Miracle-dz/UniFAR-FTUs huggingface dataset:
Menopause and risk of hip fracture in middle-aged Chinese women: a 10-year follow-up of China Kadoorie Biobank.

OBJECTIVE Bone loss is accelerated after menopause in women, as is the risk of hip fracture, but little is known about the importance of age at menopause, time since menopause, and total reproductive years for risk of hip fracture. METHODS Between 2004 and 2008, the China Kadoorie Biobank recruited 125,336 postmenopausal women who had a natural menopause and recorded 1,327 incident cases of hip fracture during the first 10 years of follow-up. Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for incident hip fracture for age at menopause, time since menopause, and total reproductive years. RESULTS The mean (SD) age at menopause was 48.8 (4.0) years. Compared with women who reached menopause before age 53 years, women with a later age at menopause had a 22% (95% CI, 11%-35%) lower risk of hip fracture. Compared with women who were <5 years since menopause, those who were 5 to 9, 10 to 14, 15 to 19, and ≥20 years since menopause had hazard ratios of hip fracture of 1.43 (95% CI, 1.01-2.04), 2.10 (95% CI, 1.71-2.57), 2.50 (95% CI, 2.21-2.83), and 2.33 (95% CI, 1.97-2.75), respectively. Women with a longer (≥36 y) versus shorter (<30 y) duration of total reproductive years had a 19% (95% CI, 9-28) lower risk of hip fracture. CONCLUSIONS Women with younger age at menopause, longer interval since menopause, or shorter duration of total reproductive years had the highest risks of hip fracture.
The importance of physical activity

Case history: A 69-year-old man with COPD (FEV1 59% predicted, 6MWD 85% pred) visits the outpatient clinic after 1 week of wearing an activity monitor. The device shows that the patient currently has a physical activity level of 4500 steps per day. Is this patient sufficiently active? Would you coach him towards a higher physical activity level? Chapter summary: The promotion of a physically active lifestyle is recommended for all patients with COPD, based on a large evidence base of the health benefits of being physically active. The available physical activity recommendations differ considerably. It has been demonstrated that these differences have a significant impact on the classification of patients with COPD into categories of sufficient and insufficient physical activity. Functional capacity and functional reserve become increasingly limited with progressing disease severity. This Q1 ¶ makes it difficult for many patients to achieve at least moderate intensity in the recommendations based on time of physical activity. Preventing Q2 ¶ sedentary time might be a relevant and more realistic treatment goal in these patients. Objective measures are available to measure physical activity and their characteristics make these tools suitable for use in clinical practice. Treatment approaches to modify physical activity have gained popularity in recent years. Self-monitoring of daily activities and goal setting with feedback from a pedometer are common elements in these interventions, which have the potential to improve health in patients with COPD.
Prevention of malaria in pregnancy in Malawi: Encounters and non-encounters between global policies, national programmes and local realities

A current problem of malaria prevention programmes is that not enough attention is paid to understanding the local socio-cultural context prior to programme implementation. The aim of this study is to discover how Yao women in rural Malawi understand and explain malaria in pregnancy, how they perceive it and what type of knowledge they have on it. Women’s knowledge of the adverse effects of malaria in pregnancy is also investigated. At first phase a total of 34 in-depth interviews were conducted. At second phase a KAP survey (n = 248) was conducted for cross-validation of the qualitative information. The findings showed that there is neither a vernacular word for malaria nor malaria in pregnancy. Women used a local word, malungo, to refer to malaria. Malungo is an ambiguous disease term because of its multiple meanings which are used interchangeably to refer to many types of feverish illnesses of various causes, not only malaria. Most women did not perceive malungo during pregnancy as a serious illness. There
Effectiveness of single and double phototherapy on indirect hyperbilirubinemia in neonates

Background Hyperbilirubinemia is a common problem in full term newborns and phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. Double phototherapy could increase the effectiveness of treatment. Objective To compare the effectiveness of single and double phototherapy and increasing spectral irradiance for decreasing serum bilirubin levels in neonates for indirect hyperbilirubinemia. Methods An open, randomized, controlled trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. Subjects were divided into two groups, those who received single phototherapy (n=30) and those who received double phototherapy (n=30) treatments. We included term newborns with neonatal jaundice in the first week of life. Serum bilirubin and average spectral irradiation levels were measured at baseline and after 12 hours and 24 hours of phototherapy treatment. Results The mean total bilirubin levels of the single and double phototherapy groups at the beginning of therapy were 17.6 mg/dL (SD1.41) and 17.5 mg/dL (SD 1.32), respectively, with no significant difference between values. During the study period the sum of average spectral irradiance by double phototherapy was significantly higher than that of single phototherapy (P < 0.05). A significantly greater decrease in bilirubin levels was observed in the double phototherapy group at 12 hours and 24 hours of phototherapy compared to the single phototherapy group (P = 0.001). Conclusion Double phototherapy is more effective than single phototherapy in reducing bilirubin levels in jaundiced newborns.
Multidisciplinary Approach to Prevent Limb Amputation in Diabetic Patients

Diabetes mellitus is a complex disease with clinical sequelae including cardiovascular disease, renal failure, extremity complications, and death. Lower limb amputation is the most serious morbidity and consequence for diabetic patients due to its associated burden on quality of life and economic implications. Limb amputation is caused by a series of complications involving multiple organ systems. We believe that a multidisciplinary diabetic care team, consisting of vascular specialists, wound care specialists, and cardiologists, will facilitate in systematically addressing each complication leading to amputation. Diabetic patients have an increased risk of developing cardiovascular diseases, resulting in the expanding involvement and importance of interventional cardiologists on these multidisciplinary diabetic care teams. Several national and global institutions have successfully demonstrated the multidisciplinary approach to facilitate efficient and timely care, and most importantly, reduce the rates of diabetes-related limb amputation. The Heart, Vascular and Leg Center coordinates vascular specialty care and provides dedicated patient management in order to increase treatment quality, patient literacy, and medication adherence to decrease lower extremity amputation rates. J Endocrinol Metab. 2019;9(5):120-126 doi: https://doi.org/10.14740/jem615
Dose-dependent degeneration of non-cancerous brain tissue in post-radiotherapy patients: A diffusion tensor imaging study

Radiation-induced changes in brain tissue may relate to post-radiotherapy (RT) cognitive decline. Our aim is to investigate changes of the brain microstructural properties after exposure to radiation during clinical protocols of RT using diffusion MRI (dMRI). The susceptibility of tissue changes to radiation was investigated in a clinically heterogenic cohort (age, pathology, tumor location, type of surgery) consisting of 121 scans of 18 patients (10 females). The imaging dataset included 18 planning CTs and 103 dMRI scans (range 2-14, median = 6 per patient) assessing pre-operative, post-operative pre-RT and post-RT states. Diffusion tensor imaging (DTI) metrics were estimated from all scans for a region-of-interest based linear relation analysis between mean dose and change in DTI metrics, while partial volume effects were regressed out.The largest regional dose dependency with mean diffusivity appear in the white matter of the frontal pole in the left hemisphere by an increase of 2.61 %/(Gy x year). Full brain-wise, pooled results for white matter show fractional anisotropy to decrease by 0.85 %/(30Gy x year); mean diffusivity increase by 9.17 %/(30Gy x year); axial diffusivity increase by 7.30%/(30Gy x year) and radial diffusivity increases by 10.63%/(30Gy x year). White matter is susceptible to radiation with some regional variability where diffusivity metrics demonstrate the largest relative sensitivity. This suggests that dMRI is a promising tool in assessing microstructural changes after RT, which can help in understanding treatment-induced cognitive decline.
Heart Disease and Its Risk Factors Among Slum-Dwelling Women in Mysore, India

Background: Three quarters of cardiovascular disease (CVD) deaths occur in lowand middleincome countries killing more than twice as many people as HIV, malaria, and tuberculosis combined. The World Health Organization estimates that as much as 80% of premature CVD deaths are preventable through behavioral changes related to seven modifiable risk factors (blood pressure, cholesterol, serum glucose, physical activity, diet, weight, and smoking). This study is one of the first to assess knowledge about modifiable CVD risk factors among slumdwelling Indian women. Methods: The study used a cross-sectional design to collect data from a nonprobability sample of 607 urban slum-dwelling women, 40 – 64 years of age, living in Mysore city, India, between October 2017 and May 2018. Participants underwent an interviewer administered questionnaire measuring demographics, CVD risk factor knowledge, and chronic disease medical history. Participants underwent a biomedical examination that included testing for anemia, hypertension, blood glucose, lipids, and a resting electrocardiogram. Results: Heart disease risk factor knowledge was extremely low in this population. CVD knowledge was significantly associated with age, education, monthly household income, marital status and caste. Conclusions: Previous research among slum dwellers in India report a high prevalence of modifiable CVD risk factors compared to more affluent urban peers. Our results suggest that interventions aimed at educating slum-dwellers about CVD risk factors may be an important first step in controlling the burden of heart disease in this vulnerable population.
Containment and care? A qualitative interview study exploring police custody staff views about delivering brief alcohol interventions to heavy drinking arrestees

Abstract Heavy alcohol use and associated needs are prevalent amongst arrestees. The custody suite offers an opportunity to identify and intervene with this population. However, it is unclear whether functions of care can be effectively delivered within an environment of containment. This study aimed to examine custody staff experiences of screening and delivering brief alcohol interventions to heavy drinking arrestees. Qualitative interviews were conducted with 25 custody staff (detention officers and assessment, intervention and referral staff), involved in a pilot feasibility trial of alcohol screening and brief interventions in the police custody suite. We examined the tension between containment and care using concepts of role security and therapeutic commitment to guide our analysis. Our findings show that custody staff considered brief interventions to be legitimate in the custody suite setting, although there were differing views relating to which staff are best placed to deliver them. Detention officers reported vacillating therapeutic commitment to intervening with heavy drinking arrestees, compounded by some arrestees being perceived to be ‘undeserving’ of care. Tensions inherent in the need for ‘containment’ as well as ‘care’ must be addressed if brief alcohol interventions are to be implemented within the custody suite.
Epidemiology of primary brain tumors in dr. Kariadi Hospital Semarang in 2015-2018

Background: Primary brain tumors are neoplasm originated from brain parenchyma and its surrounding structures. Although primary brain tumors is only 1,4% of all cancers, they causes significant morbidity and mortality. Objective: To study the epidemiology of primary brain tumors in Dr. Kariadi General Hospital Semarang between 2015 and 2018. Methods: a descriptive epidemiological study taken from medical records of hospitalized patients with primary brain tumors during 2015 - 2018. The data includes demographic characteristics and clinical characteristics. Results: There were 175 suspected cases of primary brain tumor, 38.3% occurred in males and 61.7% in females. The peak incidence is in 41-50 years (34.3%). 61.1% live in coastal areas. The frequent symptoms is headache (44.9%), with the most common location was in the frontal lobe (17.7%). The most common type was meningioma (24.5%). Meningioma were more common in females (90.7%), whereas glioma were more common in males (60%). 46.3% patients experienced clinical improvement at the time of discharge. Conclusions: The incidence of primary brain tumors are more common in females, the peak incidence are age 41-50 years, and most of them live in coastal areas.
The effects of respiratory and metabolic acidosis on the metabolic rate of anaesthetized, paralyzed, and artificially ventilated ground squirrels (Spermophilus lateralis)

This study was designed to test the hypothesis that changes in arterial pH (pHa) reflecting proportional changes in arterial hydrogen ion concentration ([H +]a) effect a change in oxygen consumption (VO2) or metabolic rate (MR), in euthertnic golden mantled ground squirrels (Spermophilus lateralis). Of interest were the specific effects, either local or reflex, of changing arterial pH on metabolic rate . Therefore, it was imperative that experimentally produced changes in pHa did not cause any compensatory changes in ventilation, since this would indirectly alter metabolic rate due to changes in the cost of breathing . It was also important that any changes in metabolic rate produced by the experimental manipulations did not cause any change in body temperature (Tb), since this would secondarily cause further changes in metabolic rate . As a consequence, these experiments were conducted on anaesthetized, paralyzed, and artificially ventilated animals maintained at constant Tb . Three series of experiments were conducted, each of which altered pHa in a different fashion. In the first series of experiments, (Series I, n = 6) pHa was randomly made either alkalotic or acidotic by altering the frequency and/or volume of the respirator, to increase or decrease minute ventilation (11E), and consequently hyperor hypo-ventilate the animals . The average pHa was varied from 7 . 19 ± 0.03 Units in the acidotic range, to 7 . 55 ± 0.02 Units in the alkalotic range with corresponding arterial partial pressures of CO 2 (Paco) of 52.8 ± 3 Torr and 25.9 ± 2 Ton, respectively. In this series, VO2 showed a significant (p < 0.001) positive correlation with pHa (r = + 0.84), decreasing 0 . 24 ml.min-1 for every 0 . 1 Unit decrease in pHa
Alte und neue Antikoagulantien und Endoskopie: Was ist erlaubt?

Novel (Direct) Oral Anticoagulants and Endoscopy. Major advantages of novel (di- rect) oral anticoagulants (NOAC, DOAC) lead to an increasing use of these substances in orthope- dic thrombosis prophylaxis, stroke prevention in atrial fi brillation, and treatment of venous throm- boembolism. Substantial pharmacologic differ- ences of the new substances compared to vita- min K antagonists result in relevant new aspects for daily clinical practice in gastrointestinal en- doscopy and gastrointestinal bleeding. This pa- per addresses the periprocedural management of anticoagulation in patients undergoing endosco- py and the management of acute gastrointestinal bleeding in patients receiving DOACs. J Gastro- enterol Hepatol Erkr 2014; 12 (3): 17-21.
Erfaringer med bruk av skåringssystemene SAPS II og NEMS i virksomhetsregistrering i en intensivavdeling

Background. Intensive care is highly expensive, hence the requirement of efficient use of resources calls for evaluation of the severity of disease or injury for each individual patient, so that management may be optimised. Material and methods. At Ullevaal University Hospital, two different scoring systems have been used since 1996: SAPS II (Simplified Acute Physiology Score) for severity of illness and NEMS (Nine Equivalents of Nursing Manpower Use Score) for assessment of resource utilisation. Results. A significant relationship between severity of illness and mortality was found. Length of stay in ICU correlated with increasing SAPS II score in the range 0 to 50, but at higher scores no relationship was found. Patients with trauma and cardiovascular surgical patients used most of the resources. 79 % of total NEMS score consisted of vital signs monitoring, intravenous drug medication and mechanical ventilation of the patients. Interpretation. SAPS II and NEMS scoring systems provide useful information needed in the assessment of patient care in the ICU and are helpful in the documentation of financial and medical resource needs. Intensivbehandling er kostbart og det er mangel på intensivplasser. Det er derfor viktig å kartlegge alvorlighetsgraden av pasientenes sykdommer og skader og hvordan en intensivavdeling bruker sine ressurser. Vi har anvendt skåringssystemene SAPS II (Simplified Acute Physiology Score II) for alvorlighetsgrad og NEMS (Nine Equivalents of Nursing Manpower Use Score) for ressursbruk ved Postoperativ/Intensivavdelingen, Ullevål sykehus, i perioden mars 1996 til oktober 1999. Vi fant sammenheng mellom alvorlighetsgrad av sykdom og mortalitet og mellom alvorlighetsgrad og ressursbruk. Liggetiden økte med SAPS II-skåre inntil 40–50, for deretter å avta med økende skåre. Det var ingen ukedager eller perioder med lav aktivitet, men stor forskjell i ressursbruk for ulike hovedtyper innleggelse, der øyeblikkelig hjelp-kirurgi dominerte. Pasienter med traumer og opererte for hjerteog karsykdom var mest ressurskrevende. Basal monitorering, intravenøs medisinering og mekanisk ventilasjon utgjorde 79% av totale NEMS-poeng. Registreringene med systemene SAPS II og NEMS har gitt bedre grunnlag for evaluering av behandlingsresultater og dokumentasjon av avdelingens ressursbehov.
Evaluation of the relation between fractional flow reserve and midterm graft patency in CABG patients

Objectives: The severity of the stenosis in left anterior descending artery might be misdiagnosed in coronary angiography. Fractional flow reserve is an important tool in such patient group in order to determine the modality of the treatment; medical, percutaneous intervention or surgical revascularization. We proposed to evaluate the midterm outcome of patients with moderate left anterior descending artery stenosis, who under- went surgical revascularization with regard to fractional flow rate studies. Materials and Methods: Eleven patients were identified who were operated between 2005 and 2007. The mean age was 54.2 ±6.88 (range between 44 and 66). Our study group was composed of patients with mod- erate (50-60%) left anterior descending artery stenosis in whom a left anterior descending thoracic artery-left anterior descending artery anastomosis had been performed with the decision for surgical revascularization given with regard to fractional flow rate values. The symptomatic patients were evaluated with conventional angiography or three dimensional computed tomography, whereas asymptomatic patients were evaluated with Doppler ultrasonography. Results: All the patients had been operated under cardiopulmonary bypass with cross clamping of the aorta. The left anterior descending thoracic artery-left anterior descending artery anastomosis had been performed in all cases. Any mortality was not encountered. All the patients were evaluated within a mean interval of 2.4 years after the surgical revascularization. Five of the patients (45.5%) had left anterior descending thoracic artery flow, whereas 6 of the patients (54.5%) did not. Three dimensional computed tomography was per - formed in 5 of the asymptomatic patients, which demonstrated the 'string sign' of the left internal thoracic artery conduit as well as a left anterior descending artery without any significant stenotic lesion. The midterm (2-4 years) patency of left internal thoracic artery graft was found to be 54.5%. Conclusions: Our study demonstrates that when the patients with moderate left anterior descending artery stenosis undergo bypass surgery with regard to fractional flow rate measurement, graft stenosis might be en - countered in the follow up. This patient group may not be suitable for surgical revascularization.
Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media

Objective: To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. Method: A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. Results: Three themes emerged that incorporated a range of subthemes: (1) the impact of the child’s underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents’ expectations of the health-care system. The child’s otitis media disrupted the day-to-day functioning of the family and the child’s well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. Conclusion: Parents need support during their child’s illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.