bluuebunny/crossref_metadata_2025_split huggingface dataset:
Older adults can use technology: why healthcare professionals must overcome ageism in digital health
Authors: Mace Ryan A , Mattos Meghan K , Vranceanu Ana-Maria 
Published: September 2022

Abstract
Older adults rapidly adopted technology for healthcare, known as digital health, during the COVID-19 pandemic. Older adults are increasingly using telehealth, smartphone apps, and other digital health technologies to reduce barriers to care, maintain patient-provider communication, and promote disease self-management. Yet, many healthcare professionals have maintained outdated beliefs rooted in societal ageism that digital health and older adults are incompatible. As a result, older adults have been disproportionally excluded from health services and clinical trials that use digital health relative to their younger counterparts. In this commentary, we urge all healthcare disciplines to challenge ageist beliefs and practices that have contributed to the “digital health divide” among older patients. We provide examples of evidence-based strategies and current scientific initiatives that can promote digital health inclusion in research, clinical practice, and training. By achieving digital health inclusion, we can increase access, provide preventative and comprehensive care, and decrease healthcare costs for older patients.
Morinda umbellata active fraction inhibits lipopolysaccharide induced proinflammatory cytokines by downregulating NF-κB activation
Authors: Krishnakumar Neenthamadathil Mohandas , Manikantan Kuttapetty , Suja Somasekharan Nair Rajam , Latha Panickamparambil Gopalakrishnan , Ceasar Stanislaus Antony 
Published: September 2022

Abstract
Morinda umbellata L. is a woody climber or liana distributed in south East Asia. It is a traditional medicinal plant with excellent curative effects against diarrhea, dysentery, and other stomach disorders. The present study was aimed to assess the effect of M. umbellata active fraction (MUAF) on various inflammatory mediators using lipopolysaccharide (LPS) induced in vivo model in Wistar rats. The effect of MUAF on secretion of TNF-α, IL-1β, and IL-6 were evaluated in LPS-induced experimental animals. The expression of TNF-α, IL-1β, IL-6, iNOS, COX-2, and nuclear factor NF-κB genes were also evaluated. The gas chromatography–mass spectrometry (GC–MS) analysis of the active fraction was carried out to identify the active compounds present in MUAF. The results of oral acute toxicity suggested the non-toxic nature of MUAF. GC–MS analysis of the MUAF leaves revealed the presence of 8 compounds. The study demonstrated that the proinflammatory cytokines such as TNF-α, IL-1β, and IL-6 were significantly inhibited by MUAF in a dose-dependent manner. Moreover, MUAF down-regulated the expression of TNF-α, IL-1β, IL-6, iNOS, COX-2, and NF-κB genes. Our research findings suggest that the presence of anti-inflammatory compounds in MUAF can effectively inhibit LPS-induced proinflammatory cytokines TNF-α, IL-β, and IL-6 in vivo. It also suppressed the over expression of TNF-α, IL-1β, IL-6, iNOS, and COX-2 possibly via downregulating NF-κB activation.
Income and Wealth Inequality in Hong Kong, 1981–2020: The Rise of Pluto-Communism?
Authors: Piketty Thomas , Yang Li 
Published: September 2022

Abstract
The objective of this paper is to better understand the evolution and institutional roots of Hong Kong's growing economic inequality and political cleavages. By combining multiple sources of data (household surveys, fiscal data, wealth rankings, national accounts) and methodological innovations, two main findings are obtained. First, he evidence suggests a very large rise in income and wealth inequality in Hong Kong over the last four decades. Second, based on the latest opinion poll data, business elites, who carry disproportionate weight in Hong Kong's Legislative Council, are found to be more likely to vote for the pro-establishment camp (presumably to ensure that policies are passed that protect their political and economic interests). This paper argues that the unique alliance of government and business elites in a partially democratic political system is the plausible institutional root of Hong Kong's rising inequality and political cleavages.
Role of Pessaries in the Treatment of Pelvic Organ Prolapse
Authors: Sansone Stephanie , Sze Christina , Eidelberg Andrew , Stoddard Michelina , Cho Ahra , Asdjodi Saman , Mao Jialin , Elterman Dean S. , Zorn Kevin C. , Chughtai Bilal 
Published: September 2022

OBJECTIVE:
To evaluate the existing evidence on the efficacy of pessaries in improving quality of life when used for the treatment of pelvic organ prolapse (POP).

DATA SOURCES:
We searched for the terms “pelvic organ prolapse” and “pessar/y/ies/ium or vaginal support device,” and “safety or safe or outcome or complication or efficacy or effective or effectiveness” in PubMed, EMBASE, and CINAHL on March 16, 2020. A search was also performed on ClinicalTrials.gov, with no studies fitting our strict inclusion and exclusion criteria.

METHODS OF STUDY SELECTION:
Studies that reported pretreatment and posttreatment mean scores and SDs after pessary treatment for standardized questionnaires were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for prolapse were excluded. Three reviewers independently screened studies.

TABULATION, INTEGRATION, AND RESULTS:
Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were pooled for meta-analysis when reported by at least three studies. The primary study outcome was change in mean pretreatment and posttreatment questionnaire scores, which included those for the PFDI-20 (Pelvic Floor Distress Inventory- Short Form 20), PFIQ-7 (Pelvic Floor Impact Questionnaire - Short Form 7), and subscale POPIQ (Pelvic Organ Prolapse Impact Questionnaire Long Form). A random-effects model was used to combine estimates and capture between-study heterogeneity using the I2-statistic. Eight studies including 627 patients were included for systematic review. The mean (SD) age was 63.0±12.2 years, and the majority of patients had stage III prolapse (48.1%) followed by stage II prolapse (43.2%) when reported. Although variable, the majority of studies conducted 3-month follow-up. A negative change in pretreatment and posttreatment scores was noted, signifying improvement after pessary use: PFDI-20 mean change −46.1 (95% CI −65.4 to −26.8); PFIQ-7 mean change −36.0 (95% CI −46.0 to −26.0); POPIQ-7 (Pelvic Organ Prolapse Impact Questionnaire-7) mean change −16.3 (95% CI −26.8 to −5.7). No significant heterogeneity was found.

CONCLUSION:
Based on improvements in standardized questionnaire scores, pessaries are effective treatment options for POP.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42020172618.
Association of Availability of State Medicaid Coverage for Abortion With Abortion Access in the United States
Authors: McDonnell Jill , Jarlenski Marian , Borrero Sonya , Vinekar Kavita 
Published: September 2022

OBJECTIVE:
To evaluate the association between state Medicaid coverage for abortion and abortion access measures among U.S. patients.

METHODS:
We analyzed data from the Guttmacher Institute’s 2014 Abortion Patient Survey. Respondents were included if they reported being enrolled in Medicaid, regardless of whether Medicaid covered the abortion. The exposure was self-report of residence in a state where Medicaid can be used to pay for abortion. Access outcomes included more than 14 days’ wait time between decision for abortion and abortion appointment, presentation at more than 10 weeks of gestation when in the first trimester, and travel time more than 60 minutes to the clinic. Multivariable regression was performed to test the association between state Medicaid abortion coverage and dichotomous access outcomes, controlling for patient demographics.

RESULTS:
Of 2,579 respondents enrolled in Medicaid who reported state of residence, 1,694 resided in states with Medicaid coverage for abortion and 884 resided in states without Medicaid coverage for abortion. Patients residing in states with Medicaid coverage for abortion had lower odds and rates of waiting more than 14 days between deciding to have an abortion and the appointment (adjusted odds ratio [aOR] 0.70; 95% CI 0.57–0.85, 66.8% vs 74.1%, P<.001), having abortions at more than 10 weeks of gestation when in the first trimester (aOR 0.62; 95% CI 0.49–0.80, 13.6% vs 20.1%, P<.001), and traveling more than 60 minutes to the abortion clinic (aOR 0.63; 95% CI 0.51–0.78, 18.7% vs 27.6%, P<.001) when compared with patients residing in states without Medicaid coverage for abortion.

CONCLUSION:
Availability of state Medicaid coverage for abortion is associated with increased abortion access. Our findings support repealing the Hyde Amendment to promote equitable access to reproductive health care, particularly in the post-Roe era.
Pilot Implementation of a Health Equity Checklist to Improve the Identification of Equity-Related Adverse Events
Authors: Fan Linda L. , Sheth Sangini S. , Pettker Christian M. 
Published: September 2022

OBJECTIVE:
To establish a sustainable and trackable process to delineate the role of social determinants of health, bias, and racism in adverse gynecologic events.

METHODS:
The existing process entails monthly reviews of adverse events. Each case is assessed for preventability, harm, and standards of care. The equity-focused process consists of: 1) creation of a standardized health equity checklist; 2) application of the checklist to each gynecologic adverse event beginning on September 1, 2020; 3) collection of event review data in a secure central digital repository; 4) review of the cases to understand apparent causes of the event; 5) exploration of areas for improvement by using standard fields; and 6) identification of specific ideas for change.

RESULTS:
Within 15 months, 46 safety events were identified by standard criteria. Twenty-four of the cases were deemed preventable. Of the 24, there were 12 cases in which social determinants of health or bias or both social determinants of health and bias were identified playing a role. Diagnostic delays and care delays were attributed to social determinants of health and implicit bias. Our process has mapped areas of infrastructure as well as the need for culture improvement and has also highlighted the need for restorative work on addressing implicit bias and improving approaches to shared decision making.

CONCLUSION:
Through the use of a health equity checklist, we have illustrated the feasibility of creating a systematic and trackable process to begin delineating the role of social determinants of health, bias, and racism in adverse gynecologic events.
Weight-Based Compared With Fixed-Dose Enoxaparin Prophylaxis After Cesarean Delivery
Authors: Bruno Ann M. , Allshouse Amanda A. , Campbell Heather M. , Branch D. Ware , Lim Ming Y. , Silver Robert M. , Metz Torri D. 
Published: September 2022

OBJECTIVE:
To evaluate fixed compared with weight-based enoxaparin dosing to achieve prophylactic anti-Xa levels after cesarean delivery.

METHODS:
Individuals meeting institutional criteria for enoxaparin thromboprophylaxis after cesarean delivery were randomly allocated to fixed (40 mg daily for body mass index [BMI, calculated as weight in kilograms divided by height in meters squared] lower than 40; 40 mg every 12 hours for BMI 40 or higher) or weight-based (0.5 mg/kg every 12 hours) enoxaparin dosing. Enoxaparin was initiated during inpatient hospitalization and continued at discharge for 14 days. Those with contraindication to anticoagulation, plan for therapeutic anticoagulation, or known renal impairment were excluded. The trial was unmasked. The primary outcome was prophylactic (0.2–0.6 international units/mL) peak anti-Xa level 4–6 hours after at least the third enoxaparin dose (at steady state). Secondary outcomes included subprophylactic and supraprophylactic peaks, outpatient peak, and venous thromboembolism (VTE) and wound complications in the first 6 weeks postpartum. Sample size of 121 per group was planned. At interim analysis with 50% enrollment, the trial was stopped early for efficacy. Primary analyses followed intention-to-treat principle with worst-case imputation for missing outcomes. Secondary analyses were complete case.

RESULTS:
From June 2020 to November 2021, 74 individuals were randomized to weight-based enoxaparin and 72 to fixed-dose enoxaparin. Those who received weight-based dosing were more likely to achieve prophylactic anti-Xa levels than those who received fixed dosing in primary analysis (49/74 [66%] vs 32/72 [44%], relative risk [RR] 1.49, 95% CI 1.10–2.02) and secondary analysis (49/60 [82%] vs 32/57 [56%], RR 1.45, 95% CI 1.12–1.88). Subprophylactic levels occurred more frequently with fixed dosing; supraprophylactic levels did not differ significantly by dosing. At the outpatient postoperative visit, 52% of participants (15/29) with weight-based dosing compared with 15% (5/33) with fixed dosing achieved prophylactic peak anti-Xa level (RR 3.41, 95% CI 1.42–8.24). There were no VTEs in either group. Wound complications occurred in five individuals (7%) with weight-based enoxaparin dosing compared with one individual (1%) with fixed enoxaparin dosing (RR 4.86, 95% 0.58–40.63).

CONCLUSION:
Weight-based dosing was more effective than fixed enoxaparin dosing in achieving prophylactic peak anti-Xa levels after cesarean delivery.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, NCT04305756.
The effect of extracorporeal shock wave therapy in coccydynia: a systematic review and meta-analysis
Authors: Nikouei Farshad , Shakeri Mohammadreza , Ghandhari Hasan , Motalebi Mohsen , Ameri Ebrahim 
Published: September 2022

Background:
Extracorporeal shock wave therapy (ESWT) has been used in the treatment of coccydynia. However, it has not yet been validated due to the dispersion of studies, the low number of patients, and the use of different measuring instruments. This meta-analysis was performed with the aim of collecting homogeneous studies to achieve a reliable result.

Methods:
The authors searched electronic databases including Google Scholar, Scopus, ScienceDirect, ISI Web of Science, Embase, and PubMed to find studies in which the effect of ESWT on coccydynia using visual analog scale (VAS) scores was evaluated starting in January 1990 through August 2021. All search procedures were performed by two authors.

Results:
The mean pain changes of 81 patients from four studies in 1 mo, 2 to 4 mo, and 6 to 12 mo after using ESWT were analyzed. Overall mean change of VAS score in 1 mo, 2 to 4 mo, and 6 to 12 mo after applying ESWT was -42.41 (I2=86.96%, 95% confidence interval [CI] of −56.88, −27.94, P=0.001), −41.01 (I2=0.0%, 95% CI of −46.98, −35.04, P=0.001) and −50.13 (I2=82.41%, 95% CI of −67.33; −32.94, P=0.001), respectively.

Conclusions:
The authors showed that ESWT lessened pain in patients with coccydynia. This effect did not diminish during a year; instead, it further reduced pain in patients. However, more research is needed to verify the results.

Level of Evidence:
Level I.
Pitfalls and suggestions for the treatment of open, comminuted fractures of the middle phalanx using custom-made dynamic external fixators: a retrospective case series
Authors: Ntourantonis Dimitrios , Iliopoulos Ilias , Pantazis Konstantinos , Baikousis Andreas , Korovessis Panagiotis 
Published: September 2022

Background:
The proximal interphalangeal joint (PIPJ) is a synovial joint prone to injury encompassing a wide spectrum of severity. In the setting of complicated injuries, dynamic external traction systems are considered to be the optimal treatment modality with numerous different Kirschner-wire configurations combined with rubber bands, springs, pulleys, or hinges being described. However, many of these pose significant technical challenges for the surgeon or are unwieldy to the patient emphasizing the need for simple, easy to construct, and well-tolerated modifications, which are equally effective in reducing the fracture and allowing early motion.

Methods:
The authors retrospectively analyzed prospectively collected data of 12 patients with open complex PIPJ fracture dislocations treated with a custom-made external fixator based on the one that was originally suggested by Suzuki et al. All patients were men with an average age of 55.1 yr (23 to 81). Injured digits involved four index, five middle, and three ring fingers.

Results:
The mean follow-up was 54.36 mo, and all patients healed without a second operation and returned to their jobs and preinjury level of activity. The average active range of motion of the PIPJ was 75.16±3.18 degrees, DIPJ was 69.33±14.7 degrees, and MCPJ was 88.75±1.97 degrees. Mean Quick Disabilities of Arm, Shoulder, and Hand (DASH)-Japan Society for Surgery of the Hand (JSSH) score at the final examination was 4.33±1.38 (range 2.3 to 6.8). The authors recorded five complications involving two rubber bands breaking, one pin-track infection, one rubber band-axial traction pin malposition, and one swan neck deformity, which were treated accordingly.

Conclusions:
One of the most crucial factors affecting outcome in this kind of injury is the appearance of the digit and functional results. None of the participants in this series had any complaint about the appearance of their fingers in the final examination, and 10 out of 12 judged the cosmetic result as very good. To the authors' knowledge, this report is one of the few that describes the functional outcome of pins and rubbers traction system (PRTS) application in complex fracture and fractures-dislocations with severe comminution of the middle phalanx and not only fractures related to the PIP joint.

Level of Evidence:
Level V.
A retrospective study on internal fixation of femoral neck fractures with Hansson Pins® in Switzerland
Authors: Conti Tiziano , Majewski Martin 
Published: September 2022

Background:
Hansson Pins® (The Swemac Group, Linköping, Sweden) are devices for the internal fixation of femoral neck fractures that are widely used in Scandinavia. The authors hypothesized that the pins could be used with satisfactory results outside of Scandinavia, that they were a valid alternative to cancellous screws and the dynamic hip screw, and that they also could be used in elderly patients.

Methods:
Sixty-five consecutive patients with femoral neck fractures who received internal fixation with Hansson Pins between January 2007 and December 2016 at the Oberengadin Hospital in Switzerland were included in this retrospective study. The hospital’s electronic database was searched for information, and questionnaires were sent to the patients.

Results:
After internal fixation with Hansson Pins, 22% of the patients needed a hip prosthesis. For patients 70 yr and older, this rate was 33%. For 60% of the patients who needed a hip prosthesis, the reason for arthroplasty was nonunion. For 20%, the reason was avascular necrosis of the femoral head, and for another 20% of the patients symptomatic coxarthrosis was the cause.

Conclusions:
The rate of salvage arthroplasties in this study was similar to the rates in the literature of Hansson Pins (mostly from studies performed in Scandinavia), cancellous screws and dynamic hip screws. The findings suggested that Hansson pins could be used with good results outside of Scandinavia and that they were a reasonable alternative to cancellous screws and the dynamic hip screw. The pins also could be used with satisfactory outcomes in elderly patients, but the rate of salvage arthroplasties would be higher.

Level of Evidence:
Level IV.
Comparison of manipulation rates for robot-assisted, customized, and conventional total knee arthroplasty: a retrospective cohort study
Authors: Markel Michael J. , Grieme Caleb , Szakiel Paulina , Abraham Nijo , Rigor Paolo Diaz , Geng Xue , Lee Ji Won , Boucher Henry R. 
Published: September 2022

Background:
With projected increases in total knee arthroplasties (TKA), patient outcomes without complications are essential. Arthrofibrosis, a potential complication after TKA that may impact long-term patient outcome, may be remedied by manipulation under anesthesia (MUA); however, it is not risk-free. This study investigated the association between manipulation and newer implants and sophisticated techniques, which hold promise for preventing arthrofibrosis and improving patient outcomes.

Methods:
The authors retrospectively reviewed 1260 primary knee arthroplasty cases (717 conventional, 217 customized, and 326 robot-assisted) performed by an orthopaedic surgeon from January 1, 2016 to May 31, 2020. Patient records were reviewed for manipulation and demographics (type of implant, sex, body mass index [BMI], smoking status, and prior surgery).

Results:
Overall manipulation rate was 1.3% (n=17). Manipulation rates for conventional customized and robot-assisted TKAs did not vary significantly (1.84%, n=6; 0.46%, n=1; 1.39%, n=10, respectively; P=0.466). Multivariable logistic regression showed no statistically significant difference in the odds of manipulation depending on the type of implant. However, those who smoked were 4 times more likely to have a manipulation (OR: 4.187, 95% CI: 1.119 to 15.673) when controlling for covariates (type of implant, sex, BMI, and prior surgery). Additionally, those with prior surgery were 2.8 times as likely to have a manipulation (OR: 2.808, 95% CI: 1.039 to 7.589) when controlling for covariates.

Conclusions:
There were no statistically significant differences in manipulation rates among conventional, customized, and robot-assisted TKAs. However, current smoking status and prior surgery were associated with higher risk of manipulation.

Level of Evidence:
Level III.
Understanding Perceived Barriers to Colposcopy Follow-Up Among Underserved Women at an Urban Teaching Hospital: A Qualitative Study
Authors: Kulkarni Amita , Glynn Shannon , Gamble Charlotte R. , Shen Megan Johnson , Cantillo Evelyn , Frey Melissa K. , Holcomb Kevin M. , Safford Monika M. , Chapman-Davis Eloise 
Published: September 2022

Abstract

Objective
Loss to follow-up after abnormal cervical cancer screening disproportionately impacts underserved populations. Our objective was to identify perceived barriers to follow-up after abnormal Pap smear among underserved women.

Methods
Women with abnormal Pap smear presenting for colposcopy at an urban teaching hospital were asked to participate in qualitative interviews. A topic guide was developed to assess knowledge about cervical cancer screening and perceived barriers to follow-up. A demographic survey was completed and interviews were recorded and transcribed. Responses were coded and placed into a framework: intrapersonal, interpersonal, and community barriers. Major themes and subthemes were identified. Demographic data were reported descriptively.

Results
Of 24 women enrolled, 18 (75%) completed full interviews. Median age was 38 years (range = 21–64). Participants were racially diverse: 10 (56%) Hispanic, 7 (39%) non-Hispanic White, 1 (5.5%) non-Hispanic Black, and 1 (5.5%) Asian, and all had public insurance. Seven (39%) presented for their 1st colposcopy visit and 11 (61%) had previous visits. Seventeen (94%) had a positive human papillomavirus test and 7 (39%) had atypical squamous cells of undetermined significance. The most common themes identified were related to knowledge gaps, including lack of understanding of Pap smears/human papillomavirus and cervical cancer risk factors. Most participants were satisfied with provider communication but dissatisfied with communication with the office, like scheduling appointments.

Conclusions
Despite positive patient perception of physician communication, knowledge was most commonly identified as a barrier to colposcopy follow-up. Implementing a web-based intervention addressing knowledge gaps may improve abnormal cervical cancer screening follow-up among this population.