bluuebunny/crossref_metadata_2025_split huggingface dataset:
Where to buy OTC medications? A cross-sectional survey investigating consumers’ confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers
Authors: Brabers A E M , Van Dijk L , Bouvy M L , De Jong J D 
Published: September 2013

ObjectiveTo examine consumers’ confidence in their own, and also in other people's, over-the-counter (OTC) skills and to describe their attitude towards the availability of OTC painkillers. Moreover we examined the association between confidence in OTC skills and attitudes.DesignCross-sectional survey. Mixed methods (postal and electronic) self-administered questionnaire.ParticipantsMembers of the Dutch Health Care Consumer Panel.Main outcome measuresConsumers’ confidence in their own, and in other people's, OTC skills was examined. Confidence was measured by three questions regarding obtaining information on, choosing and using OTC medication. Consumers’ attitudes towards availability were assessed using six safety profiles, by asking which channel consumers prefer for each profile.ResultsThe response rate was 68% (n=972). Consumers feel confident about their own OTC skills (mean 3.74; 95% CI 3.69 to 3.79, on a 5-point Likert scale), but have less confidence in OTC skills of others (mean 2.92; 95% CI 2.88 to 2.96). Consumers are conservative in their attitudes towards the availability of OTC painkillers. Most consumers prefer painkillers to be available exclusively in pharmacies (41–71% per profile indicated pharmacy only). Moreover, there is an association between confidence in OTC skills and attitudes (p=0.005; β=−0.114). Consumers who are more confident about their own OTC skills prefer OTC painkillers to be more generally available.ConclusionsConsumers feel confident about their own OTC skills. However, they would prefer painkillers with safety profiles resembling those currently available OTC, to be available as OTC in pharmacies exclusively. Consumers’ confidence in the OTC skills of others is more consistent with their attitudes towards availability of OTC painkillers. Until consumers themselves realise that they are also one of the others, they may overestimate their own OTC skills, which may entail health risks.
Impact on cardiovascular risk follow-up from a shift to the CKD-EPI formula for eGFR reporting: a cross-sectional population-based primary care study
Authors: van Gelder Vincent A , Scherpbier-de Haan Nynke D , de Grauw Wim J C , O'Callaghan Christopher A , Wetzels Jack F M , Lasserson Daniel S 
Published: September 2013

ObjectiveTo assess the impact on cardiovascular risk factor management in primary care by the introduction of chronic kidney disease epidemiological collaboration (CKD-EPI) for estimated-glomerular filtration rate (eGFR) reporting.Design and settingCross-sectional study of routine healthcare provision in 47 primary care practices in The Netherlands with Modification of Diet and Renal Disease Study eGFR reporting.MethodseGFR values were recalculated using CKD-EPI in patients with available creatine tests. Patients reclassified from CKD stage 3a to CKD stage 2 eGFR range were compared to those who remained in stage 3a for differences in demographic variables, blood pressure, comorbidity, medication usage and laboratory results.ResultsAmong the 60 673 adult patients (37% of adult population) with creatine values, applying the CKD-EPI equation resulted in a 16% net reduction in patients with CKD stage 3 or worse. Patients reclassified from stage 3a to 2 had lower systolic blood pressure (139.7 vs 143.3 mm Hg p<0.0001), higher diastolic blood pressure (81.5 vs 78.4 mm Hg p<0.0001) and higher cholesterol (5.4 vs 5.1 mmol/L p<0.0001) compared to those who remained in stage 3a. Of those reclassified out of a CKD diagnosis 463 (32%) had no comorbidities that would qualify for annual CVD risk factor assessment and 20 (12% of those with sufficient data) had a EuroSCORE CVD risk >20% within 10 years.ConclusionsUse of the CKD-EPI equation will result in many patients being removed from CKD registers and the associated follow-up. Current risk factor assessment in this group may be lacking from routine data and some patients within this group are at an increased risk for cardiovascular events.
Critical care paramedics: where is the evidence? a systematic review
Authors: von Vopelius-Feldt Johannes , Wood John , Benger Jonathan 
Published: September 2013

ObjectivesParamedic-delivered prehospital critical care is an established concept in a number of emergency medical services around the world and, more recently, has been introduced to the UK. This review identifies and describes the available evidence relating to paramedics who routinely provide prehospital critical care as primary scene response (critical care paramedics, or CCP).MethodsA systematic search of electronic databases was performed: CENTRAL, EMBASE, MEDLINE (through EMBASE and Web of Knowledge) and Web of Science (through Web of Knowledge).ResultsThe search identified 12 relevant publications, one of which was a randomised controlled trial. The remaining 11 were retrospective studies. Five studies compared CCPs with physician-led care. Three of these publications demonstrated improved outcomes with physician care, while two showed no difference. Four further publications examined CCPs versus non-physician-led care and found improved outcomes (two studies), mixed effects (one study) and no difference (one study) for CCPs. Finally, three publications addressed the addition of skills to CCP competencies. A randomised controlled trial of CCP rapid sequence induction (RSI) and tracheal intubation demonstrated improved neurologic outcomes. CCP tube thoracostomy was shown to have similar complication rates to the same procedure performed in the emergency department, while addition of a non-invasive ventilation protocol to CCP practice had no effect on long-term mortality.ConclusionsThere is limited evidence to support the concept of paramedic-delivered prehospital critical care. The best available evidence suggests a benefit from prehospital RSI carried out by CCPs in patients with severe traumatic brain injury, but the impact of CCPs remains unclear for many conditions. Further high-quality research in this area would be welcome.
Is the ATLS classification of hypovolaemic shock appreciated in daily trauma care? An online-survey among 383 ATLS course directors and instructors
Authors: Mutschler Manuel , Hoffmann Marzellus , Wölfl Christoph , Münzberg Matthias , Schipper Inger , Paffrath Thomas , Bouillon Bertil , Maegele Marc 
Published: September 2013

ObjectiveFor the early recognition and management of hypovolaemic shock, ATLS suggests four shock classes based upon an estimated blood loss in percent. The aim of this study was to assess the confidence and acceptance of the ATLS classification of hypovolaemic shock among ATLS course directors and instructors in daily trauma care.MethodsDuring a 2-month period, ATLS course directors and instructors from the ATLS region XV (Europe) were invited to participate in an online survey comprising 15 questions.ResultsA total of 383 responses were received. Ninety-eight percent declared that they would follow the ‘A, B, C, D, E’ approach by ATLS in daily trauma care. However, only 48% assessed ‘C-Circulation’ according to the ATLS classification of hypovolaemic shock. One out of four respondents estimated that in daily clinical routine, less than 50% of all trauma patients can be classified according to the current ATLS classification of hypovolaemic shock. Additionally, only 10.9% considered the ATLS classification of hypovolaemic shock as a ‘good guide’ for fluid resuscitation and blood product transfusion, whereas 45.1% stated that this classification only ‘may help’ or has ‘no impact’ to guide resuscitation strategies.ConclusionsAlthough the ‘A, B, C, D, E’ approach according to ATLS is widely implemented in daily trauma care, the use of the ATLS classification of hypovolaemic shock in daily practice is limited. Together with previous analyses, this study supports the need for a critical reassessment of the current ATLS classification of hypovolaemic shock.
Diagnosing paediatric myocarditis: what really matters
Authors: Chong Shu-Ling , Bautista Dianne , Ang Angelina Su-Yin 
Published: September 2013

ObjectivePaediatric myocarditis has remained a diagnostic challenge. We aim to identify distinct characteristics and derive a scoring system that will trigger further investigations to be performed among paediatric patients presenting to the emergency department (ED) with clinically suspected myocarditis.DesignWe performed an age-matched case-control study of children seen in a large tertiary institution. Cases and controls were patients less than 16 years’ old who presented to the ED over a 10-year period from Jan 2001 to Dec 2010. Cases were identified with a final discharge or postmortem diagnosis of acute myocarditis. Controls were those who presented to the ED in the same period and were initially diagnosed with acute myocarditis, but who were later found to have other diagnoses. We compared their vital signs, presenting symptoms, physical examination findings, electrocardiogram and chest radiograph findings.ResultsBased on domain-specific stepwise conditional logistic regression analyses, five characteristics were found to be potentially discriminating: respiratory distress, poor perfusion, hypotension, an abnormal chest radiograph and any electrocardiogram abnormalities. Satisfactory discrimination was attained using these five parameters. The estimated area under receiver operating characteristic curve was 90% (95% CI 0.83 to 0.97). A cut-off score of 3 would give a positive likelihood ratio of 13 (95% CI 3.31 to 51.06) and a negative likelihood ratio of 0.35 (95% CI 0.22 to 0.55).ConclusionsA cut-off risk score of 3, though not yet validated, may be potentially useful in future to trigger further investigations for children with suspected myocarditis. It allows for the appropriate use of resources, while minimising on misdiagnosis.
p53 and hepatoma-derived growth factor expression and their clinicopathological association with Ewing family tumour
Authors: Yang Yang , Zhen Tiantian , Zhang Fenfen , Dai Sujuan , Kang Lili , Liang Yingjie , Xue Ling , Han Anjia 
Published: September 2013

PurposeTo investigate p53 and hepatoma-derived growth factor (HDGF) expression and their association with clinicopathological features of Ewing family tumour (EFT).Experimental designA total of 108 cases of EFT were retrospectively analysed. p53 and HDGF expression were detected using immunohistochemistry, and the relationships between p53 expression and HDGF expression and clinicopathological features of EFT were analysed. Kaplan–Meier curves were applied to estimate overall survival, log-rank test was used to assess prognostic relevance of p53 expression with overall survival and Cox regression model was performed to evaluate HRs.Resultsp53 expression and high HDGF expression was found in 17 (15.7%) and 55 (50.9%) patients, respectively. p53 expression was significantly associated with metastatic stage at initial diagnosis (p=0.007) and tumour venous/nerve invasion (p=0.023). A significant positive correlation was found between p53 expression and HDGF expression in EFT (p=0.022). p53 expression was an independent prognostic factor for overall survival of patients with EFT (p<0.001). Patients with p53-positive/high HDGF expression had a significantly shorter overall survival than those with p53-positive/low HDGF expression or p53-negative/high HDGF expression or p53-negative/low HDGF expression. We first constructed a novel molecular staging system by combining p53 expression and HDGF expression, which significantly improved prognostic stratification for patients with EFT.Conclusionsp53 expression was an independent prognostic factor for patients with EFT. Combining p53 expression and HDGF expression significantly improved prognostic stratification for patients with EFT.
Neighbourhood economic deprivation explains racial/ethnic disparities in overweight and obesity among children and adolescents in the USA
Authors: Rossen Lauren M 
Published: September 2013

BackgroundLow-income and some racial and ethnic subpopulations are more likely to suffer from obesity. Inequities in the physical and social environment may contribute to disparities in paediatric obesity, but there is little empirical evidence to date. This study explored whether neighbourhood-level socioeconomic factors attenuate racial and ethnic disparities in obesity among youth in the USA and whether individual-level socioeconomic status (SES) interacts with neighbourhood deprivation.MethodsThis analysis used data from 17 100 youth ages 2–18 years participating in the 2001–2010 National Health and Nutrition Examination Survey linked to census tract-level socioeconomic characteristics. Multilevel logistic regression models were used to examine neighbourhood deprivation in association with odds of obesity (age-specific and sex-specific body mass index percentile ≥95).ResultsThe unadjusted prevalence of obesity was 15% among non-Hispanic white children and 21% among non-Hispanic black and Mexican-American children. Adjustment for individual-level SES neighbourhood deprivation and the interaction between these two factors resulted in a 74% attenuation of the disparity in obesity between non-Hispanic black and non-Hispanic white children and a 49% attenuation of the disparity between Mexican-American and non-Hispanic white children. There was a significant interaction between individual-level SES and neighbourhood deprivation where higher individual-level income was protective for children living in low-deprivation neighbourhoods, but not for children who lived in high-deprivation areas. Conversely, area deprivation was associated with higher odds of obesity, but only among children who were above the poverty threshold.ConclusionsFuture research on disparities in obesity and other health outcomes should examine broader contextual factors and social determinants of inequities.
Calculated phase equilibria for phengite-bearing eclogites from NW Spitsbergen, Svalbard Caledonides
Authors: Elvevold Synnøve , Ravna Erling J. K. , Nasipuri Pritam , Labrousse Loic 
Published: September 2013

Abstract

Phengite-bearing eclogites occur in the Richarddalen Complex of NW Spitsbergen, Arctic Caledonides. Phase equilibrium modelling and conventional geothermobarometry have been used to constrain the metamorphic evolution of these eclogites. Pseudosections are calculated for the peak-pressure assemblage garnet+omphacite+phengite+amphibole+dolomite quartz+rutile. Compositional isopleths for garnet and phengite constrain the pressure–temperature (
P–T
) conditions to 1.9–2.0 GPa and 720–730 °C, in good agreement with the results obtained from conventional thermobarometry (720–740 °C and 2.4–2.5 GPa). Further
P–T
pseudosection modelling of clinopyroxene+plagioclase±amphibole±clinozoisite symplectites after omphacite suggests that decompression to
c.
1.2 GPa occurred along a steep exhumation path. The eclogite-bearing Richarddalen Complex constitutes the uppermost unit of a simple stack of thrust sheets where the metamorphic grade is increasing structurally upwards in the pile. Thrusting is the favoured uplift mechanism for the initial syn-orogenic exhumation to lower crustal levels. Constrictional north–south stretching in a transpressional regime is interpreted to be responsible for the final exhumation of the assembled stack of thrust sheets. Late Silurian–Early Devonian conglomerates were deposited directly on the eclogite-bearing gneisses of the Richarddalen Complex, and mark the end of exhumation of the nappe stack.
Chk1 Targeting Reactivates PP2A Tumor Suppressor Activity in Cancer Cells
Authors: Khanna Anchit , Kauko Otto , Böckelman Camilla , Laine Anni , Schreck Ilona , Partanen Johanna I. , Szwajda Agnieszka , Bormann Stefanie , Bilgen Turker , Helenius Merja , Pokharel Yuba R. , Pimanda John , Russel Mike R. , Haglund Caj , Cole Kristina A. , Klefström Juha , Aittokallio Tero , Weiss Carsten , Ristimäki Ari , Visakorpi Tapio , Westermarck Jukka 
Published: September 2013

AbstractCheckpoint kinase Chk1 is constitutively active in many cancer cell types and new generation Chk1 inhibitors show marked antitumor activity as single agents. Here we present a hitherto unrecognized mechanism that contributes to the response of cancer cells to Chk1-targeted therapy. Inhibiting chronic Chk1 activity in cancer cells induced the tumor suppressor activity of protein phosphatase protein phosphatase 2A (PP2A), which by dephosphorylating MYC serine 62, inhibited MYC activity and impaired cancer cell survival. Mechanistic investigations revealed that Chk1 inhibition activated PP2A by decreasing the transcription of cancerous inhibitor of PP2A (CIP2A), a chief inhibitor of PP2A activity. Inhibition of cancer cell clonogenicity by Chk1 inhibition could be rescued in vitro either by exogenous expression of CIP2A or by blocking the CIP2A-regulated PP2A complex. Chk1-mediated CIP2A regulation was extended in tumor models dependent on either Chk1 or CIP2A. The clinical relevance of CIP2A as a Chk1 effector protein was validated in several human cancer types, including neuroblastoma, where CIP2A was identified as an NMYC-independent prognostic factor. Because the Chk1–CIP2A–PP2A pathway is driven by DNA-PK activity, functioning regardless of p53 or ATM/ATR status, our results offer explanative power for understanding how Chk1 inhibitors mediate single-agent anticancer efficacy. Furthermore, they define CIP2A-PP2A status in cancer cells as a pharmacodynamic marker for their response to Chk1-targeted therapy. Cancer Res; 73(22); 6757–69. ©2013 AACR.
C-Reactive Protein, Fatal and Nonfatal Coronary Artery Disease, Stroke, and Peripheral Artery Disease in the Prospective EPIC-Norfolk Cohort Study
Authors: van Wijk Diederik F. , Boekholdt S. Matthijs , Wareham Nicholas J. , Ahmadi-Abhari Sara , Kastelein John J.P. , Stroes Erik S.G. , Khaw Kay-Tee 
Published: September 2013

Objective—
Circulating levels of C-reactive protein (CRP) are associated with an increased risk of coronary artery disease (CAD), stroke, and peripheral artery disease (PAD). Observational and experimental evidence suggest that CRP might differentially predict fatal and nonfatal cardiovascular events. Here, we sought to determine the predictive value of CRP for fatal and nonfatal CAD, stroke, or PAD.

Approach and Results—

CRP levels were measured in 18 450 apparently healthy participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort. Cox proportional hazards models were used to quantify the association between CRP levels and fatal and nonfatal CAD events, strokes, and PAD events. Bootstrapping was applied to test for significant differences between the risk of fatal and nonfatal events. During 208 485 person-years at risk, 2915 CAD events, 361 strokes, and 657 PAD events occurred. CRP was associated with fatal and nonfatal CAD events and nonfatal PAD events. When adding CRP to predictive risk models for fatal and nonfatal events corrected for known cardiovascular risk factors, the net reclassification index was 2.1% for fatal and 1.9% for nonfatal events. Multivariate adjusted hazard ratios for fatal CAD events (hazard ratio, 1.36; 95% confidence interval, 1.27–1.46) differed significantly (mean difference, 13%; 95% confidence interval, 5.1%–21.9%;
P
<0.001) from the multivariate adjusted hazard ratio for nonfatal CAD events (hazard ratio, 1.21; 95% confidence interval, 1.15–1.26).

Conclusions—
In the EPIC-Norfolk cohort, CRP was associated with fatal and nonfatal CAD events, as well as nonfatal PAD events. Adding CRP to risk stratification models resulted in a small improvement in classification for both fatal and nonfatal events. Importantly, CRP was significantly more strongly associated with fatal CAD events than with nonfatal CAD events.
Clopidogrel Use Is Associated With an Increased Prevalence of Cerebral Microbleeds in a Stroke‐Free Population: The Rotterdam Study
Authors: Darweesh Sirwan K.L. , Leening Maarten J.G. , Akoudad Saloua , Loth Daan W. , Hofman Albert , Arfan Ikram M. , Vernooij Meike W. , Stricker Bruno H. 
Published: September 2013

Background

Although clopidogrel reduces the incidence of atherothrombotic events, its use is associated with an increased risk of major bleeding. Cerebral microbleeds (
CMB
s) are indicative of subclinical microangiopathy in the brain and may prelude symptomatic intracerebral hemorrhage. We examined the association between use of clopidogrel and
CMB
s in persons without a history of stroke.

Methods and Results

We performed a cross‐sectional analysis using data from the Rotterdam Study, a prospective population‐based cohort of persons aged 45 years and older. Among 4408 stroke‐free individuals who underwent brain magnetic resonance imaging for the detection of
CMB
s, we identified 121 ever‐users and 4287 never‐users of clopidogrel before magnetic resonance imaging. We used multiple logistic regression to analyze the association between clopidogrel and
CMB
s with adjustment for age, sex, cardiovascular risk factors, and common cardiovascular medication. Users of clopidogrel had a higher prevalence of
CMB
s (odd ratio 1.55,
95% CI
1.01 to 2.37) than nonusers and more often had a high number (>4) of
CMB
s (odds ratio 3.19, 95% CI 1.52 to 6.72). Clopidogrel use was associated with a significantly higher prevalence of deep or infratentorial
CMB
s (odd ratio 1.90, 95% CI 1.05 to 3.45). Among clopidogrel users, we were unable to demonstrate differences in the prevalence of
CMB
s by indication of prescription, history of coronary heart disease, or common genetic variants in

CYP
2C19

.

Conclusions

In stroke‐free individuals, clopidogrel use was associated with a higher prevalence and higher number of
CMB
s. Whether this association is causal requires confirmation in prospective studies, especially given the small number of participants taking clopidogrel and the possibility of residual confounding in this study.
Nox2-Derived Superoxide Contributes to Cerebral Vascular Dysfunction in Diet-Induced Obesity
Authors: Lynch Cynthia M. , Kinzenbaw Dale A. , Chen Xunxheng , Zhan Shanshan , Mezzetti Erin , Filosa Jessica , Ergul Adviye , Faulkner Jessica L. , Faraci Frank M. , Didion Sean P. 
Published: September 2013

Background and Purpose—
Obesity is an increasing epidemic worldwide; however, little is known about effects of obesity produced by high-fat diet (HFD) on the cerebral circulation. The purpose of this study was to examine the functional and temporal effects of a HFD on carotid and cerebral vascular function and to identify mechanisms that contribute to such functional alterations.

Methods—

Responses of cerebral arterioles (in vivo) and carotid arteries (in vitro) were examined in C57Bl/6 (wild-type) and Nox2-deficient (
Nox2
−/−
) mice fed a control (10%) or a HFD (45% or 60% kcal of fat) for 8, 12, 30, or 36 weeks.

Results—

In wild-type mice, a HFD produced obesity and endothelial dysfunction by 12 and 36 weeks in cerebral arterioles and carotid arteries, respectively. Endothelial function could be significantly improved with Tempol (a superoxide scavenger) treatment in wild-type mice fed a HFD. Despite producing a similar degree of obesity in both wild-type and
Nox2
−/−
mice, endothelial dysfunction was observed only in wild-type, but not in
Nox2
−/−
, mice fed a HFD.

Conclusions—
Endothelial dysfunction produced by a HFD occurs in a temporal manner and appears much earlier in cerebral arterioles than in carotid arteries. Genetic studies revealed that Nox2-derived superoxide plays a major role in endothelial dysfunction produced by a HFD. Such functional changes may serve to predispose blood vessels to reduced vasodilator responses and thus may contribute to alterations in cerebral blood flow associated with obesity.