bluuebunny/crossref_metadata_2025_split huggingface dataset:
Service user violence against social workers in Italy: Prevalence and characteristics of the phenomenon
Authors: Sicora Alessandro , Nothdurfter Urban , Rosina Barbara , Sanfelici Mara 
Published: April 2021

Summary Client violence in social services is perceived as constantly increasing in Italy, raising deep concern. This article presents the results of the first online survey on the phenomenon. Involving 20,112 social workers, the aim was to determine the prevalence and forms of client violence towards social workers and to identify key factors associated with such events. Findings The results suggest that the vast majority of Italian social workers experience client violence during their careers. Verbal aggression and threats were most common forms of violence, followed by physical attacks and property damage. Young and less experienced social workers appeared more likely to be victims of violence, as well as those who more frequently work in isolation or without their colleagues’ support. Social workers in child protection services, services for adults and municipality services accessible to the entire population were found to be at higher risk of client violence. The social workers considered the quality of the client/professional relationship and communication skills to be critical in preventing and dealing with aggression by users. Unfulfilled clients’ expectation was considered to be one of the main factors contributing to frustration and the consequent hostile behaviour. Applications Violence against social workers is a ‘wake-up call’ that makes the weakening of welfare services, and therefore of professional social work, more visible. The first nationwide study on service user violence reported by this paper may significantly contribute to raising awareness about the phenomenon in Italy and to the devising of effective prevention programmes.
Expression Profiles Reveal Involvement of VEGF, IGF1, BIRC5, and MMP1 in Vulvar Carcinogenesis
Authors: Zhang Tao , Liu Qin , Yu Minghua , Lan Yibing , Zhou Jianghong 
Published: April 2021

Objective: The objective of this study was to identify key genes and shed light on the underlying molecular mechanisms of vulvar squamous cell carcinoma (VSCC). Methods: Bioinformatic software was utilized for the identification and characterization of key differentially expressed genes (DEGs) from microarrays GSE63678 and GSE38228, which contain VSCC and normal vulvar tissue data. These microarrays were obtained from Gene Expression Omnibus (GEO). Immunohistochemical assays (55 VSCC and 50 normal vulvar tissues) were utilized to validate the expression of VEGF, IGF1, BIRC5, and MMP1 screened from the identified DEGs. SPSS 18.0 software was used for statistical analyses of the relationships between IGF1, BIRC5, VEGF, MMP1 expression levels and patient clinicopathological characteristics. Results: A total of 141 DEGs were identified, among which 18 genes were closely correlated with the biological characteristics of VSCC. Four of the 18 genes ( VEGF, IGF1, BIRC5, and MMP1) screened from the GEO database were markedly enriched in pathways in cancer ( P < 0.05), and could be considered key genes in VSCC based on KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analysis in DAVID (Database for Annotation, Visualization and Integrated Discovery).The expression levels of these 4 hub genes, determined by immunohistochemical assays, were consistent with the bioinformatics results. Higher expression of IGF1 showed significant association with well-differentiated carcinomas ( P = 0.017). BIRC5 expression levels showed a positive correlation with clinical stage ( P = 0.039); compared with those in menopause for over 10 years, patients in menopause for less than 10 years at the time of diagnosis tended to have significantly higher expression of BIRC5 ( P = 0.003). VEGF and MMP1 expression levels were not correlated with any of the tested clinicopathological characteristics. Conclusion: VEGF, IGF1, BIRC5, and MMP1 were identified as being associated with VSCC using integrated bioinformatic methods, which may provide important insights into the pathogenesis of this disease and help to identify new biomarkers.
Hand Surgeons Are Tackling Tougher Scaphoids: A Study of ABOS Candidate Data
Authors: Nicholson Tyler , Dunn John C. , Nesti Leon J. 
Published: April 2021

Background This study will evaluate whether those who have completed a hand fellowship treat a disproportionate number of scaphoid fractures based on recent American Board of Orthopaedic Surgery (ABOS) data. We hypothesize that surgeons who have completed a fellowship in hand surgery will address most surgically treated scaphoid fractures, particularly those with fracture nonunions or requiring graft. Methods We queried the ABOS database for case log information submitted for part II of the ABOS examination. This search included all cases with Current Procedural Terminology codes for procedures related to scaphoid fixation. Demographic information, case volume, type of case, and complication rate were compared for hand fellowship–trained surgeons and those who had completed other fellowships as well as non-fellowship-trained surgeons. Results During the study period, 1686 surgeons reported treating 4244 scaphoid fractures. Of these surgeons, 1180 had completed a hand surgery fellowship. Hand fellowship–trained surgeons were shown to have operatively treated more scaphoid fractures both in total volume and on a per-surgeon basis. Hand fellowship–trained surgeons were also found to have performed a significantly higher proportion of difficult cases, which were those listed as being a malunion/nonunion or those incorporating a pedicle graft. There was no difference in the complication rate between the 2 groups. Conclusion Among those orthopedic surgeons reporting case information for part II of the ABOS certification examination, statistically significant differences exist in case volume and case difficulty among surgeons with different areas of fellowship training. Complication rates increase with patient age and examination year.
Variation and appropriateness of antipsychotic use in long-term care facilities across Newfoundland and Labrador
Authors: Giovannini-Green Zachary E. M. , Gamble John-Michael , Barrett Brendan , Gao Zhiwei , Stuckless Susan , Parfrey Patrick S. 
Published: April 2021

Objective: The use of antipsychotics to treat seniors in long-term care facilities (LTCFs) has raised concern because of health consequences (i.e., increased risk of falls, stroke, death) in this vulnerable population. This study measured geographic patterns of antipsychotic utilization among seniors living in LTCFs in Newfoundland and Labrador (NL) and assessed potential inappropriateness. Method: We analyzed prescription records among adults 66 years and older with provincial prescription drug coverage admitted to LTCFs in NL between April 1, 2011, and March 31, 2014. Patterns of use were analyzed across the 4 regional health authorities (RHAs) in NL and LTCFs. Logistic, Poisson and linear regression models were used to test variations in prevalence, rate and volume of antipsychotic utilization. To assess potential inappropriateness of antipsychotic use, we analyzed data from Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 forms from NL LTCFs between January 1, 2016, and December 31, 2018. Pearson chi-squared analysis was performed at the RHA and LTCF levels to determine changes in percentage of total prescriptions or antipsychotic prescriptions without psychosis. Results: Between 2011 and 2014, 2843 seniors were admitted to LTCFs across NL; of these, 1323 residents were prescribed 1 or more antipsychotics. Within the 3-year period, the percentage of antipsychotic use across facilities ranged from 35% to 78%. Using data from 27,260 RAI-MDS 2.0 assessments between 2016 and 2018, 71% (6995/9851) of antipsychotic prescriptions were potentially inappropriate. Discussion: There is substantial variation across NL regions concerning the utilization of antipsychotics for senior in LTCFs. Facility size and management styles may be reasons for this. Conclusion: With nearly three-quarters of antipsychotic prescriptions shown to be potentially inappropriate, systematic interventions to assess indications for antipsychotic use are warranted. Can Pharm J (Ott) 2021;154:xx-xx.
Does regulatory chill still concern states?
Authors: Boru Zeleke Temesgen 
Published: April 2021

Public health measures taken by States have been subject to mounting arbitration legal challenges. These challenges resulted in an argument that investment agreements in general and the prevalence of the Investor-State Dispute Settlement (ISDS) mechanism, in particular, may force governments to refrain from introducing new legislative or policy measures due to a fear that the measures could be contested by investors. This situation, a fear to adopt legislative and similar other measures, is often referred to as “regulatory chill.” Recent arbitration cases show, however, that some of the cases involving pharmaceutical and similar other companies have been decided in favor of State Parties to the ISDS. In this regard, the legal claims initiated by Eli Lilly against the Government of Canada or the arbitration claims brought by Philip Morris against the Government of Australia and Uruguay can be cases in point. Due to these recent cases, some scholars have argued that the ISDS decisions (such as Eli Lilly and Government of Canada) demonstrate that regulatory chill may not be States’ concern anymore. This paper examines the obligations of State Parties to the International Covenant on Economic, Social and Cultural Rights (ICESCR or Covenant) to ensure access to affordable health technologies (medicines, vaccines, etc.) and the likelihood of investment agreements to result in a “regulatory chill” that hinders the realization of the obligations. In order to do so, the paper takes the TPP’s (now CPTPP) investment chapter as a case in point.
The efficacy and tolerance of prone positioning in non-intubation patients with acute hypoxemic respiratory failure and ARDS: a meta-analysis
Authors: Tan Wei , Xu Dong-yang , Xu Meng-jiao , Wang Zan-feng , Dai Bing , Li Li-li , Zhao Hong-wen , Wang Wei , Kang Jian 
Published: April 2021

Background and aims: The application of prone positioning with acute hypoxemic respiratory failure (AHRF) or acute respiratory distress syndrome (ARDS) in non-intubation patients is increasing gradually, applying prone positioning for more high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) patients. This meta-analysis evaluates the efficacy and tolerance of prone positioning combined with non-invasive respiratory support in patients with AHRF or ARDS. Methods: We searched randomized controlled trials (RCTs) (prospective or retrospective cohort studies, RCTs and case series) published in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 1 July 2020. We included studies that compared prone and supine positioning with non-invasive respiratory support in awake patients with AHRF or ARDS. The meta-analyses used random effects models. The methodological quality of the RCTs was evaluated using the Newcastle–Ottawa quality assessment scale. Results: A total of 16 studies fulfilled selection criteria and included 243 patients. The aggregated intubation rate and mortality rate were 33% [95% confidence interval (CI): 0.26–0.42, I2 = 25%], 4% (95% CI: 0.01–0.07, I2 = 0%), respectively, and the intolerance rate was 7% (95% CI: 0.01–0.12, I2 = 5%). Prone positioning increased PaO2/FiO2 [mean difference (MD) = 47.89, 95% CI: 28.12–67.66; p < 0.00001, I2 = 67%] and SpO2 (MD = 4.58, 95% CI: 1.35–7.80, p = 0.005, I2 = 97%), whereas it reduced respiratory rate (MD = −5.01, 95% CI: −8.49 to −1.52, p = 0.005, I2 = 85%). Subgroup analyses demonstrated that the intubation rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 34% and 21%, respectively; and the mortality rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 6% and 0%, respectively. PaO2/FiO2 and SpO2 were significantly improved in COVID-19 patients and non-COVID-19 patients. Conclusion: Prone positioning could improve the oxygenation and reduce respiratory rate in both COVID-19 patients and non-COVID-19 patients with non-intubated AHRF or ARDS. The reviews of this paper are available via the supplemental material section.
Efficacy and safety of alemtuzumab over 6 years: final results of the 4-year CARE-MS extension trial
Authors: Coles Alasdair J. , Arnold Douglas L. , Bass Ann D. , Boster Aaron L. , Compston D. Alastair S. , Fernández Óscar , Havrdová Eva Kubala , Nakamura Kunio , Traboulsee Anthony , Ziemssen Tjalf , Jacobs Alan , Margolin David H. , Huang Xiaobi , Daizadeh Nadia , Chirieac Madalina C. , Selmaj Krzysztof W. 
Published: April 2021

Background: In the 2-year CARE-MS I and II trials, alemtuzumab 12 mg administered on 5 consecutive days at core study baseline and on 3 consecutive days 12 months later significantly improved outcomes versus subcutaneous interferon beta-1a (SC IFNB-1a) in relapsing–remitting multiple sclerosis patients. Here, we present the final 6-year CARE-MS extension trial results (CAMMS03409), and compare outcomes over 6 years in patients randomized to both treatment groups at core study baseline. Methods: Over a 4-year extension, alemtuzumab patients (alemtuzumab-only) received as-needed additional alemtuzumab (⩾12 months apart) for disease activity after course 2. SC IFNB-1a patients who entered the extension discontinued SC IFNB-1a and received 2 alemtuzumab 12 mg courses (IFN–alemtuzumab), followed by additional, as-needed, alemtuzumab. Results: Through year 6, 63% of CARE-MS I and 50% of CARE-MS II alemtuzumab-only patients received neither additional alemtuzumab nor other disease-modifying therapy, with lasting suppression of disease activity, improved disability, and slowing of brain volume loss (BVL). In CARE-MS I patients (treatment-naive; less disability; shorter disease duration), disease activity and BVL were significantly reduced in IFN–alemtuzumab patients, similar to alemtuzumab-only patients at year 6. Among CARE-MS II patients (inadequate response to prior treatment; more disability; longer disease duration), alemtuzumab significantly improved clinical and magnetic resonance imaging outcomes, including BVL, in IFN–alemtuzumab patients; however, disability outcomes were less favorable versus alemtuzumab-only patients. Safety profiles, including infections and autoimmunities, following alemtuzumab were similar between treatment groups. Conclusion: This study demonstrates the high efficacy of alemtuzumab over 6 years, with a similar safety profile between treatment groups. ClinicalTrials.gov identifiers: NCT00530348; NCT00548405; NCT00930553
Favourable outcome of patients with breast cancer brain metastases treated with dual HER2 blockade of trastuzumab and pertuzumab
Authors: Bergen Elisabeth Sophie , Binter Amelie , Starzer Angelika Martina , Heller Gerwin , Kiesel Barbara , Tendl-Schulz Kristina , Bago-Horvath Zsuzsanna , Furtner Julia , Leitner Johannes , Exner Ruth , Fitzal Florian , Dieckmann Karin , Widhalm Georg , Preusser Matthias , Berghoff Anna Sophie , Bartsch Rupert 
Published: April 2021

Background: Dual human epidermal growth factor receptor 2 (HER2) blockade with trastuzumab and pertuzumab (TP) is a standard therapy of metastatic and localized HER2-positive breast cancer (BC), but its activity in breast cancer brain metastases (BCBM) is unknown. Methods: Patients with HER2-positive BCBM were identified from the Vienna Brain Metastasis Registry and clinical data including patient characteristics, therapies and overall survival (OS) were obtained. Patients were grouped into ‘TP’, ‘other-HER2-targeted therapy’ and ‘no-HER2-targeted therapy’ according to received first-line systemic therapy after diagnosis of BCBM. Radiological re-assessment of intracranial lesions was performed in patients treated with TP as systemic first-line therapy according to RANO response criteria for brain metastases (BM). Results: A total of 252 HER2-positive BC patients with BM were available for this analysis. Patients treated with TP as systemic first-line therapy after diagnosis of BM had a significantly longer OS compared with treatment with other-HER2-targeted therapy and no-HER2-targeted therapy (44 versus 17 versus 3 months, p < 0.001; log-rank test). Among radiologically re-assessed patients treated with TP as systemic first-line therapy after diagnosis of BM, 5/14 patients (35.7%) had complete intracranial remission (CR), 8/14 patients (57.1%) partial intracranial remission (PR), 1/14 patients (7.1%) stable intracranial disease (SD) and 0/14 patients (0.0%) progressive intracranial disease (PD) as best response resulting in an intracranial objective response rate (iORR) of 92.9% and an intracranial clinical benefit rate (iCBR) of 100.0%. Conclusion: First-line therapy with dual HER2-inhibition of TP after BM diagnosis was associated with the longest median OS times in patients with BCBM.
Association of Serum Vitamin D with Serum Cytokine Profile in Patients with Knee Osteoarthritis
Authors: Amini Kadijani Azade , Bagherifard Abolfazl , Mohammadi Fatemeh , Akbari Abolfazl , Zandrahimi Farshad , Mirzaei Alireza 
Published: April 2021

Objective The role of vitamin D in the pathogenesis of osteoarthritis (OA) is not well understood. In this study, we aimed to investigate the association of serum vitamin D with the serum cytokine profile in patients with primary knee OA. Design In a cross-sectional study, 116 patients with radiologic diagnosis of grade I to III knee OA were included. The study population included 79 (75.9%) females and 25 (24.1%) males with a mean age of 55.1 ± 9.6 years. The serum concentration of IL-6, IL-8, TNF-α, IL-4, IL-10, IL-13, and vitamin D were assessed using an enzyme-linked immunosorbent assay. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for the assessment of patient’s reported disability associated with knee OA. Results Serum vitamin D status was deficient, insufficient, and sufficient in 18 (15.5%), 63 (54.3%), 35 (30.2%) patients, respectively. Higher levels of serum IL-6 were observed in patients with vitamin D deficiency ( P = 0.022). The mean serum vitamin D level was not associated with OA grade ( P = 0.88) and WOMAC scores of the patients ( P = 0.67). Serum IL-6 level was significantly associated with both OA grade and WOMAC scores of the patients ( P < 0.001 and P = 0.001, respectively). The vitamin D status was not significantly associated with the serum levels of other evaluated cytokines. Conclusion Vitamin D deficiency in knee OA seems to be associated with a higher release of IL-6. Therefore, vitamin D supplementation could reduce the disease burden by controlling the IL-6 release.
Clinical pharmacist interventions in elderly patients with mental disorders in primary care focused on psychotropics: a retrospective pre–post observational study
Authors: Stuhec Matej , Lah Lea 
Published: April 2021

Background: Mental disorders pose a significant clinical burden and affect approximately one-third of older adults. Although studies have shown positive impacts of clinical pharmacist (CP) interventions within the general population, the long-term effects of such cooperation on geropsychiatric patients in primary care settings are not yet known. This study evaluated whether CP interventions have a long-term impact on the quality of medication prescribing in geropsychiatric patients. Methods: We conducted a retrospective non-interventional observational pre–post study for the 2015–2017 period, involving patients aged 65 or above for whom a medication review was provided by a CP. The study included participants with mental disorders treated with polypharmacy, including at least one psychotropic. Potentially inappropriate medications (PIMs) in elderly patients were determined with the Priscus list, and potential type X drug–drug interactions (pXDDIs) with Lexicomp®. Up-to-date treatment guidelines were used to evaluate patient pharmacotherapy, and patient medication was evaluated before the initial medication review and again 6 months later. Results: The study included 48 patients (79.4 years, SD = 8.13) receiving a total of 558 medications (155 for the treatment of mental disorders). The number of medications decreased by 9.5% after the medication review. The CP proposed 198 interventions related to psychotropics, of which 108 (55%) were accepted by the general practitioners. All accepted (99.1%) interventions except one were still maintained 6 months after the interventions had been proposed. They led to a significant decrease in the total number of medications, PIMs, and pXDDIs ( p < 0.05), and improved treatment guidelines adherence. Conclusions: CP interventions decreased the number of medications, PIMs, and pXDDIs, and almost all interventions were maintained 6 months later. These results provide evidence for the positive effects of CP interventions in a primary care setting. Additional research with a larger sample size and a randomized study design is needed.
Efficacy and safety of pulmonary vasodilators in the patients with Eisenmenger syndrome: a meta‐analysis of randomized controlled trials
Authors: Hou Yulin , Wen Li , Shu Tingting , Dai Rong , Huang Wei 
Published: April 2021

Few meta‐analyses evaluated the efficacy and safety of pulmonary vasodilators in patients with Eisenmenger syndrome. Recently, some studies have reported conflicting results regarding improvements in exercise capacity. This study evaluated the efficacy and safety of pulmonary vasodilators in patients with Eisenmenger syndrome. Relevant studies were identified by searching major databases. Pooled outcomes were used to assess the efficacy and safety of pulmonary vasodilators. In total, five studies with 508 patients were included. Meta‐analysis indicated that the pulmonary vasodilators reduced the mortality (odd risk (OR) = 0.35; 95% CI, 0.13 to 0.95; P = 0.04), slashed the mean pulmonary artery pressure (mean difference (MD) = −4.35 mmHg; 95% CI, −7.19 to −1.50; P = 0.003), decreased pulmonary vascular resistance index (MD = −480.08 dyn · s · cm−5 · m2; 95% CI, −753.51 to −206.64; P = 0.0006), increased the 6‐min walk distance (MD = 28.38 m; 95% CI, 2.99 to 53.77; P = 0.03), and elevated the systemic oxygen saturation at rest (MD = 1.00%; 95% CI, 0.12 to 1.88; P = 0.03). Four studies reported side effects, but only two studies reported serious adverse effects which were mostly rare and curable. The present meta‐analysis indicated that pulmonary vasodilators decrease mortality and improve hemodynamics and exercise capacity in patients with Eisenmenger syndrome. Overall, pulmonary vasodilators are well tolerated.