Miracle-dz/UniFAR-FTUs huggingface dataset:
Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures

Background: Treatment intervention thresholds for prevention of osteoporotic fractures can be derived from reports from the World Health Organization (diagnostic criteria) and National Osteoporosis Foundation (treatment criteria). It is not known how well these thresholds work to identify women who will fracture and are therefore candidates for treatment interventions. We used data from the National Osteoporosis Risk Assessment (NORA) to examine the effect of different treatment thresholds on fracture incidence and numbers of women with fractures within the year following bone mineral density measurement. Methods: The study comprised 149 524 white postmenopausal women aged 50 to 104 years (mean age, 64.5 years). At baseline, bone mineral density was assessed by peripheral bone densitometry at the heel, finger, or forearm. New fractures during the next 12 months were self-reported. Results: New fractures were reported by 2259 women, including 393 hip fractures; only 6.4% had baseline T scores of �2.5 or less (World Health Organization definition for osteoporosis). Although fracture rates were highest in these women, they experienced only 18% of the osteoporotic fractures and 26% of the hip fractures. By National Osteoporosis Foundation treatment guidelines, 22.6% of the women had T scores of 2.0 or less, or �1.5 or less with 1 or more clinical risk factors. Fracture rates were lower, but 45% of osteoporotic fractures and 53% of hip fractures occurred in these women. Conclusions: Using peripheral measurement devices, 82% of postmenopausal women with fractures had T scores better than �2.5. A strategy to reduce overall fracture incidence will likely require lifestyle changes and a targeted effort to identify and develop treatment protocols for women with less severe low bone mass who are nonetheless at increased risk for future fractures.
Patients perceptions of the role of the general practitioner in the management of emotional problems.

Objectives. To investigate the nature of patients' perceptions of the role of the general practitioner in the management of emotional problems in primary care; the association between patient characteristics and perceptions; and the association between perceptions and the recognition of psychiatric morbidity by the GP. Design. Cross-sectional correlation design. Methods. Patients attending their GPs completed the General Health Questionnaire (N = 1511) and a scale measuring perceptions of the GP's role (the Patient Perceptions Scale (PPS), N = 867). Forty-three volunteer GPs assessed patients for psychiatric symptomatology. Self-report and GP assessments of psychiatric status were compared to examine detection of disorder. Results. Principal component analysis of responses to the PPS indicated four dimensions. A multilevel model indicated that some of these PPS dimensions were related to patient age, sex and current levels of psychiatric symptomatology. Furthermore, in one dimension there was significant variation at the GP level (i. e. in the average PPS scores between patients consulting different GPs). The likelihood of a patient with significant psychiatric symptoms being recognized was related to the disorder's severity and to the patient's perception of the degree to which the GP was oriented to the management of emotional problems. There were no other significant associations with the perception questionnaire factors or patient demographic characteristics. Conclusions. The perceived role of the GP in the management of emotional problems varies among patients, reflecting both patient characteristics and the characteristics of their own GP. Perceptions of the orientation of the GP towards emotional issues may influence the likelihood of the recognition of disorder.
Azithromycin and Levofloxacin Use and Increased Risk of Cardiac Arrhythmia and Death

PURPOSE Azithromycin use has been associated with increased risk of death among patients at high baseline risk, but not for younger and middle-aged adults. The Food and Drug Administration issued a public warning on azithromycin, including a statement that the risks were similar for levofloxacin. We conducted a retrospective cohort study among US veterans to test the hypothesis that taking azithromycin or levofloxacin would increase the risk of cardiovascular death and cardiac arrhythmia compared with persons taking amoxicillin. METHODS We studied a cohort of US veterans (mean age, 56.8 years) who received an exclusive outpatient dispensation of either amoxicillin (n = 979,380), azithromycin (n = 594,792), or levofloxacin (n = 201,798) at the Department of Veterans Affairs between September 1999 and April 2012. Azithromycin was dispensed mostly for 5 days, whereas amoxicillin and levofloxacin were dispensed mostly for at least 10 days. RESULTS During treatment days 1 to 5, patients receiving azithromycin had significantly increased risk of death (hazard ratio [HR] = 1.48; 95% CI, 1.05–2.09) and serious arrhythmia (HR = 1.77; 95% CI, 1.20–2.62) compared with patients receiving amoxicillin. On treatment days 6 to 10, risks were not statistically different. Compared with patients receiving amoxicillin, patients receiving levofloxacin for days 1 to 5 had a greater risk of death (HR = 2.49, 95% CI, 1.7–3.64) and serious cardiac arrhythmia (HR = 2.43, 95% CI, 1.56–3.79); this risk remained significantly different for days 6 to 10 for both death (HR = 1.95, 95% CI, 1.32–2.88) and arrhythmia (HR = 1.75; 95% CI, 1.09–2.82). CONCLUSIONS Compared with amoxicillin, azithromycin resulted in a statistically significant increase in mortality and arrhythmia risks on days 1 to 5, but not 6 to 10. Levofloxacin, which was predominantly dispensed for a minimum of 10 days, resulted in an increased risk throughout the 10-day period.
Exploring the Patient and Staff Experience With the Process of Primary Care

PURPOSE Previous studies suggest that the highest-risk patients value accessible, coordinated primary care that they perceive to be of high technical quality. We have limited understanding, however, of how low-income, chronically ill patients and the staff who care for them experience each individual step in the primary care process. METHODS We conducted qualitative interviews with uninsured or Medicaid patients with chronic illnesses, as well as with primary care staff. We interviewed 21 patients and 30 staff members with a variety of job titles from 3 primary care practices (1 federally qualified health center and 2 academically affiliated clinics). ] RESULTS The interviews revealed 3 major issues that were present at all stages of a primary care episode: (1) information flow throughout an episode of care is a frequent challenge, despite systems that are intended to improve communication; (2) misaligned goals and expectations among patients, clinicians, and staff members are often an impediment to providing and obtaining care; and (3) personal relationships are highly valued by both patients and staff. CONCLUSIONS Vulnerable populations and the primary care staff who work with them perceive some of the same challenges throughout the primary care process. Improving information flow, aligning goals and expectations, and developing personal relationships may improve the experience of both patients and staff.
The Reliability and Validity of the Rhodes Index of Nausea, Vomiting and Retching in Postoperative Nausea and Vomiting

Background: The Rhodes index of nausea, vomiting and retching (RINVR) is a patient self-report instrument to assess the objective and subjective factors of nausea and vomiting. The aim of this study is to evaluate the reliability and validity of the RINVR in postoperative nausea and vomiting (PONV). Methods: The RINVR, VAS for nausea and incidence of emetic episodes were administered to 150 patients approximately 30 minutes apart at 6 hours and 24 hours after surgery. The validity was evaluated by Spearman's correlation and internal consistency of reliability was determined using Cronbach's alpha. To determine test-retest reliability, second administration of the RINVR was done 2 hours after the first. The test-retest reliability was evaluated by Spearman's correlation and agreement. Results: Cronbach's alpha of nausea, vomiting, retching and total experience scores of the RINVR ranged from 0.912 to 0.968. Test-retest scores of all items were strongly correlated (Spearman's coefficients: 0.962-1.000, P < 0.0001) and highly agreed (weighted kappa: 0.932-1.000). Coefficients of construct validity for nausea components (vs VAS for nausea) and emetic components (vs incidence of emetic episodes) of the RINVR were 0.860-0.928 and 0.724-0.811, respectively (P < 0.0001). The overall weighted kappa between the incidences of PONV assessed by the RINVR and by patient self-assessment of VAS for nausea and incidence of emetic episodes was 0.917-0.945. The number of patients in "great" total experience category was 1.33% or less. There was no significant difference of VAS for nausea between "severe" and "great" nausea experience categories. Conclusions: The RINVR was a reliable and valid instrument to assess PONV. (Korean J Anesthesiol 2007; 52: 59~65)
Managing teams managing crises: principles of teamwork to improve patient safety in the Emergency Room and beyond

Teamwork is an essential component of safety in most work environments, especially in healthcare. Significant gains toward team-based approaches to healthcare have been made, but there remains a large knowledge base on teamwork that can be tapped. It is suggested that improvement in patient safety can be made by drawing on the science of team effectiveness and specifically focusing on investigation where team share characteristics to those in healthcare (e.g. emergency medicine). This article briefly outlines some core features of the current scientific understanding of teams. The relationship between teamwork and patient safety is then discussed. Finally, a set of scientific-rooted principles are extracted from the literature, which can guide the effectiveness of teams working in healthcare contexts.
Evaluation of nutritional composition, sensory and physical property of home processed weaning food based on low cost locally available food materials

– The objectives of this study are to develop low cost weaning food for the economically disadvantaged nursing mothers and also to prevent protein energy malnutrition among the infants in Nigeria. , – The blends (sweet potato and soybean flour) were prepared (homogenously) in the ratio of 90:10, 80:20, 70:30, 60:40 and 50:50 of sweet potato and soybean respectively. Triplicate samples of each blend were analyzed for moisture, fat, protein (N × 6.25), crude fiber and ash. Total lipid was estimated by petroleum ether extraction. Carbohydrate content was estimated by difference. Gross energy was determined. Water absorption capacity and bulk density were determined using standard procedures. The pasting characteristics of the flours were evaluated using a standard procedure. The sensory evaluation was carried out on the following parameters: taste, appearance, aroma, mouth (texture), colour and overall acceptability by a panel of ten members using a nine‐point hedonic scale. , – The results of nutritional composition of the supplements showed protein 11.2–33.72 per cent, carbohydrates 42.91–76.51 per cent, fat 3.10–12.78 per cent, energy values 329.5–366.74 kcal/100 g and appreciable quantities of P, Zn, Fe, Mg, Ca, K and Na. The soy‐sweet potato flours had peak viscosity values between 180–365 BU. These values increased when cooled to 50°C, (420–760 BU). Results of this study showed that at 30 per cent soy flour supplementation, the meal could meet satisfactorily the recommended dietary allowances (RDA) for children of 1–3 years old, and that the developed soy‐sweet potato diets were nutritious, inexpensive and can easily be prepared from locally available raw food materials by using simple domestic processing techniques. , – Evidence has shown that the cost of commercial weaning formula is very high and most of the low‐income family cannot afford to purchase this commercial weaning food and for such people an alternative low cost weaning formula is helpful.
A Randomized Controlled Trial of Filgrastim as an Adjunct to Antibiotics for Treatment of Hospitalized Patients with Community-Acquired Pneumonia

Because of the critical role of neutrophils in host defenses, it was hypothesized that stimulation of neutrophil production and function with Filgrastim would improve the outcome of hospitalized patients with community-acquired pneumonia. To test this hypothesis, a randomized, placebo-controlled, multicenter trial of Filgrastim (300 micrograms/day up to 10 days) as an adjunct to antibiotics was conducted for these patients. Outcome measures included time to resolution of morbidity (TRM, a composite measure of temperature, respiratory rate, blood oxygenation, and chest radiograph), 28-day mortality, length of stay, and adverse events. Filgrastim increased blood neutrophils 3-fold, but TRM, mortality, and length of hospitalization were not affected. Treatment, however, accelerated radiologic improvement and appeared to reduce serious complications (e.g., empyema, adult respiratory distress syndrome, and disseminated intravascular coagulation). Filgrastim administration was safe and well tolerated in these patients. Additional trials are needed to establish the value of this approach to treatment of infectious diseases.
Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection

Background/methods To better understand dengue fever in the elderly, we compared clinical features, World Health Organization (WHO) dengue classification and outcomes between adult (<60) and elderly (≥60) dengue patients. We explored the impact of co-morbidity and hospital-acquired infection (HAI) on clinical outcomes in the elderly. All patients managed at the Communicable Disease Centre, Singapore, between 2005 and 2008 with positive dengue polymerase chain reaction (PCR) or who fulfilled WHO 1997 or 2009 probable dengue criteria with positive dengue IgM were included. Results Of the 6989 cases, 295 (4.4%) were elderly. PCR was positive in 29%. The elderly suffered more severe disease with more dengue haemorrhagic fever (DHF) (29.2% vs. 21.4%) and severe dengue (SD) (20.3% vs. 14.6%) (p<0.05). Classic dengue symptoms were more common in the adult group. The elderly were less likely to fulfill WHO 1997 (93.6% vs. 96.4%) (p = 0.014), but not WHO 2009 probable dengue (75.3% vs. 71.5%). Time to dengue diagnosis was similar. There was no significant difference in the frequency of warning signs between the two groups, but the elderly were more likely to have hepatomegaly (p = 0.006) and malaise/lethargy (p = 0.033) while the adults had significantly more mucosal bleeding (p<0.001). Intensive care admission occurred in 15 and death in three, with no age difference. Notably, the elderly stayed in hospital longer (median 5 vs. 4 days), and suffered more pneumonia (3.8% vs. 0.7%) and urinary infection (1.9% vs. 0.3%) (p = 0.003). Predictors of excess length of stay were age (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.37–2.88), critical illness (aOR 5.13, 95%CI 2.59–9.75), HAI (aOR 12.06, 95%CI 7.39–19.9), Charlson score (aOR 6.9, 95%CI 2.02–22.56) and severe dengue (DHF/dengue shock syndrome/SD) (aOR 2.24, 95%CI 1.83–2.74). Conclusion Elderly dengue patients present atypically and are at higher risk of DHF, SD and HAI. Aside from dengue severity, age, co-morbidity and HAI were associated with longer hospital stay.
Child Health Survellience - Analysis of the Existing Services

The Child Health Surveillance (CHS) is the core of a healthy childhood programme for the children living in the United Kingdom. The change of the GP contract in 2004 may have significant implications on the CHS services. The GPs will no longer be required to provide a CHS service under their contract requirements and there is a chance that the increase in workload will have to be borne by the HVs and other community practitioners. This is likely to leave gaps in the service provided and may have an indirect effect on children from the deprived social class who are largely dependent on the services provided by the CHS. A questionnaire survey was thus organised in the early years after the implementation of the GP 2004 contract to understand the level of success of the CHS services, deficiencies that may have arose and also how the HVs and GPs are working with each other in an era of changed service contract. The main findings from the study was encouraging that 91% of the GPs have opted to continue providing the CHS services, and >85% of the surveyed staff group were having dedicated baby clinics once a week. The GPs were mainly doing the newborn checks and the 6 weeks check whereas the other aspects of CHS were largely done by the HVs along with advice on health promotion. Few discrepancies were highlighted from the study, these were taken up and adequately addressed by the Barnsley PCT and the localities managers. We hope this study reflects on the CHS service requirements in light of the new GP contract and will help in delivering service in other PCTs, although regional differences and needs will vary and consideration for that is very important.
En anticipación de una vacuna antirrotavirus: revisión de estudios epidemiológicos sobre la diarrea por rotavirus en la Argentina

En todo el mundo, los rotavirus son la causa mas comun de diarrea grave en los ninos pequenos y actualmente se estan ensayando sobre el terreno vacunas que posiblemente permitan inmunizar a la poblacion infantil dentro de varios anos. Con el fin de estimar la carga de enfermedad por rotavirus en la Argentina y la utilidad de establecer en el pais un sistema de vigilancia de la enfermedad, se revisaron datos sobre la deteccion de estos virus, segun estudios publicados y otros ineditos de nueve ciudades argentinas y uno multicentrico. Los informes revisados indican que se detectaron rotavirus en 20% de 5 226 especimenes (con un recorrido de 6 a 54% entre estudios) tomados de ninos hospitalizados por diarrea y en 9% de 6 587 especimenes (recorrido de 5 a 22% entre estudios) tomados de pacientes ambulatorios, miembros de poblaciones mixtas (ninos hospitalizados y ambulatorios) y sujetos de encuestas comunitarias. Los datos hospitalarios muestran que, si bien los virus se detectaron durante todo el ano, en los meses de invierno (mayo a julio) hubo un pico de intensidad cuando hasta la mitad de los ninos con diarrea dieron resultados positivos a los rotavirus. En tres laboratorios se logro serotipificar para la proteina G 230 de 294 especimenes positivos (78%); los resultados indican que el serotipo G1 fue el mas comun (presente en 60% de los especimenes serotipificados) seguido del G2 (en 20%), G4 (en 14%) y G3 (en 5%). Sobre la base de los datos obtenidos en el pais, se estimo que en 1991 en la Argentina hubo aproximadamente 84 500 visitas de pacientes ambulatorios (1 de cada 8 nacimientos) y 21 000 hospitalizaciones de 4 dias en promedio (1 de cada 31 nacimientos) asociadas con rotavirus, que en conjunto costaron unos US$27,7 millones. Estos datos preliminares muestran que la carga de enfermedad por rotavirus en los ninos argentinos es muy pesada y podria disminuirse con una vacuna segura y efectiva. Ademas se necesita ampliar la vigilancia para mejorar el conocimiento de la epidemiologia y de la distribucion de las cepas de rotavirus en el pais, calcular mas exactamente la eficacia en funcion del costo de un programa de vacunacion antirrotavirus y determinar los mejores metodos de monitorear sus efectos.
Atypical large four-quadrant complex odontomas : Report of two cases in siblings

Odontomas are the most common types of odontogenic tumors in the jaw bone. They are considered to be developmental anomalies (hamartomas) rather than true neoplasms. We are reporting 2 siblings in which atypical large complex odontomas were found in the oral cavity in all four quadrants. A 15-year-old Thai male with end stage renal disease visited the oral surgery unit with pain at lower left alveolar ridge posterior to the deciduous second molar. Clinical and radiographic findings showed multiple malformed tooth-like structures of variable sizes exposed into the posterior region of the four quadrants of the oral cavity and appearing as irregular radiopaque masses which the radiodensity was equal to tooth structure. These unusual features were also found in his elder sister. Nature of these odontomas including histopathological pattern, clinical features, diagnosis and treatment were also discussed. Key word: odontoma, panoramic radiography, computed tomography
Effectiveness of a Worksite Mindfulness-Related Multi-Component Health Promotion Intervention on Work Engagement and Mental Health: Results of a Randomized Controlled Trial

BackgroundModern working life has become more mental and less physical in nature, contributing to impaired mental health and a disturbed energy balance. This may result in mental health problems and overweight. Both are significant threats to the health of workers and thus also a financial burden for society, including employers. Targeting work engagement and energy balance could prevent impaired mental health and overweight, respectively.Methods/DesignThe study population consists of highly educated workers in two Dutch research institutes. The intervention was systematically developed, based on the Intervention Mapping (IM) protocol, involving workers and management in the process. The workers' needs were assessed by combining the results of interviews, focus group discussions and a questionnaire with available literature. Suitable methods and strategies were selected resulting in an intervention including: eight weeks of customized mindfulness training, followed by eight sessions of e-coaching and supporting elements, such as providing fruit and snack vegetables at the workplace, lunch walking routes, and a buddy system. The effects of the intervention will be evaluated in a RCT, with measurements at baseline, six months (T1) and 12 months (T2). In addition, cost-effectiveness and process of the intervention will also be evaluated.DiscussionAt baseline the level of work engagement of the sample was "average". Of the study population, 60.1% did not engage in vigorous physical activity at all. An average working day consists of eight sedentary hours. For the Phase II RCT, there were no significant differences between the intervention and the control group at baseline, except for vigorous physical activity. The baseline characteristics of the study population were congruent with the results of the needs assessment. The IM protocol used for the systematic development of the intervention produced an appropriate intervention to test in the planned RCT.Trial registration numberNetherlands Trial Register (NTR): NTR2199