Miracle-dz/UniFAR-FTUs huggingface dataset:
Pregnant Women’s Health Literacy in the South of Iran

Objective: Investigate the health literacy of pregnant women in the south of Iran. Materials and methods: The present descriptive-analytical study was conducted on 775 pregnant women in the south of Iran (including Boushehr, Ahvaz, Zahedan and Bandar Abbas cities) through the clustering sample selection method. The data were collected through the Test of Functional Health Literacy in Adults: TOFHLA, and were analyzed statistically via SPSS 16 through independent-sample t-test and ANOVA. Results: The average age of the subjects was 31.89 ± 7.54 years. The results indicated that 15.5% of the subjects had an inadequate level of health literacy; 41.7% had a border-line level of health literacy, and 42.8% had an adequate level of literacy. Significant correlations were found between each of these variables and the subjects’ level of health literacy: education, age, occupation and care provision during pregnancy (p ˂ 0.05). The highest mean score of health literacy belonged to Ahvaz while the lowest belonged to Boushehr. Conclusion: According to the results, the health literacy level of pregnant women in the target geographical areas showed to be inadequate or on a border-line. Moreover, subjects’ education, age and occupation showed to be significantly correlated with health literacy. Therefore, promoting pregnant women’s health literacy through simplifying health-related information, use of audio-visual media, improving communicative skills among the health staff and mothers can be effective.
Shared Decision-Making Tool for Self-Management of Home Therapies for Patients With Cystic Fibrosis

Objective: Patients with cystic fibrosis (CF) undertake time-consuming programs of home therapies. Our objective was to develop a tool to help CF patients prioritize personal goals for some of these treatments. We describe the development and results of initial evaluation of this shared decision-making tool. Methods: Multicriteria decision-making method to develop a shared decision-making tool that integrates patient’s values and perceptions of treatment impact on functionality/sense of well-being. Treatment efficacy data obtained through comprehensive review of English language literature and Cochrane reviews. Field study of 21 patients was performed to assess acceptability of the approach, understandability of the tool, and to determine whether there was sufficient patient-to-patient variability in treatment goals and patient preferences to make use of a personalized tool worthwhile. Results: Patients found the tool easy to understand and felt engaged as active participants in their care. The tool was responsive to variations in patient preferences. Priority scores were calculated (0–1.0 ± SD). Patients’ most important treatment goals for improving lung health included improving breathing function (0.27 ± 0.11), improving functionality/sense of well-being (0.24 ± 0.13), preventing lung infection (0.21 ± 0.08), minimizing time to complete treatments (0.16 ± 0.12), and minimizing cost (0.11 ± 0.09). Conclusions: A shared decision-making tool that integrates patients’ values and best evidence is feasible and could result in improved patient engagement in their own care.
Implementation of the Smart Use of Antibiotics Program to Reduce Unnecessary Antibiotic Use in a Neonatal ICU: A Prospective Interrupted Time-Series Study in a Developing Country

Objectives: We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance. Design: We compared the time periods before (baseline) and after (intervention) the implementation of an antibiotic protocol by performing surveillance and assessments of all antibiotic use during a 29-month interrupted period. Setting: Level 3–4 neonatal ICU in one referral center. Patients: All 13,540 infants who received antibiotics during their hospital stay from 2015 to 2017. Interventions: Prospective audit of targeted antibiotic stewardship program. Measurements and Main Results: The primary outcome was the change in total antibiotic days of therapy per 1,000 patient-days between the baseline and intervention periods. The secondary outcomes included readmissions for infection, late-onset sepsis (length of stay), necrotizing enterocolitis, or death in infants at 32 weeks of gestation or younger and the prevalence of multidrug-resistant organism colonization. No differences in safety outcomes were observed between the intervention and baseline periods. Following the implementation of our Smart Use of Antibiotics Program, the total quantity of antibiotics in the intervention phase was significantly decreased from 543 days of therapy per 1,000 patient-days to 380 days of therapy/1,000 patient-days compared with that of baseline (p = 0.0001), which occurred in parallel with a reduction in length of stay from 11.4% during the baseline period to 6.5% during the intervention period (p = 0.01). A reduced multidrug-resistant organism rate was also observed following Smart Use of Antibiotics Program implementation (1.4% vs 1.0%; p = 0.02). The overall readmission rate did not differ between the two periods (1.2% vs 1.1%; p = 0.16). Conclusions: Smart Use of Antibiotics Program implementation was effective in reducing antibiotic exposure without affecting quality of care. Antibiotic stewardship programs are attainable through tailoring to special stewardship targets even in a developing country.
Increased derived neutrophil-to-lymphocyte ratio and Breast Imaging-Reporting and Data System classification predict poor survival in patients with non-distant metastatic HER2+ breast cancer treated with neoadjuvant chemotherapy

Introduction The prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR) in human patients with HER2+ breast cancer is not well understood. Here, we aimed to investigate the prognostic significance of dNLR in patients with HER2+ breast cancer undergoing neoadjuvant chemotherapy. Methods A total of 310 patients with non-distant metastatic HER2+ breast cancer who had received neoadjuvant chemotherapy in our hospital from May 2006 to November 2013 were retrospectively included in this study. Kaplan–Meier curves were used to assess overall survival (OS) and disease-free survival (DFS). The Cox regression model was used to evaluate the prognostic value of dNLR and Breast Imaging-Reporting and Data System (BI-RADS) classification, as well as other clinicopathological parameters in patients with HER2+ breast cancer treated with neoadjuvant chemotherapy. Results We found that dNLR prior to treatment was positively correlated with tumor size, tumor stage, lymphovascular invasion, and histological grade (P<0.05). The median OS of patients with high dNLR and low dNLR were 44.2 and 69.9, respectively (P<0.001), and the median DFS of patients with high dNLR and low dNLR were 15.3 and 22.1 months, respectively (P<0.001). Multivariate analysis showed that dNLR was an independent risk factor for OS (HR =1.726; 95% CI: 1.072–2.662; P=0.009) and DFS (HR =1.658; 95% CI: 1.125–2.426; P=0.026). Moreover, increased BI-RADS classification independently predicted short OS (HR =1.609; 95% CI: 1.216–2.351; P=0.015) and DFS (HR =1.925; 95% CI: 1.526–2.635; P=0.021). Conclusion dNLR prior to treatment and BI-RADS classification are independent prognostic factors in patients with HER2+ breast cancer receiving neoadjuvant chemotherapy.
What Can Be Done to Improve Research Biopsy Quality in Oncology Clinical Trials?

PURPOSE: Research biopsy specimens collected in clinical trials often present requirements beyond those of tumor biopsy specimens collected for diagnostic purposes. Research biopsies underpin hypothesis-driven drug development, pharmacodynamic assessment of molecularly targeted anticancer agents, and, increasingly, genomic assessment for precision medicine; insufficient biopsy specimen quality or quantity therefore compromises the scientific value of a study and the resources devoted to it, as well as each patient's contribution to and potential benefit from a clinical trial. METHODS: To improve research biopsy specimen quality, we consulted with other translational oncology teams and reviewed current best practices. RESULTS: Among the recommendations were improving communication between oncologists and interventional radiologists, providing feedback on specimen sufficiency, increasing academic recognition and financial support for the time investment required by radiologists to collect and preserve research biopsy specimens, and improving real-time assessment of tissue quality. CONCLUSION: Implementing these recommendations at the National Cancer Institute's Developmental Therapeutics Clinic has demonstrably improved the quality of biopsy specimens collected; more widespread dissemination of these recommendations beyond large clinical cancer centers is possible and will be of value to the community in improving clinical research and, ultimately, patient care.
Emerging clinical significance of claudin-7 in colorectal cancer: a review

Tight junctions (TJs) play an important role in maintaining cell polarity and regulating cell permeability. In recent years, many studies have shown that TJ proteins, especially claudin-7, are closely related to inflammation and the development of various malignant tumors. Claudin-7 plays a significant role in maintaining the physiological functions and pathological conditions of the TJ barrier. The dysregulation of claudin-7 plays a tumor suppressor role or conversely has carcinogenic effects in different target tissues or cells, but the exact underlying mechanism is still unclear. In this review, we will summarize the expression pattern of claudin-7 in tumors, focusing on the expression and regulation of claudin-7 in colorectal cancer and discussing the correlation between claudin-7 and invasion, metastasis and epithelial–mesenchymal transition (EMT) in colorectal cancer. The construction of Cldn7−/− mice and conventional claudin-7 knockout mouse models has helped determine the mechanisms by which claudin-7 promotes tumorigenesis. Elucidation of the expression and subcellular localization of claudin-7 under pathological conditions will help develop claudin-7 as a useful biomarker for detecting and diagnosing cancer, and thus may help combat the occurrence, development, and invasion of cancers.
Patterns of Telehealth Use Among Rural Medicaid Beneficiaries.

PURPOSE Few studies have examined telehealth use among rural Medicaid beneficiaries. This study produced a descriptive overview of telehealth use in 2011, including the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use. METHODS Using data from the 2011 Medicaid Analytic eXtract (MAX), we conducted bivariate analyses to test the associations between rurality and prevalence and patterns of telehealth use among Medicaid beneficiaries. FINDINGS Rural Medicaid beneficiaries were more likely to use telehealth services than their urban counterparts, but absolute rates of telehealth use were low-0.26% of rural nondual Medicaid beneficiaries used telehealth in 2011. Psychotropic medication management was the most prevalent use of telehealth for both rural and urban Medicaid beneficiaries, but the proportion of users who accessed nonbehavioral health services through telehealth was significantly greater as rurality increased. Regardless of telehealth users' residence, mood disorders were the most common reason for obtaining telehealth services. As rurality increased, significantly higher proportions of telehealth users received services to address attention-deficit/hyperactivity disorder (ADHD) and other behavioral health problems usually diagnosed in childhood. CONCLUSIONS These findings provide a baseline for further policy-relevant investigations including examinations of changes in telehealth use rates in Medicaid since 2011. Reimbursement policies and unique rural service needs may account for the observed differences in rural-urban Medicaid telehealth use rates.
Risk of hip fracture in patients on dialysis or kidney transplant: a meta-analysis of 14 cohort studies

Purpose We aimed to conduct a meta-analysis of published cohort studies to evaluate the risk of hip fracture in patients undergoing dialysis or kidney transplantation (KT). Methods We identified relevant studies by searching PubMed, EMBASE and Google Scholar databases from their inception to December 31, 2017. Cohort studies evaluating risk of hip fractures in patients undergoing dialysis or KT were considered included. The methodological quality of the cohort studies was assessed using the modified Newcastle-Ottawa scale. Results In our meta-analysis of 14 retrospective cohort studies, a total of more than 1.5 million patients undergoing dialysis or KT were included, of whom more than 30,000 had hip fractures. After the merger, the proportion of hip fractures was 1.92% (95% CI, 1.38%−2.46%) with significant heterogeneity (I2=99.9%, P=0.000) in all patients, and the incidence rate of hip fractures (per 1,000 person-years) was 8.95 (95% CI, 4.05–13.85) with significant heterogeneity (I2=99.9%, P=0.000). The pooled relative risks (RR) value for dialysis patients compared with the general population were 6.35 (95% CI, 4.53–8.88) for male and 5.57 (95% CI, 4.44–6.99) for female. The pooled RR value for hemodialysis (HD) patients compared with peritoneal dialysis (PD) patients was 1.39 (95% CI, 1.13–1.70) with no heterogeneity (I2=0.0%, P=0.763). Conclusion In conclusion, the present meta-analysis reveals that about 2% of dialysis or KT patients go on to sustain a hip fracture during follow-up, with the overall hip fracture incidence rates being 8.95 per 1,000 person-years. The overall risk of hip fracture was more than 5-fold higher in dialysis patients than in the general population. Among patients on PD, HD, and KT, HD and KT patients had the highest and the lowest risk of hip fractures, respectively.
Ploidy Has Minimal Effect on Hypoxia Tolerance at High Temperature in Rainbow Trout (Oncorhynchus mykiss)

Polyploidy is an important driver of evolutionary change (generally via tetraploidy) and also serves a practical role in aquaculture and fisheries management (via triploidy). Fundamental changes in cell size and number that accompany polyploidy are predicted to affect cellular and whole-animal physiology due to constraints placed on surface-mediated processes at the cellular level, potentially altering environmental tolerances and optima. The aim of this study was to determine whether the documented reduction in thermal tolerance of aquatic polyploids is a result of their being less hypoxia tolerant. This was assessed by holding diploid and triploid rainbow trout for 1 h above their thermal optima in separate trials at eight temperatures between 20° and 27°C and then rapidly reducing the oxygen tension (Po2) of the water and determining the nonlethal Po2 at which fish lost equilibrium. As expected, there was a highly significant (P<0.0001) effect of temperature on Po2 at loss of equilibrium. Although there was also a significant (P<0.05) effect of ploidy on Po2 at loss of equilibrium, with triploid values higher than diploid, post hoc analyses showed no significant effect of ploidy at any specific temperature. Oxygen availability alone therefore does not appear to play a major role in determining the thermal tolerance of polyploids.
The fault in his seeds: Lost notes to the case of bias in Samuel George Morton’s cranial race science

The discovery of nearly 180-year-old cranial measurements in the archives of 19th century American physician and naturalist Samuel George Morton can address a lingering debate, begun in the late 20th century by paleontologist and historian of science Stephen Jay Gould, about the unconscious bias alleged in Morton’s comparative data of brain size in human racial groups. Analysis of Morton’s lost data and the records of his studies does not support Gould’s arguments about Morton’s biased data collection. However, historical contextualization of Morton with his scientific peers, especially German anatomist Friedrich Tiedemann, suggests that, while Morton’s data may have been unbiased, his cranial race science was not. Tiedemann and Morton independently produced similar data about human brain size in different racial groups but analyzed and interpreted their nearly equivalent results in dramatically different ways: Tiedemann using them to argue for equality and the abolition of slavery, and Morton using them to entrench racial divisions and hierarchy. These differences draw attention to the epistemic limitations of data and the pervasive role of bias within the broader historical, social, and cultural context of science.
Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

The World Health Organization HCV Guideline Development Group is considering a “treat all” recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited treatment access policies, focusing primarily on evaluations of all-oral directly acting antivirals published after 2012. Searching PubMed, we identified 2,917 unique titles. Sequentially reviewing titles and abstracts identified 226 potentially relevant articles for full-text review. Sixty-nine articles met all inclusion criteria—42 cost-effectiveness analyses and 30 models of population-health impacts, with 3 articles presenting both types of analysis. Cost-effectiveness studies for many countries concluded that expanding treatment to people with mild liver fibrosis, who inject drugs (PWID), or who are incarcerated is generally cost-effective compared to more restrictive treatment access policies at country-specific prices. For certain patient subpopulations in some countries—for example, elderly individuals without fibrosis—treatment is only cost-effective at lower prices. A frequent limitation is the omission of benefits and consequences of HCV transmission (i.e., treatment as prevention; risks of reinfection), which may underestimate or overestimate the cost-effectiveness of a “treat all” policy. Epidemiologic modeling studies project that through a combination of prevention, aggressive screening and diagnosis, and prompt treatment for all fibrosis stages, it may be possible to virtually eliminate HCV in many countries. Studies show that if resources are not available to diagnose and treat all HCV-infected individuals, treatment prioritization may be needed, with alternative prioritization strategies resulting in tradeoffs between reducing mortality or reducing incidence. Notably, because most new HCV infections are among PWID in many settings, HCV elimination requires unrestricted treatment access combined with injection transmission disruption strategies. The model-based evidence suggests that a properly constructed strategy that substantially expands HCV treatment could achieve cost-effective improvements in population health in many countries.
Obesity and nonalcoholic fatty liver disease: current perspectives

Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common cause of chronic liver disease due to an increase in the prevalence of obesity. The development of NASH leads to an increase in morbidity and mortality. While the first line of treatment is lifestyle modifications, including dietary changes and increased physical activity, there are no approved pharmacological treatment agents for NAFLD and NASH currently. Due to its complex pathophysiology, different pathways are under investigation for drug development with the focus on metabolic pathways, inflammation, and slowing or reversing fibrosis. There are several agents advancing in clinical trials, and promising results have been seen with drugs that affect hepatic steatosis, inflammation, and fibrosis. This review will provide an overview on NAFLD and some of the mechanisms of disease that are being targeted with pharmacologic agents.
Registered blindness in Kuwait – 15 years of dynamic changes

ABSTRACT Purpose: Incidence rate of registered blindness and low vision (IR) among the Kuwaitis from 2005 to 2014 and longitudinal changes since 2000. Methods: Data of newly certified Kuwaitis with best-corrected visual acuity 0.1 or less or visual field constriction to 20 ° or less in their better eye, aggregated in intervals from 2005 to 2009 and 2010 to 2014 and presented as IR per 100 000 person years of observation by age, gender, severity and leading cause. Results: Delayed certification resulted in rise of IR from 2005. IR of males declined since 2010, whereas among the females it continued rising at a slower rate. After 2010 IR of patients from 40 to 59 years expanded significantly and declined in the group over 60 years. Retinitis pigmentosa was the leading cause driven by high prevalence of consanguineous marriages; the large difference between the males and females is due mainly to cultural factors. Diabetic complications escalated from 2005 affecting patients over 40 years. Glaucoma became the leading cause in the age over 60 years after 2005 and while the male patients decreased after 2010 by 18%, disabled females grew by further 35%. Conclusions: Demographic, social and behavioral factors had impact on the structure and time trends of registered blindness among the Kuwaitis. High prevalence of diabetes and aging of the population resulted in rise of certification from diabetic complications and glaucoma in the last 10 years.
Relationship between irritable bowel syndrome and plasma and tissue ghrelin levels.

BACKGROUND/AIMS This study aimed to evaluate the relationship between irritable bowel syndrome (IBS) and plasma and tissue ghrelin levels. MATERIALS AND METHODS Patients who had undergone gastroscopy procedure for any reason previously were enrolled in the study. Among these, patients with IBS symptoms were evaluated according to the Roma III criteria. The healthy control group comprised patients with no IBS symptom and had undergone gastroscopy procedure for another reason. The plasma ghrelin level and tissue ghrelin level obtained by immunohistochemical examination of biopsy specimens taken from the gastric antrum and corpus were evaluated in all participants. RESULTS The mean age of 90 participants was 43.64}12.64 years. The median value of the plasma ghrelin level was 3.29 (1.2-12.7) in the diarrhea group (IBS-D), 1.49 (0.82-7.08) in the constipation group (IBS-C), and 1.5 (0.2-3.7) in the control group. The plasma ghrelin levels between the groups were found to be significantly higher in IBS-D than in IBS-C and the control groups (p=0.001 and p=0.001, respectively). On comparing antral mucosal gland biopsy outcomes among the groups, staining intensity score was found to be significantly high in IBS-C as compared with the control group, whereas no significant difference was observed between IBS-D and the control groups (p=0.020 and p=0.429, respectively). CONCLUSION The plasma ghrelin level in IBS-D and the staining intensity in the antral mucosal gland in IBS-C were found to be significantly higher. In addition, there was no difference between the groups in terms of ghrelin staining intensity in the gastric corpus.