bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of factors associated with resilience in medical students through a cross-sectional census
Authors: Oliveira Anna Christina Pinho de , Machado André Paes Goulart , Aranha Renata Nunes 
Published: November 2017

ObjectivesResearch on resilience has been gaining momentum, and it has already been shown that increased resilience creates positive changes at the individual and collective levels. Understanding of the factors associated with resilience may guide specific actions directed towards different populations. The objective of this study was to investigate these associated factors within a population of medical students.DesignCross-sectional census.SettingA public medical school in the state of Rio de Janeiro, Brazil.ParticipantsOut of a total of 551 medical students, five students were excluded due to inactive registrations, and four transferred students were also excluded, resulting in a total of 542 remaining participants.MeasuresAdopting an anonymous questionnaire that included the Resilience Scale, in addition to questions related to sociodemographic, behavioural health-related and academic variables, the association between these variables and resilience was investigated.ResultsThe high rate of answers to each item constitutes a indication of students’ interest in participating, whereas the lowest percentile was 97.1%. The mean resilience score obtained was considered moderate. Factors such as gender, race, previous schools attended, financial independence, living situation, parents’ education level, religion, quota-based admission, smoking, alcohol abuse and use of illegal drugs were not associated with resilience. In a multivariate analysis using ordinal logistic regression, associations were maintained only between the highest resilience score and the non-use of habit-forming prescription drugs (OR: 0.58; 95% CI 0.41 to 0.80), having a better perception of one’s own health (OR: 0.57; 95% CI 0.41 to 0.81) and being older (OR: 1.37; 95% CI 1.12 to 1.67).ConclusionThe census performed with the medical students showed, with the multivariate analysis, that besides age, the variables most closely tied with resilience were health and medicalisation, and the variables connected with income and religion showed no association.
Easier said than done: a qualitative study conducted in the USA exploring Latino family child care home providers as role models for healthy eating and physical activity behaviours
Authors: Lindsay Ana Cristina , Greaney Mary L , Wallington Sherrie F , Wright Julie A 
Published: November 2017

ObjectiveLatinos are the largest and most rapidly growing minority population group in the USA and are disproportionally affected by obesity and related chronic diseases. Child care providers likely influence the eating and physical activity behaviours of children in their care, and therefore are important targets for interventions designed to prevent childhood obesity. Nonetheless, there is a paucity of research examining the behaviours of family child care home (FCCH) providers and whether they model healthy eating and physical activity behaviours. Therefore, this study explored Latino FCCH providers’ beliefs and practices related to healthy eating, physical activity and sedentary behaviours, and how they view their ability to serve as role models for these behaviours for young children in their care.MethodsThis is a qualitative study consisting of six focus groups conducted in Spanish with a sample of 44 state-licensed Latino FCCH providers in the state of Massachusetts. Translated transcripts were analysed using thematic analyses to identify meaningful patterns.ResultsAnalyses revealed that Latino FCCH providers have positive beliefs and attitudes about the importance of healthy eating and physical activity for children in their care, but personally struggle with these same behaviours and with maintaining a healthy weight status. The ability of Latino FCCH providers to model healthy eating and physical activity may be limited by their low self-efficacy in their ability to be physically active, eat a healthy diet and maintain a healthy weight.ConclusionsInterventions designed to improve healthy eating and physical activity behaviours of children enrolled in FCCHs should address providers’ own health behaviours as well as their modelling of these health behaviours. Future research can build on the findings of this qualitative study by quantifying Latino FCCH providers’ eating and physical activity behaviours, and determining how these behaviours influence behaviours and health outcomes of children in their care.
Associations of time of day with cardiovascular disease risk factors measured in older men: results from the British Regional Heart Study
Authors: Sartini Claudio , Whincup Peter H , Wannamethee S Goya , Jefferis Barbara J , Lennon Lucy , Lowe Gordon DO , Welsh Paul , Sattar Naveed , Morris Richard W 
Published: November 2017

ObjectiveWe estimated associations of time of day with cardiovascular disease (CVD) risk factors measured in older men.MethodsCVD risk factors (markers of inflammation and haemostasis, and cardiac markers) were measured on one occasion between 08:00 and 19:00 hours in 4252 men aged 60–79 years from the British Regional Heart Study. Linear models were used to estimate associations between time of day and risk factors. When an association was found, we examined whether the relationship between risk factors and cardiovascular mortality was affected by the adjustment for time of day using survival analyses.ResultsN-terminal pro-brain natriuretic peptide (NT-proBNP) levels increased by 3.3% per hour (95% CI 1.9% to 4.8%), interleukin-6 (IL-6) increased by 2.6% per hour (95% CI 1.8% to 3.4%), while tissue plasminogen activator (t-PA) decreased by 3.3% per hour (95% CI 3.7% to 2.9%); these associations were unaffected by adjustment for possible confounding factors. The percentages of variation in these risk factors attributable to time of day were less than 2%. In survival analyses, the association of IL-6, NT-proBNP and t-PA with cardiovascular mortality was not affected by the adjustment for time of day. C reactive protein, fibrinogen, D-dimer, von Willebrand factor and cardiac troponin T showed no associations with time of day.ConclusionsIn older men, markers of inflammation (IL-6), haemostasis (t-PA) and a cardiac marker (NT-proBNP) varied by time of day. The contribution of time of day to variations in these markers was small and did not appear to be relevant for the CVD risk prediction.
National citation patterns ofNEJM,The Lancet,JAMAandThe BMJin the lay press: a quantitative content analysis
Authors: Casino Gonzalo , Rius Roser , Cobo Erik 
Published: November 2017

ObjectivesTo analyse the total number of newspaper articles citing the four leading general medical journals and to describe national citation patterns.DesignQuantitative content analysis.Setting/sampleFull text of 22 general newspapers in 14 countries over the period 2008–2015, collected from LexisNexis. The 14 countries have been categorised into four regions: the USA, the UK, Western World (European countries other than the UK, and Australia, New Zealand and Canada) and Rest of the World (other countries).Main outcome measurePress citations of four medical journals (two American:NEJMandJAMA; and two British:The LancetandThe BMJ) in 22 newspapers.ResultsBritish and American newspapers cited some of the four analysed medical journals about three times a week in 2008–2015 (weekly mean 3.2 and 2.7 citations, respectively); the newspapers from other Western countries did so about once a week (weekly mean 1.1), and those from the Rest of the World cited them about once a month (monthly mean 1.1). The New York Times cited above all other newspapers (weekly mean 4.7). The analysis showed the existence of three national citation patterns in the daily press: American newspapers cited mostly American journals (70.0% of citations), British newspapers cited mostly British journals (86.5%) and the rest of the analysed press cited more British journals than American ones.The Lancetwas the most cited journal in the press of almost all Western countries outside the USA and the UK. Multivariate correspondence analysis confirmed the national patterns and showed that over 85% of the citation data variability is retained in just one single new variable: the national dimension.ConclusionBritish and American newspapers are the ones that cite the four analysed medical journals more often, showing a domestic preference for their respective national journals; non-British and non-American newspapers show a common international citation pattern.
Barriers and facilitators to learn and improve through morbidity and mortality conferences: a qualitative study
Authors: de Vos Marit S , Hamming Jaap F , Marang-van de Mheen Perla J 
Published: November 2017

ObjectivesTo explore barriers and facilitators to successful morbidity and mortality conferences (M&M), driving learning and improvement.DesignThis is a qualitative study with semistructured interviews. Inductive, thematic content analysis was used to identify barriers and facilitators, which were structured across a pre-existing framework for change in healthcare.SettingDutch academic surgical department with a long tradition of M&M.ParticipantsAn interview sample of surgeons, residents and physician assistants (n=12).ResultsA total of 57 barriers and facilitators to successful M&M, covering 18 themes, varying from ‘case type’ to ‘leadership’, were perceived by surgical staff. While some factors related to M&M organisation, others concerned individual or social aspects. Eight factors, of which four were at the social level, had simultaneous positive and negative effects (eg, ‘hierarchy’ and ‘team spirit’). Mediating pathways for M&M success were found to relate to availableinformation, staffmotivationandrealisationprocesses.ConclusionsThis study provides leads for improvement of M&M practice, as well as for further research on key elements of successful M&M. Various factors were perceived to affect M&M success, of which many were individual and social rather than organisational factors, affecting information and realisation processes but also staff motivation. Based on these findings, practical recommendations were formulated to guide efforts towards best practices for M&M.
Identification of myocardial infarction type from electronic hospital data in England and Australia: a comparative data linkage study
Authors: Nedkoff Lee , Lopez Derrick , Goldacre Michael , Sanfilippo Frank , Hobbs Michael , Wright F Lucy 
Published: November 2017

ObjectiveTo determine the utility of International Classification of Diseases (ICD) codes in investigating trends in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) using person-linked electronic hospitalisation data in England and Western Australia (WA).MethodsAll hospital admissions with myocardial infarction (MI) as the principal diagnosis were identified from 2000 to 2013 from both jurisdictions. Fourth-digit ICD-10 codes were used to delineate all MI types—STEMI, NSTEMI, unspecified and subsequent MI. The annual frequency of each MI type was calculated as a proportion of all MI admissions. For all MI and each MI type, age-standardised rates were calculated and age-adjusted Poisson regression models used to estimate annual percentage changes in rates.ResultsIn 2000, STEMI accounted for 49% of all MI admissions in England and 59% in WA, decreasing to 35% and 25% respectively by 2013. Less than 10% of admissions were recorded as NSTEMI in England throughout the study period, whereas by 2013, 70% of admissions were NSTEMI in WA. Unspecified MI comprised 60% of all MI admissions in England by 2013, compared with <1% in WA. Trends in age-standardised rates differed for all MI (England, −2.7%/year; WA, +1.7%/year), underpinned by differing age-adjusted trends in NSTEMI (England, −6.1%/year; WA, +10.2%/year).ConclusionDifferences between the proportion and trends for MI types in English and WA data were observed. These were consistent with the coding standards in each country. This has important implications for using electronic hospital data for monitoring MI and identifying MI types for outcome studies.
Prediagnostic Smoking Is Associated with Binary and Quantitative Measures of ER Protein and ESR1 mRNA Expression in Breast Tumors
Authors: Butler Eboneé N. , Bensen Jeannette T. , Chen Mengjie , Conway Kathleen , Richardson David B. , Sun Xuezheng , Geradts Joseph , Olshan Andrew F. , Troester Melissa A. 
Published: November 2017

Abstract
Background: Smoking is a possible risk factor for breast cancer and has been linked to increased risk of estrogen receptor–positive (ER+) disease in some epidemiologic studies. It is unknown whether smoking has quantitative effects on ER expression.
Methods: We examined relationships between smoking and ER expression from tumors of 1,888 women diagnosed with invasive breast cancer from a population-based study in North Carolina. ER expression was characterized using binary (±) and continuous measures for ER protein, ESR1 mRNA, and a multigene luminal score (LS) that serves as a measure of estrogen signaling in breast tumors. We used logistic and linear regression models to estimate temporal and dose-dependent associations between smoking and ER measures.
Results: The odds of ER+, ESR1+, and LS+ tumors among current smokers (at the time of diagnosis), those who smoked 20 or more years, and those who smoked within 5 years of diagnosis were nearly double those of nonsmokers. Quantitative levels of ESR1 were highest among current smokers compared with never smokers overall [mean (log2) = 9.2 vs. 8.7, P &lt; 0.05] and among ER+ cases; however, we did not observe associations between smoking measures and continuous ER protein expression.
Conclusions: In relationship to breast cancer diagnosis, recent smoking was associated with higher odds of the ER+, ESR1+, and LS+ subtype. Current smoking was associated with elevated ESR1 mRNA levels and an elevated LS, but not with altered ER protein.
Impact: A multigene LS and single-gene ESR1 mRNA may capture tumor changes associated with smoking. Cancer Epidemiol Biomarkers Prev; 27(1); 67–74. ©2017 AACR.
Regulatory T-cell Genes Drive Altered Immune Microenvironment in Adult Solid Cancers and Allow for Immune Contextual Patient Subtyping
Authors: Brouwer-Visser Jurriaan , Cheng Wei-Yi , Bauer-Mehren Anna , Maisel Daniela , Lechner Katharina , Andersson Emilia , Dudley Joel T. , Milletti Francesca 
Published: November 2017

AbstractBackground: The tumor microenvironment is an important factor in cancer immunotherapy response. To further understand how a tumor affects the local immune system, we analyzed immune gene expression differences between matching normal and tumor tissue.Methods: We analyzed public and new gene expression data from solid cancers and isolated immune cell populations. We also determined the correlation between CD8, FoxP3 IHC, and our gene signatures.Results: We observed that regulatory T cells (Tregs) were one of the main drivers of immune gene expression differences between normal and tumor tissue. A tumor-specific CD8 signature was slightly lower in tumor tissue compared with normal of most (12 of 16) cancers, whereas a Treg signature was higher in tumor tissue of all cancers except liver. Clustering by Treg signature found two groups in colorectal cancer datasets. The high Treg cluster had more samples that were consensus molecular subtype 1/4, right-sided, and microsatellite-instable, compared with the low Treg cluster. Finally, we found that the correlation between signature and IHC was low in our small dataset, but samples in the high Treg cluster had significantly more CD8+ and FoxP3+ cells compared with the low Treg cluster.Conclusions: Treg gene expression is highly indicative of the overall tumor immune environment.Impact: In comparison with the consensus molecular subtype and microsatellite status, the Treg signature identifies more colorectal tumors with high immune activation that may benefit from cancer immunotherapy. Cancer Epidemiol Biomarkers Prev; 27(1); 103–12. ©2017 AACR.
Lifestyle and Reproductive Factors and Ovarian Cancer Risk by p53 and MAPK Expression
Authors: Harris Holly R. , Rice Megan S. , Shafrir Amy L. , Poole Elizabeth M. , Gupta Mamta , Hecht Jonathan L. , Terry Kathryn L. , Tworoger Shelley S. 
Published: November 2017

Abstract
Background: One model of ovarian cancer development model divides tumors into two types. Type I tumors are characterized by KRAS and BRAF mutations, which can activate mitogen-activated protein kinase (MAPK). Type II tumors are characterized by tubal precursor lesions with p53 mutations. We evaluated the association between lifestyle and reproductive factors and risk of ovarian cancer defined by p53 and MAPK expression.
Methods: Epithelial ovarian cancer cases (n = 274) and controls (n = 1,907) were identified from the Nurses' Health Study and Nurses' Health Study II prospective cohorts, and the population-based New England Case–Control study. Reproductive and lifestyle exposures were assessed by questionnaire/interview. We performed immunohistochemical assays for p53 and MAPK expression. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using polytomous logistic regression.
Results: Parity was associated with a decreased risk of p53 wild-type tumors (OR = 0.31; 95% CI, 0.18–0.55), but not p53-mutant tumors (OR = 0.92; 95% CI, 0.54–1.59)(Pheterogeneity &lt; 0.01). Family history of breast or ovarian cancer was associated with risk of MAPK-negative (OR = 2.06; 95% CI, 1.39–3.06), but not MAPK-positive tumors (OR = 0.74; 95% CI, 0.43–1.27; Pheterogeneity&lt; 0.01). In cross-classified analyses, family history of breast or ovarian cancer was most strongly associated with p53-mutant/MAPK-negative tumors (OR = 2.33; 95% CI, 1.44–3.75). Differences by MAPK expression were also observed for estrogen plus progesterone hormone therapy use (Pheterogeneity = 0.03).
Conclusions: These findings provide evidence that parity, family history, and estrogen plus progesterone hormone therapy use may be differentially associated with tumor subtypes defined by p53 and MAPK expression.
Impact: In future studies, other immunohistochemical markers or gene expression profiles that more clearly define these subtypes should be considered. Cancer Epidemiol Biomarkers Prev; 27(1); 96–102. ©2017 AACR.
Availability and Use of Shared Data From Cardiometabolic Clinical Trials
Authors: Vaduganathan Muthiah , Nagarur Amulya , Qamar Arman , Patel Ravi B. , Navar Ann Marie , Peterson Eric D. , Bhatt Deepak L. , Fonarow Gregg C. , Yancy Clyde W. , Butler Javed 
Published: November 2017

Background:
Sharing of patient-level clinical trial data has been widely endorsed. Little is known about how extensively these data have been used for cardiometabolic diseases. We sought to evaluate the availability and use of shared data from cardiometabolic clinical trials.

Methods:
We extracted data from ClinicalStudyDataRequest.com, a large, multisponsor data-sharing platform hosting individual patient–level data from completed studies sponsored by 13 pharmaceutical companies.

Results:
From January 2013 to May 2017, the platform had data from 3374 clinical trials, of which 537 (16%) evaluated cardiometabolic therapeutics (phase 1, 36%; phase 2, 17%; phase 2/3, 1%; phase 3, 42%; phase 4, 4%). They covered 74 therapies and 398 925 patients. Diabetes mellitus (60%) and hypertension (15%) were the most common study topics. Median time from study completion to data availability was 79 months. As of May 2017, ClinicalStudyDataRequest.com had received 318 submitted proposals, of which 163 had signed data-sharing agreements. Thirty of these proposals were related to cardiometabolic therapies and requested data from 79 unique studies (15% of all trials, 29% of phase 3/4 trials). Most (96%) data requesters of cardiometabolic clinical trial data were from academic centers in North America and Western Europe, and half the proposals were unfunded. Most proposals were for secondary hypothesis-generating questions, with only 1 proposed reanalysis of the original study primary hypothesis. To date, 3 peer-reviewed articles have been published after a median of 19 months (9–32 months) from the data-sharing agreement.

Conclusions:
Despite availability of data from >500 cardiometabolic trials in a multisponsor data-sharing platform, only 15% of these trials and 29% of phase 3/4 trials have been accessed by investigators thus far, and a negligible minority of analyses have reached publication.
Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease
Authors: Bonaca Marc P. , Nault Patrice , Giugliano Robert P. , Keech Anthony C. , Pineda Armando Lira , Kanevsky Estella , Kuder Julia , Murphy Sabina A. , Jukema J. Wouter , Lewis Basil S. , Tokgozoglu Lale , Somaratne Ransi , Sever Peter S. , Pedersen Terje R. , Sabatine Marc S. 
Published: November 2017

Background:
The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab reduced low-density lipoprotein cholesterol and cardiovascular events in the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). We investigated the efficacy and safety of evolocumab in patients with peripheral artery disease (PAD) as well as the effect on major adverse limb events.

Methods:
FOURIER was a randomized trial of evolocumab versus placebo in 27 564 patients with atherosclerotic disease on statin therapy followed for a median of 2.2 years. Patients were identified as having PAD at baseline if they had intermittent claudication and an ankle brachial index of <0.85, or if they had a prior peripheral vascular procedure. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, hospital admission for unstable angina, or coronary revascularization. The key secondary end point was a composite of cardiovascular death, myocardial infarction, or stroke. An additional outcome of interest was major adverse limb events defined as acute limb ischemia, major amputation, or urgent peripheral revascularization for ischemia.

Results:

Three thousand six hundred forty-two patients (13.2%) had PAD (1505 with no prior myocardial infarction or stroke). Evolocumab significantly reduced the primary end point consistently in patients with PAD (hazard ratio [HR] 0.79; 95% confidence interval [CI], 0.66–0.94;
P
=0.0098) and without PAD (HR 0.86; 95% CI, 0.80–0.93;
P
=0.0003;
P
interaction
=0.40). For the key secondary end point, the HRs were 0.73 (0.59–0.91;
P
=0.0040) for those with PAD and 0.81 (0.73–0.90;
P
<0.0001) for those without PAD (
P
interaction
=0.41). Because of their higher risk, patients with PAD had larger absolute risk reductions for the primary end point (3.5% with PAD, 1.6% without PAD) and the key secondary end point (3.5% with PAD, 1.4% without PAD). Evolocumab reduced the risk of major adverse limb events in all patients (HR, 0.58; 95% CI, 0.38–0.88;
P
=0.0093) with consistent effects in those with and without known PAD. There was a consistent relationship between lower achieved low-density lipoprotein cholesterol and lower risk of limb events (
P
=0.026 for the beta coefficient) that extended down to <10 mg/dL.

Conclusions:
Patients with PAD are at high risk of cardiovascular events, and PCSK9 inhibition with evolocumab significantly reduced that risk with large absolute risk reductions. Moreover, lowering of low-density lipoprotein cholesterol with evolocumab reduced the risk of major adverse limb events.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01764633.