bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of expansion of primary care in child health: a population-based panel study in municipalities in the Brazilian Amazon
Authors: Carneiro Vânia Cristina Campelo Barroso , Ribeiro de Oliveira Paulo de Tarso , Rassy Carneiro Saul , Cardoso Maciel Marinalva , Pedroso Janari da Silva 
Published: March 2022

ObjectivesConsidering the expansion of primary care in areas of difficult access in the Brazilian territory in recent decades, the aim of this study to evaluate the effect of the Family Health Strategy (FHS) expansion on hospitalisations due to ambulatory care-sensitive conditions (ACSCs) and mortality in children under 5 years of age in the state of Pará, Brazilian Amazon.MethodsA longitudinal analysis from 2008 to 2017 was conducted for data collected from the SUS’s database (DATASUS) using panel regression methods to determine the association between the expansion FHS coverage, ACSC rate, under 5 mortality rate and child mortality rate in municipalities of the state of Pará.ResultsThere was an expansion of 40% of the population coverage of the FHS, in the same period there were 347 468.55 hospitalisations due to ASCSs of children under 5 years of age in the public health network in the state of Pará, which represented a reduction of almost 28% (p value <0001), and significant reduction of almost 57.67% in government hospital expenditures with hospitalisations between 2008 and 2017. In this period, there was also a significant decrease in the mortality rate in children under 5 years of age.ConclusionsOur findings reinforce the importance of the public health protection for the child population and the positive impacts of FHS in the state of Pará, in the Brazilian Amazon. The government actions aimed at reducing regional health disparities and the effort to strengthen primary care can improve health indicators of children and be an important strategy to developing countries.
Four reasons why too many informed consents to clinical research are invalid: a critical analysis of current practices
Authors: Wisgalla Anne , Hasford Joerg 
Published: March 2022

ObjectiveInformed consent (IC) is a central ethical and legal requirement for clinical research that aims to protect the autonomy of participants. To enable an autonomous decision and valid consent, adequate understanding must be ensured. However, a considerable proportion of participants do not understand the relevant aspects about participation in research, for example, approximately 45% could not name at least one risk. As such, the inadequate understanding of IC has been known for several decades, and it still constitutes a severe problem for the ethical conduct of research. Through delineating the most pressing deficits of current IC procedures that lead to insufficient understanding, we aim to encourage the discussion among stakeholders, for example, clinical researchers, and to provide the grounds for practical solutions.Main arguments(1) IC documents are too long to be read completely, thus, make it very difficult for potential participants to identify the material facts about the trial. (2) The low readability of the IC documents disadvantages persons with limited literacy. (3) The therapeutic misconception frequently prevents participants to realise that the primary purpose of clinical research is to benefit future patients. (4) Excessive risk disclosures, insufficient information about expected benefits and framing effects compromise a rational risk/benefit assessment.ConclusionDue to these deficits, practices of IC in clinical research too often preclude adequate understanding of prospective participants, thus, invalidating IC. The gap between the well-specified ethical norm to enable IC and its insufficient translation into practice can no longer be accepted, as participant rights and the public trust in responsible research are at stake. Hence, immediate action is needed to address the prevailing deficits.
Effect of health extension workers led home-based intervention on hypertension management in Northwest Ethiopia, 2021: study protocol for a cluster randomised controlled trial
Authors: Teshome Destaw Fetene , Alemu Shitaye , Ayele Tadesse Awoke , Atnafu Asmamaw , Gelaye Kassahun Alemu 
Published: March 2022

IntroductionAlthough hypertension is highly prevalent in Ethiopia, it is poorly diagnosed, treated and controlled. Poor access to care and a shortage of healthcare providers are major barriers. This study aims to evaluate the effects of health extension workers’ led home-based intervention on hypertension management in patients with hypertension in rural districts of northwest Ethiopia.Methods and analysisA two-arm cluster randomised controlled trial will be conducted among 456 hypertensive patients. Adults aged ≥25 years who have a diagnosis of hypertension both in the home-based hypertension screening study and at another measurement prior to recruitment will be eligible for the study. Randomisation will be done at the kebele level. In the intervention clusters, trained health extension workers will provide home-based intervention for hypertensive patients every 2 months for 9 months. The primary outcomes of the trial will be clinical linkage and blood pressure changes, whereas the secondary outcomes will be lifestyle modification, medication adherence and blood pressure control. Intention-to-treat analysis will be used for all primary analyses. A linear mixed-effect regression model will be used to model the change in blood pressure, while a mixed effect logistic regression model will be used to evaluate the intervention’s effect on the binary outcomes. Effect sizes such as mean difference for the continuous outcomes and relative risk, attributable risk and population attributable risk for binary outcomes will be used. All statistical analyses are two sided and a p<0.05 will be used.Ethics and disseminationThis study has been approved by institutional review board of the University of Gondar (Ref. No: V/P/RCS/05/2293/2020). The district’s health office will grant permission for cluster randomisation, and each participant will provide written informed consent for participation. The findings will be presented at scientific conferences and published in peer-reviewed scientific journals.Trial registration numberPACTR202102729454417.
Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey
Authors: Nakkash Rima , Khader Yousef , Chalak Ali , Abla Ruba , Abu-Rmeileh Niveen M E , Mostafa Aya , Jawad Mohammed , Lee Ji-Hyun , Salloum Ramzi G 
Published: March 2022

ObjectivesTobacco smoking is on the rise in the Eastern Mediterranean region. In light of limited surveillance of smoking in the region, this study sought to understand the prevalence of cigarette and waterpipe smoking among adults and the factors associated with smoking in Lebanon, Jordan and Palestine (West Bank only).Design, setting and participantsHousehold surveys were conducted with participants over the age of 18 in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679) between June and August 2019. A multistage cluster sampling approach with probability-proportional-to-size random selection method was followed in the three countries.Primary and secondary outcome measuresGender-specific prevalence rates for cigarette and waterpipe smoking were estimated. Multivariable logistic regression was used to examine factors associated with current cigarette and waterpipe tobacco smoking.ResultsThe prevalence of cigarette smoking among males and females respectively was 48.6% and 21.5% in Lebanon, 50.4% and 9.1% in Jordan, and 53.4% and 3.1% in Palestine. The prevalence of waterpipe smoking among males and females respectively was 32.7% and 46.2% in Lebanon, 13.4% and 7.8% in Jordan, and 18.0% and 7.9% in Palestine. Cigarette smokers were significantly (p<0.05) more likely to be male, younger and with lower educational attainment across the three countries. Waterpipe smokers were more likely to be young adults across the three countries (p<0.001). They were more likely to be male in Jordan and Palestine, and more likely to be female in Lebanon.ConclusionsThe high prevalence rates of smoking in Lebanon, Jordan and Palestine are concerning. Continued surveillance is key to monitor smoking patterns and inform stronger tobacco control measures.
Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland
Authors: Pereira Filipa , Verloo Henk , von Gunten Armin , del Río Carral María , Meyer-Massetti Carla , Martins Maria Manuela , Wernli Boris 
Published: March 2022

ObjectiveTo investigate patient characteristics and the available health and drug data associated with unplanned nursing home admission following an acute hospital admission or readmission.DesignA population-based hospital registry study.SettingA public hospital in southern Switzerland (Valais Hospital).ParticipantsWe explored a population-based longitudinal dataset of 14 705 hospital admissions from 2015 to 2018.Outcome measuresSociodemographic, health and drug data, and their interactions predicting the risk of unplanned nursing home admission.ResultsThe mean prevalence of unplanned nursing home admission after hospital discharge was 6.1% (n=903/N=14 705). Our predictive analysis revealed that the oldest adults (OR=1.07 for each additional year of age; 95% CI 1.05 to 1.08) presenting with impaired functional mobility (OR=3.22; 95% CI 2.67 to 3.87), dependency in the activities of daily living (OR=4.62; 95% CI 3.76 to 5.67), cognitive impairment (OR=3.75; 95% CI 3.06 to 4.59) and traumatic injuries (OR=1.58; 95% CI 1.25 to 2.01) had a higher probability of unplanned nursing home admission. The number of International Classification of Diseases, 10th version diagnoses had no significant impact on nursing home admissions, contrarily to the number of prescribed drugs (OR=1.17; 95% CI 1.15 to 1.19). Antiemetics/antinauseants (OR=2.53; 95% CI 1.21 to 5.30), digestives (OR=1.78; 95% CI 1.09 to 2.90), psycholeptics (OR=1.76; 95% CI 1.60 to 1.93), antiepileptics (OR=1.49; 95% CI 1.25 to 1.79) and anti-Parkinson’s drugs (OR=1.40; 95% CI 1.12 to 1.75) were strongly linked to unplanned nursing home admission.ConclusionsNumerous risk factors for unplanned nursing home admission were identified. To prevent the adverse health outcomes that precipitate acute hospitalisations and unplanned nursing home admissions, ambulatory care providers should consider these risk factors in their care planning for older adults before they reach a state requiring hospitalisation.
Evaluation of response to 13-valent conjugated pneumococcal vaccination in patients with rheumatoid arthritis receiving upadacitinib: results from a phase 2 open-label extension study
Authors: Winthrop Kevin , Vargas Juan Ignacio , Drescher Edit , Garcia Conrado , Friedman Alan , Hendrickson Barbara , Li Yihan , Klaff Justin , Kivitz Alan 
Published: March 2022

ObjectiveTo assess the immunogenicity of pneumococcal 13-valent conjugate vaccination (PCV-13) in patients with rheumatoid arthritis receiving upadacitinib and background methotrexate (MTX).MethodsEligible patients from the phase 2 open-label extension trial BALANCE-EXTEND (NCT02049138) receiving stable dosing of upadacitinib 15 mg or 30 mg once daily plus background MTX were given PCV-13. Antibody titres were collected prevaccination and 4 and 12 weeks postvaccination. The primary endpoint was the proportion of patients with satisfactory humoral response to PCV-13, defined as a ≥2-fold increase in ≥6 of 12 pneumococcal antigens at 4 weeks postvaccination.ResultsOf 111 patients (upadacitinib 15 mg, N=87; 30 mg, N=24), 85.6% were women, 97.3% used concomitant MTX and 44.1% used oral corticosteroids. At 4 weeks, 67.5% (95% CI 57.4 to 77.5) of patients receiving upadacitinib 15 mg and 56.5% (36.3 to 76.8) receiving 30 mg had a satisfactory PCV-13 response. Responses were similar in patients who used or did not use concomitant corticosteroids. No deaths or serious adverse events were reported.ConclusionsApproximately two-thirds of patients receiving upadacitinib 15 mg once daily achieved a satisfactory humoral response to PCV-13 despite receiving concomitant MTX. Concomitant corticosteroid use did not negatively affect PCV-13 response.
MOTION – A Framework for Mixed-Protocol Multi-Party Computation
Authors: Braun Lennart , Demmler Daniel , Schneider Thomas , Tkachenko Oleksandr 
Published: March 2022

We present MOTION, an efficient and generic open-source framework for mixed-protocol secure
multi-party computation (MPC)
. MOTION is built in a user-friendly, modular, and extensible way, intended to be used as a tool in MPC research and to increase adoption of MPC protocols in practice. Our framework incorporates several important engineering decisions such as full communication serialization, which enables MPC over arbitrary messaging interfaces and removes the need of owning network sockets. MOTION also incorporates several performance optimizations that improve the communication complexity and latency, e.g.,

\( 2\times \)

better online round complexity of precomputed correlated
Oblivious Transfer (OT)
.

We instantiate our framework with protocols for
N
parties and security against up to

\( N-1 \)

passive corruptions: the MPC protocols of
Goldreich-Micali-Wigderson (GMW)
in its arithmetic and Boolean version and OT-based BMR (Ben-Efraim et al., CCS’16), as well as novel and highly efficient conversions between them, including a non-interactive conversion from BMR to arithmetic GMW.

MOTION is highly efficient, which we demonstrate in our experiments. Compared to secure evaluation of AES-128 with

\( N=3 \)

parties in a high-latency network with OT-based BMR, we achieve a 16

\( \times \)

better throughput of 16 AES evaluations per second using BMR. With this, we show that BMR is much more competitive than previously assumed. For

\( N=3 \)

parties and full-threshold protocols in a LAN, MOTION is

\( 10\times \)

–

\( 18\times \)

faster than the previous best passively secure implementation from the MP-SPDZ framework, and

\( 190\times \)

–

\( 586\times \)

faster than the actively secure SCALE-MAMBA framework. Finally, we show that our framework is highly efficient for privacy-preserving neural network inference.
Creatine Kinase Is Associated With Recurrent Stroke and Functional Outcomes of Ischemic Stroke or Transient Ischemic Attack
Authors: Li Shiyu , Wang Anxin , Zhang Yijun , Tian Xue , Meng Xia , Wang Yilong , Li Hao , Wang Yongjun 
Published: March 2022

Background
Many patients after stroke are found to have elevated serum creatine kinase (CK). This study aimed to investigate the associations between serum CK levels and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack.

Methods and Results

The study included 8910 patients with acute ischemic stroke or transient ischemic attack from the CNSR‐III (Third China National Stroke Registry). Baseline serum CK levels after admission were measured. The associations between CK and clinical outcomes (stroke recurrence, death, and disability, defined as modified Rankin scale score 3–6 or 2–6) were analyzed. Patients with elevated CK levels had higher risks of recurrent stroke (hazard ratio [HR], 1.53; 95% CI, 1.21–1.93), death (HR, 1.68; 95% CI, 1.10–2.58), and disability (modified Rankin scale score, 3–6; odds ratio, 1.57; 95% CI, 1.29–1.90) at 3 months after adjusting confounding factors. Similar results were found at 1 year. The effects of CK on death and disability were more significant in male patients than female patients (
P
value for interaction <0.05). Elevated CK‐MB levels were not associated with clinical outcomes in this study.

Conclusions
Elevated serum CK after ischemic stroke or transient ischemic attack is associated with higher risks of recurrent stroke, death, and disability at 3 months and 1 year. Serum CK may act as a useful predictor for recurrent stroke and poor functional outcomes in patients with acute ischemic stroke or transient ischemic attack. Sex modifies the relationship between elevated CK and disability or death.
Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review
Authors: Aguiar de Sousa Diana , Romoli Michele , Sánchez Van Kammen Mayte , Heldner Mirjam R. , Zini Andrea , Coutinho Jonathan M. , Arnold Marcel , Ferro José M. 
Published: March 2022

Background:
Cerebral venous thrombosis (CVT) has recently been reported as a common thrombotic manifestation in association with vaccine-induced thrombotic thrombocytopenia, a syndrome that mimics heparin-induced thrombocytopenia (HIT) and occurs after vaccination with adenovirus-based SARS-CoV-2 vaccines. We aimed to systematically review the incidence, clinical features, and prognosis of CVT occurring in patients with HIT.

Methods:
The study protocol was registered with PROSPERO (CRD42021249652). MEDLINE, EMBASE and Cochrane CENTRAL were searched up to June 1, 2021 for HIT case series including >20 patients, or any report of HIT-related CVT. Demographic, neuroradiological, clinical, and mortality data were retrieved. Meta-analysis of proportions with random-effect modeling was used to derive rate of CVT in HIT and in-hospital mortality. Pooled estimates were compared with those for CVT without HIT and HIT without CVT, to determine differences in mortality.

Results:

From 19073 results, we selected 23 case series of HIT (n=1220) and 27 cases of HIT-related CVT (n=27, 71% female). CVT developed in 1.6% of 1220 patients with HIT (95% CI,1.0%–2.5%,
I
2
=0%). Hemorrhagic brain lesions occurred in 81.8% of cases of HIT-related CVT and other concomitant thrombosis affecting other vascular territory was reported in 47.8% of cases. In-hospital mortality was 33.3%. HIT-related CVT carried a 29% absolute increase in mortality rate compared with historical CVT controls (33.3% versus 4.3%,
P
<0.001) and a 17.4% excess mortality compared with HIT without CVT (33.3% versus 15.9%,
P
=0.046).

Conclusions:
CVT is a rare thrombotic manifestation in patients with HIT. HIT-related CVT has higher rates of intracerebral hemorrhage and a higher mortality risk, when compared with CVT in historical controls. The recently reported high frequency of CVT in patients with vaccine-induced thrombotic thrombocytopenia was not observed in HIT, suggesting that additional pathophysiological mechanisms besides anti-platelet factor-4 antibodies might be involved in vaccine-induced thrombotic thrombocytopenia-related CVT.
Association of Intravenous Alteplase, Early Reperfusion, and Clinical Outcome in Patients With Large Vessel Occlusion Stroke: Post Hoc Analysis of the Randomized DIRECT-MT Trial
Authors: Zhou Yu , Zhang Lei , Ospel Johanna , Goyal Mayank , McDonough Rosalie , Xing Pengfei , Li Zifu , Zhang Xiaoxi , Zhang Yongxin , Zhang Yongwei , Hong Bo , Xu Yi , Huang Qinghai , Li Qiang , Yu Ying , Zuo Qiao , Ye Xiaofei , Yang Pengfei , Liu Jianmin ,   on behalf of the DIRECT-MT Investigators
Published: March 2022

Background:
The added value of intravenous alteplase in reperfusing ischemic brain tissue in patients undergoing endovascular treatment and directly presented to an endovascular treatment-capable hospital is uncertain. We conducted this post hoc analysis of a randomized trial (DIRECT-MT [Direct Intraarterial Thrombectomy in Order to Revascularize Acute Ischemic Stroke Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: A Multicenter Randomized Clinical Trial]) to explore the association of intravenous alteplase, early (preendovascular treatment) reperfusion, and clinical outcome and to determine factors which may modify alteplase treatment effect on early reperfusion.

Methods:
In this post hoc analysis of the DIRECT-MT randomized trial comparing intravenous alteplase before endovascular treatment versus endovascular treatment only, 623 of 656 randomized patients, with adequate angiographic evaluation for early reperfusion assessment, were included. The association of intravenous alteplase and early reperfusion (defined as expanded Thrombolysis in Cerebral Infarction score ≥2a on angiogram) was assessed using unadjusted comparisons and multivariable logistic regression.

Results:

Among 623 patients included (317 received intravenous alteplase and 306 did not), early reperfusion occurred in 91 (15%) patients and was associated with better functional outcome (modified Rankin Scale score, 0–2 of 49/91 [54%] versus 178/531 [34%]; adjusted odds ratio, 1.92 [95% CI, 1.15–3.21];
P
<0.001). Intravenous alteplase was independently associated with early reperfusion (59/317 [19%] versus 32/306 [10%]; adjusted odds ratio, 2.06 [95% CI, 1.27–3.33];
P
=0.003), and the alteplase effect was modified by time from randomization to groin puncture (dichotomized by median, ≤33 minutes; adjusted odds ratio, 1.06 [95% CI, 0.53–2.10] versus >33 minutes; adjusted odds ratio, 4.07 [95% CI, 1.86–8.86];
P
interaction
=0.012).

Conclusions:
For patients with large vessel occlusion directly presenting to an endovascular treatment–capable hospital, intravenous alteplase increases early reperfusion when endovascular treatment gets delayed more than approximately half an hour. Thus, intravenous alteplase should be considered if endovascular treatment delays are anticipated by the treating medical team.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03469206.
Environmental and biological drivers of prevalence and number of eggs and oocysts of intestinal parasites in red howler monkeys from Central Amazonia
Authors: de Souza Jesus Anamélia , de Oliveira-Ramalho Miguell Lemos , El Bizri Hani R. , Valsecchi João , Mayor Pedro 
Published: March 2022

Abstract
Host-parasite relationships can be directly affected by host’s biological aspects and environmental factors, which influence both the survival of infective forms and the incidence of parasites. However, logistical difficulties in accessing biological samples for parasitological studies makes the Amazon Forest into a poorly known region in relation to the dynamic of parasites of wild animals. Here, using 34 red howler monkeys’ biological samples donated by local subsistence hunters from two Amazon habitat types (white-water flooded forest and upland forest) as an opportune alternative, we detected four intestinal parasite taxa infecting this species (two nematodes – Trypanoxyuris sp. and Strongyloides sp., one protozoan – Entamoeba sp. –, and one not-identified trematode, the last just found for white-water flooded forest). Trypanoxyuris was the most prevalent intestinal parasite (56.5% at flooded forest and 54.5% at upland forest). There was no difference between habitat types or individual sex regarding the prevalence for any parasite taxa. On the other hand, we found a strong influence of seasonality, with increasing prevalence of all parasite taxa as the river water level increased. In terms of egg and cyst counts, we found a difference between sexes (females > males, p = 0.002) and habitat types (upland forest > white-water flooded forest, p = 0.02), and a positive relationship with river water level (p = 0.002). Although some of these parasite taxa can be shared between humans and howlers, further investigations are necessary to study the parasites taxonomy thoroughly and to assess the potential zoonotic cross-transmission of these pathogens to local people living in the Amazon. In this study, we unveiled a seasonal effect for howler monkeys’ intestinal parasites, that also might occur in other non-human primates of the Amazon. In addition, our results on periods of high risk of intestinal parasite infection are useful to estimate future impacts of climate change on host-parasite dynamics.