bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender differences in asthma prevalence: Variations with socioeconomic disadvantage
Authors: CHITTLEBOROUGH Catherine R. , TAYLOR Anne W. , DAL GRANDE Eleonora , GILL Tiffany K. , GRANT Janet F. , ADAMS Robert J. , WILSON David H. , RUFFIN Richard E. ,   On Behalf of The North West Adelaide Health Study Team
Published: October 2009

ABSTRACTBackground and objective:  Socioeconomic inequalities in health have been shown to vary for different diseases and by gender. This study aimed to examine gender differences in associations between asthma and socioeconomic disadvantage.Methods:  Socioeconomic variables were assessed among men and women in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Asthma was determined from spirometry and self‐reported doctor diagnosis.Results:  The prevalence of asthma was 12.0% (95% CI: 11.1–13.1), and was significantly higher among women (13.5%) than men (10.5%). For participants aged 18–64 years a higher prevalence of asthma was associated with an education level of secondary school or lower, or not being in the paid labour force among men, and with a gross annual household income of $20 000 or less among women. Among socioeconomically advantaged groups, the prevalence of asthma was significantly higher among women than men.Conclusions:  Socioeconomic disadvantage was associated with higher asthma prevalence, although this varied by gender depending on the indicator of socioeconomic position used. Men with low education or those not employed in the paid labour force had higher asthma prevalence than more socioeconomically advantaged men. Women with low income had higher asthma prevalence than those with higher income. Among all socioeconomically advantaged groups, and also the low‐income group, women experienced a higher prevalence of asthma than men.
Chronic neck pain following car crashes: a population‐based study from Auckland, New Zealand
Authors: Ameratunga S. , Tin S. T. , Connor J. , Norton R. 
Published: October 2009

AbstractBackground:  In a setting with a ‘no fault’ universal government‐funded accident compensation system, we undertook a study to (i) estimate the prevalence and predictors of chronic neck pain in car occupants surviving serious injury‐producing crashes and (ii) compare the longer‐term health‐related quality of life of crash survivors with and without neck discomfort.Methods:  A prospective cohort study recruited hospitalized survivors aged ≥16 years and non‐hospitalized drivers of cars involved in serious crashes in Auckland over a 10‐month period. Participants completed a structured questionnaire at recruitment and 5 and 18 months later.Results:  Of the 268 participants, 50 (18.7%) reported neck pain or stiffness at 5 and 18 months following the crash. Of these, 70% noted the discomfort led to limitations in work and recreation. Depressive and post‐traumatic stress symptoms at 5 months were associated with an increased risk of moderate to severe neck discomfort at 18 months. Participants with and without neck discomfort had significantly reduced health‐related quality of life based on Short Form‐36 scores.Conclusion:  Significant neck discomfort limiting usual function is relatively common up to 18 months following crashes. The reductions in health status among crash survivors with and without neck pain reveal the complexities in attributing longer‐term adverse outcomes to a particular condition in the absence of an appropriate comparison group. The findings indicate the need to manage judiciously comorbid conditions while prioritizing efforts to support crash survivors' return to their usual social roles and activities.
The utility of transoesophageal echocardiography to determine management in suspected embolic stroke
Authors: Galougahi K. K. , Stewart T. , Choong C. Y. P. , Storey C. E. , Yates M. , Tofler G. H. 
Published: October 2009

AbstractBackground:  Assessment for source of stroke is a common indication for transoesophageal echocardiography (TOE). Although an abnormality is frequently found, it remains uncertain how frequently the findings alter patient management. Also, the role of transthoracic echocardiography (TTE) prior to or instead of TOE is not well defined. We sought to determine the use of TTE prior to TOE, the outcome of the TOE and its impact on management.Methods:  We retrospectively reviewed the records and echocardiography results of 100 consecutive patients who underwent TOE for any reason at a tertiary hospital. In 35 subjects (35%), the indication was evaluation for source of stroke. Among these, we determined clinical risk factors for stroke, if a TTE was performed prior to their TOE, the results of the TOE and its effect on management.Results:  The mean age of the stroke patients was 64.6 years (17–90) and 49% were women. Eighty per cent had at least one risk factor for stroke and 17% had atrial fibrillation. A TTE, performed in 40% prior to the TOE, found an abnormality in 14% (2/14). The TOE showed an abnormality in 71% of patients; 54% had aortic atheroma; 17% PFO; 14% spontaneous echo contrast; 6% left atrial appendage thrombus, 3% left ventricular thrombus and 3% vegetation. In only one patient (3%) the management was altered based on the abnormal TOE findings.Conclusion:  An abnormality on TOE, although common (71%) and more sensitive than TTE, altered management in only 3% of subjects referred for stroke assessment. Its role requires further consideration.
Prevalence and predictors of premature discontinuation of dual antiplatelet therapy after drug‐eluting stent implantation: importance of social factors in Asian patients
Authors: Poh C‐L. , Chan M. Y. , Lau C. , Teo S‐G. , Low A. F. , Tan H‐C. , Lee C‐H. 
Published: October 2009

AbstractAim:  Premature discontinuation of antiplatelet therapy is an independent predictor of late stent thrombosis. We sought to determine the prevalence and predictors of premature discontinuation of antiplatelet therapy after drug‐eluting stent implantation among patients in Asia.Methods:  A total of 207 consecutive patients who underwent drug‐eluting stent implantation at our institution was followed up after 1 year. Premature discontinuation of antiplatelet therapy was defined as omission of aspirin and/or clopidogrel for 1 week or more.Results:  Four (1.9%) patients died and the remaining 203 patients formed the study population. Prevalence of premature discontinuation of antiplatelet therapy was 12.8% (n= 26, aspirin, n= 12; clopidogrel, n= 9; both, n= 5). The median duration between stent implantation and discontinuation of antiplatelet therapy was 2.8 months. Reasons for discontinuation included cost (n= 1), gastric discomfort (n= 1), allergy (n= 3), bleeding (n= 3), advice from doctors (n= 7) and no reason (n= 11). Logistic regression showed that living alone was the only independent predictor of premature discontinuation of dual antiplatelet therapy (50.0% vs 11.3%, P= 0.001).Conclusion:  Among Asian patients who have undergone drug‐eluting stent implantation, 12.8% discontinued dual antiplatelet therapy within 12 months. Living alone is associated with a fivefold increase in risk of premature drug discontinuation.
Continuity of care: when do patients visit community healthcare providers after leaving hospital?
Authors: Roughead E. E. , Kalisch L. M. , Ramsay E. N. , Ryan P. , Gilbert A. L. 
Published: October 2009

AbstractBackground/Aims:  Enhanced communication and transfer of information between healthcare providers and healthcare settings can reduce medication and healthcare errors post‐hospital discharge. The timeframes within which patients access community healthcare providers post‐hospital discharge are not well studied. This study aimed to determine length of time from hospital discharge until a general practice, pharmacy or specialist visit, or care planning service.Methods:  We conducted a retrospective analysis of Department of Veterans' Affairs health claims data. All 109 860 veterans hospitalized in 2006 were included. Main outcome measures were time from first hospital discharge to first claim for a general practice, pharmacy, specialist visit and/or care planning service.Results:  Within 30 days of hospital discharge 71% of subjects visited a general practitioner (GP), 86% had medicines dispensed from a community pharmacy and 44% saw a specialist. Median time to first pharmacy visit was 6 days (interquartile range 2–14) and 12 days for a GP visit (interquartile range 4–31). Less than 2% of the cohort received a discharge plan, case conference or medication review in the month after discharge.Conclusions:  With 25% of patients having a claim for a GP service within 4 days of discharge, discharge summaries need to reach community‐based health professionals within this time. Most patients visited their community pharmacy within 2 weeks of hospital discharge and before they saw their GP. Pharmacists are not routinely advised of hospitalization or provided with discharge summaries. More active engagement of this professional group in the continuum of care might improve care after hospital discharge.
Clinical and biochemical characteristics of patients with thyroid‐stimulating hormone‐secreting pituitary adenomas from one New Zealand centre
Authors: Elston M. S. , Conaglen J. V. 
Published: October 2009

AbstractBackground:  Thyroid‐stimulating hormone (TSH)‐secreting pituitary adenomas (TSHoma) are a rare cause of thyrotoxicosis and need to be distinguished from the syndrome of resistance to thyroid hormone. Patients with TSHoma may also be misdiagnosed as having primary hyperthyroidism and receive inappropriate treatment directed towards the thyroid gland.Methods:  We performed a retrospective review of patients with TSHoma who presented to one New Zealand endocrine service between 1989 and 2003.Results:  Six patients with TSHoma were managed during this time period. All patients had elevated free thyroid hormone levels with elevated, or inappropriately normal, TSH levels. The median age at presentation was 43 years and the median time from symptom onset to correct diagnosis was 3 years (range 0.25–12 years). Five patients had a macroadenoma at the time of diagnosis. Three had been treated elsewhere for primary hyperthyroidism prior to referral. Three patients received octreotide as primary treatment with two of these patients later undergoing transsphenoidal resection of the pituitary adenoma.Conclusion:  With increased awareness and earlier diagnosis of TSH‐secreting pituitary adenomas, management can be appropriately directed towards the pituitary.
Long‐term percutaneous endoscopic gastrostomy feeding in young adults with multiple disabilities
Authors: Lee L. , MacPherson M. 
Published: October 2009

AbstractAim: To study the outcomes from initiation of percutaneous endoscopic gastrostomy (PEG) feeding in young people with profound multiple disabilities.Methods: Observations were made on 40 adults with lifelong intellectual disability (mental retardation) and quadriplegia, in whom PEG feeding was initiated during 1990–2008. There were 20 men and 20 women aged 15–40 years at the time of the audit, living in settings with 24 h registered nurse staffing.Results: Undernutrition and recurrent aspiration with frequent infections were cited as reasons for PEG feeding. The positive outcomes were that some were said to be more alert for a time following the procedure; and these young adults lived with PEG feeding for an average of 8.5 years, some up to 18 years. In that time, however, they all experienced complications of the PEG insertion, and of the PEG feeding process. There were no measurable improvements in cognition. There were no reductions in prescription of medications. They all required frequent daily interventions by nurses to maintain medical stability. Ten people died during this review period, from continued deterioration in neurological status, with pneumonia cited as the terminal event.Conclusions: Unlike other people with neurological deterioration, young adults with lifelong multiple disabilities may live for many years with PEG feeding. There is little gain in quality of life.
Cardiovascular mortality and morbidity in chronic obstructive pulmonary disease: the impact of bronchodilator treatment
Authors: Wood‐Baker R. , Cochrane B. , Naughton M. T. 
Published: October 2009

AbstractChronic obstructive pulmonary disease (COPD) is a substantial health burden. Cardiovascular disease (CVD), the leading cause of death, frequently coexists with COPD, an effect attributed to high individual disease prevalences and shared risk factors. It has long been recognized that COPD, whether stable or during acute exacerbations, is associated with an excess of cardiac arrhythmias. Bronchodilator medications have been implicated in the excess CVD seen in COPD, either as an intrinsic medication effect or related to side‐effects. Despite the theory behind increased pro‐arrhythmic effects in COPD, the reported results of trials investigating this for inhaled formulations at therapeutic doses are few. Methodological flaws, retrospective analysis and inadequate adjustment for concomitant medications, including short‐acting ‘relief’ bronchodilators and non‐respiratory medications with known arrhythmia propensity, mar many of these studies. For most bronchodilators at therapeutic levels in stable COPD, we can be reassured of their safety from current studies. The exception to this is ipratropium bromide, where the current data indicate an association with increased cardiovascular adverse effects. Moreover, there is no proven benefit from combining short‐acting beta‐agonists with short‐acting anticholinergics at high doses in the acute setting, and although this practice is widespread, it is associated with increased cardiovascular risk.
Intraperitoneal distribution imaging in ovarian cancer patients
Authors: Dawson S. J. , Hicks R. J. , Johnston V. , Allen D. , Jobling T. , Quinn M. , Rischin D. 
Published: October 2009

AbstractBackground/Aims: Optimal delivery of intraperitoneal (IP) chemotherapy is dependent on adequate drug distribution. An accurate understanding of the limitations of IP distribution is critical if we are to improve cytotoxic delivery through this route.Methods: Using repeated scintigraphic peritoneography we investigated peritoneal fluid distribution in patients receiving IP therapy. Both early (1–6 h) and late (24–48 h) images were performed. The peritoneal cavity was divided into six regions; pouch of Douglas, left and right paracolic gutters, left and right subphrenic spaces and the right subhepatic space. The distribution in each region was classified as absent (0), faint (1) or intense (2). A total distribution score was calculated from the summation of distribution values for each of the six regions. Distribution was then graded according to the total distribution score as follows: Grade 0 = 0–3; Grade 1 = 4–6; Grade 2 = 7–9; and Grade 3 = 10–12.Results: Twenty‐six participants were included in the study: all 26 patients had early imaging performed and 21 of these also had late imaging. Thirteen (50%) and 15 (71%) patients had grade 1 or 2 IP distribution on early and late imaging respectively. The most common abdominal regions to show maldistribution were the subphrenic spaces.Conclusions: This study highlights the deficiencies of distribution following IP drug delivery, with the majority of patients demonstrating multiple regions of faint or absent uptake on scintigraphic peritoneography imaging. Future large clinical studies investigating IP chemotherapy should include analyses of IP distribution to improve our understanding of optimal drug delivery through this route.
Managing obstruction of the central airways
Authors: Williamson J. P. , Phillips M. J. , Hillman D. R. , Eastwood P. R. 
Published: October 2009

AbstractLung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20–30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post‐obstructive pneumonia and ultimately death. Non‐malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre‐procedure work‐up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.
Vaccination and screening for infections in patients with inflammatory bowel disease: a survey of Australian gastroenterologists
Authors: Gupta A. , Macrae F. A. , Gibson P. R. 
Published: October 2009

AbstractAims: To survey the practice among gastroenterologists in Australia relating to screening for latent infections and vaccination of patients with inflammatory bowel disease prior to treatment with tumour necrosis factor alpha (TNF‐α) inhibitors.Methods: A structured 15 question electronic survey was advertised to gastroenterologists in Australia through an email mailing list and through a hardcopy newsletter.Results: Forty‐four clinicians responded to the survey. Screening practice relating to latent tuberculosis infection and hepatitis B virus (HBV) was performed variably, with significant differences in screening methodology. Vaccination for HBV, influenza and pneumococcus was performed infrequently, and the timing of when vaccination should be offered varied considerably.Conclusions: Despite published guidelines advocating screening for latent infections and vaccination of patients treated with TNF‐α inhibitors, compliance with recommendations was poor. Recommendations for screening and vaccination of these patients are provided based on these findings.
Weak population regulation in ecological time series
Authors: Ziebarth Nicolas L. , Abbott Karen C. , Ives Anthony R. 
Published: October 2009

AbstractHow strongly natural populations are regulated has a long history of debate in ecology. Here, we discuss concepts of population regulation appropriate for stochastic population dynamics. We then analyse two large collections of data sets with autoregressive‐moving average (ARMA) models, using model selection techniques to find best‐fitting models. We estimated two metrics of population regulation: the characteristic return rate of populations to stationarity and the variability of the stationary distribution (the long‐term distribution of population abundance). Empirically, longer time series were more likely to show weakly regulated population dynamics. For data sets of length ≥ 20, more than 35% had characteristic return times > 6 years, and more than 29% had stationary distributions whose coefficients of variation were more than two times greater than would be the case if they were maximally regulated. These results suggest that many natural populations are weakly regulated. Ecology Letters (2010) 13: 21–31
The role of surveillance in the treatment of patients with muscle‐invasive bladder cancer after chemotherapy
Authors: Hellenthal Nicholas J. , Ramirez Michelle L. , Evans Christopher P. , DeVere White Ralph W. 
Published: October 2009

Study Type – Prognosis (case series) Level of Evidence 4OBJECTIVETo determine the survival of patients at our institution who were clinically tumour‐free (cT0) on re‐staging transurethral resection (TUR) after treatment with chemotherapy for muscle‐invasive bladder cancer.PATIENTS AND METHODSIn all, 55 patients with muscle‐invasive, organ‐confined transitional cell carcinoma of the bladder were treated with TUR followed by systemic chemotherapy, over a 10‐year period. Patients were separated into two groups, those who were clinically T0 and those who showed persistent disease (>cT0) on re‐biopsy after chemotherapy. Overall and disease‐specific survival rates were calculated for the two groups. The cT0 group was further followed for tumour recurrence and clinical outcomes.RESULTSThirty‐one patients (56%) were clinically T0 on TUR after chemotherapy; of these patients, 22 (71%) either died from other causes (with no disease recurrence) or are alive and with no evidence of disease at a mean follow‐up of 53 months. Twenty of the 31 patients (65%) have retained their bladder with no evidence of cancer recurrence at a mean follow‐up of 46 months. Disease‐free status (cT0) at the time of TUR after chemotherapy was associated with significantly higher overall and cancer‐specific survival (hazard ratio 3.40, P = 0.003; and 8.63, P = 0.001, respectively).CONCLUSIONPrevious studies suggest that surveillance can be a reasonable option for patients with muscle‐invasive transitional cell carcinoma of the bladder who show no evidence of disease on TUR after chemotherapy. Patients with persistent bladder cancer on re‐biopsy after chemotherapy tend to fare poorly even with immediate cystectomy.
Is surveillance of small renal masses safe in the elderly?
Authors: O’Malley Rebecca L. , Godoy Guilherme , Phillips Courtney K. , Taneja Samir S. 
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo determine if preoperative variables, including gender, age and tumour size, influence the decision for active surveillance of renal masses, as due to the increasing detection of incidental renal masses within the ageing population there is a need to identify reliable means of selecting patients who require therapy.PATIENTS AND METHODSWe retrospectively identified all renal masses resected at our institution between 1 December 1999, and 1 October 2005. The size of tumour, patient age and gender were compared between those with and without malignancy on final pathology. The influence of these variables in predicting malignancy, high grade, and high stage were assessed by univariate and multivariate analysis using logistic regression models, with a significance level of P < 0.05. Subsets were analysed for the groups of patients with tumours of ≤3 or >3 cm and those aged ≤75 or >75 years.RESULTSAmong 466 of 501 patients with evaluable data, univariate analysis showed that both male gender and increasing size positively predicted malignancy (odds ratio 1.13 and 1.40, respectively), but age, treated as a continuous variable, did not. On multivariate analysis both remained independent predictors of malignancy (odds ratio 1.13 and 1.40, respectively). Size was the only independent predictor of high‐stage and high‐grade disease on both univariate and multivariate analysis. Among 156 patients with tumours of ≤3 cm, on multivariate analysis, male gender was only weakly associated with the risk of malignancy, whereas size remained strongly predictive (odds ratio 1.98, P = 0.076; and 2.16, P = 0.015, respectively). Neither male gender, size nor age increased the risk of high‐stage or high‐grade disease in this cohort. Patients who were aged >75 years had a greater risk of high‐stage disease than those aged <75 years (odds ratio 2.64, P = 0.008). On multivariate analysis, age >75 years remained an independent predictor of malignancy and high‐stage, along with size (odds ratio 2.75, P = 0.014; and 1.35, P < 0.001).CONCLUSIONSIncreased size of tumour increases the risk of malignancy and the likelihood of high‐stage and high‐grade disease. Among patients aged >75 years there was a higher risk of malignancy and high‐stage disease than in those aged ≤75 years. As such, the decision for observation should not be based upon age alone, and should be approached with caution in patients aged >75 years, particularly for larger lesions.