Miracle-dz/UniFAR-FTUs huggingface dataset:
Burn survivors' perceptions regarding relevant sexual education strategies.

Purpose – This paper aims to investigate the unique issues childhood burn survivors experience in relation to sex education and sexual development.Design/methodology/approach – Using a phenomenological approach, participants described their lived experiences with regards to sex education and the sexuality issues they encountered as child burn survivors. One‐to‐one semi‐structured interviews and a focus group were used to gather data, which were analyzed using a constant comparison method.Findings – Results provide educators with better insight into the experiences of burn survivors as well as strategies for approaching sex education. Findings centered around five areas: exposure, sex education content, timing of sex education, characteristics of the educator and most appropriate methods of delivery.Research limitations/implications – Sexuality is a value‐laden topic that has the potential to increase apprehension and decrease willingness to discuss. As a result, the sample may not be wholly representative.
Association between insomnia symptoms and functional status in U.S. older adults.

OBJECTIVES We studied the association between insomnia symptoms and late-life functioning, including physical capacity, limitations in household activities, and participation in valued activities. METHODS Participants were 6,050 adults independent in self-care activities from a representative sample of older Medicare beneficiaries. They completed objective measures of physical capacity and self-report measures of insomnia symptoms, help and difficulty with household activities, and participation in valued activities. RESULTS After adjustment, insomnia symptoms were associated with a greater odds of receiving help or having difficulty with selected household activities (laundry, shopping), greater odds of help or difficulty with ≥ 1 household activity [1 symptom vs. 0, odds ratio (OR)=1.27, p < . 05; 2 symptoms vs. 0, OR = 1.35, p < . 01), and of restricted participation in specific valued activities (attending religious services, going out for enjoyment) and in ≥ 1 valued activity (1 symptom vs. 0, OR = 1.29, p < .05; 2 symptoms vs. 0, OR = 1.50, p < .01). There was no independent association between insomnia symptoms and physical capacity. DISCUSSION Among older adults, insomnia symptoms are associated with a greater odds of limitation in household activities and of restricted participation in valued activities. Insomnia interventions may improve functioning and quality of life among elders.
Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis

Importance Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. Objective To assess the potential effectiveness of interventions for preventing falls. Data Sources MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned. Study Selection Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older. Data Extraction and Synthesis Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted. Main Outcomes and Measures Injurious falls and fall-related hospitalizations. Results A total of 283 RCTs (159 910 participants; mean age, 78.1 years; 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio [OR], 0.51 [95% CI, 0.33 to 0.79]; absolute risk difference [ARD], −0.67 [95% CI, −1.10 to −0.24]); combined exercise and vision assessment and treatment (OR, 0.17 [95% CI, 0.07 to 0.38]; ARD, −1.79 [95% CI, −2.63 to −0.96]); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 [95% CI, 0.13 to 0.70]; ARD, −1.19 [95% CI, −2.04 to −0.35]); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 [95% CI, 0.03 to 0.55]; ARD, −2.08 [95% CI, −3.56 to −0.60]). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 [95% CI, 0.33 to 1.81]). Conclusions and Relevance Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.
Investigation of the relationship among fatigue, self‐efficacy and quality of life during chemotherapy in patients with breast, lung or gastrointestinal cancer

To explore the relationship between fatigue and self-efficacy, and quality of life (QoL) during chemotherapy of patients with breast, lung or gastrointestinal cancers. This study is a descriptive-correlational research. The study population comprised of patients with breast, lung and gastrointestinal cancer treated at the outpatient chemotherapy unit. Patients' self-efficacy and QoL were assessed using Functional Assessment of Chronic Illness Therapy-Fatigue scale and Strategies Used by Patients to Promote Health scale. The sample included 236 patients receiving chemotherapy for lung cancer (30.9%), gastrointestinal (25.8%) or breast cancers (25.4%). The patients had little confidence in performing self-care self-efficacy during chemotherapy for the management of illness and chemotherapy-related side effects. The study found that the patients with cancer were moderately fatigued and all the domains of QoL of patients with cancer undergoing chemotherapy were considerably impaired. Positive correlations were found between self-efficacy scores and fatigue scores (p < 0.001), and QoL scores (p < 0.001). Better self-efficacy beliefs were associated with better QoL and lower fatigue. Improving the cancer patients' self-confidence in performing self-care behaviours may have a positive impact on performing cognitive and behavioural fatigue management strategies and can influence positively the patients' QoL during chemotherapy.
The Revised Declaration of Geneva: A Modern-Day Physician's Pledge.

As the contemporary successor to the 2500-year-old Hippocratic Oath, the Declaration of Geneva, which was adopted by the World Medical Association (WMA) at its second General Assembly in 1948,1 outlines in concise terms the professional duties of physicians and affirms the ethical principles of the global medical profession. The current version of the Declaration, which had to this point been amended only minimally in the nearly 70 years since its adoption, addresses a number of key ethical parameters relating to the patientphysician relationship, medical confidentiality, respect for teachers and colleagues, and other issues. A newly revised version adopted by the WMA General Assembly on October 14, 2017, includes several important changes and additions (Supplement). It is standard practice for the WMA to circulate its policy papers for review every 10 years to reevaluate the accuracy, essentiality, and relevance of the documents. The Declaration of Geneva is no exception. In 2016 (10 years following the most recent editorial revision of the Declaration), the WMA established an international workgroup to assess the Declaration of Geneva’s content, structure, audience, and implementation and to determine whether any amendments were necessary. Given the crucial nature of this document, the assigned workgroup charted a generous timeline of nearly 2 years to allow ample opportunity to gather feedback and suggestions not only from member national medical associations, but also from external experts. The goal in doing so was to ensure that the revision was as transparent and collaborative an effort as possible. Chaired by the German Medical Association and composed of workgroup members of different cultural, religious, and racial backgrounds, the workgroup tasked with determining the need for a revision carefully considered the Declaration in light of modern developments in medicine and medical ethics, as well as in the context of other important WMA policies and respected international literature. The workgroup also based its recommendations on comments solicited from WMA members on several occasions (most recently in July and August 2017), as well as a 3-week public consultation carried out in May and June 2017, during which the draft version of the revised Declaration was published on the WMA website and distributed to an international network of experts and stakeholders for comment. Each comment received over the course of the revision process was carefully reviewed VIEWPOINT
Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement

Importance Menopause occurs at a median age of 51.3 years, and the average US woman who reaches menopause is expected to live another 30 years. The prevalence and incidence of most chronic conditions, such as coronary heart disease, dementia, stroke, fractures, and breast cancer, increase with age; however, the excess risk for these conditions that can be attributed to menopause alone is uncertain. Since the publication of findings from the Women’s Health Initiative that hormone therapy use is associated with serious adverse health effects in postmenopausal women, use of menopausal hormone therapy has declined. Objective To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the use of menopausal hormone therapy for the primary prevention of chronic conditions. Evidence Review The USPSTF reviewed the evidence on the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal women and whether outcomes vary among women in different subgroups or by timing of intervention after menopause. The review did not address hormone therapy for preventing or treating menopausal symptoms. Findings Although the use of hormone therapy to prevent chronic conditions in postmenopausal women is associated with some benefits, there are also well-documented harms. The USPSTF determined that the magnitude of both the benefits and the harms of hormone therapy in postmenopausal women is small to moderate. Therefore, the USPSTF concluded with moderate certainty that combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions for most postmenopausal women with an intact uterus and that estrogen alone has no net benefit for the primary prevention of chronic conditions for most postmenopausal women who have had a hysterectomy. Conclusions and Recommendation The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (D recommendation)
Effects of the implementation of an evidence-based program to manage concerns about falls in older adults.

PURPOSE OF THE STUDY Concerns about falls and related activity avoidance are common in older people. A multicomponent program reduced these concerns and increased daily activity among older people in a randomized controlled trial. This study explored whether the effects and acceptability of the program maintain after its implementation into home care organizations. DESIGN AND METHODS In a pretest-post-test study, the effects and acceptability of the 8-week cognitive behavioral program was evaluated in 125 community-living older adults. Data on concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of loneliness and anxiety, and symptoms of depression were collected prior to the start of the program and at 2 and 4 months. RESULTS Pretest-post-test analyses showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for daily activity, feelings of loneliness, and fall-related medical attention. IMPLICATIONS After implementation in home care organizations, the program reduced concerns about falls, avoidance behavior, and falls in community-living older adults. These findings are highly consistent with the outcomes of a previously performed randomized controlled trial, indicating that the program can be successfully implemented in practice. Further dissemination of the program is recommended to reduce concerns about falls and related activity avoidance in community-living older people.
Discussing physician-assisted dying: physicians' experiences in the United States and the Netherlands.

PURPOSE OF THE STUDY This study aims to further our understanding of the experiences of physicians when discussing physician-assisted dying (PAD) within the context of doctor-patient relationships in various sociolegal settings. Although patients bring up PAD in diverse settings, little is known about how physicians experience these discussions, and such experiences have not been directly compared across countries. DESIGN AND METHODS A total of 36 physicians in the Netherlands and the United States (including Oregon) were interviewed using individual semistructured interview guides. Interviews were conducted by a single interviewer, audiotaped, and independently transcribed. Inductive qualitative analysis, aided by NVivo7 software, directed purposive sampling of physicians until saturation was met. Multiple coders in a multidisciplinary team analyzed emerging themes and developed theory. RESULTS PAD discussions, which ranged from theoretical discussions to actual requests, could be gateways to discussions of other end-of-life issues important to patients and could strengthen doctor-patient relationships. Physicians found discussions to be emotionally intense, but often rewarding. Where PAD was legal, physicians utilized existing criteria to guide communication, and discussions were open and honest with patients and colleagues. Where PAD was illegal, conversations were less explicit, and physicians dealt with requests in relative isolation. In addition, physicians' views of their professional role, patients' rights, and religion influenced both their willingness to have and the content of PAD discussions. IMPLICATIONS Discussion of PAD is an energy-consuming, yet potentially enriching part of the doctor-patient relationship. Legal guidelines may help to provide structure and support for physicians when patients broach the topic of PAD.
Does Gestational Diabetes History Increase Epicardial Fat and Carotid Intima Media Thickness?

Gestational diabetes mellitus (GDM) is defined as glucose intolerance that has begun during pregnancy. Recent studies have proven that development of atherosclerosis may be established in this population even without presence of type 2 diabetes. For assessment of atherosclerosis, epicardial fat thickness (EFT) is recently being used as a surrogate marker. In this study, we aimed to prove that women with GDM history are more inclined to have higher EFT levels than women without GDM history.
Changing the culture of mouth care: mouth care without a battle.

PURPOSE OF THE STUDY Culture change aims to fundamentally improve care provision in a manner consistent with individual preferences. However, few studies of culture change have focused on the quality of daily care, despite the fact that system-wide efforts are important to assure the effectiveness, adoption, and sustainability of person-centered care to meet daily needs. This paper describes a new culture change practice, Mouth Care Without a Battle. The focus on mouth care is predicated on the important association between person-centered support for oral hygiene and quality of life. DESIGN AND METHODS Mouth Care Without a Battle is a person-centered approach to quality mouth care for persons with cognitive and physical impairment. It was developed by an interdisciplinary team of clinician researchers based on literature review, consultation with experts, environmental scan of existing programs, and testing in nursing homes. Building from the success of Bathing Without a Battle, Mouth Care Without a Battle was evaluated in terms of changed care practices and outcomes, developed into a training program, and packaged for dissemination as a digital video disk (DVD) and website. RESULTS The development and evaluation of Mouth Care Without a Battle demonstrate attention to the areas necessary to establish the evidence-base for culture change, to ultimately empower and support staff to provide care to achieve quality outcomes. IMPLICATIONS As illustrated in this paper, it is beneficial to build the evidence base for culture change by attending to care processes and outcomes benefiting all residents, ability to implement culture change, and costs of implementation.
Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer.

BACKGROUND Colon cancers with high-frequency microsatellite instability have clinical and pathological features that distinguish them from microsatellite-stable tumors. We investigated the usefulness of microsatellite-instability status as a predictor of the benefit of adjuvant chemotherapy with fluorouracil in stage II and stage III colon cancer. METHODS Tumor specimens were collected from patients with colon cancer who were enrolled in randomized trials of fluorouracil-based adjuvant chemotherapy. Microsatellite instability was assessed with the use of mononucleotide and dinucleotide markers. RESULTS Of 570 tissue specimens, 95 (16.7 percent) exhibited high-frequency microsatellite instability. Among 287 patients who did not receive adjuvant therapy, those with tumors displaying high-frequency microsatellite instability had a better five-year rate of overall survival than patients with tumors exhibiting microsatellite stability or low-frequency instability (hazard ratio for death, 0.31 [95 percent confidence interval, 0.14 to 0.72]; P=0.004). Among patients who received adjuvant chemotherapy, high-frequency microsatellite instability was not correlated with increased overall survival (hazard ratio for death, 1.07 [95 percent confidence interval, 0.62 to 1.86]; P=0.80). The benefit of treatment differed significantly according to the microsatellite-instability status (P=0.01). Adjuvant chemotherapy improved overall survival among patients with microsatellite-stable tumors or tumors exhibiting low-frequency microsatellite instability, according to a multivariate analysis adjusted for stage and grade (hazard ratio for death, 0.72 [95 percent confidence interval, 0.53 to 0.99]; P=0.04). By contrast, there was no benefit of adjuvant chemotherapy in the group with high-frequency microsatellite instability. CONCLUSIONS Fluorouracil-based adjuvant chemotherapy benefited patients with stage II or stage III colon cancer with microsatellite-stable tumors or tumors exhibiting low-frequency microsatellite instability but not those with tumors exhibiting high-frequency microsatellite instability.
Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.

BACKGROUND Severe, refractory obsessive-compulsive disorder (OCD) is a disabling condition. Stimulation of the subthalamic nucleus, a procedure that is already validated for the treatment of movement disorders, has been proposed as a therapeutic option. METHODS In this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus, we randomly assigned eight patients with highly refractory OCD to undergo active stimulation of the subthalamic nucleus followed by sham stimulation and eight to undergo sham stimulation followed by active stimulation. The primary outcome measure was the severity of OCD, as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), at the end of two 3-month periods. General psychopathologic findings, functioning, and tolerance were assessed with the use of standardized psychiatric scales, the Global Assessment of Functioning (GAF) scale, and neuropsychological tests. RESULTS After active stimulation of the subthalamic nucleus, the Y-BOCS score (on a scale from 0 to 40, with lower scores indicating less severe symptoms) was significantly lower than the score after sham stimulation (mean [+/-SD], 19+/-8 vs. 28+/-7; P=0.01), and the GAF score (on a scale from 1 to 90, with higher scores indicating higher levels of functioning) was significantly higher (56+/-14 vs. 43+/-8, P=0.005). The ratings of neuropsychological measures, depression, and anxiety were not modified by stimulation. There were 15 serious adverse events overall, including 1 intracerebral hemorrhage and 2 infections; there were also 23 nonserious adverse events. CONCLUSIONS These preliminary findings suggest that stimulation of the subthalamic nucleus may reduce the symptoms of severe forms of OCD but is associated with a substantial risk of serious adverse events. (ClinicalTrials.gov number, NCT00169377.)
Non-convergent literacy practices and Dominican students in the U.S.

We articulate a pedagogical rationale for integrating English writing instruction with writing instruction in Spanish as a strategy for improving success rates among Spanish speaking ESL students (SS-ESL) at Hispanic serving institutions such as Bronx Community College (BCC). We adopt a New Literacy Studies theoretical framework (Street, 1984; Barton & Hamilton, 1998), and review research showing that academic literacy acquisition in a second language is positively correlated to solid literacy foundations in the mother tongue (Cummins, 1979, 2000; Ferguson, 2006; Ramirez, 1992; Skutnabb-Kangas, 2000). Studies suggest that many Dominican SS-ESL students might not have had the opportunity to develop solid academic literacy skills in Spanish and that what is considered effective academic writing in Dominican secondary schools can differ significantly from what U.S. college professors expect from writing assignments. This rationale underpins the creation of a new learning community cluster that included an advanced ESL class, a Spanish composition class, and a Freshmen Year Seminar (FYS). We discuss how the integration of ESL and Spanish composition has helped SS-ESL students bridge the gap between the divergent literacy practices.
Linking Home and School Through Children's Questions That Followed Family Science Workshops

Author(s): Callanan, Maureen; Alba-Speyer, Consuelo; Tenenbaum, Harriet | Abstract: This research brief describes some preliminary findings from the CREDE research project, "At-Risk Preschoolers' Questions and Explanations: Science in Action at Home and in the Classroom," conducted in collaboration with the Family Science project of Life Lab Science at the University of California, Santa Cruz. Life Lab Science also collaborates with another CREDE project called LASERS (Language Acquisition through Science Education for Rural Schools). Together, these three projects conducted a set of Family Science workshops that comprise the focus of this research brief.