bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glucose abnormalities and heart failure predict poor prognosis in the population-based Reykjavik Study
Authors: Thrainsdottir Inga S. , Aspelund Thor , Hardarson Thordur , Malmberg Klas , Sigurdsson Gunnar , Thorgeirsson Gudmundur , Gudnason Vilmundur , Rydén Lars 
Published: October 2005

Background The risk of cardiovascular disease increases progressively with increasing blood glucose from levels well below the diabetic threshold. In the Reykjavik Study the relationship between heart failure and abnormal glucose regulation was already apparent at the level of impaired glucose tolerance. The aim of this study was to determine the prognosis of participants with any glucose abnormality and heart failure and to test whether the combination of these conditions may adversely affect the subsequent prognosis. Design A prospective population-based study. Methods Data from the first visit of 19 381 participants were used. Participants were divided into groups according to their glycaemic and heart failure level, and comparisons were made between the groups and disease-free participants serving as a reference group. The risk of mortality and morbidity was calculated with adjustments for main cardiovascular risk factors and ischaemic heart disease. Results Participants in the reference group were younger, had lower body mass indices and more seldom a history of myocardial infarction compared with diseased groups. Mortality was lowest in the reference group ( P < 0.0001) increasing to a maximum in participants with the combination of glucose abnormality and heart failure. Prognostically, the mortality risk associated with abnormal glucose regulation was increased but was lower than the risk of diabetes. The risk of a new myocardial infarction was highest in participants with diabetes [hazard ratio (HR) 1.6; 95% confidence interval (CI) 1.3-2.0] or diabetes in combination with heart failure (HR 1.8; CI 1.1-2.7). Conclusions Heart failure or glucose abnormalities are related to increased morbidity and mortality. The combination of glucose abnormality and heart failure did, however, not add further to the unfavourable prognosis in the presence of ischaemic heart disease.
Predictive accuracy of the SCORE risk function for cardiovascular disease in clinical practice: a prospective evaluation of 44 649 Austrian men and women
Authors: Ulmer Hanno , Kollerits Barbara , Kelleher Cecily , Diem Günter , Concin Hans 
Published: October 2005

Background In 2003, a new risk function for cardiovascular risk in clinical practice was developed by the SCORE project group. The aim of this paper was to evaluate the predictive accuracy of the SCORE in a large Austrian population. Design A prospective, multicentre, longitudinal linkage project. Methods Using the ‘SCORE risk function for low-risk regions', we calculated the risk of death from cardiovascular and coronary heart disease events over a 10-year period for 44 649 participants aged 40-65 years in the Vorarlberg Health Monitoring and Promotion Programme (VHM&PP). The predicted risks were compared with the 95% confidence intervals (CI) of the observed events. Results We observed a total of 487 deaths (1.1%; 95% CI 1.0-1.2) for all cardiovascular disease within 10 years, 371 (1.8%; 95% CI 1.6-2.0) in men and 116 (0.5%; 95% CI 0.4-0.6) in women. The SCORE function overestimated cardiovascular mortality and predicted 666 (1.5%) events, 444 (2.2%) in men and 222 (0.9%) in women. Receiver operating characteristics analyses revealed area under the curve values of 0.76 (95% CI 0.74-0.79) for men and 0.78 (95% CI 0.74-0.82) for women. Multivariable analyses showed that obesity (in men only) increased levels of glucose, gamma-glutamyl transferase, triglycerides (in women only), and blue-collar job status (in women only) significantly contributed to the SCORE as additional independent risk factors. Conclusion Although the SCORE overpredicted the mortality pattern in the cohort as a whole, its predictive ability at the individual level still demonstrates a potentially widespread utility in clinical practice.
The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality
Authors: Silventoinen Karri , Pankow James , Lindström Jaana , Jousilahti Pekka , Hu Gang , Tuomilehto Jaakko 
Published: October 2005

Background Cardiovascular disease shares several risk factors with type 2 diabetes. We tested whether the Finnish Diabetes Risk Score (FINDRISC), recently developed in a Finnish population to estimate the future risk of diabetes, would also identify individuals at high risk of coronary heart disease (CHD) and stroke, and total mortality in this same population. Design Independent risk factor surveys were conducted in 1987, 1992, and 1997 in Finland, comprising 8268 men and 9457 women aged 25-64 years and free of CHD and stroke at baseline. During the follow-up until the end of 2001, 699 incident acute CHD events, 324 acute stroke events, and 765 deaths occurred. Methods The data were analysed by using receiver operating characteristic (ROC) curves and the Cox-regression model. Results The areas under the ROC curves (AUC) were 71% for CHD, 73% for stroke, and 68% for total mortality in men and 78, 68, and 72% in women, respectively. The addition of systolic and diastolic blood pressures, total and high-density lipoprotein cholesterol, and smoking increased the AUC values modestly (the change of the absolute values from 2.6 to 6.5%), but the additional use of plasma glucose had only a slight effect on the AUC values for CHD and stroke. Conclusions The FINDRISC is a reasonably good predictor of CHD, stroke and total mortality.
Physical performance and physical activity in grown-up congenital heart disease
Authors: Reybrouck Tony , Mertens Luc 
Published: October 2005

Aim To review exercise performance and exercise habits in patients with congenital heart disease (CHD). Background and methods Physical exercise and physical activity has shown beneficial effects on the physical, psychological and social level in adult patients with cardiovascular disease. Favourable effects have also been documented in children with CHD. Exercise testing is preferentially performed on a treadmill in children, with the measurement of gas exchange. Results An overview of the literature showed that formal exercise testing has frequently documented reduced or suboptimal values for aerobic exercise performance in children with left-to-right shunts (atrial septal defect, ventricular septal defect), valvular heart disease and obstructive anomalies (aortic stenosis, pulmonary stenosis, coarctation of the aorta). Subnormal values for exercise tolerance have also been observed in patients with successfully repaired cyanotic heart disease (tetraology of Fallot, transposition of the great arteries, Fontan operation). An important contributing factor to the impaired exercise performance is the hypoactive lifestyle, as often observed in patients with CHD. This frequently results from parental or environmental overprotection. Conclusion These patients should be stimulated to be physically active, unless medical restriction is imposed. Fortunately, this represents only a small fraction of the total number of congenital heart defects for which sports participation is allowed.
A comparison of Framingham and SCORE-based cardiovascular risk estimates in participants of the German National Health Interview and Examination Survey 1998
Authors: Neuhauser Hannelore K. , Ellert Ute , Kurth Bärbel-Maria 
Published: October 2005

Background Overestimation of risk by Framingham risk functions not only in southern but also in northern European populations including Germany, has led to the development of the SCORE risk estimation model. Design Data of the German National Health Interview and Examination Survey 1998 was used to determine whether SCORE leads to lower estimates of the 10-year absolute risk of fatal cardiovascular disease and fatal coronary heart disease than a Framingham model. Predicted numbers of events were compared with approximations based on national mortality statistics. Methods Inclusion criteria followed the recommendations for the use of SCORE: age 30 to 69 years, no previous history of cardiovascular disease and no markedly raised levels of single risk factors (leaving 1811 men and 1955 women for analysis). Results The SCORE model for high-risk regions (SCORE-HIGH, which is recommended for Germany pending calibration with national data) predicted the highest number of events, followed by the estimations with mortality statistics, the Framingham model and SCORE-LOW (87 fatal cardiovascular disease events versus 77, 62 and 47; fatal coronary heart disease events 62 versus 46, 46 and 30). Agreement on high-risk status, defined as the 10-year risk of fatal cardiovascular disease of 5% or higher now or if extrapolated to age 60, was moderate for both men and women (≤ 0.52 and 0.42 for Framingham and SCORE-HIGH). Conclusions Our results suggest that SCORE-HIGH may overestimate absolute risk of fatal coronary heart disease and cardiovascular disease in Germany and may need calibration. Furthermore, the limitations of current risk prediction tools emphasize the ongoing need for comprehensive, high-quality and timely European cohort data.
Exercise as a treatment for depression in elders
Authors: Palmer Carol 
Published: October 2005

PurposeTo describe the use of exercise when treating depression in elders and to discuss the data supporting the relationship between increased physical activity and decreased depression.Data sourcesExtensive review of recent scientific literature, both medical and gerontological in content.ConclusionsIncreasing physical activity markedly reduces depressive symptoms and is a safe adjunct or alternative to medication therapy.Implications for practiceExercise has numerous physical and psychological benefits to patients. Physical activity should be recommended to all patients of all ages.
Recognizing health risks in childhood cancer survivors
Authors: Nelson Mary Baron , Meeske Kathy 
Published: October 2005

PurposeTo provide information about the special health needs of childhood cancer survivors through a discussion of Wilms’ tumor, a common childhood renal tumor, and case studies of two survivors of Wilms’ tumor, who encountered significant health problems as adults. This information may be generalized to many cancer survivors.Data sourcesActual case studies as well as extensive review of the current literature on childhood cancer survivorship.ConclusionsAdult healthcare practitioners may help to decrease morbidity of childhood cancer survivors in adulthood when they are knowledgeable about the risks of this population. Resources are readily available, both in the medical literature and on the Internet.Implications for practiceWith well‐established success in the treatment of childhood cancer, there are many young and middle‐aged adult survivors of the disease. However, as many as two‐thirds of survivors may have chronic long‐term effects of treatment. Most survivors eventually discontinue follow‐up with their pediatric oncologists and receive primary health care from adult providers, many of whom are unaware of survivors’ health risks. Awareness of primary care providers regarding the special health needs of childhood cancer survivors is critical to decrease morbidity and improve quality of life. The ever‐increasing number of childhood cancer survivors is creating a public health issue as they transition into adulthood.
Polypharmacy in the elderly: A literature review
Authors: Fulton Maryann M. , Riley Allen Elizabeth 
Published: October 2005

PurposeTo review the body of literature addressing polypharmacy in individuals aged 60 years and older to (a) determine primary care providers’ definition of polypharmacy, (b) explore how polypharmacy was assessed in primary care, and (c) seek tested interventions that address polypharmacy.Data sourcesA systematic review of electronic bibliographic databases (e.g. EBSCOHost, InfoTrac, OVID, FirstSearch, and FirstSearch Deluxe) utilizing the search terms “polypharmacy,”“polypharmacy and elderly,”“polypharmacy and research,” and “multiple medications” for the period January 1991 to October 2003 was completed. The search was supplemented with online site searches of relevant journals and review of reference lists of each article.ConclusionsResults of the literature review revealed that polypharmacy continues to be a significant issue and little research has been conducted regarding the methods primary care providers utilize to assess polypharmacy. Also, there is a gap in the literature regarding the interventions implemented by primary care providers to address polypharmacy.Implications for practiceThe following definition of polypharmacy in clinical practice might be more practical: the use of medications that are not clinically indicated. Selecting appropriate limits for numbers of medications may be counterproductive in populations with multiple comorbidities.
Primary care needs of patients who have undergone gender reassignment
Authors: Sobralske Mary 
Published: October 2005

PurposeThe purpose of this article is to inform nurse practitioners (NPs) about the primary care needs of patients who have undergone gender reassignment, either by hormone therapy alone or in conjunction with surgery.Data sourcesData sources used were mainly from a review of the literature about gender identity disorder and gender reassignment. Information was also gathered from several leading surgeons on gender reassignment surgical procedures and subsequent clinical considerations.ConclusionsThere is very little written on the primary care clinical ramifications of transsexual patients and how clinicians can adapt their approaches to healthcare delivery to accommodate their special situations.Implications for practiceImplications for practice include how an NP can adapt clinical practice approaches to provide for patients who have undergone gender reassignment. Changes that occur in the transsexual process may warrant noncustomary primary healthcare screening and examination.
Toward a predictive model of patient satisfaction with nurse practitioner care
Authors: Green Ann , Davis Sheila 
Published: October 2005

Purpose(a) To determine if caring behaviors of nurse practitioners (NPs), gender of NPs, setting (urban or rural), and age, gender, ethnicity, education, and income of patients were predictors of patient satisfaction; (b) to determine which of these characteristics was the best predictor(s) of patient satisfaction; and (c) begin to develop a conceptual model for explaining patient satisfaction with NP care.Data sourcesResponses to the Caring Behaviors Inventory (CBI) and a demographic inquiry by 348 NPs in Louisiana and completion of the Di’Tomasso–Willard Patient Satisfaction Questionnaire (DWPSQ) and a demographic inquiry from 817 patients in Louisiana served as data sources. A predictive modeling design explored which variable(s) is the best predictor of patient satisfaction, and multiple regression was used to determine the equation for the best‐fitting line and the optimal model for the best predictor(s) of patient satisfaction.ConclusionsCBI mean scores were high for all NPs. No statistically significant difference was found between male NPs’ and female NPs’ total mean CBI scores and between urban or rural total mean CBI scores. DWPSQ mean scores and subscale scores indicated high satisfaction with NP care. No statistically significant relationships were found between the NPs’ CBI mean scores and the patients’ DWPSQ mean scores. There were significant relationships between the DWPSQ subscales, including Wait Time and Patient Management. Stepwise linear regression revealed that patients’ age group was a predictor of DWPSQ total mean scores.Implications for practiceNPs need to be aware of developmental differences in all age groups and the differences in perceptions of care. There are many variables to consider when determining patient satisfaction with care, including the patients’ sociodemographic and health variables, the healthcare system, and characteristics of the healthcare providers. Awareness of these variables may affect how NPs deliver care and ensure quality care with which the patients are satisfied.
Factors influencing women's decisions to self‐treat vaginal symptoms
Authors: Theroux Rosemary 
Published: October 2005

PurposeTo review the research on women's self‐treatment of vaginal symptoms, describe factors influencing this phenomenon, identify evidence‐based interventions, and suggest strategies for nurse practitioners (NPs) to promote safe and effective self‐treatment decisions by women.Data sourcesResearch articles identified through Medline and CINAHL databases.ConclusionsThe primary factors influencing women's decisions to self‐treat vaginal symptoms were personal (attitudes, beliefs, values, knowledge and experience, and emotions) and environmental (culture, social networks and norms, media, and life context).Implications for practiceWomen's self‐diagnostic skills and decision making for self‐treatment can be improved through education and support from NPs. The traditional office visit may not provide an opportunity to teach women appropriate self‐care because many women do not access providers for advice or information. Different methods of providing information to large numbers of women through consumer publications need to be developed and evaluated.
Exploration of genes showing intramuscular fat deposition‐associated expression changes in musculus longissimus muscle
Authors: Sasaki Y. , Nagai K. , Nagata Y. , Doronbekov K. , Nishimura S. , Yoshioka S. , Fujita T. , Shiga K. , Miyake T. , Taniguchi Y. , Yamada T. 
Published: October 2005

SummaryMarbling, as defined by the amount of intramuscular fat, is an economically important trait in beef cattle. Intramuscular fat deposition is postulated to arise mainly from a series of adipogenic events in intramuscular adipocyte‐lineage cells and in the physiological or anatomical milieux surrounding them. This study was designed to investigate gene‐expression patterns associated with fat deposition in musculus longissimus muscle, including adipocyte‐lineage cells and part of the milieux. Differential‐display PCR (ddPCR) was used to examine expression differences between low‐marbled and high‐marbled steer groups at 8, 10, 12 and 14 months of age, encompassing the time that marbling starts to appear. Seventy‐four of 2114 total bands on ddPCR gel‐bands were significant (P < 0.05) for the group effect, the interaction effect between group and age, or both the group and the interaction effects. Sequence analysis of 72 of these bands revealed 77 genes, including 35 annotated genes and 42 novel sequences. Among the 35 annotated genes, 6 (BTG2, PDHB, SORBS1, TRDN, TTN and MGP) have been related to changes in intramuscular fat deposition, possibly by exerting effects on adipocyte‐lineage cells or on the milieux surrounding them.
Interleukin (IL)-2 and IL-12 responses to Chlamydia trachomatis infection in adolescents
Authors: Wang C , Tang J , Crowley-Nowick P A , Wilson C M , Kaslow R A , Geisler W M 
Published: October 2005

Summary
Chlamydia trachomatis infects epithelial cells at the mucosal surface. While in vitro and animal studies have shown changes in mucosal TH1-associated cytokines in the presence of C. trachomatis infection and with its progression to the upper genital tract or clearance, in vivo cytokine responses to chlamydial infection in humans are not well understood. Using a quantitative enzyme-linked immunosorbent assay (ELISA), we examined the endocervical production of two TH1-associated cytokines, i.e. interleukin (IL)-2 and IL-12, in relation to C. trachomatis infection in adolescents. At a randomly selected visit for 396 females, median endocervical IL-2 levels were significantly lower (190 versus 283 pg/ml, P = 0·02) and median IL-12 levels significantly higher (307 versus 132 pg/ml, P &lt; 0·001) in subjects testing positive versus negative for C. trachomatis. These divergent TH1-associated cytokine responses were: (1) confirmed in paired analyses of 96 individuals before and after infection within 6-month intervals, (2) reversible in 97 patients who cleared infection during consecutive visits, (3) not attributable to sociodemographic factors or other genital infections and (4) independent of common genetic variants at the IL2 and IL12B loci associated previously with differential gene expression. From these findings we infer that increased IL-12 and decreased IL-2, observed commonly during mucosal inflammation, are important features of mucosal immune defence against C. trachomatis infection.
Dendritic cell immunizations alone or combined with low doses of interleukin-2 induce specific immune responses in melanoma patients
Authors: Escobar A , López M , Serrano A , Ramirez M , Pérez C , Aguirre A , González R , Alfaro J , Larrondo M , Fodor M , Ferrada C , Salazar-Onfray F 
Published: October 2005

SummaryDendritic cell (DC)-based therapy has proved to be effective in patients with a variety of malignancies. However, an optimal immunization protocol using DCs and the best means for delivering antigens has not yet been described. In this study, 20 patients with malignant melanoma in stages III or IV were vaccinated with autologous DCs pulsed with a melanoma cell lysate, alone (n = 13) or in combination with low doses of subcutaneous (s.c.) interleukin (IL)-2 injections (n = 7), to assess toxicity, immunological and clinical responses. Monocyte-derived DCs were morphological, phenotypic and functionally characterized in vitro. Peripheral blood mononuclear cells (PBMC), harvested from patients either prior to and after the treatment, were analysed using enzyme-linked immunosorbent spot (ELISPOT). After vaccination, 50% of the patients tested (seven of 13) from the first group and (three of seven) from the second, showed an increase in interferon (IFN)-γ production in response to allogeneic melanoma cell lines but not to controls. Four of five tested human leucocyte antigen (HLA)-A2+ patients with anti-melanoma activity also showed specific T cell responses against peptides derived from melanoma-associated antigens. Delayed type IV hypersensitivity reaction (DTH) against melanoma cell lysate was observed in six of 13 patients from the group treated with DC vaccines only and four of seven from the group treated with the combination of DCs and IL-2. Significant correlations were found between DTH-positive responses against tumour lysate and both disease stability and post-vaccination survival on the stage IV patients. There were no toxicities associated with the vaccines or evidence of autoimmunity including vitiligo. Furthermore, no significant enhancement was observed as a result of combining DC vaccination with IL-2. Our data suggest that autologous DCs pulsed with tumour lysate may provide a standardized and widely applicable source of melanoma specific antigens for clinical use. It is safe and causes no significant side effects and has been demonstrated to be partially efficient at triggering effective anti-melanoma immunity.