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    Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System
    (2022)
    Barry Ting Sheen Kweh
    ;
    Jin Wee Tee
    ;
    Sander Muijs
    ;
    F. Cumhur Oner
    ;
    Klaus John Schnake
    <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p &lt; 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.</jats:p> </jats:sec>
      17Scopus© Citations 3
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    Hantavirus in humans: a review of clinical aspects and management
    (2023)
    Pablo A Vial
    ;
    Marcela Ferrés
    ;
    VIAL COX, MARIA CECILIA  
    ;
    Jonas Klingström
    ;
    Clas Ahlm
    Scopus© Citations 77  79
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    Scrub typhus: A new cause of acute undifferentiated febrile illness in Latin America?
    (2021)
    Carlos Ramiro Silva-Ramos
    ;
    Fernando de Castro Jacinavicius
    ;
    WEITZEL, THOMAS  
    ;
    David H. Walker
    ;
    Álvaro A. Faccini-Martínez
      16Scopus© Citations 8
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    Multi-Criteria Decision Analysis for Renewable Energies: Research Trends, Gaps and the Challenge of Improving Participation
    (2021)
    Rodrigo A. Estévez
    ;
    Valeria Espinoza
    ;
    PONCE OLIVA, ROBERTO DANIEL  
    ;
    VÁSQUEZ LAVÍN , FELIPE ANTONIO  
    ;
    Stefan Gelcich
    <jats:p>The global increase in renewable energy initiatives has been followed by the need to include the social impact of any project as a core element. Significant challenges for renewable energy development include uncertainty in assessing social impacts at local scales, participation and social acceptance. Multi-criteria decision analysis (MCDA) approaches have been widely used in energy planning to address these challenges. This article reviews how social criteria and participation mechanisms have been incorporated into decision-making processes for renewable energy projects. A total of 184 articles were analyzed. A total of 490 indicators that estimated social impacts were identified and organized into nine criteria: employment, social acceptance, social development, health impact, governance, visual impact, knowledge and awareness, cultural value and social justice. Most research included analytical hierarchy process methodologies, and the articles were geographically concentrated in Asia and Europe. Most articles included a participative component (92.3%), and the majority of them were based on expert consultation (75.4%). Of the articles that exclusively considered experts, almost 40% did not provide any description of the expert elicitation process. Results revealed advances in the use of MCDA but highlighted important challenges—related to improving expert consultation methodologies and broadening the participation of stakeholders—when developing renewable energy initiatives and policies.</jats:p>
    Scopus© Citations 87  1
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    Molecular Description of a Novel <i>Orientia</i> Species Causing Scrub Typhus in Chile
    (2020)
    Katia Abarca
    ;
    Constanza Martínez-Valdebenito
    ;
    Jenniffer Angulo
    ;
    Ju Jiang
    ;
    Christina M. Farris
      1  1Scopus© Citations 95
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    Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study
    (2021)
    Clementina López-Medina
    ;
    Anna Molto
    ;
    Joachim Sieper
    ;
    Tuncay Duruöz
    ;
    Uta Kiltz
    <jats:sec><jats:title>Objectives</jats:title><jats:p>To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).</jats:p><jats:p>Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.</jats:p></jats:sec>
      2Scopus© Citations 103
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    Scopus© Citations 7  2
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    Profile and complexity of travel medicine consultations in Chile: unicentric cross-sectional study
    (2020)
    WEITZEL, THOMAS  
    <jats:sec><jats:title>Objective</jats:title><jats:p>To analyse the spectrum, vaccination needs and pretravel advice complexity of travellers presenting at a travel medicine clinic in Santiago, Chile.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross-sectional study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Pretravel consultations in a private healthcare centre in Chile, an ‘emerging market’ country in South America.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Travellers (n=1341) seeking pretravel advice at the Travel Medicine Program of Clínica Alemana, Santiago, from April 2016 to March 2018.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>Demographical and travel characteristics, indications for travel vaccines and malaria prophylaxis, and complexity of travel consultations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 1341 travellers, 51% were female; the median age was 33 years. Most frequent travel reasons were tourism (67%) and business (20%). Median travel duration and time to departure were 21 days and 28 days, respectively. Most destinations were located in America (41%), followed by Asia (36%) and Africa (26%); 96% visited less developed countries, mostly in tropical regions, with risk of arboviral infections (94%) and malaria (69%). The indicated vaccine indications comprised hepatitis A (84%), yellow fever (58%), typhoid fever (51%), rabies (29%), polio (8%), Japanese encephalitis (6%) and meningococcal meningitis (5%). More than 60% of consultations were classified as complex.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The studied population mostly visited less developed tropical regions, resulting in a high requirement of yellow fever and other travel-related vaccinations. Most consultations were complex and required a comprehensive knowledge and training in travel medicine.</jats:p></jats:sec>
      1Scopus© Citations 2
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    Purchases of psychotropic drugs among the migrant population in Finland: a nationwide register-based cohort study
    (2020)
    Venla Lehti
    ;
    Jaana Suvisaari
    ;
    Mika Gissler
    ;
    MARKKULA NIINA, KATARIINA  
    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Migrant populations may have different mental health service needs when compared with native populations. One indicator of service use is the use of psychotropic medication. The aim of this study was to compare the purchases of psychotropic drugs among different migrant populations with the native population in Finland.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Foreign-born participants (n = 184 805) and their Finnish-born controls (n = 185 183) were identified from the Finnish Central Population Register. Information on their purchases of psychotropic drugs in 2011–15 was collected from the National Prescription Register. A washout period of 2009–10 was used to define incident purchases. Cox regression analysis was the statistical method used.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>At least one incident purchase of a psychotropic drug was identified for 11.1% of migrant women, 11.4% of Finnish-born women, 8.7% of migrant men and 9.8% of Finnish-born men. When controlled for age, sex, marital status, socioeconomic status and social assistance, migrants were less likely to purchase psychotropic drugs (adjusted hazard ratio 0.96, 95% confidence interval 0.93–0.98), but there was variation between different drug categories. Recent migrants and migrants from Asia and Sub-Saharan Africa were least likely to purchase drugs. Migrants from Nordic countries and other Western countries most closely resembled the Finnish-born controls.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Recent migrants in Finland appear to use fewer psychotropic drugs than native Finns. It is important to analyze the reasons for this pattern, as they may indicate delays in access to care or benefits. The heterogeneity of migrant populations must also be considered when developing services to better address their needs.</jats:p> </jats:sec>
    Scopus© Citations 8  1