bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza
Authors: Jha Akhilesh , Dunning Jake , Tunstall Tanushree , Thwaites Ryan S. , Hoang Long T. ,   The MOSAIC Investigators, Kon Onn Min , Zambon Maria C. , Hansel Trevor T. , Openshaw Peter J. 
Published: August 2019

BackgroundPatients with asthma are at risk of hospitalisation with influenza, but the reasons for this predisposition are unknown.Study settingA prospective observational study of adults with PCR-confirmed influenza in 11 UK hospitals, measuring nasal, nasopharyngeal and systemic immune mediators and whole-blood gene expression.ResultsOf 133 admissions, 40 (30%) had previous asthma; these were more often female (70%versus38.7%, OR 3.69, 95% CI 1.67–8.18; p=0.0012), required less mechanical ventilation (15%versus37.6%, Chi-squared 6.78; p=0.0338) and had shorter hospital stays (mean 8.3versus15.3 days, p=0.0333) than those without. In patients without asthma, severe outcomes were more frequent in those given corticosteroids (OR 2.63, 95% CI 1.02–6.96; p=0.0466) or presenting >4 days after disease onset (OR 5.49, 95% CI 2.28–14.03; p=0.0002). Influenza vaccination in at-risk groups (including asthma) were lower than intended by national policy and the early use of antiviral medications were less than optimal. Mucosal immune responses were equivalent between groups. Those with asthma had higher serum interferon (IFN)-α, but lower serum tumour necrosis factor, interleukin (IL)-5, IL-6, CXCL8, CXCL9, IL-10, IL-17 and CCL2 levels (all p<0.05); both groups had similar serum IL-13, total IgE, periostin and blood eosinophil gene expression levels. Asthma diagnosis was unrelated to viral load, IFN-α, IFN-γ, IL-5 or IL-13 levels.ConclusionsAsthma is common in those hospitalised with influenza, but may not represent classical type 2-driven disease. Those admitted with influenza tend to be female with mild serum inflammatory responses, increased serum IFN-α levels and good clinical outcomes.
Complex post-traumatic stress disorder: a new diagnosis in ICD-11
Authors: Brewin Chris R. 
Published: August 2019

SUMMARYThe World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous similar formulations, describes its definition and requirements, and reviews the evidence concerning its epidemiology, differential diagnosis, assessment and treatment.
Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level
Authors: Anselmi Laura , Everton Anna , Shaw Robert , Suzuki Wataru , Burrows Jeremy , Weir Richard , Tatarek-Gintowt Roman , Sutton Matt , Lorrimer Stephen 
Published: August 2019

BackgroundEquitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need.AimsTo produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England.MethodWe used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula.ResultsHigher costs were associated with: being 30–50 years old, compared with 20–24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost.ConclusionsThe resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.
Impact of Peer Review in the Radiation Treatment Planning Process: Experience of a Tertiary Care University Hospital in Pakistan
Authors: Qureshi Bilal Mazhar , Mansha Muhammad Atif , Karim Muneeb Uddin , Hafiz Asim , Ali Nasir , Mirkhan Benazir , Shaukat Fatima , Tariq Maria , Abbasi Ahmed Nadeem 
Published: August 2019

PURPOSE To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week. MATERIALS AND METHODS Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. All recommendations were stratified on the basis of treatment intent, site, and technique. Data were analyzed by Statistical Package for the Social Sciences and are presented descriptively. RESULTS Out of 116 plans, 26 (22.4%) were recommended for changes. Minor changes were suggested in 15 treatment plans (12.9%) and a major change in 10 (8.6%), and only one plan was suggested for missing contour. The frequency of change recommendations was greater in radical radiation plans than in palliative plans (92.3% v 7.7%). The head and neck was the most common treatment site recommended for any changes (42.3%). Most of the changes were recommended in the technique planned with three-dimensional conformal radiation therapy (50%). Clinical target volume (73.1%) was identified as the most frequent parameter suggested for any change, followed by treatment field (19.2%) and dose (0.08%). CONCLUSION Peer review is an important tool that can be used to overcome deficiencies in radiation treatment plans, with a goal of improved and individualized patient care. Our study reports changes in up to a quarter of radiotherapy plans.
High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use?
Authors: Zheng Zhiyuan , Jemal Ahmedin , Banegas Matthew P. , Han Xuesong , Yabroff K. Robin 
Published: August 2019

PURPOSE: To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization. MATERIALS AND METHODS: The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the associations among HDHP/health savings account (HSA) status, delayed/forgone care for financial reasons, and hospital emergency department (ED) visits among cancer survivors compared with individuals without a cancer history. RESULTS: Among cancer survivors, HDHPs with or without HSA (8.9% and 13.9%, respectively; both P < .05) were associated with more delayed/forgone care compared with low-deductible health plans (LDHPs) (7.9%). HSA enrollment was associated with less delayed/forgone care among HDHP cancer survivors ( P < .05). ED visits were similar by insurance type. Among individuals without a cancer history, HDHP with or without HSA (9.5% and 10.8%, respectively; both P < .05) were both associated with more delayed/forgone care compared with LDHPs (5.9%). HSA enrollment also was associated with less delayed/forgone care among HDHP enrollees without a cancer history. A small difference in ED visits was observed between HDHPs without HSA (15.3%) and LDHPs (14.1%; P < .05) or HDHPs with HSA (13.4%; P < .05) among individuals without a cancer history. CONCLUSION: HDHP enrollment and HSA status affect access to care and hospital ED visits similarly by cancer history. HDHP enrollment may serve as a barrier to access to care among cancer survivors, although HSA enrollment coupled with an HDHP may mitigate the impact on access. HDHPs and HSA status were not associated with ED visits among cancer survivors. Improvement to care coordination efforts may be needed to reduce ED visits among privately insured cancer survivors.
A Narrative Review of Placental Contribution to Adverse Pregnancy Outcomes in Women With Polycystic Ovary Syndrome
Authors: Kelley Angela S , Smith Yolanda R , Padmanabhan Vasantha 
Published: August 2019

AbstractContextPolycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. In pregnancy, women with PCOS experience increased risk of miscarriage, gestational diabetes, preeclampsia, and extremes of fetal birth weight, and their offspring are predisposed to reproductive and cardiometabolic dysfunction in adulthood. Pregnancy complications, adverse fetal outcomes, and developmental programming of long-term health risks are known to have placental origins. These findings highlight the plausibility of placental compromise in pregnancies of women with PCOS.Evidence SynthesisA comprehensive PubMed search was performed using terms “polycystic ovary syndrome,” “placenta,” “developmental programming,” “hyperandrogenism,” “androgen excess,” “insulin resistance,” “hyperinsulinemia,” “pregnancy,” and “pregnancy complications” in both human and animal experimental models.ConclusionsThere is limited human placental research specific to pregnancy of women with PCOS. Gestational androgen excess and insulin resistance are two clinical hallmarks of PCOS that may contribute to placental dysfunction and underlie the higher rates of maternal–fetal complications observed in pregnancies of women with PCOS. Additional research is needed to prevent adverse maternal and developmental outcomes in women with PCOS and their offspring.
Longitudinal Changes in Fasting and Glucose-Stimulated GLP-1 and GIP in Healthy Older Subjects
Authors: Pham Hung , Marathe Chinmay S , Phillips Liza K , Trahair Laurence G , Hatzinikolas Seva , Huynh Lian , Wu Tongzhi , Nauck Michael A , Rayner Christopher K , Horowitz Michael , Jones Karen L 
Published: August 2019

AbstractContextIt is not known whether glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) levels correlate within individuals, nor whether levels change with age. Previous studies have all been cross-sectional in design.ObjectiveTo evaluate longitudinal changes in fasting and glucose-stimulated incretin hormone concentrations in healthy older subjects.Patients and DesignForty-one healthy older subjects had measurements of plasma GLP-1 and GIP while fasting and after a 75-g oral glucose load on two occasions separated by 5.9 ± 0.1 years [mean age at the initial study: 71.2 ± 3.8 (SD) years]. Breath samples were collected to calculate the gastric 50% emptying time (T50).ResultsFor GLP-1, both fasting concentrations (P < 0.001) and area under the curve 0 to 120 minutes (P = 0.001) were decreased at followup. Fasting GIP was also lower (P = 0.03) at follow up, but there was no change in the area under the curve 0 to 120 minutes (P = 0.26). The gastric emptying T50 was slower at followup (P = 0.008). Neither the change in T50 nor the body mass index at the initial study was a determinant of the change in incretin responses. Between the two study days, fasting GIP (r = 0.72, P < 0.001) correlated well, but not fasting GLP-1 (r = 0.23, P = 0.18). However, both glucose-stimulated GLP-1 (r = 0.50, P = 0.002) and GIP (r = 0.60, P < 0.001) showed correlations between the initial and follow-up studies.ConclusionsFasting GIP and glucose-stimulated GLP-1 and GIP concentrations correlate within individuals over a follow-up period of ∼5.9 years. Aging is associated with reductions in fasting GLP-1 and GIP, and glucose-stimulated GLP-1, which may predispose to the development of glucose intolerance and type 2 diabetes.
Apolipoprotein(a) Kinetics in Statin-Treated Patients With Elevated Plasma Lipoprotein(a) Concentration
Authors: Ma Louis , Chan Dick C , Ooi Esther M M , Marcovina Santica M , Barrett P Hugh R , Watts Gerald F 
Published: August 2019

AbstractBackgroundLipoprotein(a) [Lp(a)] is a low-density lipoprotein‒like particle containing apolipoprotein(a) [apo(a)]. Patients with elevated Lp(a), even when treated with statins, are at increased risk of cardiovascular disease. We investigated the kinetic basis for elevated Lp(a) in these patients.ObjectivesApo(a) production rate (PR) and fractional catabolic rate (FCR) were compared between statin-treated patients with and without elevated Lp(a).MethodsThe kinetics of apo(a) were investigated in 14 patients with elevated Lp(a) and 15 patients with normal Lp(a) levels matched for age, sex, and body mass index using stable isotope techniques and compartmental modeling. All 29 patients were on background statin treatment. Plasma apo(a) concentration was measured using liquid chromatography–mass spectrometry.ResultsThe plasma concentration and PR of apo(a) were significantly higher in patients with elevated Lp(a) than in patients with normal Lp(a) concentration (all P < 0.01). The FCR of apo(a) was not significantly different between the groups. In univariate analysis, plasma concentration of apo(a) was significantly associated with apo(a) PR in both patient groups (r = 0.699 and r = 0.949, respectively; all P < 0.01). There was no significant association between plasma apo(a) concentration and FCR in either of the groups (r = 0.160 and r = −0.137, respectively).ConclusionElevated plasma Lp(a) concentration is a consequence of increased hepatic production of Lp(a) particles in these patients. Our findings provide a kinetic rationale for the use of therapies that target the synthesis of apo(a) and production of Lp(a) particles in patients with elevated Lp(a).
Adult anthropometry in Type 2 diabetic population: A case-control study
Authors: Qureshi Sarah Shoaib , Amer Wasim , Kaleem Maryam , Mahmood Bilal 
Published: August 2019

Objectives: This study was aimed to compare the body mass index (BMI) and waist-to-hip ratio (WHR) in their ability to predict type 2 diabetes risk in a large prospective cohort of men and women in Pakistan.
Methods: This was a case-control study conducted at Diabetic and medical OPD of GTTH. Anthropometric measures including BMI and WHR were analyzed. Student’s t-test, Chi-squared test along with Cramer’s V value, was applied to evaluate association between variables. Receiver operating curve (ROC) was used to assess anthropometric measures.
Results: The study included 804 diabetics and 396 non-diabetics between 30–60 years of age. Comparing the BMI parameters it was found that 717 (89·2%) in diabetic group were overweight or obese (p-value < 0·001). On comparing the WHR, 97·9% diabetics had increased WHR (p-value <0·001). Both BMI & WHR were further compared using ROC curve which found out that WHR had an area under ROC of 0·720 & BMI has 0·680, suggesting that WHR is more better predictor of diabetes as compared to BMI.
Conclusions: Both BMI and WHR were strong discriminators of T2DM but WHR was found superior according to ROC value. Family history is significantly associated in patients with diabetes.
doi: https://doi.org/10.12669/pjms.35.5.759
How to cite this:Qureshi SS, Amer W, Kaleem M, Beg BM. Adult anthropometry in Type 2 diabetic population: A case-control study. Pak J Med Sci. 2019;35(5):1284-1289. doi: https://doi.org/10.12669/pjms.35.5.759
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dismal situation of cardio pulmonary resuscitation knowledge and skills among junior doctors in twin cities of Pakistan
Authors: Ghauri Sanniya  Khan , Javaeed Arslaan , Shah Faiza , Ghani Misbah-ul-Hasan 
Published: August 2019

Objective: To assess the knowledge, attitude, and practice of cardio pulmonary resuscitation (CPR) among junior doctors in 13 tertiary care hospitals of Rawalpindi and Islamabad.
Methods: A total of 317 junior doctors from 13 tertiary care hospitals in Rawalpindi and Islamabad in Pakistan were included in this cross-sectional study. Data were collected using a 37-item interviewer-administered structured questionnaire by the researchers. Informed consent and ethical approval were secured. Doctors’ knowledge, attitude, and practice regarding CPR were presented and compared across the demographic variables (age, gender, CPR training etc.). Data analysis was done using SPSS V 23 at an alpha level of 5%.
Results: Response rate for this study was 87.08%. Abbreviations of BLS, AED, and EMS were known by 94.3%, 36.0%, and 41.0% doctors respectively. No doctor had complete knowledge of CPR. Less than half of the participants knew the proper compression depths. Overall knowledge regarding CPR steps was poor. Out of 31 CPR knowledge, attitude, and practice related questions 21 correct answers were given by two doctors which was the highest score. The mean KAP score was 14.18 ± 0.15.
Conclusion: Awareness regarding CPR is essential for all doctors. Many authorities in developed countries are giving CPR training to the general population whereas in Pakistan, many of the doctors never had CPR training. The current study showed the clear majority wants hands-on CPR training. Hospital authorities may find this as an opportunity to improve the knowledege and skills of health workers.
doi: https://doi.org/10.12669/pjms.35.5.785
How to cite this:Ghauri SK, Javaeed A, Shah F, Ghani MH. Dismal situation of cardio pulmonary resuscitation knowledge and skills among junior doctors in twin cities of Pakistan. Pak J Med Sci. 2019;35(5):1295-1300. doi: https://doi.org/10.12669/pjms.35.5.785
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Malaria elimination transmission and costing in the Asia-Pacific: a multi-species dynamic transmission model
Authors: Silal Sheetal Prakash , Shretta Rima , Celhay Olivier J. , Gran Mercado Chris Erwin , Saralamba Sompob , Maude Richard James , White Lisa Jane 
Published: August 2019

Background: The Asia-Pacific region has made significant progress in combatting malaria since 2000 and a regional goal for a malaria-free Asia Pacific by 2030 has been recognised at the highest levels. External financing has recently plateaued and with competing health risks, countries face the risk of withdrawal of funding as malaria is perceived as less of a threat. An investment case was developed to provide economic evidence to inform policy and increase sustainable financing. Methods: A dynamic epidemiological-economic model was developed to project rates of decline to elimination by 2030 and determine the costs for elimination in the Asia-Pacific region. The compartmental model was used to capture the dynamics of Plasmodium falciparum and Plasmodium vivax malaria for the 22 countries in the region in a metapopulation framework. This paper presents the model development and epidemiological results of the simulation exercise. Results: The model predicted that all 22 countries could achieve Plasmodium falciparum and Plasmodium vivax elimination by 2030, with the People’s Democratic Republic of China, Sri Lanka and the Republic of Korea predicted to do so without scaling up current interventions. Elimination was predicted to be possible in Bangladesh, Bhutan, Malaysia, Nepal, Philippines, Timor-Leste and Vietnam through an increase in long-lasting insecticidal nets (and/or indoor residual spraying) and health system strengthening, and in the Democratic People’s Republic of Korea, India and Thailand with the addition of innovations in drug therapy and vector control. Elimination was predicted to occur by 2030 in all other countries only through the addition of mass drug administration to scale-up and/or innovative activities. Conclusions: This study predicts that it is possible to have a malaria-free region by 2030. When computed into benefits and costs, the investment case can be used to advocate for sustained financing to realise the goal of malaria elimination in Asia-Pacific by 2030.
Medical Tourism and Inclusive Growth: Significance of Ayurveda Sector
Authors: John Jacob , Chelat Seema 
Published: August 2019

Medical tourism has emerged as a critical component of tourism in India. Medical tourism, a subset of health tourism, is an emerging segment of tourism industry and there are only a few serious studies conducted on the topic. With the growing importance of medical tourism and the thrust given by central and state governments to promote tourism, the paper explores the potential role of Ayurveda in medical tourism sector. A survey of practitioners, manufacturers, researchers, representatives of various associations in Ayurveda sector was carried out and the findings of the survey, which have policy implications, have been used to explore the possibilities of promoting Ayurveda sector in the medical tourism with the participation of local government institutions and community in order to achieve inclusive growth. The dominance of small and medium enterprises, individual researchers and practitioners, and labour intensive operations in Ayurveda based medical tourism and its impact on inclusive growth is highlighted. The paper also aims to formulate an action plan to address the critical issues of Ayurveda sector to enable it to play a central role in medical tourism.
Ecotourism in Eaglesnest, West Kameng, Arunachal Pradesh: A Case Study
Authors: Lobo Peter 
Published: August 2019

This study was aimed at exploring tourism resources and Ecotourism behaviour of tourists and local people to provide guidelines for Ecotourism development of Eaglesnest, West Kameng, Arunachal Pradesh. Tourists were selected by applying the method of convenience sampling, wherein, local people were interviewed in depth to gather local information. Results of the research showed that Eaglesnest had an outstanding tourism resource which was Bird watching, especially after the discovery of the new species of bird to the world, which is known as Bugun Liochicla, which attracted tourists from all over the world. Most of the tourists received tourism information from trip reports and advertising. They were normally grouped visitors who visited the destination for wildlife, especially Bird watching. On an average, they stayed over seven nights at different campsites. Nearly all tourists were aware of Ecotourism. The most attractive resource was Bird watching. They also admired the landscapes, the scenery of the forest and mountains