bluuebunny/crossref_metadata_2025_split huggingface dataset:
Caring for people with chronic disease: is ‘muddling through’ the best way to handle the multiple complexities?
Authors: Sturmberg Joachim P. 
Published: July 2012

AbstractIt is stated everywhere that chronic care poses one of the biggest challenges for the future of medicine. Critical analysis however suggests that these statements are oversimplistic and based on limited, and at times, spurious assumptions. This paper highlights some basic realities: epidemiology shows that at any time, 80% of people experience ‘good enough health’, and that only 0.8% require tertiary medical care; most people with chronic conditions experience a stable illness trajectory; ‘true’ multi‐morbidity is a pattern of advanced age; ageing and the physiological decline of our organ systems is a slow and steady process starting at the age of 30; and, as our health declines in a variety of patterns with disease and ageing, our psycho‐socio‐semiotic care needs increase dramatically. I argue that managing the complexities associated with chronic disease care successfully requires an equally complex management approach, ‘muddling through’, defined by Lindblom as making decisions based on successive limited comparisons. Our patients – rightly – expect that we make these decisions in their best interest. Individual health care professionals and health care policy makers firmly need to put the patient at the centre of the health care system.
Estimating measurement error when annualizing health care costs
Authors: Linden Ariel , Samuels Steven J. 
Published: July 2012

AbstractObjectiveHealth insurers routinely annualize members’ health care costs for reporting, predicting high cost cases and evaluating health management programmes. Annualization is the practice of extrapolating to a yearly cost from less than a year of data. In this paper, we systematically estimate the measurement error inherent in this approach.Study designThe paper uses a retrospective observational study using longitudinal claims data from three types of insured populations: Medicare managed care, public employees and a self‐insured employer.MethodsThe unit of analysis was a block ‘year’ consisting of 12 consecutive months of cost data for any individual member. These blocks were constructed recursively allowing use of all available data that an individual could contribute. We tested the accuracy of the annualized costs by calculating the absolute error (AE) representing the difference, in dollars, between the actual annual costs and the predicted annual costs, and the absolute percentage error (APE) which is the absolute error divided by the actual 12‐month costs.ResultsUnder the best case scenario (when 11 months of data were used to annualize costs), the mean AE ranged from approximately $2700 for the Medicare population to about $400 for the two working‐aged populations; and the mean APE ranged from 9.6% to 11.0% in the three populations. Accuracy diminished systematically with fewer months of available data.ConclusionsDue to the largely unpredictable nature of monthly costs, annualization can produce substantial measurement error. Given the importance of cost metrics for decision making, we offer several alternative approaches that insurers should consider to improve measurement accuracy.
Are health professionals’ perceptions of patient safety related to figures on safety incidents?
Authors: Martijn Lucie , Harmsen Mirjam , Gaal Sander , Mettes Dirk , van Dulmen Simone , Wensing Michel 
Published: July 2012

AbstractObjectiveThe study aims to explore whether health care professionals’ perceptions of patient safety in their practice were associated with the number of patient safety incidents identified in patient records.SettingSeventy primary care practices of general practice, general dental practice, midwifery practices and allied health care practices were used in the study.MethodsA retrospective audit of 50 patient records was performed to identify patient safety incidents in each of the practices and a survey among health professionals to identify their perceptions of patient safety.ResultsAll health professions felt that ‘communication breakdowns inside the practice’ as well as ‘communication breakdowns outside the practice’ and ‘reporting of patient safety concerns’ were a threat to patient safety in their work setting. We found little association between the perceptions of health professionals and the number of safety incidents. The only item with a significant relation to a higher number of safety incidents referred to the perception of ‘communication problems outside the practice’ as a threat to patient safety.ConclusionsThis study indicates that the assessment of professionals’ perceptions may be complementary to observed safety incidents, but not linked to an objective measure of patient safety.
Dietary practices in glutaric aciduria type 1 over 16 years
Authors: Gokmen‐Ozel H. , MacDonald A. , Daly A. , Ashmore C. , Preece M. A. , Hendriksz C. , Vijay S. , Chakrapani A. 
Published: July 2012

How to cite this article
Gokmen‐Ozel H., MacDonald A., Daly A., Ashmore C., Preece M.A., Hendriksz C., Vijay S. & Chakrapani A. (2012) Dietary practices in glutaric aciduria type 1 over 16 years. J Hum Nutr Diet.AbstractBackground:  In glutaric aciduria type 1 (GA1), dietary treatment with emergency management (EM) is essential to prevent encephalopathic crisis (EC). In the present study, dietary practices were examined in a single UK centre without access to newborn screening.Methods:  Twenty GA1 patients (11 males, median age: 10.2 years, range 2.2–24.1 years) were evaluated. Nine presented without EC (median diagnosis age: 1.1 years, range 4 days to 8 years) and 11 with EC (median diagnosis age 10 months, range 6 months to 1.7 years). Dietary treatment, neurological outcome, anthropometry and biochemical/haematological markers were assessed.Results:  Diet treatment varied according to age of diagnosis and symptom severity. Four of six pre‐encephalopathic children diagnosed before 2 years of age were treated with carnitine, protein restriction (medium l.2 g kg day−1) and lysine‐free/low tryptophan protein substitute (PS) (medium dose: 1.6 g kg day−1). EM consisted of natural protein cessation and glucose polymer with PS delivered via an enteral feeding tube. Older children (>3 years) without EC were given carnitine and protein restriction, and seven of nine EC patients had PS via an enteral feeding tube. Clinical deterioration occurred in two patients without EC; one taking PS and protein restriction (with a second untreatable pathology) and one after protein restriction only. In patients presenting with EC, four died and one had some improvement in movement, with the rest remaining stable but with severe disability. Patients taking PS had better nutritional markers [serum vitamin B12 (P < 0.001), albumin (P < 0.001), haemoglobin (P < 0.001) and essential plasma amino acids].Conclusions:  Early diagnosis of GA1 before EC is essential because PS and protein restriction with meticulous EM prevents EC. PS also improves nutritional status irrespective of clinical condition.
Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP‐QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour
Authors: McVilly K. , Webber L. , Paris M. , Sharp G. 
Published: July 2012

AbstractBackground  Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II (BSP‐QEII) was developed to monitor and assess BSPs prepared by teachers to support children with disability in the school system. This study investigated the application of the BSP‐QEII to the assessment of BSPs for adults with ID in community support services.Method  The inter‐rater reliability of the BSP‐QEII was assessed. The utility of the BPS‐QEII was then investigated with reference to a time series study of matched pairs of BSPs, developed for the same clients over a period of approximately 3 years. Differences in plan quality measured across a number of service and systemic variables were also investigated.Results  The BSP‐QEII was found to have good inter‐rater reliability and good utility for audit purposes. It was able to discriminate changes in plan quality over time. Differences in plan quality were also evident across different service types, where specialist staff had or had not been involved, and in some instances where a statutory format for the plan had or had not been used. There were no differences between plans developed by government and community sector agencies, nor were there any regional differences across the jurisdiction.Conclusions  The BSP‐QEII could usefully be adopted as an audit tool for measuring the quality of BSPs for adults with ID. In addition to being used for research and administrative auditing, the principles underpinning the BSP‐QEII could also be useful to guide policy and educational activities for staff in community based services for adults with ID.
Association of suppressor of cytokine signalling 3 polymorphisms with insulin resistance in patients with chronic hepatitis C
Authors: Zheng Y.‐Y. , Wang L.‐F. , Fan X.‐H. , Wu C.‐H. , Huo N. , Lu H.‐Y. , Xu X.‐Y. , Wei L. 
Published: July 2012

SummarySuppressor of cytokine signalling 3 is thought to be associated with insulin resistance in patients with chronic hepatitis C. We evaluated the role of suppressor of cytokine signalling 3 polymorphisms in determining insulin resistance in patients with chronic hepatitis C. Two hundred and ninety untreated hepatitis C virus‐infected patients without diabetes and cirrhosis were genotyped for the SNPs rs4969168, rs4969170 and rs12952093 of suppressor of cytokine signalling 3 using the TaqMan Genotyping Assay. We found that the rs4969170 AA genotype and rs4969170 A allele frequency were significantly more common in the insulin‐resistant group than the non‐insulin‐resistant group (89.5% vs 76.1%, OR = 2.693, 95% CI: 1.221‐5.939, P = 0.012 and 94.8% vs 88.0%, OR = 2.463, 95% CI: 1.151–5.271, P = 0.017, respectively). Haplotype G‐C was likely associated with non‐insulin resistance (adjusted P = 0.011). Multiple logistic regression analysis indicates that the independent risk factors for insulin resistance are the SNP rs4969170 AA genotype (OR = 3.005, 95% CI: 1.194–7.560, P = 0.019), HCV genotype 1 (OR = 2.524, 95% CI: 1.099–5.794, P = 0.029) and BMI (OR = 0.514, 95% CI: 0.265–0.999, P = 0.05).
Stochasticity of TOL plasmid catabolic promoters sets a bimodal expression regime in Pseudomonas putida mt‐2 exposed to m‐xylene
Authors: Silva‐Rocha Rafael , de Lorenzo Víctor 
Published: July 2012

SummaryThe expression dynamics of the catabolic promoters of the TOL plasmid pWW0 has been examined in single cells of Pseudomonas putida mt‐2 exposed to m‐xylene. To this end, we employed an á la carte bi‐cistronic gfp–lacZ reporter system for generating monocopy transcriptional fusions to each of the four promoters (Pr, Ps, Pu and Pm) of the regulatory network. Whereas expression of xylR (the master regulatory gene of the TOL system) behaved in a unimodal fashion, the activation of Pu and Pm displayed a high degree of stochasticity. This event resulted in a time‐dependent shift in the bacterial population between two induction states without intermediate expression levels. Bimodality of the Pm promoter for the lower TOL pathway was largely due to the propagation of the Ps output throughout the network, which caused stochastic overproduction of the second regulator of the system, XylS. Surprisingly, activation of Pm by the form of XylS that was bound to the pathway intermediate 3‐methylbenzoate was relatively minor. These stochastic phenomena in response to m‐xylene disappeared in the stationary phase. Taken together, the data suggests that genetically homogeneous populations of P. putida mt‐2 employ a strategy of phenotypic variation (metabolic bet‐hedging) when confronted with mixtures of nutrients.
Regulation of archaella expression by the FHA and von Willebrand domain‐containing proteins ArnA and ArnB in Sulfolobus acidocaldarius
Authors: Reimann Julia , Lassak Kerstin , Khadouma Sunia , Ettema Thijs J. G. , Yang Nuan , Driessen Arnold J. M. , Klingl Andreas , Albers Sonja‐Verena 
Published: July 2012

SummaryThe ability of microorganisms to sense and respond to sudden changes in their environment is often based on regulatory systems comprising reversible protein phosphorylation. The archaellum (former: archaeal flagellum) is used for motility in Archaea and therefore functionally analogous to the bacterial flagellum. In contrast with archaellum‐mediated movement in certain members of the Euryarchaeota, this process, including its regulation, remains poorly studied in crenarchaeal organisms like Sulfolobus species. Recently, it was shown in Sulfolobus acidocaldarius that tryptone limiting conditions led to the induction of archaella expression and assembly. Here we have identified two proteins, the FHA domain‐containing protein ArnA and the vWA domain‐containing protein ArnB that are involved in regulating archaella expression in S. acidocaldarius. Both proteins are phosphorylated by protein kinases in vitro and interact strongly in vivo. Phenotypic analyses revealed that these two proteins are repressors of archaella expression. These results represent the first step in understanding the networks that underlie regulation of cellular motility in Crenarchaeota and emphasize the importance of protein phosphorylation in the regulation of cellular processes in the Archaea.
The impact of antiretroviral therapy on adult mortality in rural Tanzania
Authors: Marston Milly , Michael Denna , Wringe Alison , Isingo Raphael , Clark Benjamin D. , Jonas Aswile , Mngara Julius , Kalongoji Samweli , Mbaga Joyce , Changalucha John , Todd Jim , Zaba Basia , Urassa Mark 
Published: July 2012

AbstractObjective  To describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north‐west Tanzania.Methods  Serological and demographic surveillance rounds have been undertaken in a population of approximately 30 000 people since 1994. Free HIV care including ART has been available since 2005. Event history analysis was used to compare mortality rates among HIV‐negative and HIV‐positive adults in the 5‐year period before and after the introduction of ART. Crude and adjusted hazard ratios were calculated using exponential regression models. Interaction between time period and HIV status was assessed to investigate whether there was a non‐linear relationship between these two variables.Results  Male and female mortality patterns varied over the pre‐ and post‐ART period. In women, the crude death rate fell for both HIV negatives and HIV positives hazard rate ratio (HRR = 0.71; 95%CI 0.51–0.99 and HRR = 0.68; 95%CI: 0.46–0.99, respectively). For men, the mortality among the HIV negatives increased (HRR = 1.47; 95%CI: 1.06–2.03) while the decline in mortality among the HIV positives (HRR = 0.77; 95%CI 0.52–1.13) was not statistically significant. The largest decrease in HIV‐positive mortality over the two periods was among the 30‐ to 44‐year‐old age group for women and among the 45‐ to 59‐year‐old age group for men.Conclusion  There has been a modest effect on mortality in the study population following the introduction of free ART 5 years ago. Improving access to treatment and placing greater focus on retaining individuals on treatment are essential if the full potential of treatment for reducing HIV‐related mortality is to be realised.
Using age‐specific mortality of HIV infected persons to predict Anti‐Retroviral Treatment need: a comparative analysis of data from five African population‐based cohort studies
Authors: Żaba Basia , Kasamba Ivan , Floyd Sian , Isingo Raphael , Herbst Kobus , Bärnighausen Till , Gregson Simon , Nyamukapa Constance , Kayuni Ndoliwe , Todd Jim , Marston Milly , Wringe Alison 
Published: July 2012

AbstractObjectives  To present a simple method for estimating population‐level anti‐retroviral therapy (ART) need that does not rely on knowledge of past HIV incidence.Methods  A new approach to estimating ART need is developed based on calculating age‐specific proportions of HIV‐infected adults expected to die within a fixed number of years in the absence of treatment. Mortality data for HIV‐infected adults in the pre‐treatment era from five African HIV cohort studies were combined to construct a life table, starting at age 15, smoothed with a Weibull model. Assuming that ART should be made available to anyone expected to die within 3 years, conditional 3‐year survival probabilities were computed to represent proportions needing ART. The build‐up of ART need in a successful programme continuously recruiting infected adults into treatment as they age to within 3 years of expected death was represented by annually extending the conditional survival range.Results  The Weibull model: survival probability in the infected state from age 15 = exp(−0.0073 × (age − 15)1.69) fitted the pooled age‐specific mortality data very closely. Initial treatment need for infected persons increased rapidly with age, from 15% at age 20–24 to 32% at age 40–44 and 42% at age 60–64. Overall need in the treatment of naïve population was 24%, doubling within 5 years in a programme continually recruiting patients entering the high‐risk period for dying.Conclusion  A reasonable projection of treatment need in an ART naive population can be made based on the age and gender profile of HIV‐infected people.
Determinants of low birthweight, small‐for‐gestational‐age and preterm birth in Lombok, Indonesia: analyses of the birthweight cohort of the SUMMIT trial
Authors: Sebayang Susy K. , Dibley Michael J. , Kelly Patrick J. , Shankar Anita V. , Shankar Anuraj H. ,   on behalf of the SUMMIT Study Group
Published: July 2012

AbstractObjective  To examine the determinants of low birthweight (LBW), small‐for‐gestation (SGA) and preterm births in Lombok, Indonesia, an area of high infant mortality.Methods  Data from The Supplementation with Multiple Micronutrient Intervention Trial (SUMMIT), a double‐blind cluster‐randomised controlled trial, were analysed. The odds ratio of factors known to be associated with LBW, SGA and preterm birth was assessed and adjusted for the cluster design of the trial using hierarchical logistic regression. Determinants included constitutional, demographic and psychosocial factors, toxic exposure, maternal nutrition and obstetric history and maternal morbidity during and prior to pregnancy. Population attributable risks of modifiable determinants were calculated.Results  A cohort of 14 040 singleton births was available for analysis of LBW, with 13 498 observations for preterm births and 13 461 for SGA births. Determinants of LBW and SGA were similar and included infant’s sex, woman’s education, season at birth, mothers’ residence, household wealth, maternal mid‐upper arm circumference (MUAC), height and a composite variable of birth order and pregnancy interval. Socioeconomic indicators were also related to preterm births and included mother’s education, residence and household wealth, while nutritional‐related factors including low MUAC and birth order and interval were associated with preterm birth but not maternal height. Nausea was protective of preterm birth, while diarrhoea was associated with higher odds of preterm birth. Oedema during pregnancy was protective of SGA but associated with higher odds of preterm delivery. Around 33%, 13% and 13% of the determinants of LBW, SGA and preterm births were preventable.Conclusion  Women’s education, maternal nutrition and household wealth and family planning are key factors to improving birth outcomes.
Hygiene and sanitation practices amongst residents of three long‐term refugee camps in Thailand, Ethiopia and Kenya
Authors: Biran Adam , Schmidt Wolf‐Peter , Zeleke Lemlem , Emukule Haron , Khay Hla , Parker Julian , Peprah Dorothy 
Published: July 2012

AbstractObjective  To further the understanding of sanitation and hygiene in long‐term camp populations.Methods  Data were collected by structured observation of handwashing (126 households), a questionnaire on sanitation, hygiene and household characteristics (1089 households) and discussions with mothers. Random walk algorithms were used to select households for observation and survey. Respondents for qualitative methods were a convenience sample.Results  Across all key handwash occasions [excluding events with no handwash (n = 275)], soap was used for 30% of handwashes. After latrine use, both hands were washed with soap on 20% of occasions observed. Availability of soap in households differed across sites and mirrored the extent to which it was distributed free of charge. Qualitative data suggested lack of free soap as a barrier to ‘safe’ handwashing. Laundry was the priority for soap. In Ethiopia and Kenya, open defecation was practised by a significant minority and was more prevalent amongst households of rural origin. In Ethiopia, open defecation was significantly more prevalent amongst women.Conclusions  Despite continuing hygiene education, rates of ‘safe’ handwashing are sub‐optimal. Soap scarcity in some households and the prioritisation of laundry are barriers to safe practice. Heterogeneity with respect to education and place of origin may need to be taken into account in the design of improved interventions.
Contraceptive use among HIV‐positive women in Quang Ninh province, Vietnam
Authors: Chi Bui Kim , Gammeltoft Tine , Hanh Nguyen Thi Thuy , Rasch Vibeke 
Published: July 2012

AbstractObjective  To investigate contraceptive use among HIV‐positive women in Ha long city and Cam Pha town of Quang Ninh, a Northern province of Vietnam.Methods  Cross‐sectional questionnaire study among HIV‐positive women identified through the district HIV/AIDS register. Information on socioeconomic characteristics and contraceptive use before and after HIV diagnosis was obtained through structured questionnaires. Chi‐square testing was used to assess whether the included women differed from the target population in terms of age. Crude Odds ratios (ORs) were calculated to show the association between contraceptive use and the women’s socioeconomic characteristics. Logistic regression analyses were applied to adjust for possible confounding. The women’s contraceptive use before HIV testing and after HIV testing was described and compared by Chi‐square testing, and the association between post‐test counselling and the women’s use of condom was assessed by ORs.Results  Of the 351 participants, 63% stated they had used contraception before HIV diagnosis and 89% stated they had used contraception after HIV diagnosis. Forty six per cent of the women had been using either the pill or an intrauterine device (IUD) before the diagnosis whereas the same applied for only 8% of the women after diagnosis. Thirty‐nine per cent stated they had been using condom before HIV diagnosis whereas 87% stated condom use after HIV diagnosis. Condom use was more common among women who had received post‐test counselling (OR 3.03, 95% CI 1.03–8.90).Conclusions  A change of contraceptive methods from IUD and oral contraception before HIV diagnosis to condom use after HIV diagnosis was observed. The women’s use of condoms after HIV diagnosis was associated with having received post‐test counselling.