Miracle-dz/UniFAR-FTUs huggingface dataset:
Recent advances help understand and improve the safety of menopausal therapies

ObjectiveHormone therapy (HT) remains a mainstay of treatment of vasomotor symptoms, which are among the most common and most bothersome of menopausal symptoms. This review provides updates on HT and reviews newer menopausal therapies, focusing on recent safety data. MethodsAn interpretative review of recent medical literature was conducted using computerized databases. ResultsThe latest analyses from the Women’s Health Initiative and other trials suggest that there is a window shortly after the onset of menopause in which HT provides optimal benefit with minimal risk. Risks of breast cancer, coronary heart disease, and probable dementia increase when a progestin is included in the HT regimen, which is necessary in nonhysterectomized women to counter the proliferative effects of estrogens on the endometrium. Attempts to further optimize the risk-benefit profile of menopausal therapies have led to the introduction of newer selective estrogen receptor modulators (bazedoxifene for osteoporosis, ospemifene for dyspareunia), tissue-selective estrogen complexes (conjugated estrogens/bazedoxifene for vasomotor symptoms and osteoporosis), and non-HT (low-dose paroxetine for vasomotor symptoms). ConclusionsRecent studies suggest that HT has a neutral or even beneficial effect on coronary heart disease and cognition when used in the early postmenopausal years. The risk-to-benefit ratio of estrogen therapy in hysterectomized women is more favorable than that of estrogen-progestin regimens in nonhysterectomized women. Conjugated estrogens/bazedoxifene now provides a progestin-free option for managing vasomotor symptoms in postmenopausal women with an intact uterus. Low-dose paroxetine may be an alternative for some women when hormonal treatments are contraindicated.
The Diagnosis of Stupor and Coma, 3rd ed

lished research. The areas of research covered include biochemistry, sociology (a most stimulating paper by George Brown), epidemiology, motivation of research workers and the quality of their work (an original and fascinating paper by John Cooper), mental handicap, child psychiatry, clinical research generally (a thoughtful paper by Robert Kendall), psychogeriatrics, behavioural and dynamic psychotherapies, pharmacology and neuropsychiatry. Finally Sir Denis Hill and Peter Sainsbury consider research in academic and hospital (and community) settings respectively. Some of the discussion after each paper is also recorded: this is of rather more variable quality. The editor is to be congratulated on the speed of publication and the book is recommended reading for anyone interested in (and especially anyone contemplating) psychiatric research.
Childhood chronic daily headache: a biopsychosocial perspective

The aim of our observational study was to highlight some clinical observations on chronic daily headache (CDH) in children and adolescents. Data on patients ≤18 years aged presenting with CDH to the Pediatric Headache Clinic at the Royal University Hospital, Saskatoon, Canada, were collected prospectively and sequentially from February 2004 to July 2006. Standardized data sheets and definitions were used. Follow‐up information on the 70 participants (22 males, 48 females) was current to February 2007. Fifty‐four participants (77%) had had recurrent headaches before transformation to CDH. Comorbid chronic migraine and chronic tension‐type headache was the most frequent subtype of CDH (37 participants; 53%). Anxiety and mood disorders were diagnosed in 17 and 15 children respectively. Stressors that precipitated or contributed to the maintenance of CDH were judged important in 44 (63%). The possibility of a somatoform disorder was considered in five children, a factitious disorder in one, and malingering in another. We suggest that CDH be viewed from a biopsychosocial rather than a narrow biomedical perspective and the classification improved to enhance clinical utility.
Modeling vascular inflammation and atherogenicity after inhalation of ambient levels of ozone: exploratory lessons from transcriptomics

Abstract Background: Epidemiologic studies have linked inhalation of air pollutants such as ozone to cardiovascular mortality. Human exposure studies have shown that inhalation of ambient levels of ozone causes airway and systemic inflammation and an imbalance in sympathetic/parasympathetic tone. Methods: To explore molecular mechanisms through which ozone inhalation contributes to cardiovascular mortality, we compared transcriptomics data previously obtained from bronchoalveolar lavage (BAL) cells obtained from healthy subjects after inhalational exposure to ozone (200 ppb for 4 h) to those of various cell samples from 11 published studies of patients with atherosclerotic disease using the Nextbio genomic data platform. Overlapping gene ontologies that may be involved in the transition from pulmonary to systemic vascular inflammation after ozone inhalation were explored. Local and systemic enzymatic activity of an overlapping upregulated gene, matrix metalloproteinase-9 (MMP-9), was measured by zymography after ozone exposure. Results: A set of differentially expressed genes involved in response to stimulus, stress, and wounding were in common between the ozone and most of the atherosclerosis studies. Many of these genes contribute to biological processes such as cholesterol metabolism dysfunction, increased monocyte adherence, endothelial cell lesions, and matrix remodeling, and to diseases such as heart failure, ischemia, and atherosclerotic occlusive disease. Inhalation of ozone increased MMP-9 enzymatic activity in both BAL fluid and serum. Conclusions: Comparison of transcriptomics between BAL cells after ozone exposure and various cell types from patients with atherosclerotic disease reveals commonly regulated processes and potential mechanisms by which ozone inhalation may contribute to progression of pre-existent atherosclerotic lesions.
Association of waterpipe smoking with myocardial infarction and determinants of metabolic syndrome among catheterized patients

Abstract Background: Waterpipe smoking is a rising global public health epidemic perceived by many users to be less harmful, though its toxicity overlaps or even exceeds that of cigarette smoking. Short-term cardiovascular changes due to waterpipe smoking are well established, but longer-term health impacts are still not fully elucidated. Objective: We aim to investigate the association of waterpipe smoking with myocardial infarction among patients undergoing cardiac catheterization. Methods: The study was performed on Lebanese patients referred for cardiac catheterization. Patient’s blood was collected for metabolic measures and questionnaires were filled out to include socio-demographic, behavioral and pertinent medical characteristics of the study subjects. Results: Myocardial infarction is significantly and independently associated with waterpipe smoking, with odds ratio (OR) of 1.329 (95% CI: [1.04–1.68]; p = .021), which is lower than that for cigarette smoking (OR = 1.87, 95% CI: [1.63–2.15]; p < .001). Only diabetes showed significant association with waterpipe smoking among MI enrollees (OR = 1.66, 95%CI: [1.04–2.63]; p = .032). Conclusion: The study provides yet another evidence for the adverse cardiovascular effects of waterpipe smoking on a clinical level. The harmful effects of waterpipe smoking should be underscored by health care professionals.
Remifentanil Preconditioning Confers Cardioprotection via Cardiac κ- and δ-Opioid Receptors

Background:Remifentanil preconditioning (RPC) reduces the infarct size in anesthetized rat hearts, and this effect seems to be mediated by all three types of opioid receptors (ORs). Because there is evidence of only κ- and δ- but not μ-ORs in the rat heart, the authors investigated whether RPC confe
Debates in Personalisation

personalisation and the reality of its application. Examples are given of where co-production has worked and service users have been at the heart of driving changes forward. Transparency and openness are considered the only way forward accompanied by the use of advocates. A user-led direct payment model is promoted accompanying a complete culture and power shift. The Scottish context is of interest, but the broader comparisons make this book useful beyond Scottish boundaries. It would be valuable for social work students and practitioners attempting to understand and analyse why personalisation appears to be difficult to achieve. The book has a strong value base and is challenging in relation to the cultural context of care, making it a refreshing read. Although most useful for Scotland, other readers will find it stimulating and interesting in terms of the huge change required to make personalisation meaningful for users of services.
Acute inhalation of ozone induces DNA methylation of apelin in lungs of Long-Evans rats

Abstract Apelin has cardiopulmonary protective properties that promote vasodilation and maintenance of the endothelial barrier. While reductions in apelin have been identified as a contributor to various lung diseases, including pulmonary edema, its role in the effect of air pollutants has not been examined. Thus, in the current study, we sought to investigate if apelin is a downstream target of inhaled ozone and if such change in expression is related to altered DNA methylation in the lung. Male, Long-Evans rats were exposed to filtered air or 1.0 ppm ozone for 4 h. Ventilation changes were assessed using whole-body plethysmography immediately following exposure, and markers of pulmonary edema and inflammation were assessed in the bronchoaveolar lavage (BAL) fluid. The enzymatic regulators of DNA methylation were measured in the lung, along with methylation and hydroxymethylation of the apelin promoter. Data showed that ozone exposure was associated with increased enhanced pause and protein leakage in the BAL fluid. Ozone exposure reduced DNA cytosine-5-methyltransferase (DNMT) activity and Dnmt3a/b gene expression. Exposure-induced upregulation of proliferating cell nuclear antigen, indicative of DNA damage, repair, and maintenance methylation. Increased methylation and reduced hydroxymethylation were measured on the apelin promoter. These epigenetic modifications accompanied ozone-induced reduction of apelin expression and development of pulmonary edema. In conclusion, epigenetic regulation, specifically increased methylation of the apelin promoter downstream of DNA damage, may lead to reductions in protective signaling of the apelinergic system, contributing to the pulmonary edema observed following the exposure to oxidant air pollution.
Análise da discrepância de tamanho dentário em pacientes da clínica de ortodontia da FO/UERJ

The purpose of this study was to evaluate the tooth size discrepancies in patients of Rio de Janeiro State University Orthodontic Clinic. The sample was composed of 161 patients, which fulfilled the including criteria. Mesiodistal width of all permanent teeth were measured, from first left molar to first right molar, in both arches. The Bolton's discrepancy ratio was calculated for each set of models. The means for overall and anterior ratios were obtained for the whole sample, also evaluating differences between sexes and malocclusion (Angle's Class I, Class II and Class III). The values found were compared to Bolton's means. The overall and anterior ratios demonstrated no significant differences between sexes. No significant differences were found among the means obtained for each malocclusion group. These results suggested no influence of malocclusion status in the intermaxillary tooth size ratios of the studied sample. However, when comparing the sample's means to the one proposed in Bolton's analysis, it was found that they were greater for the whole sample, for both sexes and for Class I and Class II patients, indicating the tooth size discrepancies could occur more frequently in malocclusion groups than in patients with normal occlusion. The overall and anterior ratio found for malocclusion group of Class III did not demonstrate significant differences when compared to Bolton's means.
Do High Rates of OSCAR Deficiencies Prompt Improved Nursing Facility Processes and Outcomes?

Recently, some researchers have argued that high state rates of Centers for Medicare and Medicaid Services (CMS) Online Survey, Certification and Reporting (OSCAR) nursing facility deficiencies indicate stringent enforcement, leaving the impression of better-quality care soon to follow; others maintain that the rank ordering of states' quality of nursing facility care remains fairly constant, resting on deep-seated state characteristics that change slowly, so that short-term improvement in poor-quality care is unlikely. The authors examine change in the process and outcome quality of states' Medicare nursing facility long-term care programs across 1999 to 2005, using linear and two-stage least squares regression. They find that (1) nationally, process quality generally falls across this period while outcome quality generally increases; (2) neither a prominent enforcement stringency index nor state culture, a relatively stable state characteristic, exerts much influence on state process and outcome quality scores over time, but (3) the relative costs and benefits for CMS compliance appear to contribute to explaining change in states' quality of resident outcomes over time; and (4) states' process quality is much less stable than outcome quality, and outcome indices distinct from OSCAR deficiency data provide more reliable and possibly more valid measures of care quality.
The association between recent abuse and menopausal symptom bother: results from the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS)

Objective:The aim of the study was to determine whether there is an association between current menopausal symptom bother and a history of abuse (physical, sexual, or emotional/verbal) in the last year. Methods:A cross-sectional survey was completed using the Data Registry on Experiences of Aging, Menopause, and Sexuality and the Menopause Health Questionnaire. Data from the Menopause Health Questionnaire were collected from 4,956 women seen consecutively for menopause consultation in the Women's Health Clinic at Mayo Clinic (Rochester, MN) from January 1, 2006 through October 7, 2014. Data from 3,740 women were included in the analysis. Menopausal symptom ratings were compared between women reporting a history of abuse (physical, sexual, or emotional/verbal) in the last year and those not using a two-sample t test. Analysis of covariance was used to assess whether abuse was associated with menopausal symptom bother after adjusting for baseline participant characteristics. Results:Of the 3,740 women, 253 (6.8%) reported experiencing one or more forms of abuse in the last year, the majority (96%) of which was verbal/emotional abuse. Those reporting abuse in the last year had higher (P < 0.001) mean total menopausal symptom bother scores. Consistent findings were obtained from multivariable analyses adjusting for all demographic and substance use characteristics. Conclusions:In the present study from the Data Registry on Experiences of Aging, Menopause, and Sexuality, menopausal symptom bother scores were directly associated with recent self-reported abuse.
Quality of life of adolescents with cerebral palsy: perspectives of adolescents and parents

Quality of life (QOL) has emerged over the past 20 years as an outcome for measuring the effectiveness of health‐improvement interventions. The Cerebral Palsy Quality of Life Questionnaire for Children (CPQOL‐Child) is well regarded and now integrated into research internationally. We describe the results of qualitative research, using grounded research in which we aimed to identify domains of QOL for adolescents with cerebral palsy (CP) from adolescent and parent perspectives to guide the development of an adolescent version. Seventeen adolescents (nine males, eight females) aged 13 to 18 years (mean=15.53 SD=1.74), with varying levels of impairment (Gross Motor Function Classification System levels I n=5, II n=2, III n=6, IV n=4, and V n=6) and their parents (n=23) participated in semi‐structured interviews. Questions included: ‘What do you think is important to your (child’s) QOL? ’ and ‘How does CP impact on your (child’s) life? ’ Fifteen themes were identified, including domains related to health issues in adolescence, participation, education, specific CP‐related issues (pain and discomfort, communication), family issues, practical issues (financial resources), and changes associated with adolescence (sexuality, independence). The composition of these QOL domains reflects the developmental concerns of adolescents with CP, adding to the views of children, and strongly supports adolescent participation in the development of self‐reported well‐being and QOL measures. Many of the domains are consistent with child reports of QOL and thus it appears feasible and valid to develop a measure that will be transferable across childhood and adolescence.
Relationship between sociodemographic, reproductive, and lifestyle factors and the severity of menopausal symptoms among Egyptian women in Alexandria

Objective:During menopause, women often experience some symptoms which may affect their daily activities. Information about menopausal experiences among different racial and ethnic groups is important for healthcare personnel to provide appropriate and specific interventions. The aim of the present study was thus to determine the frequency and determinants of severity of menopausal symptoms among Egyptian women using the Menopause Rating Scale as a screening tool for identification of menopausal symptoms. Methods:A total of 540 women (aged 40-65 y) were recruited in this cross-sectional study. Demographic information was collected, and the Menopause Rating Scale questionnaire was administered. Results:Most frequently reported symptoms were joint and muscular discomfort (501, 92.8%) followed by urogenital symptoms (460, 85.2%). A significant association was found between the number of menopausal symptoms and working status of participants (r = 0.504, P = 0.005), number of children (r = 0.474, P = 0.042), and body mass index (r = 0.544, P = 0.006). Women who reported urogenital symptoms and self-perceived general health as poor were more frequently referred to a gynecologist for moderate-to-severe menopausal symptoms. Conclusions:Participant-related information such as working status, which was shown to increase the frequency of psychological symptoms in our ethnic group, should be noted by the physician, and a suitable approach should be adopted to achieve better therapy outcomes. Counseling about the importance of maintaining an ideal body weight and exercise should be emphasized to reduce menopausal symptoms. Appropriate advice and support in improving the overall state of the postmenopausal women is essential.
Transforming the Way We Live Together: A Model to Move Communities From Policy to Implementation

Most cities, counties, and neighborhoods are not designed for an aging population. By providing a range of services to all residents, Lifelong Communities allow individuals to age in place. Although the Lifelong Communities Initiative is based on established guiding principles, little information exists regarding the realities of moving from policy to implementation. The Atlanta Regional Commission conducted a case study in Mableton, Georgia, and found successful implementation requires a combination of support from local citizen groups and government. The Atlanta Regional Commission is replicating these best practices in other communities and providing support to those aspiring to launch or expand Lifelong Communities.
Long‐term efficacy and tolerability of 4‐monthly versus yearly botulinum toxin type A treatment for lower‐limb spasticity in children with cerebral palsy

In this study, we compared the long‐term efficacy and tolerability of two dosage regimens of the potent botulinum toxin type A (BoNT‐A; Dysport; Ipsen Ltd, Slough, UK) in children with cerebral palsy (CP) and lower‐limb spasticity. Children aged 1 to 8 years with diplegic CP who were able to walk (aided or unaided) were randomized (1:1) to 30 LD50 units/kg total body weight of BoNT‐A (injected into gastrocnemius muscles) every 4 months or once yearly for 2 years in this multicentre, assessor‐blinded, parallel‐group study. In the 4‐monthly group (n=110, 39 males, 71 females), mean age was 3 years 8 months (SD 1y 6mo, range 1–8y). In the yearly group (n=104, 47 males, 57 females), mean age was 4 years 4 months (SD 1y 6mo, range 2–8y). Both treatment groups had similar baseline Gross Motor Function Measure scores. At month 28 (primary endpoint; intention‐to‐treat group), median maximum passive ankle dorsiflexion was 12.00° in the 4‐monthly and 11.00° in the yearly group. Between‐group difference of 1.67° was not statistically significant (p=0.055). Other efficacy endpoints showed no significant difference between the regimens. The results of the study do not allow a clear conclusion of the preferred injection regimen.
How does adjuvant chemotherapy affect menopausal symptoms, sexual function, and quality of life after breast cancer?

Objective:The aim of the study was to determine the association between adjuvant chemotherapy for breast cancer and menopausal symptoms, sexual function, and quality of life. Methods:Participants attended a menopause clinic with a dedicated service for cancer survivors at a large tertiary women's hospital. Information about breast cancer treatments including adjuvant chemotherapy was collected from medical records. Menopausal symptoms were recorded with the Greene Climacteric Scale and Functional Assessment of Cancer Therapy, Breast Cancer, and Endocrine Symptom Subscales. Sexual symptoms were recorded using Fallowfield's Sexual Activity Questionnaire. Quality of life was measured with Functional Assessment of Cancer Therapy scales. Results:The severity of vasomotor, psychological, or sexual symptoms (apart from pain) did not differ between those who had received adjuvant chemotherapy (n = 339) and other breast cancer survivors (n = 465). After adjustment for current age, time since menopause, and current use of antiestrogen endocrine therapy, the risk of “severe pain” with sexual intercourse was twice as common after chemotherapy (31.6% vs 20.0%, odds ratio [OR] 2.18, 95% CI 1.25-3.79). Those treated with chemotherapy were more likely to report “severe problems” with physical well-being (OR 1.92, 95% CI 1.12-3.28) and lower breast cancer-specific quality of life (OR 1.89 95% CI 1.13-3.18), but did not differ in other quality of life measures. Conclusions:In this large study of breast cancer patients presenting to a specialty menopause clinic, previous chemotherapy was not associated with current vasomotor or psychological symptoms. Severe pain with intercourse was significantly more common in those treated with adjuvant chemotherapy.
Life-Stage and Mobility: An Exploratory GPS Study of Mobility in Multigenerational Families, Ahmedabad, India

As the population of older adults in India grows, research is needed to plan a sustainable future for India’s older adults. This article reports results from a Global Positioning System (GPS)–based pilot study that examined the mobility of middle-class, older adults living in Ahmedabad, Gujarat, India. Using mobility as a lens through which to examine the lives of older adults, we map potential research and identify policy areas of interest considering older adults in urban India. The study explores the role of life stage in mobility as well as the effects of gender and urban environment on mobility. Using this distinctive perspective on day-to-day life, we propose themes through which, using policy and planning tools, the living environments of older adults in Indian cities can be improved. These policy measures include focusing on walkability and pedestrian safety in residential areas and building on existing mixed land use to create high accessibility to goods and services in urban environments.