Miracle-dz/UniFAR-FTUs huggingface dataset:
The use of psychotropic medication for the management of problem behaviours in adults with intellectual disabilities living in Canada

The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis‐reactive than those in the UK.
Self- and physician-rated general health in relation to symptoms and diseases among women

Self-rated general health has been demonstrated as an important predictor of future morbidity and mortality, but the determinants of perceived good or poor general health are less clear. The aim of the present study was to investigate self- and physician-rated general health status in relation to self-reported symptoms and diseases (n = 488) as well as to physician-reported health problems based on medical examinations (n = 369) among 43-year-old women representing the general population of a Swedish community. Although most women had good general health as reflected by their own as well as by the physicians' ratings, the physicians rated about twice as many women (12%) to have poor health compared to the women themselves (6%). The agreement between the womens' self-reported general health and the physicians' ratings was significant but low (22%). Bivariate correlations showed that many of the symptoms and diseases in the present sample were significantly associated with both self- and physician-rated general health, but the explained variance was low, varying from 1 to 12%. The exception was for a self-reported sense of powerlessness that explained 20% of the variance in self-rated general health. When taken together and analysed by multivariate logistic regression, it was found that only self-reported symptoms predicted the self-rated general health of the women, contributing to 24% of the variance (p < 0.001). In contrast, both physician-reports of health problems (11%) and self-reports of symptoms (13%), respectively, significantly predicted the physician-rated general health of the women, together contributing to 24% of the variance (p < 0.001). Self-reported diseases did not predict either the self-rated or the physician-rated general health of the women. The findings from the present study support the notion that general health status, when rated by a physician or by the woman herself, is a complex and multidimensional concept that is only partly predicted by symptoms and conditions. Thus, future studies should focus on additional tentative factors in determining self-rated health, as well as on how evaluations of health are communicated to, and interpreted by physicians.
Survival after whole brain radiotherapy for brain metastases from lung cancer and breast cancer is poor in 6325 Dutch patients treated between 2000 and 2014

Abstract Background: Whole brain radiotherapy (WBRT) is considered standard of care for patients with multiple brain metastases or unfit for radical treatment modalities. Recent studies raised discussion about the expected survival after WBRT. Therefore, we analysed survival after WBRT for brain metastases ‘in daily practice’ in a large nationwide multicentre retrospective cohort. Methods: Between 2000 and 2014, 6325 patients had WBRT (20 Gy in 4 Gy fractions) for brain metastases from non-small cell lung cancer (NSCLC; 4363 patients) or breast cancer (BC; 1962 patients); patients were treated in 15 out of 21 Dutch radiotherapy centres. Survival was calculated by the Kaplan–Meier method from the first day of WBRT until death as recorded in local hospital data registration or the Dutch Municipal Personal Records Database. Findings: The median survival was 2.7 months for NSCLC and 3.7 months for BC patients (p < .001). For NSCLC patients aged <50, 50–60, 60–70 and >70 years, survival was 4.0, 3.0, 2.8 and 2.1 months, respectively (p < .001). For BC patients, survival was 4.5, 3.8, 3.2 and 2.9 months, respectively (p = .047). In multivariable analyses, higher age was related to poorer survival with hazard ratios (HR) for patients aged 50–60, 60–70 and >70 years being 1.05, 1.19 and 1.34, respectively. Primary BC (HR: 0.83) and female sex (HR: 0.85) were related to better survival (p < .001). Interpretation: The survival of patients after WBRT for brain metastases from NSCLC treated in Dutch ‘common radiotherapy practice’ is poor, in breast cancer and younger patients it is disappointingly little better. These results are in line with the results presented in the QUARTZ trial and we advocate a much more restrictive use of WBRT. In patients with a more favourable prognosis the optimal treatment strategy remains to be determined. Prospective randomized trials and individualized prognostic models are needed to identify these patients and to tailor treatment.
Pre-existing diabetes mellitus and all-cause mortality in cancer patients: a register-based study in Latvia

Abstract Background: Most studies from high income countries consistently report that preexisting diabetes reduces overall survival of cancer patients. We examined this association in a retrospective cohort study using two nation-wide population-based data sets in Latvia. Material and methods: The Cancer Register, linked with the Diabetes Register and Causes of Death Database, was the first data source used to select 22,936 men and 25,338 women with cancer diagnosed from 2009 to 2013. The follow-up period ended on 28 February 2015. The National Health Service data served as a second data source, which was used to select 10,130 men and 13,236 women with cancer as the main diagnosis, who were discharged from oncology hospitals from 2009 to 2012. Prescriptions of reimbursed antidiabetic medications indicated prior diabetes status. The follow-up period started at the date of discharge and ended on 31 December 2013. A Cox proportional hazards model was used to assess association between preexisting diabetes and all-cause mortality, adjusted for age. Results: Men with preexisting diabetes had better overall short-term survival: the age-adjusted hazard ratios (95% CI) were 0.86 (0.79–0.93) for the first year and 0.89 (0.80–0.98) for the first two years after cancer diagnosis according to the disease register and health service data, respectively. After three full follow-up years, their relative mortality increased, with an age-adjusted hazard ratio of 1.60 (1.28–1.99). Among women, preexisting diabetes was associated with slightly higher all-cause mortality during the entire follow-up period, with age-adjusted hazard ratios of 1.17 (1.10–1.24) for the disease register data and 1.11 (1.02–1.21) for the health service data. Conclusion: Interestingly, we found better overall survival of diabetic men during the first years after cancer diagnosis. We hypothesize that access to health services may be advantageous to diabetic patients who are in close contact with the healthcare system.
JAVENGA: JAva‐based Visualization Environment for Network and Graph Algorithms

This paper presents JAVENGA, which is an acronym for JAva‐based Visualization Environment for Network and Graph Algorithms. It is a new visualization software for educational purposes. It includes visualizations of many well‐known graph and network algorithms. However, besides simple algorithms the tool also illustrates a visualization of a quite complex one, such as the Network Simplex algorithm. The recommended tool includes a graph editor where directed and undirected graphs can be drawn, it allows users to give input to an algorithm and then see its visualization in a user‐controlled way, and finally it incorporates a solution window where one can see the values of variables at each step of algorithm execution. JAVENGA, as its name states, has been implemented in Java language and it can be run either as an applet or as a Java application. Further, one can execute the program either locally or remotely via the Web. It can be used by instructors as auxiliary teaching material in the context of a graph theory or network optimization course. Besides, instructors can use the tool to grade students' assignments or exams. Students can also use the software in a self‐learning approach. © 2009 Wiley Periodicals, Inc. Comput Appl Eng Educ 20: 255–268, 2012
Skeletal morbidity among survivors of critical illness*

Objectives: To describe the incident fracture rate in survivors of critical illness and to compare fracture risk with population-matched control subjects. Design: Retrospective longitudinal case–cohort study. Setting: A tertiary adult intensive care unit in Australia. Patients: All patients ventilated admitted to intensive care and requiring mechanical ventilation for ≥48 hrs between January 1998 and December 2005. Interventions: None. Measurements and Main Results: New fractures were identified in the study population for the postintensive care unit period (intensive care unit discharge to January 2008). The incident fracture rate and age-adjusted fracture risk of the female intensive care unit population were compared with the general population adult females derived from the Geelong Osteoporosis Study. Over the 8-yr period, a total of 739 patients (258 women, 481 men) were identified. After a median follow-up of 3.7 yrs (interquartile range, 2.0–5.9 yrs) for women and 4.0 yrs (interquartile range, 2.1–6.1 yrs) for men, incident fracture rates (95% confidence interval) per 100 patient years were 3.84 (2.58–5.09) for females 2.41 (1.73–3.09) for males. Compared with an age-matched random population-based sample of women, elderly women were at increased risk for sustaining an osteoporosis-related fracture after critical illness (hazard ratio, 1.65; 95% confidence interval, 1.08–2.52; p = .02). Conclusions: The increase in fracture risk observed in postintensive care unit older females suggests an association between critical illness and subsequent skeletal morbidity. The explanation for this association is not explored in this study and includes the effects of pre-existing patient factors and/or direct effects of critical illness. Prospective research evaluating risk factors, the relationship between critical illness and bone turnover, the extent and duration of bone loss, and the associated morbidity in this population is warranted.
Multiple antimicrobial-resistant Salmonella serotypes isolated from chicken carcass and giblets in Debre Zeit and Addis Ababa, Ethiopia

Background: Antimicrobial-resistant Salmonella and other zoonotic bacterial pathogens can be transferred from animals to humans through consumption of contaminated food and food products and thus present a public health risk. The increase in Salmonella resistance to the commonly used antimicrobials both in the public health and veterinary sectors is one of the major threats of health care worldwide. Objectives: The present study was undertaken to determine the antimicrobial resistance pattern of eighty Salmonella strains isolated from chicken carcass and giblets (liver, gizzard and heart) obtained from processing plants at Debre Zeit and supermarkets in Addis Ababa, Ethiopia. Methods: Eighty Salmonella strains were isolated from a total of 378 chicken carcass and giblet samples. Isolated Salmonella strains were serotyped and tested for resistance to 23 different antimicrobial agents with the agar dilution method at the Health Canada, Office International des Epizooties (OIE) Reference Laboratory for Salmonellosis in Guelph, Ontario, Canada. Results: Fifty-one (63.7%) of the 80 Salmonella strains were resistant to one or more antimicrobials of which 42 (52.5%) displayed multiple-drug resistance. Among the strains, 51.2% were resistant to sulfisoxazole, 46.2% to spectinomycin, 45% to amoxicillin-clavulanic acid and ampicillin, 41.2% to tetracycline and 30% to chloramphenicol. Less than 27.5% of the strains showed resistance to florfenicol, streptomycin, cotrimoxazole and to trimethoprim. S. typhimurium var. Copenhagen (100%), S. anatum (62.5%), S. typhimurium (33.3%) and S. braenderup (34.3%) showed multiple antimicrobial resistance to up to eight antimicrobials. None of the strains were resistant to amikacin, apramycin, gentamicin, kanamycin, neomycin, tobramycin, quinolones, cephalosporins and nitrofurantoin. Conclusion: Results of the present study indicated the potential importance of chickens as source of multiple antimicrobial-resistant Salmonella for human infections and suggest the need for detailed epidemiological and molecular studies in food animals, food products and humans in Ethiopia. [Ethiop.J.Health Dev. 2003;17(2):131-149]
Histopathology of human epilepsy

The histopathology of the hippocampus of patients with temporal lobe epilepsy shows two major processes. One involves reorganization of neural circuits in the dentate gyrus and the other a proliferation of reactive astrocytes that have many unusual properties. These modified astrocytes may play a major role in creating an epileptic focus. For an expanded treatment of this topic see Jasper’s Basic Mechanisms of the Epilepsies, Fourth Edition (Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado‐Escueta AV, eds) published by Oxford University Press (available on the National Library of Medicine Bookshelf [NCBI] at http://www.ncbi.nlm.nih.gov/books).
Implantation of Schwann cells in rat tendon autografts as a model for peripheral nerve repair: Long term effects on functional recovery

Cultured Schwann cells in tendon autografts for nerve repair improve the early phase of nerve regeneration in rat sciatic nerves as judged by the rate of axonal outgrowth. We tested the long-term effects on functional recovery using measurements of muscle force, the number of axons and myelination, using morphometry. In addition, we recorded wet weight of the gastrocnemius muscle. Schwann cell cultures were prepared from predegenerated nerves. Ten and 15mm defects in rat sciatic nerves were bridged using bilateral tendon autografts with Schwann cell-seeded tendon autografts on one side, and untreated tendon autografts on the other. Animals were evaluated at six and 12 weeks, respectively. At six weeks, myelination, as judged by G-ratio (ratio of axonal diameter to diameter of nerve fibres), was significantly increased in tendon autografts pretreated with Schwann cells in 10mm defects. No such difference was seen in the 15 mmdefects. We found no difference in functional recovery, other morphometric variables, or muscle weight between the two grafts. We conclude that early effects on nerve regeneration using transplantation of cultured Schwann cells in rat sciatic nerves are temporary. Other strategies are necessary to obtain lasting effects on functional recovery.
What is the benefit of a high intensive exercise program? A randomized controlled trial

Abstract The aim of the study was to evaluate a high intensive exercise program in stroke subjects with risk of falls regarding balance, activities of daily life, falls efficacy, number of falls and lifestyle activities. The intervention program contained high intensity functional exercises (HIFE) implemented to real-life situations together with education on falls and security aspects. This was a single-center, single-blinded, randomized controlled trial. Consecutive >55-year-old patients with risk of falls were enrolled and randomized 3–6 months after first or recurrent stroke to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussions about hidden dysfunctions after stroke. Outcomes were Berg Balance Scale (BBS) primarily, Barthel Index (BI), Falls Efficacy Scale – International (FES-I) and number of falls secondarily and Frenchay Activities Index last 3 months (FAI-3) tertially. Assessments were done at baseline, post-intervention, 3- and 6-month follow-up by two physiotherapists and one nurse blinded to group allocation. Generalized Estimating Equations with Repeated-measure statistics were used to analyze the data. There were no significant differences between the IG and the CG regarding balance (BBS). BI at 6 months and FES-I post-intervention and 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). Number of falls and FAI-3 were without significant change. This study suggests that our program consisting of HIFE implemented in real-life situations together with educational discussions may improve performance of everyday life activities and improve falls efficacy in stroke subjects with risk of falls.
Applying a social determinants of health perspective to early adolescent cannabis use – An overview

Cannabis is the most widely used illicit drug in the world. Although the risk of problematic cannabis use is relatively low, the lifetime prevalence of dependence is greater than for all other illicit drugs. As such, the population burden of problematic cannabis use warrants attention. Many health and psychosocial risks associated with cannabis use are exacerbated or predicted by initiation of cannabis use in early adolescence and early adolescent users are more vulnerable to negative developmental outcomes, longer cannabis use trajectories, earlier transitions to heavier use and dependence. This suggests a need for effective prevention interventions targeting this age group. Unfortunately, most prevention efforts focus on individual-level risk factors and evidence indicates that they are not particularly effective for deterring use. This overview outlines a more effective approach for preventing cannabis-related harm. Using a social determinants of health perspective, it highlights peer networks and family structure and quality as the main risk factors associated with early adolescent cannabis use. This article suggests that interventions that targeting these determinants can be effective for preventing cannabis use. It concludes by suggesting complementary harm reduction programmes for older adolescents as a means to further reduce cannabis-related harm.
Mental Health Help-Seeking and Young People: A Review

Abstract In the United Kingdom, the issue of health and social care of young people is now a major concern for the government. Thus, a recent government green paper has insisted on the provision of early and appropriate interventions for young peoples' mental health difficulties and that their views must be incorporated into the design of mental health services. More recently, the NHS Health Advisory Service has recommended that schools and teachers should assume some responsibility in the identification of pupils who may have mental health difficulties. Unfortunately, there is scant information in the United Kingdom on young peoples' pathways into services. We know very little about their help-seeking strategies and service use, barriers or facilitators to care, satisfaction with services and service preferences. In addition, we have limited knowledge of how young people conceptualize mental health or how they perceive mental health professionals. In brief, the needs and help-seeking behaviours of young people in psychological distress are poorly understood and often mediated through older people such as parents and teachers. In this paper, we examine these issues and discuss the implications of such gaps in the evidence base for our understanding of adolescent help-seeking and our ability to provide appropriate well-targeted services.
Burden of illness and health care resource utilization in adult psychiatric outpatients with attention-deficit/hyperactivity disorder in Europe

Abstract Objective: To assess the burden of illness and health care resource utilization of adult nonpsychotic psychiatric outpatients with attention-deficit/hyperactivity disorder (ADHD) in Europe. Methods: This was a multicountry, cross-sectional, observational study where unselected routine patients from clinical psychiatric outpatient settings were screened and assessed for ADHD. Patients were evaluated using the Clinical Global Impressions of Severity (CGI-S) scale, the Sheehan Disability Scale (SDS), and the EuroQol-5 Dimensions questionnaire. Data on comorbidities, functional impairment, and health care resource utilization were captured. Results: The study enrolled 2284 patients, of whom 1986 completed the study. The prevalence of ADHD was 17.4%, of whom 46.0% had a previous ADHD diagnosis. Patients with ADHD had a high clinical burden with psychiatric comorbidities, especially depression (43.0%) and anxiety disorders (36.4%). Substance abuse (9.2% vs. 3.4%) and alcohol abuse (10.3% vs. 5.2%) were more common in the ADHD cohort vs. the non-ADHD cohort. Only 11.5% of the patients with ADHD had no other psychiatric disorder. Various measures indicated a significantly poorer level of functioning for patients with ADHD than without ADHD, as indicated by higher scores for CGI-S (3.8 vs. 3.3) and SDS (18.9 vs. 11.6) and higher percentages of debt (35.5% vs. 24.3%) and criminality (13.8% vs. 6.1%). Lastly, the health care resource utilization was considerable and similar between adult psychiatric outpatients diagnosed and not diagnosed with ADHD. Conclusions: Although care was taken when choosing the sites for this study, to make it representative of the general outpatient adult psychiatric population, caution should be advised in generalizing the findings of our study to the general ADHD or psychiatric outpatient population. This was an observational study, thus no inference on causality can be drawn. Having ADHD imposes a considerable health and social burden on patient and health care resource utilization comparable to other chronic psychiatric disorders.