Miracle-dz/UniFAR-FTUs huggingface dataset:
Self-Rated Health and Association with ACEs -

Background: Prior studies have demonstrated an association between experiencing trauma in childhood and poorer self-rated health in adulthood. Much less is known about this association among low-income minority patients in primary care settings. Methods: We replicated the Adverse Childhood Experiences (ACE) Study, a collaborative venture between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, with a low-income minority sample of primary care patients (N = 801) at a community-based healthcare center. We conducted a cross-sectional retrospective quantitative survey study. Data were analyzed using binary logistic regression to evaluate the hypothesis that low-income minority patients who reported more childhood trauma (abuse, neglect, household dysfunction, cumulative adverse childhood experiences [ACEs]) would more likely have reported poorer health in adulthood. Results: The number of ACEs in our sample was considerably higher than the original CDC ACE Study, as almost 50% of patients surveyed at our clinic reported 4 or more ACEs, confirming that trauma is central among individuals served in many urban primary care settings. The results of the ACE abuse, neglect, and cumulative ACEs score were in the expected direction and statistically significant suggesting that participants who reported more childhood abuse and neglect and who reported more childhood trauma (cumulative/total ACEs) were more likely to report poorer health in adulthood. Conclusion: These findings have implications for providers, researchers, and policy makers to develop more collaborative approaches to primary care that better target the negative sequelae of ACEs.
Multidisciplinary approach in the immediate replantation of a maxillary central incisor - A six and a half year follow-up

This report proposes a discussion of the various peculiarities of a tooth 21 replantation in a 9-year-old patient and describes different treatment facets and a 6-year follow-up of the case. The splint was maintained for a 3-month period. After a 1΍ year therapy with calcium hydroxide to control inflammatory resorption, the final canal obturation was performed 18 months after trauma with mineral trioxide aggregate. Two years after replantation, the orthodontic treatment had been initiated and 5 years after avulsion, whitening of tooth 21 was also done. Clinical and radiographic follow-up at regular intervals revealed that the treated tooth was still functional, showing normal mobility, resorption stabilization, and normal appearance of the bone tissue and lamina dura, testifying the treatment has been so far successful. The possibility of submitting avulsed teeth to other dental treatments once, there is close professional monitoring by controlling the risks and benefits of each therapy, as well as the patient′s cooperation, extra-oral time, and storage media for transport to the dentist among other details is emphasized.
BUILDING AND EVALUATING AN ANIMAL MODEL FOR SYNDROME IN TRADITIONAL CHINESE MEDICINE IN THE CONTEXT OF UNSTABLE ANGINA (MYOCARDIAL ISCHEMIA) BY SUPERVISED DATA MINING APPROACHES

Building an animal model for a disease is a better avenue to understand the inner mechanism of it. Traditional Chinese Medicine accumulated much practical experience and a large amount of literature to heal diseases during the past 3000 years. However, as there is no available animal model for TCM research because syndrome, the core of TCM theory, it is hard to be diagnosed from animals. In this paper, we present a novel strategy to build and evaluate an animal model for syndrome in TCM in the context of a disease. We first carried out a clinical epidemiology survey for a syndrome ( Blood stasis syndrome, BSS) diagnosed by TCM experts in the context of a disease ( Unstable angina, UA). Meanwhile, the blood samples of patients included in the survey were collected and measured as physical and chemical specifications by laboratory examinations. Alternatively, we used supervised data mining methods to build association between the specifications and the syndrome in the context of UA. The accuracy of classification was used to evaluate performance of the association built. Finally, we built an animal model for myocardial ischemia and validated the model by established diagnosis criterion of myocardial ischemia. Furthermore, the built association was used to evaluate whether an animal is with BSS. The results indicated that the strategy successfully evaluates and separates the animal model for syndrome in TCM from the counterpart for myocardial ischemia. The novel strategy presented in the paper provides a better insight to understand the nature of syndrome in TCM and pave a basis for personalized therapies of UA.
Analysis of 6 cases of drug-induced pemphigus.

OBJECTIVES To study clinical and laboratory characteristics of drug-induced pemphigus. METHODS Using direct immunofluorescence (IF), indirect IF, ELISA and immunoblotting to characterize 6 patients with drug-induced pemphigus (DIP) and compared them with 20 cases of idiopathic pemphigus. RESULTS All the 6 cases of DIP showed obvious itching (100%) and no damage to the oral mucosa. Five out of 6 DIP cases (83.33%) presented as pemphigus folicaeus (PF) since they contained circulating Dsg1-specific IgG, were sensitive to low doses of glucocorticoid, and had good prognosis. One case was showed as pemphigus vulgaris (PV). Dsg1-specific IgA was positive in peripheral blood of 4 cases (66.67%), and the antibody disappeared after treatment. In patients with idiopathic pemphigus, only 6 cases (30%) had mild itching, and 12 cases (60%) had oral mucosal lesions. Twelve cases (60%) were PV with anti-Dsg1 and -Dsg3 antibodies, and 8 cases (40%) were PF with anti-Dsg1 antibody only. One case (5%) had anti-Dsg1 IgA. CONCLUSION Drug factors should be considered for pemphigus as some common antibiotics can cause pemphigus.
Baroreflex Sensitivity in Relation to Clinical Characteristics in Subject Aged 40 to 80 Years

Baroreflex function measured as baroreflex sensitivity (BRS) mirrors an integrated capacity of the autonomic nervous system. We aimed to assess the relationship between measures of BRS and age and relevant clinical characteristics. 80 subjects participating in the Copenhagen City Heart study (43 women) with a mean age of 59 ± 11 years (range 41-79 years) were included. Baroreceptor activity was quantified through the Valsalva manoeuvre (VM) and as a spontaneous function. BRS was tested against age, gender, smoking status, body size and predicted risk of coronary heart disease based on the Framingham score. BRS was found to decline with age, but this change disappeared when correcting for the age related increase in systolic blood pressure. We found that the VM-derived indices of sympathetic vascular control declined with age as did the vagally controlled heart rate changes in response to deep breathing and VM. We could not demonstrate any correlation between BRS, smoking status, and body size when adjusting for age and gender, whereas spontaneous BRS was reduced with increasing Framingham risk score. Principal component analysis revealed three component explaining 69% of the total variance in our population comprising one component reflecting the sympathetic activity, the parasympathetic system, and the integrated spontaneous BRS, respectively. The parasympathetic component was the only one correlating with clinical characteristics of declining age, smoking habits, systolic blood pressure and Framingham score. It is concluded that the parasympathetic and sympathetic parts of the baroreflex arch behave differently with respect to aging and cardiovascular risk factors. The most prominent changes are seen in cardiovagal control whereas the effects of age related changes in sympathetic vascular control are less noticeable. Our study supports the use of the cardiovagal part of the baroreflex arch as an indicator of cardiovascular risk.
Community pharmacists' work activities in the United States during 2000.

OBJECTIVES To describe community pharmacists' work activities in the United States during 2000 and to investigate the effects of position, pharmacy type, and prescription volume on work activities. DESIGN Cross-sectional descriptive survey of a systematic sample of 4,895 U.S. pharmacists, of which 2,250 responded. SETTING United States. PARTICIPANTS A sample of 832 community pharmacists working full-time (at least 30 hours per week) out of the total of 2,250 who responded to the survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Workload (hours worked and proportion of prescriptions dispensed at the site with which the pharmacist was personally involved) and professional responsibilities (proportion of time spent in medication dispensing, consultation, business management, and drug use management). RESULTS As of 2000, the typical community pharmacist in the United States devoted 56% of his or her time to medication dispensing responsibilities, 19% to consultation responsibilities, 16% to business management responsibilities, and 9% to drug use management responsibilities. These results were consistent for pharmacists regardless of pharmacy type or prescription volume; however, position did significantly affect the proportion of time spent in the various activities. CONCLUSION Pharmacists are still devoting the majority of their time to medication dispensing responsibilities. However, our findings also show that pharmacists would prefer to devote more of their time to professional responsibilities, such as consultation and drug use management, and less time to medication dispensing and business management.
Port-wine stains are more than skin-deep! Expanding the spectrum of extracutaneous manifestations of nevi flammei of the head and neck.

UNLABELLED It is well known that port-wine stains of the upper part of the face may herald abnormalities of the brain or eye in the form of Sturge-Weber syndrome. This study focuses on other extracutaneous anomalies in patients with nevi flammei of the head and neck, giving rise to functional complications. PATIENTS AND METHODS A retrospective study was performed on patients with port-wine stains involving the head and neck area. Records were reviewed for demographic parameters, extent of the lesion, clinical complications, diagnostic measures, previous treatments, ultimate therapeutic approach, and outcome. RESULTS Nine patients, mean age 50.4 years, with port-wine stains and clinical symptoms due to extracutaneous involvement, were admitted and treated from 2006 to 2009. Major clinical features included macrocheilia in three cases, gingival bleeding in two, dysphonia with globus sensation, painful parotideal swelling with recurrent otitis, painful lingual swelling, recurrent epistaxis, and nasal obstruction in one case each. Cases with lower lip hypertrophy were treated by conventional surgical approaches. Recurrent epistaxis and nasal obstruction due to affected inferior turbinate were treated by Nd:YAG laser therapy, and globus sensation and dysphonia by speech therapy. Patients with gingival affection and recurrent otitis were treated by local ear care. CONCLUSION Port-wine stains in the head and neck may develop extracutaneous manifestations causing severe problems. A multimodal and interdisciplinary approach is mandatory for an appropriate treatment.
The efficacy of NHIS-listed anti-glaucoma drugs in the manage- ment of primary open-angle glaucoma

Ghana is the most affected country in Africa as far as glaucoma is concerned. This study therefore aims at determining the efficacy of the National Health Insurance Scheme listed anti-glaucoma drugs in the management of primary open-angle glaucoma in Ghana. This retrospective survey was carried out at the Golden Jubilee Eye Centre of St Michael’s Catholic Hospital, Pramso in the Bosomtwi Atwima Kwanwoma District of the Ashanti Region of Ghana from January 2008 to December 2010. By random and purposive sampling, 141 patient folders (35.25% of total folders studied) were selected and data on drugs and intra-ocular pressure measurements for eight consecutive visits to the centre were recorded and analyzed appropriately. The outcome of primary open-angle glaucoma in the study was not gender sensitive but increased with age (majority 70 – 79 years). While Timolol, in monotherapy, reduced but not significantly (p > 0.05) the initial mean intraocular pressure measurements, Latanoprost reduced the initial mean intra-ocular pressure very significantly (p ≤ 0.001). Combination therapies involving Latanoprost and listed anti-glaucoma drugs reduced intra-ocular pressure significantly than combination therapies involving NHISlisted drugs only (p ≤ 0.01). Though the National Health Insurance Scheme listed anti-glaucoma drug show intra-ocular pressure reduction in mono- and combination therapies, reduction by Latanoprost and combination of Latanoprost with the NHIS-listed drugs is very much significant. An addition of Latanoprost to the National Health Insurance Scheme list of anti-glaucoma medications would therefore be very beneficial to glaucoma patients in Ghana. Journal of Medical and Biomedical Sciences (2012) 1(2), 50-58
Outcomes from DiabetesCARE: a pharmacist-provided diabetes management service.

OBJECTIVE To describe outcomes attained by the DiabetesCARE component of the PharmacistCARE program, which is an innovative pharmacy practice model implemented within a self-insured employer. DESIGN Descriptive nonexperimental study. SETTING University of Kentucky (UK), from March 2003 through December 2006. PATIENTS 236 patients with diabetes (95% with type 2 diabetes). INTERVENTION Three clinical pharmacists provided UK Health Plan (UKHP) members with diabetes with comprehensive disease state and medication therapy management. MAIN OUTCOME MEASURES Clinical outcomes included glycosylated hemoglobin (A1C), fasting lipid panels, blood pressure, weight, vaccination rates, and aspirin use. Humanistic outcomes included the mental and physical components of the 12-Item Short-Form Health Survey (SF-12) and patient satisfaction with health services related to their diabetes care. Screening parameters included the proportion of patients meeting Healthcare Effectiveness Data and Information Set expectations for patients with diabetes. Productivity and health resource use were also assessed based on patient responses to survey questions. RESULTS After 1 year of enrollment, patients in the DiabetesCARE program achieved improved clinical outcomes compared with baseline, as evidenced by statistically significant reductions in A1C, low-density lipoprotein cholesterol, triglycerides, and total cholesterol. Statistically significant increases were seen in high-density lipoprotein cholesterol and the proportion of patients obtaining influenza vaccine, yearly screenings for lipid level assessment, screenings for kidney disease, and eye examinations. The mental component score of the SF-12 was significantly increased. Patients were highly satisfied with the DiabetesCARE service, and satisfaction with their overall diabetes care within UKHP was significantly enhanced. Based on the patient provided survey data analyzed here, productivity and health resource use were unchanged; however, additional analyses using UKHP claims data are ongoing. CONCLUSION The DiabetesCARE program is a unique pharmacist-provided service delivered in a freestanding pharmacist clinic that enhances health outcomes for adult members with diabetes in a self-insured employer group.
Uma revisão sobre os conceitos de acesso e utilização de serviços de saúde

The purposes of this article are to review the concepts of health services access and utilization and to analyze how these concepts interrelate. Access is a complex concept (often used inaccurately) which changes over time and according to the context. Health services utilization is at the core of health systems functioning. Despite some disagreement, according to this review the prevailing perspective is that access is related to characteristics of services supply. Health care services utilization can be applied as a measure of access, but use of services depends on other factors. Individual and contextual factors influence the use of services. The article shows that the concept of access is becoming more comprehensive and is changing its focus from entry into the health system to outcome of care. Access is valued in relation to its impact on health and depends on the effectiveness of care delivered. As an outcome measure, access becomes multidimensional and difficult to operationalize. Finally, the article discusses how health determinants differ from those of health services utilization, which impacts directly on illness, but only indirectly on health.
The 'third class' of medications: Sales and purchasing behavior are associated with pharmacist only and pharmacy medicine classifications in Australia.

OBJECTIVE Nonprescription (over-the-counter) medications in Australia are classified as Pharmacist Only Medicines, Pharmacy Medicines, or unscheduled medications. This report characterizes these medication classifications using key sales and purchasing behavior variables. DESIGN Descriptive, nonexperimental, cross-sectional study. SETTING 15 pharmacies in southeast Queensland, Australia, with data recorded over 36 hours per pharmacy in mid-August, 2006. PARTICIPANTS Eligible purchasers (n = 3,470 medication purchases) of all nonprescription medications (including nutritional supplements). INTERVENTION Researchers documented details of all observed nonprescription medication sales and interviewed all available patients following the transaction. MAIN OUTCOME MEASURES Incidence of product-related consultation, products purchased (brand, dosage form, classification), and purchasing behavior data (including previous purchase, intended use, intended user, and intention to purchase a particular brand). RESULTS More restrictive classification of the purchased medication was significantly (P < 0.01) associated with younger purchasers, purchase of a single nonprescription medication, intent to self-use the medication, intent to purchase a particular brand, repeat purchase, brand-switching interventions by pharmacy staff, pharmacy staff influence on first-time purchases, and observed consultation by pharmacists. Legislative compliance issues were identified: Pharmacists consulted in only 54.7% of Pharmacist Only Medicine sales and 13 cases (1.7% of observed sales) occurred in which Pharmacist Only and Pharmacy Medicines had been sourced from publicly accessible areas of the store. CONCLUSION Pharmacist Only Medicines received greater levels of professional involvement during their sale than Pharmacy Medicines and unscheduled medications, despite higher levels of product familiarity among patients. To optimize the benefits of this classification system, emphasis on professional guidelines is recommended.
Perceptions of patients on Medicare Part D medication therapy management services.

OBJECTIVES To determine patients' perceptions and expectations about medication therapy management (MTM) services pertaining to the core elements of an MTM service in the community pharmacy setting, and to develop educational strategies and outreach programs aimed at increasing patients' knowledge of MTM services and the expanded role of pharmacists in the community pharmacy setting. DESIGN Multicenter, cross-sectional, anonymous study. SETTING Four regional community chain pharmacies in Maryland and Delaware in January and February 2006. PATIENTS 81 patients who were 18 years of age or older and able to complete the survey. INTERVENTION Survey containing 14 questions administered within pharmacies, two of which had patient care centers that were providing clinical services. MAIN OUTCOME MEASURE Patients' perceptions and expectations regarding MTM services. RESULTS 49 of 81 patients (60%) had never heard of MTM services. A total of 65 patients (80%) had never had or received a medication therapy review, 63 (78%) never had or received a personal medication record, and 70 (86%) never had or received a medication action plan. Some 56% of participants (n = 45) thought that pharmacist provision of medication therapy reviews, personal medication records, medication action plans, recommendations about medications, and referral to other health care providers was very important. At least 70% of participants (n = 57) thought that having one-on-one consultation sessions with pharmacists to improve communication and relationships with their pharmacists and to improve their medication use and overall health was very important. More than 50% of participants indicated that they would like to receive brochures or talk to their pharmacist to learn more about MTM services. CONCLUSION Patients have very limited knowledge of the core elements of an MTM service in the community pharmacy setting. Patients reported that pharmacist provision of MTM services was important, but they were concerned about privacy and pharmacists' time. Patients are also supportive of and believe that MTM services can improve communication and relationship with their pharmacist and improve medication use. Patients appear to prefer receiving brochures and talking to pharmacists to learn more about MTM services. This survey identified a key opportunity for pharmacists to inform patients about MTM services.
Implementing the Chronic Care Model to Improve Diabetes Care in the Community: Translating Theory to Practice

Diabetes mellitus is a prevalent, costly condition associated with substantial morbidity and mortality. It is an important public health problem as it is equally burdensome to individuals and to society, and disproportionately affects disadvantaged people and nations. Despite the number of possibilities for reducing much of this burden, the incidence of diabetes continues to grow. New approaches to how diabetes care is delivered are needed to improve care at the patient, provider, community, and health systems levels. It was therefore our objective to explore the effectiveness of implementing a multifaceted diabetes care intervention, based on the Chronic Care Model, into an underserved community, with the goal of changing the way diabetes care is delivered to improve outcomes in patients who receive their diabetes care in the primary care setting. A marked decline in HbA1c was observed in the multifaceted intervention group (-0.6%, p=0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (p=0.01). The same pattern was observed for a decline in Non-HDL-c and for the proportion of participants who self-monitor blood glucose (SMBG) in the multifaceted intervention group (Non-HDL-c: -10.4 mg/dl, p=0.24; SMBG: +22.2%, p<0.0001) with statistically significant between group differences in improvement (Non-HDL-c: p=0.05; SMBG: p=0.03) after adjustment. The multifaceted intervention group also showed improvement in diabetes knowledge test scores (+6.7%, p=0.07), and empowerment scores (+2, p=0.02). Secondary analyses revealed that psychosocial and psychological factors accounted for a greater amount of the variation in HbA1c, Non-HDLc, and blood pressure values than clinical factors, and are important in contributing to improvement. The improvements observed in HbA1c, systolic and diastolic blood pressure, and the proportion of participants who self monitor their blood glucose at 12-month follow-up were sustained at 36-month follow-up in all study groups. Additional improvements occurred in Non-HDLc levels in all study groups, and quality of well-being scores in the multifaceted intervention group, but not the other groups. These findings are important as they help to close a gap in the literature on improving the quality of care for people with diabetes through redesigning the process of diabetes care delivery.