bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Obesity Paradox Is Not Observed in Critically Ill Patients on Early Enteral Nutrition*
Authors: Harris Kimberley , Zhou Jiachen , Liu Xinggang , Hassan Erkan , Badawi Omar 
Published: March 2017

Objectives:
To investigate the association between body mass index and mortality in a large, ICU population and determine if the relationship is observed among a subgroup of patients ordered early enteral nutrition.

Design:
Retrospective cohort study within a national clinical mixed ICU database of patients admitted between January 1, 2008, and June 30, 2015.

Setting:
Initial ICU admissions among patients monitored by tele-ICU programs and recorded in the Philips eICU Research Institute database.

Patients:
A total of 1,042,710 adult patient stays with ICU length of stay more than 24 hours, of which 74,771 were ordered enteral nutrition within the first 48 hours.

Intervention:
None.

Measurements and Main Results:
Patient stays from 409 ICUs were included. The average age, Acute Physiology and Chronic Health Evaluation IV score, and hospital mortality were 63.6 years, 56.7, and 9.0%, respectively. Hospital mortality among body mass index categories was estimated by multivariable modified Poisson regression models. Compared with the body mass index category 25.0–29.9 kg/m2, hospital mortality was higher among underweight (body mass index, < 18.5; relative risk, 1.35; 95% CI, 1.32–1.39), normal weight (body mass index, 18.5–24.9; relative risk, 1.10; 95% CI, 1.09–1.12), and the extremely obese (body mass index, ≥ 50.0; relative risk, 1.10; 95% CI, 1.05–1.15). However, the risk was not statistically different from patients with body mass index 30.0–49.9 kg/m2. Among patients ordered early enteral nutrition, the risk of mortality in the body mass index category 25.0–29.9 kg/m2 was not statistically different from those in the normal weight or extremely obese groups.

Conclusions:
A survival advantage for overweight and obese patients was observed in this large cohort of critically ill patients. However, among those ordered early enteral nutrition, the survival disadvantage for body mass index categories less than 25.0 kg/m2 was minimal or unobservable when compared with higher body mass index categories.
Parity and increased risk of insulin resistance in postmenopausal women: the 2010 Korean National Health and Nutrition Examination Survey
Authors: Kim Jin Hwi , Lee Sung Jong 
Published: March 2017

Abstract

Objective:
The objective of this study was to assess the association between parity and insulin resistance in nondiabetic, postmenopausal women.

Methods:
This cross-sectional study was conducted using data from the 2010 Korean National Health and Nutrition Examination Survey administered by the Korean Ministry of Health and Welfare. A total of 1,243 nondiabetic postmenopausal women were included in this study and subdivided into three groups according to parity (1-2, 3-4, and ≥5 live births). Insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA-IR) index. The relationship between parity and insulin resistance was investigated using analysis of covariance.

Results:
HOMA-IR showed a positive relationship with parity. Mean HOMA-IR (geometric mean and 95% CI) increased according to increasing parity group (1-2, 3-4, and ≥5 live births) after adjustment for age, smoking, alcohol consumption, exercise, education, income, and body mass index as follows: 2.1 (2.0-2.2) < 2.2 (2.1-2.3) < 2.5 (2.2-2.8) (P = 0.040 and P for trend = 0.012). In addition, this positive association was more apparent when insulin resistance was accompanied by obesity. The mean parity of the obese and insulin-resistant group was significantly higher than that of the nonobese insulin-sensitive group (3.6 ± 0.1 vs 3.2 ± 0.1, P = 0.047).

Conclusions:
Our study provides the first evidence that parity is significantly associated with insulin resistance in nondiabetic postmenopausal women. Further prospective longitudinal studies are needed to confirm the impact of parity on insulin resistance.
Tailoring strategies for the management of depression in midlife years
Authors: Soares Claudio N. 
Published: March 2017

Abstract
Depression affects one in every five adults in North America. Women are more affected than men, possibly because of genetics, coping strategies, and hormone variations. The concept of a menopause-associated depression, however, remains a complex and controversial topic. Although hormone therapy is not recommended as first-line therapy for depression in midlife women, estrogen-based hormone therapy may minimize the need for or enhance the response to antidepressant or behavior-based therapies in select perimenopausal women.
A sex-specific dose-response curve for testosterone: could excessive testosterone limit sexual interaction in women?
Authors: Krapf Jill M. , Simon James A. 
Published: March 2017

Abstract
Testosterone treatment increases sexual desire and well-being in women with hypoactive sexual desire disorder; however, many studies have shown only modest benefits limited to moderate doses. Unlike men, available data indicate women show a bell-shaped dose-response curve for testosterone, wherein a threshold dosage of testosterone leads to desirable sexual function effects, but exceeding this threshold results in a lack of further positive sexual effects or may have a negative impact. Emotional and physical side-effects of excess testosterone, including aggression and virilization, may counteract the modest benefits on sexual interaction, providing a possible explanation for a threshold dose of testosterone in women. In this commentary, we will review and critically analyze data supporting a curvilinear dose-response relationship between testosterone treatment and sexual activity in women with low libido, and also explore possible explanations for this observed relationship. Understanding optimal dosing of testosterone unique to women may bring us one step closer to overcoming regulatory barriers in treating female sexual dysfunction.
Cost-effectiveness of the 13-valent Pneumococcal Conjugate Vaccine in Children in Portugal
Authors: Gouveia Miguel , Fiorentino Francesca , Jesus Gonçalo , Costa João , Borges Margarida 
Published: March 2017

Background:
Pneumococcal infections are the leading cause of vaccine-preventable death in children. In June 2015, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the Portuguese Immunization Program. We evaluated the cost-effectiveness of children vaccinated with PCV13 versus no vaccination for preventing pneumococcal diseases.

Methods:
A cohort simulation model for 2014 Portuguese newborns was used, considering a lifetime horizon and existence of herd effect on adults. Model outcomes measured life years gained, direct and indirect healthcare costs and net benefits considering €20,000 per life years gained. PCV13 clinical effectiveness rate by serotype covered was assumed similar to PCV7. Patients’ resource use was based on 2014 diagnostic-related group database and experts’ opinion, while national legislation and official drug cost database were the main sources for unitary costs. Univariate sensitivity analyses were conducted to assess results’ effectiveness.

Results:
In base case scenario, PCV13 was a dominant strategy, being associated with better health outcomes and lower costs. In a lifetime, a total of 6238 infections (excluding acute otitis media) and 130 deaths were averted, with a total saving of €397,217 ($432,966). Net benefits were estimated above €28 million ($30 million). Results were robust in all sensitivity analyses, with positive net benefits, except when herd effect was excluded.

Conclusions:
Vaccination of children with PCV13 starting in their first year of life is a cost-effective intervention with the potential to save costs to the Portuguese health system and to provide health gains by reducing the burden of pneumococcal disease in the vaccines and through the herd effect of this vaccine.
Impact of Multisystem Health Care on Readmission and Follow-up Among Veterans Hospitalized for Chronic Obstructive Pulmonary Disease
Authors: Rinne Seppo T. , Elwy Anashua R. , Bastian Lori A. , Wong Edwin S. , Wiener Renda S. , Liu Chuan-Fen 
Published: March 2017

Background:
Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown.

Objective:
To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD.

Design:
This is a retrospective cohort study using VA administrative data and Medicare claims.

Subjects:
In total, 20,472 Medicare-eligible veterans who were admitted to VA hospitals for COPD during October 1, 2008 and September 30, 2011.

Measures:
We identified the source of outpatient care during the year before the index hospitalization as VA-only, dual-care (VA and Medicare), and Medicare-only. Outcomes of interest included any-cause 30-day readmission, COPD-specific 30-day readmission and follow-up visit within 30 days of discharge. We used mixed-effects logistic regression, controlling for baseline severity of illness, to examine the association between non-VA care and postdischarge outcomes.

Results:
There was no association between non-VA care and any-cause readmission. We did identify an increased COPD-specific readmission risk with both dual-care [odds ratio (OR)=1.20; 95% confidence interval (CI), 1.02–1.40] and Medicare-only (OR=1.41; 95% CI, 1.15–1.75). Medicare-only outpatient care was also associated with significantly lower rates of follow-up (OR=0.81; 95% CI, 0.72–0.91).

Conclusions:
Differences in disease-specific readmission risk may reflect differences in disease management between VA and non-VA providers. Further research is needed to understand how multisystem care affects coordination and other measures of quality for veterans with COPD.
Association of the Affordable Care Act With Smoking and Tobacco Treatment Utilization Among Adults Newly Enrolled in Health Care
Authors: Young-Wolff Kelly C. , Klebaner Daniella , Campbell Cynthia I. , Weisner Constance , Satre Derek D. , Adams Alyce S. 
Published: March 2017

Objectives:
To examine rates of smoking and tobacco treatment utilization by insurance coverage status (Medicaid, commercial, exchange) among newly enrolled patients in the post Affordable Care Act (ACA) era.

Methods:
We examined new members who enrolled in Kaiser Permanente Northern California through Medicaid, the California exchange, or nonexchange commercial plans (N=122,298) in the first 6 months of 2014 following ACA implementation. We compared these groups on smoking prevalence and tested whether smokers in each group differed on sociodemographic characteristics and in their utilization of tobacco treatment (pharmacotherapy and counseling) in 2014.

Results:
Smoking prevalence was higher among Medicaid (22%) than exchange (13%) or commercial (12%) patients (P<0.0001). Controlling for key sociodemographic and clinical characteristics, Medicaid (odds ratio, 1.49; 95% confidence interval, 1.29–1.73) smokers had greater odds of tobacco treatment use than commercial smokers. Other groups at risk for underuse included men, younger patients, Asians, and Latinos.

Conclusions:
In this cohort of newly enrolled patients after ACA implementation, Medicaid patients were more likely to be smokers compared with exchange and commercial patients, but they were also more likely to use tobacco treatment. Low tobacco treatment use among exchange and commercial plan smokers, as well as younger men, Asians and Latinos poses a significant obstacle to improving public health and additional targeted outreach strategies may be needed to engage these patients with available health services.
Dissecting Leapfrog
Authors: Smith Shawna N. , Reichert Heidi A. , Ameling Jessica M. , Meddings Jennifer 
Published: March 2017

Background:
Voluntary Leapfrog Safe Practices Score (SPS) measures were among the first public reports of hospital performance. Recently, Medicare’s Hospital Compare website has reported compulsory measures. Leapfrog’s Hospital Safety Score (HSS) grades incorporate SPS and Medicare measures. We evaluate associations between Leapfrog SPS and Medicare measures, and the impact of SPS on HSS grades.

Methods:
Using 2013 hospital data, we linked Leapfrog HSS data with central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) standardized infection ratios (SIRs), and Hospital Readmission and Hospital-Acquired Condition (HAC) Reduction Program penalties incorporating 2013 performance. For SPS-providing hospitals, we used linear and logistic regression models to predict CLABSI/CAUTI SIRs and penalties as a function of SPS. For hospitals not reporting SPS, we simulated change in HSS grades after imputing a range of SPS.

Results:
In total, 1089 hospitals reported SPS; >50% self-reported perfect scores for all but 1 measure. No SPS measures were associated with SIRs. One SPS (feedback) was associated with lower odds of HAC penalization (odds ratio, 0.86; 95% confidence interval, 0.76–0.97). Among hospitals not reporting SPS (N=1080), 98% and 54% saw grades decline by 1+ letters with first and 10th percentile SPS imputed, respectively; 49% and 54% saw grades improve by 1+ letter with median and highest SPS imputed.

Conclusions:
Voluntary Leapfrog SPS measures skew toward positive self-report and bear little association with compulsory Medicare outcomes and penalties. SPS significantly impacts HSS grades, particularly when lower SPS is reported. With increasing compulsory reporting, Leapfrog SPS seems limited for comparing hospital performance.
Variability in Objective Refraction for Persons with Down Syndrome
Authors: Marsack Jason D. , Ravikumar Ayeswarya , Benoit Julia S. , Anderson Heather A. 
Published: March 2017

ABSTRACTPurposeDown syndrome (DS) is associated with ocular and cognitive sequelae, which both have the potential to influence clinical measures of refractive error. This study compares variability of autorefraction among subjects with and without DS.MethodsGrand Seiko autorefraction was performed on 139 subjects with DS (age: 8–55, mean: 25 ± 9 yrs) and 138 controls (age: 7–59, mean: 25 ± 10 yrs). Subjects with three refraction measures per eye (DS: 113, control: 136) were included for analysis. Each refraction was converted to power vector notation (M,J0,J45) and a difference in each component (ΔM, ΔJ0, ΔJ45) was calculated for each refraction pairing. From these quantities, average dioptric strength ( JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic1/v/2023-08-23T160455Z/r/image-tiff : square root of the sum of the squares ofM,J0, andJ45) and average dioptric difference ( JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic2/v/2023-08-23T160455Z/r/image-tiff : square root of the sum of the squares of ΔM, ΔJ0, and ΔJ45) were calculated.ResultsThe DS group exhibited a greater median JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic3/v/2023-08-23T160455Z/r/image-tiff (1Q: 1.38D M: 2.38D 3Q: 3.41D) than control eyes (1Q: 0.47D M: 0.96D 3Q: 2.75D) (P< .001). Likewise, the DS group exhibited a greater median JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic4/v/2023-08-23T160455Z/r/image-tiff in refraction (1Q: 0.27D M: 0.42D 3Q: 0.78D) than control eyes (1Q: 0.11D M: 0.15D 3Q: 0.23D) (P< .001) with 97.1% of control eyes exhibiting JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic5/v/2023-08-23T160455Z/r/image-tiff ≤0.50D, compared to 59.3% of DS eyes. An effect of JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic6/v/2023-08-23T160455Z/r/image-tiff on JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic7/v/2023-08-23T160455Z/r/image-tiff was not detected (P= .3009) nor was a significant interaction between JOURNAL/opvis/04.03/00006324-201705000-00005/inline-graphic8/v/2023-08-23T160455Z/r/image-tiff and group detected (P= .49).ConclusionsIn the current study, comparing three autorefraction readings, median total dioptric difference with autorefraction in DS was 2.8 times the levels observed in controls, indicating greater potential uncertainty in objective measures of refraction for this population. The analysis demonstrates thatJ45is highly contributory to the observed variability.
Task-induced Changes in Idiopathic Infantile Nystagmus Vary with Gaze
Authors: Salehi Fadardi Marzieh , Bathke Arne C. , Harrar Solomon W. , Abel Larry Allen 
Published: March 2017

ABSTRACT

Purpose
Investigations of infantile nystagmus syndrome (INS) at center or at the null position have reported that INS worsens when visual demand is combined with internal states, e.g. stress. Visual function and INS parameters such as foveation time, frequency, amplitude, and intensity can also be influenced by gaze position. We hypothesized that increases from baseline in visual demand and mental load would affect INS parameters at the null position differently than at other gaze positions.

Methods
Eleven participants with idiopathic INS were asked to determine the direction of Tumbling-E targets, whose visual demand was varied through changes in size and contrast, using a staircase procedure. Targets appeared between ±25° in 5° steps. The task was repeated with both mental arithmetic and time restriction to impose higher mental load, confirmed through subjective ratings and concurrent physiological measurements.

Results
Within-subject comparisons were limited to the null and 15° away from it. No significant main effects of task on any INS parameters were found. At both locations, high mental load worsened task performance metrics, i.e. lowest contrast (P = .001) and smallest optotype size reached (P = .012). There was a significant interaction between mental load and gaze position for foveation time (P = .02) and for the smallest optotype reached (P = .028). The increase in threshold optotype size from the low to high mental load was greater at the null than away from it. During high visual demand, foveation time significantly decreased from baseline at the null as compared to away from it (mean difference ± SE: 14.19 ± 0.7 msec; P = .010).

Conclusions
Under high visual demand, the effects of increased mental load on foveation time and visual task performance differed at the null as compared to 15° away from it. Assessment of these effects could be valuable when evaluating INS clinically and when considering its impact on patients’ daily activities.
Methodology for self-report of rest pain (or spontaneous pain) vs evoked pain in chronic neuropathic conditions: a prospective observational pilot study
Authors: He David , Grant Brian , Holden Ronald R. , Gilron Ian 
Published: March 2017

Abstract

Introduction:
The distinction between pain at rest and pain evoked by touch or movement has important clinical implications and may be associated with different mechanisms. However, current methods of clinical pain assessment pay little attention to directly distinguishing between these contrasting components of symptom burden.

Objectives:
We developed the 10-item “Functional Impact of Neuropathic Evoked and Spontaneous Symptom Evaluation” questionnaire designed to distinguish between rest and evoked pain.

Methods:
A prospective observational pilot study of this questionnaire was conducted in 78 participants with neuropathic pain diagnoses. Other study measures included the self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs questionnaire and a modified Brief Pain Inventory. Exploratory analyses were conducted to evaluate the validity of the Functional Impact of Neuropathic Evoked and Spontaneous Symptom Evaluation questionnaire.

Results:
Pain symptoms often/very often/always (1) evoked by touch or movement, and (2) occurring at rest without tactile stimulation were reported by 81% and 65%, respectively. Evoked pain was associated with walking (64%) and standing (35%); and rest pain was associated with watching television (47%), reading (37%), and sitting (36%). Participants reporting both rest and evoked pain tended to report higher levels of pain interference compared to those reporting evoked pain only.

Discussion:
These results provide support for the feasibility and validity of new patient-report methods to distinguish between rest pain and evoked pain in chronic neuropathic conditions. Future studies are needed to confirm the reliability and validity of these methods, which may facilitate important improvements in the research and development of new treatments for chronic pain.
Brief Report: Hormonal Contraception Is Not Associated With Reduced ART Effectiveness Among Women Initiating ART: Evidence From Longitudinal Data
Authors: Patel Rena C. , Baeten Jared M. , Heffron Renee , Hong Ting , Davis Nicole L. , Nanda Kavita , Coombs Robert W. , Lingappa Jairam R. , Bukusi Elizabeth A. , Hurst Stacey , Thomas Katherine K. , Kourtis Athena P. , Mugo Nelly ,   for the Partners in Prevention HSV/HIV Transmission Study and Partners PrEP Study Teams
Published: March 2017

Background:
To explore the association between concomitant hormonal contraceptive and antiretroviral therapy (ART) use and (1) plasma viral suppression and (2) genital HIV shedding among HIV-positive women initiating ART.

Methods:
We analyzed plasma viral load and genital viral RNA shedding from 1079 HIV-positive women initiating ART who were followed prospectively in 3 sub-Saharan African HIV prevention studies. Plasma and endocervical swab samples were collected every 6 months. Self-reported contraceptive use was categorized into injectable, implant, oral, or nonhormonal/no contraception. We used multivariate Cox regression to assess time to plasma viral suppression and logistic regression with generalized estimating equations to assess genital viral shedding for each contraceptive method.

Results:
At the time of ART initiation, there were 211 (20%) injectable, 69 (6%) implant, 50 (5%) oral, and 749 (69%) nonhormonal or no method users. Plasma viral suppression was high (90% by 6 months) and hormonal contraceptives did not diminish time to plasma viral suppression as compared to nonhormonal/no methods [adjusted hazard ratios: injectables 0.89 (95% confidence interval: 0.75 to 1.07), implants 0.91 (0.68 to 1.23), and oral methods 1.33 (1.06 to 1.66)]. Genital viral shedding was uncommon any time after ART initiation (only 9% of samples had detectable viral shedding) and hormonal contraceptives were not associated with an increased detection of genital viral shedding [adjusted odds ratios: injectables 1.07 (0.69 to 1.65), implants 0.67 (0.31 to 1.49), and oral methods 0.56 (0.19 to 1.69)].

Conclusions:
The hormonal contraceptives assessed were not associated with reduced ART effectiveness among HIV-positive women initiating ART. HIV-positive women should continue to be offered contraceptive options, including hormonal ones that best meet their needs.