bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do California Counties With Lower Socioeconomic Levels Have Less Access to Emergency Department Care?
Authors: Ravikumar Deepa , Hsia Renee 
Published: April 2010

AbstractObjectives:  The study objective was to examine the relationship between number of emergency departments (EDs) per capita in California counties and measures of socioeconomic status, to determine whether individuals living in areas with lower socioeconomic levels have decreased access to emergency care.Methods:  The authors linked 2005 data from the American Hospital Association (AHA) Annual Survey of Hospitals with the Area Resource Files from the United States Department of Health and Human Services and performed Poisson regression analyses of the association between EDs per capita in individual California counties using the Federal Information Processing Standard (FIPS) county codes and three measures of socioeconomic status: median household income, percentage uninsured, and years of education for individuals over 25 years of age. Multivariate analyses using Poisson regression were also performed to determine if any of these measures of socioeconomic status were independently associated with access to EDs.Results:  Median household income is inversely related to the number of EDs per capita (rate ratio = 0.83; 95% confidence interval [CI] = 0.71 to 0.96). Controlling for income in the multivariate analysis demonstrates that there are more EDs per 100,000 population in FIPS codes with more insured residents when compared with areas having less insured residents with the same levels of household income. Similarly, FIPS codes whose residents have more education have more EDs per 100,000 compared with areas with the same income level whose residents have less education.Conclusions:  Counties whose residents are poorer have more EDs per 100,000 residents than those with higher median household incomes. However, for the same income level, counties with more insured and more highly educated residents have a greater number of EDs per capita than those with less insured and less educated residents. These findings warrant in‐depth studies on disparities in access to care as they relate to socioeconomic status.ACADEMIC EMERGENCY MEDICINE 2010; 17:508–513 © 2010 by the Society for Academic Emergency Medicine
Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy
Authors: Garra Gregory , Singer Adam J. , Leno Richard , Taira Breena R. , Gupta Neeraj , Mathaikutty Beena , Thode Henry J. 
Published: April 2010

AbstractObjectives:  Acute back and neck strains are very common. In addition to administering analgesics, these strains are often treated with either heat or cold packs. The objective of this study was to compare the analgesic efficacy of heat and cold in relieving pain from back and neck strains. The authors hypothesized that pain relief would not differ between hot and cold packs.Methods:  This was a randomized, controlled trial conducted at a university‐based emergency department (ED) with an annual census of 90,000 visits. ED patients >18 years old with acute back or neck strains were eligible for inclusion. All patients received 400 mg of ibuprofen orally and then were randomized to 30 minutes of heating pad or cold pack applied to the strained area. Outcomes of interest were pain severity before and after pack application on a validated 100‐mm visual analog scale (VAS) from 0 (no pain) to 100 (worst pain), percentage of patients requiring rescue analgesia, subjective report of pain relief on a verbal rating scale (VRS), and future desire for similar packs. Outcomes were compared with t‐tests and chi‐square tests. A sample of 60 patients had 80% power to detect a 15‐mm difference in pain scores.Results:  Sixty patients were randomized to heat (n = 31) or cold (n = 29) therapy. Mean (±standard deviation [SD]) age was 37.8 (±14.7) years, 51.6% were female, and 66.7% were white. Groups were similar in baseline patient and pain characteristics. There were no differences between the heat and cold groups in the severity of pain before (75 mm [95% CI = 66 to 83] vs. 72 mm [95% CI = 65 to 78]; p = 0.56) or after (66 mm [95% CI = 57 to 75] vs. 64 mm [95% CI = 56 to 73]; p = 0.75) therapy. Pain was rated better or much better in 16/31 (51.6%) and 18/29 (62.1%) patients in the heat and cold groups, respectively (p = 0.27). There were no between‐group differences in the desire for and administration of additional analgesia. Twenty‐five of 31 (80.6%) patients in the heat group and 22 of 29 (75.9%) patients in the cold group would use the same therapy if injured in the future (p = 0.65).Conclusions:  The addition of a 30‐minute topical application of a heating pad or cold pack to ibuprofen therapy for the treatment of acute neck or back strain results in a mild yet similar improvement in the pain severity. However, it is possible that pain relief is mainly the result of ibuprofen therapy. Choice of heat or cold therapy should be based on patient and practitioner preferences and availability.ACADEMIC EMERGENCY MEDICINE 2010; 17:484–489 © 2010 by the Society for Academic Emergency Medicine
Occupational allergic contact dermatitis from tetrazepam in nurses
Authors: Hulst Kim Vander , Kerre Stefan , Goossens An 
Published: April 2010

Background: Tetrazepam is a muscle relaxant belonging to the benzodiazepine group. Drug eruptions following ingestion of tetrazepam tablets are well known. Objective: To draw the attention to occupational airborne dermatitis and/or hand dermatitis in nurses resulting from crushing of tablets for elderly or disabled people. Methods: Since 2003, 16 nurses with facial (eyelid) and/or hand dermatitis, suspected to be of occupational origin, were patch tested with the medication they handled during work. Results: Ten nurses presented with a positive patch test reaction to tablets containing tetrazepam, 14 controls remaining negative. Some of them also reacted to other drugs. Conclusion: Occupational airborne and/or hand contact dermatitis from tetrazepam might be much more common than suspected by dermatologists, particularly in view of the short period in which all cases have been observed.
Variability in patch test reactions – first report from the Norwegian Patch Test Registry*
Authors: Helsing Per , Gjersvik Petter , Holm Jan‐Øivind , Steinkjer Bjarte , Holsen Dag , Johnsson Margareta , Braun Rosemarie , Vårdal Mari , Austad Joar 
Published: April 2010

Background: A nation‐wide Norwegian Patch Test Registry (NOLAR) was established in 2005 as a collaboration between six dermatology departments. International, multi‐centre studies have documented great variability in the frequency of positive patch test reactions, considered as mainly due to heterogeneity of test populations. Objectives: To analyse the variability of positive test reactions by studying patch tests performed at the six collaborating departments, using standardized procedures. Materials and methods: Data from all patch tests (n = 2089) performed in 2007–2008 as registered in the NOLAR program. Differences between centres were analysed using Exact Pearson χ2 test. Results: Between the centres, positive test reactions (+, ++, or +++) varied significantly for 8 of the 26 allergens in the European Baseline Series. When considering strong reactions (++ or +++) only, the differences were statistically significant for six of these allergens, i.e. cobalt chloride, potassium dichromate, p‐phenylenediamine, formaldehyde, paraben mix, and mercaptobenzothiazole. Conclusion: The results indicate regional differences in the prevalence of sensitization to certain allergens within the Norwegian population, although inter‐observer differences cannot be ruled out as a factor.
REVIEW ARTICLE: Th1/Th2/Th17 and Regulatory T‐Cell Paradigm in Pregnancy
Authors: Saito Shigeru , Nakashima Akitoshi , Shima Tomoko , Ito Mika 
Published: April 2010

Citation Saito S, Nakashima A, Shima T, Ito M. Th1/Th2/Th17 and regulatory T‐cell paradigm in pregnancy. Am J Reprod Immunol 2010T‐helper (Th) cells play a central role in modulating immune responses. The Th1/Th2 paradigm has now developed into the new Th1/Th2/Th17 paradigm. In addition to effector cells, Th cells are regulated by regulatory T (Treg) cells. Their capacity to produce cytokines is suppressed by immunoregulatory cytokines such as transforming growth factor (TGF)‐β and interleukin (IL)‐10 or by cell‐to‐cell interaction. Here, we will review the immunological environment in normal pregnancy and complicated pregnancy, such as implantation failure, abortion, preterm labor, and preeclampsia from the viewpoint of the new Th1/Th2/Th17 and Treg paradigms.
Facial fractures in children and adolescents: a retrospective study of 3 years in a hospital in Belo Horizonte, Brazil
Authors: Chrcanovic Bruno Ramos , Abreu Mauro Henrique Nogueira Guimarães , Freire‐Maia Belini , Souza Leandro Napier 
Published: April 2010

Abstract –  Aim:  The purpose of this study was to review the etiology, incidence and treatment of selected oral and maxillofacial fractures in children in Belo Horizonte, Brazil, during a period of 3 years.Materials and methods:  The data collected for this study included age, gender, etiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture and treatment. The analysis involved descriptive statistics and chi‐squared test, Bonferroni test, Kolmogorov–Smirnov, Kruskal–Wallis and Mann–Whiney tests and analysis of variance.Results and conclusions:  This study examined 566 facial fractures in 464 children of 18 years of age or less. The majority of fractures were observed in children within the age group of 13–18 years of age. Bicycle accidents were the major cause of trauma, followed by falls. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the nose. A conservative approach was applied in most cases.
Botulinumtoxin A treatment in toddlers with cerebral palsy
Authors: Tedroff K , Löwing K , Haglund‐Åkerlind Y , Gutierrez‐Farewik EM , Forssberg H 
Published: April 2010

AbstractAims:  In this study the aim was to evaluate the effect of botulinum toxin A (BoNT‐A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP).Method:  Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT‐A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait‐analysis was performed at 5 years of age.Results:  Plantarflexor muscle tone in the BoNT‐A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change‐score in knee‐flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT‐A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM‐66 or PEDI.Conclusion:  Early treatment of BoNT‐A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.
Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis
Authors: Marks Stephen D , Tullus Kjell 
Published: April 2010

AbstractThere is still a significant morbidity and mortality associated with childhood‐onset systemic lupus erythematosus (SLE), despite an increasing armamentarium of immunosuppressive agents. The ideal therapeutic strategy for children and adolescents with SLE should provide the right amount of treatment to allow normal growth, development and fertility while reducing the disease activity and damage that can be accrued over the years. Each patient should have individualized treatments tailored to their organ involvement, disease severity and history of flares together with recent clinical, haematological and immunological parameters to avoid further flares of disease activity and side‐effects of treatment, especially severe infections and future malignancies. The most commonly cited side‐effects of medications include Cushingoid features of corticosteroids, infective complications of cyclophosphamide and gastrointestinal side‐effects of mycophenolate mofetil. There is increasing evidence to support the use of oral mycophenolate mofetil as opposed to cyclophosphamide for both induction and maintenance therapies in many children with SLE with or without lupus nephritis (LN). Recently, case series utilizing B‐lymphocyte depletion therapies with rituximab look promising for patients with severe or refractory disease activity. In this article, we explore current evidence to effectively treat children and adolescents with SLE with or without LN.Conclusion:  Modern therapeutic strategies include reduced doses and use of corticosteroids and intravenous cyclophosphamide respectively, with increased use of azathioprine, MMF and rituximab.
Effects of Local Melatonin Application on Implant Osseointegration
Authors: Tresguerres Isabel F. , Clemente Celia , Blanco Luis , Khraisat Ameen , Tamimi Faleh , Tresguerres Jesús A.F. 
Published: April 2010

ABSTRACTPurpose: The aim of this study was to assess the effect of local melatonin administration on bone osseointegration around implants in rabbit tibiae.Material and Methods: Ten female, 6‐month‐old New Zealand rabbits were randomly divided into two groups: the experimental group, where five rabbits were treated with local application of melatonin (3 mg) to implant sites when placed into the rabbit tibia, and the control group, those who where without additive materials. Four weeks later, animals were sacrificed; tibiae were dissected from soft tissues and fixed in buffered formaldehyde, and then included in methacrylate. Histological sections were performed to be studied under light microscopy and analyzed morphometrically to evaluate the amount of bone to implant contact (BIC), trabecular area density, and cortical area density. One‐way analysis of variance test was used for statistical evaluation. p < .05 was considered to be significant.Results: Histological evaluation showed more trabecular reaction in the melatonin group. Morphometrical analysis showed a statistically significant increase in trabecular BIC in the melatonin group when compared with the control group (24.61% ± 2.87 vs 13.62% ± 1.44; p < .01). Cortical BIC was decreased in the melatonin group, without statistical significance (71.08 ± 3.63 vs 76.28 ± 2.57; p = 0.31). Trabecular area density was increased significantly in the melatonin group (8.68 ± 1.61 vs 4.02 ± 0.36; p < .05). Cortical area density was decreased significantly in the melatonin group (91.31 ± 1.6 vs 95.7 ± 0.5; p < .05).Conclusion: Within the limitation of this animal study, local melatonin application at the time of implant placement might induce more trabecular bone at implant contact and higher trabecular area density.
Titanium Implants after Alkali Heating Treatment with a [Zn(OH)4]2− Complex: Analysis of Interfacial Bond Strength Using Push‐Out Tests
Authors: Alvarez Kelly , Fukuda Masayuki , Yamamoto Osamu 
Published: April 2010

ABSTRACTBackground: Clinical demands for stronger and faster bone bonding to implants have motivated the development of chemically and topographically modified surfaces capable of chemical bonding. This study presents a new one‐step alkali heat treatment performed with a solution containing [Zn(OH)4]2− complex as an alternative to the conventional NaOH solution.Purpose: The objective of this work is to assess the effect of a Zn‐modified surface chemistry on bone‐implant shear strength using a rabbit model.Materials and Methods: The study was conducted on mechanical‐grinded and smooth surfaces of Ti cylindrical implants. The topographical structure, chemical surface composition, and structural properties of the chemically modified titanium surface were studied by scanning electron microscopy, x‐ray photoelectron spectroscopy, and x‐ray diffractometry. Implant‐bone shear strength was evaluated by push‐out tests undertaken at 4, 12, and 24 weeks after insertion in rabbit femora.Results: Implants with smooth and rough surfaces chemically‐modified with a solution containing [Zn(OH)4]2− complex demonstrated significantly stronger bone fixation than nonmodified implants at all healing times (p < 0.05).Conclusions: The obtained results suggest that biochemical bonding at the bone‐implant interface, stimulated by the Zn2+ ion release in combination with mechanical interlocking definitively improved the implant fixation.
Gender role attitudes of hospital nurses in Japan: Their relation to burnout, perceptions of physician–nurse collaboration, evaluation of care, and intent to continue working
Authors: USHIRO Rei , NAKAYAMA Kazuhiro 
Published: April 2010

AbstractAim:  The purpose of the present study is to examine the relationship between gender role attitudes of nurses and burnout, perceptions of physician–nurse collaboration, evaluation of care, and intent to continue working.Methods:  The subjects of the study were 798 full‐time female nurses working in non‐managerial positions at three large hospitals. We analyzed five key survey items – gender role attitudes, burnout, perceptions of physician–nurse collaboration, evaluation of care, and intent to continue working – and showed how these items are related using structural equation modeling.Results:  Whether nurses' gender role attitudes were egalitarian or conservative, we found a direct positive effect on burnout. However, a conservative gender role attitude not only showed a direct positive effect on burnout, but also exhibited a direct negative effect on the intent to continue working and on the collaboration constructs cooperativeness with physicians. Conservative gender role attitudes thus have an indirect positive effect on burnout through the corollaries cooperativeness and intent to continue working. We found that cooperativeness not only has a direct negative effect on burnout, but also an indirect negative effect on burnout through evaluation of care.Conclusions:  It was found that nurses harboring conservative gender role attitudes are more vulnerable to burnout, and also less likely to improve their quality of care.
Surgical management of retroperitoneal tumours: A 12‐year review
Authors: Tai Dora K.C. , Li Wing‐Hong , Cheung Moon‐Tong 
Published: April 2010

Background:  The aim of the present study was to determine the long‐term outcome of patients who had undergone resection of retroperitoneal tumours.Methods:  This was a retrospective review of 44 patients with preoperative diagnoses of retroperitoneal tumours, who had resections carried out between April 1996 and June 2008 at our institution.Results:  Forty‐four patients at our hospital underwent resection with curative intent for retroperitoneal tumours. Eight patients developed recurrences, and reoperations were carried out in these patients. Merely 23.1% of the patients underwent fine‐needle aspiration, and of those patients, just 15.4% received the correct diagnosis for their retroperitoneal tumour. Liposarcoma was the most common tumour (31.1%). The overall mean largest diameter of the retroperitoneal tumours was 13.4 ± 8.8 cm, and the median largest diameter was 11.0 cm (range: 2–43 cm). No significant difference was found between the mean largest diameters of benign and malignant tumours (P = 0.08). Simultaneous surgical resection of adjacent organs was required in 46.1% of the patients. The overall survival at 5 years for patients with liposarcomas, other malignancies and benign tumours was 20%, 50% and 100%, respectively. The disease‐free survival at 5 years for patients with liposarcomas was zero (P = 0.013), whereas, for other retroperitoneal malignancies and benign tumours, the disease free survival at 5 years was 38% and 100%, respectively.Conclusion:  Surgical management of retroperitoneal tumours often requires a multidisciplinary approach. Long‐term survival rates for patients with liposarcomas are relatively poor, and recurrences after surgical resection are common.
Destruction of the urinary tract by ketamine abuse: Hong Kong local experience
Authors: Chu Peggy Sau‐Kwan , Ma Wai‐Kit , Yu Cheong , Yiu Ming‐Kwong , Man Chi‐Wai 
Published: April 2010

Aim:  To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients.Methods:  The hospital records of 80 ketamine abusers who attended the urology clinics of Princess Margaret Hospital and Tuen Mun Hospital were retrospectively reviewed. Their blood creatinine level, cystoscopic and urodynamic findings were analyzed.Results:  Up to 30–50% of our patients had either contracted bladder with diminished bladder capacity (< 100 mL) or sonographic evidence of hydronephrosisConclusion:  Ketamine abuse can lead to structural damage of the entire urinary tract, but whether the damage is reversible after quitting ketamine abuse requires further studies.
Interactions of Fire and Nonnative Species Across an Elevation/Plant Community Gradient in Hawaii Volcanoes National Park
Authors: Ainsworth Alison , Kauffman J. Boone 
Published: April 2010

ABSTRACTInvasive species interacting with fires pose a relatively unknown, but potentially serious, threat to the tropical forests of Hawaii. Fires may create conditions that facilitate species invasions, but the degree to which this occurs in different tropical plant communities has not been quantified. We documented the survival and establishment of plant species for 2 yr following 2003 wildfires in tropical moist and wet forest life zones in Hawaii Volcanoes National Park, Hawaii. Fires were ignited by lava flows and burned across a steep environmental gradient encompassing two previously burned shrub‐dominated communities and three Metrosideros polymorpha forest communities. Fires in all community types were stand replacing, where >95 percent of overstory trees were top killed. Over half (>57%) of the trees survived via basal sprouting, but sprout growth differed among forest communities. Sprout growth (>250,000 cm3) was greatest in the forest community where postfire understory cover was lowest presumably due to thick native Dicranopteris linearis fern litter that remained postfire. In contrast, M. polymorpha sprout growth was much slower (<100,000 cm3) in the two forest communities where there was rapid understory recovery of nonnative ferns Nephrolepis multiflora and invasive grasses Paspalum conjugatum. These results suggest that the rapid establishment of an invasive‐dominated understory limited recovery of the overstory dominant M. polymorpha. In contrast to the three forest communities, there were few changes in vegetation composition in the shrubland communities. Nonnative species invasions coupled with repeated fires selectively eliminated fire‐sensitive species thereby maintaining these communities in dominance of primarily nonnative, fire‐resilient, species.