bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the Airway Questionnaire 20 to Detect Changes in Quality of Life in Asthmatic Patients and its Association with the St George’s Respiratory Questionnaire and Clinical Parameters
Authors: Win Thida , Pearce Linda , Nathan James , Cafferty Fay , Laroche Clare 
Published: March 2016

BACKGROUND AND OBJECTIVES: The usefulness of the Airway Questionnaire 20 (AQ20) – a short version of the St George’s Respiratory Questionnaire (SGRQ) – to evaluate quality of life (QOL) in asthmatic patients following a hospital admission was assessed.METHODS: At baseline and at six months following the index admission, 135 asthmatic patients were asked to complete the AQ20 and the SGRQ. The patient’s peak flow, number of subsequent asthma exacerbations and number of repeat hospital admissions were also recorded.RESULTS: The AQ20 scores ranged from 0 to 20, with a high score indicating poor QOL. The AQ20 had good coverage, with no obvious ceiling or floor effects. In multiple regression analysis, all three SGRQ components were important in predicting AQ20 scores (R2 values were 61.9% and 73.1% for baseline and six‐month scores, respectively). The AQ20 was closely correlated with the SGRQ, but not redundant when used together. Bias was low when the retest reliability of the AQ20 was evaluated using the Bland‐Altman method, but variation was high (−0.64). Patients with subsequent exacerbations (n=52) had higher AQ20 scores at six‐month follow‐up (P=0.002). In logistic regression, the AQ20 score was closely associated with the incidence of exacerbations (OR 1.15, 95% CI 1.05 to 1.25), with a similar magnitude of association between the AQ20 and the SGRQ. The AQ20 score did not correlate with peak flow at baseline (r=−0.05; P=0.573) or at six months (r=−0.31; P=0.006), and was not responsive to changes in peak flow (r=−0.06; P=0.583).CONCLUSION: The AQ20 can be substituted for the more complicated SGRQ in the assessment of QOL in patients following a hospital admission for an asthma exacerbation.
The Burden of Hepatitis C Virus Infection Is Growing: A Canadian Population-Based Study of Hospitalizations from 1994 to 2004
Authors: Myers Robert P , Liu MingFu , Shaheen Abdel Aziz M 
Published: March 2016

BACKGROUND: Nearly 1% of Canadians are infected with the hepatitis C virus (HCV). Simulation analyses have suggested that HCV will place an increasing burden on the health care system as the infected population ages, but supportive clinical data are limited.OBJECTIVES: To study temporal trends in HCV-related hospitalizations and predictors of increased health care utilization from a Canadian population-based perspective.METHODS: An administrative hospitalization database from the Calgary Health Region was used to identify patients who were admitted for HCV between 1994 and 2004. The primary outcomes were liver-related HCV hospitalizations, length of stay, hospital costs and in-hospital mortality. Average annual growth rates in outcomes were calculated and subgroup analyses were conducted according to age, sex and HIV/HCV coinfection status.RESULTS: Between 1994 and 2004, there were 4002 HCV-related hospitalizations; 22% were liver-related. Liver-related hospitalizations, lengths of stay and in-hospital mortality increased approximately fourfold or an average of 15% to 18% annually (P<0.0005). Patients aged 40 to 59 years and HIV/HCV coinfected patients experienced the largest average annual growth rates (19% to 27% and 30% to 40%, respectively; P<0.0005), reflecting the accelerated natural history of HCV in these subgroups. Hospital costs for liver-related HCV hospitalizations increased by an average of 41% annually (P=0.001) between 2000 and 2004. The average annual increase in liver-related hospitalizations remained significant in a sensitivity analysis, even when 75% of HCV cases were under-reported in 1994.CONCLUSIONS: The present studies’ findings confirm the growing burden of HCV on the Canadian health care system. Strategies to prevent HCV infection and maximize the dissemination and most effective use of potentially curative antiviral therapies are necessary to reduce these trends.
Platelet Count to Spleen Diameter Ratio for the Diagnosis of Esophageal Varices: Is It Feasible?
Authors: Baig Waqas Wahid , Nagaraja MV , Varma Muralidhar , Prabhu Ravindra 
Published: March 2016

AIM: To study the value of platelet count to spleen diameter ratio as a noninvasive parameter for diagnosing esophageal varices (EVs) in liver cirrhosis.METHODS: The laboratory and ultrasonographic variables were prospectively evaluated in 150 patients with liver cirrhosis. Only stable patients were included in the study. Patients with active gastrointestinal bleeding at the time of admission were excluded. All patients underwent screening upper gastrointestinal endoscopy.RESULTS: The platelet count, spleen diameter and platelet count to spleen diameter ratio in patients with EVs were significantly different from patients without EVs. The platelet count to spleen diameter ratio had the highest accuracy among the three parameters. By applying receiver operating characteristic curves, a platelet count to spleen diameter ratio cut-off value of 1014 was obtained, which gave positive and negative predictive values of 95.4% and 95.1%, respectively. The accuracy of this cut-off value as evaluated by applying receiver operating characteristic curves was 0.942 (95% CI 0.890 to 0.995).CONCLUSION: Among the noninvasive parameters studied, platelet count to spleen diameter ratio had the highest accuracy for diagnosing EVs. However, the evidence for the noninvasive diagnosis is not yet sufficient to replace endoscopy as a diagnostic screening tool for EVs in all cirrhotic patients. The platelet count to spleen diameter ratio may be a useful tool for diagnosing EVs in liver cirrhosis noninvasively when endoscopy facilities are not available.
Use of Pain Threshold Reports to Satisfy Social Needs
Authors: MacDonald Geoff 
Published: March 2016

OBJECTIVE: To examine the hypothesis that experimental threats to social belongingness, interacting with individual differences in attachment security, cause modification of pain threshold reports by individuals who report high pain thresholds at baseline.METHODS: In each of three studies, baseline pain threshold and tolerance were assessed in response to a pain task (cold pressor pain in Studies 1 and 2, finger pressure pain in Study 3). Participants then completed a measure of attachment security and were randomly assigned to a social exclusion or control condition (exclusion from a computer game in Study 1, recalling past rejection experiences in Studies 2 and 3). The pain task was administered again to examine the effects on pain threshold and tolerance.RESULTS: Those with high anxious attachment and high baseline pain thresholds reported higher postmanipulation pain thresholds in the exclusion conditions than in the control conditions. Those with low anxious attachment and high baseline pain thresholds reported lower postmanipulation pain thresholds in the exclusion conditions than in the control conditions. No differences were found for pain tolerance.CONCLUSIONS: Across studies, results suggested that postmanipulation pain threshold reports of individuals with high baseline pain thresholds were particularly responsive to social exclusion. The form of the response was dependent on the level of anxious attachment. The present studies provide evidence that variance in pain threshold reports not accounted for by pain intensity may reflect the use of pain reports to satisfy social needs. This work also suggests that baseline measures of pain thresholds may, in interaction with psychological variables, have predictive power beyond serving as a control variable.
Enhancing the Sexual Function of Women Living with Chronic Pain: A Cognitive‐Behavioural Treatment Group
Authors: Breton Annie , Miller Colleen M , Fisher Kim 
Published: March 2016

BACKGROUND: Chronic pain significantly impacts women’s quality of life in the domain of sexual function. Treatment aimed at improving the sexual function of women living with chronic pain is minimal or absent within an interdisciplinary rehabilitation pain program.OBJECTIVE: To evaluate a cognitive‐behavioural treatment group designed to improve the sexual function of women with chronic pelvic pain, daily headache pain and neuromusculoskeletal pain within an interdisciplinary rehabilitation pain program.METHODS: Participants were 47 women who attended the treatment group. A physical therapist and a psychologist facilitated the group. The participants completed a modified version of the Sexual Activity Questionnaire pregroup and at one month postgroup, and a Treatment Helpfulness Questionnaire at the final group session.RESULTS: All 47 women found the treatment group helpful. Sexual function improved as evidenced by significant differences (Wilcoxon signed‐rank test, P<0.05) from pregroup to postgroup on measures of enjoyment, lubrication, satisfaction after sexual activity and satisfaction with frequency. Improvements occurred despite no change in pain level during penetration or fatigue level from pregroup to post‐group. Treatment helpfulness results showed that women valued the knowledge and skills gained in the group. Qualitative findings suggest that a cognitive shift, and communication and partner involvement may be mechanisms of change for improved sexual function.CONCLUSIONS: The sexual function of women with chronic pain can be significantly enhanced by a cognitive‐behavioural treatment group delivered within an interdisciplinary rehabilitation pain program.
Asthma Control Score Based on Filled Medication Prescriptions: A Validation Study
Authors: Beauchesne Marie-France , Chartier Amélie , Fillion Anne , Lemière Catherine , Lecompte Sophie , Blais Lucie 
Published: March 2016

BACKGROUND: Periodic measurement of disease control is recommended to characterize asthma and monitor treatment.OBJECTIVE: To elaborate and validate an asthma control score (ACS) for use in studies based on administrative health databases.METHODS: Adult patients with asthma were recruited from a clinic. The ACS is based on the average number of doses of short‐acting inhaled beta2‐agonists taken per week and short courses of oral corticosteroids dispensed over a three‐month period. Data were obtained from the Régie de l’assurance maladie du Québec database in Canada. The ACS was compared with the asthma control questionnaire and the use of health care services for asthma over a 12‐month period.RESULTS: A total of 60 patients were enrolled. They had a mean (± SD) age of 50.4±13.9 years, and 43.3% were male. Patients had had asthma for 20.8±15.1 years on average and had a mean prebronchodilator forced expiratory volume in 1 s of 77.0% of the predicted value. The mean ACS was 8.3±11.6, with a range of 0 to 60. The ACS was not found to be correlated with the asthma control questionnaire, but it was significantly associated with health care services used. For each additional point in the ACS, patients were 2% more likely to need acute care for asthma (rate ratio 1.02; P=0.02).CONCLUSIONS: Further studies including patients followed by general practitioners are required before the general use of this score. This innovative score is useful to rapidly assess the control of asthma over long periods of time and at a low cost in studies using administrative drug databases.
Effect of Fluticasone 250 μg/salmeterol 50 μg and Montelukast on Exhaled Nitric Oxide in Asthmatic Patients
Authors: Gelb Arthur F , Taylor Colleen Flynn , Shinar Chris M , Gutierrez Carlos A , Zamel Noe 
Published: March 2016

BACKGROUND: Monitoring noninvasive biomarkers of inflammation is an important adjunct in asthma therapy.OBJECTIVE: The goal of the present study was to identify airway and alveolar site(s) of inflammation using exhaled nitric oxide (NO) as a marker in asthmatic patients, and to evaluate the NO response to maintenance fluticasone 250 μg/salmeterol 50 μg (F/S) and add‐on montelukast 10 mg (M).METHODS: Thirty (24 women) nonsmoking, mild to moderate asthmatic patients were studied, mean age (± SD) 43±9 years, treated with F/S for more than one year. All were clinically stable for longer than eight weeks and had not taken oral corticosteroids and/or leukotriene antagonists for eight weeks before the present study. Spirometry, Juniper asthma symptom score, fractional exhaled NO (FENO) 100 mL/s, bronchial NO and alveolar NO concentration (CANO) were measured in a single‐blind, nonrandomized crossover study.PROTOCOL: Visit 1: baseline F/S; visit 2: after four weeks of F/S plus M; visit 3: after four weeks of S plus M; and visit 4: after four weeks of S only. Values in asthmatic patients were also compared with 34 nonsmoking age‐matched healthy controls with normal lung function.RESULTS: After 180 μg aerosolized metered dose inhaler albuterol, the forced expiratory volume in 1 s at baseline was 2.6±0.8 L (86%±16% of the predicted value) and the forced expiratory volume in 1 s over the forced vital capacity was 77%±9% (mean ± SD), and was similar at visits 2 to 4. Juniper scores were mildly abnormal at visits 1 to 3, but significantly worse (P=0.03) at visit 4 versus visits 1 to 3. FENO values at visits 1 to 3 were similar but significantly increased (P=0.007) at visit 4. Bronchial NO was higher (P=0.03) at visit 4, versus visits 1 and 2, and was no different at visit 3. Compared with the healthy subjects, FENO and bronchial NO values were abnormal (greater than the normal mean plus 2 SD) in 33% of asthmatic patients at visits 1 to 3. CANO was similar for visits 1 to 4. CANO was abnormal (greater than the normal mean + 2 SD) in 20% of asthmatic patients.CONCLUSION: In clinically stable asthmatic patients, despite controller treatment including moderate‐dose inhaled corticosteroids and add‐on M, 33% of mild to moderate asthmatic patients have ongoing nonsuppressed bronchial sites of increased NO production, compared with healthy control subjects. These controllers have no effect on CANO, which was abnormal in 20% of the asthmatic patients studied. The addition of add‐on M to baseline moderate‐dose inhaled corticosteroid did not further reduce total exhaled, bronchial and/or alveolar NO production.
Validation of a French‐Canadian Version of the Pain Disability Index
Authors: Gauthier Nathalie , Thibault Pascal , Adams Heather , Sullivan Michael JL 
Published: March 2016

OBJECTIVE: To examine the psychometric properties of the Index de l’incapacité reliée à la douleur, a French‐Canadian version of the Pain Disability Index (PDI).METHODS: A total of 176 chronic pain patients (94 women, 82 men) completed the French‐Canadian version of the PDI (PDI‐CF), as well as other pain‐related measures. A subset of 52 patients (27 women, 25 men) also completed a lifting task designed to assess physical tolerance and pain behaviour.RESULTS: Confirmatory factor analysis of the PDI‐CF supported the two‐factor structure of the original PDI. Reliability analyses revealed that the PDI‐CF total score had a high degree of internal consistency, comparable with the original PDI. The PDI‐CF total score was significantly correlated with self‐reported pain, pain catastrophizing, depressive symptoms, fear of movement or (re)injury, lift duration and pain behaviours.CONCLUSIONS: The results suggest that the PDI‐CF is a reliable and valid measure of self‐reported disability that is psychometrically similar to the original scale.
Pain in Hospitalized Children: A Prospective Cross‐Sectional Survey of Pain Prevalence, Intensity, Assessment and Management in a Canadian Pediatric Teaching Hospital
Authors: Taylor Elsa M , Boyer Kristina , Campbell Fiona A 
Published: March 2016

BACKGROUND: Pain is under‐recognised and undertreated. Although standards now exist for pain management, it is not known if this has improved care of hospitalized children.OBJECTIVES: To benchmark pain prevalence, pain intensity, pain assessment documentation and pharmacological treatment of pain. The aim was to highlight areas of good practice, identify areas for improvement and inform development of hospital standards, education, future audits and the research agenda.METHODS: The present prospective cross‐sectional survey of all medical and surgical inpatient units took place on a single day at the Hospital for Sick Children (Toronto, Ontario), a Canadian tertiary and quaternary pediatric hospital. A structured, verbally administered questionnaire was used to obtain information on patient demographics, pain before admission, pain intensity during admission and pain treatment. Charts were reviewed to establish frequency of documented pain assessment, the pain assessment tool used and analgesics given. Subgroup analysis was included for age, sex, visible minority or fluency in English, medical versus surgical services and acute pain service input.RESULTS AND CONCLUSIONS: Two hundred forty‐one (83%) of the 290 inpatients or their carergivers were interviewed. It was found that 27% of patients usually had pain before admission, and 77% experienced pain during admission. Of these, 23% had moderate or severe pain at interview and 64% had moderate or severe pain sometime in the previous 24 h. Analgesics were largely intermittent and single‐agent, although 90% of patients found these helpful. Fifty‐eight per cent of those with pain received analgesics in the preceding 24 h but only 25% received regular analgesia. Only 27% of children had any pain score documented in the preceding 24 h. It was concluded that pain was infrequently assessed, yet occurred commonly across all age groups and services and was often moderate or severe. Although effective, analgesic therapy was largely single‐agent and intermittent. Widespread dissemination of results to all professional groups has resulted in the development of a continuous quality assurance program for pain at the Hospital for Sick Children. A re‐audit is planned to evaluate changes resulting from the new comprehensive pain strategies.
The Use of Budesonide in the Treatment of Autoimmune Hepatitis in Canada
Authors: Zandieh Iman , Krygier Darin , Wong Victor , Howard John , Worobetz Lawrence , Minuk Gerald , Witt-Sullivan Helga , Yoshida Eric M 
Published: March 2016

BACKGROUND: Autoimmune hepatitis (AIH) is a chronic inflammatory disease that is successfully treated with prednisone and/or azathioprine immunosuppressive therapy in 70% to 80% of patients. The remaining patients are intolerant or refractory to these standard medications. Budesonide, a synthetic glucocorticoid, undergoes a high degree of first-pass metabolism, reducing its systemic bioavailability, and has a 15-fold greater affinity for the glucocorticoid receptor than prednisolone. Budesonide may be a potentially useful systemic steroid-sparing immunosuppressive agent in the treatment of AIH.OBJECTIVE: To review the Canadian experience using budesonide to treat AIH.METHODS: Patients with AIH currently or previously treated with budesonide were identified through the Canadian Association for the Study of the Liver membership. Data were collected regarding their clinical and treatment history.RESULTS: A total of nine patients were identified. All patients were female, with an average age of 39 years (range 12 to 66 years). The indications for budesonide were adverse side effects of prednisone in two patients, noncompliance with prednisone and azathioprine in one patient and intolerance to azathioprine resulting in prednisone dependence in the remaining six patients. Patients were treated in doses ranging from 9 mg daily to 3 mg every other day for 24 weeks to eight years. Seven of nine patients had a complete response, defined as sustained normalization of the aminotransferase levels. The remaining two patients were classified as nonresponders (less than a 50% reduction in pretreatment aminotransferase levels).CONCLUSIONS: In Canada, budesonide has been successfully used in seven of nine patients with autoimmune hepatitis who were either intolerant to prednisone and azathioprine or prednisone-dependent. No adverse effects were reported with budesonide. Budesonide is potentially a valuable treatment option for AIH patients refractory or intolerant to standard therapy, and is deserving of further study.
CagA and VacAHelicobacter PyloriAntibodies in Gastric Cancer
Authors: Suriani Renzo , Colozza Maurilio , Cardesi Enrico , Mazzucco Dario , Marino Maria , Grosso Silvia , Sanseverinati Sabina , Venturini Ivo , Borghi Athos , Zeneroli Maria Luisa 
Published: March 2016

BACKGROUND: Infection with different genotypes of virulentHelicobacter pyloristrains (cytotoxin-associated gene A [CagA]-and/or vacuolating cytotoxin A [VacA]-positive) can play a role in the development of atrophic gastritis, duodenal ulcer (DU) and gastric cancer (GC).OBJECTIVE: To determine whether patients with GC andH pylori-negative histological staining had previously been infected withH pyloriCagA- and/or VacA-positive virulent strains.METHODS: Twenty-three GC patients with a mean (± SD) age of 68.14±9.8 years who testedH pylori-negative on histological staining took part in the study. Three control groups were included. The first group comprised 19 patients with pastH pyloriinfection and DUs eradicated 10 years earlier, with a mean age of 58±18.2 years.H pylori-negative status for this group was determined every year with Giemsa staining, and follow-up testing occured 120±32 months (mean ± SD) after therapy. The subsequent control groups included 20 asymptomatic children, with a mean age of 7±4.47 years, and withH pylori-negative fecal tests; the final group contained 30 patients without clinical symptoms ofH pyloriinfection, with a mean age of 68±11.6 years, who testedH pylori-negative by histological staining.RESULTS: Prevalence of CagA and VacA seropositivity, respectively was 82.6% and 73.91% in GC patients; 84.2% and 84.2% inH pylori-negative DU patients; 25% and 5% inH pylori-negative children; and 36.6% and 16.6% in the patients without clinical symptoms on histological staining. CagA and VacA antibody positivity was not significantly different between GC patients and patients with DUs that had been eradicated 10 years earlier. Significant positivity was found between the children’s group and theH pylori-negative (with past DUs) group (P<0.001). A statistically significant difference was found in age between groups (P<0.03).CONCLUSIONS: Patients with GC, even whenH pylori-negative at the time of the present study, may have been infected byH pyloribefore the onset of the disease, as confirmed by CagA and VacA seropositivity. These data reinforce the hypothesis thatH pylorimay be a direct carcinogenic agent of GC.