network and core symptom-index combined network. Simultaneously, canonical correlation analysis was used to analyze the objective tongue and pulse data between the two groups of fatigue population and analyze the distribution of tongue and pulse data.ResultsSome similarities were found in the core symptoms of sub-health fatigue and disease fatigue population, but with different node importance. The node-importance difference indicated that the diagnostic contribution rate of the same symptom to the two groups was different. The canonical correlation coefficient of tongue and pulse data in the disease fatigue group was 0.42 (P < 0.05), on the contrast, correlation analysis of tongue and pulse in the sub-health fatigue group showed no statistical significance.ConclusionsThe complex network technology was suitable for correlation analysis of symptoms and indexes in fatigue population, and tongue and pulse data had a certain diagnostic contribution to the classification of fatigue population.
Bringing two worlds closer together: a critical analysis of an integrated approach to guideline development and quality assurance schemes
Authors: Piggott Thomas , Langendam Miranda , Parmelli Elena , Adolfsson Jan , Akl Elie A. , Armstrong David , Braithwaite Jeffrey , Brignardello-Petersen Romina , Brozek Jan , Gore-Booth Jolanta , Follmann Markus , Leś Zbigniew , Meerpohl Joerg J , Neamţiu Luciana , Nothacker Monika , Qaseem Amir , Giorgi Rossi Paolo , Saz-Parkinson Zuleika , van der Wees Philip , Schünemann Holger J. 
Published: February 2021

Abstract
Background
Although quality indicators are frequently derived from guidelines, there is a substantial gap in collaboration between the corresponding parties. To optimise workflow, guideline recommendations and quality assurance should be aligned methodologically and practically. Learning from the European Commission Initiative on Breast Cancer (ECIBC), our objective was to bring the key knowledge and most important considerations from both worlds together to inform European Commission future initiatives.

Methods
We undertook several steps to address the problem. First, we conducted a feasibility study that included a survey, interviews and a review of manuals for an integrated guideline and quality assurance (QA) scheme that would support the European Commission. The feasibility study drew from an assessment of the ECIBC experience that followed commonly applied strategies leading to separation of the guideline and QA development processes. Secondly, we used results of a systematic review to inform our understanding of methodologies for integrating guideline and QA development. We then, in a third step, used the findings to prepare an evidence brief and identify key aspects of a methodological framework for integrating guidelines QA through meetings with key informants.

Results
Seven key themes emerged to be taken into account for integrating guidelines and QA schemes: (1) evidence-based integrated guideline and QA frameworks are possible, (2) transparency is key in clearly documenting the source and rationale for quality indicators, (3) intellectual and financial interests should be declared and managed appropriately, (4) selection processes and criteria for quality indicators need further refinement, (5) clear guidance on retirement of quality indicators should be included, (6) risks of an integrated guideline and QA Group can be mitigated, and (7) an extension of the GIN-McMaster Guideline Development Checklist should incorporate QA considerations.

Discussion
We concluded that the work of guideline and QA developers can be integrated under a common methodological framework and we provided key findings and recommendations. These two worlds, that are fundamental to improving health, can both benefit from integration.
Influence of the capping of biogenic silver nanoparticles on their toxicity and mechanism of action towards Sclerotinia sclerotiorum
Authors: Guilger-Casagrande Mariana , Germano-Costa Taís , Bilesky-José Natália , Pasquoto-Stigliani Tatiane , Carvalho Lucas , Fraceto Leonardo F. , de Lima Renata 
Published: February 2021

Abstract
Background
Biogenic nanoparticles possess a capping of biomolecules derived from the organism employed in the synthesis, which contributes to their stability and biological activity. These nanoparticles have been highlighted for the control of phytopathogens, so there is a need to understand their composition, mechanisms of action, and toxicity. This study aimed to investigate the importance of the capping and compare the effects of capped and uncapped biogenic silver nanoparticles synthesized using the filtrate of Trichoderma harzianum against the phytopathogenic fungus Sclerotinia sclerotiorum. Capping removal, investigation of the composition of the capping and physico-chemical characterization of the capped and uncapped nanoparticles were performed. The effects of the nanoparticles on S. sclerotiorum were evaluated in vitro. Cytotoxicity and genotoxicity of the nanoparticles on different cell lines and its effects on nontarget microorganisms were also investigated.

Results
The capped and uncapped nanoparticles showed spherical morphology, with greater diameter of the uncapped ones. Functional groups of biomolecules, protein bands and the hydrolytic enzymes NAGase, β-1,3-glucanase, chitinase and acid protease from T. harzianum were detected in the capping. The capped nanoparticles showed great inhibitory potential against S. sclerotiorum, while the uncapped nanoparticles were ineffective. There was no difference in cytotoxicity comparing capped and uncapped nanoparticles, however higher genotoxicity of the uncapped nanoparticles was observed towards the cell lines. Regarding the effects on nontarget microorganisms, in the minimal inhibitory concentration assay only the capped nanoparticles inhibited microorganisms of agricultural importance, while in the molecular analysis of the soil microbiota there were major changes in the soils exposed to the uncapped nanoparticles.

Conclusions
The results suggest that the capping played an important role in controlling nanoparticle size and contributed to the biological activity of the nanoparticles against S. sclerotiorum. This study opens perspectives for investigations concerning the application of these nanoparticles for the control of phytopathogens.