Miracle-dz/UniFAR-FTUs huggingface dataset:
Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial.

IMPORTANCE Prevention of atherosclerotic cardiovascular diseases is an important public health priority in Japan due to an aging population. OBJECTIVE To determine whether daily, low-dose aspirin reduces the incidence of cardiovascular events in older Japanese patients with multiple atherosclerotic risk factors. DESIGN, SETTING, AND PARTICIPANTS The Japanese Primary Prevention Project (JPPP) was a multicenter, open-label, randomized, parallel-group trial. Patients (N = 14,464) were aged 60 to 85 years, presenting with hypertension, dyslipidemia, or diabetes mellitus recruited by primary care physicians at 1007 clinics in Japan between March 2005 and June 2007, and were followed up for up to 6.5 years, with last follow-up in May 2012. A multidisciplinary expert panel (blinded to treatment assignments) adjudicated study outcomes. INTERVENTIONS Patients were randomized 1:1 to enteric-coated aspirin 100 mg/d or no aspirin in addition to ongoing medications. MAIN OUTCOMES AND MEASURES Composite primary outcome was death from cardiovascular causes (myocardial infarction, stroke, and other cardiovascular causes), nonfatal stroke (ischemic or hemorrhagic, including undefined cerebrovascular events), and nonfatal myocardial infarction. Secondary outcomes included individual end points. RESULTS The study was terminated early by the data monitoring committee after a median follow-up of 5.02 years (interquartile range, 4.55-5.33) based on likely futility. In both the aspirin and no aspirin groups, 56 fatal events occurred. Patients with an occurrence of nonfatal stroke totaled 114 in the aspirin group and 108 in the no aspirin group; of nonfatal myocardial infarction, 20 in the aspirin group and 38 in the no aspirin group; of undefined cerebrovascular events, 3 in the aspirin group and 5 in the no aspirin group. The 5-year cumulative primary outcome event rate was not significantly different between the groups (2.77% [95% CI, 2.40%-3.20%] for aspirin vs 2.96% [95% CI, 2.58%-3.40%] for no aspirin; hazard ratio [HR], 0.94 [95% CI, 0.77-1.15]; P = .54). Aspirin significantly reduced incidence of nonfatal myocardial infarction (0.30 [95% CI, 0.19-0.47] for aspirin vs 0.58 [95% CI, 0.42-0.81] for no aspirin; HR, 0.53 [95% CI, 0.31-0.91]; P = .02) and transient ischemic attack (0.26 [95% CI, 0.16-0.42] for aspirin vs 0.49 [95% CI, 0.35-0.69] for no aspirin; HR, 0.57 [95% CI, 0.32-0.99]; P = .04), and significantly increased the risk of extracranial hemorrhage requiring transfusion or hospitalization (0.86 [95% CI, 0.67-1.11] for aspirin vs 0.51 [95% CI, 0.37-0.72] for no aspirin; HR, 1.85 [95% CI, 1.22-2.81]; P = .004). CONCLUSIONS AND RELEVANCE Once-daily, low-dose aspirin did not significantly reduce the risk of the composite outcome of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction among Japanese patients 60 years or older with atherosclerotic risk factors. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00225849.
Risk of dementia: The Rotterdam Study

textabstractDementia is a frequent disorder in the elderly. It is also a distressing condition both for the patient and caregiver. Dementia puts a high claim on health care costs. In the Netherlands about one tenth of the yearly health budget is spent on nursing homes. Dementia is the. main diagnosis in 40% of nursing home patients and coexisting dementia may be the underlying. motive for admittance to a nursing home in patients with other diseases. 1•2 The need for dementia care will probably grow since the elderly population is increasing both in percentage and in absolute number. J,4 Reliable estimates of the frequency of dementia are important. Prevalence figures are used by health planners to determine the demand for disease-specific services. The incidence rate is morc informative when etiologic questions are addressed. For assessment of prevalence and incidence of dementia one cannot rely on medical registers; the disease is rarely reported on death celiificates and usually mild cases are not recognised. Therefore we studied the prevalence (chapter 2.1) and incidence (chapter 2.2) of dementia in a population-based study by active screening of participants. This study formed p31i of the Rotterdam Study, a prospective cohort study on medical disorders in the elderly.s Previous epidemiologic studies suggested that not all social layers are equally affected by dementia.6 Especially lower educated people might be more susceptible. Therefore, we examined the association between education and prevalent dementia (chapter 2.1) and also assessed if lower educated were at higher risk of incident dementia (chapter 2.3). The lack of knowledge on Causes of dementia, especially Alzheimer's disease, motivated the second pm of this thesis.7 We mainly studied associations with other COlfunon disorders of old age that have vascular implications.
Frequent premature atrial complexes... truly a benign finding? Author reply.

We thank Dr Sergio Barra for his comments1 on our recent observation of the association between frequent premature atrial complexes (PACs) and new-onset atrial fibrillation (AF) and ischaemic stroke in symptomatic patients published in the Journal.2 We generally agree with Dr Barra's comment that rapid runs of PACs at least mechanistically would be a better surrogate marker for AF than absolute number of PACs. While conceptually attractive, the use of rapid runs of PACs as a marker for AF could present clinical difficulty because of its heterogeneity and complexity. Specifically, the quantification of runs of PACs include parameters that include number of runs …
Moral concerns and the willingness to donate to a research biobank.

Research biobanks are increasing in number and importance, with great potential for advancing knowledge of human health, disease, and treatment. Recruitment of donors is vital to their success and relies largely on blanket consent, in which donors give one-time permission for any future research uses of their coded specimen. This approach to consent has been endorsed recently in proposed changes to federal regulations. Previous studies suggest that donors may have moral, religious, and cultural concerns about the use to which their specimens are put, which may affect their willingness to give blanket consent.These earlier studies, however, used convenience samples unrepresentative of the US population.
EPIDEMIOLOGY OF CONGENITAL GASTROINTESTINAL ANOMALIES IN LIVE NEWBORNS IN TUZLA CANTON

Objective â€“ The aim of this study was to evaluate the epidemiologic characteristics of gastrointestinal anomaly (GIA) in newborns in the Tuzla Canton. Â Patients and methods â€“ We analyzed retrospectively the medical records of live newborns with GIA born at the Clinic of Gynecology and Obstetrics in Tuzla in the period from 1.1. 1998 to 31.12. 2007. A questionnaire was used to gather data on the mothersâ€™ age, gestational age, birth weight and presence of an anomaly. According to gestational age the patients were divided into two groups. The first group consisted of newborns born before the 37th week of gestation and the second group consisted of newborns with gestational age between 37-42 weeks. According to birth weight the patients were divided into 3 groups: eutrophic, hypertrophic and hypotrophic, and in relation to mothersâ€™ age they were grouped into 3 groups: from 16 to 20, from 21 to 35 and from 36 to 40 years. Â Results â€“ During period in question 69 live newborns were registered with GIA. The lowest prevalence was 6.6/104 in 2001 and the highest prevalence was 31.2/104 in 2004. The most frequent GIA was congenital diaphragmatic hernia with a prevalence of 4.2/104, and the rarest was omphalocele with a prevalence of 0.2/104. There was no significant difference between male and female newborns with GIA. Of the total number of newborns with GIA, 58 or 84.1% were eutrophic, 32 or 46.4% were pretermâ€™s with average gestational age of 34,8Â±1,3 weeks and of the total number of preterm newborns, 29 or 90.6% were eutrophic. Associated anomalies were most frequent with duodenal atresia (75.0%) and rarest in newborns with congenital diaphragmatic hernia (5.3%). Â Conclusion â€“ The overall prevalence of GIA during the period in question was 15.3/104. Newborns with GIA were equally distributed according to sex and most of them were born from mothers in the age group from 21 to 35 years. GIA in newborns in nearly half of cases were in preterm babies, but a high percentage were eutrophic. In our study we noted a low association of GIA with other system anomalies.
Identifying and Assessing Substance Use: Findings from a National Survey of Social Work and Social Care Professionals

Social care practitioners regularly encounter problematic substance use among their service users. However, most social care practitioners do not specialise in substance use and there is limited evidence on their practice with it. This study aimed to explore the practice of social care professionals when they encounter substance use in the course of their work. This article focuses specifically on how they identify and assess substance use. A web-based survey was disseminated to 3,164 practitioners in adults' (AS) and children's (CS) social care in eleven different local authorities in England. Twelve focus groups were also held. AS and CS practitioners identified substance problems by their impact on their service user's ability to fulfil their responsibilities or perform daily functions. Differences in relation to assessment were found between AS and CS practitioners. CS practitioners asked questions more frequently and were more likely to state that asking about substance use was a legitimate task. Very few practitioners had practice guidance or tools to help them assess substance use. Substance use is being identified and assessed in social care but often at a late stage with little to no guidance on how to do so effectively.
Another disappointing result with implantable cardioverter-defibrillator therapy in patients with Chagas disease.

We disagree with Barbosa et al . 's1 conclusion from their study, published in February 2013, that implantable cardioverter-defibrillator (ICD) is ‘the standard therapy for secondary prevention in patients with Chagas disease (ChD) and the need for a randomized clinical trial (RCT) is doubtful and, maybe, unethical. ’ Their conclusion was based on the largest study of the efficacy and safety of ICD therapy for secondary prevention in ChD vs. non-ChD patients. After a median follow-up of 8.7 months, all-cause mortality (the only indisputable and unbiased endpoint in ICD recipients) was similar in the two groups: 12.3% in 65 ChD patients versus 11.4% in 70 non-ChD patients ( P = 0.82). But …
Establishment of sustainable patient health education in clinical care: An action research study

Background: Despite the great body of knowledge on the effects of patient education, it has not been institutionalized in hospital settings. A collective effort was implemented to establish sustainable patient education in the clinical care of neurosurgical patients in a university hospital in Arak through an action research in 2011-2012. This article shares a part of experiences and knowledge obtained from the second cycle of the action research including action and reflection phases. Method s : The study was conducted using cooperative inquiry as a form of action research study. A head nurse, ten staff nurses and a nursing faculty member participated in changing patient/family education practice in the ward. In action phase, oral and written education was presented to patients during the hospitalization, and while discharging from the unit. In reflection phase, the activities were critically reflected using focus group discussions. Qualitative content analysis was recruited to analyze the data. Results: The results showed that moving towards sustainable patient education has started in the ward. Learning in action, the head nurse leadership, receiving reinforcing feedbacks, and improving nurse-patient relationship indicated the success of the change process. However, lack of support on the part of nursing administrators, constraints in practice environment, and the need to become expert in teaching were encountered as challenges ahead. Conclusion: The collective participation of the nurses made moving towards sustainable patient education possible. The continuity of the educational practice needs overcoming challenges related to insufficient support on behalf of the nursing administrators as well as environmental constraints.
Scar extent as a predictive factor of ventricular tachycardia cycle length after myocardial infarction: implications for implantable cardioverter-defibrillator programming optimization.

AIMS After an old myocardial infarction (MI), patients are at risk for reentrant ventricular tachycardia (VT) due to scar tissue that can be accurately identified by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Although the ability of LGE-CMR to predict sustained VT in implantable cardioverter-defibrillator (ICD) recipients has been well established, its use to predict monomorphic VT (sustained or not) cycle length (CL) and so, optimize ICD programming has never been investigated. METHODS AND RESULTS We included retrospectively 49 consecutive patients with an old MI who had undergone LGE-CMR before ICD implantation over a 4-year period (2006-09). Patients with amiodarone used were excluded. Scar extent was assessed by measuring scar mass, percent scar, and transmural scar extent. The endpoint was the occurrence of monomorphic VT, requiring an ICD therapy or not. The endpoint occurred in 26 patients. The median follow-up duration was 31 months. Scar extent parameters were significantly correlated with the study endpoint. With univariate regression analysis, the scar mass had the highest correlation with the VT CL (R = 0.671, P = 0.0002). Receiver-operating characteristic curve showed that scar mass can predict VT CL (area under the curve = 0.977, P < 0.0001). For a cut-off value of scar mass at 17.6 g, there is 100% specificity and 94.4% sensitivity. CONCLUSION In this observational and retrospective study, scar mass studied by LGE-CMR was specific and sensitive to predict VT CL and so could be a promising option to improve ICD post-implantation programming and decrease appropriate and inappropriate shocks. These conclusions must now be confirmed in a large and prospective study.
Swedish moist snuff and the risk of cardiovascular diseases

The snuff consumption in Sweden has increased substantially during recent decades and today more than every fifth male adult uses snuff daily. However, the evidence on health effects from long-term use of snuff is limited, especially regarding cardiovascular diseases. The overall objective of this thesis was to study the association between snuff use and cardiovascular diseases. Two epidemiological materials were used and both were restricted to men only. One material included a population based case-control study with 1 437 cases of myocardial infarction and 1 810 matched controls, aged 45-70 years and living in Stockholm or Vasternorrland county between 1992 and 1994. The second material was a large nationwide cohort based on construction workers who attended at least one health check-up between 1978 and 1993. We found that snuff use was highly correlated with smoking and some cardiovascular risk factors. Furthermore, snuff users were generally younger than the non snuff users and there were geographical differences with a higher prevalence of snuff use in northern Sweden. To avoid confounding from smoking the main analyses were restricted to never smokers. We found no evidence that the snuff use increased the overall risk of myocardial infarction. In the large prospective cohort, consisting of more than 100 000 non-smoking construction workers, we observed an increased risk of fatal myocardial infarction among current snuff users compared to never users, the risk being even higher among heavy users, with relative risk estimates of 1.32 (95% CI, 1.08-1.68) and 1.96 (95% CI, 1.08-3.58), respectively. Furthermore, no increased overall risk of stroke was observed among the snuff users. However, the relative risk for fatal cases was 1.38 (95% CI 0.99-1.91) among current snuff users and for fatal ischemic stroke the relative risk was 1.72 (95% CI 1.06-2.78). For those who suffered non-fatal myocardial infarction or non-fatal ischemic stroke we found an increased mortality both overall and in cardiovascular diseases among snuff users compared to never tobacco users. We also found associations between snuff use and high blood pressure as well as hypertension. The prevalence of high blood pressure was significantly higher among snuff users than non-users at the time of first blood pressure measurement. During follow-up, snuff users who were normotensive at the first blood pressure measurement, had an increased risk of developing hypertension or high blood pressure at a subsequent measurement with relative risks of 1.36 (95% CI, 1.07-1.72) and 1.39 (95% CI 1.08-1.79), respectively. In conclusion, snuff use does not seem to increase the risk of myocardial infarction or stroke. However, an increased risk of fatal diseases was observed among snuff users, both for myocardial infarction and stroke, suggesting that snuff use could influence the severity of these outcomes. Snuff use was also associated with an increased risk for high blood pressure and hypertension.
A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry.

AIMS Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. METHODS AND RESULTS We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (∼20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. CONCLUSION The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal.
Four-year follow-up of children born to women in a randomized trial of prenatal DHA supplementation.

Four-Year Follow-up of Children Born to Women in a Randomized Trial of Prenatal DHA Supplementation Despite the paucity of evidence, recommendations exist internationally for pregnant women to increase their docosahexaenoic acid (DHA) intake to optimize fetal brain development. Our randomized controlled trial (RCT), in which pregnant women were allocated to 800 mg/d of DHA or matched placebo, showed that children’s mean cognitive, language, and motor scores did not differ between groups at 18 months, although fewer children in the DHA group had delayed development compared with controls.1 Surprisingly, girls in the DHA group had poorer language scores than girls in the control group.1 Herein we report neurodevelopmental outcomes at 4 years, which is when any subtle to moderate effects on development should have emerged and can be more reliably assessed.
Does change in device detected frequency of non-sustained or diverted episodes serve as a marker for inappropriate shock therapy? Analyses from the INTRINSIC RV and ALTITUDE-REDUCES Trials.

AIMS Implantable cardioverter-defibrillators (ICDs) treat ventricular tachycardia or fibrillation but may also deliver unnecessary shocks. We sought to determine if the frequency of ICD-detected non-sustained or diverted (NSD) episodes increases before appropriate or inappropriate ICD shocks. METHODS AND RESULTS We evaluated NSD episodes in the INTRINSIC RV Trial and their relationship to ICD shocks (appropriate and inappropriate). Time from NSD to shock was analysed. Results were validated by utilizing 1495 adjudicated ICD and cardiac resynchronization therapy-defibrillator shocks following NSD episodes collected through the LATITUDE remote monitoring system as part of the ALTITUDE-REDUCES Study. In INTRINSIC RV, 185 participants received 373 shocks; 148 had at least 1 NSD episode. Non-sustained or diverted frequency increased 24 h before the first shock for those receiving an inappropriate (P < 0.01) but not an appropriate shock (P = 0.17). Patients with NSD episodes within 24 h of a shock were significantly more likely to receive inappropriate therapy [odds ratio (OR) = 3.12, P < 0.01]. At the receiver operator curve determined optimal cutoff, an NSD episode within 14 min before shock strongly predicted inappropriate therapy (sensitivity 48%, specificity 91%; OR = 8.8, and P < 0.001). The 14 min cut-off evaluated on an independent dataset of 1495 shock episodes preceded by an NSD in the ALTITUDE-REDUCES Study confirmed these results (sensitivity = 47%, specificity = 85%, OR = 5.0, and P < 0.001). CONCLUSION Device-detected NSD episodes increase before inappropriate but not appropriate shocks. Novel alerts or automated algorithms based on NSD episodes may reduce inappropriate shocks.
Principles and Practice of Pediatric Oncology

This authoritative reference is the single most comprehensive resource on the biology and genetics of childhood cancer as well as its diagnosis, multimodal treatment, as well as long-term management of young patients with cancer. Also addressed are a broad array of topics on the supportive and psychosocial aspects of care of children and families. Covering virtually every aspect of the breadth and depth of childhood cancer, this 7th edition provides expert guidance on state-of-the-art, multidisciplinary care for children and families.