bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health promotion and prevention among the unemployed: a systematic review
Authors: Hollederer Alfons 
Published: August 2018

Abstract
The interactions between unemployment and health create a need for specific interventions for health promotion and prevention. This overview provides information on how health promotion for the unemployed has been approached with an analysis of controlled intervention studies between 1996 and 2016. The literature search consulted 11 international databases in medicine, social sciences and psychology. A total of 30 health interventions for the unemployed were identified, with 43 articles that included the effects of intervention. A controlled-study design was used in 14 studies. The health promotion measures were generally based on individual counselling, case management, training or group services. The overview demonstrates the breadth of variation in target groups and types of measures. Their result indicators for health and integration into the labor market vary substantially, as do the employment promotion effects. There is evidence of improved health and labor market integration for established approaches like the JOBS Program and JobFit. Effects are rather moderate or low in magnitude and the effect mechanisms often remain unclear. Effects weaken over time. While success is more common in the areas of health, physical activity, nutrition and stress relief, there was no impact on smoking behavior. A significant evolution can be observed in the quality and quantity of health promotion for the unemployed over time. There is a need for further research on the effectiveness and sustainability of interventions. Intervention strategies should be developed that take account of the diversity of the unemployed and their different needs.
San Juan Bautista School of Medicine’s Experience in the Aftermath of Hurricane Maria
Authors: Brugal Yocasta , Pérez Jorge 
Published: August 2018

The San Juan Bautista School of Medicine (SJBSM) is located in Caguas, Puerto Rico. On September 20, 2017, Hurricane Maria hit the island, making landfall as a Category 4 storm. The extreme wind force and rainfall caused extensive power outages and other damage. In this Invited Commentary, the authors discuss SJBSM’s actions and lessons learned in the aftermath of Hurricane Maria.
By September 25, SJBSM had contacted students to ensure their safety and identify their immediate needs. The medical school’s primary goal was to restore services as expeditiously as possible. By October 9, SJBSM had reopened and adjusted its offerings and practices to accommodate students’ needs. The medical school worked to support students’ emotional and physical well-being as well as meet their academic needs. First- and second-year students who could not be present received recorded lectures, study guides, assessments, and other materials electronically or via hard copy. Third- and fourth-year students were authorized to complete a single clerkship rotation at another medical school in the United States. During this time, SJBSM consulted with the Association of American Medical Colleges, the Liaison Committee on Medical Education, and other academic agencies. These groups offered advice on how to proceed given the hardships the medical school faced.
Since then, SJBSM has applied lessons learned from Hurricane Maria and taken measures to ensure that it can meet the needs of faculty, staff, and students in the immediate aftermath of future disasters.
The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible
Authors: Carroll Jennifer J. , Rich Josiah D. , Green Traci C. 
Published: August 2018

Objectives:
Buprenorphine/naloxone, an evidence-based treatment for opioid use disorder, is sometimes diverted for non-medical use. In Rhode Island, the prevalence of opioid use and, more recently, of fentanyl in the illicit drug supply is driving overdose fatalities, which increases the need for treatment and raises questions about the changing role of diverted medication in shaping overdose risk.

Methods:
This study considered data from 2 Rhode Island based studies (conducted in 2009 and 2016, respectively) of people who use illicit or diverted prescription opioids and their patterns of buprenorphine/naloxone diversion. Using targeted sampling, individuals who use opioids completed a brief questionnaire about their drug use. For the 2016 study, logistic regression was used to identify associations with recent and lifetime use of diverted medication.

Results:
A total of 128 individuals who use opioids non-medically participated in the 2016 study. Of these, 38% (n = 13) reported diverted buprenorphine/naloxone use in the past 2 months, similar to the pattern observed in 2009 (41%, n = 41). Common motivations for using diverted medication included the management of withdrawal symptoms (40%, n = 35) and self-treatment of opioid use disorder (39%, n = 34). Few reported using to “get high” (12%, n = 4). Seeking buprenorphine/naloxone treatment in the previous 12 months was positively associated with using diverted medication in the past 2 months (odds ratio = 5.14, 95% confidence interval = 1.0–26.5, P = 0.05). Participants of both studies reported the same barriers to care in 2009 and 2016.

Conclusion:
The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.
Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain
Authors: Azad Tej D. , Vail Daniel , Bentley Jason , Han Summer S. , Suarez Paola , Varshneya Kunal , Mittal Vaishali , Veeravagu Anand , Desai Manisha , Bhattacharya Jay , Ratliff John K. 
Published: August 2018

Study Design.
Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.

Objective.
To determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis.

Summary of Background Data.
Patients with low back pain present to a variety of providers and receive a spectrum of treatments, including opiate medications. The impact of initial provider type on opiate use in this population is uncertain.

Methods.
We performed a retrospective analysis of opiate-naïve adult patients in the United States with newly diagnosed low back or lower extremity pain. We estimated the risk of early opiate prescription (≤14 d from diagnosis) and long-term opiate use (≥six prescriptions in 12 mo) based on the provider type at initial diagnosis using multivariable logistic regression, adjusting for patient demographics and comorbidities.

Results.
We identified 478,981 newly diagnosed opiate-naïve patients. Of these, 40.4% received an opiate prescription within 1 year and 4.0% met criteria for long-term use. The most common initial provider type was family practice, associated with a 24.4% risk of early opiate prescription (95% CI, 24.1–24.6) and a 2.0% risk of long-term opiate use (95% CI, 2.0–2.1). Risk of receiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine (43.1%; 95% CI, 41.6–44.5) or at an urgent care facility (40.8%; 95% CI, 39.4–42.3). Risk of long-term opiate use was highest for patients initially diagnosed by pain management/anesthesia (6.7%; 95% CI, 6.0–7.3) or physical medicine and rehabilitation (3.4%; 95% CI, 3.1–3.8) providers.

Conclusion.
Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.

Level of Evidence: 3
Shoulder Impairment Following Critical Illness: A Prospective Cohort Study
Authors: Gustafson Owen D. , Rowland Matthew J. , Watkinson Peter J. , McKechnie Stuart , Igo Simon 
Published: August 2018

Objectives:
Identify the prevalence of shoulder impairment in ICU survivors within 6 months of discharge from ICU. Evaluate the impact of shoulder impairment on upper limb functional status in patients treated on an ICU. Identify risk factors for the development of shoulder impairment.

Design:
Prospective cohort study.

Setting:
A tertiary care medical-surgical-trauma ICU at a U.K. hospital over 18 months, with a further 6-month follow-up after hospital discharge.

Subjects:
Adult patients with an ICU length of stay of greater than 72 hours with no preexisting or new neurologic or traumatic upper limb injury.

Interventions:
None.

Measurements and Main Results:
Patients underwent targeted shoulder assessments (pain, range of movement, Constant-Murley Score, shortened version of the disabilities of the arm, shoulder, and hand [DASH] score [QuickDASH] score) at hospital discharge, 3 and 6 months after hospital discharge. Assessments were undertaken on 96 patients, with 62 patients attending follow-up at 3 months and 61 patients at 6 months. Multivariate regression analysis was used to investigate risk factors for shoulder impairment. ICU-related shoulder impairment was present in 67% of patients at 6 months following discharge from hospital. Upper limb dysfunction occurred in 46%, with 16% having severe dysfunction (equivalent to shoulder dislocation). We were unable to identify specific risk factors for shoulder impairment.

Conclusions:
Shoulder impairment is a highly prevalent potential source of disability in ICU survivors. This persists at 6 months after discharge with a significant impact on upper limb function. More research is needed into potential mechanisms underlying shoulder impairment and potential targeted interventions to reduce the prevalence.
The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study*
Authors: Irving Sharon Y. , Daly Bridget , Verger Judy , Typpo Katri V. , Brown Ann-Marie , Hanlon Alexandra , Weiss Scott L. , Fitzgerald Julie C. , Nadkarni Vinay M. , Thomas Neal J. , Srinivasan Vijay 
Published: August 2018

Objectives:
The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis.

Design:
Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards). Multivariable regression models were developed to determine adjusted differences in all-cause ICU mortality and ICU length of stay by nutrition status.

Setting:
One-hundred twenty-eight PICUs across 26 countries.

Patients:
Children less than 18 years with severe sepsis enrolled in the Sepsis Prevalence, Outcomes, and Therapies study (n = 567).

Interventions:
None.

Measurements and Main Results:
Nutrition status data were available for 417 patients. Severe undernutrition was seen in Europe (25%), Asia (20%), South Africa (17%), and South America (10%), with severe overnutrition seen in Australia/New Zealand (17%) and North America (14%). Severe undernutrition was independently associated with all-cause ICU mortality (adjusted odds ratio, 3.0; 95% CI, 1.2–7.7; p = 0.02), whereas severe overnutrition in survivors was independently associated with longer ICU length of stay (1.6 d; p = 0.01).

Conclusions:
There is considerable variation in nutrition status for children with severe sepsis treated across this selected network of PICUs from different geographic regions. Severe undernutrition was independently associated with higher all-cause ICU mortality in children with severe sepsis. Severe overnutrition was independently associated with greater ICU length of stay in childhood survivors of severe sepsis.
Extracorporeal Membrane Oxygenation Can Successfully Support Patients With Severe Acute Respiratory Distress Syndrome in Lieu of Mechanical Ventilation
Authors: Kurihara Chitaru , Walter James M. , Singer Benjamin D. , Cajigas Hector , Shayan Shahriar , Al-Qamari Abbas , DeCamp Malcolm M. , Wunderink Rich , Budinger GR Scott , Bharat Ankit 
Published: August 2018

Objectives:
Extracorporeal membrane oxygenation is increasingly used in the management of severe acute respiratory distress syndrome. With extracorporeal membrane oxygenation, select patients with acute respiratory distress syndrome can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Published experience with this approach, specifically with attention to a patient’s respiratory drive following cannulation, is limited.

Design:
We describe our experience with three consecutive patients with severe acute respiratory distress syndrome supported with right jugular-femoral configuration of venovenous extracorporeal membrane oxygenation without therapeutic anticoagulation as an alternative to lung-protective mechanical ventilation. Outcomes are reported including daily respiratory rate, vital capacities, and follow-up pulmonary function testing.

Results:
Following cannulation, patients were extubated within 24 hours. During extracorporeal membrane oxygenation support, all patients were able to maintain a normal respiratory rate and experienced steady improvements in vital capacities. Patients received oral nutrition and ambulated daily. At follow-up, no patients required supplemental oxygen.

Conclusions:
Our results suggest that venovenous extracorporeal membrane oxygenation can provide a safe and effective alternative to lung-protective mechanical ventilation in carefully selected patients. This approach facilitates participation in physical therapy and avoids complications associated with mechanical ventilation.
Aggressive Angiomyxoma—Report of a Rare Male Buttock Lesion
Authors: Hsieh Frank , Chuang Kai-Ti , Wu You-Ting , Lin Chih-Hung 
Published: August 2018

Summary:Aggressive angiomyxoma is a very rare benign tumor for male population with fewer than 50 cases reported since the description of this tumor. Most documented cases of aggressive angiomyxomas were found in genital, perineal, and pelvic regions in women of child bearing age. We report a case of a massive (> 20 cm) aggressive angiomyxomas in a man who presented with perineal swellings. Macroscopically the mass was highly vascular and lobulated with high similarity to plexiform neurofibroma. Microscopic examination revealed a hypocellular tumor comprising bland oval and spindle-shaped cells along with vessels of varying calibre. The accompanying stroma was myxocollagenous. Immunohistochemical staining showed CD34 and focal estrogen receptors positivity and negative staining for S100, actin, desmin, and progesterone receptors. The histologic and immunohistochemical features favored the diagnosis of aggressive angiomyxoma. Despite the rarity of such tumor in the male population, aggressive angiomyxoma should be considered in the differential diagnosis when encountering chronic para-perineal lesions.
Coincidence of Malignant Melanoma and an Incidently Discovered Parotid Mass Presenting a Diagnostic Challenge
Authors: Derebaşinlioğlu Handan , Yilmaz Sarper 
Published: August 2018

Summary:
Parotid masses coincided with skin tumors in head and neck region may represent a serious diagnostic challenge. Conventional imaging modalities such as computed tomography, magnetic resonance imaging may help to determine nature of the masses. Positron emission tomography - computed tomography imaging is reported to be useful for the detection of malignancy in the parotid gland. But in some situations all of them become insufficient. We present a case of cheek malignant melanoma with an incidentally discovered parotid mass during the investigation. We describe the problems experienced in the course of differential diagnosis and decision making in terms of surgical management. As a result, the most reliable diagnosis of suspicious parotid lesions accompanying head and neck melanomas comes from frozen section analyses. The other diagnostic tools are not reliable enough to allow a safe surgical plan in terms of regional treatment; however, the significance of positron emission tomography - computed tomography in distant metastasis investigation should always be kept in mind.
Age-Related Variations in Corneal Asphericity and Long-Term Changes
Authors: Amorim-de-Sousa Ana , Vieira Ana Cláudia , González-Méijome José Manuel , Queirós António 
Published: August 2018

Purpose:
Corneal front-surface asphericity is directly related with the optical quality of the eye and with contact lenses fitting. The purpose of this study was to evaluate the corneal asphericity as a function of age, sex, and refractive error measured with autokeratometry and corneal topography and its long-term changes (5- to 10-year period).

Methods:
The asphericity and corneal curvature were obtained with the autorefractometer/autokeratometer NIDEK ARK-700A and with the videokeratoscope MODI 2.0 and compared. Corneal asphericity was retrospectively analyzed with NIDEK ARK-700A. The longitudinal study of asphericity was conducted with the same device between 2 appointments within an interval of 5 to 10 years.

Results:
NIDEK ARK-700A showed agreement of asphericity values with those of MODI 2.0 (P=0.172) for a 7-mm diameter chord. The mean Q value of 1,484 right eyes (58.6% female), with a mean age of 40.2±18.4 years, was −0.24±0.12. No differences were found for Q value between sexes (P=0.424), age groups (P=0.268), and refractive error groups (P=0.107). The longitudinal analysis of corneal asphericity in 190 eyes (62.1% female) over a mean period of 5.9±1.4 years showed no significant differences in the Q value (0.00±0.08, P=0.813) over time. However, 14% showed asphericity changes of ±0.10 or higher while 86% of the subjects showed a change below ±0.10.

Conclusions:
The mean Q value observed in this study agrees with the average values of a white population and contributes to slightly reduce the positive spherical aberration of the eye. For the large majority of this population, the asphericity did not show significant changes within a period of 5 to 10 years, but significant changes can be observed in some patients.
Characterization of Primary Cilia in Normal Fallopian Tube Epithelium and Serous Tubal Intraepithelial Carcinoma
Authors: Abdelhamed Zakia A. , Ryan Thomas A. , Fuller Martin , Coulson-Gilmer Camilla , Abdelmottaleb Dina I. , Wang Tian-Li , Kaun Jen-Chun , Wang Peiyi , Hutson Richard , Wilkinson Nafisa , Bell Sandra M. , Johnson Colin A. 
Published: August 2018

ObjectivesThe aim of this study was to investigate the distribution of primary cilia on secretory cells in normal fallopian tube (FT) and serous tubal intraepithelial carcinoma (STIC).MethodsFallopian tube tissue samples were obtained from 4 females undergoing prophylactic hysterectomies and 6 patients diagnosed with STIC. A mogp-TAg transgenic mouse STIC sample was also compared with a wild-type mouse FT sample. Serous tubal intraepithelial carcinoma was identified by hematoxylin and eosin staining and confirmed by positive Ki-67 and p53 immunohistochemical staining of tissue sections. We assessed the relative distribution of primary cilia on secretory cells and motile cilia on multiple ciliated cells by immunofluorescence and immunohistochemical staining. Ciliary function was assessed by immunofluorescence staining of specific ciliary marker proteins and responsiveness to Sonic Hedgehog signaling.ResultsPrimary cilia are widespread on secretory cells in the ampulla, isthmus, and in particular, the fimbriae of human FT where they may appear to mediate ciliary-mediated Sonic Hedgehog signaling. A statistically significant reduction in the number of primary cilia on secretory cells was observed in human STIC samples compared with normal controls (P < 0.0002, Student t test), supported by similar findings in a mouse STIC sample. Immunohistochemical staining for dynein axonemal heavy chain 5 discriminated multiple motile cilia from primary cilia in human FT.ConclusionsPrimary cilia are widespread on secretory cells in the ampulla, isthmus, and in particular, the fimbriae of the human FT but are significantly reduced in both human and mouse STIC samples. Immunohistochemical staining for ciliary proteins may have clinical utility for early detection of STIC.
Incidence and Clinical Features of Autoimmune Hepatitis in the Province of Santa Fe (Argentina)
Authors: Costaguta Alejandro , González Andrea , Pochettino Sandra , Trotta Liliana , Vicentín Rosalía , Wagener Marta 
Published: August 2018

ABSTRACTObjetives:The aim of the study is to investigate the incidence and clinical features of autoimmune hepatitis (AIH) in children from the province of Santa Fe, Argentina, for 10 years.Methods:From the records of all of the pediatric hepatologists in the province of Santa Fe, Argentina, we reviewed the clinical charts of patients <18 years who were diagnosed with AIH (simplified score >6 points) and followed between January 2003 and December 2013. Population data were extracted from the 2010 national census. Values were expressed as percentages and median ± interquartile range. Mann‐Whitney U test was used for comparison between the groups.Results:Sixty‐seven patients fulfilled inclusion criteria, from which 11 (16%) were later reclassified as having “autoimmune sclerosing cholangitis” according to biochemical, histological, and radiological findings. A final sample of 56 patients (39 F) with AIH was analyzed, giving an annual incidence of 0.56/100,000. Median age at presentation was 8 (5.7–11) years, and the median follow‐up was 4 (2–7) years. Type 1 AIH was diagnosed in 89%. An acute presentation was observed in 53%, while 13 (23%) showed cirrhosis on initial biopsy. Prednisone (87%) and azathioprine (60%) were the most common drugs prescribed. At the end of follow‐up, 53/56 (95%) were alive, including 4 patients (7%) who underwent liver transplantation.Conclusions:AIH has an estimated incidence of 0.56/100,000 per year in children from the province of Santa Fe (Argentina). Overall survival rate was 95%. A subgroup of patients diagnosed as AIH develops predominant biliary disease and should be better classified as autoimmune sclerosing cholangitis.
Early Infant Risk Factors for Pediatric Eosinophilic Esophagitis
Authors: Witmer Claire P. , Susi Apryl , Min Steve B. , Nylund Cade M. 
Published: August 2018

ABSTRACTObjectives:Eosinophilic esophagitis (EoE) is an inflammatory, atopic disease of the esophagus without a clear etiology. Our objective was to identify exposures and conditions in early infancy associated with the development of EoE.Methods:A case‐control study was performed using the Military Health System Database. Subjects diagnosed with EoE from October 2008 to September 2015 were matched 1:2 on age and sex. Early infant risk factors from the first 6 months of life were investigated.Results:A total of 1410 cases with EoE were matched to 2820 controls. The median (interquartile range) age at diagnosis of EoE was 4.2 years (2.1–7.2) and 68.7% were boys. Proton pump inhibitors (adjusted odds ratio [aOR], 2.73; 95% confidence interval [CI] 1.93–3.88), histamine‐2 receptor antagonists (aOR, 1.64; 95% CI 1.27–2.13), and antibiotics (aOR, 1.31; 95% CI 1.10–1.56) were associated with EoE. Prematurity (aOR, 1.46; 95% CI 1.12–1.89) and early manifestations of atopic disease such as milk protein allergy (aOR, 2.37; 95% CI 1.26–4.44) and eczema (aOR, 1.97; 95% CI 1.64–2.36) were related to increased odds for EoE. Erythema toxicum in infancy was strongly associated with a diagnosis of EoE (aOR 3.52; 95% CI 1.03–12.04). Infants with feeding difficulty (aOR, 1.45; 95% CI 1.18–1.77) and gastroesophageal reflux disease (aOR, 1.79; 96% CI 1.43–2.26) were also at increased risk for EoE.Conclusions:Acid‐blocking medications and antibiotics during infancy were associated with later diagnosis of EoE. Erythema toxicum neonatorum, an eosinophilic immune phenomenon, was strongly associated with EoE. Identifying early infant risk factors for EoE may help to risk stratify the need for endoscopy.