bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-sectional study of glucose regulation in young adults with very low birth weight: impact of male gender on hyperglycaemia
Authors: Sato Ryosuke , Watanabe Hiroshi , Shirai Kenji , Ohki Shigeru , Genma Rieko , Morita Hiroshi , Inoue Eisuke , Takeuchi Masahiro , Maekawa Masato , Nakamura Hirotoshi 
Published: February 2012

ObjectivesTo investigate glucose regulation in young adults with very low birth weight (VLBW; <1500 g) in an Asian population.DesignCross-sectional observational study.SettingA general hospital in Hamamatsu, Japan.Participants111 young adults (42 men and 69 women; aged 19–30 years) born with VLBW between 1980 and 1990. Participants underwent standard 75 g oral glucose tolerance test (OGTT).Primary and secondary outcome measuresThe primary outcomes were glucose and insulin levels during OGTT and risk factors for a category of hyperglycaemia defined as follows: diabetes mellitus, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and non-diabetes/IGT/IFG with elevated 1 h glucose levels (>8.6 mmol/l). The secondary outcomes were the pancreatic β cell function (insulinogenic index and homeostasis model of assessment for beta cell (HOMA-β)) and insulin resistance (homeostasis model of assessment for insulin resistance (HOMA-IR)).ResultsOf 111 young adults with VLBW, 21 subjects (19%) had hyperglycaemia: one had type 2 diabetes, six had IGT, one had IFG and 13 had non-diabetes/IGT/IFG with elevated 1 h glucose levels. In logistic regression analysis, male gender was an independent risk factor associated with hyperglycaemia (OR 3.34, 95% CI 1.08 to 10.3, p=0.036). Male subjects had significantly higher levels of glucose and lower levels of insulin during OGTT than female subjects (p<0.001 for glucose and p=0.005 for insulin by repeated measures analysis of variance). Pancreatic β cell function was lower in men (insulinogenic index: p=0.002; HOMA-β: p=0.001), although no gender difference was found in insulin resistance (HOMA-IR: p=0.477). In male subjects, logistic regression analysis showed that small for gestational age was an independent risk factor associated with hyperglycaemia (OR 33.3, 95% CI 1.67 to 662.6, p=0.022).Conclusions19% of individuals with VLBW already had hyperglycaemia in young adulthood, and male gender was a significant independent risk factor of hyperglycaemia. In male young adults with VLBW, small for gestational age was associated with hyperglycaemia.
Emergency and surgery services of primary hospitals in the United Republic of Tanzania
Authors: Penoyar Tom , Cohen Hillary , Kibatala P , Magoda A , Saguti G , Noel L , Groth S , Mwakyusa D H , Cherian M 
Published: February 2012

ObjectiveThe primary objective was to evaluate the capacity of first-referral health facilities in Tanzania to perform basic surgical procedures. The intent was to assist in planning strategies for universal access to life-saving and disability-preventing surgical services.DesignCross-sectional survey.SettingFirst-referral health facilities in the United Republic of Tanzania.Participants48 health facilities.MeasuresThe WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was employed to capture a health facility's capacity to perform basic surgical (including obstetrics and trauma) and anaesthesia interventions by investigating four categories of data: infrastructure, human resources, interventions available and equipment. The tool queried the availability of eight types of care providers, 35 surgical interventions and 67 items of equipment.ResultsThe 48 facilities surveyed served 18.6 million residents (46% of the population). Supplies for basic airway management were inconsistently available. Only 42% had consistent access to oxygen, and only six functioning pulse oximeters were located in all facilities surveyed. 37.5% of facilities reported both consistent running water and electricity. While very basic interventions (suturing, wound debridement, incision and drainage) were provided in nearly all facilities, more advanced life-saving procedures including chest tube thoracostomy (30/48), open fracture management (29/48) and caesarean section delivery (32/48) were not consistently available.ConclusionsBased on the results in this WHO country survey, significant gaps exist in the capacity for emergency and essential surgical services in Tanzania including deficits in human resources, essential equipment and infrastructure. The information in this survey will provide a foundation for evidence-based decisions in country-level policy regarding the allocation of resources and provision of emergency and essential surgical services.
Short sleep and obesity in a large national cohort of Thai adults
Authors: Yiengprugsawan Vasoontara , Banwell Cathy , Seubsman Sam-ang , Sleigh Adrian C ,   Thai Cohort Study Team
Published: February 2012

ObjectiveTo investigate the relationship between short sleep and obesity among Thai adults.DesignBoth 4-year longitudinal and cross-sectional analyses of a large national cohort.SettingThai adults residing nationwide from 2005 to 2009.ParticipantsCohort members were enrolled as distance learners at Sukhothai Thammathirat Open University (N=87 134 in 2005 and 60 569 at 2009 follow-up). At 2005 baseline, 95% were between 20 and 49 years of age.MeasuresSelf-reported sleep duration was categorised as <6, 6, 7, 8 and ≥9 h. For all analyses (2005 and 2009 cross-sectional and 2005–2009 longitudinal), we used multinomial logistic regression models to assess the effect of sleep duration on abnormal body size (underweight, overweight-at-risk, obese). Results were adjusted for an array of relevant covariates.ResultsAt the last cohort follow-up in 2009, cross-sectional associations linked short sleep (<6 h) and obesity: adjusted ORs (AOR) =1.49, 95% CIs 1.32 to 1.68 for women and AOR=1.36, 95% CI 1.21 to 1.52 for men. The earlier cross-sectional baseline results in 2005 were quite similar. Longitudinal analysis (2005–2009) of 4-year incremental weight gain (5 to <10%, 10 to <20% and 20%+) strongly supported the short sleep–obesity relationship (significant AORs of 1.10, 1.30 and 1.69, respectively).ConclusionsThe results are internally consistent (2005 and 2009) and longitudinally confirmatory of a short sleep effect on obesity among Thai adults. Further research is needed to elucidate causal mechanisms underlying the sleep–obesity relationship.
Lifestyle counselling targeting infant's mother during the child's first year and offspring weight development until 4 years of age: a follow-up study of a cluster RCT
Authors: Mustila Taina , Raitanen Jani , Keskinen Päivi , Saari Antti , Luoto Riitta 
Published: February 2012

ObjectiveTo investigate the effect of intensified lifestyle counselling targeting infants' mothers on offspring weight development during the first 4 years of life.Design and settingFollow-up of a cluster-randomised controlled trial in primary care child health clinics during 2004–2006 in Finland. Participants received a follow-up survey during 2010 concerning weight and height measurements of their offspring. Number of clusters was six and the response rate to the follow-up 71.9% (N=64/89).ParticipantsThe participants (N=89) were mothers of infants aged 2–10 months.InterventionThe intervention included individual counselling on diet and physical activity when the infant was 2–10 months of age and an option to attend supervised group exercise sessions.Primary and secondary outcome measuresThe authors analysed the secondary outcome of the intervention study: the weight development of the offspring. The primary outcome was the proportion of women returning to their prepregnancy weight by 10 months post partum, reported earlier.ResultsMultilevel mixed effect non-linear regression models included group, age of the child and interaction between group and age of the child. The increase of BMI z-score between 24 and 48 months was slower among the intervention group offspring (−0.034 to −0.002, p=0.028) as compared with control group. Z-scores for weight-for-length/height did not differ between groups when the period 0–48 months was analysed (p=0.23) but for the period of 24–48 months, between-group differences were significant (p=0.012).ConclusionsLifestyle counselling targeting mothers during the child's first year may be effective in slowing offspring weight gain until 4 years of age. However, larger studies are needed to confirm the findings which may have the potential in combatting the obesity epidemic.Trial registration numberCurrent Controlled TrialsISRCTN21512277.
A prospective follow-up study of the association of radiation exposure with fatal and non-fatal stroke among atomic bomb survivors in Hiroshima and Nagasaki (1980–2003)
Authors: Takahashi Ikuno , Abbott Robert D , Ohshita Tomohiko , Takahashi Tetsuya , Ozasa Kotaro , Akahoshi Masazumi , Fujiwara Saeko , Kodama Kazunori , Matsumoto Masayasu 
Published: February 2012

ObjectiveUse of medical radiotherapy has increased markedly in recent decades. Whether the consequence includes an increased risk of cardiovascular disease remains to be determined. The purpose of this study was to examine the association between radiation exposure and the incidence of stroke among Japanese atomic bomb survivors.DesignA prospective follow-up study.Setting and participantsRadiation exposure from the atomic bombing was assessed in 9515 subjects (34.8% men) with 24-year follow-up from 1980. Subjects were free of prevalent stroke when follow-up began.Outcome measuresStroke events and the underlying cause of death were reviewed to confirm the first-ever stroke. Subtypes (ischaemic and haemorrhagic events) were categorised based on established criteria according to the definitions of typical/atypical stroke symptoms.ResultsOverall mean radiation dose (±SD) in units of gray (Gy) was 0.38±0.58 (range: 0–3.5). During the study period, 235 haemorrhagic and 607 ischaemic events were identified. For men, after adjusting for age and concomitant risk factors, the risk of haemorrhagic stroke rose consistently from 11.6 to 29.1 per 10 000 person-years as doses increased from <0.05 to ≥2 Gy (p=0.009). Incidence also rose within the dose range <1 Gy (p=0.004) with no dose threshold. In women, the risk of haemorrhagic stroke rose with increasing radiation exposure but not until doses reached a threshold of 1.3 Gy (95% CI 0.5 to 2.3). Among women, for doses <1.3 Gy, differences in stroke risk were modest (13.5 per 10 000 person-years), while it increased to 20.3 per 10 000 person-years for doses that ranged from 1.3 to <2.2 Gy and to 48.6 per 10 000 person-years for doses that were higher (p=0.002). In both sexes, dose was unrelated to ischaemic stroke.ConclusionWhile the risk of haemorrhagic stroke increases with rising radiation exposure for both sexes, effects in women are less apparent until doses exceed a threshold at 1.3 Gy.
Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q
Authors: Vaucher Paul , Bischoff Thomas , Diserens Esther-Amélie , Herzig Lilli , Meystre-Agustoni Giovanna , Panese Francesco , Favrat Bernard , Sass Catherine , Bodenmann Patrick 
Published: February 2012

ObjectivesAdvances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level.MethodsWe identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty.ResultsDeprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (rs=−0.539).ConclusionThe DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.
Evaluating the travel, physical activity and carbon impacts of a ‘natural experiment’ in the provision of new walking and cycling infrastructure: methods for the core module of the iConnect study
Authors: Ogilvie David , Bull Fiona , Cooper Ashley , Rutter Harry , Adams Emma , Brand Christian , Ghali Karen , Jones Tim , Mutrie Nanette , Powell Jane , Preston John , Sahlqvist Shannon , Song Yena 
Published: February 2012

IntroductionImproving infrastructure to support walking and cycling is often regarded as fundamental to encouraging their widespread uptake. However, there is little evidence that specific provision of this kind has led to a significant increase in walking or cycling in practice, let alone wider impacts such as changes in overall physical activity or carbon emissions. Connect2 is a major new project that aims to promote walking and cycling in the UK by improving local pedestrian and cycle routes. It therefore provides a useful opportunity to contribute new evidence in this field by means of a natural experimental study.Methods and analysisiConnect is an independent study that aims to integrate the perspectives of public health and transport research on the measurement and evaluation of the travel, physical activity and carbon impacts of the Connect2 programme. In this paper, the authors report the study design and methods for the iConnect core module. This comprised a cohort study of residents living within 5 km of three case study Connect2 projects in Cardiff, Kenilworth and Southampton, supported by a programme of qualitative interviews with key informants about the projects. Participants were asked to complete postal questionnaires, repeated before and after the opening of the new infrastructure, which collected data on demographic and socioeconomic characteristics, travel, car fuel purchasing and physical activity, and potential psychosocial and environmental correlates and mediators of those behaviours. In the absence of suitable no-intervention control groups, the study design drew on heterogeneity in exposure both within and between case study samples to provide for a counterfactual.Ethics and disseminationThe study was approved by the University of Southampton Research Ethics Committee. The findings will be disseminated through academic presentations, peer-reviewed publications and the study website (http://www.iconnect.ac.uk) and by means of a national seminar at the end of the study.
Emergency department management of undifferentiated abdominal pain with hyoscine butylbromide and paracetamol: a randomised control trial
Authors: Remington-Hobbs Jennifer , Petts Gemma , Harris Tim 
Published: February 2012

ObjectiveTo compare the effectiveness of paracetamol, hyoscine butylbromide and the combination of paracetamol plus hyoscine butylbromide (paracetamol + hyoscine butylbromide) in the management of patients with acute undifferentiated abdominal pain attending the emergency department (ED).SettingA large teaching hospital with an annual ED census of 120 000 adult patients.MethodsA prospective, randomised placebo controlled trial of a convenience sample of patients attending the ED. The trial compared the analgesic effect of intravenous hyoscine butylbromide, oral paracetamol and the combination of both drugs using a Visual Analogue Scale pain scoring tool. Rescue analgesia was administered when pain was inadequately controlled by trial medication.Results132 patients were recruited to the trial. At 30 min, all analgesic combinations produced significant similar levels of pain relief. At 60 min after administration of the trial medication, mean reductions in pain scores for patients receiving paracetamol only were significantly greater than those receiving paracetamol + hyoscine butylbromide (ANCOVA model, p=0.0180). No relationship was seen between treatment arm and the need for rescue analgesia (χ2, p value=0.846).ConclusionThe trial data suggest that oral paracetamol is at least as effective as intravenous hyoscine butylbromide and a combination of both drugs in the management of acute undifferentiated abdominal pain presenting to the ED. Based on these results and factors such as cost and tolerability, we recommend single agent paracetamol as the agent of choice for the management of acute mild to moderate undifferentiated abdominal pain.Trial registration numberMHRA Ref: 19717/0226/001-0001; European Clinical Trials Database. EUDRAct No: 2006-005395-40.
Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department
Authors: Santos I S , Benseñor I M , Machado J B A , Fedeli L M G , Lotufo P A 
Published: February 2012

IntroductionC-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality.ObjectiveTo determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED.MethodsData regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010.ResultsFrom 2007 to 2009, there were 11 786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests.DiscussionInexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.
Sensitivity of Gram stain in the diagnosis of urethritis in men
Authors: Orellana Mª Angeles , Gómez-Lus Mª Luisa , Lora David 
Published: February 2012

BackgroundAcute urethritis is among the most common types of sexually transmitted diseases in men. The diagnosis usually requires microscopic evidence of urethritis, but sometimes urethral pathogens are detected in asymptomatic men without such evidence. The aims of this study were to assess the sensitivity of Gram stain in men with urethral symptoms and to relate it to the microorganisms isolated.MethodsBetween January 2006 and December 2007, 491 urethral samples were analysed. The authors assessed the presence of leukocytes by Gram stain and tested specifically forChlamydiatrachomatis,Ureaplasma urealyticum,Mycoplasma hominisandTrichomonas vaginalis, as well as analysing the results of conventional culture.ResultsThe percentages of positive samples as a function of Gram category were two or less polymorphonuclear leukocytes (PMNLs)/high-power field (HPF) 25% (92/364), three to four PMNLs/HPF 32% (18/57) and five or more PMNLs/HPF 54% (38/70). Classing samples with more than two PMNLs/HPF as positive, the sensitivity, specificity and positive likelihood ratio for Gram stain were 38% (95% CI 30 to 46), 79% (95% CI 75 to 84) and 1.8 (95% CI 1.4 to 2.4), respectively. On the other hand, taking as positive five or more PMNLs/HPF, the sensitivity, specificity and positive likelihood ratio for Gram stain were 26% (95% CI 18 to 33), 91% (95% CI 87 to 94) and 2.7 (95% CI 1.8 to 4.2), respectively. The sensitivity of Gram stain toNeisseria gonorrhoeae,Chlamydia trachomatisandUreaplasma urealyticumwere 80% (95% CI 64 to 96), 23% (95% CI 8 to 39) and 11% (95% CI 2 to 20), respectively.ConclusionThe low sensitivity of Gram stain means that negative results do not exclude the presence of urethritis in symptomatic patients.
The Dark Side of Mast Cell–Targeted Therapy in Prostate Cancer
Authors: Pittoni Paola , Colombo Mario Paolo 
Published: February 2012

Abstract
Tumor development requires accomplices among white blood cells. Other than macrophages, mast cells have been observed to support the outgrowth of certain neoplasias because of their proangiogenic properties. In some tumor settings, however, mast cells may have a protective role, exerted by their proinflammatory mediators. In prostate cancer, no conclusive data on mast cell function were available. Here, we discuss recent work on the role of mast cells in mouse and human prostate cancer, showing that mast cells can behave alternatively as dangerous promoters, innocent bystanders, or essential guardians of tumors, according to the stage and origin of transformed cells. In particular, mast cells are essential for the outgrowth of early-stage tumors due to their matrix metalloproteinase–9 production, become dispensable in advanced-stage, post–epithelial-to-mesenchymal transition, and are protective against neuroendocrine prostate tumor variants. The common expression of c-Kit by mast cells and neuroendocrine clones suggests a possible competition for the ligand Stem cell factor and offers the chance of curing early-stage disease while preventing neuroendocrine tumors using c-Kit–targeted therapy. This review discusses the implications of these findings on the advocated mast cell–targeted cancer therapy and considers future directions in the study of mast cells and their interactions with other c-Kit–expressing cells. Cancer Res; 72(4); 831–5. ©2012 AACR.