bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methodological and Clinical Challenges in Evaluating Treatment Outcome of Substance-Related Disorders and Comorbidity
Authors: el-Guebaly N , Hodgins DC , Armstrong S , Addington J 
Published: January 2017

Objective: To review the steps required to develop an outcome evaluation package and to report on the 12-month outcome of an integrated day program. Method: Based on the identification of salient outcome predictors, standardized instruments were selected. A cohort of 78 patients was assessed at the time of admission to the program, at discharge, and 3, 6, and 12 months afterward. Results: Improvements were sustained over 1 year in all areas including treatment needs, quality of life, and readiness to change. Conclusions: The gap between the “cultures” of treatment and research must be narrowed. Following evidence of a program's general effectiveness through outcome monitoring, a randomized control design is optimal for specific interventions. The optimal length of follow-up depends on the perceived confounds.
Hospital Outcome Measures following Assertive Community Treatment in Edmonton, Alberta
Authors: Tibbo Philip , Chue Pierre , Wright Evelyn 
Published: January 2017

Objective: To examine hospital outcome measures for individuals with chronic and severe mental illnesses before and after their registration in an assertive community treatment (ACT) program in Edmonton, Alberta. Methods: Data were collected from Alberta Health on individuals who were registered in ACT from April 1993 to April 1995. For each individual, hospital outcome measures were calculated for the 365 days prior to and 365 days after registration for ACT (thus covering April 1, 1992-March 31,1996). Results: Data were collected from 295 individuals. Compared with 1 year prior to beginning ACT, there was a 34% reduction in hospital separations for patients with psychiatric diagnoses. The average length of stay (LOS) for each separated patient decreased by 56%, and the hospitalization days for each patient separated also decreased by 39%. The number of emergency visits for psychiatric reasons was reduced by 32%, and the number of clients visiting emergency departments for psychiatric reasons declined by 30%. Conclusions: In the 1-year period after registration in an ACT program, hospital outcome measures were improved in this cohort of 295 individuals with severe and chronic mental illnesses.
Difficulties in Treating Patients with Eating Disorders: A Review of Patient and Clinician Variables
Authors: Kaplan Allan S , Garfinkel Paul E 
Published: January 2017

Objective: Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment. Method: The authors relate their clinical experience and synthesize the literature examining aspects of patients with EDs that may contribute to their treatment resistance and therapist variables that may contribute to negative nontherapeutic reactions. Results: Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatments, and issues related to comorbidity. Aspects of clinicians include lack of understanding of the biopsy chosocial pathophysiology of these conditions and lack of experience and appreciation for the countertransferential reactions that these patients evoke in caregivers. Conclusions: Improving understanding of the reasons for treatment refractoriness inpatients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process.
Bilateral Anterior Cortical Atrophy and Subcortical Atrophy in Reduplicative Paramnesia: A Case-Control Study of Computed Tomography in 10 Patients
Authors: Joseph Anthony B , O'Leary Daniel H , Kurland Robert , Ellis Hadyn D 
Published: January 2017

Objective: Reduplicative paramnesia (RP) is thought to be related to other delusional misidentification syndromes (DMS) such as Capgras syndrome. DMS are thought to occur when brain lesions disrupt cortical functioning. This study tests this hypothesis and tries to understand whether focal lesions are as important in the etiology of RP as they are in other types of DMS. Method: The computed tomography (CT) scans of 10 consecutive psychiatric inpatients with RP and another principal psychiatric diagnosis were compared with those of control patients without RP matched for age, sex, and principal psychiatric diagnosis. The scans were assessed blindly by a neuroradiologist using a previously published rating scale for the presence of lesions in 11 discrete anatomic areas. The differences between the 2 groups were examined statistically using log-linear analysis. Results: Statistical analysis revealed that index patient cortical atrophy, cortical fissure enlargement, and deep brain atrophy distinguished the 2 groups significantly (P < 0.05). Conclusions: Bilateral anterior cortical, brain stem, and cerebellar vermis atrophy and dysfunction may be important in the pathogenesis of RP in particular and of DMS in general.
The Influence of Health Literacy on Reach, Retention, and Success in a Worksite Weight Loss Program
Authors: Zoellner Jamie , You Wen , Almeida Fabio , Blackman Kacie C. A. , Harden Samantha , Glasgow Russell E. , Linnan Laura , Hill Jennie L. , Estabrooks Paul A. 
Published: January 2017

Purpose: To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program. Design: The study was a two-group cluster randomized controlled weight loss trial. Setting: The study was conducted in 28 worksites. Subjects: Subjects comprised 1460 employees with a body mass index >25 kg/m2. Interventions: Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin’ My Weigh (LMW; less-intense quarterly newsletters). Measures: A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up. Analysis: The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects. Results: Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] ( p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects ( beta = .66; SE = 027; p = .014) and losing >5% weight ( beta = −1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up. Conclusion: HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.
The Impact of Breastfeeding on Early Childhood Obesity
Authors: Hansstein Francesca V. 
Published: January 2017

Purpose: To investigate how breastfeeding initiation and duration affect the likelihood of being overweight and obese in children aged 2 to 5. Design: Cross-sectional data from the 2003 National Survey of Children’s Health. Setting: Rural and urban areas of the United States. Subjects: Households where at least one member was between the ages of 2 and 5 (sample size 8207). Measures: Parent-reported body mass index, breastfeeding initiation and duration, covariates (gender, family income and education, ethnicity, child care attendance, maternal health and physical activity, residential area). Analysis: Partial proportional odds models. Results: In early childhood, breastfed children had 5.3% higher probability of being normal weight ( p = .002) and 8.9% ( p < .001) lower probability of being obese compared to children who had never been breastfed. Children who had been breastfed for less than 3 months had 3.1% lower probability of being normal weight ( p = .013) and 4.7% higher probability of being obese ( p = .013) with respect to children who had been breastfed for 3 months and above. Conclusion: Study findings suggest that length of breastfeeding, whether exclusive or not, may be associated with lower risk of obesity in early childhood. However, caution is needed in generalizing results because of the limitations of the analysis. Based on findings from this study and others, breastfeeding promotion policies can cite the potential protective effect that breastfeeding has on weight in early childhood.
Correlates of Reported Use and Perceived Helpfulness of Calorie Information in Restaurants Among U.S. Adults
Authors: Oh April , Nguyen Anh Bao , Patrick Heather 
Published: January 2017

Purpose: This study reports correlates in reported use and helpfulness of calorie information, when available, in restaurants on a national scale in the United States for demographic behavioral and health-related conditions. Design: This study is a secondary data analysis of the 2013 National Cancer Institute’s Health Information National Trends Survey data. Setting: United States. Subjects: Adults ( n = 3407). Measures: Menu labeling use and helpfulness; behavior change attempts; reported fruit, vegetable, and soda consumption; weight status; and chronic health conditions. Analysis: Trends were identified in weighted logistic and linear regression models. Results: U.S. adults who intended to lose weight (odds ratio [OR] = 5.01 [95% confidence interval 2.96, 8.46]), increase fruit (OR = 1.10 [.66, 1.84]) or vegetable consumption (OR = 2.25 [1.32, 3.83]), or reduce soda consumption (OR = 1.67 [1.11, 2.51]) were more likely to report using menu-labeling information when available. More women reported calorie information was helpful when ordering ( p < .05). Racial/ethnic and socioeconomic status disparities were identified in use (non-Hispanic [NH] blacks vs. NH whites OR = .43 [.25, .74]) and helpfulness (NH blacks vs. NH whites β = –.06 [–.44, .32]). Conclusion: Findings highlight potential subgroups to target for communication and education efforts regarding use of calorie information in restaurants. Following publication of final rules for federal menu-labeling legislation and implementation, further surveillance of public response to this information may inform message framing and educational interventions to promote use of calorie information on menu boards.
Effects of Exercise-Based Interventions on Neonatal Outcomes
Authors: Sanabria-Martínez Gema , García-Hermoso Antonio , Poyatos-León Raquel , González-García Alberto , Sánchez-López Mairena , Martínez-Vizcaíno Vicente 
Published: January 2017

Objective: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing the influence of physical exercise interventions during pregnancy on some neonatal outcomes. Data Source: Key words were used to conduct a computerized search in six databases: Cochrane Library Plus, Science Direct, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov . Study Inclusion and Exclusion Criteria: RCTs that included an exercise program for healthy pregnant women who were sedentary or had low levels of physical activity were selected. Data Extraction: Two independent reviewers extracted data and assessed the quality of the studies included. Of 4296 articles retrieved, 14 RCTs (3044 pregnant women) met the inclusion criteria. Data Synthesis: Pooled effect sizes (ESs) were calculated using a fixed model. Results: Overall, physical exercise programs during pregnancy produced a small reduction in neonatal birth weight (ES = −.10; p = .04). The Apgar score at 1 minute was also weakly increased with combined exercise (aerobic, strength, and flexibility) (ES = .09; p = .048) and no differences between groups were observed in gestational age at delivery and Apgar score at 5 minutes. Conclusion: Structured physical exercise programs during pregnancy appear to be safe for the neonate, mainly favoring a lower birth weight within normal range. However, more studies are needed to establish recommendations.
The Effects of For-Profit Multihospital System Ownership on Hospital Financial and Operating Performance
Authors: Lynch Janet R. , McCue Michael J. 
Published: January 2017

The financial and operating performance of independent not-for-profit hospitals acquired by US for-profit multi-hospital systems in 10 Southern states between the years 1978 and 1982 was explored. The impact of system ownership on acquired hospitals was investigated by comparing the average financial performance of hospitals in the two years immediately prior to acquisition to the average for 1984 and 1985 and by comparing changes in the performance of acquired hospitals with changes in matched independent facilities. Findings suggest that for-profit multi-hospital systems were able to improve many of the financial and operating problems of acquired facilities. In comparison to independent not-for-profit hospitals, acquired hospitals were found to increase access to long-term debt, make improvements to plant and equipment, improve profitability, and increase efficiency to a greater extent. Prices in acquired hospitals rose more than those in independents and liquidity decreased to a greater extent.
Impact of Counselling on Safer Sex and STD Occurrence among STD Patients in Malawi
Authors: Wynendaele B , Bomba W , M'Manga W , Bhart S , Fransen L 
Published: January 2017

In developing countries where professional manpower and basic supplies are lacking for STD control, low-cost prevention strategies must be explored. This study assesses the impact of counselling on STD treatment and prevention in Malawi. Increases in safer sex practices are used as indicators of prevention behaviour. A pre-test post-test control group design over a 4-month interval was conducted in 1991 in 2 comparable hospitals approximately 100 km apart. STD was diagnosed symptomatically and Knowledge Attitude Practice and Behaviour (KAPB) data collected using a structured questionnaire. In one group, trained counsellors discussed modes of transmisison and prevention of STD/AIDS including a condom demonstration; symptoms and treatment of STDs; partner notification; risk taking and reasons for doing so; and motivations for behaviour change. The results show that counselling reduces the occurrence of STDs; increases concern for sexual partners; increases knowledge about and use of condoms; reduces mean number of partners; and reduces health costs due to fewer hospital visits. Although the observed behaviour change was short term, these outcomes argue in favour of counselling as a low-cost effective strategy for STD control.
Lack of Association between Breast Artery Calcification Seen on Mammography and Coronary Artery Disease on Angiography
Authors: Henkin Y , Abu-Ful A , Shai I , Crystal P 
Published: January 2017

Objectives: Some studies have found correlations between the presence of breast artery calcium (BAC) observed on routine mammograms and risk factors for coronary artery disease (CAD). The aim of this study was to investigate whether such calcifications could predict the presence of coronary atherosclerosis. Methods: A total of 319 female patients between 50 and 70 years of age, 187 with significant CAD and 132 with angiographically normal coronary arteries, were randomly selected from a computerised database of our central catheterisation laboratory. The patients' mammograms were evaluated independently for the presence of BAC in a blinded fashion by an experienced breast radiologist, and additional clinical data were extracted from clinical charts. Results: The women in the CAD group were older (62.5 vs 60.7 years, p=0.05) and had a higher prevalence of hypertension, diabetes mellitus and dyslipidaemia. Although the prevalence of BAC was marginally higher in the CAD group (43.9% vs 37.1 %, p=0.138), this tendency was eliminated after controlling for confounders. Multiple regression analyses indicated that only age above 63 years (odds ratio [OR]=3.0, 95% confidence interval [CI]= 1.8–4.9) and hypertension (OR=2.2, 95% CI= 1.2–4.1), but not angiographic evidence of CAD (OR=1.0,95% CI=0.6–1.6), predict with BAC on mammography. Conclusions: Despite correlation with some risk factors For CAD, the presence of BAC does not differentiate between patients with angiographic evidence of CAD and those with angiographically normal coronary arteries.
Colposcopy Information Leaflets: What Women Want to Know and When They Want to Receive This Information
Authors: Byrom J , Dunn P D J , Hughes G M , Lockett J , Johnson A , Neale J , Redman C W E 
Published: January 2017

Objectives: To evoluate whether the information leoflets produced by UK colposcopy clinics provide women with the information they desire and to determine when they would like to receive this information. Design: Questionnaire study and structured evaluation. Setting: The colposcopy clinic of a UK cancer centre. Participants: Forty-two women attending a pre-colposcopy counselling session and 100 consecutive women attending the colposcopy clinic. Methods: Thirty-eight standards derived from the concerns/questions asked by women attending a pre-colposcopy counselling session were used to assess locally produced colposcopy clinic leaflets from UK colposcopy clinics, the leaflets produced by the Royal College of Obstetricians and Gynaecologists and the National Health Service Cervical Screening Programme (NHSCSP), and two “leaflets” obtained from internet sites. The Gunning fog test was used to assess the leaflets' readability. A questionnaire survey of 100 women attending the colposcopy clinic was used to determine when women wanted to receive information about colposcopy. Main outcome measures: Percentage of questions answered by a given leaflet and Gunning fog scores for readability. Results: The information leaflets of 128 colposcopy clinics were received and assessed. Thirty-two clinics only sent women the NHSCSP leaflet. No leaflet answered all 38 questions. Less than half (36/100) of the leaflets answered more than 50% of the questions. In addition to the lack of advice given, different leaflets frequently gave conflicting advice. The average Gunning fog score was 9.7 (range 5.5–15.5). The majority of women (70%) wanted to receive information about colposcopy at or prior to the time of receiving their abnormal smear test result, although only 42% of women actually received information at this time. Conclusions: Many UK colposcopy clinics do not appear to be providing women with the information they require to understand their condition and the procedure that they are about to undergo. Furthermore, this information is often not provided at the appropriate time in the screening process.
Usefulness of Routine Urine Analysis in Medical Outpatients
Authors: Rüttimann Sigmund , Clémençon Désirée 
Published: January 2017

Objective— To investigate prospectively the value of routine urine analysis in a university based, medical outpatient clinic providing primary (> 90%) and referral care (< 10%) in general internal medicine, as determined by whether it led to a new diagnosis requiring a change in medical management (new treatment; advice to patient; further follow up appointment). Methods— A dipstick urine analysis was performed in 610 consecutive patients (mean (SD) age 41 (16) years) making their first clinic visit. A urinary sediment of the same specimen was examined in those patients with abnormal results for haemoglobin, leucocytes, or protein. A urine analysis was defined as routine when it was not considered indicated for diagnostic or management purposes by the resident in charge at the patients' initial clinic visit. The main outcome measures were the number and nature of new diagnoses leading to a change in patient management. Results— In 183 patients (30%, 95% confidence interval (CI) 27% to 34%) the urine analysis was performed as an indicated test and in 427 (70%; 95% CI 64% to 73%) as a routine test. Urine analysis was abnormal in 71 of the 427 patients (17%) in whom it had been performed as a routine test. Abnormal findings led to a change in management in three patients only (0·7%; 95% CI 0·2% to 2·2%). Critical assessment makes the value of routine urine analysis debatable even in these three patients. Conclusions— In a middle aged medical outpatient group of a university based, teaching clinic providing predominantly primary care, urine analysis can be restricted to patients in whom it is clinically indicated.
Excess Mortality from Breast Cancer in Relation to Mammography Screening in Northern Sweden
Authors: Lenner Per , Jonsson Håkan 
Published: January 2017

Objectives— Previous randomised studies of mammography screening have shown a significant effect on breast cancer mortality, particularly in women aged 50–Q69 at randomisation. Breast cancer mortality has traditionally been studied by judgments on causes of death, either from cause of death registers or from medical records. In this study an alternative method was used, estimating the excess mortality associated with breast cancer. Setting— In 1990 two counties of northern Sweden started population based mammography screening of women aged 40–74. The unscreened population in the two other counties of the same region were selected as controls. Results— Excess mortality associated with breast cancer was lower in the screened population, and was discernible three to four years after the start of screening. The relative risk estimate, based on the cumulative excess number of deaths from breast cancer during 1990–95 in the screened versus the control population aged 40–74 (at diagnosis of breast cancer), was 0.72 (95% confidence interval (CI) 0.53 to 0.99). For women aged 50–69 it was 0.67 (95% CI 0.46 to 0.99). In the 50–69 age group the estimated excess number of deaths from breast cancer during 1995 was 17.0 per 100 000 women (95% CI 5.0 to 29.0) in the screened counties and 51.1 per 100 000 (95% CI 30.2 to 71.9) in the unscreened counties. Conclusions— Population based routine screening has substantial effects on breast cancer mortality in women aged 50–69. Estimation of excess mortality can be used in future studies to evaluate the effects of mammography screening on breast cancer mortality.
General Practitioner Based Screening for Cervical Cancer: Higher Participation of Women with a Higher Risk?
Authors: Kant A C , Palm B T H M , Wentink E , van Weel C 
Published: January 2017

Objective— To test the hypothesis that a personal invitation for cervical screening by a woman's own general practitioner (GP) achieves a higher attendance of women with an increased risk for cervical cancer. Setting— Two general practices and the local health authority screening programme for cervical cancer, Nijmegen, The Netherlands. Methods— Attendance rates of women with an increased risk of cervical cancer were compared for two invitation strategies: (a) invitation by the woman's own GP, and ( b) invitation by a national call system through the local health authority. Data on risk profiles were gathered by questionnaire. Two hundred and thirty eight women eligible for screening were invited by their GPs (GP group), and 235 women by the local health authority (control group) in 1992. Results— The personal invitation by the GP resulted in an 18% higher overall attendance, and a 28% higher attendance of women with greater risk because of sexual behaviour and smoking. Conclusion— Greater involvement of the GP in inviting women for cervical cancer screening results in a higher attendance, particularly among women with increased risk, than a less personal health authority call system.