bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review
Authors: Magnan Elizabeth , Weyrich Meghan , Miller Marykate , Melnikow Joy , Moulin Aimee , Servis Mark , Chadha Puja , Spivack Sarah , Henry Stephen G. 
Published: October 2023

Abstract

Purpose
In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma.

Method
The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality.

Results
A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention.

Conclusions
SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.
Integrating Public and Population Health Into Medical Education Curricula: Opportunities and Challenges for Reform
Authors: Mehta Shobha H. , Shah Nirav R. 
Published: October 2023

Abstract
In a review of U.S. medical education curricular guidance, from premedical studies through to continuing medical education, Maeshiro and colleagues found limited examples of public and population health topics. In this Commentary, the authors emphasize the importance of including public and population health in the curriculum, pointing to curricular reform efforts to integrate these topics into teaching of basic sciences and clinical studies. In addition, they consider the expectations placed on physicians to meet the needs of the population and argue that policies that support public health funding, infrastructure, and workers are also critical to improving the health of communities.
Epidemiology of systemic vasculitis
Authors: Ozguler Yesim , Esatoglu Sinem Nihal , Hatemi Gulen 
Published: October 2023

Purpose of review
Epidemiology of vasculitides exhibit geographic variation and data from some parts of the world are still scarce. Increased recognition of these rare diseases and improvement in diagnosis and patient care may lead to changes in their epidemiology. In this review, we aimed to highlight the most recent work on the epidemiology of systemic vasculitis.

Recent findings
New data from countries where information on the epidemiology of giant cell arteritis, Takayasu arteritis and Behçet syndrome were limited have revealed that these conditions are not as rare as previously believed. The incidence rates during the coronavirus disease 2019 pandemic highlight the link between Kawasaki disease and respiratory pathogens. The use of different classification criteria hampers the comparison of true incidence and prevalence rates in antineutophil cytoplasmic antibody (ANCA)-associated vasculitis and its subtypes between geographies and over time.

Summary
Recent studies have highlighted the epidemiology of vasculitides in different parts of the world and changing trends. Standardization of study design and disease definitions is needed to improve the reliability and comparability of the results.
Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis
Authors: Huffman William H. , Gupta Radhika , Ayotte Steven R. , Lawrence J. Todd R. 
Published: October 2023

Background:
Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth.

Methods:
The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs).

Results:
A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period (R
2=0.899; P<0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%).

Conclusions:
Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males.

Level of Evidence:
Level III—prognostic.
Preoperative Cervical Range of Motion in Flexion as a Risk Factor for Postoperative Cervical Sagittal Imbalance After Laminoplasty
Authors: Liu Chengxin , Wang Wei , Li Xiangyu , Shi Bin , Lu Shibao 
Published: October 2023

Study Design.
Retrospective study.

Objective.
To investigate factors associated with cervical sagittal imbalance (CSI) after cervical laminoplasty (LMP).

Summary of Background Data.
Preoperative dynamic cervical sagittal alignment is an important predictor for changes in cervical sagittal alignment and clinical outcomes after LMP. However, the impact of preoperative dynamic cervical sagittal alignment on postoperative changes in the cervical sagittal vertical axis (cSVA) after LMP remains unclear. We hypothesized that preoperative cervical flexion and extension function are associated with the changes in cSVA and clinical outcomes and found potential risk factors for post-LMP CSI.

Patients and Methods.
Patients undergoing LMP at a single institution between January 2019 and December 2021 were retrospectively reviewed. The average follow-up period was 19 months. The parameters were collected before the surgery and at the final follow-up. We defined the changes in cSVA (△cSVA) ≤ −10 mm as the improvement group, −10 mm < △cSVA ≤ 10 mm as the stable group, and △cSVA > 10 mm as the deterioration group. Multivariate logistic regression was used to evaluate factors associated with postoperative CSI. The χ2 test was used to compare categorical data between groups. T tests, analysis of variance, Kruskal-Wallis tests, and Mann-Whitney Wilcoxon tests were used to assess the differences between radiographic and clinical parameters among groups. A receiver operating characteristic curve analysis was used to identify optimal cutoff values.

Results.
The study comprised 102 patients with cervical spondylotic myelopathy. The Japanese Orthopedic Association recovery rate was better in the improvement group and a significant aggravation in neck pain was observed in the deterioration group after surgery. Cervical Flex range of motion (ROM; spine range of flexion) was significantly higher in the deterioration group. The multivariate logistic regression model suggested that greater Flex ROM and starting LMP at C3 were significant risk factors for postoperative deterioration of cervical sagittal balance. Receiver operating characteristic curves showed that the cutoff value for preoperative Flex ROM was 34.10°.

Conclusion.
Preoperative dynamic cervical sagittal alignment influences postoperative cervical sagittal balance after LMP. Cervical LMP should be carefully considered for patients with a preoperative high Flex ROM, as CSI is likely to occur after surgery.

Level of Evidence:
Level 3.
Early Compensatory Segmental Angle Changes at L3-L4 and L4-L5 After a L5-S1 Interbody Fusion for a Grade 1 Spondylolisthesis
Authors: O’Connor Bailey , Bansal Aiyush , Leveque Jean-Christophe , Drolet Caroline E. , Shen Jesse , Nemani Venu , Canlas Gina , Louie Philip K. 
Published: October 2023

Study Design.
The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022.

Objective.
To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1.

Background.
Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1. This can lead to lordotic overcompensation at adjacent levels to maintain spinopelvic balance. However, the fate of adjacent angles after interbody fusion is not well understood.

Patients and Methods.
Preoperative and 6-month postoperative measurements of SL (L3-L4, L4-L5, and L5-S1), lumbar lordosis, and pelvic incidence (PI) were obtained from sagittal standing radiographs. Preliminary t tests were performed for descriptive purposes, and multiple regression was used for hypothesis testing.

Results.
Ninety-eight patients met the inclusion criteria (50 ALIF and 48 TLIF). A greater amount of lordosis achieved at L5-S1 was significantly associated with a greater reduction of SL at L4-L5 (r = −0.65, P < 0.001) or L3-L4 (r = −0.46, P < 0.001). A greater preoperative PI was associated with a greater reduction of SL at L4-L5 (r = −0.42, P < 0.001) and at L3-L4 (r = −0.44, P < 0.001)

Conclusion.
At 6 months after a lumbar interbody fusion at L5-S1, greater compensatory changes with lordosis reduction are observed at the supra-adjacent L4-L5 and L3-L4 levels in patients achieving greater L5-S1 SL. In addition, preoperative PI played a role in influencing lordotic correction.
Access to Care Limitations: When Distance and Lack of Evidence Meet
Authors: Olsen Darren , Patel Lina , Spinazzi Noemi Alice , Nyp Sarah S. 
Published: October 2023

CASE:
Jimmy is a 13-year-old adolescent boy who was diagnosed with Down syndrome (trisomy 21) prenatally. Jimmy is the only individual with Down syndrome in the small, rural community where he lives with his parents. He has mild sleep apnea, and his gross and fine motor developmental milestones were generally consistent with those expected among children with Down syndrome. At age 4, his parents raised concerns about his limited language, strong preference to be alone, and refusal to leave the house. Parents had observed his marked startle response to loud laughter and adult male voices. At age 7, his preferred activities consisted of dangling necklaces or shoelaces in front of his face and rocking his body forward and backward when seated. After limited progress in special education, speech, and occupational therapies, he was referred, at age 8, to a specialty center 3 hours from his home for a multidisciplinary evaluation. There, he received a diagnosis of co-occurring autism spectrum disorder (ASD).
Over the last year, his repetitive behaviors have become more intense. He hits the side of his head with his fist and presses his thumbs into his eyes, causing bruising. Any attempts to remove his dangle objects are met with aggressive behaviors, including hitting, kicking, scratching, and elopement. At school, he refuses to complete work and sometimes hits his teacher. Aggression stops in the absence of educational demands. School staff informed parents they are not equipped to handle Jimmy's behaviors.
Jimmy recently presented to the specialty center for developmental-behavioral pediatric and psychology support at the request of his primary care clinician. The developmental pediatrician discussed with Jimmy's parents the possibility of a trial of medication to address disruptive/aggressive behavior if there is not improvement with initiation of behavioral strategies. The psychologist began weekly behavioral parent training visits through telehealth, including prevention strategies, reinforcement, and functional communication training. The strategies have helped decrease the frequency of elopement and aggressive behaviors. Self-injurious behaviors and refusal at school have remained constant.
Despite some stabilization, limited local resources as well as the lack of evidence-based guidelines for people with both Down syndrome and ASD have impeded improvements in Jimmy's significant behavioral and developmental challenges. His parents have become increasingly isolated from critical family and community support as well. In what ways could the clinicians and community support this child and his family and prevent others from experiencing similar hardships?
Optimal surgical techniques for curative resection of the rectal cancer
Authors: Bae Hyeon Woo , Kim Nam Kyu 
Published: October 2023

Abstract
The aim of rectal cancer surgery is to achieve a curative resection by completely removing the rectum involved with cancer surrounding the mesorectum, obtaining a safe adequate resection margin, and preserving important structures crucial for the patient's quality of life. Optimal dissection along the avascular embryological fusion line and among deep invisible structures is essential. Whereas a minimally invasive surgical approach allows for better visibility of deep pelvic structures compared with the open surgery period, the sequence of dissection and anatomical knowledge about pelvic fascia and relevant nerve structures are crucial for safe pelvic dissection in terms of oncologic and functional outcomes. In this review, we represent practical technical tips based on personal experience and previous studies to achieve the mentioned goals.
A Prospective Multicenter Study of a Weekly Application Regimen of Viable Human Amnion Membrane Allograft in the Management of Nonhealing Diabetic Foot Ulcers
Authors: Galiano Robert D. , Orgill Dennis P. , Armstrong David G. , Glat Paul M. , Carter Marissa J. , Zelen Charles M. 
Published: October 2023

Background:
Diabetic foot ulcers (DFUs) pose a significant clinical challenge for providers and patients, and often precede devastating complications such as infection, hospitalization, and amputation. Therefore, advanced treatment options are needed to facilitate the healing of chronic DFUs and improve outcomes in this high-risk population. Cryopreserved viable human amnion membrane allograft (vHAMA) has shown great promise in the treatment of recalcitrant DFUs as a supplement to standard of care (SOC). Placental grafts are rich in extracellular matrix proteins, growth factors, and cytokines, which can induce angiogenesis and dermal fibroblast proliferation, resulting in accelerated healing.

Methods:
In this prospective, multicenter single arm trial, 20 patients with nonhealing DFUs received weekly application of vHAMA, in addition to SOC, for up to 12 weeks. The primary study endpoint was proportion of healed wounds at 12 weeks. Secondary endpoints included proportion of wounds healed at 6 weeks, time to heal, and percentage area wound reduction. Subjects were evaluated for ulcer healing and assessed for adverse events at every treatment visit.

Results:
At study conclusion, 85% of patients receiving vHAMA healed. Ten wounds healed (50%) by 6 weeks, and 17 wounds (85%) healed by 12 weeks. The mean time to heal was 46.6 days (95% CI: 35.1–58.0), and the average number of vHAMAs used was 5.4 (SD: 3.25). The mean PAR was 86.3% (SD: 40.51).

Conclusions:
Aseptically processed, cryopreserved vHAMA should be considered as a safe and effective option for DFUs refractory to SOC therapy.
Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey
Authors: Crizzle Alexander M. , Wawzonek Peter A. , Bigelow Philip L. 
Published: October 2023

Background
This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population.

Methods
This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population.

Results
Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population.

Conclusions
Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.
The Nutritional Characteristics of Usual Lunches Consumed Among Japanese Workers
Authors: Sugimoto Minami , Asakura Keiko , Mori Sachie , Shinozaki Nana , Murakami Kentaro , Imamura Haruhiko , Nishiwaki Yuji 
Published: October 2023

Objective
This study investigated whether the nutritional characteristics of lunches consumed by Japanese workers differ by where the meal is usually prepared or eaten.

Methods
This cross-sectional study included 620 employees (aged 20 to 75 years) from eight business offices in Tokyo, Japan. Dietary data were collected using the validated Meal-based Diet History Questionnaire. The Healthy Eating Index 2015 and dietary intakes from lunch were compared between workers classified by usual lunch type: homemade (n = 190), staff canteen (n = 77), restaurant (n = 109), and takeaway (n = 244).

Results
Healthy Eating Index 2015 for lunch was highest in the staff canteen group, followed by the homemade group. The staff canteen group had higher intakes of total vegetables, potatoes, fish, and several vitamins from lunch than the restaurant or takeaway groups.

Conclusions
Homemade and canteen lunches are relatively healthy options for lunch for Japanese workers.
Comparing the safety and efficacy of sleeve gastrectomy vs. Roux-en Y gastric bypass in elderly (>60 Years) with severe obesity; An umbrella systematic review and meta-analysis
Authors: Kermansaravi Mohammad , Vitiello Antonio , Valizadeh Rohollah , Shahmir Shahab Shahabi , Musella Mario 
Published: October 2023

Background:
Today, bariatric surgeons face the challenge of treating older adults with class III obesity. The indications and outcomes of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) also constitute a controversy.

Methods:
PubMed, Web of Science and Scopus were searched to retrieve systematic reviews/meta-analyses published by March 1, 2022. The selected articles were qualitatively evaluated using A Measurement Tool to Assess systematic Reviews (AMSTAR).

Results:
An umbrella review included six meta-analyses retrieved from the literature. The risk of early- and late-emerging complications decreased by 55% and 41% in the patients underwent SG than in those receiving RYGB, respectively. The chance of the remission of hypertension and obstructive sleep apnea, respectively increased by 43% and 6%, but type-2 diabetes mellitus (T2DM) decreased by 4% in the patients underwent RYGB than in those receiving SG. RYGB also increased excess weight loss (EWL) by 15.23% in the patients underwent RYGB than in those receiving SG.

Conclusion:
Lower levels of mortality and early- and late-emerging complications were observed in the older adults undergoing SG than in those receiving RYGB, which was, however, more efficient in term of weight loss outcomes and recurrence of obesity-related diseases
Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study
Authors: Raptis Dimitri Aristotle , Salinas Camila Hidlago , Malagò Massimo ,   The LiverGroup.org Collaborative (Appendix)
Published: October 2023

Background:
The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.

Methods:
LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrolment within January to December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country- and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141)

Results:
A total of 2,159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among higher and lower HDI groups, respectively.

Conclusions:
This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. We identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index (HDI) countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.