tbuckley/cabot-search huggingface dataset:
Implications of scaling up cardiovascular disease treatment in South Africa: a microsimulation and cost-effectiveness analysis
Authors: Sanjay Basu, Ryan G Wagner, Ronel Sewpaul, Priscilla Reddy, Justine Davies
Journal: The Lancet Global Health (2018)

Cardiovascular diseases and their risk factors-particularly hypertension, dyslipidaemia, and diabetes-have become an increasing concern for middle-income countries. Using newly available, nationally representative data, we assessed how cardiovascular risk factors are distributed across subpopulations within South Africa and identified which cardiovascular treatments should be prioritised.We created a demographically representative simulated population for South Africa and used data from 17 743 respondents aged 15 years or older of the 2012 South African National Health and Nutrition Examination Survey (SANHANES) to assign information on cardiovascular risk factors to each member of the simulated population. We created a microsimulation model to estimate the health and economic implications of two globally recognised treatment recommendations: WHO's package of essential non-communicable disease interventions (PEN) and South Africa's Primary Care 101 (SA PC 101) guidelines. The primary outcome was total disability-adjusted life-years (DALYs) averted through treatment of all cardiovascular disease or microvascular type 2 diabetes complications per 1000 population. We compared outcomes at the aspirational level of achieving access to treatment among 70% of the population.Based on the SANHANES data, South Africans had a high prevalence of hypertension (24·8%), dyslipidaemia (17·5%), and diabetes (15·3%). Prevalence was disproportionately high and treatment low among male, black, and poor populations. Our simulated population experienced a burden of 40·0 DALYs (95% CI 29·5-52·0) per 1000 population per year from cardiovascular disease or type 2 diabetes complications at current treatment levels, which lowered to 32·9 DALYs (24·4-44·7) under WHO PEN implementation and to 32·5 (24·4-44·8) under SA PC 101 implementation. Under both guidelines, there were increases in blood pressure treatment (4·2 percentage points under WHO PEN vs 12·6 percentage points under SA PC 101), lipid treatment (16·0 vs 14·9), and glucose control medications (1·2 vs 0·6). The incremental cost-effectiveness of implementing SA PC 101 over current treatment would be a saving of US$24 902 (95% CI 14 666-62 579) per DALY averted compared with a saving of $17 587 (1840-42 589) under WHO PEN guidelines.Cardiovascular risk factors are common and disproportionate among disadvantaged populations in South Africa. Treatment with blood pressure agents and statins might need greater prioritisation than blood glucose therapies, which contrasts with observed treatment levels despite a lower monthly cost of blood pressure or statin treatment than of sulfonylurea or insulin treatment.Stanford University.
Variant Prolactin Receptor in Agalactia and Hyperprolactinemia
Authors: Tatsuya Kobayashi, Hirokazu Usui, Hirokazu Tanaka, Makio Shozu
Journal: New England Journal of Medicine (2018)

A loss-of-function variant in the gene encoding the prolactin receptor ( PRLR) was reported previously in a woman with persistent postpartum galactorrhea; however, this paradoxical phenotype is not completely understood. Here we describe a 35-year-old woman who presented with idiopathic hyperprolactinemia that was associated with a complete lack of lactation after each of her two deliveries. She is a compound heterozygote for loss-of-function variants of PRLR. Her unaffected parents are heterozygotes. These findings are consistent with previous work showing that mice deficient in functional Prlr do not lactate.
Associations between the patient-physician relationship and health-related quality of life among patients with cancer.
Authors: Olive Mbah, Jennifer Schaal, Samuel Cykert, Eugenia Eng, Linda Robertson, Stephanie Baker, Kristin Z. Black, Crystal Dixon, Katrina Ellis, Wendi Elkins, Fatima Guerrab, Lauren C Jordan, Alexandra Lightfoot, Neda R. Padilla, Cleo A. Samuel
Journal: Journal of Clinical Oncology (2018)

162 Background: Health-related quality of life (HRQOL) is an important cancer care outcome. Patient-physician communication is linked to HRQOL, yet less is known about the role of other aspects of the patient-physician relationship in explaining HRQOL outcomes in cancer patients. Using secondary data from the Accountability for Cancer Care through Undoing Racism and Equity study, we examined associations between multiple patient-physician relationship factors and HRQOL in breast and lung cancer patients. Methods: The analysis included 283 patients receiving care at two cancer centers from 2013-2017. Survey data on socio-demographics, HRQOL, and patient-physician relationship (i.e., doctors’ respectfulness, time spent with doctors, doctors’ involvement of patient in decision-making, satisfaction with quality of care) were collected at baseline and during treatment. The primary outcome was a binary measure of poor-fair (vs. good-excellent) HRQOL 90 days post-diagnosis. We employed multivariate logistic regression to assess associations between patient-physician relationship factors and HRQOL. Results: In adjusted analyses, patients reporting high levels of physician respect had 78% lower odds of reporting poor-fair HRQOL than patients reporting low levels of respect (Adjusted Odds Ratio[AOR] = 0.22; 95%CI = 0.08-0.59). Patients who were optimally involved in their care had lower odds of poor-fair HRQOL than those less involved (AOR = 0.30; 95%CI = 0.12-0.77). Finally, patients who very satisfied with the quality of their care had a 40% lower odds of poor-fair HRQOL than those less satisfied with care (AOR = 0.40; 95% CI = 0.13-0.99). There was no association between amount of time spent with doctor and HRQOL. Conclusions: Multiple aspects of the patient-physician relationship, including doctor’s respectfulness, doctors’ involvement of patient in decision-making, and patient satisfaction with quality of care are associated with HRQOL among breast and lung cancer patients. Given the important role that HRQOL plays in treatment adherence and outcomes, these findings highlight the need for systems of care that optimize the physician-patient relationship in cancer care.
A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents
Authors: Ole Köhler-Forsberg, Liselotte Petersen, Christiane Gasse, Preben B. Mortensen, Soren Dalsgaard, Robert H. Yolken, Ole Mors, Michael E. Benros
Journal: JAMA Psychiatry (2018)

Infections have been associated with increased risks for mental disorders, such as schizophrenia and depression. However, the association between all infections requiring treatment and the wide range of mental disorders is unknown to date.To investigate the association between all treated infections since birth and the subsequent risk of development of any treated mental disorder during childhood and adolescence.Population-based cohort study using Danish nationwide registers. Participants were all individuals born in Denmark between January 1, 1995, and June 30, 2012 (N = 1 098 930). Dates of analysis were November 2017 to February 2018.All treated infections were identified in a time-varying manner from birth until June 30, 2013, including severe infections requiring hospitalizations and less severe infection treated with anti-infective agents in the primary care sector.This study identified all mental disorders diagnosed in a hospital setting and any redeemed prescription for psychotropic medication. Cox proportional hazards regression was performed reporting hazard rate ratios (HRRs), including 95% CIs, adjusted for age, sex, somatic comorbidity, parental education, and parental mental disorders.A total of 1 098 930 individuals (51.3% male) were followed up for 9 620 807.7 person-years until a mean (SD) age of 9.76 (4.91) years. Infections requiring hospitalizations were associated with subsequent increased risk of having a diagnosis of any mental disorder (n = 42 462) by an HRR of 1.84 (95% CI, 1.69-1.99) and with increased risk of redeeming a prescription for psychotropic medication (n = 56 847) by an HRR of 1.42 (95% CI, 1.37-1.46). Infection treated with anti-infective agents was associated with increased risk of having a diagnosis of any mental disorder (HRR, 1.40; 95% CI, 1.29-1.51) and with increased risk of redeeming a prescription for psychotropic medication (HRR, 1.22; 95% CI, 1.18-1.26). Antibiotic use was associated with particularly increased risk estimates. The risk of mental disorders after infections increased in a dose-response association and with the temporal proximity of the last infection. In particular, schizophrenia spectrum disorders, obsessive-compulsive disorder, personality and behavior disorders, mental retardation, autistic spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, and tic disorders were associated with the highest risks after infections.Although the results cannot prove causality, these findings provide evidence for the involvement of infections and the immune system in the etiology of a wide range of mental disorders in children and adolescents.
The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come
Authors: Nick Watts, Markus Amann, Nigel Arnell, Sonja Ayeb-Karlsson, Kristine Belesova, Helen Berry, Timothy Bouley, Maxwell Boykoff, Peter Byass, Wenjia Cai, Diarmid Campbell-Lendrum, Jonathan Chambers, Meaghan Daly, Niheer Dasandi, Michael Davies, Anneliese Depoux, Paula Dominguez-Salas, Paul Drummond, Kristie L Ebi, Paul Ekins, Lucia Fernandez Montoya, Helen Fischer, Lucien Georgeson, Delia Grace, Hilary Graham, Ian Hamilton, Stella Hartinger, Jeremy Hess, Ilan Kelman, Gregor Kiesewetter, Tord Kjellstrom, Dominic Kniveton, Bruno Lemke, Lu Liang, Melissa Lott, Rachel Lowe, Maquins Odhiambo Sewe, Jaime Martinez-Urtaza, Mark Maslin, Lucy McAllister, Slava Jankin Mikhaylov, James Milner, Maziar Moradi-Lakeh, Karyn Morrissey, Kris Murray, Maria Nilsson, Tara Neville, Tadj Oreszczyn, Fereidoon Owfi, Olivia Pearman, David Pencheon, Steve Pye, Mahnaz Rabbaniha, Elizabeth Robinson, Joacim Rocklöv, Olivia Saxer, Stefanie Schütte, Jan C Semenza, Joy Shumake-Guillemot, Rebecca Steinbach, Meisam Tabatabaei, Julia Tomei, Joaquin Trinanes, Nicola Wheeler, Paul Wilkinson, Peng Gong, Hugh Montgomery, Anthony Costello
Journal: The Lancet (2018)
Trends in seasonal influenza vaccine coverage of target groups in France, 2006/07 to 2015/16: Impact of recommendations and 2009 influenza A(H1N1) pandemic
Authors: Pierre Verger, Lisa Fressard, Sébastien Cortaredona, Daniel Lévy-Bruhl, Pierre Loulergue, Florence Galtier, Aurélie Bocquier
Journal: Eurosurveillance (2018)

Background and aimsSeasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects of the 2009 influenza A(H1N1) pandemic and the publication of new SIV recommendations in 2011 and 2013.MethodsOur study was based on records of vaccines delivered in community pharmacies for a permanent, representative sample of 805,000 beneficiaries of the French National Health Insurance Fund. For the first objective, we analysed SIVU rate trends among ≥ 65 year olds as well as among < 65 year olds with each of the following conditions: diabetes, respiratory, cardiovascular, neuromuscular, or chronic liver disease. For the second goal, we computed segmented log-binomial regression analyses.ResultsAfter the 2009 pandemic, except for the target group with liver diseases, where the difference was not statistically significant, SIVU fell significantly in all groups during the 2010/11 season, remaining relatively stable until 2015/16 in groups not targeted by new recommendations. Crude SIVU rates in 2015/16 were 48% (43,950/91,794) for ≥ 65 year olds and between 16% (407/2,565) and 29% (873/3,056) for < 65 year olds depending on their condition. SIVU increased modestly after new recommendations were published, but only in patients newly eligible for a free vaccine voucher.ConclusionsOur results suggest: (i) a prolonged confidence crisis in SIV, initially impelled by the 2009 pandemic vaccination campaign; (ii) that new recommendations are ineffective without additional measures. Interventional research in this field is a priority.
High dose estradiol increases but lower dose estradiol with progesterone decreases the time for tumor development in (Her-2/neu x BALB/c) F1 transgenic mice.
Authors: E. Blank, P. Wong, R. Lakshmanaswamy, G. Thordarson, R. Guzman, S. Nandi
Journal: Cancer Research (2007)

2221  This study investigates the effect of short term treatment with ovarian steroids on the latency of tumor appearance in hybrid transgenic FVB (MMTV)Her-2/neu female x BALB/c male mice, in which all mice will eventually develop mammary cancer. Her2/neu which is also known as ErbB2 is a proto-oncogene, and a member of the epidermal growth factor receptor (EGFR) family. When present in human breast cancer its overexpression is associated with a more aggressive disease, increased disease occurrence and a worse prognosis. Since FVB (MMTV)Her-2/neu mice have multiple insertion sites of the transgene, Her-2/neu, hybrids were made to increase the latency of mammary tumor development by decreasing the Her-2/neu gene multiplicity. This breeding scheme was done to possibly enable the efficacious use of various hormonal combinations to either decrease or increase the latency of tumor appearance. We have earlier shown that pregnancy level of estradiol (E) used in short, continuous 3 week treatments with or without progesterone (P) greatly decreases the incidence of mammary cancer induced by the injection of the carcinogen, MNU (Proc. Natl. Acad. Sci. 96, 2520, 1999 and 98, 11755, 2001). At 6 weeks of age female F1 mice were implanted with silastic capsules and left for 3 weeks. At 9 weeks the capsules were removed and thereafter the mice were palpated weekly for the appearance of mammary tumors. Tumors were monitored and removed when they reached 1 cm in diameter. Mice were terminated when a third mammary tumor reached 1 cm. Groups of 15 -20 mice with the latency in days of first tumor appearance were: (1) untreated (274 ± 10 ), (2) 10 ug E (277 ± 13) , (3) 10 ug E + 15 mg P (237± 7), (4) 20 ug E (251 ± 8), (5) 20 μg E + 15 mg P (234 ± 10), (6) 100 ug E (260 ± 12), (7)100 ug E + 15 mg P (245 ±11), (8) 15 mg P (258 ± 9), (9) 2 mg E (311 ± 15).All E + P groups showed a statistically significant decrease in the time of appearance of the 1st tumor when compared with the untreated control as did 20 μg E and 15 mg P. Only the highest dose of E at 2 mg showed a statistically significant increase (p
Deficiency of TLR4 ameliorates hypoperfusion-induced brain pathology
Authors: Yang Liu, Klaus Fassbender
Journal: Theranostics (2018)

Microglial inflammatory activation contributes to chronic cerebral hypoperfusion-induced brain pathology. This editorial highlights a study by Qin et al. (Theranostics 2018; 8(19):5434-5451. doi:10.7150/thno.27882) that deficiency of TLR4 attenuates cognitive dysfunction and white matter injury by reducing autophagy and pro-inflammatory activation in microglia.
New insights on the regulation of cancer cachexia by N-3 polyunsaturated fatty acids
Authors: Renata Gorjao, Cesar Miguel Momesso dos Santos, Tamires Duarte Afonso Serdan, Vinicius Leonardo Sousa Diniz, Tatiana Carolina Alba-Loureiro, Maria Fernanda Cury-Boaventura, Elaine Hatanaka, Adriana Cristina Levada-Pires, Fábio Takeo Sato, Tania Cristina Pithon-Curi, Luiz Claudio Fernandes, Rui Curi, Sandro Massao Hirabara
Journal: Pharmacology & Therapeutics (2018)

Cancer cachexia is a multifactorial syndrome that develops during malignant tumor growth. Changes in plasma levels of several hormones and inflammatory factors result in an intense catabolic state, decreased activity of anabolic pathways, anorexia, and marked weight loss, leading to cachexia development and/or accentuation. Inflammatory mediators appear to be related to the control of a highly regulated process of muscle protein degradation that accelerates the process of cachexia. Several mediators have been postulated to participate in this process, including TNF-α, myostatin, and activated protein degradation pathways. Some interventional therapies have been proposed, including nutritional (dietary, omega-3 fatty acid supplementation), hormonal (insulin), pharmacological (clenbuterol), and nonpharmacological (physical exercise) therapies. Omega-3 (n-3) polyunsaturated fatty acids (PUFAs), especially eicosapentaenoic acid (EPA) and docosahexaenoic acid, are recognized for their anti-inflammatory properties and have been used in therapeutic approaches to treat or attenuate cancer cachexia. In this review, we discuss recent findings on cellular and molecular mechanisms involved in inflammation in the cancer cachexia syndrome and the effectiveness of n-3 PUFAs to attenuate or prevent cancer cachexia.
Effectiveness of the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ and an e‐health adjusted care pathway in patients with stable heart failure: results of the ‘e‐Vita HF’ randomized controlled trial
Authors: Kim P. Wagenaar, Berna D.L. Broekhuizen, Tiny Jaarsma, Ilse Kok, Arend Mosterd, Frank F. Willems, Gerard C.M. Linssen, Willem R.P. Agema, Sander Anneveldt, Carolien M.H.B. Lucas, Herman F.J. Mannaerts, Elly M.C.J. Wajon, Kenneth Dickstein, Maarten J. Cramer, Marcel A.J. Landman, Arno W. Hoes, Frans H. Rutten
Journal: European Journal of Heart Failure (2018)

Background Efficient incorporation of e‐health in patients with heart failure (HF) may enhance health care efficiency and patient empowerment. We aimed to assess the effect on self‐care of (i) the European Society of Cardiology/Heart Failure Association website ‘ heartfailurematters.org ’ on top of usual care, and (ii) an e‐health adjusted care pathway leaving out ‘in person’ routine HF nurse consultations in stable HF patients. Methods and results In a three‐group parallel‐randomized trial in stable HF patients from nine Dutch outpatient clinics, we compared two interventions ( heartfailurematters.org website and an e‐health adjusted care pathway) to usual care. The primary outcome was self‐care measured with the European Heart Failure Self‐care Behaviour Scale. Secondary outcomes were health status, mortality, and hospitalizations. In total, 450 patients were included. The mean age was 66.8 ± 11.0 years, 74.2% were male, and 78.8% classified themselves as New York Heart Association I or II at baseline. After 3 months of follow‐up, the mean score on the self‐care scale was significantly higher in the groups using the website and the adjusted care pathway compared to usual care (73.5 vs. 70.8, 95% confidence interval 0.6–6.2; and 78.2 vs. 70.8, 95% confidence interval 3.8– 9.4, respectively). The effect attenuated, until no differences after 1 year between the groups. Quality of life showed a similar pattern. Other secondary outcomes did not clearly differ between the groups. Conclusions Both the heartfailurematters.org website and an e‐health adjusted care pathway improved self‐care in HF patients on the short term, but not on the long term. Continuous updating of e‐health facilities could be helpful to sustain effects. Clinical Trial registration: ClinicalTrials.gov ID NCT01755988.
Five year lung plan calls for wider use of spirometry
Authors: Jacqui Wise
Journal: BMJ (2018)

Spirometry should be used much more by general practices to improve the diagnosis of lung disease, says a five year plan for lung health in England.1

The Taskforce for Lung Health recommends changes in the whole patient pathway, including lung health MOTs for high risk groups, time targets to improve early diagnosis, and public awareness campaigns about the symptoms of lung disease.

The taskforce is independent of government. Its membership includes 29 organisations representing healthcare professionals, patients, professional associations, and respiratory charities. An industry forum provides evidence for the taskforce, and eight companies provide financial backing.

A spirometry test usually takes under 10 minutes and can be used to help diagnose lung conditions such as chronic obstructive pulmonary disease (COPD). …
Single cell dissection of plasma cell heterogeneity in symptomatic and asymptomatic myeloma
Authors: Guy Ledergor, Assaf Weiner, Mor Zada, Shuang-Yin Wang, Yael C. Cohen, Moshe E. Gatt, Nimrod Snir, Hila Magen, Maya Koren-Michowitz, Katrin Herzog-Tzarfati, Hadas Keren-Shaul, Chamutal Bornstein, Ron Rotkopf, Ido Yofe, Eyal David, Venkata Yellapantula, Sigalit Kay, Moshe Salai, Dina Ben Yehuda, Arnon Nagler, Lev Shvidel, Avi Orr-Urtreger, Keren Bahar Halpern, Shalev Itzkovitz, Ola Landgren, Jesus San-Miguel, Bruno Paiva, Jonathan J. Keats, Elli Papaemmanuil, Irit Avivi, Gabriel I. Barbash, Amos Tanay, Ido Amit
Journal: Nature Medicine (2018)
Pediatric cancer care professionals’ experiences with an interprofessional communication intervention.
Authors: Angela Marie Feraco, Sarah R. McCarthy, P. Jeet Das, Anna Revette, James A. Tulsky, Joanne Wolfe
Journal: Journal of Clinical Oncology (2018)

53 Background: The National Academy of Medicine recommends interprofessional collaboration to promote optimal patient- and family-centered care. We sought to understand whether medical and psychosocial professionals who participated in an interprofessional communication intervention perceived it as distinct from usual clinical care. Methods: Our intervention targeted “medical” (physicians, nurse practitioners) and “psychosocial” (social workers, psychologists) professionals. It consisted of an interprofessional family conference, using a structured conversation guide, conducted during the first 6 months of a child’s cancer care. Conferences aimed to enable families to share hopes and worries and ask questions about their child’s care. Clinicians received a 60-minute training focused on communication skills, such as eliciting families’ hopes and worries, and suggested approaches to collaborating during conferences. Clinicians participated in debriefing interviews after each conference (range 1-3). Three of us conducted thematic analysis of interview data. Results: Twenty-two professionals (6 attending MDs, 4 fellow MDs, 8 NPs, and 8 psychosocial clinicians) gave 34 interviews. Medical and psychosocial professionals described interprofessional family conferences as distinct from usual practice patterns, largely due to their interprofessional colleagues’ presence. This co-presence contributed to “being on the same page.” Conferences sometimes bred a new understanding of a family’s needs and consequent care changes. However, both medical and psychosocial professionals noted that psychosocial professionals often were not vocal contributors to the conference. Some psychosocial clinicians reported being unsure of “the rules.” Conclusions: An interprofessional communication intervention promoted shared understanding between interprofessional colleagues. However, medical professionals were described as more vocal, perhaps due to insufficient role clarity or medical dominance.