bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Patient Demographics and Socioeconomic Status Influence Severity and Time to Diagnosis in Children With Stable Slipped Capital Femoral Epiphysis?
Authors: Loder Randall T. , Sun Seungyup , Gunderson Zachary J. 
Published: February 2022

Background:
The time to diagnosis in stable slipped capital femoral epiphysis (SCFE) is often several months because of nebulous history, symptoms of knee/thigh pain, and Medicaid insurance. This study examined the impact of socioeconomic status and demographics on the time to diagnosis and SCFE severity in Indiana children.

Methods:
A retrospective review of all patients at a tertiary children’s hospital with SCFE from January 2010 through March 2021 was performed. Standard demographic data and type of insurance was collected. Neighborhood Atlas Mapping was used to determine the state decile of the area deprivation index (ADI), a measure of socioeconomic status using 17 variables related to income, employment, education, and housing. Statistical analyses consisted of standard univariate and bivariate analyses; logistic regression analysis was used to determine predictors of a mild SCFE. A P<0.05 was considered statistically significant.

Results:
There were 142 patients; 81 male and 61 female. The average age was 12.2±1.7 years, lateral epiphyseal shaft angle of 35±19 degrees, and symptom duration of 4.5±5.0 months. There was no correlation between ADI state deciles and lateral epiphyseal shaft angle (r
2=0.008) or symptom duration (r
2=0.019). Insurance status and race differed by ADI deciles. In the first decile (least disadvantaged), 44% had government insurance and 89% were White; in the 10th decile (most disadvantaged), 95% had government insurance and 38% were White. Predictors of a mild SCFE were female sex [odds ratio (OR): 3.2 [1.5, 7.0]; P=0.004], symptom duration <3 months [OR: 5.3 (2.4, 11.7); P=0.00004], and White race [OR: 2.4 (1.3, 6.2); P=0.01]. Insurance status and ADI were not significant.

Conclusions:
Contrary to other studies, neither insurance or socioeconomic status were associated with a delay in diagnosis or SCFE severity. The symptom duration in children with SCFE does not appear to be decreasing over the last several decades. Further investigation is required as to why.

Level of Evidence:
Level III—retrospective comparative study.
Association of Arterial pH With Hemodynamic Response to Vasopressin in Patients With Septic Shock: An Observational Cohort Study
Authors: Bauer Seth R. , Sacha Gretchen L. , Siuba Matthew T. , Lam Simon W. , Reddy Anita J. , Duggal Abhijit , Vachharajani Vidula 
Published: February 2022

OBJECTIVES:
Vasopressin is reported to retain vasoconstrictive activity in the setting of acidemia, but preclinical models are inconsistent and studies have not evaluated the clinical effectiveness of vasopressin based on arterial pH. This study sought to determine the association between arterial pH and blood pressure after vasopressin initiation in septic shock.

DESIGN:
This retrospective, multicenter, observational cohort study evaluated the association of arterial pH at the time of vasopressin initiation with hemodynamic response to vasopressin and change in catecholamine dose after vasopressin initiation. Hemodynamic response was defined as a catecholamine dose decrease with mean arterial pressure greater than or equal to 65 mm Hg at 6 hours after vasopressin initiation.

SETTING:
Patients from eight hospitals in a health system were evaluated.

PATIENTS:
Patients with septic shock initiated on vasopressin as a catecholamine adjunct between January 2012 and November 2017 were screened for inclusion.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 1,350 patients were included. At the time of vasopressin initiation patients were severely ill with arterial pH 7.28 ± 0.13, Sequential Organ Failure Assessment 14.1 ± 3.5, lactate 5.6 ± 4.6 mmol/L, and norepinephrine-equivalent catecholamine dose 32.3 ± 25.4 µg/min. After adjusting for lactate and Sequential Organ Failure Assessment with multivariable logistic regression, lower arterial pH was independently associated with lower odds of hemodynamic response to vasopressin (for each 0.1 unit arterial pH was below 7.40, response odds ratio 0.79; 95% CI, 0.72–0.87). For each 0.1 unit the pH was below 7.40 at vasopressin initiation, the norepinephrine-equivalent catecholamine dose increased by 1.5 µg/min (95% CI, 0.5–2.5 µg/min) at 1 hour, and increased by 2.5 µg/min (95% CI, 1.4–3.5 µg/min) at 6 hours after vasopressin initiation.

CONCLUSIONS:
Compared with higher arterial pH, patients with septic shock and low arterial pH had lower odds of vasopressin response and higher catecholamine doses after vasopressin initiation. Similar to other vasopressors, the clinical effectiveness of vasopressin appears to be impaired in the setting of acidemia.
Lifestyle and dietary factors associated with serologically detected gastric atrophy in a Caucasian population in the GISTAR study
Authors: Razuka-Ebela Danute , Polaka Inese , Daugule Ilva , Parshutin Sergei , Santare Daiga , Ebela Inguna , Rudzite Dace , Vangravs Reinis , Herrero Rolando , Young Park Jin , Leja Marcis 
Published: February 2022

Objective
To identify dietary and lifestyle factors associated with decreased pepsinogen levels indicative of gastric atrophy.

Methods
Participants aged 40 to 64 from the “Multicentric randomized study of H. pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (GISTAR study)” in Latvia tested for serum pepsinogen, as well as for Helicobacter pylori infection by 13C-urea breath test or serology were included. Data on sex, age, education, employment, diet, smoking, alcohol and proton pump inhibitor use were obtained by survey and compared for participants with and without serologically detected gastric atrophy defined as pepsinogen I/pepsinogen II ≤ 2 and pepsinogen I ≤ 30 ng/mL.

Results
Of 3001 participants (median age 53, interquartile range, 11.0, 36.9% male) 52.8% had H. pylori and 7.7% had serologically detected gastric atrophy. In multivariate analysis, increasing age, consumption of alcohol, coffee, and onions were positively, while H. pylori, former smoking, pickled product and proton pump inhibitor use were inversely associated with gastric atrophy. Pepsinogen values were higher in smokers and those with H. pylori. Pepsinogen ratio was lower in those with H. pylori. When stratifying by H. pylori presence, significantly higher pepsinogen levels remained for smokers without H. pylori.

Conclusion
Several dietary factors and smoking were associated with serologically detected gastric atrophy. Pepsinogen levels differed by smoking and H. pylori status, which may affect the serologic detection of gastric atrophy. There seems to be a complicated interaction between multiple factors. A prospective study including atrophy determined by both serology and histology is necessary.
The analgesic efficacy of transversus abdominis plane block vs. wound infiltration after inguinal and infra-umbilical hernia repairs
Authors: Grape Sina , Kirkham Kyle R. , Albrecht Eric 
Published: February 2022

BACKGROUND
Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair.

OBJECTIVES
To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair.

DESIGN
Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES
MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020.

ELIGIBILITY CRITERIA
We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic.

RESULTS
Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of −0.8 (−1.3 to -0.2); I
2 = 85%; P
= 0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate.

CONCLUSION
There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair.

TRIAL REGISTRY NUMBER
PROSPERO CRD42020208053.
Self-identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy
Authors: Adetunji Modupe O. , Meer Elana , Whitehead Gideon , Hua Peiying , Badami Avni , Addis Victoria , Gorry Thomasine , Lehman Amanda , Sankar Prithvi S. , Miller-Ellis Eydie , Ying Gui-Shuang , Cui Qi N. 
Published: February 2022

Précis:
In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis.

Purpose:
The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS.

Materials and Methods:
The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension.

Results:
The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all).

Conclusions:
The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.
Comparison of Antimicrobial Stewardship and Infection Prevention and Control Activities and Resources Between Low-/Middle- and High-income Countries
Authors: Villanueva Paola , Coffin Susan E. , Mekasha Amha , McMullan Brendan , Cotton Mark F. , Bryant Penelope A. 
Published: February 2022

Background:
The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC). We aimed to compare pediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings.

Methods:
An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020.

Results:
Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76% and IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for pediatric patients, with less reliable availability of World Health Organization Access list antibiotics (29% of LMIC facilities). Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to pediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing and only 25% on IPC.

Conclusions:
Marked differences exist in availability of AMS and IPC resources in LMIC as compared with HIC. A collaborative international approach is urgently needed to combat antimicrobial resistance, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.
Dying in the emergency service: nurses’ attitudes before and after the first critical period of COVID-19
Authors: Cardoso Maria Filomena Passos Teixeira , Martins Maria Manuela Ferreira Pereira da Silva , Ventura-Silva João Miguel Almeida , Mota Paulo Emílio , Costa Paula Cristina Rodrigues , Ribeiro Olga Maria Pimenta Lopes 
Published: February 2022

Abstract

Background:
Death is an increasingly frequent event in hospitals, and nurses are the health professionals who live with this reality the most. The pandemic caused by COVID-19 made this event more present, showing that nurses’ attitudes toward death may influence the care provided to people at the end of life. The objective of this study was to analyze the attitudes of nurses in the emergency service toward death, before and after the first critical period of the pandemic by COVID-19 in Portugal.

Methods:
A quantitative, comparative, and cross-sectional study was conducted in a hospital in Northern Portugal at 2 different moments: the first in February 2018 and the second in May 2020, after the first critical period of the pandemic by COVID-19. In both moments, data were collected using a self-completion questionnaire, which included the Death Attitude Profile Assessment Scale.

Results:
The attitudes fear, avoidance, closeness, and escape did not show significant differences. In neutral/neutral acceptance, differences were found between the first and second moments of data collection (P
= .01), with a lower mean after the critical period of the pandemic.

Conclusions:
The results obtained in 2018 and 2020 showed slight changes in attitudes toward death. The need to invest in the training and preparation of nurses who deal directly with death and the dying process was evident. Nurse managers should promote spaces for reflection and team training on death, aiming to reduce the professionals’ suffering and anxiety.
AlergiaPT: A Portuguese media campaign to inspire people with allergies to make a positive change in their life
Authors: Moreira André , Mendes Francisca de Castro , Rama Tiago , Mota Diogo , Silva Diana , Pádua Inês , Abreu Cristina , Vasconcelos Maria João , Farraia Mariana , Paciência Inês , Rufo João , Barros Renata , Padrão Patrícia , Moreira Pedro , Seabra Diana , Barros Henrique 
Published: February 2022

Abstract
Allergic diseases comprise a significant cause of morbidity worldwide and a substantial burden on the health and medical systems of both developed and emerging economies. Although highly prevalent, relatively severe, and largely impactful on the quality of life of patients, allergic diseases are commonly trivialized. Increasing awareness of the relevance of allergic diseases as a major public health problem might lead to an improved acknowledgment by governments and health authorities. Based on the positive impact that media campaigns might have on health-related behaviors, as well as the large use of social media by different types of users, social media might be used as a powerful tool for spreading awareness and education even more effective than traditional face-to-face communication. Therefore, we aimed to develop a social media-based communication program, the AlergiaPT, reaching all stakeholders, to increase the awareness of allergic diseases tackling the causes, prevention, control, and economic impact. The AlergiaPT will provide user-generated and interactive content toward engagement, include both long-form and short-form video productions toward education, as well as stories and time-sensitive content toward empowerment. It will be targeted to all populations, engaging different stakeholders. Contents will address the 5 campaign goals: i) allergy health is promoted; ii) tolerance is actively reinforced, and avoidance reduced; iii) treatment control and guided self-management of patients of asthma, rhinitis, food allergy, and atopic eczema are strengthened; iv) recognition and treatment of severe allergy and anaphylaxis are improved, and v) indoor air quality is promoted. Engagement on the campaign will be promoted through stepwise educational takeaways meetings using different social media, and targeting all audience groups, by promoting the organization of resources for common goals and the involvement of social media to improve public awareness. The impact of AlergiaPT will be assessed through google analytics.
Environments of professional nursing practice in the context of the COVID-19 pandemic
Authors: Ribeiro Olga Maria Pimenta Lopes , Trindade Letícia de Lima , de Sousa Clemente Neves , Teles Paulo João Figueiredo Cabral , Cardoso Maria Filomena Passos Teixeira , da Rocha Carla Gomes , Barros Sónia Cristina Costa , Ventura-Silva João Miguel Almeida 
Published: February 2022

Abstract

Background:
Although COVID-19 attracted attention to the environments of professional nursing practice, triggering a series of responses to address some of the most pressing problems, it is important to identify the size and scope of other weaknesses that have emerged.

Methods:
In an observational and cross-sectional study, using the Scale for the Evaluation of the Environment of Professional Nursing Practice, 752 nurses from a Portuguese university hospital, provided socio-demographic and professional data about the components structure, process and outcome of their professional nursing environment. Data collection took place from June 1–30, 2020, immediately after the first critical period of the COVID-19 pandemic in Portugal.

Results:
In the analysed environment of professional nursing practice, Process factors were favourable to the quality of care, while the Structure and Outcome factors had a moderately favourable effect. Structure factors related to work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .001). Process factors related significantly to work contexts (P < .001). A significant association was found between Outcome factors and work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .005).

Conclusion:
The environments of professional nursing practice in the hospital under study are moderately favourable to the quality of care. However, the need to invest in nurses’ participation, involvement and professional qualification is clear. Maintenance of a sustainable nursing workforce requires attention to be given to ensuring that practice environments are conducive to the quality of care and geared to promoting professional involvement and job satisfaction among nurses.
Sugar-sweetened beverages, effects on appetite and public health strategies to reduce the consumption among children: a review
Authors: Costa Daniela , Warkentin Sarah , Oliveira Andreia 
Published: February 2022

Abstract
Sugar-sweetened beverages (SSBs) consumption have been of public health concern and a target of interventions due to their high consumption and burden in health-related consequences, particularly in children and adolescents. SSBs provide high energy intake with low nutritional value and are a major contributor for added and free sugars intake of Portuguese in all age-groups, especially adolescents. Despite its recognized effect on weight gain, it might also disrupt appetite regulation. Research on the effect of SSBs on appetitive traits is still scarce and unclear, and the current knowledge of these potential effects will be discussed in this review. This review also aims to describe public health strategies implemented to decrease SSBs consumption among children, particularly in Portugal, such as: (i) implemented taxation measures and its impact in sales and in preventable cases of disease and death, (ii) marketing regulations applied to children and adolescents, and ultimately (iii) the intention of application of a single Front-of-Package labeling system in all countries, aiming to increase consumers’ food literacy.
Use of biologics for the treatment of moderate-to-severe asthma: the age of personalized medicine
Authors: Mustafa S. Shahzad , Patrawala Sara , Khurana Sandhya 
Published: February 2022

Purpose of review
There are multiple FDA-approved biologics to treat poorly controlled moderate-to-severe asthma. Given the heterogeneity of asthma and the lack of head-to-head data between biologics, selecting the best biologic for a patient can be difficult. This review summarizes the key literature to date, in hopes of facilitating an evidence-based approach to selecting the most appropriate biologic for patients with asthma.

Recent findings
In addition to unique mechanisms of action, there is increasing literature on predictors of response to each biologic, such as sensitizations to aeroallergens, peripheral eosinophil count, total serum IgE, and exhaled nitric oxide. Biologics available for asthma are also being increasingly studied in comorbid conditions with asthma, and this may facilitate selecting the most appropriate biologic for a patient. In the absence of head-to-head studies, there is literature of switching between biologics whenever necessary.

Summary
The authors outline an approach to selecting a biologic based on various considerations, and hope this suggested approach facilitates selecting the biologic most suitable for each individual with poorly controlled moderate-to-severe asthma.
A clinical review of long-COVID with a focus on the respiratory system
Authors: Daines Luke , Zheng Bang , Pfeffer Paul , Hurst John R. , Sheikh Aziz 
Published: February 2022

Purpose of review
Persistence of symptoms after acute coronavirus disease 2019 (COVID-19), often described as long- COVID, is common and debilitating. In this article, we review the epidemiology, clinical features, and research priorities for long-COVID focusing on the respiratory system.

Recent findings
Breathlessness, cough and chest pain were the most commonly reported respiratory symptoms associated with long-COVID. In hospitalised patients, abnormalities on lung function testing or chest imaging were observed less commonly at 12 months compared to six months since discharge. Clinical assessment of patients with persisting symptoms after acute COVID-19 requires a comprehensive evaluation to exclude other possible causes for symptoms. With no robust current evidence for interventions to treat long-COVID respiratory symptoms, symptomatic treatment, supported self-management and pulmonary rehabilitation should be considered to help individuals with respiratory symptoms associated with long-COVID.

Summary
Long-COVID is a debilitating syndrome that often includes persisting respiratory symptoms and to a lesser degree, abnormalities in lung physiology or imaging. Respiratory features of long-COVID may reduce over time, yet resolution is not seen in all cases. Future research is needed to understand the natural history of long-COVID, identify factors associated with spontaneous improvement/persistence, investigate mechanisms for persisting symptoms, and test interventions to prevent and treat long-COVID.