Miracle-dz/UniFAR-FTUs huggingface dataset:
Unemployment and mortality—a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men

Background: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all-cause and cause-specific mortality, adjusting for indicators of mental disorder, behavioural risk factors and social factors over the life course. Methods: This study was based on a cohort of 49321 Swedish males, born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990–4 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973–2004 were collected in national registers. Results: An increased risk of mortality 1995–2003 was found among individuals who experienced 90 days or more of unemployment during 1992–4 compared with those still employed (all-cause mortality HR 1.91, 95% CI 1.58 to 2.31. Adjustment for risk factors measured along the life course considerably lowered the relative risk (all cause mortality HR 1.30, 95% CI 1.06 to 1.58). Statistically significant increased relative risk was found during the first 4 years of follow up (all-cause mortality, adjusted HR 1.57, 95% CI 1.13 to 2.18, but not the following 4 years (all cause mortality, adjusted HR 1.17, 95% CI 0.91 to 1.50). Conclusion: The results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.
Creating a demand for bias analysis in epidemiological research

In 2005, Ross and colleagues found a protective association between maternal multivitamin supplementation during the periconceptual period and acute lymphoblastic leukaemia among children with Down’s syndrome (OR 0.51; CI 0.30 to 0.89). 1 In their discussion they noted, “Maternal vitamin supplementation was collected by self-report, which is subject to…recall bias. However, a validation study…reported excellent agreement. ” The validation study appears to imply that the bias from misclassification should be minimal. But given the number of false-positive published research findings,2 which are partly explained by issues of misclassification, the discussion of the potential misclassification raises more questions than it answers. First, we want to know what is the expected magnitude and direction of the bias. Second, given the potential bias, how we should interpret the 95% CI which is calculated assuming no bias? 3 And how should we as readers integrate ideas about the magnitude and direction of the bias into our interpretation of the results. For example, if we believe the misclassification …
Prevalence of proteinuria among type 2 diabetic patients in Menoufia governorate, Egypt

Objective The aim of the study was to determine the prevalence and risk factors of proteinuria among type 2 diabetic patients in Menoufia governorate. Background Type 2 diabetes is the leading cause of end-stage renal disease worldwide. Microalbuminuria or incipient diabetic nephropathy is one of the initial clinical manifestations of early diabetic nephropathy. Patients and methods A total of 234 type 2 diabetic patients were included in this study; they attended the outpatient clinics of the Family Health Center of 'Kafr Tanbedy' and Internal Medicine Department of Faculty of Medicine, Menoufia University, for routine follow-up. Patients were classified according to their urinary albumin-to-creatinine ratio (ACR) as having normoalbuminuria (ACR Results Prevalence of microalbuminuria (incipient diabetic nephropathy) was 34.2% and that of macroalbuminuria (overt diabetic nephropathy) was 12.8% in the studied group. Conclusion The overall prevalence rate of albuminuria was considerably high (47.01%) among the studied diabetic patients. Therefore, regular screening for microalbuminuria is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease).
Polypharmacy and its correlates in village health clinics across 10 provinces of Western China

Background Polypharmacy represents a growing public health concern for its associations with drug-related adverse events, poor adherence, medication errors and increased healthcare costs. Aim To assess the occurrence of polypharmacy prescribing and to identify the correlates in terms of doctors and patients characteristics in rural Western China. Methods 20 125 prescriptions were collected from 680 primary health clinics in villages from 40 counties in 10 provinces of Western China. Two outcome variables are used in the analysis: number of drug items prescribed and use of five or more drugs (polypharmacy). A multilevel Poisson regression model and a multilevel logistic regression model were employed to examine the socio-economic, demographic determinants of the above two outcome variables, respectively. Results The average drug number per prescription was 2.36, and the percentage of polypharmacy was 5.8%. The odds for polypharmacy were higher for village doctors with a heavier workload than those with less workload (OR=1.70; 95% CI 1.26 to 2.29). Patients with injections prescribed had higher odds for polypharmacy than patients without injections (OR=4.61; 95% CI 3.93 to 5.42). Village doctor's workload, subsidy for doctors from government and injection in prescriptions, patient's age and gender were also significant predictors of number of drug items prescribed in the studied areas. Conclusions Polypharmacy seems to be associated with the village doctors' and patients' background and government policy. Intervention studies are needed to promote rational use of drugs in rural China.
Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study

Objectives To determine the impact of comorbid chronic diseases on mortality in older people. Design Prospective cohort study (1992–2006). Associations between numbers of chronic diseases or mutually exclusive comorbid chronic diseases on mortality over 14 years, by Cox proportional hazards model adjusting for sociodemographic variables or Kaplan–Meier analyses, respectively. Setting Population based, Australia. Participants 2087 randomly selected participants aged ≥65 years old, living in the community or institutions. Main results Participants with 3–4 or ≥5 diseases had a 25% (95% CI 1.05 to 1.5, p=0.01) and 80% (95% CI 1.5 to 2.2, p<0.0001) increased risk of mortality, respectively, by comparison with no chronic disease, after adjusting for age, sex and residential status. When cardiovascular disease (CVD), mental health problem or diabetes were comorbid with arthritis, there was a trend towards increased survival (range 8.2–9.5 years) by comparison with CVD, mental health problem or diabetes alone (survival 5.8–6.9 years). This increase in survival with arthritis as a comorbidity was negated when CVD and mental health problems or CVD and diabetes were present in disease combinations together. Conclusion Older people with ≥3 chronic diseases have increased risk of mortality, but discordant effects on survival depend on specific disease combinations. These results raise the hypothesis that patients who have an increased likelihood of opportunity for care from their physician are more likely to have comorbid diseases detected and managed.
Imprint regulatory elements as epigenetic biosensors of exposure in epidemiological studies

Mapping the human genome has provided the foundation for studies investigating the role of genetic and environmental factors in the aetiology of complex diseases and neurological disorders. Assessment of genetic risk factors is becoming increasingly comprehensive with the advent of high-throughput, genome-wide approaches. The constancy of genotypes has enabled their use as risk factors in case–control and related hybrid study designs. These genetic risk factors not only carry a low misclassification potential, but they also promise to result in epidemiological studies focused on individuals at high risk of developing chronic complex disease. Exposure ascertainment for complex diseases largely relies on participants to recall past lifestyle behaviours and diet. Poor recall, especially differential recall between cases and controls, remains a fundamental concern threatening the validity of epidemiological studies. As we embark on studies evaluating exposure throughout human life, such as testing for the developmental origins of adult disease,123 we can anticipate misclassification resulting from poor recall to worsen. A growing body of evidence now suggests that epigenetic features of the genome that regulate phenotype without changing the nucleotide sequence may provide …
A breast navigator program: barriers, enhancers, and nursing interventions.

PURPOSE/OBJECTIVES to identify barriers to and enhancers of completion of breast cancer treatment from the perspective of participants in a breast health navigator program. RESEARCH APPROACH qualitative, using focus group methodology and telephone interview. SETTING two teaching hospital ambulatory cancer centers. PARTICIPANTS women enrolled in the breast navigator program, including patients who completed (n = 13) and did not complete (n = 1) breast cancer treatment. METHODOLOGIC APPROACH researchers used semistructured, open-ended questioning to guide the interviews and elicit identification of barriers to and enhancers of treatment. A flexible approach was used and the interviews were recorded. Content analysis was used to identify themes. MAIN RESEARCH VARIABLES perceived barriers and enhancers of breast cancer treatment. FINDINGS the most common theme was the value of the education and information received from the navigator. Several participants saw this as the essence of the role. Assistance with managing symptoms, access to financial and community resources, and the team approach were completion enhancers. CONCLUSIONS completion of breast cancer therapy and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role. INTERPRETATION the intentional presence of the oncology nurse and the nursing emphasis on culturally appropriate education and care can be seen as key competencies of the navigator. As the concept of the navigation process is expanded to other cancers, oncology nurses are particularly well positioned to advocate for the navigator role as a nursing domain.
Impact of outdoor biomass air pollution on hypertension hospital admissions

Background This study aimed to evaluate the association between the total suspended particles (TSP) generated from burning sugar cane plantations and the incidence of hospital admissions from hypertension in the city of Araraquara. Methods The study was an ecological time-series study. Total daily records of hypertension (ICD 10th I10-15) were obtained from admitted patients of all ages in a hospital in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (μg/m3) was obtained using a Handi-Vol sampler placed in downtown Araraquara. The local airport provided daily measures of temperature and humidity. In generalised linear Poisson regression models, the daily number of hospital admissions for hypertension was considered to be the dependent variable and the daily TSP concentration the independent variable. Results TSP presented a lagged effect on hypertension admissions, which was first observed 1 day after a TSP increase and remained almost unchanged for the following 2 days. A 10 μg/m3 increase in the TSP 3 day moving average lagged in 1 day led to an increase in hypertension-related hospital admissions during the harvest period (12.5%, 95% CI 5.6% to 19.9%) that was almost 30% higher than during non-harvest periods (9.0%, 95% CI 4.0% to 14.3%). Conclusions Increases in TSP concentrations were associated with hypertension-related hospital admissions. Despite the benefits of reduced air pollution in urban cities achieved by using ethanol produced from sugar cane to power automobiles, areas where the sugar cane is produced and harvested were found to have increased public health risk.
Hysterosalpingo‐foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post‐procedure

Fallopian tube patency testing is an essential part of infertility evaluation. Hysterosalpingo‐contrast sonography (HyCoSy) has been described as reliable, well tolerated and safe compared to other modalities such as laparoscopy and a dye test or hysterosalpingography. Limited availability of the previously used contrast has led to the introduction of a foam contrast agent as an alternative.
The relationship between temperature and ambulance response calls for heat-related illness in Toronto, Ontario, 2005

Background Concern over the adverse effects of heat on human health has led to numerous studies assessing the relationship between heat and mortality. Few studies have quantified the impact of heat on morbidity, including ambulance response calls. This study describes the association between temperature and ambulance response calls for heat-related illness (HRI) in Toronto, Ontario, Canada during the summer of 2005. Methods Data sources included daily temperature, relative humidity and humidex information from Environment Canada, and Medical Priority Dispatch System data from Toronto Emergency Medical Services. Time series and regression analyses were used to examine the relationship between daily temperature and ambulance response calls for HRI during the summer (1 June to 31 August) of 2005. Results In 2005, there were 201 ambulance response calls for HRI. On average, for every one degree increase in maximum temperature (°C) there was a 29% increase in ambulance response calls for HRI (p<0.0001). For every one degree increase in mean temperature (°C) there was a 32% increase in ambulance response calls for HRI (p<0.0001). Conclusions Given these associations, we urge further exploration of ambulance response calls as a source of HRI morbidity data particularly given the increasing health concerns associated with climate change.
The association of childhood height, leg length and other measures of skeletal growth with adult cardiovascular disease: the Boyd–Orr cohort

Background Taller adults have a reduced risk of cardiovascular disease, and there is some evidence that pre-adolescent exposures, indexed by leg length, underlie this association. Associations with other aspects of skeletal size in childhood have not previously been investigated. Methods We have examined associations of cardiovascular mortality and morbidity with childhood height, shoulder breadth, leg, trunk and foot length using a cohort of children whose families participated in a 1937–9 survey of diet and health followed up for 59 years. Results Altogether 2642 traced participants had at least one anthropometric measurement; a subsample (n=1043), completed the Rose angina questionnaire and provided information about doctor-diagnosed ischaemic heart disease (IHD) in 1997–8. Childhood stature was weakly inversely associated with cardiovascular mortality, and leg length was the component with the strongest associations. There was evidence from secondary analyses that childhood anthropometric measurements were inversely related to early (age <65 years) rather than late cardiovascular mortality. Childhood stature was inversely associated with self-reported IHD and associations with leg length were strongest. Associations were somewhat attenuated in models including terms for having been breastfed and socioeconomic position. Conclusion Pre-adult exposures are more strongly associated with cardiovascular morbidity than mortality, and they affect premature cardiovascular mortality more than later mortality.
Intergenerational social mobility and the risk of hypertension

Background Low socioeconomic status (SES) has been linked to increased risk of hypertension, a known risk factor for cardiovascular disease. How the risk is altered by intergenerational social mobility is not well known. The aim of this study is to investigate parental SES, adult SES and the intergenerational social mobility in relation to hypertension risk. Methods By using data from the Swedish Twin Registry, the authors obtained information about both parental and adult SES and hypertension in 12 030 individuals born from 1926 to 1958. Generalised estimating equations were used to estimate ORs with 95% CIs. Results Low parental SES was associated with increased odds of hypertension (OR 1.42, 95% CI 1.14 to 1.76). Low SES in adulthood was associated with increased odds for women but not for men (OR 1.40, 95% CI 1.15 to 1.70 and OR 1.01, 95% CI 0.83 to 1.24, respectively). Compared with the stable low social status group, the upward mobile group had lower odds of hypertension (OR 0.82, 95% CI 0.70 to 0.97). Compared with the stable high social status group, the results for the downward mobile group indicated an increased risk. A co-twin case-control analysis indicated that the results were independent of familial factors. Conclusions These findings suggest that the risk of hypertension associated with low parental social status can be modified by social status later in life. Possibly, this could be targeted by public health or political interventions. As parental social status has an impact on later health, such interventions should be introduced early.
Free bus passes, use of public transport and obesity among older people in England

Background All residents of England aged 60 years and older became entitled to free travel on local buses on 1 April 2006. This study examines the impact of this policy on public transport use, a mode of active transport and levels of obesity. Methods Logistic regression analyses using three waves of data (2004, 2006 and 2008) from the English Longitudinal Study of Ageing. Our main outcome measures were changes in self-reported public transport use, body mass index, waist circumference and obesity. Results Eligibility for free bus travel was associated with increased use (adjusted odds ratio (AOR) 1.51, 95% CI 1.14 to 2.00) of public transport among older people. Older people who used public transport had reduced odds of being obese in 2008 compared with those who did not (AOR 0.75, 95% CI 0.65 to 0.86), as did those who were eligible for free local bus travel (AOR 0.75, 95% CI 0.59 to 0.97). Older people who used public transport had reduced odds of becoming obese between 2004 and 2008 (AOR 0.79, 95% CI 0.63 to 0.98). Conclusion The introduction of free bus travel for older residents of England appears to have increased public transport use and may have conferred a protective effect against obesity.
Risk factors for gestational diabetes mellitus: ethnic disparities.

OBJECTIVE Gestational diabetes mellitus (GDM) increases the risk of poor maternal and infant health outcomes; therefore, the objective of this study was to compare the ethnic disparities and identify the risk factors for GDM. DESIGN We performed a cross-sectional analysis using patient records from a hospital located in the Puli area of Central Taiwan. SETTING A teaching hospital located in a rural mountainous area of Central Taiwan. PARTICIPANTS Between 2002 and 2012, the hospital admitted 154 patients (107 non-aborigines, 30 aborigines, and 17 non-Taiwanese) who exhibited glucose intolerance during their pregnancy. MAIN OUTCOME MEASURES GDM was confirmed using the oral-glucose-tolerance-test administered in dose of either 100 g or 75 g. The incidence and risk factors for GDM in the aboriginal and non-aboriginal women was compared. RESULTS We excluded the patients who had overt diabetes or were non-Taiwanese. Thus, 132 patients (28 aboriginal and 104 non-aboriginal women; mean age 30 years) were enrolled in the final study. A total of 51 patients (15 aboriginal, 36 non-aboriginal women) had GDM, which was more prevalent among the aboriginal mothers (53.6% versus 34.6%). The risk factors for GDM among the aboriginal women were persistent glycosuria and prior macrosomia. CONCLUSION The Taiwanese aboriginal women exhibited higher incidence of GDM; thus, we recommend that early screening and health education for pregnant aboriginal women be provided.
Non-Orthogonal Multiple Access ( NOMA ) for Future Radio Access

This paper presents a non-orthogonal multiple access (NOMA) concept for future radio access (FRA) towards the 2020s information society. Different from the current LTE radio access scheme (until Release 11), NOMA superposes multiple users in the power domain although its basic signal waveform could be based on the orthogonal frequency division multiple access (OFDMA) or the discrete Fourier transform (DFT)-spread OFDM the same as LTE baseline. In our concept, NOMA adopts a successive interference cancellation (SIC) receiver as the baseline receiver scheme for robust multiple access, considering the expected evolution of device processing capabilities in the future. Based on system-level evaluations, we show that the downlink NOMA with SIC improves both the capacity and cell-edge user throughput performance irrespective of the availability of the frequency-selective channel quality indicator (CQI) on the base station side. Furthermore, we discuss possible extensions of NOMA by jointly applying multiantenna/site technologies with a proposed NOMA/MIMO scheme using SIC and an interference rejection combining (IRC) receiver to achieve further capacity gains, e.g., a three-fold gain in the spectrum efficiency representing a challenging target for FRA.
Quiet about pain: experiences of Aboriginal people in two rural communities.

OBJECTIVE This study explores communications experienced by Aboriginal people in health care encounters about pain. It examines barriers that can impact upon effective pain management for Aboriginal patients. (This article refers to Aboriginal people, as these were the study participants. It is not intended to exclude Torres Strait Islander people.) DESIGN A qualitative study using focus groups. SETTING Two Aboriginal communities in South East Queensland. PARTICIPANTS The participants were 20 men and 20 women who identified a health condition with associated pain for which they had sought health care, including pain relief. Their conditions included arthritis, orthopaedic injuries, back pain and coronary artery disease. RESULTS Physical pains associated with participants' health conditions were accorded a second place to deep emotional pain attributed to dispossession, dislocation and loss. At health facilities, prominent perceptions were that health professionals held a negative attitude towards them, and lacked respect and caring. Participants experienced that the language used by health professionals in consultations was complex. CONCLUSIONS Aboriginal people often do not report pain, on the basis of previous negative encounters with the health system. Other perceived barriers to effective pain management included discriminatory attitudes of health professionals and communication problems.