Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of a dietary self‐management programme for community‐dwelling older adults: a quasi‐experimental design

RATIONALE Nutritional health plays a crucial role in determining successful ageing and differs by different living area. Although nutritional interventions have long been advocated, little research has directly assessed the effectiveness of nutritional interventions on community-dwelling older adults in urban and rural areas and compared intervention effects on these two populations. AIMS AND OBJECTIVES To examine the effectiveness of a 12-week dietary self-management programme for salt-, fluid-, fat- and cholesterol-intake behaviours of community-dwelling older adults and to compare these effects in rural- and urban-dwelling older adults. METHODS For this quasi-experimental two-group study, older adults (≥65 years old) were recruited from two randomly selected public health centres in a rural north-eastern county and a northern city of Taiwan from January through December 2011. Outcomes included nutritional status, nutritional self-efficacy and health locus of control. Data were collected at baseline and 12 weeks later. To compare changes in outcome variables over time between the control (usual care) and intervention (nutritional programme) groups and between the urban- and rural-dwelling participants in the experimental group, we used generalised estimating equation analysis. RESULTS Of the 129 participants, 120 completed this study (58 in the intervention group and 62 in the control group). After 12 weeks, the intervention group had significantly better nutritional status and higher internal health locus of control than the control group. Moreover, older rural participants who received the intervention tended towards higher nutritional self-efficacy and internal health locus of control than their urban counterparts. CONCLUSIONS Our research findings support the positive effect of our nutritional self-management programme for community-dwelling older adults. The knowledge gained from this study can help stakeholders recognise the need for healthcare policy to establish effective strategies and sustainable intervention programmes for this population, especially those living in rural areas.
Attempted suicide in the elderly in England: age-associated rates, time trends and methods

ABSTRACT Background: Critical study of attempted suicides may allow greater understanding of completed suicides because of the considerable overlap between attempted and completed suicides in the elderly. Methods: Age-associated rates (60–74 years versus 75+ years), trends over time and methods of attempted suicide in the elderly in England were examined using recently collected national data for a nine-year period. Results: The rate of attempted suicides in the 60–74 years age-band increased over the nine-year study period. Rates of intentional self-poisoning by and exposure to non-opiod analgesics, antipyretics and antirheumatics, intentional self-poisoning by and exposure to narcotics and psychodysleptics and intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system increased over the nine-year study period in both elderly age-bands. The rates and the frequency of intentional self-poisoning by and exposure to non-opiod analgesics, antipyretics and antirheumatics and intentional self-harm by sharp objects were higher in the 75+ years age-band compared to the 60–74 years age-band. The rates and frequency of intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system, intentional self-poisoning by and exposure to alcohol and intentional self-harm by smoke, fire and flames were higher in the 60–74 year age-band compared to the 75+ years age-band. Conclusions: There is a need to develop strategies to reduce access to targetted methods of attempted suicide in elderly that are most prevalent and increasing over time.
Screening for HIV-1 antibodies in pregnancy: results from the Swedish national programme.

OBJECTIVE--To determine the effectiveness of a national screening programme for HIV infection in pregnant women. DESIGN--Observational study. SUBJECTS--All pregnant women presenting to antenatal or abortion clinics. SETTING--Sweden, September 1987 to December 1991. MAIN OUTCOME MEASURES--Number and characteristics of infected women. RESULTS--By the end of the study period 510,000 tests had been performed and 54 women with HIV infection identified (1.06/10,000). Of the 33 women identified in Stockholm, 14 women (4.4/10,000) had attended abortion clinics and 19 antenatal clinics (1.8/10,000; p < 0.05). Three women had been intravenous drug users, one was infected through a blood transfusion, and 50 were probably infected sexually. Of the 20 women who attended antenatal clinics early enough to allow an abortion, 12 continued with their pregnancies. CONCLUSIONS--Testing of all women, not just those perceived to be at risk, probably contributed to the high uptake of HIV testing. With high uptake such screening provides valuable data on spread of HIV in the heterosexual population and presents opportunity for preventing transmission of HIV to children and partners.
Gluteus Medius: Applied Anatomy, Dysfunction, Assessment, and Progressive Strengthening

ONE OF THE MORE COMMON DEFICITS IDENTIFIED BY REHABILITATION SPECIALISTS AND STRENGTH AND CONDITIONING PRACTITIONERS IS WEAKNESS OF THE GLUTEI MUSCLES, PARTICULARLY THE GLUTEUS MEDIUS (GM). GLUTEAL WEAKNESS CAN REDUCE ATHLETIC PERFORMANCE AND PRECIPITATE A NUMBER OF LOWER EXTREMITY INJURIES. IN THIS ARTICLE, WE DISCUSS THE ANATOMY AND FUNCTION OF THE GM MUSCULATURE, PRESENT A REVIEW OF THE CURRENT LITERATURE PERTAINING TO GM CONDITIONING, AND RECOMMEND AN EXERCISE MODEL BASED ON CURRENT STRENGTHENING GUIDELINES.
Original Contribution Prospective Study of Ultraviolet Radiation Exposure and Mortality Risk in the United States

Geographic variations in mortality rate in the United States could be due to several hypothesized factors, one of which is exposure to solar ultraviolet radiation (UVR). Limited evidence from previous prospective studies has been inconclusive. The association between ambient residential UVR exposure and total and cause-specific mortality risks in a regionally diverse cohort (346,615 white, non-Hispanic subjects, 50–71 years of age, in the National Institutes of Health (NIH)–AARP Diet and Health Study) was assessed, with accounting for individual-level confounders. UVR exposure (averaged for 1978–1993 and 1996–2005) from NASA’s Total Ozone Mapping Spectrometer was linked to the US Census Bureau 2000 census tract of participants’ baseline residence. Multivariateadjusted Cox proportional-hazards models were used to estimate hazard ratios and 95% confidence intervals. Over 12 years, UVR exposure was associated with total deaths (n = 41,425; hazard ratio for highest vs. lowest quartiles (HRQ4 vs. Q1) = 1.06, 95% confidence interval (CI): 1.03, 1.09; Ptrend < 0.001) and with deaths (all Ptrend < 0.05) due to cancer (HRQ4 vs. Q1 = 1.06, 95% CI: 1.02, 1.11), cardiovascular disease (HRQ4 vs. Q1 = 1.06, 95% CI: 1.00, 1.12), respiratory disease (HRQ4 vs. Q1 = 1.37, 95% CI: 1.21, 1.55), and stroke (HRQ4 vs. Q1 = 1.16, 95% CI: 1.01, 1.33) but not with deaths due to injury, diabetes, or infectious disease. These results suggest that UVR exposure might not be beneficial for longevity.
Systematic Reviews and Meta- and Pooled Analyses Cigarette, Cigar, and Pipe Smoking and the Risk of Head and Neck Cancers: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium

Cigar and pipe smoking are considered risk factors for head and neck cancers, but the magnitude of effect estimates for these products has been imprecisely estimated. By using pooled data from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium (comprising 13,935 cases and 18,691 controls in 19 studies from 1981 to 2007), we applied hierarchical logistic regression to more precisely estimate odds ratios and 95% confidence intervals for cigarette, cigar, and pipe smoking separately, compared with reference groups of those who had never smoked each single product. Odds ratios for cigar and pipe smoking were stratified by ever cigarette smoking. We also considered effect estimates of smoking a single product exclusively versus never having smoked any product (reference group). Among never cigarette smokers, the odds ratio for ever cigar smoking was 2.54 (95% confidence interval (CI): 1.93, 3.34), and the odds ratio for ever pipe smoking was 2.08 (95% CI: 1.55, 2.81). These odds ratios increased with increasing frequency and duration of smoking ( P trend ≤ 0.0001). Odds ratios for cigar and pipe smoking were not elevated among ever cigarette smokers. Head and neck cancer risk was elevated for those who reported exclusive cigar smoking (odds ratio = 3.49, 95% CI: 2.58, 4.73) or exclusive pipe smoking (odds ratio = 3.71, 95% CI: 2.59, 5.33). These results suggest that cigar and pipe smoking are independently associated with increased risk of head and neck cancers.
L‐Carnitine Supplementation in Dialysis: Treatment in Quest of Disease

L‐Carnitine (LC) administration has been recommended for specific indications in dialysis patients, including epoetin‐resistant anemia, intradialytic hypotension, cardiomyopathy, fatigue, muscle weakness, and exercise performance; it may ameliorate insulin resistance, inflammation, and protein wasting. Use of LC for anemia and intradialytic hypotension has been approved for reimbursement by the Centers for Medicare and Medicaid Services. Yet, the data to support these recommendations are inadequate and have not been bolstered over several decades. LC administration continues to appeal to nephrologists because its use in dialysis patients has an attractive rationale, it addresses problems that persist despite dialysis, it is safe, and the existing literature does not refute its use. Nevertheless, definitive trials to justify LC administration have not been conducted and are increasingly unlikely to be funded. In an era of shrinking resources and bundling of dialysis services, the use of LC in dialysis patients will, appropriately, diminish.
Evaluating patient capacity for medical decision making: Individual and interpersonal dimensions.

Patients' decision-making capacity is a common concern in acute-care settings, particularly when patients refuse recommended treatment. Competence, the legal analogue of decisional capacity, is often misunderstood. Common misconceptions include a view that medical decision making is a global and permanent condition determined by psychiatrists. The role of the family in deciding capacity has also been an arbitrary issue. Basic dimensions of patients' decisional capacity include choice fulness, understanding, and applying medical information to one's own condition, as well as internally consistent reasoning, which may include value and religious dimensions. Clinical capacity interviews should focus on these basic dimensions.
Helping Adolescents with Greater Psychosocial Needs: Evaluation of a Positive Youth Development Program

The Tier 2 Program of the Project P.A. T.H. S. (Positive Adolescent Training through Holistic Social Programmes), designed and implemented primarily by school social workers, attempts to help adolescents with greater psychosocial needs. After completion of the Tier 2 Program in the Full Implementation Phase (2006/07 school year), 10,255 Secondary 1 students in 207 schools responded to the Subjective Outcome Evaluation Form (Form C) to assess their views of the program, instructors, and perceived effectiveness of the program. Results showed that high proportions of the respondents had positive perceptions of the program and the instructors, and roughly four-fifths of the respondents regarded the program as helpful to them. Pearson correlation analyses showed that perceptions of the program and instructors were significantly correlated with perceived effectiveness of the program. Participants who joined volunteer training activities generally had higher global subjective outcome evaluation scores than did participants who attended programs without volunteer training activities.
The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70–90 years

ABSTRACT Background: The Sydney Memory and Ageing Study (Sydney MAS) was initiated in 2005 to examine the clinical characteristics and prevalence of mild cognitive impairment (MCI) and related syndromes, and to determine the rate of change in cognitive function over time. Methods: Non-demented community-dwelling individuals (N = 1037) aged 70–90 were recruited from two areas of Sydney, following a random approach to 8914 individuals on the electoral roll. They underwent detailed neuropsychiatric and medical assessments and donated a blood sample for clinical chemistry, proteomics and genomics. A knowledgeable informant was also interviewed. Structural MRI scans were performed on 554 individuals, and subgroups participated in studies of falls and balance, metabolic and inflammatory markers, functional MRI and prospective memory. The cohort is to be followed up with brief telephone reviews annually, and detailed assessments biannually. Results: This is a generally well-functioning cohort mostly living in private homes and rating their health as being better than average, although vascular risk factors are common. Most (95.5%) participants or their informants identified a cognitive difficulty, and 43.5% had impairment on at least one neuropsychological test. MCI criteria were met by 34.8%; with19.3% qualifying for amnestic MCI, whereas 15.5% had non-amnestic MCI; 1.6% had impairment on neuropsychological test performance but no subjective complaints; and 5.8% could not be classified. The rate of MCI was 30.9% in the youngest (70–75) and 39.1% in the oldest (85–90) age bands. Rates of depression and anxiety were 7.1% and 6.9% respectively. Conclusions: Cognitive complaints are common in the elderly, and nearly one in three meet criteria for MCI. Longitudinal follow-up of this cohort will delineate the progression of complaints and objective cognitive impairment, and the determinants of such change.
Risk of progression from mild memory impairment to clinically diagnosable Alzheimer's disease in a Japanese community (from the Nakayama Study)

ABSTRACT Background: Memory impairment has been proposed as the most common early sign of Alzheimer's disease (AD). The aims of this work were to evaluate the risk of progression from mild memory impairment/no dementia (MMI/ND) to clinically diagnosable AD in a community-based prospective cohort and to establish the risk factors for progression from MMI/ND to AD in the elderly. Methods: Elderly subjects aged over 65 years were selected from the participants in the first Nakayama study. MMI/ND was defined as memory deficit on objective memory assessment, without dementia, impairment of general cognitive function, or disability in activities of daily living. A total of 104 MMI/ND subjects selected from 1242 community-dwellers were followed longitudinally for five years. Results: During the five-year follow-up, 11 (10.6%) subjects were diagnosed with AD, five (4.8%) with vascular dementia (VaD), and six (5.8%) with dementia of other etiology. Logistic regression analysis revealed that diabetes mellitus (DM) and a family history of dementia (within third-degree relatives) were positively associated with progression to AD, while no factor was significantly associated with progression to VaD or all types of dementia. Conclusions: DM and a family history of dementia were significant risk factors for progression from MMI/ND to clinically diagnosable AD in the elderly in a Japanese community.
Prevalence, incidence and risk factors of paratonia in patients with dementia: a one-year follow-up study

ABSTRACT Background: Paratonia is a progressive motor problem that is observed in individuals with dementia and is not a well-known phenomenon. This study explores the development and risk factors of paratonia in moderate stage dementia patients. Methods: A multi-center, longitudinal, one-year follow-up cohort study was performed. Patients with an established diagnosis of dementia, with a score of 6 or lower on the Global Deterioration Scale (GDS) were included. The participants were assessed using the Paratonia Assessment Instrument (PAI), the Timed Up and GO test, the Qualidem, the Global Deterioration Scale (Reisberg et al., 1982) and the Mini-mental State Examination. Information about each patient's diagnosis of dementia, comorbidities and use of medication were obtained from the participant's medical file. The PAI was assessed every three months, the other variables at baseline and after 12 months. Cross-tabulation χ2 and logistic regression tests were used for the statistical analyses. Results: Baseline measures were assessed in the 204 participants – 111 (54%) female and 93 (46%) male, with a mean age of 79.8 years (56–97). Seventy-one patients (34.8%) were diagnosed with paratonia at baseline, and 51 patients developed paratonia over one year. The highest hazard ratio (3.1) for developing paratonia within one year was observed in the vascular dementia group. The logistic regression analysis revealed that the presence of diabetes mellitus (OR = 10.7) was significantly related to the development of paratonia (Wald χ2 p-value < 0.01). Conclusions: Diabetes mellitus and likely vascular damage are risk factors for the development of paratonia.
Elderly suicide attempters by self-poisoning in Korea

ABSTRACT Background: Suicide is a major public health concern. The elderly have the highest rate of suicide and they make more lethal suicide attempts and have fewer psychiatric interventions than young people. Furthermore, they have old-age specific psychosocial difficulties. The present study investigated psychosocial risk factors and characteristics of an index suicide attempt of the elderly suicide attempters. Methods: Subjects included 388 patients who were admitted to the emergency room following self-poisoning. Two age groups were defined: younger patients (aged less than 65 years) and older patients (aged over 65 years). Data including demographic factors, suicidal risk factors and information about the current suicide attempt were obtained from a retrospective chart review. Results: The number of suicide attempters over the age of 65 years old was 57, and their mean age was 73.5 ± 7.5 years. The elderly patients had more underlying medical illnesses than the under-65 group (p < 0.001). Depression was the most common psychiatric diagnosis. Psychotropics were the most commonly ingested drugs in both groups, but the use of pesticides was more notable in the elderly. The elderly suicide attempters had higher risk-rating scores (p < 0.001) and lower rescue-rating scores (p = 0.014) than the under-65 group. Male-to-female ratio of the elderly group was nearly 1:1 unlike the under-65 group (p = 0.004). Conclusion: Elderly suicide attempters had different psychosocial stressors such as physical illness and more lethal suicide attempts. Our study suggests the need for development of specific preventive strategies and management guidelines for the elderly suicide attempters.
Development of a method for quantifying cognitive ability in the elderly through adaptive test administration

ABSTRACT Background: The field of geriatric medicine has identified a need for an evaluative tool that can rapidly quantify global cognitive ability and accurately monitor change over time in patients with a wide range of impairments. We hypothesized that the development of an adaptive test approach to cognitive measurement would help to meet that need. This study aimed to provide evidence for the interpretability of scores obtained from a novel, adaptive approach to cognitive assessment, called the Geriatric Rapid Adaptive Cognitive Estimate (GRACE) method. Methods: An adaptive method for cognitive assessment was developed using data from 185 patients referred for geriatric cognitive assessment, and pilot tested in an additional 137 patients. Correlations between test scores and between rank orders of patients were computed to examine the reliability and validity of cognitive ability scores obtained by (1) administering test questions out of their usual order, (2) administering only a subset of questions, and (3) administering questions adaptively using simplified selection rules based on the most difficult question passed. Results: Cognitive ability scores obtained with the GRACE method correlated highly with the Montreal Cognitive Assessment (MoCA) scores (r = 0.93) and ranked patients similarly in order of ability (r > 0.87). A simplified adaptive testing algorithm for pencil-and-paper assessment demonstrated moderately high correlations with scores obtained from administering the full set of MMSE and MoCA items as well as the MoCA items alone. Conclusions: Scores from the GRACE method can be obtained easily in 5–10 minutes, reducing test burden. The resulting numeric score quantifies cognitive ability, allowing clinicians to compare patients and monitor change in global cognition over time. The adaptive nature of this method allows for evaluation of persons across a broader range of cognitive ability levels than currently available tests.
The Elderly are Different: Initiating Dialysis in Frail Geriatric Patients

Decisions and discussions about the initiation of dialysis in the elderly are often challenging because of the high prevalence of comorbidities and frailty in this population. Mortality is high, functional decline is likely, and quality of life tends to be lower in the elderly on dialysis. It is thus important to counsel these patients on the risks, benefits, and burdens of dialysis to assist them in making an informed choice that is in line with their goals, preferences, and expectations. For some patients, dialysis may be a desirable choice. For others, the alternative of palliative care may provide a more favorable balance of benefits versus burdens. Elderly patients who choose to proceed with dialysis often benefit from an interdisciplinary team that helps to manage and monitor their health status, while maximizing the benefits of treatment and decreasing its potential harms. These goals can be promoted by effective communication and through individualized decisions about vascular access, medication choices, and dietary limitations. Finally, close monitoring of functional status will help to determine whether dialysis remains in a patient's best interest and when alternatives should be offered.
Practice of Epidemiology Propensity Score Methods for Analyzing Observational Data Like Randomized Experiments: Challenges and Solutions for Rare Outcomes and Exposures

Randomized controlled trials are the “ gold standard ” for estimating the causal effects of treatments. However, it is often not feasible to conduct such a trial because of ethical concerns or budgetary constraints. We expand upon an approach to the analysis of observational data sets that mimics a sequence of randomized studies by implementing propensityscore models within each trial to achieve covariate balance, using weighting and matching. The methods are illustrated using data from a safety study of the relationship between second-generation antipsychotics and type 2 diabetes (outcome) in Medicaid-insured children aged 10 – 18 years across the United States from 2003 to 2007. Challenges in this data set include a rare outcome, a rare exposure, substantial and important differences between exposure groups, and a very large sample size. randomized