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Tobacco endgame in the WHO European Region: Feasibility
in light of current tobacco control status
(2023)
Adrián González-Marrón
;
Helena Koprivnikar
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Judit Tisza
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Zsuzsa Cselkó
;
Angeliki Lambrou
10Scopus© Citations 10
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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
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F. Cumhur Oner
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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 < 0.001) and A4 (p < 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 < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 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 < 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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The Global Otolaryngology–Head and Neck Surgery Workforce
(2023)
Beatriz Petrucci
;
Samuel Okerosi
;
Rolvix H. Patterson
;
Sara B. Hobday
;
Valerie Salano
<jats:sec id="ab-ooi230053-4"><jats:title>Importance</jats:title><jats:p>A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, <jats:italic>Multi-Country Assessment of National Capacity to Provide Hearing Care</jats:italic>, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed.</jats:p></jats:sec><jats:sec id="ab-ooi230053-5"><jats:title>Objective</jats:title><jats:p>To establish comprehensive workforce metrics for global otolaryngology–head and neck surgery (OHNS) with updated data from more countries/territories.</jats:p></jats:sec><jats:sec id="ab-ooi230053-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians.</jats:p></jats:sec><jats:sec id="ab-ooi230053-7"><jats:title>Main Outcome</jats:title><jats:p>The OHNS workforce per capita, stratified by income and region.</jats:p></jats:sec><jats:sec id="ab-ooi230053-8"><jats:title>Results</jats:title><jats:p>Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world’s population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally.</jats:p></jats:sec><jats:sec id="ab-ooi230053-9"><jats:title>Conclusion and Relevance</jats:title><jats:p>This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.</jats:p></jats:sec>
Scopus© Citations 6 14
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Hantavirus in humans: a review of clinical aspects and management
(2023)
Pablo A Vial
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Marcela Ferrés
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VIAL COX, MARIA CECILIA
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Jonas Klingström
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Clas Ahlm
Scopus© Citations 77 79
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Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities–focused research
(2023)
Sanne Franzen
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Karen Nuytemans
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Renelle Bourdage
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Paulo Caramelli
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Ratnavalli Ellajosyula
<jats:title>Abstract</jats:title><jats:p>Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.</jats:p>
27Scopus© Citations 12
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Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity—GoPA! 2015 and 2020 Surveys
(2023)
Andrea Ramírez Varela
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Pedro C. Hallal
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Juliana Mejía Grueso
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Željko Pedišić
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Deborah Salvo
<jats:p><jats:italic><jats:bold>Background</jats:bold>:</jats:italic> Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. <jats:italic><jats:bold>Methods</jats:bold>:</jats:italic> We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. <jats:italic><jats:bold>Results</jats:bold>:</jats:italic> The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world’s population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world’s population live in countries where PA promotion capacity should be significantly improved. <jats:italic><jats:bold>Conclusion</jats:bold>:</jats:italic> Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.</jats:p>
1 2Scopus© Citations 46
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Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis
(2023)
Carlos Cifuentes-González
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William Rojas-Carabali
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Álvaro Olate Pérez
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Érika Carvalho
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Felipe Valenzuela
<jats:sec id="sec001"> <jats:title>Background</jats:title> <jats:p>Ocular toxoplasmosis (OT) is caused by the parasite <jats:italic>Toxoplasma gondii</jats:italic>. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods and findings</jats:title> <jats:p>We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836).</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Results</jats:title> <jats:p>Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%–58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%–48%) and blindness in 20% (95% CI 13%–30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72–8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59–6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Conclusion</jats:title> <jats:p>Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.</jats:p> </jats:sec>
4Scopus© Citations 18
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Achilles insertional tendinopathy: state of the art
(2019)
Nicola Maffulli
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Amol Saxena
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WAGNER, EMILIO
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Guglielmo Torre
Scopus© Citations 40 1
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Multi-Criteria Decision Analysis for Renewable Energies: Research Trends, Gaps and the Challenge of Improving Participation
(2021)
Rodrigo A. Estévez
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Valeria Espinoza
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PONCE OLIVA, ROBERTO DANIEL
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VÁSQUEZ LAVÍN , FELIPE ANTONIO
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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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Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
(2021)
Thanh N Nguyen
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Diogo C Haussen
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Muhammad M Qureshi
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Hiroshi Yamagami
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Toshiyuki Fujinaka
<jats:sec><jats:title>Background</jats:title><jats:p>During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170–1035 procedures, respectively, representing an 11.5% (95%CI −13.5% to −9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI −28.0% to −22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.</jats:p></jats:sec>
Scopus© Citations 33 1

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