bluuebunny/crossref_metadata_2025_split huggingface dataset:
The CUORE project cardiovascular risk assessment in primary care: the ongoing experience in Italy
Authors: Palmieri L , Vannucchi S , Lo Noce C , Di Lonardo A , Unim B , Grisetti T , Meduri C , Donfrancesco C 
Published: October 2020

Abstract

Background
Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO).

Aim
To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population.

Methods
Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples.

Results
Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR &lt; 3%); 9.9% of M, 0.4% of W were at high risk (CR ≥ 20%); 26% of M, 16% of W were current smokers; 13% of M, 10% of W were diabetic; 33% of hypertensive M, 35% of hypertensive W were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14% of M, 7% of W). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (0.2-0.7 mmHg), total cholesterol by 4.1 mg/dl (3.0-5.2 mg/dl), smokers prevalence by 3.1% (2.3%-4.0%); HDL-cholesterol increased in W by 0.3 mg/dl (0.1-0.5 mg/dl).

Conclusions
Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process.

Key messages
The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.
Cut-off values of surrogate indices of insulin resistance as risk predictors for metabolic syndrome
Authors: Pikó P , Fiatal S z , Kósa Z s , Sándor J , Ádány R 
Published: October 2020

Abstract

Background
The metabolic syndrome (MS) based on insulin resistance (IR) is a cluster of conditions indicating an increased risk of cardiometabolic diseases. This study aimed to define valid cut-off values for surrogate measures for IR to predicting the risk for the development of MS in the Hungarian general (HG) and Roma (HR) populations.

Methods
This study included 397 HG and 368 HR subjects aged 20-64 years from a complex health survey in 2018/2019. Four surrogate measures, namely the homeostasis model assessment-IR (HOMA-IR), McAuley index (McA), TG to HDL-cholesterol ratio (TG/HDL-C) and TG and glucose index (TyG) were calculated for all participants. The cut-off values were determined as the value with the highest Youden index (YI) on the basis of results obtained by receiver operating characteristic (ROC) curve analysis for the development of MS on separate and combined populations.

Results
Since no significant difference could be detected between the results obtained on separate populations, cut-off values defined on the combined one are proposed to use for risk prediction. The area under the ROC curve was 0.753 (95%CI: 0.718-0.787) for HOMA-IR, 0.827 (95%CI: 0.797-0.856) for McA, 0.843 (95%CI: 0.814-0.872) for TG/HDL-C ratio and 0.862 (95%CI: 0.835-0.889) for TyG. The cut-off value was 2.32 (sensitivity (sens.) 70.9%; specificity (spec.) 69.0%; YI: 0.399) for HOMA-IR, 5.989 (sens. 69.7%; spec. 82.7%; YI: 0.524) for McA, 1.274 (sens. 73.4; spec. 84.3%; YI: 0.574) for TG/HDL-C ratio and 4.694 (sens. 77.2%; spec. 84.3%; YI: 0.615) for TyG. Concerning the fact, that the TyG has the best indicative power for predicting IR to the estimation of MS risk in both populations the IR/MS prevalence was defined by using TyG and found to be as high as 42.3% and 40.5% in the HG and HR populations, respectively.

Conclusions
Based on our results the TyG index could be a useful supplementary method for identifying individuals at risk for MS.

Key messages
The optimal cut-off points’ four surrogate indices of insulin resistance for the prediction of metabolic syndrome did not differ significantly between the Hungarian general and Roma populations. The triglyceride and glucose index proved to be the strongest predictor for the risk of metabolic syndrome in the Hungarian general and Roma populations.
Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort
Authors: Guerrero Fernández de Alba I , Gimeno-Miguel A , Poblador Plou B , Bliek Bueno K , Carmona Pirez J , Rodriguez-Blázquez C , Forjaz M J , Prados-Torres A 
Published: October 2020

Abstract

Background
Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes.

Methods
Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities.

Results
Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23).

Conclusions
The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes.

Key messages
Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.
Trends of polypharmacy among older adults with schizophrenia in Quebec, Canada between 2000 and 2017
Authors: Lunghi C , Rochette L , Ouali A , Sirois C 
Published: October 2020

Abstract

Background
Schizophrenia is a severe psychiatric disorder associated with an increased risk of type 2 diabetes, dyslipidemia and obesity. As adults with schizophrenia age, they become at high risk for multimorbidity and polypharmacy. However, little is known about the trends in total medications use within this population. The objective of this study was to draw a portrait of polypharmacy among Quebec older adults with schizophrenia from 2000 to 2017.

Methods
This population-based cohort study used the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medications use, according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia. We calculated the total number of medications used by every individual in each year under study, and the age- and sex-standardized proportion of individuals with polypharmacy (10+ medications, 15+, and 20+). We further identified the clinical and socio-demographic factors associated with polypharmacy using Poisson regression models with robust variance estimation.

Results
From 2000 to 2017, the prevalence of total medications used increased across all age groups, with a median of 8 medications consumed in 2000-2001, which rose to 11 in 2016-2017. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased over time: 5+: 76.6% to 89.3%; 10+ drugs: 36.9% to 62.2%; 15+: 13.3% to 34.4%; 20+: 3.9% to 14.4%. In the multivariate regression, the only clinically significant factor associated with polypharmacy was the high number of diseases (e.g., 5+: RR = 1.29; 95% IC:1.44-1.53).

Conclusions
This study shows a noticeable increase in polypharmacy exposure of older adults with schizophrenia, raising concerns about the growing risks for adverse effects and drug interactions with antipsychotic treatments.

Key messages
Polypharmacy has constantly grown in the last two decades. Further research is needed to better understand outcomes of polypharmacy among older individuals with schizophrenia.
The effect of levothyroxine therapy on depressive symptoms in adults with subclinical hypothyroidism
Authors: Wildisen L , Del Giovane C , Feller M , Moutzouri E , Mooijaart S , Poortvliet R , Du Puy R , Peeters R , Gussekloo J , Rodondi N 
Published: October 2020

Abstract

Background
Levothyroxine is one of the most commonly prescribed drugs. A common reason for levothyroxine treatment on patients with subclinical hypothyroidism are depressive symptoms. A meta-analysis of four RCTs (n = 278) found no benefit of levothyroxine therapy on depressive symptoms. However, the confidence interval does not exclude a small clinical benefit. We aim to assess the effect of levothyroxine therapy for depressive symptoms in patients with subclinical hypothyroidism using data from a RCT with more than 400 adults.

Methods
The TRUST trial was a double-blind, randomized, placebo-controlled trial involving adults aged ≥65y with subclinical hypothyroidism (elevated TSH levels (4.6-19.9 mU/L) and free thyroxine within the reference range). The outcome was depressive symptoms after 12 months based on the Geriatric Depression Scale (GDS-15), a 15-item questionnaire (range: 0 to 15, higher scores indicate more depressive symptoms, minimal clinical important difference: 2). The multivariable linear regression model was adjusted for levothyroxine starting dose, sex, site, and GDS-15 baseline score.

Results
425 Swiss and Dutch adults with subclinical hypothyroidism were randomised (mean age 75y, 56% female). The mean (SD) TSH was 6.6 (2.1) mU/L at baseline and after 12 months decreased to 3.8 (2.3) mU/L in the levothyroxine group vs 5.9 (2.7) mU/L in the placebo group. At baseline, the mean GDS-15 score was 1.3 (1.9) in the levothyroxine group and 1.0 (1.6) in the placebo group. The mean GDS-15 score at 12 months was 1.4 (2.1) in the levothyroxine and 1.1 (1.7) in the placebo group with an adjusted between-group difference of 0.2 for levothyroxine vs. placebo (95% CI:-0.1 to 0.5; p = 0.29).

Conclusions
In this by far largest RCT on the topic, levothyroxine therapy did not confer a benefit for depressive symptoms. Consequently, our results do not support the practice of prescribing levothyroxine for depressive symptoms when they co-occur with subclinical hypothyroidism.

Key messages
Levothyroxine has no benefit on depressive symptoms in patients with subclinical hypothyroidism. Levothyroxine prescription to patients with subclinical hypothyroidism and depressive symptoms should be reconsidered.
Depression and physical multimorbidity during the adulthood. Cross-sectional associations
Authors: Arias de la Torre J , Ronaldson A , Valderas J M , JAlonso  , Prina M , Hatch S , Rayner L , Pickles A , Hotopf M , ADregan  
Published: October 2020

Abstract

Introduction
The prevalence of depression and physical multimorbidity (pMM) might vary over the life course in a non-random fashion. The aims of our study were to: 1) assess the prevalence of depression and pMM over the life course; and 2) estimate changes in their pattern of association at different ages.

Methods
Data from 13,736 participants aged 26, 30, 34, 38, 42 and 46 years old of the British Child Study cohort was used. Individuals with information on current self-reported depression were selected as study sample. pMM (yes/no) caseness was defined as the coexistence of 2 or more self-reported physical conditions (e.g. asthma, diabetes, epilepsy). The prevalence of depression and pMM was calculated for each wave. To assess their relationship, prevalence ratios (PR) adjusted by gender, socioeconomic (e.g. educational level) and health-related variables (e.g. BMI and smoking status) and their 95% Confidence Intervals (95%CI) were obtained at each wave from multivariable Poisson models.

Results
Prevalence of depression varied with age (10.0% at age 26, 7.8% at age 38 and 18.3% at age 46) as did prevalence of pMM (37% at age 26, 15.6% at age 34, and 20.2% at age 46). A non-linear trend in the prevalence both of depression and pMM was observed with a decrease from age 26 to age 38 (34 for pMM) followed by a consistent increment to age 46. In all ages depression was significantly associated with pMM the magnitude ranging from PR: 1.52 (95%CI 1.41-1.65) at age 26 to PR: 1.96 (95%CI 1.72-2.23) at age 38.

Conclusions
There is consistent association between the prevalence of depression and pMM over different ages during adulthood. The non-linear pattern suggests differences in the type of conditions contributing to pMM at different ages (non-chronic in young adulthood vs chronic from middle adulthood). Further research on clusters and trajectories of different conditions over life course might be valuable to understand the association between depression and pMM.

Key messages
There is consistent association between the prevalence of depression and pMM over different ages during adulthood. They could be differences in the type of conditions contributing to depression related pMM at different ages (non-chronic in young adulthood vs chronic from middle adulthood).
Effect of group treatment on physical inactivity among Syrian refugees. Randomized controlled trial
Authors: Hasha W , Fadnes L T , Igland J , Strømme E M , Younes J H , Kumar B , Diaz E 
Published: October 2020

Abstract

Background
Refugees in Norway show low levels of physical activity, and have relatively high prevalence of pain disorders and post-traumatic symptoms. Physical inactivity can be both a cause of and a consequence of physical and mental symptoms. In CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), two group interventions, one based on physiotherapy and body awareness (PAAI) and the other on Teaching Recovery Techniques (TRT), were developed to treat patients with pain disorders and/or post-traumatic symptoms.

Objective
As a secondary outcome of study, we assessed the effect of these group interventions on physical inactivity.

Methods
We conducted a randomized controlled trial testing two group interventions. Syrian adults ≥16 years with pain and/or post-traumatic symptoms were randomized to either intervention group or control group. Effect of the intervention was measured after 8 (PAAI) and 6 (TRT) weeks, as relative risk (RR) with 95% confidence intervals for being inactive for intervention versus control groups, using log-binomial regression with adjustment for baseline inactivity and type of intervention (PAAI or TRT).

Results
177 Syrian refugees were recruited between July 2018-September 2019. 88 were randomized to the intervention group and 89 to the control group. Mean age was 35 years (SD 11) and 38% were women. Inactivity at recruitment was reported by 126 (71%) participants. The follow-up questionnaire was completed at 6/8 weeks by 116 (66%) participants. At that point, 39% in the intervention group were inactive as compared to 56% in the control group. RR for inactivity for the intervention group adjusted for inactivity at baseline was 0.68 (0.47-0.99) and remained 0.68 (0.48-0.99) when further adjusting for type of intervention (PAAI vs TRT).

Conclusions
PAAI and TRT group interventions reduced inactivity among refugees by 32%. Effect on physical inactivity was similar between PAAI and TRT interventions.

Key messages
Public health care should be aware of physical inactivity, especially in relation to pain disorders and post-traumatic symptoms among refugees. Group treatment interventions succeeded to encourage refugees to increase their physical activity.
No ordinary leaders - Analysing female-headed households in Palestine refugee camps
Authors: Valente de Almeida S , Ghattas H , Pita Barros P 
Published: October 2020

Abstract
We explore the potential impacts of being a female head of household (FH) or a family member in a female-headed household (MFH) in terms of budget expenditures and socio-economic determinants. Female household leaders in Palestine Refugee Camps find themselves with more barriers to provide the basic needs to their families. However, there is yet no analysis on the different household typologies, nor whether these translate into differences in healthcare spending and well-being outcomes.
We perform a cross section analysis using two-part models (probit and glm) to understand correlations between household composition and spending decisions, as well as healthcare indicators. The data are from AUB Socioeconomic Surveys from 2010 and 2015 with household and individual level information.
Our preliminary results follow the evidence in the literature and show that expenditure in healthcare as a percentage of total spending is 2.3%*** higher in 2010 and 3.3%*** in 2015 in female headed households. This difference is higher in families headed by widows or single women. Comparing 2010 to 2015 female-headed households are better off financially and belonging to these families is a significant determinant of receiving remittances from family abroad or in Lebanon and being self-employed.
Our results suggest that family remittances for female-headed households, heads of households having their own business and better budget management may be helping these families to cope with financial distress. These families are also target of special social support, but further research is needed to understand whether this support should target the gender of the household head or a more specific issue, that might be common to most of these households, but not the female leadership itself.

Key messages
Female-headed households are related to higher household budget spending on healthcare, are more likely to receive remittances from abroad and most of female heads of households are self-employed. We contribute to the discussion on whether special social support should target specifically female headed households or other specific poverty related issues.
Racial differences in mammographic density in Brazil: implications for mammographic screening
Authors: Gabrielli L , Ghaderi S , Almeida M C C , Goes E , Gnoatto C , Almeida L , Menezes G M S , dos-Santos-Silva I , Aquino E M L 
Published: October 2020

Abstract

Background
Mammographic density (MD)-the amount of radio-dense fibroglandular tissue seen on a mammogram - is a stronger biomarker of susceptibility to breast cancer and a major determinant of the sensitivity of mammographic screening. This study examined for the first time racial differences in MD in Brazil.

Methods
555 women (215 from the Longitudinal Study of Adult Health - ELSA-Brasil and 340 users of the Unified Health System - SUS) in Bahia were enrolled into the study. Participants completed an interview, had their heights and weights measured, and underwent a 2-view (cranio-caudal (CC) and medio-lateral-oblique (MLO)) digital mammography of each breast. MD was measured on the left MLO image using the semi-automated Cumulus software, and expressed as the percentage (PMD) of the breast area occupied by fibroglandular tissue. Linear regression models were fitted to assess ethnicity-PMD associations adjusting for age at mammography, body mass index (BMI) and reading batch (minimally-adjusted) and further for socio-economic and reproductive variables.

Results
The study population comprised 95 White (W), 270 Brown-mixed (Bm) and 169 Black (B) women, with a mean age at mammography of 58 (SD = 5.4) years. 63% W, 69% Bm and 49% B women had low educational level; 24% W, 47% Bm and 31% B women had ≥4 children. Minimally-adjusted analysis showed that relative to W women, PMD was 23% (1.23; 95% CI 1.04-1.45) higher in Bm and 4% (1.04; 0.89-1.21) higher in B; however, further adjustment for socio-economic and reproductive variables attenuated the racial differences (fully-adjusted model: 16% (1.16; 0.96-1.40) and 9% (1.09; 0.92-1.29) for Bm and B, respectively.

Conclusions
The racial differences in PMD were mainly accounted by ethnic differences in socio-economic and reproductive-related factors.
Implications Further studies should examine whether racial differences in PMD in Brazil lead to racial differences in false negative and interval cancer rates of mammographic screening.

Key messages
In Brazil, ethnic differences in socio-economic and reproductive-related factors are responsible for racial differences in mammographic density. More research is needed to address racial differences in breast cancer risk in Brazil.