Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of Escitalopram on All-Cause Mortality and Hospitalization in Patients With Heart Failure and Depression: The MOOD-HF Randomized Clinical Trial.

IMPORTANCE Depression is frequent in patients with heart failure and is associated with adverse clinical outcomes. Long-term efficacy and safety of selective serotonin reuptake inhibitors in these patients are unknown. OBJECTIVE To determine whether 24 months of treatment with escitalopram improves mortality, morbidity, and mood in patients with chronic systolic heart failure and depression. DESIGN, SETTING, AND PARTICIPANTS The Effects of Selective Serotonin Re-Uptake Inhibition on Morbidity, Mortality, and Mood in Depressed Heart Failure Patients (MOOD-HF) study was a double-blind, placebo-controlled randomized clinical trial conducted at 16 tertiary medical centers in Germany. Between March 2009 and February 2014, patients at outpatient clinics with New York Heart Association class II-IV heart failure and reduced left ventricular ejection fraction (<45%) were screened for depression using the 9-item Patient Health Questionnaire. Patients with suspected depression were then invited to undergo a Structured Clinical Interview based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to establish the diagnosis. INTERVENTIONS Patients were randomized 1:1 to receive escitalopram (10-20 mg) or matching placebo in addition to optimal heart failure therapy. Study duration was 24 months. MAIN OUTCOMES AND MEASURES The composite primary outcome was time to all-cause death or hospitalization. Prespecified secondary outcomes included safety and depression severity at 12 weeks of treatment (including the titration period), which were determined using the 10-item Montgomery-Åsberg Depression Rating Scale (total possible score, 0 to 60; higher scores indicate more severe depression). RESULTS A total of 372 patients (mean age, 62 years; 24% female) were randomized and had taken at least 1 dose of study medication when the data and safety monitoring committee recommended the trial be stopped early. During a median participation time of 18.4 months (n = 185) for the escitalopram group and 18.7 months (n = 187) for the placebo group, the primary outcome of death or hospitalization occurred in 116 (63%) patients and 119 (64%) patients, respectively (hazard ratio, 0.99 [95% CI, 0.76 to 1.27]; P = .92). The mean Montgomery-Åsberg Depression Rating Scale sum score changed from 20.2 at baseline to 11.2 at 12 weeks in the escitalopram group and from 21.4 to 12.5 in the placebo group (between-group difference, -0.9 [95% CI,-2.6 to 0.7]; P = .26). Safety parameters were comparable between groups. CONCLUSIONS AND RELEVANCE In patients with chronic heart failure with reduced ejection fraction and depression, 18 months of treatment with escitalopram compared with placebo did not significantly reduce all-cause mortality or hospitalization, and there was no significant improvement in depression. These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN33128015.
Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis.

IMPORTANCE Between 40% and 50% of women in Western countries use complementary therapies to manage menopausal symptoms. OBJECTIVE To determine the association of plant-based therapies with menopausal symptoms, including hot flashes, night sweats, and vaginal dryness. DATA SOURCES The electronic databases Ovid MEDLINE, EMBASE, and Cochrane Central were systematically searched to identify eligible studies published before March 27, 2016. Reference lists of the included studies were searched for further identification of relevant studies. STUDY SELECTION Randomized clinical trials that assessed plant-based therapies and the presence of hot flashes, night sweats, and vaginal dryness. DATA EXTRACTION Data were extracted by 2 independent reviewers using a predesigned data collection form. MAIN OUTCOMES AND MEASURES Hot flashes, night sweats, and vaginal dryness. RESULTS In total, 62 studies were identified, including 6653 individual women. Use of phytoestrogens was associated with a decrease in the number of daily hot flashes (pooled mean difference of changes, -1.31 [95% CI, -2.02 to -0.61]) and vaginal dryness score (pooled mean difference of changes, -0.31 [95% CI, -0.52 to -0.10]) between the treatment groups but not in the number of night sweats (pooled mean difference of changes, -2.14 [95% CI, -5.57 to 1.29]). Individual phytoestrogen interventions such as dietary and supplemental soy isoflavones were associated with improvement in daily hot flashes (pooled mean difference of changes, -0.79 [-1.35 to -0.23]) and vaginal dryness score (pooled mean difference of changes, -0.26 [-0.48 to -0.04]). Several herbal remedies, but not Chinese medicinal herbs, were associated with an overall decrease in the frequency of vasomotor symptoms. There was substantial heterogeneity in quality across the available studies, and 46 (74%) of the included randomized clinical trials demonstrated a high risk of bias within 3 or more areas of study quality. CONCLUSIONS AND RELEVANCE This meta-analysis of clinical trials suggests that composite and specific phytoestrogen supplementations were associated with modest reductions in the frequency of hot flashes and vaginal dryness but no significant reduction in night sweats. However, because of general suboptimal quality and the heterogeneous nature of the current evidence, further rigorous studies are needed to determine the association of plant-based and natural therapies with menopausal health.
Getting Answers We Can Believe In: Methodological Considerations When Using Electronic Clinical Data for Research

The increasing availability of electronic clinical data (ECD) may present opportunities to answer research questions that can drive improvement in patient outcomes. This brief outlines important research design considerations when using ECD for comparative effectiveness research (CER) and patient-centered outcomes research (PCOR). A practical orientation to study designs is provided to encourage consideration of which methods are best suited to answer particular research and quality improvement (QI) questions using ECD, and ways of making information obtained from ECD more useful in the clinical setting are suggested. Differences between observational studies and randomized controlled trials (RCTs) are outlined, and specific challenges of each are discussed. Promising study design and analytic approaches that can be used with observational ECD for CER and considerations for each are addressed.
Association of strength with patellar tendinopathy in female runners

Muscle weakness and muscle imbalance may lead to musculotendinous injuries since the energy absorption capacity of the affected muscle tendon unit is reduced. The purpose of this study was to investigate the maximum strength and strength endurance of the thigh musculature in healthy female runners (F: n = 26) and female runners suffering from patellar tendinopathy (PT: n = 20). Isokinetic strength measurements were recorded in a seated position. Primary outcome variables were maximum concentric and eccentric peak torque (at 60°/s) and concentric hamstrings-quadriceps-quotient (HQQ). Secondary outcome variables were relative peak torques [Nm/kilogram] and eccentric endurance quotient calculated as the ratio of muscle strength at the end of a 1-minute exercise compared to at the beginning of the exercise period. The primary outcome variables were analyzed using Student's t-test for each measure (a = 0.05). Secondary outcome variables were qualified descriptively. The results showed no statistically significant differences between injured and healthy female runners in concentric and eccentric peak torque or HQQ. Secondary outcome variables also failed to show inter-group differences. We therefore conclude that these variables are not relevant with respect to PT in female runners.
Do the Obese Really Die Younger or Do Health Expenditures Buy Them Extra Years?

A recent debate in the medical literature has arisen around the mortality effects of obesity. Whereas it has been argued that the obese die younger, the data that have become available do not immediately support this. This potentially undermines the hypothesis that modern life with its physical ease and cheap food would eventually make us die younger, and undermines the notion that economic growth comes with health warnings. We revisit this debate going over the mortality effects of obesity, using the US Health and Retirement Study. Whilst we find that obesity leads to chronic diseases that reduce length of life, we also find that the obese survive strokes and lung disease more often than the non-obese. A possible explanation is that the obese are under greater medical scrutiny, meaning that lung disease is more quickly diagnosed. This result holds when controlling for smoking and the long-term effects of obesity.
Serum 25-Hydroxyvitamin D, Plasma Klotho, and Lower-Extremity Physical Performance Among Older Adults: Findings From the InCHIANTI Study.

BACKGROUND The hormone klotho is encoded by aging-suppressor gene klotho and has multiple roles, including regulating mineral (calcium and phosphate) homeostasis. Vitamin D also regulates mineral homeostasis and upregulates klotho expression. Klotho positively relates to longevity, upper-extremity strength, and reduced disability in older adults; however, it is unknown whether circulating klotho relates to lower-extremity physical performance or whether the relation of vitamin D with physical performance is mediated by klotho. METHODS Klotho and 25-hydroxyvitamin D [25(OH)D] were measured in 860 participants aged ≥ 55 years in Invecchiare in Chianti, "Aging in Chianti" (InCHIANTI), a prospective cohort study comprising Italian adults. Lower-extremity physical performance was measured using the Short Physical Performance Battery, a summary score of balance, chair stand ability, and walking speed. Weighted estimating equations related plasma klotho and serum 25(OH)D concentrations measured at one visit to Short Physical Performance Battery measured longitudinally at multiple visits. RESULTS Each additional natural log of klotho (pg/mL) was associated with 0.47 higher average Short Physical Performance Battery scores (95% confidence interval: 0.08 to 0.86, p value = .02) after adjustment for covariates, including 25(OH)D. Each natural log of 25(OH)D (ng/mL) was associated with 0.61 higher average Short Physical Performance Battery scores (95% confidence interval: 0.35 to 0.88, p value < .001) after adjustment for covariates, a result that changed little after adjustment for klotho. CONCLUSIONS Plasma klotho and 25(OH)D both positively related to lower-extremity physical performance. However, the findings did not support the hypothesis that klotho mediates the relation of 25(OH)D with physical performance.
Current trends in biobanking for rare diseases: a review

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress. com/permissions.php Journal of Biorepository Science for Applied Medicine 2014:2 49–61 Journal of Biorepository Science for Applied Medicine Dovepress
Control and Innervation of Skeletal Muscle.

This volume is based on a symposium that was held in 1965 at the University of St. Andrews, to coincide with the visit to Queens College of Carlos Eyzaguirre, Professor of Physiology at the University of Utah. Eyzaguirre gave a report on "Properties of Intrafusal Muscle Fibers of Amphibians and Mammals. " All but four of the other participants were from British institutions and the papers thus give a cross section of current studies in Great Britain. The subject matter of the 18 papers ranged from morphology to clinical pathophysiology. Some of the papers are only five or six pages long and none is longer than 18 pages. However, the material is well presented and in most cases there is a brief discussion by the participants. The book provides a useful summary of many aspects of muscle physiology and neurology.
High-intensity functional training improves functional movement and body composition among cancer survivors: a pilot study.

This pilot study investigated feasibility and preliminary efficacy of a high-intensity functional training (HIFT) group-exercise programme among adult cancer survivors within 5 years of last cancer treatment. Eight participants were assigned to a 5-week, 3 days/week HIFT intervention with four testing sessions and 12 workouts along with mobility and stretching exercises. Feasibility was assessed by initiation, adherence, and acceptability. Efficacy was determined by changes from baseline to post-test in health-related quality of life, body composition and functional movement. The recruitment rate was 80% and the adherence rate was 75%. Significant improvements were found for emotional functioning (P = 0.042) and body composition (lean mass +3.8 ± 2.1 kg, P = 0.008; fat mass -3.3 ± 1.0 kg, P = 0.001; body fat percentage -4.7 ± 1.2%, P < 0.001). Participants also significantly improved on five of seven functional movements: balance (P = 0.032), carrying a weighted object (P = 0.004), lower body strength and power (P = 0.009), aerobic capacity and endurance (P = 0.039), and perceived difficulty for flexibility (P = 0.012). Five weeks of HIFT training was well-received and feasible for most cancer survivors, and effective for improving emotional functioning, body composition and functional movement.
FNIH-defined Sarcopenia Predicts Adverse Outcomes Among Community-Dwelling Older People in Taiwan: Results From I-Lan Longitudinal Aging Study

Background To evaluate the predictive validity of sarcopenia defined by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project among Asian older adults. Methods Data of the I-Lan Longitudinal Aging Study were obtained for analysis. Overall, 1,839 community-dwelling people aged 50 years and older, capable of completing a 6-m walk, with life expectancy of more than 6 months, and not institutionalized at time of data collection were enrolled for study. Data for subjects aged 65 years and older were obtained for study. The outcome measures were all-cause mortality and a composite adverse outcome which includes hospitalizations, emergency department visits, institutionalization, and falls. Results Data of 728 eligible elderly participants (73.4 ± 5.4 years; 52.9% males) were analyzed. The prevalence of FNIH-diagnosed sarcopenia was 9.5%: 11.9% males; 6.7% females. Participants having FNIH-defined sarcopenia were considerably older, frailer, more obese, with poorer physical performance than nonsarcopenic subjects (All p < .001); during mean follow-up of 32.9 ± 8.8 months, they also had 3.8 times higher risk of dying, independent of age, sex, multimorbidity, cognitive function, and nutritional status (hazard ratio = 3.8; 95% confidence interval = 1.26-11.45; p = .018). Moreover, sarcopenia defined by grip strength-BMI ratio (WeakBMI) showed stronger association with composite adverse outcomes than traditional handgrip strength (hazard ratio = 1.99; 95% confidence interval = 1.01-3.93; p = .047 vs hazard ratio = 1.80; 95% confidence interval = 0.89-3.62; p = .102 in fully-adjusted model). Conclusion Among community-dwelling older people in Taiwan, participants with FNIH-defined sarcopenia had a significantly greater risk of all-cause mortality and composite falls, emergency department visits, institutionalization, and hospitalization.
Delirium in Older Persons: Advances in Diagnosis and Treatment

Importance Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual’s function and quality of life, as well as broad societal effects with substantial health care costs. Objective To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field. Evidence Review Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non–English-language articles were excluded. Findings Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment; 4 A’s Test; and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method–Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies. Conclusions and Relevance Advances in diagnosis can improve recognition and risk stratification of delirium. Prevention of delirium using nonpharmacologic approaches is documented to be effective, while pharmacologic prevention and treatment of delirium remains controversial.
The molecular and serological detection of Chlamydia trachomatis in women with reproductive abnormalities

The primary aim of this study was to evaluate the role of C. trachomatis in women with ectopic pregnancy (EP), miscarriage and tubal factor infertility (TFI) using PCR, non- isotopic in situ hybridization (NISH) and serology when compared to controls. Also, the influence of polymorphisms in the TNF gene were investigated in a pilot study to determine if there was an association between chlamydial infection and the development of tubal pathology. The primary study included patients from the UK and Trinidad. A secondary study was also conducted to assess the impact of anti-chlamydial IgG on ovarian response to gonadotropin stimulation prior to in vitro fertilization (IVF). Significant levels of anti-chlamydial IgG were found in the UK patients presenting with TFI, and a similar association was seen in the Trinidad EP group. In the case of miscarriage the detection of anti-chlamydial antibody was not significant. The IVF study showed that women undergoing IVF, who also detectable levels of anti-chlamydial IgG were statistically more likely to respond poorly to gonadotropin ovarian stimulation prior to IVF. The presence of chlamydial DNA, as determined by both PCR and ISH was significant in the UK TFI group. There was an increased detection of chlamydial DNA in both EP groups, although this association was found not to be significant. Statistically the presence of chlamydial DNA in the Trinidad miscarriage group was not suggestive of a role for C. trachomatis in the development of this condition. Within the EP and TFI groups investigated, the presence of either anti-chlamydial IgG or chlamydial DNA was suggestive of tubal damage. In the case of the EP patients, a large number of patients had detectable levels of anti-chlamydial IgM and/or chlamydial DNA in serum and tissue samples respectively; whereas in the TFI group there was increased detection of anti-chlamydial IgG and/ or chlamydial DNA. From theses data it is proposed that EP is positively associated with a concurrent C. trachomatis infection of the genital tract as supported by both serological evidence, and the detection of chlamydial DNA in genital specimens. In the case of tubal damage found in TFI patients the presence of anti-chlamydial IgG and/ or chlamydial DNA suggests that this condition is associated with a repeated past/persistent C. trachomatis infection as opposed to a current genital chlamydial infection
How "successful" do older Europeans age? Findings from SHARE.

OBJECTIVES We estimate comparable prevalence estimates of "successful aging" for 14 European countries and Israel, adding a new cross-nationally comparative perspective to recently published findings for the United States. METHODS Measures for a variety of specific successful aging criteria were derived from baseline interviews of respondents aged 65+ who participated in the Survey of Health, Ageing, and Retirement in Europe (n=21,493). A multivariate logistic model was run for our global successful aging measure. RESULTS Our analysis revealed substantial cross-country variation around a mean value of 8.5%: Although as many as 21.1% of older Danes meet our successful aging criteria, the respective proportion in Poland is only 1.6%. Age, gender, and socioeconomic status are shown to bear highly significant associations with individuals' odds of successful aging. DISCUSSION The observed cross-national variation in successful aging-which continues to exist if population composition is controlled for-highlights the importance of taking into consideration structural factors at the societal level. It also suggests a potential for policy interventions supporting individuals' opportunities for successful aging.
Bereavement-related regret trajectories among widowed older adults.

OBJECTIVES Although regrets and unfinished business with a deceased spouse are frequently discussed as crucial determinants of one's postloss adjustment, there have been few empirical investigations of bereavement-related regrets. This present study aimed to investigate the longitudinal course of these regrets and their correlates among widowed older adults. METHODS Drawing upon information from 201 widowed older adults in the Changing Lives of Older Couples study, this present study used latent class growth analysis to identify unique longitudinal trajectories of regret from 6 to 48 months postloss and examine differences between these trajectories with regard to grief and depressive symptomatology. RESULTS Three distinct bereavement-related regret trajectories were identified, characterized by Stable Low Regret, Stable High Regret, and Worsening High Regret. Results revealed that those in the Worsening High Regret group, whose bereavement-related regrets were exacerbated during the study, had the poorest grief outcomes. No differences were observed between these groups with regard to depressive symptoms, indicating that regret may be a unique marker of difficulties in the grieving process. DISCUSSION These findings highlight the importance of periodically reassessing bereavement-related regrets (and perhaps other aspects of the continued relationship with the deceased) over time and support the rationale behind interventions designed to facilitate resolution of these issues.