Miracle-dz/UniFAR-FTUs huggingface dataset:
Metformin Treatment Among Men With Diabetes and the Risk of Prostate Cancer: A Population-Based Historical Cohort Study

Abstract There is conflicting evidence regarding the association between metformin treatment and prostate cancer risk in diabetic men. We investigated this association in a population-based Israeli cohort of 145,617 men aged 21–89 years with incident diabetes who were followed over the period 2002–2012. We implemented a time-dependent covariate Cox model, using weighted cumulative exposure to relate metformin history to prostate cancer risk, adjusting for use of other glucose-lowering medications, age, ethnicity, and socioeconomic status. To adjust for time-varying glucose control variables, we used inverse probability weighting of a marginal structural model. With 666,553 person-years of follow-up, 1,592 men were diagnosed with prostate cancer. Metformin exposure in the previous year was positively associated with prostate cancer risk (per defined daily dose; without adjustment for glucose control, hazard ratio (HR) = 1.53 (95% confidence interval (CI): 1.19, 1.96); with adjustment, HR = 1.42 (95% CI: 1.04, 1.94)). However, exposure during the previous 2–7 years was negatively associated with risk (without adjustment for glucose control, HR = 0.58 (95% CI: 0.37, 0.93); with adjustment, HR = 0.60 (95% CI: 0.33, 1.09)). These positive and negative associations with previous-year and earlier metformin exposure, respectively, need to be confirmed and better understood.
Cost-effectiveness analysis of left atrial appendage occlusion in patients with atrial fibrillation and contraindication to oral anticoagulation

Abstract Aims This study aims to estimate the cost-effectiveness of percutaneous left atrial appendage occlusion (LAAO) compared to standard stroke prevention care for patients with atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC) in a Swedish healthcare and public sector perspective. Methods and results We used a combined decision tree and cohort Markov model to estimate costs and quality-adjusted life-years (QALYs) over a lifetime horizon with LAAO compared to standard of care where the treatment effect is based on a recent meta-analysis. According to our analysis, LAAO gives more QALYs than standard of care (7.11 vs. 6.12). Furthermore, LAAO treatment is related to the first-year cost of 14 984 Euro (EUR) and higher average healthcare costs over the lifetime by about 4010 EUR, which gives an incremental cost-effectiveness ratio of LAAO vs. standard of care at 4047 EUR per gained QALY. From a public sector perspective, LAAO reduces average costs due to substantial reductions in long-term care and, thus, implies that LAAO is dominant from a public sector perspective (lower average costs and better health outcomes). Conclusion From both Swedish healthcare and public sector perspectives, LAAO can be considered cost-effective compared to standard of care for individuals with AF and contraindication to OAC. However, these results must be confirmed in health economic evaluations alongside the ongoing randomized clinical trials. Key Question Is left atrial appendage occlusion (LAAO) cost-effective for patients with atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC) compared to the standard of care from a Swedish healthcare and public sector perspective? Key Finding LAAO is associated with lower cost than the standard of care from a public sector perspective and an incremental cost of 4010 Euro from a healthcare perspective. Furthermore, LAAO is related to better health outcomes than the standard of care. Take Home Message Treatment with LAAO among individuals with AF and contraindication to OAC can be considered as cost-effective compared to the standard of care from a Swedish healthcare and public sector perspective.
Evaluation of health belief model-based educational intervention on colorectal cancer screening behavior at South Khorasan, Iran

BACKGROUND: Colorectal cancer is the most common cancer of the gastrointestinal tract. Health beliefs play an important role in the development of health behaviors. In this study, the effect of educational intervention based on Health Belief Model on colorectal cancer screening behavior was investigated. MATERIALS AND METHODS: This study was performed as a randomized controlled intervention. The study population was 50–70-years old in Khosf city. Initially, 120 eligible populations were randomly divided into intervention and control groups (60 people in each group). The data collection tool was a standard colorectal cancer screening questionnaire that was completed before, immediately, and 3 months after the intervention. The intervention consisted of eight 60-min training sessions. The collected data were analyzed using SPSS19 software and statistical tests. RESULTS: The mean age of the intervention and control groups was 63.53 ± 5.67 and 57.73 ± 5.77 years. In terms of mean scores of knowledge, perceived susceptibility, perceived severity, and perceived barriers were homogeneous before intervention. After the intervention, the mean score of the model constructs showed significant changes, which was statistically significant (P < 0.05). The rate of occult blood test in stool 3 months after training reached 90% in the intervention group and 15% in the control group. CONCLUSIONS: The results of this study showed that by taking measures to reduce perceived barriers as well as increase knowledge, perceived susceptibility, severity, benefits and self-efficacy, the rate of participation in occult blood testing in feces can be significantly increased.
Six-minute walk test and its predictability in outcome of COVID-19 patients

BACKGROUND: The world is worsely hit by the COVID-19 pandemic resulting in increased morbidity and mortality. Increased mortality has been observed in older adults with multiple comorbidities. Six-minute walk distance (6MWD) at admission can help us to guide the requirement of oxygen during hospital stay that can be used to determine which patient can be managed at home. MATERIALS AND METHODS: This study was a prospective observational study conducted on COVID-19 patients admitted at AIIMS, New Delhi, from October to December 2020. Patients aged more than 60 years were included in the study and underwent 6-min walk tests. Polypharmacy and multimorbidity were also assessed along with dyspnea which was measured on BORG scale. P < 0.05 was considered statistically significant. Statistical software STATA (version 14.2) was used for all the analyses. RESULTS: The mean age of the study population was 68.76 (7.4). Oxygen saturation prior to the 6-MWT was normal and has significantly higher than the post test (P ≤ 0.001). 6MWD was significantly correlated with pre values of oxygen saturation. 6MWD was observed more in patients who did not require oxygen during hospital stay. Self-reported dyspnea, pulse rate, oxygen saturation, and systolic blood pressure were significantly associated with the patients who had an oxygen requirement during the hospital stay. CONCLUSION: Self-reported dyspnea after 6MWT was found to be associated with oxygen requirement during hospital stay. Patients who have covered more distance in 6-min walk test have less oxygen requirement during hospital stay hence can be managed at home. This will reduce the health-care burden and will help to tackle the outburst during the ongoing pandemic.
Assessment of patient’s knowledge, attitude, and beliefs about cancer: An institute-based study

INTRODUCTION: Knowledge about cancer, treatment, and likely treatment outcomes is critically important for decision-making regarding adherence to the treatment. Hence, it seems imperative to find out the attitude and belief of cancer patients to determine the efficacy of cancer diagnostic and treatment available along with assessing the efficacy of prevention. The purpose of this study was to determine the level of knowledge, belief, and attitude of cancer patients who came to our facility. MATERIALS AND METHODS: The present study was a descriptive cross-sectional study which was conducted at All India Institute of Medical Sciences, Rishikesh, from July 2020 to December 2020. One hundred fifty-six newly diagnosed cancer patients were recruited. The participants were provided with a validated 44 key questionnaire divided into four different categories including the sociodemographic profile, knowledge, belief, and attitude subheading. Mean, frequency, percentage, and Chi-square test were calculated to do data analysis using SPSS version 23.0. RESULTS: Out of the total of 156 newly diagnosed cancer patients, only 130 patients provided responses so the overall response rate was 84.3%. Most of cancer patients had moderately adequate knowledge (79 [60.5%]), poor belief (111 [86%]), and neutral attitude (69 [54%]) regarding cancer. The Chi-square test revealed a link between educational level and cancer knowledge (P = 0.01). Males showed a more positive attitude than females, and this difference was statistically significant (P = 0.02). CONCLUSIONS: Cancer patients need to be made more aware of the red flag signs of cancer and improvise their attitude toward cancer. Cancer care programs should not only involve cancer patients but also involve their caregivers because the understanding of family members is of utmost importance to fight this disease.
Calcipotriol attenuates liver fibrosis through the inhibition of vitamin D receptor-mediated NF-κB signaling pathway

ABSTRACT Liver fibrosis is an inevitable stage in the development of chronic liver disease to cirrhosis. Nonetheless, the interventional treatment and achieving control over the disease at this stage can substantially reduce the incidence of liver cirrhosis. To demonstrate these aspects, liver pathological sections of 18 patients with chronic liver disease are collected for research according to the degree of fibrosis. Further, the expressions of related proteins in each group are studied by the Western blot method. The cell proliferation and apoptosis are detected by CKK-8 and flow cytometry analyses. Further, a rat model with carbon tetrachloride (CCl4)-induced liver fibrosis is employed to verify the effect and mechanism of VDR on the process of liver fibrosis in vivo. The expression of VDR in liver tissues of patients with liver fibrosis is negatively correlated with α-smooth muscle actin (α-SMA), Col-1, and liver fibrosis stages. Moreover, the tumor necrosis factor (TNF)-α stimulation could increase the proliferation of LX-2, up-regulate the expression of α-SMA, Col-1, NF-κB, p-IκBα, p-IKKβ, p-p65m, and some fibrosis factors, as well as down-regulate the expressions of VDR and matrix metalloproteinase-1 (MMP-1). Considering the protective actions of VDR, calcipotriol, a VDR agonist, effectively reduced the degree of liver fibrosis in a rat model of liver fibrosis by inhibiting the deposition of extracellular (ECM) and activation of hepatic stellate cells (HSCs), which is negatively correlated with the degree of liver fibrosis. Together, these shreds of evidence demonstrated that the calcipotriol showed great potential in effectively attenuating liver fibrosis. GRAPHICAL ABSTRACT
Drivers and barriers to sustained use of Blair ventilated improved pit latrine after nearly four decades in rural Zimbabwe

Background Some latrines remain unused even under conditions of high coverage in rural areas of low- and middle-income countries. Not much is known on household latrine use in the long term in the absence of an intervention. The current work assesses drivers and barriers to sustained use of a ventilated improved pit latrine (Blair VIP) design where it originated and how rural households adapt it to climate change. Methods A mixed methods study was conducted from November 2020 to May 2021 among rural households of Mbire district, Zimbabwe. A cross sectional survey of 238 households with Blair ventilated improved pit (BVIP) latrines was conducted using a questionnaire and a latrine observation checklist. Data were analysed using logistic regression. Qualitative data were collected using six focus groups among house heads and analysed by thematic analysis. Result The latrine has perceived health, non-health and hygiene benefits for its sustained use. However, there are design, environmental and social barriers. The quantitative study indicated that determinants of latrine use were contextual (individual and household levels) and technology (individual level) factors. Focus groups indicated that latrine use was influenced by social, technology and contextual factors at multiple level factors. Interplay of factors influenced the intention to adapt the BVIP latrine to climate change. Local climate change adaptation strategies for the latrine were odour and erosion control, construction of the conventional latrine design and raised structures. Conclusion The conventional BVIP latrine design is durable and relatively resilient to climate change with high local household use. High construction cost of the latrine causes households to build incomplete and poor quality designs which affect odour and fly control. These are barriers to sustained latrine use. The government should implement the new sanitation policy which considers alternative sanitation options and offer community support for adapting sanitation to climate change.
The association between provider characteristics and post-catheterization interventions

Objectives To examine whether the demographics of providers’ prior year patient cohorts, providers’ historic degree of catheter-based fractional flow reserve (FFR) utilization, and other provider characteristics were associated with post-catheterization performance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Study design A retrospective, observational analysis of outpatient claims data was performed. Methods All 2018 outpatient catheterization claims from a national organization offering commercial and Medicare Advantage health plans were examined. Claims were excluded if the patient had a prior catheterization in 2018, had any indications of CABG or valvular heart disease in the prior year of claims, or if the provider had ≤10 catheterization claims in 2017. Downstream PCI and CABG were determined by examining claims 0–30 days post-catheterization. Using multivariate mixed effects logistic regression with provider identity random effects, the association between post-catheterization procedures and provider characteristics was assessed, controlling for patient characteristics. Results The sample consisted of 31,920 catheterization claims pertaining to procedures performed by 964 providers. Among the catheterization claims, 8,554 (26.8%) were followed by PCI and 1,779 (5.6%) were followed by CABG. Catheterizations performed by providers with older prior year patient cohorts were associated with higher adjusted odds of PCI (1.78; CI: 1.26–2.53), even after controlling for patient age. Catheterizations performed by providers with greater historic use of FFR had significantly higher adjusted odds of being followed by PCI (1.73; CI: 1.26–2.37). Conclusion Provider characteristics may impact whether patients receive a procedure post-catheterization. Further research is needed to characterize this relationship.
Perspective: Estrogen and the Risk of Cognitive Decline: A Missing Choline(rgic) Link?

ABSTRACT Factors that influence the risk of neurocognitive decline and Alzheimer's disease (AD) may provide insight into therapies for both disease treatment and prevention. Although age is the most striking risk factor for AD, it is notable that the prevalence of AD is higher in women, representing two-thirds of cases. To explore potential underlying biological underpinnings of this observation, the intent of this article is to explore the interplay between cognitive aging and sex hormones, the cholinergic system, and novel hypotheses related to the essential nutrient choline. Mechanistic evidence points toward estrogen's neuroprotective effects being strongly dependent on its interactions with the cholinergic system, a modulator of attentional functioning, learning, and memory. Estrogen has been shown to attenuate anticholinergic-induced impairments in verbal memory and normalize patterns of frontal and occipital cortex activation, resulting in a more “young adult” phenotype. However, similar to estrogen replacement's effect in cardiovascular diseases, its putative protective effects may be restricted to early postmenopausal women only, a finding supportive of the “critical window hypothesis. ” Estrogen's impact on the cholinergic system may act both locally in the brain but also through peripheral tissues. Estrogen is critical for inducing endogenous choline synthesis via the phosphatidylethanolamine N-methyltransferase (PEMT) gene–mediated pathway of phosphatidylcholine (PC) synthesis. PEMT is dramatically induced in response to estrogen, producing not only a PC molecule and source of choline for the brain but also a key source of the long-chain ω-3 fatty acid, DHA. Herein, we highlight novel hypotheses related to hormone replacement therapy and nutrient metabolism aimed at directing future preclinical and clinical investigation.
Characterization of locomotor phenotypes in zebrafish larvae requires testing under both light and dark conditions

Despite growing knowledge, much remains unknown regarding how signaling within neural networks translate into specific behaviors. To pursue this quest, we need better understanding of the behavioral output under different experimental conditions. Zebrafish is a key model to study the relationship between network and behavior and illumination is a factor known to influence behavioral output. By only assessing behavior under dark or light conditions, one might miss behavioral phenotypes exclusive to the neglected illumination setting. Here, we identified locomotor behavior, using different rearing regimes and experimental illumination settings, to showcase the need to assess behavior under both light and dark conditions. Characterization of free-swimming zebrafish larvae, housed under continuous darkness or a day/night cycle, did not reveal behavioral differences; larvae were most active during light conditions. However, larvae housed under a day/night cycle moved a shorter distance, had lower maximum velocity and maximum acceleration during the startle response under light conditions. Next, we explored if we could assess behavior under both dark and light conditions by presenting these conditions in sequence, using the same batch of larvae. Our experiments yielded similar results as observed for naïve larvae: higher activity during light conditions, regardless of order of illumination (i.e. dark-light or light-dark). Finally, we conducted these sequenced illumination conditions in an experimental setting by characterizing behavioral phenotypes in larvae following neuromast ablation. Depending on the illumination during testing, the behavioral phenotype following ablation was characterized differently. In addition, the results indicate that the order in which the light and dark conditions are presented has to be considered, as habituation may occur. Our study adds to existing literature on illumination-related differences in zebrafish behavior and emphasize the need to explore behavioral phenotypes under both light and dark condition to maximize our understanding of how experimental permutations affect behavior.
Family and school-based educational intervention on fruits and vegetable consumption of female students: Application of social cognitive theory

BACKGROUND: Fruits and vegetable (F.V) consumption is the most pivotal strategy of preventing cardiovascular diseases, obesity, diabetes, and cancers. The present study aims to evaluate the effect of educational intervention based on social cognitive theory (SCT) on consumption of F.Vs among female high schools’ students in Rafsanjan (South of Iran). SUBJECTS AND METHODS: This quasi-experimental study was carried out among 272 students (intervention = 134 and control group = 138) using a multistage sampling method. The instrument used in this study included demographic characteristics, the students’ F.V consumption during the past 7 days and its determinants based on the theory. Educational interventions were made in three sessions for students and two sessions for parents, teachers, and school officials. The data were analyzed by SPSS version 18 using the statistical tests of Chi-square, independent samples t-test, paired-samples t-test, and univariate model at a significant level of 0.05. RESULTS: Three months after the educational program, mean scores and standard deviation of F.V consumption and constructs in the intervention group increased significantly (P < 0.001). Respectively, 22.2% and 36.1% of the changes in the average unit of F.V consumption were the result of the present educational intervention. CONCLUSION: The intervention based on SCT with an emphasis on the interaction between student, family, and school has had an effect on F.V consumption behavior. Therefore, in forming behavior, attention is paid to the interaction of individual and interpersonal factors.
Relationship between fertility characteristics with spiritual intelligence and resilience in infertile couples

BACKGROUND: Infertility and the use of assisted reproductive therapies affect infertile couples quality of life. Infertile couples face many physical, psychological, and financial challenges due to having a higher level of spiritual intelligence and resilience will help the infertile couple to adapt to infertility conditions and achieve their therapeutic goals. This study was aimed to determine the relationship between fertility characteristics and spiritual intelligence and resilience in infertile couples. MATERIALS AND METHODS: This was a cross-sectional study that was conducted in 2020 on 162 infertile couples referring to infertility centers in Isfahan who met the inclusion criteria. Samples were selected by convenience sampling method. Information was gathered using a questionnaire consists of three parts: demographic and fertility characteristics, spiritual intelligence, and resilience. Data were analyzed using descriptive and inferential statistical methods (t-test, Pearson's correlation coefficient, and Chi-square). P < 0.05 was considered statistically significant. RESULTS: Pearson's correlation coefficient showed that there was no significant relationship between resilience score and spiritual intelligence score with age, duration of marriage, and duration of treatment (P > 0.05). There was no significant relationship between resilience score and spiritual intelligence score and its dimensions with the level of education and economic status of the family (P > 0.05). CONCLUSIONS: There was no significant relationship between demographic and fertility factors with spiritual intelligence and resilience.