Miracle-dz/UniFAR-FTUs huggingface dataset:
The Biopsychosocial model of dementia: its use in clinical practice. A pilot study

Background: Caring for people with dementia can be an emotionally challenging task and it is often linked with low job satisfaction and burnout amongst care staff. Training care home staff is a potentially valuable intervention in improving staff well-being and ensuring they are equipped to provide the best possible care for people with dementia. This review aimed to establish the impact of training on staff and to assess which interventions had the greatest influence. It also aimed to explore the influence of training intensity and potential barriers to its success. Method: A database search of studies evaluating staff training interventions in dementia care was conducted. The search revealed 207 papers, 188 of which were subsequently excluded based on pre-specified criteria. Nineteen studies were included in the review and synthesised using a quality rating tool designed for use with a range of study designs. Results: Overall the studies were found to be of variable quality. Sixteen studies found a significant change following training in at least one staff domain. Three studies did not find training to have a significant impact. Conclusion: The evidence suggests that training staff can be an effective method of improving staff well-being. Programmes helping staff to manage challenging behaviour appear to be the most beneficial, although further research is required. There is no clear relationship between training intensity and outcome. The majority of studies point to the importance of addressing organisational factors as a barrier to change.
Thyroid Status of Fibromyalgia Patients (Abstract)

ABSTRACT In a previous retrospective study, thyroid function tests were used to classify 38 fibromyalgia patients according to thyroid status. Results were consistent with euthyroidism (nonnal thyroid status) in 14 patients (36.8%), primary (thyroidal) hypothyroidism in 4 patients (10.5%), and central (hypothalamic or pituitary) hypothyroidism in 20 patients (52.6%). In this prospective study, an additional 54 patients were tested. Results were consistent with euthyroidism in 26 patients (48.1%), primary hypothyroidism in 8 patients (14.8%), and central hypothyroidism in 20 patients (37.0%). All patients from both studies were combined into a group of 92 to obtain the total percentage in each classification. Results were consistent with euthyroidism in 40 patients (43.5%), primary hypothyroidism in 12 patients (13.0%), and central hypothyroidism in 40 patients (43.5%). There was no statistical difference in either study for the mean intensity of fibromyalgia symptoms (measured by visual analog scales) or .
SEROPREVALENCE OF LEPTOSPIRAL ANTIBODIES AND KNOWLEDGE, ATTITUDE AND PRACTICES OF LEPTOSPIROSIS TO NON HIGH RISK GROUP IN SELANGOR

ABSTRACT Background: Leptospirosis has become an urban public health problem as the rural poor population has moved into the cities. It is not much known about seropositivity among community and factor associated with leptospirosis. This study aims to determine the seroprevalence of leptospiral antibodies and its association between identified risk factors and exposure to rodents as well as to determine knowledge, attitude, and practice (KAP) level among non high risk group in Selangor. Material and methods: A cross sectional study was conducted among 100 healthy individual in Ampang Jaya. Data of personal information of respondents and exposure to rodents were recorded. KAP survey concerning leptospirosis using modified validated questionnaires was carried out. Determinant of seroprevalence was determined through serology test and leptospiral antibodies were detected by MAT. Results: This study found that 27 sera were positive with 9 serogroups were detected. The most prevalent serovar were Sarawak and Terengganu. The most prevalence was in male and age <50 years old. Of the respondents, 2% have good knowledge, 6% have good attitude and 21% have good practice. No significant association between socio-demographic factor, exposure to rodents and knowledge, attitude, practice with seroprevalence were found. Conclusion: The results found that 27% were seropositive and there was also lack on knowledge of leptospirosis among respondents. Keywords: Leptospirosis, leptospires, seroprevalence, KAP, microscopic agglutination test
Design and conduct of the CALERIE study: comprehensive assessment of the long-term effects of reducing intake of energy.

BACKGROUND In a robust and consistent manner, sustained caloric restriction (CR) has been shown to retard the aging process in a variety of animal species. Nonhuman primate studies suggest that CR may have similar effects in longer-lived species. The CALERIE (Comprehensive Assessment of the Long-term Effects of Reducing Intake of Energy) research program is the first systematic investigation of CR in nonobese human beings. In the phase 2 study, it is hypothesized that 2 years of sustained CR, involving a 25% reduction of ad libitum energy intake, results in beneficial effects similar to those observed in animal studies. This article presents the design and implementation of this study. METHODS The study is a multicenter, parallel-group, randomized controlled trial. A sample of 225 participants (22.0 ≤ body mass index [BMI] < 28.0 kg/m(2)) is being enrolled with 2:1 allocation to CR. RESULTS An intensive dietary and behavioral intervention was developed to achieve 25% CR and sustain it over the 2 years. Adherence is monitored using a doubly labeled water technique. Primary outcomes are resting metabolic rate and core temperature, and are assessed at baseline and at 6-month intervals. Secondary outcomes address oxyradical formation, cardiovascular risk markers, insulin sensitivity and secretion, immune function, neuroendocrine function, quality of life and cognitive function. Biologic materials are stored in a central repository. CONCLUSIONS An intricate protocol has been developed to conduct this study. Procedures have been implemented to safeguard the integrity of the data and the conclusions drawn. The results will provide insight into the detrimental changes associated with the human aging process and how CR mitigates these effects.
Learning curve for endoscopic submucosal dissection of esophageal neoplasms.

There is a significant learning curve for endoscopic submucosal dissection of esophageal neoplasms that has not been fully characterized. This retrospective study included 33 consecutive superficial esophageal neoplasms for analysis of the learning curve for esophageal endoscopic submucosal dissection based on a single, novice endoscopist's experience. The study was divided into three periods (T1, T2, and T3) of 10 endoscopic submucosal dissection procedures in chronological order, with 13 procedures in the last period. Patient factors (age, sex, coexistent esophageal varices, or submucosal fibrosis) and tumor factors (location at upper esophagus, involving >3/4 esophageal circumference) for endoscopic submucosal dissection were not statistically different between the periods. The mean procedure time was 74.6 min/cm(2) , 23.4 min/cm(2) , and 10.5 min/cm(2) for T1, T2, and T3, respectively. The procedure time decreased over time (P = 0.02) and post hoc test revealed significant difference was only between T3 and T1 (P = 0.019). The en bloc resection rate was 50%, 100%, and 92.3% for T1, T2, and T3, respectively (P for trend = 0.015). R0 resection rate was 40%, 100%, and 84.6% for T1, T2, and T3, respectively (P for trend = 0.023). Two patients had complications: each one patient in T1 and T3 period experienced major bleeding during the procedure (P for trend = 0.875). None of the patients had esophageal perforation. The results of the study concluded that at least 30 cases of endoscopic submucosal dissection of esophageal neoplasms are needed for a novice endoscopist to gain early proficiency in this technique.
Pediatric Migraine Headache - Still Searching for Effective Treatments.

Migraine headaches are common in children, adolescents, and adults. In children, migraines have a considerable effect on development, often leading to missed school days, educational delays, and decreased socialization.1 In adults, migraine headaches result in a considerable number of days lost from work. Although there have been hundreds of randomized clinical trials evaluating prophylactic treatment of migraine headache in adults, there have been few controlled studies involving children. In adults, tricyclic antidepressants have shown the greatest benefit in reducing the incidence of migraine headache, but the reduction is modest (a relative difference of approximately 30% as compared with placebo), leaving .
Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women.

IMPORTANCE Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up. OBJECTIVE To determine whether rotating night shift work is associated with CHD risk. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 189,158 initially healthy women followed up over 24 years in the Nurses' Health Studies (NHS [1988-2012]: N = 73,623 and NHS2 [1989-2013]: N = 115,535). EXPOSURES Lifetime history of rotating night shift work (≥3 night shifts per month in addition to day and evening shifts) at baseline (updated every 2 to 4 years in the NHS2). MAIN OUTCOMES AND MEASURES Incident CHD; ie, nonfatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass graft surgery, stents, and angioplasty. RESULTS During follow-up, 7303 incident CHD cases occurred in the NHS (mean age at baseline, 54.5 years) and 3519 in the NHS2 (mean age, 34.8 years). In multivariable-adjusted Cox proportional hazards models, increasing years of baseline rotating night shift work was associated with significantly higher CHD risk in both cohorts. In the NHS, the association between duration of shift work and CHD was stronger in the first half of follow-up than in the second half (P=.02 for interaction), suggesting waning risk after cessation of shift work. Longer time since quitting shift work was associated with decreased CHD risk among ever shift workers in the NHS2 (P<.001 for trend). [table: see text] CONCLUSIONS AND RELEVANCE Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk. Further research is needed to explore whether the association is related to specific work hours and individual characteristics.
A randomized trial of effects of health risk appraisal combined with group sessions or home visits on preventive behaviors in older adults.

BACKGROUND To explore effects of a health risk appraisal for older people (HRA-O) program with reinforcement, we conducted a randomized controlled trial in 21 general practices in Hamburg, Germany. METHODS Overall, 2,580 older patients of 14 general practitioners trained in reinforcing recommendations related to HRA-O-identified risk factors were randomized into intervention (n = 878) and control (n = 1,702) groups. Patients (n = 746) of seven additional matched general practitioners who did not receive this training served as a comparison group. Patients allocated to the intervention group, and their general practitioners, received computer-tailored written recommendations, and patients were offered the choice between interdisciplinary group sessions (geriatrician, physiotherapist, social worker, and nutritionist) and home visits (nurse). RESULTS Among the intervention group, 580 (66%) persons made use of personal reinforcement (group sessions: 503 [87%], home visits: 77 [13%]). At 1-year follow-up, persons in the intervention group had higher use of preventive services (eg, influenza vaccinations, adjusted odds ratio 1.7; 95% confidence interval 1.4-2.1) and more favorable health behavior (eg, high fruit/fiber intake, odds ratio 2.0; 95% confidence interval 1.6-2.6), as compared with controls. Comparisons between intervention and comparison group data revealed similar effects, suggesting that physician training alone had no effect. Subgroup analyses indicated favorable effects for HRA-O with personal reinforcement, but not for HRA-O without reinforcement. CONCLUSIONS HRA-O combined with physician training and personal reinforcement had favorable effects on preventive care use and health behavior.
Changing the Discussion about On-Pump versus Off-Pump CABG.

The performance of coronary-artery bypass grafting (CABG) without the use of the heart–lung machine (pump) was introduced to avoid the damaging effects of cardiopulmonary bypass.1 On-pump CABG with cardiopulmonary bypass is generally performed on an arrested heart, and off-pump CABG on a beating heart, without cardiopulmonary bypass. Off-pump CABG became popular in the 1990s, peaking at just under 25% of the CABG operations performed in the United States in 2002; the rate then plateaued and has been slowly declining. Some surgeons remain enthusiasts, whereas others have never attempted it; many use it selectively.2,3 Controversy over the value of off-pump CABG .
Relationship between leptin and indices of obesity among apparently healthy adults in Kano, Northwestern Nigeria -

Background: Leptin secretion has been reported to be highly correlated with body fat. However, measurement of serum leptin levels is cost intensive and requires sophisticated equipment. Objective: To determine the relationship between serum leptin levels and indices of obesity among Nigerians. Materials and Methods: A random sample of 96 apparently healthy adults was studied. Anthropometric parameters and serum leptin levels were measured. Data were analyzed using Minitab statistical software. Results: The male:female ratio of the subjects was 1.28:1; their ages ranged from 30 to 85 years with a mean ± SD of 50.27 ± 1.42 years. The means of weight (% difference 11.6, p = 0.09), height (% difference 6.0, p = 0.001) and waist–hip ratio (% difference 6.4, p = 0.001) were higher in male subjects. The mean ± SD of serum leptin (ng/mL) for the male and female respondents were 4.23 ± 2.22 and 5.3 ± 2.59, respectively. A significant positive correlation between serum leptin levels and body mass index (BMI) was observed (r = 0.48, p = 0.001). Similarly, serum leptin levels were positively correlated with waist circumference (r = 0.39, p = 0.001). In a model of binary logistic regression, BMI was the only variable that emerged as the independent predictor of serum leptin level. Conclusion: This study suggests that BMI can be used to project serum leptin levels. The finding is a clarion call on clinicians and researchers to further test the effectiveness of this relationship.
Practice-related improvements in postural control during rapid arm movement in older adults: a preliminary study.

BACKGROUND Postural control associated with self-paced movement is critical for balance in older adults. The present study aimed to investigate the effects of a virtual reality-based program on the postural control associated with rapid arm movement in this population. METHODS From an upright standing position, participants performed rapid arm-raising movements toward a target. Practice-related changes were assessed by pre- and posttest comparisons of hand kinematics and center of pressure displacement parameters measured in a training group (mean age: 71.50 ± 2.67 years, n = 8) and a control group (mean age: 72.87 ± 3.09 years, n = 8). Training group participants took part in six sessions (35-40 minutes per session, three sessions per week). During the two test sessions, arm raising was analyzed under two conditions of stimuli: choice reaction time and simple reaction time. RESULTS We observed improvements in the arm movement after training under both conditions of stimuli. The initial phase of the center of pressure displacement, especially the anticipatory postural adjustments, was improved in the choice reaction time condition. CONCLUSIONS Our short training program resulted in motor optimization of the postural control associated with rapid arm movements, and this implies central changes in motor programming.
Expectations of clients enrolled in a community and home-based care programme : insights from Zimbabwe

The past two decades have witnessed a transition from in-patient hospital admission and care to community and home based care (C&HBC) due to the surge in chronic health conditions in most of southern Africa, including Zimbabwe. The purpose for this study was to explore whether C&HBC met the expectations of clients enrolled in such a programme. A mixed-method approach, combining qualitative and quantitative data collection and analysis, was used. Data from both approaches, qualitative and quantitative, were collected concurrently. Equal weighting was allocated to both sets of data. Interviews and focus group discussions were used to collect data from home-based care clients, family care givers and health providers. Quantitative data were collected from clients and primary caregivers using questionnaires. Specific data entry templates were developed for the purpose of entry and analysis in NVivo. Data were synthesised and analysed according to themes. Quantitative data were collated and entered into a CSPro data entry template, before being exported to MS excel and to the Statistical Package for Social Sciences (SPSS) version 20.0 for analysis. The quantitative questions were pre-coded before data collection and analysis.
Women’s knowledge and periconceptional use of folic acid: data from three birth centers in Italy.

The Italian strategy to prevent neural tube defects is based on the periconceptional use of folic acid. This strategy implies a good capacity of control by women over their reproductive choices. Three sample surveys of delivering women were conducted in three birth centers in two Italian cities. Overall, 973 women were interviewed through a structured questionnaire. Information on women’s socio-demographic characteristics, knowledge and use of folic acid and on counselling received by health professional in anticipation of and during pregnancy were collected. Logistic regression models were used to explore factors associated with the outcome variables. The prevalence of periconceptional use of folic acid was 37.9%. Before or during pregnancy, about half of the women had received partial information on what folic acid is and its benefits but only half of them received information on the correct period of assumption. Internet is a primary source of information for women who have the ability to search for the information they need, and these are the more educated. Older women, better educated, and Italians were more likely to plan a pregnancy, to know the correct period of folic acid assumption and to take it. Among multiparous women, those who received correct information during the previous pregnancy were more likely to use periconceptional folic acid in the present pregnancy OR=6.83 (95%CI:3.58-13.0). The provision of information on the correct period of assumption of folic acid is associated with better knowledge and with its increasing use. Investing on provision of information instead of the directive approach represented by the compulsory fortification of food, appears an appropriate action. The prevalence of periconceptional use of folic acid is an expression of the level of women’s empowerment which the public health services should always aim to improve.
Multicenter, Randomized, Phase III Study of a Single Dose of IncobotulinumtoxinA, Free from Complexing Proteins, in the Treatment of Glabellar Frown Lines

BACKGROUND Botulinum toxin type A is a proven, effective aesthetic treatment for glabellar frown lines. IncobotulinumtoxinA (NT 201, Xeomin/Xeomeen/Bocouture, Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a 150‐kDa botulinum toxin type A free of complexing proteins. OBJECTIVE To assess the efficacy and safety of incobotulinumtoxinA in a randomized, double‐blind, placebo‐controlled, Phase III study in patients with moderate to severe glabellar frown lines. MATERIALS AND METHODS Two hundred seventy‐six patients were randomized 2:1 to receive a single injection of 20 U of incobotulinumtoxinA or placebo, respectively. Efficacy was assessed at day 30 using a Food and Drug Administration–mandated composite endpoint; a responder was defined as a patient with a 2‐point or greater improvement in glabellar frown lines on a 4‐point scale as assessed by investigator and patient. Safety was assessed periodically through Day 120. RESULTS Treatment with a single dose of incobotulinumtoxinA was significantly superior to placebo in the treatment of glabellar frown lines at Day 30 using the composite endpoint (p < .001), with investigators and patients assessing glabellar frown lines as significantly more improved after incobotulinumtoxinA injection than with placebo (p < .001). IncobotulinumtoxinA was well tolerated. CONCLUSION A single dose of 20 U of incobotulinumtoxinA demonstrated efficacy and safety in the treatment of glabellar frown lines using new Food and Drug Administration efficacy variables.
The self management of heart failure: a place in practice?

BACKGROUND Self management of heart failure has been suggested as a way to prevent hospital admissions. Understanding influences on self management could help to achieve targets for clinical outcomes and patient engagement. The implementation of self management in heart failure appears to be limited compared with other long term conditions. We know little about why this is the case. AIM To identify patients‟ and healthcare professionals‟ knowledge of and attitudes towards self management of chronic heart failure. SETTING AND PARTICIPANTS Twenty-one patients (14 women and 7 men with a mean age of 74) recruited from a general medical practice in an urban area of Leeds, West Yorkshire. Professionals (six doctors, five nurses, five pharmacists and three others) recruited from the local health economy. METHODS Semi-structured interviews were recorded with patients meeting defined inclusion criteria and professionals who cared for them or developed local services. Tapes were transcribed verbatim and thematically coded. Relationships between themes were explored qualitatively using "Framework‟ analysis as a guide. RESULTS Patients‟ activities were restricted in similar ways by symptoms, but only nine had good understanding of their diagnosis. Patients trusted their doctors, but were given few opportunities to learn about their condition and engage with its management. Patients‟ need for explanations, capacity to understand and potential for clinical improvement were probably underestimated. If it was proposed, all patients would monitor and record signs or symptoms to guide variable diuretic dosing. Few patients wished to self adjust doses by protocol, preferring instead to follow direct professional instructions. Few patients felt they could learn from group work with peers: a regular part of self management training. Patients‟ attitudes towards disease management were informed by their interpretation of symptoms, care and daily living. Their greatest priority was continuity of care not having more choice or responsibility. Professionals‟ conceptions of patient self management varied considerably. Specialists tended to support full disclosure and possible self management for a wide variety of patients; whereas generalists were more cautious. CONCLUSIONS Patients who could potentially benefit from self management were not aware of it or given enough opportunities to participate. Patients and professionals should work towards more open discussions about diagnosis, expectations and care.