Miracle-dz/UniFAR-FTUs huggingface dataset:
Thyroid status, cardiovascular risk, and mortality in older adults.

CONTEXT Previous studies have suggested that subclinical abnormalities in thyroid-stimulating hormone levels are associated with detrimental effects on the cardiovascular system. OBJECTIVE To determine the relationship between baseline thyroid status and incident atrial fibrillation, incident cardiovascular disease, and mortality in older men and women not taking thyroid medication. DESIGN, SETTING, AND PARTICIPANTS A total of 3233 US community-dwelling individuals aged 65 years or older with baseline serum thyroid-stimulating hormone levels were enrolled in 1989-1990 in the Cardiovascular Health Study, a large, prospective cohort study. MAIN OUTCOME MEASURES Incident atrial fibrillation, coronary heart disease, cerebrovascular disease, cardiovascular death, and all-cause death assessed through June 2002. Analyses are reported for 4 groups defined according to thyroid function test results: subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism. RESULTS Individuals with overt thyrotoxicosis (n = 4) were excluded because of small numbers. Eighty-two percent of participants (n = 2639) had normal thyroid function, 15% (n = 496) had subclinical hypothyroidism, 1.6% (n = 51) had overt hypothyroidism, and 1.5% (n = 47) had subclinical hyperthyroidism. After exclusion of those with prevalent atrial fibrillation, individuals with subclinical hyperthyroidism had a greater incidence of atrial fibrillation compared with those with normal thyroid function (67 events vs 31 events per 1000 person-years; adjusted hazard ratio, 1.98; 95% confidence interval, 1.29-3.03). No differences were seen between the subclinical hyperthyroidism group and euthyroidism group for incident coronary heart disease, cerebrovascular disease, cardiovascular death, or all-cause death. Likewise, there were no differences between the subclinical hypothyroidism or overt hypothyroidism groups and the euthyroidism group for cardiovascular outcomes or mortality. Specifically, individuals with subclinical hypothyroidism had an adjusted hazard ratio of 1.07 (95% confidence interval, 0.90-1.28) for incident coronary heart disease. CONCLUSION Our data show an association between subclinical hyperthyroidism and development of atrial fibrillation but do not support the hypothesis that unrecognized subclinical hyperthyroidism or subclinical hypothyroidism is associated with other cardiovascular disorders or mortality.
Clinical outcome after failure of hypomethylating therapy for myelodysplastic syndrome

Around half of patients with myelodysplastic syndrome (MDS) fail to respond to hypomethylating therapy (HMT) and most responders progress within 2 yr. Retrospective studies report poor outcomes after HMT failure. Here, we analyzed the outcomes of patients suffering HMT failure. Of 149 patients with MDS treated with either azacitidine or decitabine, 91 who experienced HMT failure were included in the study. Median overall survival (OS) was 12.1 months: 16.2 months for lower‐risk MDS and 9.3 months for higher‐risk MDS. Disease status and progression to acute myeloid leukemia (AML) at the time of HMT failure were independent prognostic factors for OS. Fifty‐four patients received one or more treatment modalities, and 23 received allogeneic hematopoietic cell transplantation (HCT). The objective response to non‐transplant treatments was poor (11–17%), whereas 17 transplanted patients showed a complete response. OS probability at 2 yr post‐HCT was 60.9%: 78.6% for patients receiving HCT during MDS and 33.3% for those receiving HCT after developing AML. In conclusion, the clinical outcome of patients after HMT failure was poor. Long‐term disease‐free survival was observed in approximately 50% of patients who received allogeneic HCT. Therefore, allogeneic HCT should be performed early in appropriate patients, and particularly before progression to AML.
Differences in Aspergillus‐specific immune recovery between T‐cell‐replete and T‐cell‐depleted hematopoietic transplants

After hematopoietic stem cell transplantation, invasive aspergillosis remains one of the most lethal infections. Susceptibility may be due to prophylaxis and treatment of graft‐vs.‐host disease in T‐cell‐replete transplants, and delayed immune rebuilding due to T‐cell depletion in haploidentical transplantation.
Music and Arts in Health Promotion and Death Education: The St Christopher’s Schools Project

The reality of death and dying is rarely discussed openly in modern Western societies, while death sometimes is even considered to be a ‘failure’ in the context of traditional, medically-focused healthcare systems. Similarly, loss and transition are part of the National School Curriculum in the UK, but many schools still find approaching these subjects difficult. In this context St Christopher’s hospice in London has initiated and delivered the ‘Schools Project’ since 2005. The St Christopher’s Schools Project is an innovative community arts programme. It takes the form of short-term collaborative arts projects between terminally ill patients and students from primary and secondary schools, as well as colleges within the hospice’s catchment area. The Schools Project has attracted the interest of many other hospices, as well as other healthcare institutions and inspired the development of similar projects, both nationally and internationally. The aim of the Schools Project is to introduce the hospice and its work to the school communities in a creative and non-threatening way. Within a structured framework students are given the opportunity to interact and engage in music and art making together with terminally ill patients, culminating in an exhibition or performance. Promoting healthier attitudes towards death and dying amongst the students, their teachers, school peers, parents and carers, is at the core of the project. This paper presents the philosophy and aims, as well as the process and outcomes, of the Schools Project. Additionally, an overview of all of the projects that have taken place at St Christopher’s since 2005, as well as some prospects for future development, are given. This will hopefully stimulate a constructive dialogue with regards to the potential role of hospices and the arts in the promotion of health and death education, as well as their potential impact on the development of sustainable healthcare policies and practices not only in palliative care, but also in other health and social care contexts.
Depression after childbirth : how to recognize, treat, and prevent postnatal depression

1. Introduction 2. The role of the hormones 3. Understanding the action of progesterone 4. The blues 5. Black depression 6. Endless exhaustion 7. Irrational irritability 8. Not tonight, darling 9. Psychosis 10. Infanticide and homicide 11. Tales of three mothers 12. Maternal behaviour in animals 13. Who is at risk? 14. Premenstrual syndrome 15. Treat the cause not the symptoms 16. Progesterone preventative treatment 17. Stress - can we ease it? 18. The medical team 19. The three hourly starch diet 20. Careers and motherhood 21. And fathers too 22. A way ahead Useful addresses Further reading Glossary
Salvage chemotherapy followed by granulocyte colony‐stimulating factor‐primed donor leukocyte infusion with graft‐vs.‐host disease control for minimal residual disease in acute leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation: prognostic factors and clinical

This study investigated the prognostic factors and clinical outcomes of preemptive chemotherapy followed by granulocyte colony‐stimulating factor‐primed donor leukocyte infusion (Chemo‐DLI) according to minimal residual disease (MRD) status in patients with acute leukemia and myelodysplastic syndromes who received allogeneic hematopoietic stem cell transplantation (HSCT) (n = 101). Patients received immunosuppressive drugs to prevent graft‐vs.‐host disease (GVHD) after Chemo‐DLI. The 3‐yr cumulative incidences of relapse, non‐relapse mortality, and disease‐free survival (DFS) after HSCT were 39.5%, 9.6%, and 51.7%, respectively. The cumulative incidences of relapse and DFS were significantly poorer in patients who exhibited early‐onset MRD. Forty‐four patients turned MRD negative 1 month after Chemo‐DLI; their cumulative incidences of relapse and DFS were significantly better than those with persistent MRD 1 month after preemptive Chemo‐DLI (relapse: 19.8% vs. 46.8%, P = 0.001; DFS: 69.6% vs. 46.4%, P = 0.004). The cumulative incidences of relapse and DFS after HSCT were significantly better in patients with chronic GVHD (cGVHD) than those without cGVHD (relapse: 19.6% vs. 63.7%, P < 0.001; DFS: 74.4% vs. 23.8%, P < 0.001). Early‐onset MRD, persistent MRD after Chemo‐DLI, and non‐cGVHD after Chemo‐DLI, which were associated with increased relapse and impaired DFS, suggest unsatisfactory response to preemptive Chemo‐DLI.
Internet-based drug treatment interventions : best practice and applications in EU member states

This report provides a comprehensive review of the relatively new phenomenon of Internet-based drug treatment interventions (DTI). It presents a sample of Internet-based DTI programmes across Europe and outlines their methodologies, providing a series of screenshots to further demonstrate the websites’ content and to provide an overall impression of the types of online treatment available. This publication is a useful resource for researchers, policymakers and the general public, to gain an insight into the potential for the Internet to become a new channel for drug treatment intervention Table of contents • Executive summary • Background • Methods • Findings • Outline of European Internet-based DTIs • Discussion • Future of Internet-based DTIs in the European Union
FLAMSA reduced‐intensity conditioning is equally effective in AML patients with primary induction failure as well as in first or second complete remission

Reduced‐intensity conditioning regimens have demonstrated lower toxicity but increased relapse rates in the context of allogeneic hematopoietic stem cell transplantation (aSCT) for patients with acute myelogenous leukemia (AML). The FLAMSA‐ reduced‐intensity conditioning (RIC) regimen, combining a cytoreductive and a transplant‐conditioning part, has been described to be efficacious in patients with refractory disease. We retrospectively analyzed clinical data of 130 patients with AML after aSCT following FLAMSA RIC at our center. The median follow‐up was 37 (10–125) months. The 4‐yr overall and disease‐free survival rates of the whole cohort were 45% and 40%. Cumulative incidence of relapse was 29%, 35%, and 40% at 1, 2, and 4 yr. There were no significant differences regarding overall and disease‐free survival for patients transplanted in CR1, CR2, or primary induction failure (PIF). Patients with refractory disease after salvage therapy had significantly lower disease‐free and overall survival (OS). Disease‐free and OS rates were also significantly decreased in patients with 10% or more BLASTS at transplant. non‐relapse mortality was 15%, 19%, and 20% at 1, 2, and 4 yr and similar in all cohorts. These data underscore the potency of the FLAMSA RIC regimen for patients with AML especially with PIF. The decision for re‐induction therapy prior to aSCT in relapsed patients has to be weighed against the potential toxicity of this approach and might be influenced by the amount of leukemic BLASTS present. Only randomised trials will answer this important question.
Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy

BACKGROUND Patients who have residual invasive carcinoma after the receipt of neoadjuvant chemotherapy for human epidermal growth factor receptor 2 (HER2)‐negative breast cancer have poor prognoses. The benefit of adjuvant chemotherapy in these patients remains unclear. METHODS We randomly assigned 910 patients with HER2‐negative residual invasive breast cancer after neoadjuvant chemotherapy (containing anthracycline, taxane, or both) to receive standard postsurgical treatment either with capecitabine or without (control). The primary end point was disease‐free survival. Secondary end points included overall survival. RESULTS The result of the prespecified interim analysis met the primary end point, so this trial was terminated early. The final analysis showed that disease‐free survival was longer in the capecitabine group than in the control group (74.1% vs. 67.6% of the patients were alive and free from recurrence or second cancer at 5 years; hazard ratio for recurrence, second cancer, or death, 0.70; 95% confidence interval [CI], 0.53 to 0.92; P=0.01). Overall survival was longer in the capecitabine group than in the control group (89.2% vs. 83.6% of the patients were alive at 5 years; hazard ratio for death, 0.59; 95% CI, 0.39 to 0.90; P=0.01). Among patients with triple‐negative disease, the rate of disease‐free survival was 69.8% in the capecitabine group versus 56.1% in the control group (hazard ratio for recurrence, second cancer, or death, 0.58; 95% CI, 0.39 to 0.87), and the overall survival rate was 78.8% versus 70.3% (hazard ratio for death, 0.52; 95% CI, 0.30 to 0.90). The hand‐foot syndrome, the most common adverse reaction to capecitabine, occurred in 73.4% of the patients in the capecitabine group. CONCLUSIONS After standard neoadjuvant chemotherapy containing anthracycline, taxane, or both, the addition of adjuvant capecitabine therapy was safe and effective in prolonging disease‐free survival and overall survival among patients with HER2‐negative breast cancer who had residual invasive disease on pathological testing. (Funded by the Advanced Clinical Research Organization and the Japan Breast Cancer Research Group; CREATE‐X UMIN Clinical Trials Registry number, UMIN000000843.)
Association of Changes in Diet Quality with Total and Cause‐Specific Mortality

BACKGROUND Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS We used Cox proportional‐hazards models to calculate adjusted hazard ratios for total and cause‐specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow‐up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986–1998) were assessed with the use of the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. RESULTS The pooled hazard ratios for all‐cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12‐year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20‐percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high‐quality diet over a 12‐year period, the risk of death from any cause was significantly lower — by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score — than the risk among participants with consistently low diet scores over time. CONCLUSIONS Improved diet quality over 12 years was consistently associated with a decreased risk of death. (Funded by the National Institutes of Health.)
Pembrolizumab as Second‐Line Therapy for Advanced Urothelial Carcinoma

Background Patients with advanced urothelial carcinoma that progresses after platinum‐based chemotherapy have a poor prognosis and limited treatment options. Methods In this open‐label, international, phase 3 trial, we randomly assigned 542 patients with advanced urothelial cancer that recurred or progressed after platinum‐based chemotherapy to receive pembrolizumab (a highly selective, humanized monoclonal IgG4κ isotype antibody against programmed death 1 [PD‐1]) at a dose of 200 mg every 3 weeks or the investigator's choice of chemotherapy with paclitaxel, docetaxel, or vinflunine. The coprimary end points were overall survival and progression‐free survival, which were assessed among all patients and among patients who had a tumor PD‐1 ligand (PD‐L1) combined positive score (the percentage of PD‐L1–expressing tumor and infiltrating immune cells relative to the total number of tumor cells) of 10% or more. Results The median overall survival in the total population was 10.3 months (95% confidence interval [CI], 8.0 to 11.8) in the pembrolizumab group, as compared with 7.4 months (95% CI, 6.1 to 8.3) in the chemotherapy group (hazard ratio for death, 0.73; 95% CI, 0.59 to 0.91; P=0.002). The median overall survival among patients who had a tumor PD‐L1 combined positive score of 10% or more was 8.0 months (95% CI, 5.0 to 12.3) in the pembrolizumab group, as compared with 5.2 months (95% CI, 4.0 to 7.4) in the chemotherapy group (hazard ratio, 0.57; 95% CI, 0.37 to 0.88; P=0.005). There was no significant between‐group difference in the duration of progression‐free survival in the total population (hazard ratio for death or disease progression, 0.98; 95% CI, 0.81 to 1.19; P=0.42) or among patients who had a tumor PD‐L1 combined positive score of 10% or more (hazard ratio, 0.89; 95% CI, 0.61 to 1.28; P=0.24). Fewer treatment‐related adverse events of any grade were reported in the pembrolizumab group than in the chemotherapy group (60.9% vs. 90.2%); there were also fewer events of grade 3, 4, or 5 severity reported in the pembrolizumab group than in the chemotherapy group (15.0% vs. 49.4%). Conclusions Pembrolizumab was associated with significantly longer overall survival (by approximately 3 months) and with a lower rate of treatment‐related adverse events than chemotherapy as second‐line therapy for platinum‐refractory advanced urothelial carcinoma. (Funded by Merck; KEYNOTE‐045 ClinicalTrials.gov number, NCT02256436.)
Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis.

CONTEXT More than a quarter of the human population is likely infected with soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) in highly endemic areas. Preventive chemotherapy is the mainstay of control, but only 4 drugs are available: albendazole, mebendazole, levamisole, and pyrantel pamoate. OBJECTIVE To assess the efficacy of single-dose oral albendazole, mebendazole, levamisole, and pyrantel pamoate against A lumbricoides, hookworm, and T trichiura infections. DATA SOURCES A systematic search of PubMed, ISI Web of Science, ScienceDirect, the World Health Organization library database, and the Cochrane Central Register of Controlled Trials (1960 to August 2007). STUDY SELECTION From 168 studies, 20 randomized controlled trials were included. DATA EXTRACTION AND DATA SYNTHESIS Information on study year and country, sample size, age of study population, mean infection intensity before treatment, diagnostic method used, time between evaluations before and after treatment, cure rate (the percentage of individuals who became helminth egg negative following treatment with an anthelminthic drug), egg reduction rate, adverse events, and trial quality was extracted. Relative risk, including a 95% confidence interval (CI), was used to measure the effect of the drugs on the risk of infection prevalence with a random-effects model. RESULTS Single-dose oral albendazole, mebendazole, and pyrantel pamoate for infection with A lumbricoides resulted in cure rates of 88% (95% CI, 79%-93%; 557 patients), 95% (95% CI, 91%-97%; 309 patients), and 88% (95% CI, 79%-93%; 131 patients), respectively. Cure rates for infection with T trichiura following treatment with single-dose oral albendazole and mebendazole were 28% (95% CI, 13%-39%; 735 patients) and 36% (95% CI, 16%-51%; 685 patients), respectively. The efficacy of single-dose oral albendazole, mebendazole, and pyrantel pamoate against hookworm infections was 72% (95% CI, 59%-81%; 742 patients), 15% (95% CI, 1%-27%; 853 patients), and 31% (95% CI, 19%-42%; 152 patients), respectively. No pooled relative risks could be calculated for pyrantel pamoate against T trichiura and levamisole for any of the parasites investigated. CONCLUSIONS Single-dose oral albendazole, mebendazole, and pyrantel pamoate show high cure rates against A lumbricoides. For hookworm infection, albendazole was more efficacious than mebendazole and pyrantel pamoate. Treatment of T trichiura with single oral doses of current anthelminthics is unsatisfactory. New anthelminthics are urgently needed.
Hastanelerde Rekabet Stratejileri ve Performans / Competitive Strategies and Performance in Hospitals

Ozet: Bu calismada Turkiye'de faaliyette bulunan hastanelerin bir rekabet stratejisininolup olmadigi, rekabet stratejileri varsa hangi stratejileri izledikleri ve rekabet stratejileri ileperformanslari arasinda bir iliski olup olmadigi arastirilmaktadir. Calismada veri toplamaaraci olarak hastane yoneticilerine uygulanan bir anket ve Saglik Bakanligi 2007 Yili YatakliTedavi Kurumlari Istatistik Yilligi kullanilmistir. Calisma 165 hastane uzerinde gerceklestirilmistir.Calismanin bulgularina gore saglik sektorune giriste en onemli engeller, giris maliyetlerininyuksek olmasi ve yasal duzenlemelerdir. Hastane yoneticileri yeni hizmet alanlarinagirerken rakiplerinin pozisyonlarini dikkate almaktadirlar. Ozel hastaneler daha onde olmakuzere tum hastaneler farklilasma stratejisini izlemektedir. Bunu odaklanma ve toplam maliyetliderligi stratejileri takip etmektedir. Herhangi bir rekabet stratejisi izledigini belirten hastanelerinperformansi, hicbir strateji izlemeyen hastanelerden daha yuksektir. Ancak, rekabetstratejilerinden herhangi birini izleyen hastanelerin performanslari arasinda istatistiksel acidananlamli fark bulunmamaktadir. Ayrica hastanelerin mulkiyet bicimi de performanslarinietkilemektedir.Anahtar Kelimeler: Rekabet Stratejileri, Performans, Hastane. Abstract: The purpose of this study is to investigate hospitals, have been operating inTurkey whether they have a competitive strategy, and to investigate if they have a competitivestrategy, what strategies are followed, and to investigate whether relationship betweencompetitive strategies and performance. The data that used in the study was obtained froma questionnaire that was created by utilizing related literature and 2007 Inpatient FacilitiesStatistical Almanacs of Ministry of Health. Study was conducted on 165 hospitals. Accordingto the findings of study, the most important barriers to entry in the health sector are highentry costs and legal regulations. Hospital administrators have been taking into account ofthe positions of their competitors, while they enter to new service areas. Although privatehospitals are more ahead, all hospitals have been following to differentiation strategy. Totalcost leadership and focus have been following it. Performances of hospitals that have a strategyare higher than hospitals that have not have a strategy. However, if they have any competitivestrategies, there is not any statistically significant difference of performance among hospitals.In addition performances of hospitals are affected from ownership of hospitals.Keywords: Competitive Strategies, Performance, Hospital.