Miracle-dz/UniFAR-FTUs huggingface dataset:
Hospitalized patients' understanding of their plan of care.

OBJECTIVE To evaluate hospitalized patients' understanding of their plan of care. PATIENTS AND METHODS Interviews of a cross-sectional sample of hospitalized patients and their physicians were conducted from June 6 through June 26, 2008. Patients were asked whether they knew the name of the physician and nurse responsible for their care and specific questions about 6 aspects of the plan of care for the day (primary diagnosis, planned tests, planned procedures, medication changes, physician services consulted, and the expected length of stay). Physicians were interviewed and asked about the plan of care in the same fashion as for the patients. Two board-certified internists reviewed responses and rated patient-physician agreement on each aspect of the plan of care as none, partial, or complete agreement. RESULTS Of 250 eligible patients, 241 (96%) agreed to be interviewed. A total of 233 (97%) of 241 physicians completed the interview, although sample sizes vary because of missing data elements. Of 239 patients, 77 (32%) correctly named at least 1 of their hospital physicians, and 143 patients (60%) correctly named their nurses. For each aspect of care, patients and physicians lacked agreement on the plan of care in a large number of instances. Specifically, there was no agreement between patients and physicians on planned tests or procedures for the day in 87 (38%) of 231 [corrected] instances and in 22 (10%) of 231 [corrected] instances. Complete agreement on the anticipated length of stay occurred in only 85 (39%) of 218 instances. CONCLUSION A substantial portion of hospitalized patients do not understand their plan of care. Patients' limited understanding of their plan of care may adversely affect their ability to provide informed consent for hospital treatments and to assume their own care after discharge.
Parental Feeding and Childhood Obesity in Preschool-Age Children: Recent Findings from the Literature

Background: Research from recent studies (2005–2010) concerning parent feeding of preschool children and the risk for childhood obesity were included in this review. Methods: An integrative literature review method, as proposed by , was used to analyze data from a broad array of research methods, such as qualitative and experimental, and represent research from multiple disciplines. Rigor was maintained by using clearly defined variables, maintaining an audit trail, and opening the research for review from peers and experts. Eighteen peer reviewed journal articles (3 qualitative and 15 descriptive, cross-sectional studies) were included. Results: Findings from these articles contribute to a better understanding of factors related to feeding and parents from different cultural, educational and economic backgrounds, and their children's risk for obesity. Specifically, findings concerned how parents controlled and modified their children's eating, parental perception of their children's risk for obesity, what influenced parental feeding practices and how mothers' disinhibited eating and restrictive parenting practices related to their children's risk for obesity. Conclusions: These findings may impact the efficacy of childhood obesity prevention and intervention efforts and direct future childhood obesity research.
Relación entre función pulmonar y calidad de vida relacionada con la salud en la miastenia gravis generalizada

Objetivo Estudiar las alteraciones de la funcion pulmonary y de la calidad de vida relacionada con la salud (CVRS), asi como las relaciones entre ambas areas, en un grupo de pacientes diagnosticados de miastenia gravis generalizada. Pacientes y metodos Se ha realizado un estudio prospectivo en 20 pacientes diagnosticados de miastenia gravis generalizada. Se evaluaron la espirometria, los volumenes pulmonares estaticos, el patron respiratorio, las presiones respiratorias maximas y la ventilacion voluntaria maxima. La CVRS se valoro con el cuestionario general de salud SF-36. Resultados La edad media (± desviacion estandar) de los pacientes fue de 64 ± 11 anos. Se clasificaron en IIa (12 pacientes) y IIb (8 pacientes). Se observaron una leve disminucion de la capacidad pulmonar total (86%) y una ligera reduccion de la presion inspiratoria maxima (88%) y de la ventilacion voluntaria maxima (un 63% en el grupo IIb). Los dominios mas afectados de la CVRS fueron los relacionados con la actividad fisica y la percepcion general de la salud en todos los grupos, pero con mayor intensidad en el sexo femenino. Se observaron relaciones estadisticamente significativas entre las areas de vitalidad y actividad fisica, la capacidad vital forzada y los volumenes pulmonares. Tambien se encontraron relaciones entre la presion inspiratoria maxima, la presion espiratoria maxima, la ventilacion voluntaria maxima, la capacidad inspiratoria con volumen circulante y el indice volumen circulante. Conclusiones Se observaron un patron restrictivo muy ligero y reduccion de la fuerza muscular inspiratoria. Los ambitos de la CVRS mas afectados fueron los relacionados con la actividad fisica y la percepcion general de la salud. La afectacion muscular respiratoria contribuye a una alteracion en las variables de la funcion pulmonar y al deterioro de la calidad de vida relacionada con la salud.
General practitioners' perceptions of psychologists: A response to the Medicare changes in Australia

General practitioners (GPs) have historically been at the centre of primary health-care delivery in Australia, including delivery of mental health-care services. Recent changes, however, by the Australian Federal government have led to the creation of a number of mental health-care items provided by psychologists that are now available on the Medicare Benefits Schedule. The aim of the present study was to examine GPs' perceptions of psychologists and the ways in which GPs have responded to these policy changes in making referrals for mental health patients. Nine GPs were interviewed regarding the provision of mental health-care services. Analysis of the interviews indicated a number of themes including the benefits of the new Medicare policy in increasing accessibility of psychologists, GPs' frustrations with the bureaucracy surrounding the use of this policy, GPs' knowledge about the specific skills and training of psychologists, and the importance of GPs' matching patients and clinicians. Recommendations are made to facilitate the professional and clinical relationship between GPs and psychologists.
The Value and Application of the 6‐Minute‐Walk Test in Idiopathic Pulmonary Fibrosis

&NA; The 6‐minute‐walk test is a commonly used assessment of performance ability in a variety of cardiopulmonary diseases. It provides important functional information that is not captured in standardized pulmonary function testing. The test may be influenced by factors other than the severity of lung disease, including frailty, deconditioning, and musculoskeletal issues. The primary output measure from the 6‐minute‐walk test is the distance walked, which appears to confer prognostic information in many diverse disease states. The 6‐minute‐walk test distance has served as a primary endpoint in many drug trials, most notably in the field of pulmonary arterial hypertension, and to a lesser extent in idiopathic pulmonary fibrosis (IPF). Although the 6‐minute‐walk test has been used in clinical practice and research trials of IPF, there are no specific guidelines regarding its implementation in this growing patient population. Given that there is increasing evidence and experience with its use in clinical trials, development of nuanced standards designed specifically for IPF are much needed. This review touches on a number of complex and crucial issues in the application of this test and provides a framework for future development of 6‐minute‐walk test guidelines customized for IPF.
Approaching old problems in new ways: community mobilisation as a primary prevention strategy to combat violence against women

The Uganda-based NGO Raising Voices has been exploring and experimenting with community-based primary prevention methodologies that seek to shift attitudes and behaviours that perpetuate violence against women. This article shares some of the lessons learned from this process in East Africa over the last six years. It begins by setting forth a rationale for engaging in primary prevention efforts at the community level. It argues that comprehensive community mobilisation is essential if we are to see meaningful, sustained change on the issue of violence against women. It also describes the theoretical underpinnings of the approach and illustrates how these come to life in day-to-day programming in communities.
Sleep Disturbance in Smokers with Preserved Pulmonary Function and with Chronic Obstructive Pulmonary Disease

Rationale: Sleep disturbance frequently affects patients with chronic obstructive pulmonary disease (COPD), and is associated with reduced quality of life and poorer outcomes. Data indicate that smokers with preserved pulmonary function have clinical symptoms similar to those meeting spirometric criteria for COPD, but little is known about the driving factors for sleep disturbance in this population of emerging interest. Objectives: To compare the magnitude and correlates of sleep disturbance between smokers with preserved pulmonary function and those with airflow obstruction. Methods: Using cross‐sectional data from the COPD Outcomes‐Based Network for Clinical Effectiveness and Research Translation multicenter registry, we identified participants clinically identified as having COPD with a smoking history of at least 20 pack‐years and either preserved pulmonary function or airflow obstruction. We quantified sleep disturbance by T‐score measured in the sleep disturbance domain of the Patient‐Reported Outcomes Information System questionnaire, and defined a minimum important difference as a T‐score difference of two points. We performed univariate and multivariable linear regression to evaluate correlates within each group. Results: We identified 100 smokers with preserved pulmonary function and 476 with airflow obstruction. The sleep disturbance T‐score was 4.1 points greater among individuals with preserved pulmonary function (95% confidence interval [CI], 2.0‐6.3). In adjusted analyses, depression symptom T‐score was associated with sleep disturbance in both groups (airflow obstruction: &bgr;, 0.61 points; 95% CI, 0.27‐0.94; preserved pulmonary function: &bgr;, 0.25 points; 95% CI, 0.12‐0.38). Of note, lower percent predicted FEV1 was associated with greater sleep disturbance among those with preserved pulmonary function (&bgr;, ‐0.19 points; 95% CI, ‐0.31 to ‐0.07), whereas higher FEV1 was associated with greater sleep disturbance among individuals with airflow obstruction (&bgr;, 0.06 points; 95% CI, 0.01‐0.10). Conclusions: Among smokers with clinically identified COPD, the severity of sleep disturbance is greater among those with preserved pulmonary function compared with those with airflow obstruction. Nonrespiratory symptoms, such as depression, were associated with sleep disturbance in both groups, whereas the relationship of sleep disturbance with FEV1 differed.
Short‐Term Air Pollution and Incident Pneumonia. A Case‐Crossover Study

Rationale: The relationship between air pollution and pneumonia is poorly understood. Objectives: To examine relationships between short‐term air pollution exposure and number and severity of pneumonia cases along the Wasatch Front in Utah, a region with periodic high levels of outdoor air pollution. Methods: We applied time‐stratified case‐crossover analyses with distributed lag to patients presenting to seven emergency departments with pneumonia over a 2‐year period. We compared levels of particulate matter less than or equal to 2.5 &mgr;m in aerodynamic diameter, nitrogen dioxide, and ozone at patient residences with emergency department cases, hospitalizations, objectively defined severe pneumonia, and mortality. We calculated direct cost impacts of particulate matter less than or equal to 2.5 &mgr;m in aerodynamic diameter reduction. Results: We evaluated 4,336 pneumonia cases in seven hospitals. Among adults aged 65 years and older, we found consistently positive associations between particulate matter less than or equal to 2.5 &mgr;m in aerodynamic diameter within 6 days of presentation and instances of pneumonia (Lag Day 1 adjusted odds ratio, 1.35 per 10 &mgr;g/m3 over 12 &mgr;g/m3; 95% confidence interval, 1.16–1.57), severe pneumonia (Lag Day 1 adjusted odds ratio, 1.38; 95% confidence interval, 1.06–1.80), and inpatient mortality (Lag Day 5 adjusted odds ratio, 1.50; 95% confidence interval, 1.03–2.16). Smaller associations were found between nitrogen dioxide exposure and pneumonia occurrence, severity, and inpatient and 30‐day mortality. Ozone exposure was modestly associated with increased instance and severity of pneumonia in younger adults. Particulate matter less than or equal to 2.5 &mgr;m in aerodynamic diameter and nitrogen dioxide effects were greatest in colder months, and ozone effects were greatest in warmer months. Reduction of particulate matter less than or equal to 2.5 &mgr;m in aerodynamic diameter levels to less than 12.0 mg/m3 could prevent 76–112 cases of pneumonia per year in these hospitals serving approximately half of the Wasatch Front's population, reducing direct medical facility costs by $807,000 annually. Conclusions: Among older adults, short‐term ambient particulate matter less than or equal to 2.5 &mgr;m in aerodynamic diameter exposure is associated with more emergency department visits and hospitalizations for pneumonia, severe pneumonia, increased mortality, and increased healthcare costs. Nitrogen dioxide and ozone modestly increase pneumonia risk and illness severity.
Tissue-specific effects of fenthion on glutathione metabolism modulated by NAC and BSO in Oreochromis niloticus

Introduction: The present study was designed to understand the effects of organophosphate (OP) insecticide and avicide fenthion on cellular redox status and the role of reduced glutathione (GSH) on fenthion toxicity in the liver and kidney of Oreochromis niloticus as a model organism. N-acetylcysteine (NAC) and buthionine sulfoximine (BSO) were injected intraperitoneally to fenthion-exposed fish as modulators of GSH metabolism. GSH redox status, GSH-related enzyme activities, and thiobarbituric acid reactive substances (TBARS) contents were then measured spectrophotometrically at 24, 48, and 96 hours. To assess recovery from fenthion exposure, similar analyses were performed on fish transferred to non-treated water for 24, 48, and 96 hours. Results: Fenthion increased glutathione S-transferase (GST; EC 2.5.1.18) activity and caused changes in total GSH (tGSH), GSH and oxidized glutathione (GSSG) contents and glutathione peroxidase (GPx; EC 1.11.1.9) specific activity in the liver tissue over time. Increases observed in tGSH and GSSG contents at 24 hours were decreased by fenthion treatment at 96 hours. BSO caused a sharp decline in liver tGSH, GSH, and GSSG contents and an elevation in GST and γ-glutamyl transpeptidase (γ-GT; EC 2.3.2.2) enzyme activities. A significant decrease was observed in tGSH and GSH contents and, also, GST enzyme activities in the kidney at 48-hour fenthion treatment. On the contrary to the liver, a significant increase was observed in tGSH and GSH contents in the kidney by BSO injection. NAC application eliminated the decreasing effects of fenthion on GST activity in this tissue. NAC injection caused decreases in lipid peroxidation (LPO) levels. Decline in tGSH and GSH contents were maintained in the liver during the recovery period, and elevations in LPO levels in the kidney were observed during the same period. Conclusions: In conclusion, tissue-specific and time-dependent GSH redox status disturbance of fenthion were observed. BSO revealed the significance of GST-mediated GSH conjugation on the detoxification process of fenthion. NAC seemed useful to avoid the fenthion-related oxidative toxicity.
Sudden Infant Death Syndrome: Insulation from Bedding and Clothing and its Effect Modifiers

Background. Thermal stress related to excessive insulation from bedding and clothing has been postulated to be associated with sudden infant death syndrome (SIDS). Methods. The parents of 393 (81%) of the infants who died of SIDS in the post neonatal period were interviewed at home. Interviews were also completed with the parents of 1592 (88.4% of total) controls, a representative sample of all hospital births. The study was conducted in regions of both the North and South Island of New Zealand in which 78% of all New Zealand births occurred in 1987-1990. Temperatures for the infant's bedroom estimated from the outside temperature and a model were used to predict the appropriate insulation for the lower critical temperature (temperature below which the metabolic rate is likely to increase). Results. Sudden infant death syndrome was associated with extra thermal insulation of >2 tog above the lower critical value, the odds ratio (OR) was 1.70 (95% confidence interval [CI] : 1.31-2.20) after adjusting for season. After adjusting for a number of confounding factors the OR was reduced to 1.35 (95% CI : 0.97-1.87). Also associated with SIDS was too little thermal insulation OR = 1.67 (95% CI : 1.13-2.48), and 2.63 (95% CI : 1.61-4.30) when adjustments were made for the confounding factors. The interaction effect between infants sleeping prone and >2 tog extra thermal insulation was significant (OR = 6.07, 95% CI : 3.83-9.60). Infants with too little thermal insulation were at increased risk if they were not tightly wrapped (OR = 3.81, 95% CI : 2.04-7.09). There were also small additive interaction effects if the mother smoked and the infants had >2 tog extra thermal insulation, or if they were ill and had >4 tog extra insulation. Interaction effects between thermal insulation and other factors were not significant. Conclusion. More thermal insulation than was necessary to maintain the lower critical temperature increased the risk of SIDS primarily among infants in the prone sleep position, and to a lesser degree in infants whose mothers smoked and in infants who were unwell.
Effect of oral coadministration of artesunate with ferrous sulfate on rat liver mitochondrial membrane permeability transition

The recent resurgence of interest in the study of mitochondria has been fuelled in large part by the recognition that genetic and/or metabolic alterations in this organelle are causative or contributing factors in a variety of human diseases including cancer. This study hypothesizes that co-administration of artesunate and ferrous sulfate could induce apoptosis which can be targeted on cancerous cells in such a manner, thus providing a novel, viable and perhaps inexpensive way of dealing with the cancer scourge. Artesunate and Ferrous sulfate were co-administered to rats at various doses for seven days. At the end of the treatment, the rats were fasted overnight and sacrificed by cervical dislocation. Low ionic strength mitochondria were isolated from hepatic cells of the rats and assayed for protein content; changes in the absorbance of the liver mitochondria; and mitochondrial swelling. Co-administration of artesunate and ferrous sulfate resulted in a significant increase (P<0.05) in pore opening. The difference in pore opening was found to be statistically significant (P<0.05) when the artesunate and ferrous iron-treated groups were compared with the artesunate only treated group. Results from this study show that co-administration of artesunate and ferrous sulfate can cause an opening in the mitochondrial membrane transition pore. A combined dose of ferrous sulfate and artesunate may prove to be a more potent therapy for targeting cancerous cells.
Cardiovascular Outcomes and All‐Cause Mortality in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease (Overlap Syndrome)

Rationale: The combined impact of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) on cardiovascular outcomes remains controversial. Objectives: We determined whether the combined presence of COPD and severe OSA defined by the apnea‐hypopnea index (AHI) or degree of nocturnal hypoxemia is associated with increased hazards of cardiovascular events and mortality. Methods: Prospectively collected data from adults with suspected OSA who underwent sleep study between 1994 and 2010 were linked to provincial administrative data to determine a presence of COPD and composite outcome. Exposures of interest were: 1) AHI greater than 30, and 2) 10 or more minutes of sleep time spent with oxygen saturation (SaO2) less than 90%. The primary outcome was a composite of hospitalization due to myocardial infarction, stroke, congestive heart failure, cardiac revascularization procedures, or death from any cause. Using Cox regression and controlling for confounders, hazards were compared between four groups: AHI greater than 30 with COPD, AHI greater than 30 without COPD, AHI less than or equal to 30 with COPD, and AHI less than or equal to 30 without COPD (reference). A similar approach was used for the degree of nocturnal hypoxemia. Relative excess risk due to interaction (RERI) was calculated. To adjust for the effect of positive airway pressure treatment, given that information on its acceptance, but not adherence, was available, a separate analysis was conducted only on untreated individuals who never claimed a positive airway pressure device. Results: Among 10,149 participants, 30% had AHI greater than 30, 25% spent at least 10 minutes of sleep with SaO2 less than 90%, and 12% had COPD. Over a median of 9.4 years, 16.4% developed an outcome. In the total sample, a greater hazard of outcome was observed in individuals with COPD who spent at least 10 minutes of sleep with SaO2 less than 90% (hazard ratio, 1.91; 95% confidence interval [CI], 1.60 to 2.28) but not with AHI greater than 30; a synergistic effect was found in women (RERI, 1.18; 95% CI, 0.05 to 2.30), but not men (RERI, −0.08; 95% CI, −0.47 to 0.32). The highest hazard of outcome was associated with the co‐occurrence of AHI greater than 30 and COPD in untreated individuals (hazard ratio, 2.01; 95% CI, 1.55 to 2.62); a synergistic effect was not found. Conclusions: In adults with suspected OSA, the co‐occurrence of nocturnal hypoxemia and COPD was associated with an increased hazard of cardiovascular events and mortality with a synergistic effect found only in women.