bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and determinants of metabolic syndrome in Qatar: results from a National Health Survey
Authors: Al-Thani Mohamed Hamad , Al-Thani Al Anoud Mohammed , Cheema Sohaila , Sheikh Javaid , Mamtani Ravinder , Lowenfels Albert B , Al-Chetachi Walaa Fattah , Almalki Badria Ali , Hassan Khalifa Shamseldin Ali , Haj Bakri Ahmad Omar , Maisonneuve Patrick 
Published: September 2016

ObjectivesTo determine optimum measurements for abdominal obesity and to assess the prevalence and determinants of metabolic syndrome in Qatar.DesignNational health survey.SettingQatar National STEPwise Survey conducted by the Supreme Council of Health during 2012.Participants2496 Qatari citizens aged 18–64 representative of the general population.Primary and secondary outcome measuresMeasure of obesity (body mass index, waist circumference or waist-to-height ratio) that best identified the presence of at least 2 other factors of metabolic syndrome; cut-off values of waist circumference; frequency of metabolic syndrome.ResultsWaist circumference ≥102 for men and ≥94 cm for women was the best predictor of the presence of other determinants of metabolic syndrome (raised blood pressure, fasting blood glucose, triglycerides and reduced high-density lipoprotein cholesterol). Using these values, we identified 28% of Qataris with metabolic syndrome, which is considerably lower than the estimate of 37% calculated using the International Diabetes Federation (IDF) criteria. Restricting the analysis to participants without known elevated blood pressure, elevated blood sugar or diabetes 16.5% would be classified as having metabolic syndrome. In a multivariable logistic regression analysis, the prevalence of metabolic syndrome increased steadily with age (OR=3.40 (95% CI 2.02 to 5.74), OR=5.66 (3.65 to 8.78), OR=10.2 (5.98 to 17.6) and OR=18.2 (7.01 to 47.5) for those in the age group ‘30–39’, ‘40–49’, ‘50–59’, ‘60–64’ vs ‘18–29’; p<0.0001), decreased with increasing educational attainment (OR=0.61 (0.39 to 0.96) for those who attained ‘secondary school or more’ compared with ‘less than primary school’; p=0.03) and exercise (OR=0.60 (0.42 to 0.86) for those exercising ≥3000 vs <600 MET-min/week; p=0.006) but was not associated with smoking or diet.ConclusionsWaist circumference was the best measure of obesity to combine with other variables to construct a country-specific definition of metabolic syndrome in Qatar. Approximately 28% of adult Qatari citizens satisfy the criteria for metabolic syndrome, which increased significantly with age. Education and physical activity were inversely associated with this syndrome.
‘It's surprising how differently they treat you’: a qualitative analysis of trainee reflections on a new programme for generalist doctors
Authors: Muddiman E , Bullock A D , MacDonald J , Allery L , Webb K L , Pugsley L 
Published: September 2016

ObjectivesAn increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences.Setting9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex.ParticipantsFocus group participants (61 in total) from the first and second cohorts of BBT.ResultsEvidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity.ConclusionsBy spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of ‘belongingness’ to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.
Composition of objectively measured physical activity and sedentary behaviour participation across the school-day, influence of gender and weight status: cross-sectional analyses among disadvantaged Victorian school children
Authors: Strugnell Claudia , Turner Kyle , Malakellis Mary , Hayward Josh , Foster Charlie , Millar Lynne , Allender Steve 
Published: September 2016

BackgroundThe after-school period has been described as the ‘critical window’ for physical activity (PA) participation. However, little is known about the importance of this window compared with the before and during-school period among socioeconomically disadvantaged children, and influence of gender and weight status.Methods39 out of 156 (RR=25%) invited primary schools across 26 local government areas in Victoria, Australia, consented to participate with 856 children (RR=36%) participating in the wider study. The analysis sample included 298 Grade 4 and Grade 6 children (mean age: 11.2±1.1; 44% male) whom met minimum accelerometry wear-time criteria and had complete height, weight and health-behaviours questionnaire data. Accelerometry measured duration in daily light-intensity PA (LPA), moderate-to-vigorous PA (MVPA) and sedentary time (ST) was calculated for before-school=8–8:59, during-school=9:00–15:29 and after-school=15:30–18:00. Bivariate and multivariable linear regression analyses were conducted.ResultsDuring-school represented the greatest accumulation of LPA and MVPA compared with the before and after-school periods. Boys engaged in 102 min/day of LPA (95% CI 98.5 to 104.9) and 62 min/day of MVPA (95% CI 58.9 to 64.7) during-school; girls engaged in 103 min/day of LPA (95% CI 99.7 to 106.5) and 45 min/day of MVPA (95% CI 42.9 to 47.4). Linear regression models indicated that girls with overweight or obesity engaged in significantly less LPA, MVPA and more time in ST during-school.ConclusionsThis study highlights the importance of in-school PA compared with after-school PA among socioeconomically disadvantage children whom may have fewer resources to participate in after-school PA.
Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study
Authors: Jacobsen Ellisiv Lærum , Brovold Therese , Bergland Astrid , Bye Asta 
Published: September 2016

ObjectivesData on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status.DesignA cross-sectional study.SettingTwo acute geriatric hospital wards in Norway.ParticipantsThis study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination <23, language difficulties or severe aphasia.Main outcome measuresNutritional status was assessed using the Mini Nutritional Assessment (MNA). Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification.ResultsOn the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β −3.3, 95% CI −4.9 to −1.7), pulmonary disease (β −2.1, 95% CI −3.7 to −0.46), cancer (β −1.7, 95% CI −3.4 to −0.033) and nutritional status.ConclusionsOur study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer and pulmonary disease are significantly associated with declines in nutritional status, as measured by the MNA, in acute geriatric patients.
Is it worth screening elective orthopaedic patients for carriage ofStaphylococcus aureus? A part-retrospective case–control study in a Scottish hospital
Authors: Dancer Stephanie J , Christison Fraser , Eslami Attaolah , Gregori Alberto , Miller Roslyn , Perisamy Kumar , Robertson Chris , Graves Nick 
Published: September 2016

BackgroundWith recent focus on methicillin-resistantStaphylococcus aureus(MRSA) screening, methicillin-susceptibleS. aureus(MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery.MethodsWe broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs.FindingsTrauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened.ConclusionsMSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.
Gender- and age-specific associations between sleep duration and prevalent hypertension in middle-aged and elderly Chinese: a cross-sectional study from CHARLS 2011–2012
Authors: Guo Jing , Fei Yue , Li Junqin , Zhang Lisan , Luo Qiong , Chen Guangdi 
Published: September 2016

ObjectivesThe impact of gender and age on the association between sleep duration and hypertension is not well known in Asians. The objective of this study was to analyse gender- and age-specific associations between sleep duration and prevalent hypertension in middle-aged and elderly Chinese.DesignSecondary analysis of a cohort sample.SettingThis study used data from the national baseline survey of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2012), covering 150 counties/districts and 450 villages/resident committees from 28 provinces in China.ParticipantsCommunity-based subjects were drawn from the CHARLS through multistage probability sampling. Overall, this study included 9086 eligible subjects aged 45 years or above.Outcome measuresSelf-reported sleep duration was obtained using a structured questionnaire. The mean of three measures of systolic blood pressure and diastolic blood pressure was calculated. By gender and age groups (45–60 years, middle-aged; ≥60 years, elderly), relationships between self-reported sleep duration and prevalent hypertension were examined using logistic regression models to estimate OR and 95% CIs.ResultsCompared with the reference group (≥7 and <8 hours/night), the group who had less sleep (<6 hours/night) had a higher likelihood of hypertension in the whole sample (OR 1.26, 95% CI 1.04 to 1.52). Significant ORs (95% CIs) of hypertension were 1.68 (1.17 to 2.42), 1.69 (1.11 to 2.59) and 2.21 (1.29 to 3.80) for <6, 6–7 (≥6 and <7) and 8–9 (≥8 and <9) hours/night, respectively, in middle-aged men but not women. Interestingly, a significant association was observed between long sleep duration (≥9 hours/night) and hypertension in middle-aged women (OR 1.55, 95% CI 1.02 to 2.35) but not in men.ConclusionsExtremes of sleep duration increased the likelihood of prevalent hypertension in middle-aged Chinese depending on gender, suggesting that appropriate strategies for improvement in sleep health are required.
PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique
Authors: Barry Emma , O'Brien Kirsty , Moriarty Frank , Cooper Janine , Redmond Patrick , Hughes Carmel M , Bennett Kathleen , Fahey Tom , Smith Susan M 
Published: September 2016

ObjectiveThere is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.DesignTwo-round modified Delphi consensus method.SettingIrish and UK general practice.ParticipantsA project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.Results47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).ConclusionsThe PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.
Surgery during holiday periods and prognosis in oesophageal cancer: a population-based nationwide Swedish cohort study
Authors: Markar Sheraz R , Wahlin Karl , Mattsson Fredrik , Lagergren Pernilla , Lagergren Jesper 
Published: September 2016

ObjectivePrevious studies indicate an increased short-term and long-term mortality from major cancer surgery performed towards the end of the working week or during the weekend. We hypothesised that the prognosis after major cancer surgery is also negatively influenced by surgery conducted during holiday periods.SettingPopulation-based nationwide Swedish cohort study.ParticipantsPatients undergoing oesophagectomy for oesophageal cancer between 1987 and 2010. Among 1820 included patients, 206 (11.3%) and 373 (20.5%) patients were operated on during narrow and wide holiday periods, respectively.InterventionsNarrow (7 weeks) and wide (14 weeks) Swedish holiday periods.Primary and secondary outcome measures90-day all-cause, 5-year all-cause and 5-year disease-specific mortality.ResultsNarrow holiday period did not increase all-cause 90-day (HR=0.84, 95% CI 0.53 to 1.33), all-cause 5-year (HR=1.01, 95% CI 0.85 to 1.21) or disease-specific 5-year mortality (HR=1.04, 95% CI 0.87 to 1.26). Similarly, wide holiday period did not increase the risk of 90-day (HR=0.79, 95% CI 0.55 to 1.13), all-cause 5-year (HR=0.96, 95% CI 0.84 to 1.1) or disease-specific 5-year mortality (HR=1.03, 95% CI 0.89 to 1.19).ConclusionsNo measurable effects of holiday periods on short-term or longer term mortality following surgery for oesophageal cancer were observed in this population-based study, indicating that an adequate surgical experience was maintained during holiday periods.
Off-label use of rituximab for systemic lupus erythematosus in Europe
Authors: Rydén-Aulin Monica , Boumpas Dimitrios , Bultink Irene , Callejas Rubio Jose Luis , Caminal-Montero Luis , Castro Antoni , Colodro Ruiz Agustín , Doria Andrea , Dörner Thomas , Gonzalez-Echavarri Cristina , Gremese Elisa , Houssiau Frederic A , Huizinga Tom , Inanç Murat , Isenberg David , Iuliano Annamaria , Jacobsen Søren , Jimenéz-Alonso Juan , Kovács Lászlo , Mariette Xavier , Mosca Marta , Nived Ola , Oristrell Joaquim , Ramos-Casals Manuel , Rascón Javier , Ruiz-Irastorza Guillermo , Sáez-Comet Luis , Salvador Cervelló Gonzalo , Sebastiani Gian Domenico , Squatrito Danilo , Szücs Gabriella , Voskuyl Alexandre , van Vollenhoven Ronald 
Published: September 2016

ObjectivesRituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy.MethodsData on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries.ResultsThe estimated off-label use of RTX in Europe was 0.5%–1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy.ConclusionsRTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted.
CHA2DS2-VASc score, left atrial size and atrial fibrillation as stroke risk factors in the Tromsø Study
Authors: Tiwari Sweta , Løchen Maja-Lisa , Jacobsen Bjarne K , Hopstock Laila A , Nyrnes Audhild , Njølstad Inger , Mathiesen Ellisiv B , Schirmer Henrik 
Published: September 2016

ObjectiveCHA2DS2-VASc score, left atrial (LA) size and atrial fibrillation (AF) have individually been associated with stroke risk. Our aim was to investigate the predictive ability of combinations of these factors for the odds of incident stroke in a population-based cohort study.MethodsWe followed 2844 participants from the Tromsø Study from 1994 to 2012. Information on LA size and CHA2DS2-VASc score (age, sex, congestive heart failure, hypertension, vascular disease, stroke and diabetes) were obtained at baseline. AF status was recorded from medical records. The outcome measure was all strokes. The association between covariates and stroke was investigated by means of multivariate logistic regression analysis.ResultsA total of 325 participants (45% women, mean age at baseline 59.3 years) had a stroke. Incidence rates for stroke were 6.4 in women and 8.4 in men per 1000 person-years. Participants with CHA2DS2-VASc ≥1 and LA size <2.8 had ∼4 times (95% CI 2.6 to 5.3) increased odds of stroke, whereas participants with CHA2DS2-VASc ≥1 and LA size ≥2.8 had ∼9 times (95% CI 5.3 to 16.4) increased odds of stroke, compared with participants with CHA2DS2-VASc score 0, irrespective of AF status. Adjustment for significant covariates had minimal impact on the OR estimates.ConclusionsCombining CHA2DS2-VASc score ≥1 and enlarged LA size identified participants with high odds of stroke regardless of AF status.
A Small-Molecule Antagonist of HIF2α Is Efficacious in Preclinical Models of Renal Cell Carcinoma
Authors: Wallace Eli M. , Rizzi James P. , Han Guangzhou , Wehn Paul M. , Cao Zhaodan , Du Xinlin , Cheng Tzuling , Czerwinski Robert M. , Dixon Darryl D. , Goggin Barry S. , Grina Jonas A. , Halfmann Megan M. , Maddie Melissa A. , Olive Sarah R. , Schlachter Stephen T. , Tan Huiling , Wang Bin , Wang Keshi , Xie Shanhai , Xu Rui , Yang Hanbiao , Josey John A. 
Published: September 2016

Abstract
More than 90% of clear cell renal cell carcinomas (ccRCC) exhibit inactivation of the von Hippel–Lindau (pVHL) tumor suppressor, establishing it as the major underlying cause of this malignancy. pVHL inactivation results in stabilization of the hypoxia-inducible transcription factors, HIF1α and HIF2α, leading to expression of a genetic program essential for the initiation and progression of ccRCC. Herein, we describe the potent, selective, and orally active small-molecule inhibitor PT2385 as a specific antagonist of HIF2α that allosterically blocks its dimerization with the HIF1α/2α transcriptional dimerization partner ARNT/HIF1β. PT2385 inhibited the expression of HIF2α-dependent genes, including VEGF-A, PAI-1, and cyclin D1 in ccRCC cell lines and tumor xenografts. Treatment of tumor-bearing mice with PT2385 caused dramatic tumor regressions, validating HIF2α as a pivotal oncogenic driver in ccRCC. Notably, unlike other anticancer agents that inhibit VEGF receptor signaling, PT2385 exhibited no adverse effect on cardiovascular performance. Thus, PT2385 represents a novel class of therapeutics for the treatment of RCC with potent preclincal efficacy as well as improved tolerability relative to current agents that target the VEGF pathway. Cancer Res; 76(18); 5491–500. ©2016 AACR.