bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hormonal contraceptives and asthma in women of reproductive age: analysis of data from serial national Scottish Health Surveys
Authors: Nwaru Bright I , Sheikh Aziz 
Published: July 2015

Objectives Sex steroid hormones may explain known gender-related variations in asthma prevalence and clinical manifestation. We investigated the relationship between use of hormonal contraceptives and asthma in women, and assessed evidence of biological interaction between use of hormonal contraceptives and body mass index in this relationship. Design Population-based analysis using data from serial (i.e. 2003, 2008 and 2010) Scottish Health Surveys. Setting Random samples of the Scottish general population. Participants A total of 3257 non-pregnant, 16–45-year-old women. Exposure Current use of hormonal contraceptives. Main outcome measures Self-reported current physician-diagnosed asthma, current wheezing symptoms, wheezing attacks and treatment for asthma or wheeze. Results Women comprising 30.9% (95% confidence interval 29.3–32.5) were currently using any hormonal contraceptive and current physician-diagnosed asthma was present in 6.5% (95% confidence interval 5.7–7.4). Use of any hormonal contraceptive was associated with reduced risk of current physician-diagnosed asthma (odds ratio 0.68; 95% confidence interval 0.47–0.98) and receiving ≥3 asthma care episodes (odds ratio 0.45; 95% confidence interval 0.25–0.82), but the evidence was equivocal for wheezing attacks. Use of hormonal contraceptives among overweight or obese women was non-statistically significantly associated with asthma, but there was 42–135% increased risk in overweight and obese non-contraceptive using women. Conclusions Use of hormonal contraceptives may reduce asthma exacerbations and number of care episodes. Overweight and obese non-contraceptive-using women may be at increased risk of asthma. Prospective studies are now needed to confirm these findings. Both oestrogen and progesterone may stimulate smooth airway muscle function and inhibit the activities of TH2 responses. Future studies should investigate these underlying mechanisms.
Ethnic variations in morbidity and mortality from lower respiratory tract infections: a retrospective cohort study
Authors: Simpson Colin R , Steiner Markus FC , Cezard Genevieve , Bansal Narinder , Fischbacher Colin , Douglas Anne , Bhopal Raj , Sheikh Aziz 
Published: July 2015

Objective There is evidence of substantial ethnic variations in asthma morbidity and the risk of hospitalisation, but the picture in relation to lower respiratory tract infections is unclear. We carried out an observational study to identify ethnic group differences for lower respiratory tract infections. Design A retrospective, cohort study. Setting Scotland. Participants 4.65 million people on whom information was available from the 2001 census, followed from May 2001 to April 2010. Main outcome measures Hospitalisations and deaths (any time following first hospitalisation) from lower respiratory tract infections, adjusted risk ratios and hazard ratios by ethnicity and sex were calculated. We multiplied ratios and confidence intervals by 100, so the reference Scottish White population’s risk ratio and hazard ratio was 100. Results Among men, adjusted risk ratios for lower respiratory tract infection hospitalisation were lower in Other White British (80, 95% confidence interval 73–86) and Chinese (69, 95% confidence interval 56–84) populations and higher in Pakistani groups (152, 95% confidence interval 136–169). In women, results were mostly similar to those in men (e.g. Chinese 68, 95% confidence interval 56–82), although higher adjusted risk ratios were found among women of the Other South Asians group (145, 95% confidence interval 120–175). Survival (adjusted hazard ratio) following lower respiratory tract infection for Pakistani men (54, 95% confidence interval 39–74) and women (31, 95% confidence interval 18–53) was better than the reference population. Conclusions Substantial differences in the rates of lower respiratory tract infections amongst different ethnic groups in Scotland were found. Pakistani men and women had particularly high rates of lower respiratory tract infection hospitalisation. The reasons behind the high rates of lower respiratory tract infection in the Pakistani community are now required.
Revisiting an ancient treatment for transphincteric fistula-in-ano ‘There is nothing new under the sun’ Ecclesiastes 1v9
Authors: Soliman F , Sturgeon G , Hargest R 
Published: July 2015

Objective The history of treatments for fistula-in-ano can be traced back to ancient times. Current treatment of transphincteric fistulae is controversial, with many options available. We reviewed the history of treatment using cutting setons and present our series of transphincteric fistulae in the light of the series in the literature. Design Literature review and case series. Setting Hospital based coloproctology service Participants 140 consecutive patients presenting with fistula-in-ano were included. Main Outcome Measures The literature pertaining to treatment of transphincteric fistula was reviewed, along with the outcome of various treatment methods for this condition. Data were collected for 140 consecutive patients presenting with fistula- in-ano were assessed for fistula healing, recurrence and complications. Results A total of 140 consecutive patients with fistula-in-ano were identified, of which 111 were cryptoglandular (79.3%). Eighty-one of these 111 were transphincteric (73.0%). At a median follow-up of 35 months (range, 2–83 months), 70 transphincteric fistulae had healed (86.4%), 10 were still undergoing treatment (12.3%) and one patient was lost to follow-up prior to treatment (1.2%). Two patients in this group required a stoma (2.5%), six patients developed recurrence (7.4%); three ‘true’ recurrences (3.7%). One (1.2%) developed a chronic fissure. There were no reported cases of incontinence. Conclusions The management of transphincteric fistula-in-ano is complex and controversial, for which no clear surgical procedure has gained acceptance as the gold standard. This study demonstrates that transphincteric fistulae can be successfully treated using cutting setons. A high healing rate (86.4%), low recurrence rate (7.4%) and a low complication rate (3.7%) are shown, which compares favourably with published rates over a long follow-up.
Statistical analyses in Swedish randomised trials on mammography screening and in other randomised trials on cancer screening: a systematic review
Authors: Autier Philippe , Boniol Mathieu , Smans Michel , Sullivan Richard , Boyle Peter 
Published: July 2015

Objectives We compared calculations of relative risks of cancer death in Swedish mammography trials and in other cancer screening trials. Participants Men and women from 30 to 74 years of age. Setting Randomised trials on cancer screening. Design For each trial, we identified the intervention period, when screening was offered to screening groups and not to control groups, and the post-intervention period, when screening (or absence of screening) was the same in screening and control groups. We then examined which cancer deaths had been used for the computation of relative risk of cancer death. Main outcome measures Relative risk of cancer death. Results In 17 non-breast screening trials, deaths due to cancers diagnosed during the intervention and post-intervention periods were used for relative risk calculations. In the five Swedish trials, relative risk calculations used deaths due to breast cancers found during intervention periods, but deaths due to breast cancer found at first screening of control groups were added to these groups. After reallocation of the added breast cancer deaths to post-intervention periods of control groups, relative risks of 0.86 (0.76; 0.97) were obtained for cancers found during intervention periods and 0.83 (0.71; 0.97) for cancers found during post-intervention periods, indicating constant reduction in the risk of breast cancer death during follow-up, irrespective of screening. Conclusions The use of unconventional statistical methods in Swedish trials has led to overestimation of risk reduction in breast cancer death attributable to mammography screening. The constant risk reduction observed in screening groups was probably due to the trial design that optimised awareness and medical management of women allocated to screening groups.
No evidence for differential dose effects of hydrocortisone on intrusive memories in female patients with complex post-traumatic stress disorder – a randomized, double-blind, placebo-controlled, crossover study
Authors: Ludäscher Petra , Schmahl Christian , Feldmann Robert E. , Kleindienst Nikolaus , Schneider Miriam , Bohus Martin 
Published: July 2015

Background: Post-traumatic stress disorder is characterized by intrusive traumatic memories. Presently, a controversial debate is ongoing regarding whether reduced cortisol secretion in post-traumatic stress disorder promotes an automatic retrieval of trauma-associated memories. Hence, a pharmacological elevation of cortisol was proposed to decrease post-traumatic stress disorder symptoms, particularly intrusions. The present study investigated the impact of two different doses of hydrocortisone on automatic memory retrieval using a randomized, double-blind, placebo-controlled, crossover study in 30 inpatients with post-traumatic stress disorder. Methods: All participants were female and received various psychotropic medications. They were randomly assigned to one of two groups within a crossover design: they received either 1 week placebo followed by 1 week hydrocortisone 10/d, followed by 1 week placebo, followed by hydrocortisone 30 mg/d (15 participants) or 1 week hydrocortisone 30 mg/d, followed by 1 week placebo, followed by 1 week hydrocortisone 10 mg/d, followed by 1 week placebo (15 participants). The outcome measures were the frequency and the intensity of intrusions, the overall symptomatology of post-traumatic stress disorder and the general psychopathology. Results: We did not find any differences in the frequency and the intensity of post-traumatic stress disorder-related intrusions between the 10 mg hydrocortisone, the 30 mg hydrocortisone and the placebo condition. All effect sizes for the hydrocortisone condition vs. placebo were very small. Additionally, the overall symptomatology of post-traumatic stress disorder and the general psychopathology did not differ between the hydrocortisone therapies and placebo. Conclusions: Our results do not show any effect of the hydrocortisone administration on intrusions in complex post-traumatic stress disorder.
Breastfeeding-Friendly Erie County
Authors: Gregg Deborah J. , Prokorym Megan , Dennison Barbara A. , Waniewski Patricia 
Published: July 2015

Background: Primary care providers play an important role in encouraging and counseling pregnant and postpartum women to successfully breastfeed. Objective: One objective of this 1-year grant was to establish the Breastfeeding Friendly Practice Designation criteria and process to identify and designate at least 5 primary care practices as New York State Breastfeeding Friendly Practices in a high-need, racially/ethnically diverse, urban county in New York with very low prevalence of breastfeeding initiation, exclusivity, and duration. Methods: A partnership between the New York State Department of Health and the P2 Collaborative of Western New York and United Way of Buffalo & Erie County’s Healthy Start Healthy Future for All Coalition facilitated the development of the New York State Ten Steps to a Breastfeeding Friendly Practice, accompanying implementation guide, designation criteria, and model office policies. Practice staff and providers received on-site training and materials and participated in a virtual learning network to share their experiences, celebrate successes, and overcome challenges in implementing system changes. Practice staff completed a self-assessment survey at baseline and after implementation of the Ten Steps and submitted their written office breastfeeding policy for review. Results: Fourteen practices met the criteria for designation and were recognized by the New York State Health Commissioner. Conclusion: The number of practices designated as Breastfeeding Friendly far exceeded the grant objective. Future efforts are directed at expanding this initiative statewide and determining the impact of the designation on breastfeeding outcomes.
Procedural Sedation and Analgesia in Children: Perspectives from Paediatric Emergency Physicians
Authors: Tham Lai Peng , Lee Khai Pin 
Published: July 2015

Procedural sedation and analgesia in children is now widely practised in many emergency departments internationally. In this article, we address the general principles, indications, guidelines, medications, adverse events and future research in paediatric procedural sedation and analgesia in the Emergency Department. Procedural sedation and analgesia is the use of sedative, analgesia and dissociative drugs to provide anxiolysis, analgesia, sedation and motor control during painful or unpleasant diagnostic and therapeutic procedures. It is a continuous spectrum from mild, moderate, deep sedation and then general anaesthesia. Dissociative sedation from ketamine is also commonly used. Internationally, major clinical guidelines have been issued and revised since the 1980s. The guidelines should include the following components and documentation: pre-sedation assessment, intra-procedural monitoring and post-procedural monitoring and discharge criteria. The pre-sedation assessment involves assessing suitability of patient as candidate for sedation, any contraindications, fasting time, ensuring that the necessary equipment and drugs are available and the personnel providing the sedation are skilled in sedation and resuscitation. The common medications for sedation in the emergency departments include ketamine, midazolam, fentanyl, morphine, oral chloral hydrate and nitrous oxide inhalation. Propofol and etomidate are used widely in some of the paediatric emergency departments internationally. Procedural sedation has been documented to be safe and effective when performed by trained emergency physicians. The overall incidence of complications was 5.3% in a large prospective study, including airway and respiratory events (laryngospasm, apnoea, desaturations) and emesis. Aspirations are rare complications. Though the risks of adverse events are not high, emergency physicians need to have core competencies in sedation and resuscitation skills. The future of procedural sedation and analgesia will focus on enhancing training, safety and effectiveness.
Low Back Pain in Changi General Hospital: An Observational Study
Authors: Goh Ming Rong , Po Ivy Yee Yeung , Olafsdottir Karolina 
Published: July 2015

Aims: The aim is to study the profile of local low back pain (LBP) patients and their physiotherapy management in an outpatient physiotherapy clinic. Methods: A retrospective study was done with records of LBP patients attending the Musculoskeletal Physiotherapy Clinic at Changi General Hospital from January to June 2009. Age, LBP onset, occupation, time off work, investigation results, and functional outcomes were obtained. Results: Ninety-four records were screened. Majority of patients (59.6%) were aged between 30–50 years old. Sixty-six percent were engaged in occupations that involved sustained postures. Majority of patients (91.5%) had minor/no trauma in association to the onset of their symptoms. Although majority of patients (64.9%) did not take any time off work to manage their LBP, a total of 640 days were lost off work due to LBP. Majority of patients (93.6%) underwent radiological investigations. There was no significant correlation between radiating symptoms and presence of nerve root compression on MRI (p = 0.144). In addition, pathology did not significantly impact on rehabilitative outcome in our sample (p = 0.397, p = 0.602). A review of clinical practice with regards to ordering radiological investigations may be required to minimise radiation exposure and increase cost effectiveness. Patients improved from a mean of 4.00 to 9.10 on the Patient Specific Functional Scale (PSFS) within an average of 3.65 sessions. There was a significant relationship between earlier onset of therapy and better functional improvement on the PSFS (r= −0.299, p = 0.026). Starting a physiotherapy service in our accident and emergency department may be a good consideration to implement in our hospital. Conclusions: Sustained postures may contribute to LBP in local patients. Disability and time lost off work as result of LBP appears to be a significant problem locally. Radiology has no correlation with symptoms, nor rehabilitative outcomes. Pathology may have only limited value in determining treatment or prognosis in nontraumatic LBP. A tailored physiotherapy approach towards education, manual therapy and exercises may be effective in improving functional capabilities in local LBP patients. Earlier onset of physiotherapy is associated with better functional recovery in LBP patients.
Inguinal Hernias: A Current Review of an Old Problem
Authors: Chiow Adrian Kah Heng , Chong Chee Keong , Tan Su-Ming 
Published: July 2015

The repair of groin hernias are amongst the most commonly performed procedures by the general surgeon today, with almost as many types of repairs as there are hernias. Inguinal hernias account for 75% of all abdominal wall hernias with a lifetime risk of 27% in men and 3% in women1. Repair techniques have evolved from open suture methods to mesh repairs done either open or laparoscopically, translating to improved patient care and decreasing complications associated with hernia repair. This article is intended to provide an overview of the presentation and latest evidence based guidelines for the management of inguinal hernias.
Factors Influencing Costs of Inpatient Ischaemic Stroke Care in Singapore
Authors: Chow Wai Leng , Tin Aung Soe , Meyyappan Amutha 
Published: July 2015

Introduction: Stroke is a major public issue in Singapore, accounting for almost 10,000 admissions annually and the burden of disease is set to increase with an ageing population. We therefore seek to examine the factors influencing the cost of acute stroke care in Singapore. Methods: This is a retrospective analysis of 2,087 discharges with a primary discharge diagnosis of stroke from a tertiary hospital in Singapore from 1 January 2007 to 31 December 2008. Data including age, gender, length of hospital stay, components of direct cost and discharge disposition were obtained. A generalised linear model with a log link function and gamma distribution was used to determine the predictors of total hospital cost. Results: Mean age was 67.8 ± 12.4 years and 54.5% were males. Mean length of stay was 12.3 ± 16 days and mean total overall cost was S$6,783. Ward costs accounted for 48% of total cost. Length of stay strongly correlated to total cost. Being discharged to step-down facilities, death, receiving inpatient rehabilitation and length of stay significantly incurred higher total cost in multivariate analysis. However, there was an inverse relationship between age and total cost, possibly as a result of higher costs incurred for radiological, laboratory investigations and expert care. Conclusion: Further research is needed to examine factors influencing the cost of treatment particularly for those being discharged to step-down facilities and receiving inpatient rehabilitation as they have been found to incur higher total cost. This would impact on the planning of the continuum of healthcare facilities for stroke management.
Should Chemotherapy Be Administered for Essential Thrombocythemia (ET) Patients with Leukemic Transformation?
Authors: Wong Gee Chuan 
Published: July 2015

Introduction: Essential Thrombocythemia (ET) is a clonal myeloproliferative disease presenting predominantly with thrombocytosis. One of its rare complications is leukemic transformation (LT). Once leukemic transformation occurs, prognosis is dismal. We aim to determine the disease profile of LT in our ET patients and evaluate if chemotherapy can alter prognosis. Methods: Clinical data of all patients diagnosed and treated with ET from 1999 to 2008 in the Department of Hematology, Singapore General Hospital, were captured in the Myeloproliferative Disease(MPD) Registry. ET patients with LT were selected. Patient characteristics, disease profile, including ET treatment, duration from ET diagnosis to LT, prior myelofibrosis (MF) history, type of chemotherapy, response and eventual survival were recorded. Results: Two hundred and thirty ET patients were diagnosed and treated from 1999 to 2008. Six patients had LT (2.6%). All were Chinese. Four were females. Age range was 47–70 years (mean 61.2 years). Transformation to acute myeloid leukemia (AML) was seen in 5 patients, after a latency period of 3–28 years. Acute biphenotypic leukemia was diagnosed in 1 patient 4 years after ET diagnosis. All patients had received hydroxyurea. There was no prior evolution to MF. Complex cytogenetics were seen in all cases. Three patients treated conservatively died within 1 month. The other 3 patients did not go into durable complete remission despite chemotherapy and succumbed within 9 months. Conclusions: Leukemic transformation in ET, though rare, is associated with grave prognosis. Outcome with chemotherapy is dismal. More studies are needed to evaluate if alternative treatment can improve survival.
Do We Have the Right Prognostic Index for Diffuse Large B Cell Lymphoma (DLBCL) in the Era of Rituximab?
Authors: Tai WM , Tang PL , Koo YX , Hou X , Tay KW , Quek R , Tao M , Lim ST 
Published: July 2015

Introduction: Whilst the addition of rituximab, a humanized monoclonal antibody to standard CHOP chemotherapy (R-CHOP) has improved the outcomes of DLBCL, the validity of the previously identified prognostic index based on clinical parameters is questioned. It is conceivable that prognostic model may alter with introduction of new therapeutics with differing efficacy and mechanisms of action. Methods: We conducted a retrospective analysis comparing the relevance of International Prognostic Index (IPI), Age-adjusted IPI and Revised International Prognostic Index (R-IPI) in 320 consecutive patients with DLBCL from 2003–2008 treated with R-CHOP chemotherapy with curative intent. We evaluated the prognostic factors determinant of survival in our group of patients. Results: Patients were followed up for a median of 2.70 years. IPI was only able to stratify patients into 3 main risk groups instead of 4. In addition, among patients <60, aa-IPI no longer seem a robust prognostic model. We showed that R-IPI was able to separate patients into 3 different prognostic groups and perhaps most relevant in the era of chemo-immunotherapy. Significant prognostic factors identified in multivariate analysis were performance status (P=0.004) and bone marrow involvement (P=0.026). Conclusion: The most robust prognostic index for patients with DLBCL in the era of rituximab remains uncertain. Incorporation of molecular markers into clinical parameters should be evaluated, a study we are embarking on.