bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Olympic athletes free from cardiovascular diseases? Systematic investigation in 2352 participants from Athens 2004 to Sochi 2014
Authors: Pelliccia Antonio , Adami Paolo Emilio , Quattrini Filippo , Squeo Maria Rosaria , Caselli Stefano , Verdile Luisa , Maestrini Viviana , Di Paolo Fernando , Pisicchio Cataldo , Ciardo Roberto , Spataro Antonio 
Published: December 2016

ContextOlympic athletes represent model of success in our society, by enduring strenuous conditioning programmes and achieving astonishing performances. They also raise scientific and clinical interest, with regard to medical care and prevalence of cardiovascular (CV) abnormalities.ObjectiveOur aim was to assess the prevalence and type of CV abnormalities in this selected athlete's cohort.Design, setting and participants2352 Olympic athletes, mean age 25±6, 64% men, competing in 31 summer or 15 winter sports, were examined with history, physical examination, 12-lead and exercise ECG and echocardiography. Additional testing (cardiac MRI, CT scan) or electrophysiological assessments were selectively performed when indicated.Main outcome measuresPrevalence and type of CV findings, abnormalities and diseases found in Olympic athletes over 10 years.ResultsA subset of 92 athletes (3.9%) showed abnormal CV findings. Structural abnormalities included inherited cardiomyopathies (n=4), coronary artery disease (n=1), perimyocarditis (n=4), myocardial bridges (n=2), valvular and congenital diseases (n=45) and systemic hypertension (n=10). Primary electrical diseases included atrial fibrillation (n=2), supraventricular reciprocating tachycardia (n=14), complex ventricular tachyarrhythmias (non-sustained ventricular tachycardia, n=7; bidirectional ventricular tachycardia, n=1) or major conduction disorders (Wolff-Parkinson-White (WPW), n=1; Long QT syndrome (LQTS), n=2).ConclusionsOur study revealed an unexpected prevalence of CV abnormalities among Olympic athletes, including a small, but not negligible proportion of pathological conditions at risk. This observation suggests that Olympic athletes, despite the absence of symptoms or astonishing performances, are not immune from CV disorders and might be exposed to unforeseen high-risk during sport activity.
Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review
Authors: Heestermans Tessa , Browne Joyce L , Aitken Susan C , Vervoort Sigrid C , Klipstein-Grobusch Kerstin 
Published: December 2016

ObjectiveThe rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of patients at high risk of suboptimal adherence and targeted interventions. The aim of this review was to identify and summarise determinants of adherence to ART among HIV-positive adults.DesignSystematic review of adherence to ART in SSA from January 2002 to October 2014.MethodsA systematic search was performed in 6 databases (PubMed, Cochrane Library, EMBASE, Web of Science, Popline, Global Health Library) for qualitative and quantitative articles. Risk of bias was assessed. A meta-analysis was conducted for pooled estimates of effect size on adherence determinants.ResultsOf the 4052 articles screened, 146 were included for final analysis, reporting on determinants of 161 922 HIV patients with an average adherence score of 72.9%. Main determinants of non-adherence were use of alcohol, male gender, use of traditional/herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatisation, and poor social support. Promoters of adherence included counselling and education interventions, memory aids, and active disclosure among people living with HIV. Determinants of health status had conflicting influence on adherence.ConclusionsThe sociodemographic, psychosocial, health status, treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence. Clinics providing ART in SSA should therefore design targeted interventions addressing these determinants to optimise health outcomes.
How long do patients with chronic disease expect to live? A systematic review of the literature
Authors: Hole Barnaby , Salem Joseph 
Published: December 2016

ObjectiveTo systematically identify and summarise the literature on perceived life expectancy among individuals with non-cancer chronic disease.SettingPublished and grey literature up to and including September 2016 where adults with non-cancer chronic disease were asked to estimate their own life expectancy.ParticipantsFrom 6837 screened titles, 9 articles were identified that met prespecified criteria for inclusion. Studies came from the UK, Netherlands and USA. A total of 729 participants were included (heart failure (HF) 573; chronic obstructive pulmonary disease (COPD) 89; end-stage renal failure 62; chronic kidney disease (CKD) 5). No papers reporting on other lung diseases, neurodegenerative disease or cirrhosis were found.Primary and secondary outcome measuresAll measures of self-estimated life expectancy were accepted. Self-estimated life expectancy was compared, where available, with observed survival, physician-estimated life expectancy and model-estimated life expectancy. Meta-analysis was not conducted due to the heterogeneity of the patient groups and study methodologies.ResultsAmong patients with HF, median self-estimated life expectancy was 40% longer than predicted by a validated model. Outpatients receiving haemodialysis were more optimistic about prognosis than their nephrologists and overestimated their chances of surviving 5 years. Patients with HF and COPD were approximately three times more likely to die in the next year than they predicted. Data available for patients with CKD were of insufficient quality to draw conclusions.ConclusionsIndividuals with chronic disease may have unrealistically optimistic expectations of their prognosis. More research is needed to understand how perceived life expectancy affects behaviour. Meanwhile, clinicians should attempt to identify each patient's prognostic preferences and provide information in a way that they can understand and use to inform their decisions.Trial registration numberCRD42015020732.
Can recombinant human thrombomodulin increase survival among patients with severe septic-induced disseminated intravascular coagulation: a single-centre, open-label, randomised controlled trial
Authors: Hagiwara Akiyoshi , Tanaka Noriko , Uemura Tatsuki , Matsuda Wataru , Kimura Akio 
Published: December 2016

ObjectiveTo determine whether treatment with recombinant human thrombomodulin (rhTM) increases survival among patients with severe septic-induced disseminated intravascular coagulation (DIC).DesignSingle-centre, open-label, randomised controlled trial.SettingSingle tertiary hospital.Participant92 patients with severe septic-induced DIC.InterventionsPatients with DIC scores ≥4, as defined by the Japanese Association of Acute Medicine, were diagnosed with DIC. The envelope method was used for randomisation. The treatment group (rhTM group, n=47) was intravenously treated with rhTM within 24 hours of admission (day 0), and the control group (n=45) did not receive any anticoagulants, except in cases of deep venous thrombosis and pulmonary embolism.Primary and secondary measurementsData were collected on days 0 (admission), 1, 2, 3, 5, 7 and 10. The primary outcome was survival at 28 and 90 days. The secondary end points comprised changes in DIC scores, platelet counts,d-dimer, antithrombin III and C reactive protein levels, and Sequential Organ Failure Assessment (SOFA) scores. All analyses were conducted on an intent-to-treat basis.Main resultsThe 28-day survival rates were 84% and 83% in the control and rhTM groups, respectively (p=0.745, log-rank test). The 90-day survival rates were 73% and 72% in the control and rhTM groups, respectively (p=0.94, log-rank test). Meanwhile, the rates of recovery from DIC (<4) were significantly higher in the rhTM group than in the control group (p=0.001, log-rank test). Relative change from baseline ofd-dimer levels was significantly lower in the rhTM group than in the control group, on days 3 and 5.ConclusionsrhTM treatment decreasedd-dimer levels and facilitated DIC recovery in patients with severe septic-induced DIC. However, the treatment did not improve survival in this cohort.Trial registration numberUMIN000008339.
To condition or not condition? Analysing ‘change’ in longitudinal randomised controlled trials
Authors: Coffman Cynthia J , Edelman David , Woolson Robert F 
Published: December 2016

ObjectiveThe statistical analysis for a 2-arm randomised controlled trial (RCT) with a baseline outcome followed by a few assessments at fixed follow-up times typically invokes traditional analytic methods (eg, analysis of covariance (ANCOVA), longitudinal data analysis (LDA)). ‘Constrained’ longitudinal data analysis (cLDA) is a well-established unconditional technique that constrains means of baseline to be equal between arms. We use an analysis of fasting lipid profiles from the Group Medical Clinics (GMC) longitudinal RCT on patients with diabetes to illustrate applications of ANCOVA, LDA and cLDA to demonstrate theoretical concepts of these methods including the impact of missing data.MethodsFor the analysis of the illustrated example, all models were fit using linear mixed models to participants with only complete data and to participants using all available data.ResultsWith complete data (n=195), 95% CI coverage are equivalent for ANCOVA and cLDA with an estimated 11.2 mg/dL (95% CI −19.2 to −3.3; p=0.006) lower mean low-density lipoprotein (LDL) cholesterol in GMC compared with usual care. With all available data (n=233), applying the cLDA model yielded an LDL improvement of 8.9 mg/dL (95% CI −16.7 to −1.0; p=0.03) for GMC compared with usual care. The less efficient, LDA analysis yielded an LDL improvement of 7.2 mg/dL (95% CI −17.2 to 2.8; p=0.15) for GMC compared with usual care.ConclusionsUnder reasonable missing data assumptions, cLDA will yield efficient treatment effect estimates and robust inferential statistics. It may be regarded as the method of choice over ANCOVA and LDA.
Cohort study of early literacy and childbearing over the reproductive lifecourse
Authors: Seymour Jane W , Frasso Rosemary , Shofer Frances S , Bennett Ian M 
Published: December 2016

IntroductionLiteracy is linked to a range of health outcomes, but its association with reproductive health in high-income countries is not well understood. We assessed the relationship between early-life literacy and childbearing across the reproductive lifecourse in the USA.Study designA prospective cohort design was employed to assess early-life literacy and subsequent childbearing, using data from the National Longitudinal Survey of Youth 1979. The US youth aged 14–22 years in 1979, including 6283 women, were surveyed annually through 1994 and biannually thereafter. Literacy was assessed in 1980 using the Armed Services Vocational Aptitude Battery Reading Grade Level (RGL). Cumulative childbearing and grand multiparity (≥5 births) were assessed in 2010. Summary statistics, χ2, Kruskal-Wallis, test for trend and logistic regression, were used.ResultsOf 6283 women enrolled, 4025 (64%) had complete data and were included in the analyses. In 1980, these women were on average 18 years old and in 2010 they were 45. Median cumulative parity decreased for each RGL and ranged from 3.0 (<5th grade) to 2.0 (>12th grade) (p=0.001). Adjusting for race/ethnicity, poverty status, whether a woman had had a child in 1980, and age in 1980, odds of grand multiparity were 1.9 (95% CI 1.1 to 3.5) and 1.8 (95% CI 1.0 to 3.3), greater among women with <5th or 5–6th grade literacy compared with those ≥12th literacy.DiscussionIn the USA, early-life literacy is associated with total parity over a woman's lifecourse. Literacy is a powerful social determinant of reproductive health in this high-income nation just as it has been shown to be in low-income nations.
Effectiveness of Senior Dance on risk factors for falls in older adults (DanSE): a study protocol for a randomised controlled trial
Authors: Franco Marcia R , Sherrington Catherine , Tiedemann Anne , Pereira Leani S , Perracini Monica R , Faria Claudia R S , Pinto Rafael Z , Pastre Carlos M 
Published: December 2016

IntroductionStrong evidence shows that exercise is effective to improve fall risk factors among older people. However, older people's participation and adherence to exercise programmes is suboptimal. Type of exercise and apathy are reported to be barriers to exercise participation, suggesting that new effective interventions are needed. The primary aim of this randomised controlled trial is to investigate the effect of Senior Dance plus brief education for falls prevention on balance among people aged 60 years or over, compared with a control group receiving only brief education.Methods and analysisThis single-blind randomised controlled trial will involve 82 community-dwelling older people aged 60 years or over who are cognitively intact. Participants allocated to the intervention group will attend a single educational class on strategies to prevent falls, and will participate in a 12-week, twice-weekly group-based programme of Senior Dance. The Senior Dance consists of different choreographies, which include rhythmic and simple movements with rhythmic folk songs. Participants allocated to the control group will attend the same educational class that intervention group participants will receive, and will be instructed not to take part in any regular exercise programme. The primary outcome will be single-leg stance with eyes closed. Secondary outcomes include: Short Physical Performance Battery, Falls Efficacy Scale, Trail Making Test and the Montreal Cognitive Assessment. Continuous outcomes will be reported using mean (SD) or median (IQR), depending on the distribution of the data. The linear regression approach to analysis of covariance will be used to compare the mean effect between groups. All patients will be included in the analyses following an intention-to-treat approach.Ethics and disseminationEthics approval has been granted by the Human Ethics Committee of the São Paulo State University (CAAE 48665215.9.0000.5402). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences.Trial registration numberNCT02603523, Pre-results.
Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol
Authors: Deighton J , Edbrooke-Childs J , Stapley E , Sevdalis N , Hayes J , Gondek D , Sharples E , Lachman P 
Published: December 2016

IntroductionEvidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE.Methods and analysisIn this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change.Ethics and disseminationEthics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK.
Physical inactivity in relation to self-rated eyesight: cross-sectional analysis from the English Longitudinal Study of Ageing
Authors: Smith Lee , Timmis Matthew A , Pardhan Shahina , Latham Keziah , Johnstone James , Hamer Mark 
Published: January 2017

BackgroundTo assess the cross-sectional association between self-rated eyesight and physical activity behaviour in a large general population sample of older English adults.MethodsAnalyses of data from the English Longitudinal Study of Ageing. Participants provided information on self-rated eyesight (categorised as: excellent/very good/good/fair–poor) and their own physical activity levels (categorised as: inactive/moderate only at least 1/week, vigorous at least 1/week). Associations between self-rated eyesight and physical activity levels were examined using logistic regression.ResultsA total of 6634 participants (mean age 65.0±9.2 years) were included in the analyses. In adjusted logistic regression models, those with fair–poor and good eyesight were significantly more likely to be inactive than those who reported excellent eyesight (OR 2.07, 95% CI 1.58 to 2.72; OR 1.59, 1.27 to 1.99, respectively).ConclusionIn this sample of older English adults, those with self-rated fair–poor vision were over twice as likely to be physically inactive than those who reported having excellent vision. When consistent data have emerged, interventions to increase physical activity in those who have poor eyesight are needed.
The role of reduced heart rate volatility in predicting disposition from the emergency department
Authors: Mandel-Portnoy Ya-El , Loo George T , Gregoriou Diana , Bansilal Sameer , Richardson Lynne D 
Published: December 2016

ObjectiveHeart rate volatility (HRVO) is a physiological parameter that is believed to reflect the sympathetic activity of the autonomic nervous system. We explored the utility of HRVO as a predictive tool for declining physiological states, hypothesising that patients admitted from the resuscitation area of the ED to a high-dependency unit (HDU) experience low HRVO compared with patients who did not.MethodsWe retrospectively reviewed HR data recordings, medical charts and disposition decisions from the ED of patients who were admitted to the five resuscitation beds in our adult ED between 29 April 2014 and 30 May 2015. HRVO was calculated for each 5 min interval; it was measured as the SD of all HRs within that interval. Logistic regression was used to model the odds of admission to a HDU given low HRVO during ED stay.ResultsHR data from 2051 patients was collected and approximately 7 million HR data points were analysed. 402 patients experienced low HRVO. Patients who experienced low HRVO during their ED stay were twice as likely to be admitted to a HDU from the ED (OR=2.07, 95% CI 1.64 to 2.60; p<0.001).ConclusionsOur result provides additional evidence supporting previously published data indicating that autonomic nervous system measures such as HRVO could serve as important and useful clinical tools in the early triage of critically ill patients in the ED.
National 10-year trend in road injuries involving school children on the way to and from school in Japan, 2003–2012
Authors: Inada Haruhiko , Tomio Jun , Nakahara Shinji , Xu Xin , Taniguchi Ayako , Ichikawa Masao 
Published: December 2016

ObjectivesTo quantitatively describe the recent longitudinal trend in road injuries involving school children while commuting to and from school in Japan and to identify groups or situations with particularly large or small decreasing trends.MethodsData on the number of children aged 6–15 years who sustained road injuries while commuting were obtained, stratified by year, demographic characteristics, mode of transport and other variables. The rates of killed or seriously injured (KSI) children were calculated from the number of KSI cases (the numerator) and the product of population and the proportion of each mode of transport estimated using the Person Trip Survey data (the denominator). We conducted descriptive analyses of the longitudinal trend in KSI rates stratified by the variables, and Poisson regression analyses were employed to quantify the annualised changes in the rates.ResultsDuring the study period, 166 children were killed and 8484 children were seriously injured; the KSI rate decreased approximately 30%. The KSI rate was almost 10 times higher among cyclists than pedestrians. In cyclists, the decrease in the KSI rate among children aged 12–15 years was smaller in boys than in girls (estimated change −14% vs −30%). The KSI rate of male pedestrians aged 6–7 years was larger than female and older pedestrians, with a large decrease of 48%.ConclusionsAlthough the overall rate of road injuries among children while commuting was decreasing, cyclists were at a much greater risk than pedestrians, and the improvements for cyclists occurred at a slower pace.
Subcutaneous interferon β-1a in the treatment of clinically isolated syndromes: 3-year and 5-year results of the phase III dosing frequency-blind multicentre REFLEXION study
Authors: Comi Giancarlo , De Stefano Nicola , Freedman Mark S , Barkhof Frederik , Uitdehaag Bernard M J , de Vos Marlieke , Marhardt Kurt , Chen Liang , Issard Delphine , Kappos Ludwig 
Published: December 2016

ObjectiveEarly treatment following a first clinical demyelinating event (FCDE) delays further disease activity in patients with multiple sclerosis (MS). This study determined the effects of early versus delayed treatment (DT) with subcutaneous interferon (sc IFN) β-1a 44 μg in patients with an FCDE up to 60 months postrandomisation.MethodsPatients who completed the 24-month double-blind REFLEX (REbif FLEXible dosing in early MS) study entered an extension (REFLEXION, REbif FLEXible dosing in early MS extensION): patients initially randomised to sc IFN β-1a and not reaching clinically definite MS (clinically definite MS, CDMS (second attack or sustained Expanded Disability Status Scale (EDSS) score increase)) continued original treatment (three times weekly (tiw) or once weekly (qw)); placebo patients switched to tiw (DT); patients with CDMS switched to tiw. Clinical, MRI and adverse event data up to month 60 are reported.Results402/517 (77.8%) REFLEX patients entered REFLEXION (DT, n=133; tiw, n=127; qw, n=142). At month 60, cumulative probability of CDMS was: DT 44.6%; qw 40.7% (nominal p=0.084 vs DT); tiw 39.2% (nominal p=0.032 vs DT). Cumulative probability of McDonald MS conversion (CDMS or new MRI activity) at month 60 was also reduced for tiw versus DT (nominal p<0.001). At month 60, mean cumulative numbers of new T2, gadolinium-enhancing and T1 hypointense lesions were lower with sc IFN β-1a qw (nominal p<0.05) and tiw versus DT (nominal p<0.001); T2 and T1 hypointense lesion volume change was lower for sc IFN β-1a tiw versus DT (nominal p<0.01). Treatment was well tolerated; fewer patients receiving tiw versus qw were positive for neutralising or binding antibodies.ConclusionsOver 5 years in patients presenting with an FCDE, early sc IFN β-1a tiw administration versus DT prolonged time to CDMS and McDonald MS, and reduced overall MRI activity.Trial registration numberNCT00813709; Results.