bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmaceutical intervention after evaluation of the risk of ictus in elderly patients institutionalized with atrial fibrillation
Authors: Pérez-Surio Alberto Frutos , Ortiz Roberto Lozano , Crespo Alejandro Martínez 
Published: May 2019

Objectives To evaluate the risk of having a stroke and the risk of bleeding in institutionalized patients with atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia associated with increased morbidity and mortality. It is necessary to develop pharmacotherapy plans to minimize the risk. Design A prospective study. Setting Institutionalized patients. Participants Inclusion criteria were: patients diagnosed with atrial fibrillation, with or without treatment for the prevention of stroke. Main outcome measures The evaluation of the CHA2DS2-VASc criteria was performed. The risk of hemorrhage was assessed using the HAS-BLED scale, based on the risk factors associated with the probability of bleeding. Results We included 53 patients (86.4 ± 6.4 years, 30.2% men). Of these, 37 (69.8%) were correctly anticoagulated. Of the remaining, 5 patients (31.2%) did not have any type of anticoagulant or antiaggregant treatment and 11 (68.7%) were treated with antiaggregant alone. The pharmaceutical intervention was performed in patients who did not meet stroke criteria. Of the untreated patients: two died before the intervention, two were recommended to be referred to cardiology and in one there was no intervention because of very advanced age. In the antiaggregant patients, it was decided not to modify the treatment. The reasons were: high risk of bleeding, very advanced age, advanced dementia or terminal illness, moderate risk of stroke, and clotting factor deficiency. Conclusions The risk of stroke in elderly patients with atrial fibrillation is high, so it is important to control the risk factors.
Serum Apolipoprotein B and A1 Concentrations Predict Late-Onset Posttransplant Diabetes Mellitus in Prevalent Adult Kidney Transplant Recipients
Authors: Malyala Rohit , Rapi Lindita , Nash Michelle M. , Prasad G. V. Ramesh 
Published: May 2019

Background: Glucose metabolism links closely to cholesterol metabolism. Posttransplant diabetes mellitus (PTDM) adversely affects posttransplant outcomes, but its risk factors in relation to cholesterol metabolism have not been fully delineated. The apolipoprotein B/A1 (Apo B/A1) ratio, which is associated with insulin resistance, has not been evaluated in kidney transplant recipients as a risk factor for PTDM. Objective: The objective of this study was to determine whether serum apolipoprotein profiles predict late PTDM, defined as a new onset diabetes occurring greater than 3 months posttransplant. Design: Retrospective chart review of a prevalent population of kidney transplant recipients. Setting: Large transplant center in Ontario, Canada. Patients: We identified 1104 previously nondiabetic adults who received a kidney transplant between January 1, 1998, and December 1, 2015, and were followed at 1 transplant center. Measurements: Recipients provided testing for serum apolipoprotein B (Apo B) and apolipoprotein A1 (Apo A1) concentrations from 2010, either at 3 months posttransplant for new transplant recipients or the next clinic visit for prevalent recipients. Late PTDM defined using Canadian Diabetes Association criteria as occurring ≥3 months posttransplant was recorded until May 1, 2016. Methods: All analyses were conducted with R, version 3.4.0 (The R Foundation for Statistical Computing). Comparisons were made using Student t test, Fisher exact test or chi-square test, Kaplan-Meier methodology with the logrank test, or Cox proportional hazards analysis as appropriate. Covariates for the multivariate Cox proportional hazards models of PTDM as the outcome variable were selected based on significance of the univariate associations and biological plausibility. Results: There were 53 incident late PTDM cases, or 1.71 cases per 100 patient-years. Incident late PTDM differed between the highest and lowest quartiles for Apo B/A1 ratio, 2.47 per 100 patient-years vs 0.88 per 100 patient-years ( P = .005 for difference). In multiple Cox regression analysis, first measured serum Apo B/A1 concentration better predicted subsequent PTDM than low-density lipoprotein cholesterol (LDL-C; hazard ratio [HR] = 7.80 per unit increase, P = .039 vs HR = 1.05 per unit increase, P = .774). Non-high-density lipoprotein cholesterol (HDL-C) concentrations also did not predict PTDM ( P = .136). By contrast to Apo B, Apo A1 was protective against PTDM in statin users (HR = 0.17 per unit increase, P = .016). Limitations: Posttransplant diabetes mellitus cases occurring before apolipoprotein testing was implemented were not included in the analysis. Conclusions: Apolipoproteins B and A1 better predict late PTDM than conventional markers of cholesterol metabolism.
The economic burden of health disparities related to socioeconomic status in Israel
Authors: Politzer Eran , Shmueli Amir , Avni Shlomit 
Published: May 2019

Abstract
Background
Low socioeconomic status (SES) is often associated with excess morbidity and premature mortality. Such health disparities claim a steep economic cost: Possibly-preventable poor health outcomes harm societal welfare, impair the domestic product, and increase health care expenditures. We estimate the economic costs of health inequalities associated with socioeconomic status in Israel.

Methods
The monetary cost of health inequalities is estimated relative to a counterfactual with a more equal outcome, in which the submedian SES group achieves the average health outcome of the above-median group. We use three SES measures: the socioeceonmic ranking of localities, individuals’ income, and individuals’ education level. We examine costs related to the often-worse health outcomes in submedian SES groups, mainly: The welfare and product loss from excess mortality, the product loss from excess morbidity among workers and working-age adults, the costs of excess medical care provided, and the excess government expenditure on disability benefits. We use data from the Central Bureau of Statistics’ (CBS) surveys and socio-health profile of localities, from the National Insurance Institute, from the Ministry of Health, and from the Israel Tax Authority. All costs are adjusted to 2014 terms.

Results
The annual welfare loss due to higher mortality in socioeconomically submedian localities is estimated at about 1.1–3.1 billion USD. Excess absenteeism and joblessness occasioned by illness among low-income and poorly educated workers are associated with 1.4 billion USD in lost product every year. Low SES is associated with overuse of inpatient care and underuse of community care, with a net annual cost of about 80 million USD a year. The government bears additional cost of 450 million USD a year, mainly due to extra outlays for disability benefits. We estimate the total cost of the estimated health disparities at a sum equal to 0.7–1.6% of Israel’s GDP.

Conclusions
Our estimates underline the substantial economic impact of SES-related health disparities in Israel. The descriptive evidence presented in this paper highlights possible benefits to the economy from policies that will improve health outcomes of low SES groups.
Relationship Between Body Build and Mental Illness
Authors: Verghese Abraham , Large Pamela , Chiu Edmond 
Published: May 2019

SummaryA study to test the relationship between body build and mental illness, conducted in Royal Park Psychiatric Hospital, Melbourne, is described. The Rees-Eysenck body index (REBI) and androgyny score (AGS) were determined for 225 male patients and 24 normals. As age increases, there is a decreasing trend in the scores for these two indices. There were no significant differences between the various diagnostic groups and the normal group for the AGS. But the difference between the non-paranoid schizophrenic group and paranoid schizophrenic group in REBI was significant.
Chronic Schizophrenic Patients in the Community
Authors: Cheadle A. J. , Freeman H. L. , Korer J. 
Published: May 2019

SummaryA sample of 190 patients, diagnosed as schizophrenic by the same psychiatrist, have been surveyed in an urban community and their clinical and social status assessed. Compared to the local population as a whole, a significantly greater proportion of the men had never married, and although the women had married at approximately the same rate as those in the general population, 25 per cent of them had been divorced by the time of the interview. Assessments of the subjects' clinical condition by the Present State Examination were analysed into four groups of syndromes. Only 27 patients showed schizophrenic or paranoid symptoms, whereas neurotic symptoms were not only prevalent but seemed to cause most of the reported personal problems. Twenty-eight patients were free of symptoms at the time of interview. The great majority of the sample (72 per cent) were being maintained on long-acting neuroleptics. These data will form the baseline to assess a monitoring system, designed to keep the local psychiatric services in touch with schizophrenic patients who might otherwise drop out of treatment.
Phenomenology of Obsessive-Compulsive Neurosis
Authors: Stern R. S. , Cobb J. P. 
Published: May 2019

SummaryForty-five patients with obsessive-compulsive neurosis were given a specially devised structured interview with the aim of elucidating aspects of the phenomenology. Four main kinds of ritual were found to predominate: cleaning, avoiding, repeating and checking. A surprisingly large number of patients had little or no resistance to carrying out their rituals. The recognition of senselessness of a ritual was a more important criterion than that of resistance, but patients with predominantly repeating rituals did demonstrate resistance. It is proposed that a redefinition of obsessive-compulsive neurosis with less emphasis on resistance as a necessary condition may be appropriate.
Suicide, Cancer and Depression
Authors: Whitlock F. A. 
Published: May 2019

SummaryA comparison has been made between persons aged 50 and over dying from suicide and a matched control group of persons dying from other violent causes with respect to the incidence of malignant neoplasms and benign intracranial tumours found at autopsy. Significantly more of the suicide cases were found to have cancer, meningiomas and benign pituitary tumours. The implications of this finding and the relationship between depression and neoplasia are discussed.
Serum IL-6 and CRP as prognostic factors in melanoma patients receiving single agent and combination checkpoint inhibition.
Authors: Weber Jeffrey S. , Tang Hao , Hippeli Lauren , Qian Max , Wind-Rotolo Megan , Larkin James M.G. , Wolchok Jedd D. , Sznol Mario , Robert Caroline , Woods David Michael , Laino Andressa Sodre , Hodi F. Stephen 
Published: May 2019

100 Background: Acute phase reactants including C-reactive protein (CRP), and chronic inflammatory proteins including IL-6, which induces production of CRP from the liver, have been associated with a poor outcome in a variety of cancers. Methods: Sera from the CheckMate 064, 066 and 067 studies were assessed at baseline and on treatment for levels of IL-6 and CRP by Luminex. Associations between IL-6 and/or CRP levels and response or survival were determined. Purified endotoxin- and azide-free CRP was also tested for its immune effects in vitro using human T cells. Results: In patients receiving sequential nivolumab then ipilimumab in CheckMate 064 (cohort A), baseline serum IL-6 was associated with response (p = 0.03); serum IL-6 at week 12 after nivolumab alone (cohort A) or ipilimumab alone (cohort B), was also associated with response (p = 0.004 and 0.006, respectively). Baseline IL-6 above the median was associated with shorter survival in cohort A (p = 0.003) and cohort B (p = 0.0001). Serum CRP above the median was associated with shorter survival in cohort A (p = 0.001). Baseline IL-6 and CRP in cohort A were associated with one another, rho = 0.71 and p < 0.0001 In the randomized CheckMate 067 study, higher baseline serum CRP above the median was associated with shorter survival for ipilimumab, nivolumab or the combination with p < 0.0001, p < 0.11, and p = 0.0034, respectively. In the randomized CheckMate 066 study, higher baseline serum CRP was associated with shorter survival for nivolumab or dacarbazine (p = 0.131 and P < 0.0001 respectively). CRP suppressed T cell immunity and function, and levels above 10 micrograms/mL suppressed T cell proliferation (p = 0.005) and altered T cell signaling as well as calcium flux (p = 0.01), suggesting that CRP affected the earliest steps in T cell signaling and activation. Conclusions: High levels of CRP and IL-6 at baseline were associated with a poor response and shorter survival after nivolumab alone, and CRP with ipilimumab alone or the combination of both drugs. High levels of CRP were also associated with shorter overall survival in the randomized CheckMate 066 study of chemotherapy compared to nivolumab. CRP and IL-6 are prognostic factors for checkpoint inhibition.
Effect of intensification of induction II chemotherapy and liberalization of stem cell donor source on outcome for children with high risk acute myeloid leukemia: A report from the Children’s Oncology Group.
Authors: Aplenc Richard , Sung Lillian , Pollard Jessica Anne , Brodersen Lisa , Loken Michael , Gerbing Robert B , Getz Kelly D. , Meshinchi Soheil , Woods William G. , Kolb E. Anders , Alonzo Todd Allen , Gamis Alan S. 
Published: May 2019

10002 Background: Patients with residual acute myeloid leukemia (AML) after induction fare poorly. The recently completed AAML1031 Phase III clinical trial intensified Induction II chemotherapy, altered the stem cell transplant (SCT) conditioning regimen, and liberalized SCT donor source criteria. We sought to test whether these practice changes improved clinical outcomes. Methods: Patients on AAML0531 and AAML1031, sequential Phase III trials for AML with shared high risk features of both > 15% residual blasts by morphology and ≥ 0.1% minimal residual disease (MRD) by flow cytometry with uninformative cytogenetics or high risk cytogenetic features (-7 or -5/5q-) were included. Gemtuzmab exposed and patients with high allelic ratio FLT3 ITD were excluded. Patients were observed from the start of Induction II through last available follow up. Induction II chemotherapy (ADE or AraC/Mito) was the exposure of interest. Disease free and overall survival (DFS, OS) were the primary outcomes. Standard descriptive statistics were used to compare patient characteristics and secondary outcomes; Kaplan Meier analyses were used to evaluate DFS/OS. Results: A total of 47 patients from AAML0531 (ADE) and 95 patients from AAML1031 (AraC/Mito) were included and did not differ in baseline characteristics. Five year DFS ±2SE was 17.5 ± 11.4 for ADE and 23.9 ± 8.8 for AraC/Mito, p = 0.528. Five year OS was 38.1 ± 14.2 for ADE and 33.3 ± 10.7 for AraC/Mito, p = 0.364. End of Induction II disease response and MRD did not differ between ADE and AraC/Mito. Patients receiving ADE had a higher probability of neutrophil recovery (74% vs 53%, p = 0.019) and recovered neutrophils a median of 7 days more quickly (27 vs 34 days), p = < 0.001. ADE patients also had fewer inpatient hospital days (28 days versus 32 days, p = 0.002). The percentage of patients receiving SCT did not differ, 34% vs 44%, p = 0.253 and post-SCT outcomes did not differ. Conclusions: The intensification of Induction II chemotherapy, change in SCT conditioning regimen, and liberalization of SCT donor source was not associated with improved clinical outcomes. Intensification of Induction II was associated with increased hematologic toxicity and length of stay. These data do not support the intensification of Induction II chemotherapy with AraC/Mitoxantrone. Clinical trial information: NCT01371981.
A randomized trial of a mercaptopurine (6MP) adherence-enhancing intervention in children with acute lymphoblastic leukemia (ALL): A COG ACCL1033 study.
Authors: Bhatia Smita , Hageman Lindsey , Chen Yanjun , Wong Florence Lennie , Mascarenhas Leo , Freyer David Robert , Mba Nkechi , Aristizabal Paula , Walterhouse David , Lew Glen , Kempert Pamela , Russell Thomas , McNall-Knapp Rene , Jacobs Shana S. , Dang Ha , Raetz Elizabeth A. , Relling Mary V. , Landier Wendy 
Published: May 2019

10007 Background: We previously reported that > 40% of children with ALL are non-adherent to 6MP, and > 52% of ALL relapses are attributable to 6MP non-adherence. The most common barrier is forgetting to take 6MP; the most common facilitator is parental vigilance. These observations informed a randomized trial to enhance 6MP adherence (COG-ACCL1033, #NCT01503632; 89 COG sites). Results are described here. Methods: The Intervention Package (IP) consisted of: i) Education; ii) 6MP schedules; iii) daily personalized text message reminders from physician to patient and caregiver, to prompt iv) directly supervised therapy (DST), with text back response by patient/caregiver. Baseline adherence was measured for 4 wks, followed by intervention for 16 wks to examine the impact of IP vs. Edu (education) on 6MP adherence (measured electronically by MEMs Cap) in all patients, ≥12yo, < 12yo. Longitudinal binomial logistic regression using generalized estimating equations was used. Missing data were handled by multiple imputation. Results: 444 patients were randomly assigned to IP (n = 230) or Edu (n = 214). Baseline characteristics (age at study: 8.6y vs 7.5y; males: 67% vs 69%; non-Hispanic whites: 40% vs 42%) and adherence rates (92% vs 94%) were comparable (except paternal education: 49% vs 38%, p = 0.04). No study arm*time interaction was found; thus, the 16-week overall mean fitted adherence rates were compared between IP and Edu, adjusting for baseline adherence, time on study, parental education. All patients: Adherence rates were marginally higher on IP (94% vs 92.5%, p = 0.09). On IP, for times with a record of text response, adherence rates were higher (94%) when compared with times with no response (89%), p = 0.002. < 12yo: Adherence rates were comparable (IP: 94.4% vs Edu: 93.7%, p = 0.5). ≥12yo: Adherence rates were significantly higher on IP (93.1% vs 90.0%, p = 0.037). ≥12yo with baseline adherence < 90%: IP had the highest impact for this subgroup (83.4% vs 74.6%, p = 0.008). Conclusions: A 16-week comprehensive intervention resulted in higher 6MP adherence rates in children with ALL who were 12y or older at study. IP was most impactful in adolescents with baseline non-adherence. Clinical trial information: #NCT01503632.
Comparing late mortality risks among childhood cancer survivors: A report from the Childhood Cancer Survivor Study and British Childhood Cancer Survivor Study.
Authors: Fidler Miranda Marie , Oeffinger Kevin C. , Yasui Yutaka , Winter David L , Leisenring Wendy , Robison Leslie L. , Reulen Raoul , Chen Yan , Armstrong Gregory T. , Hawkins Mike 
Published: May 2019

10017 Background: It is unclear whether late-effect risks are comparable across international settings. We compared late mortality risks in the Childhood Cancer Survivor Study (CCSS) and British Childhood Cancer Survivor Study (BCCSS). Methods: 46,474 5-year survivors of childhood cancer diagnosed from 1970-1999 and < 15 years age were included: 28,248 from the CCSS and 18,226 from the BCCSS. Late mortality (death ≥5 years from diagnosis) was assessed by linking to national vital statistics records. Adjusted ratios of the standardized mortality ratio (RSMR) and cumulative mortality probabilities were used to compare risks between cohorts. Treatment exposures were not available for the BCCSS, precluding comparison. Results: The cumulative all-cause mortality at 10 years from diagnosis was significantly lower in the CCSS (4.8%;95%CI:4.6%-5.0%) compared to the BCCSS (6.9%;95%CI:6.5%-7.2%); this was due to a lower probability of death from recurrence/progression of the primary cancer (CCSS = 3.3% vs. BCCSS = 5.8%), with significant differences observed in survivors of leukemia (7.9% vs 4.0%), Hodgkin lymphoma (2.5% vs 1.3%), CNS tumors (6.4% vs 4.4%), and sarcoma (6.5% vs 4.0%). However, with increasing time from diagnosis, risks became more similar. The CCSS ultimately had a greater cumulative mortality at 40 years from diagnosis, attributable to a 2-fold higher mortality from subsequent neoplasms (SNs) (RSMR:2.0;95%CI:1.8-2.3), cardiac (RSMR:1.7;95%CI:1.4-2.3) and pulmonary (RSMR:1.9;95%CI:1.4-2.5) causes, and other health-related deaths (RSMR:2.4;95%CI:2.1-2.9). When assessed by follow-up interval, the differences between the CCSS and BCCSS increased significantly for deaths due to SNs, cardiac and pulmonary causes, and other health-related deaths as time increased. Among those diagnosed more recently, the gap in all-cause mortality widened, with CCSS survivors diagnosed 1990-1999 experiencing approximately half the excess (RSMR:0.5;95%CI:0.5-0.6) observed in the BCCSS; this widening was driven by declines in the RSMR for most non-recurrence/progression causes of death. Conclusions: Our findings suggest that North American survivors may have received more intensive regimens during this time period to achieve sustainable remission and cure. However, the cost of this approach was a higher risk of death from late-effects. Which approach confers a net survival advantage will depend critically on the magnitude of the excess risk of late-effect deaths as the cohorts age.