bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in dementia diagnoses in Sweden during the COVID-19 pandemic
Authors: Axenhus Michael , Schedin-Weiss Sophia , Tjernberg Lars , Wimo Anders , Eriksdotter Maria , Bucht Gustaf , Winblad Bengt 
Published: April 2022

Abstract
Introduction
The COVID-19 pandemic has caused large disruptions to healthcare systems. Refocus on COVID-19 related care might have contributed to indirect effects on other healthcare areas. Care focused on acute conditions have been negatively affected although research into the effects on chronic and care intensive patient groups such as patients with dementia diseases is lacking. In this study we evaluated dementia diagnosis trends in Sweden during 2015–2020 according to International Classification of Disease version 10 coding of common dementia diseases.

Methods
Regional and national statistics in the form of International Classification of Disease version 10 coding, COVID-19 incidence, mortality data, and population census data were collected from the National Institute of Health and Welfare. Logistic regression analysis was performed to identify trends of dementia diagnosis during 2015–2020. Correlation test was performed between COVID-19 incidence, mortality rates, and dementia coding.

Results
Dementia diagnosis incidence has been declining since 2015 and further decline was noted in many regions in Sweden during 2020. As COVID-19 incidence increased, fewer cases of dementia were diagnosed, a decrease that differentially impacted women and those who were advanced in age.

Conclusions
Dementia diagnosis incidence in Sweden has been on a decline since 2015. The COVID-19 pandemic caused a further larger decline in dementia diagnosis incidence during 2020. COVID-19 incidence, but not mortality, was associated with decrease in dementia diagnosis incidence. There might be a large number of undiagnosed patients with dementia and healthcare reforms should be enacted to address this. Women and elderly are particularly vulnerable groups.
Exploration of attitudes regarding uptake of COVID-19 vaccines among vaccine hesitant adults in the UK: a qualitative analysis
Authors: Denford Sarah , Mowbray Fiona , Towler Lauren , Wehling Helena , Lasseter Gemma , Amlôt Richard , Oliver Isabel , Yardley Lucy , Hickman Matthew 
Published: April 2022

Abstract
Background
The aim of this work was to explore barriers and facilitators to uptake of COVID-19 vaccines and to explore views and reactions to efforts to improve vaccine uptake among vaccine hesitant individuals.

Methods
Semi-structured interviews were conducted with people between the age of 18–29 years who had not had a COVID-19 vaccine, and those between 30 and 49 years who had not had a second dose of a COVID-19 vaccine.

Results
A total of 70 participants took part in the study, 35 participants had received one dose, and 35 had not been vaccinated. Participants described a willingness to be vaccinated to keep themselves and those around them safe and to avoid restrictions. Barriers to uptake included: (1) perceived lack of need for COVID-19 vaccinations, (2) concerns about the efficacy of vaccinations, (3) concerns about safety, and (4) access issues. Uptake appeared to be influenced by age and health status, trust in government, and knowledge and understanding of science. Introduction of vaccine passes may provide a motive for having a vaccine but may be viewed as coercive.

Conclusion
Participants were hesitant, rather than opposed, and had questions about their need for, and the safety and efficacy of the vaccine. Young people did not consider themselves to be at risk of becoming ill from COVID-19, did not think the vaccination was effective in preventing transmission, and did not think sufficient research had been conducted regarding possible long-term side-effects. Concerns were exacerbated by a lack of trust in government, and misunderstanding of science. To promote uptake, public health campaigns should focus on the provision of information from trusted sources that explains the benefits of vaccination and addresses safety concerns more effectively. To overcome inertia in people with low levels of motivation to be vaccinated, appointments must be easily accessible.
Risk factors for healthcare-associated infection among children in a low-and middle-income country
Authors: Murni Indah K. , Duke Trevor , Kinney Sharon , Daley Andrew J. , Wirawan Muhammad Taufik , Soenarto Yati 
Published: April 2022

Abstract
Background
Healthcare-associated infections (HAI) are one of significant causes of morbidity and mortality. Evaluating risk factors associated with HAI are important to improve clinical outcomes. We aimed to evaluate the risk factors of HAI in children in a low-to middle-income country.

Methods
A prospective cohort study was conducted during 43 months at a teaching hospital in Yogyakarta, Indonesia. All consecutive patients admitted to pediatric ICU and pediatric wards > 48 h were eligible. Those eligible patients were observed daily to identify the presence of HAI based on CDC criteria. The risk factors of HAI were identified. Multivariable logistic regression was used to identify independent risk factors.

Results
Total of 2612 patients were recruited. Of 467 were diagnosed as HAI. The cumulative incidence of HAI was 17.9%. In the multivariable analysis; length of stay > 7 days, severe sepsis, use of urine catheter, central venous catheter (CVC), non-standardized antibiotics, and aged < 1 year were independently associated with increased risk of HAI with adjusted OR (95%CI): 5.6 (4.3–7.3), 1.9 (1.3–2.9), 1.9 (1.3–2.6), 1.8 (1.1–2.9), 1.6 (1.2–2.0), and 1.4 (1.1–1.8), respectively.

Conclusions
This study found that length of stay > 7 days, use of urine catheter and CVC, non-standardized antibiotic use, aged < 1 year, and had a diagnosis of severe sepsis increased risk of HAI.
Prevalence of dry eye disease among Chinese high school students during the COVID-19 outbreak
Authors: Lin Feng , Cai Yuying , Fei Xinfeng , Wang Yimin , Zhou Minwen , Liu Yan 
Published: April 2022

Abstract
Purpose
The study aimed to investigate the prevalence of dry eye disease (DED) and relevant risk factors among Chinese high school students during the COVID-19 outbreak.

Methods
A cross-sectional study was conducted from November to December 2020, and 4825 high school students from nine high schools in Shanghai were recruited. All students completed ocular surface disease index (OSDI) and perceived stress scale (PSS) questionnaires and answered other questions designed to ascertain information on the risk factors related to DED. DED was diagnosed when OSDI scores were greater than or equal to 13. The prevalence of symptomatic DED was determined. A T-test, Kruskal-Wallis test, Chi-square test, and logistic regression analysis were used to examine the possible risk factors.

Results
The prevalence of symptomatic DED among Chinese high school students was 70.5%. In univariate analysis, higher PSS scores (P<0.001), prolonged video display terminal (VDT) use (P<0.001), wearing contact lenses (P=0.001), poor sleep quality (P<0.001), and being female (P<0.001) were significantly correlated with dry eyes. In multivariate logistic regression analysis, higher PSS scores (P<0.001, OR=1.20), prolonged VDT use (P<0.001, OR=1.07), poor sleep quality (P<0.001, OR=1.84), and being female (P=0.001, OR=1.25) were significant risk factors associated with DED.

Conclusions
Due to the epidemic, most Chinese high school students are in a high-risk environment in which they are more likely to suffer from DED, such as long online courses and heavy stress from school. Relevant preventive measures that may have a positive impact on public health and quality of life for high school students should be brought to the forefront.
Determining the effect of air quality on activities of daily living disability: using tracking survey data from 122 cities in China
Authors: Liu Huan 
Published: April 2022

Abstract
Background
Current research on activities of daily living (ADLs) disability has mostly focused on the analysis of demographic characteristics, while research on the microcharacteristics of individuals and the macroenvironment is relatively limited, and these studies solely concern the impact of air quality on individual health.

Methods
This study innovatively investigated the impact of air quality on ADL disability by matching micro data of individuals from the China Health and Retirement Longitudinal Study with data of urban environmental quality from 122 cities. In this study, an ordered panel logit model was adopted for the benchmark test, and the two-stage ordered probit model with IV was used for endogenous treatment.

Results
This innovative study investigated the impact of air quality on ADL disability by matching individual micro data from the China Health and Retirement Longitudinal Study with urban environmental quality data for 122 cities. The results showed that air quality significantly increased the probability of ADL disability. The positive and marginal effect of air quality on moderate and mild disability was higher. Generally, the marginal effect of air quality on residents’ health was negative. In terms of group heterogeneity, the ADL disability of individuals aged over 60 years, those in the high Gross Domestic Product (GDP) group, females, and those in the nonpilot long-term care insurance group was more affected by air quality, and the interaction between air quality and serious illness showed that the deterioration of air quality exacerbated the ADL disability caused by serious illness; that is, the moderating effect was significant.

Conclusions
According to the equilibrium condition of the individual health production function, the ADL disability caused by a 1% improvement in air quality is equivalent to the ADL disability caused by an 89.9652% reduction in serious illness, indicating that the effect of improved air quality is difficult to replace by any other method. Therefore, good air quality can not only reduce ADL disability directly but also reduce serious illness indirectly, which is equivalent to the reduction of ADL disability. This is called the health impact.
Restaurant managers’ readiness to maintain people’s healthy weight and minimise food waste in Japan
Authors: Akamatsu Rie , Tonsho Nozomi , Saiki Mika , Komatsu Mihono 
Published: April 2022

Abstract
Background
People who consume high amounts of ready-to-eat meals have a higher body mass index than those who do not. However, if customers adhere to eating proper amounts without restaurants reducing the portions, plate waste may occur. It is therefore incumbent upon restaurants to serve suitable meal portions to customers in the interests of their health and the environment. This study examined whether restaurants support Japan’s national goals of minimising food loss and waste and maintaining healthy body weight. Additionally, the characteristics of restaurant managers who display a willingness to meet these goals, were identified.

Methods
An internet-based nationwide cross-sectional survey was conducted among restaurant managers in Japan in May 2019. The main outcome measured was readiness to take action toward maintaining healthy weight and minimising food loss and waste. Chi-square tests were performed to examine the characteristics of three groups, divided on the basis of their readiness to take action toward achieving these two goals. The group that displayed a higher readiness toward attaining both goals was examined using logistic regression analyses.

Results
Of the 412 restaurant managers who responded, 387 (93.9%) were analysed. Few managers reported taking action toward maintaining healthy weight (n = 13, 3.4%) and minimising food loss and waste (n = 45, 11.6%). Two variables, ‘medium- or big-sized company’ and ‘referring to the United Nations’ Sustainable Development Goals for running their business’, were related to both higher readiness for maintaining healthy weight and minimising food loss and waste (odds ratio [OR] = 2.27, confidence interval [CI]: 1.11–4.62; OR = 4.06, CI: 2.39–6.88, respectively).

Conclusions
Increasing recognition of the Sustainable Development Goals among restaurant managers is needed to increase their cooperation toward meeting Japan’s national goals.
The role of synovial fluid aspiration in shoulder joint infections
Authors: Streck Laura Elisa , Forster Johannes , von Hertzberg-Boelch Sebastian Philipp , Reichel Thomas , Rudert Maximilian , Rueckl Kilian 
Published: April 2022

Abstract
Background
Joint aspiration with analysis of synovial fluid white blood cell count (WBC) and microbiological culture is a widely established aspect in the diagnosis of shoulder joint infections (SJI). In case of a two stage revision for SJI, joint aspiration before re−/implantation of a total shoulder arthroplasty (TSA) was used to rule out persistent infection for years but its value is under debate. Shoulder specific data on all aspects is rare. The current study aims to answer the following research questions: Does joint aspiration have an insufficient predictive value in the diagnosis of SJI in (1) initial workup and (2) before definite arthroplasty with polymethylmethacrylate (PMMA)-Spacer in place?

Methods
This retrospective evaluation investigates 35 patients that were treated for SJI with a two staged implantation of a TSA after debridement and implantation of an PMMA-Spacer. Joint aspirations were performed preoperatively (PA) and before re−/implantation of the prosthesis while spacer was in place (interstage aspiration, IA). Samples were taken for microbiological culture and analysis of WBC. Sensitivity and specificity were calculated with reference to intraoperative microbiological samples. Receiver Operating Characteristic (ROC), Area-Under-Curve analysis (AUC) and calculation of the Youden index were performed to find optimum cut-off for WBC.

Results
The sensitivity of microbiological cultures from PA was 58.3% and the specificity was 88.9%. The mean WBC was 27,800 leucocytes/mm3 (range 400-96,300). The maximum Youden index (0.857) was a cut-off of 2600 leucocytes/mm3 with a sensitivity of 85.7% and a specificity of 100.0%. The sensitivity and specificity of IA were 0.0% and 88.5%, respectively.

Conclusions
Preoperative aspiration is likely to miss Cutibacteria spp. and CoNS and cannot rule out infection for sure. However, we recommend it for its advantages of targeted antibiotic therapy in case of germ identification. Empiric antibiotic therapy should cover Cutibacteria and CoNS even if aspiration showed negative microbiological cultures. In contrast, the diagnostic value of interstage aspiration does not qualify for its routine use.
Hypereosinophilia is a predictive biomarker of immune checkpoint inhibitor-induced hypopituitarism in patients with renal cell carcinoma
Authors: Yamada Hodaka , Washino Satoshi , Suzuki Daisuke , Saikawa Rika , Tonezawa Shiori , Hagiwara Rie , Funazaki Shunsuke , Yoshida Masashi , Konishi Tsuzumi , Saito Kimitoshi , Miyagawa Tomoaki , Hara Kazuo 
Published: April 2022

Abstract
Background
This study aimed to evaluate whether hypereosinophilia is a clinical biomarker of immune checkpoint inhibitor-induced hypopituitarism in patients with renal cell carcinoma treated with nivolumab plus ipilimumab.

Methods
This was a retrospective cohort study conducted at Jichi Medical University Saitama Medical Center between January 2018 and December 2020. In total, 12 patients with renal cell carcinoma who presented with immune checkpoint inhibitor-induced hypopituitarism were enrolled in this study. The clinical parameters and symptoms at baseline, last visit, and onset of hypopituitarism were analyzed.

Results
The median period from the initial treatment with immune checkpoint inhibitors to the onset of hypopituitarism was 82.5 (range: 56–196) days. Most patients developed hypopituitarism within 6 months. One patient presented with hypophysitis and 11 patients presented with isolated adrenocorticotropic hormone deficiency. The major symptoms noted at onset were fatigue (66.7%) and loss of appetite (41.7%). None of the patients had symptoms during the last visit. However, four developed hypereosinophilia. Eosinophil fraction (%) and eosinophil count (/µL) increased during the last visit and at the onset of hypopituitarism, respectively. The serum sodium and plasma glucose levels were similar.

Conclusions
The eosinophil count increased before the onset of hypopituitarism. Thus, hypereosinophilia can be an early predictor of hypopituitarism.
Administrative data analysis of student attrition in hungarian medical training
Authors: Pusztai Gabriella , Demeter-Karászi Zsuzsanna , Alter Emese , Marincsák Rita , Dabney-Fekete Ilona Dóra 
Published: April 2022

Abstract
Background
There is numerous empirical evidence supporting that college students studying in fields with rigorous curriculum and high requirements, such as medical training, are characterized by a higher risk of attrition than their peers. Since Hungarian medical training attracts more and more international students every year, the issue of dropout can have a global impact. Our study aimed to examine attrition risks of local and international students in Hungarian medical training.

Methods
In our study, we examined the dropout behaviour of all medical students who started their studies in 2010 in Hungary (N = 2391) by analysing longitudinal administrative data of those who studied between 2010 and 2017. Doing this, we conducted descriptive statistics and uncovered the risks of dropout using binary logistic regression.

Results
Our results indicate that the danger is primarily increased by factors directly linked to or indicating poor academic performance (slow pace of credit accumulation, tuition-based forms of finance). Individual characteristics, namely gender, and citizenship, also have a moderate but significant effect on the latter.

Conclusions
Thus a policy proposal can be formulated consisting of making the training network less rigid, devoting more educational attention to and providing targeted mentoring for students with learning difficulties and academic hardships. Foreign medical students studying in Hungary comprise a large group that has a high attrition rate, making it a prime target for dropout-reducing programs.
The educational value of an audience response system use in an Iraqi medical school
Authors: Tuma Faiz , Majeed Husam , Blebea John , Nassar Aussama , Durchholz William C. , Schofield Susie 
Published: April 2022

Abstract
Background
Medical education is continually evolving particularly through the modern implementation of educational technology. Enhancing interactive learning in the classroom or lecture settings is one of the growing uses of educational technology. The role and potential benefits of such technology may not be as evident in developing educational systems like the one in Iraq. The purpose of this study was to examine the effect and perception of the use of an audience response system (ARS) on interactive medical education in Iraq. A mixed quantitative and qualitative research methodology approach was used to study the effects and users’ perceptions (both student and tutor) of the ARS.

Method
The study was conducted in an Iraqi medical school in the Head and Neck course during the spring semester for third-year medical students. The course involved fifteen one-hour lectures over fifteen weeks. Users’ perceptions were evaluated by survey and focus group discussions (FGD). Descriptive statistics were used for quantitative measures and thematic analysis for the qualitative data.
An ARS system was installed and integrated into the course lectures throughout the course period of three months to enhance interactive learning. Three to five interactive questions were used in each lecture. Anonymous participation and answers were maintained. The appropriate discussion was initiated when pertinent depending on students’ answers.

Result
Most students (77% of survey, 85% of FGD) perceived the use of ARS as impactful on their learning.
They found the ARS engaging (70%), motivating (76%), promoting interactions (73%), and augment learning through better understanding and remembering (81%). Through the FGD, students expressed improved focus, enhanced thinking and reflection, and joyful learning. The educator perceived the ARS use as practical, interactive, thinking-stimulator, and reflective of student’s understanding. The required technology skills were reasonable; however, it demanded extra non-insignificant time to learn the use.

Conclusion
The perception of the ARS in this study was overall positive, providing encouragement for wide application of this technology in medical education in the developing world. Further studies are needed to validate and prioritize ARS usage in medical education in Iraq.
Association between dispensing of low-value oral albuterol and removal from Medicaid preferred drug lists
Authors: Volerman Anna , Pelczar Alison , Conti Rena , Ciaccio Christina , Chua Kao-Ping 
Published: April 2022

Abstract
Background
Oral albuterol has worse efficacy and side effects compared with inhaled albuterol, and thus its use has been discouraged for decades. Drug inclusion or exclusion on formularies have been associated with reductions in low-value care. This study examines dispensing of oral albuterol and inclusion of oral albuterol on state Medicaid drug formularies--Preferred Drug Lists (PDLs). It also evaluates the association between removal of oral albuterol from the PDL and dispensing levels.

Methods
This quasi-experimental study determined oral albuterol inclusion on PDLs and dispensing between 2011 and 2018, using Medicaid program websites and the State Drug Utilization Database. Using a difference-in-differences model, we examine the association between removal of oral albuterol from Arkansas’ Medicaid PDL in 2014 and dispensing of this drug through Medicaid, with Iowa as a control state. The outcome measure was the percent of all albuterol prescriptions that were for oral albuterol.

Results
A total of 28 state Medicaid PDLs included at least one formulation of oral albuterol in 2018. In 2018, 179,446 oral albuterol prescriptions were dispensed to Medicaid beneficiaries nationally. Medicaid programs paid approximately $3.0 million for oral albuterol prescriptions in 2018. Removal of oral albuterol syrup from the Arkansas PDL in March 2014 was associated with a more rapid decline in dispensing compared with Iowa which maintained this medication on their PDL.

Conclusions
Findings suggest that removal of low-value medications, such as oral albuterol, from PDLs may be one avenue by which state Medicaid programs can reduce wasteful spending while improving guideline-based care.