bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impaired hepatic drug and steroid metabolism in congenital adrenal hyperplasia due to P450 oxidoreductase deficiency
Authors: Tomalik-Scharte Dorota , Maiter Dominique , Kirchheiner Julia , Ivison Hannah E , Fuhr Uwe , Arlt Wiebke 
Published: September 2010

ObjectivePatients with congenital adrenal hyperplasia due to P450 oxidoreductase (POR) deficiency (ORD) present with disordered sex development and glucocorticoid deficiency. This is due to disruption of electron transfer from mutant POR to microsomal cytochrome P450 (CYP) enzymes that play a key role in glucocorticoid and sex steroid synthesis. POR also transfers electrons to all major drug-metabolizing CYP enzymes, including CYP3A4 that inactivates glucocorticoid and oestrogens. However, whether ORD results in impairment ofin vivodrug metabolism has never been studied.DesignWe studied an adult patient with ORD due to homozygousPORA287P, the most frequentPORmutation in Caucasians, and her clinically unaffected, heterozygous mother. The patient had received standard dose oestrogen replacement from 17 until 37 years of age when it was stopped after she developed breast cancer.MethodsBoth subjects underwentin vivococktail phenotyping comprising the oral administration of caffeine, tolbutamide, omeprazole, dextromethorphan hydrobromide and midazolam to assess the five major drug-metabolizing CYP enzymes. We also performed genotyping for variantCYPalleles known to affect drug metabolism.ResultsThough CYP enzyme genotyping predicted normal or high enzymatic activities in both subjects,in vivoassessment showed subnormal activities of CYP1A2, CYP2C9, CYP2D6 and CYP3A4 in the patient and of CYP1A2 and CYP2C9 in her mother.ConclusionsOur results providein vivoevidence for an important role of POR in regulating drug metabolism and detoxification. In patients with ORD,in vivoassessment of drug-metabolizing activities with subsequent tailoring of drug therapy and steroid replacement should be considered.
Economic Incentives for a Healthy Diet: A Comparison of Policies in a Canadian Context
Authors: Kennedy Peter W 
Published: September 2010

Abstract
This paper examines the potential impact of policies to promote dietary health in the context of a tax-financed universal health care (TFUHC) system, as found in Canada and many other countries, in which a universal level of treatment is set by government policy. I construct a model in which a low quality diet raises the risk of disease, and disease in turn causes a loss of labor productivity. Low quality diets are less expensive than high quality diets, so dietary choices are worse for lower income households. The effect of disease can be partly offset by medical treatment. I show that dietary choices under TFUHC are distorted by a moral hazard problem which leads to diets that are lower in quality than is first-best. I then examine three different policy interventions to address the dietary distortion: a reduced level of treatment; risk-based premiums for health care; and a quality-based tax on food. I calibrate the model with Canadian data on type 2 diabetes and derive the net benefit and distributional impact for each policy.
Associations of Six Single Nucleotide Polymorphisms in Obesity-Related Genes With BMI and Risk of Obesity in Chinese Children
Authors: Wu Lijun , Xi Bo , Zhang Meixian , Shen Yue , Zhao Xiaoyuan , Cheng Hong , Hou Dongqing , Sun Dandan , Ott Jurg , Wang Xingyu , Mi Jie 
Published: September 2010

OBJECTIVEChildhood obesity strongly predisposes to some adult diseases. Recently, genome-wide association (GWA) studies in Caucasians identified multiple single nucleotide polymorphisms (SNPs) associated with BMI and obesity. The associations of those SNPs with BMI and obesity among other ethnicities are not fully described, especially in children. Among those previously identified SNPs, we selected six (rs7138803, rs1805081, rs6499640, rs17782313, rs6265, and rs10938397, in or near obesity-related genes FAIM2, NPC1, FTO, MC4R, BDNF, and GNPDA2, respectively) because of the relatively high minor allele frequencies in Chinese individuals and tested the associations of the SNPs with BMI and obesity in Chinese children.RESEARCH DESIGN AND METHODSWe investigated the associations of these SNPs with BMI and obesity in school-aged children. A total of 3,503 children participated in the study, including 1,229 obese, 655 overweight, and 1,619 normal-weight children (diagnosed by the Chinese age- and sex-specific BMI cutoffs).RESULTSAfter age and sex adjustment and correction for multiple testing, the SNPs rs17782313, rs6265, and rs10938397 were associated with BMI (P = 1.0 × 10−5, 0.038, and 0.00093, respectively) and also obesity (P = 5.0 × 10−6, 0.043, and 0.00085, respectively) in the Chinese children. The SNPs rs17782313 and rs10938397 were also significantly associated with waist circumference, waist-to-height ratio, and fat mass percentage.CONCLUSIONSResults of this study support obesity-related genes in adults as important genes for BMI variation in children and suggest that some SNPs identified by GWA studies in Caucasians also confer risk for obesity in Chinese children.
Sagittal Abdominal Diameter Is a Strong Anthropometric Measure of Visceral Adipose Tissue in the Asian General Population
Authors: Yim Jeong Yoon , Kim Donghee , Lim Seon Hee , Park Min Jeong , Choi Seung Ho , Lee Chang Hyun , Kim Sun Sin , Cho Sang-Heon 
Published: September 2010

OBJECTIVE
Finding the anthropometric measure of visceral obesity is essential to clinical practice, because it predicts cardiovascular and metabolic risks. Sagittal abdominal diameter (SAD) has been proposed as an estimate of visceral adipose tissue (VAT). The aim of the present study was to evaluate the usefulness of SAD in predicting visceral obesity by comparing SAD to other anthropometric measures.

RESEARCH DESIGN AND METHODS
Estimation of subcutaneous and visceral adipose tissue and measurement of SAD and transverse abdominal diameter using computed tomography at the umbilical level were obtained in 5,257 men and women who were enrolled in a health checkup program in Korea. To compare SAD to other anthropometric measures, linear regression analyses were used to determine correlations between anthropometrics and visceral obesity.

RESULTS
SAD showed a stronger correlation to VAT than waist circumference, BMI, and transverse abdominal diameter in the both sexes (men: r = 0.804, women: r = 0.724). Waist circumference showed generally stronger associations to subcutaneous adipose tissue (SAT) than to VAT (men: r = 0.789 vs. 0.705, women: r = 0.820 vs. 0.636). Even after subdividing according to age or BMI in both sexes and analyzing multiple regressions, SAD showed the strongest correlation to VAT.

CONCLUSIONS
SAD showed the strongest correlation to VAT irrespective of age, sex, and the degree of obesity compared with other anthropometric measures, whereas waist circumference may have a stronger correlation to SAT than to VAT. The clinical use of SAD has advantages over other anthropometric measures in predicting VAT.
Medical Expenditures Associated With Diabetes Acute Complications in Privately Insured U.S. Youth
Authors: Shrestha Sundar S. , Zhang Ping , Barker Lawrence , Imperatore Giuseppina 
Published: September 2010

OBJECTIVETo estimate medical expenditures attributable to diabetes ketoacidosis (DKA) and severe hypoglycemia among privately insured insulin-treated U.S. youth with diabetes.RESEARCH DESIGN AND METHODSWe analyzed the insurance claims of 7,556 youth, age ≤19 years, with insulin-treated diabetes. The youth were continuously enrolled in fee-for-service health plans, and claims were obtained from the 2007 U.S. MarketScan Commercial Claims and Encounter database. We used regression models to estimate total medical expenditures and their subcomponents: outpatient, inpatient, and drug expenditures. The excess expenditures associated with DKA and severe hypoglycemia were estimated as the difference between predicted medical expenditures for youth who did/did not experience either DKA or severe hypoglycemia.RESULTSFor youth with and without DKA, respectively, predicted mean annual total medical expenditures were $14,236 and $8,398 (an excess of $5,837 for those with DKA). The excess was statistically greater for those with one or more episodes of DKA ($8,455) than among those with only one episode ($3,554). Predicted mean annual total medical expenditures were $12,850 and $8,970 for youth with and without severe hypoglycemia, respectively (an excess of $3,880 for those with severe hypoglycemia). The excess was greater among those with one or more episodes ($5,929) than among those with only one ($2,888).CONCLUSIONSMedical expenditures for potentially preventable DKA and severe hypoglycemia in U.S. youth with insulin-treated diabetes are substantial. Improving the quality of care for these youth to prevent the development of these two complications could avert substantial U.S. health care expenditures.
The dependence of critical temperature on oxygen concentration in YBa2Cu3O6+x
in terms of the fragmented chain model
Authors: Milic Mirjana , Matic Vladimir , Lazarov Nenad 
Published: September 2010

Abstract
An extended ASYNNNI model, that beside nearest-neighbour and next-nearest neighbour O-O interactions in the basal plane also includes interactions between the three nearest oxygen atoms, is used to describe the statistics of CuO chain fragmentation and to calculate doping and T
c in YBa2Cu3O6+x
. Calculations were made by the Monte Carlo method employing the recently proposed charge transfer model that assumes only chains whose length is equal to, or exceeds, a characteristic (critical) length, l
cr, can provide holes to the layers and contribute to doping p. The obtained p(x) is then combined with a universal T
c versus p relation to yield T
c(x) characteristics that correlate remarkably with those reported in recent experiments. The best coordination between theoretical and experimental T
c(x) characteristics has been achieved for l
cr = 2, implying that only isolated basal plane oxygen atoms (trivial chains) do not contribute holes to CuO2 layers.
Complex patterns of hybridization between exotic and native North American poplar species
Authors: Meirmans Patrick G. , Lamothe Manuel , Gros‐Louis Marie‐Claude , Khasa Damase , Périnet Pierre , Bousquet Jean , Isabel Nathalie 
Published: September 2010

• Premise of the study: Poplars and their hybrids are seen as important candidates for bioenergy initiatives. However, many concerns have been raised about large‐scale plantations of new poplar cultivars. The deployment of such plants with novel traits brings the risk of potential spread of novel genome regions (including exotic genes, transgenes, or other heritable modifications) into natural populations of related species. The possibility of introgression is especially high in poplars because reproductive barriers between species are weak. Knowledge of the frequency of hybridization between cultivated trees and natural populations is one important step in the risk‐assessment process.• Methods: We studied the rate of spontaneous hybridization from two sexually mature poplar plantations into adjacent natural populations of Populus deltoides and P. balsamifera. The two plantations, both in eastern Canada, contain many different complex hybrid clones with components from exotic species, mostly P. nigra, P. trichocarpa, and P. maximowiczii. We analyzed 12 species‐specific single nucleotide polymorphisms from six different genes in 5373 offspring sampled from the natural populations.• Results: Contributions from all three exotics were found in the offspring, confirming low reproductive barriers among poplar species in these sections. The frequency of hybrid offspring varied among pollen donors, recipient populations, and years.• Conclusions: The remarkably high rate of hybridization that was found in the smallest natural population sampled suggests that small peripheral populations carry a higher risk of introgression. These results could be used as a starting point for developing regulatory guidelines for the introduction of plants with novel traits.
The Effects of Direct-to-Consumer-Advertising on Patients in a Northern Canadian Community: A Cross-Sectional Survey
Authors: van den Engh Michelle , Bonertz Lori 
Published: September 2010

Background: Previous studies have investigated the effects of direct-to-consumer advertising (DTCA) of prescription medication in the United States and in a large Canadian centre close to the US border. This study examined how DTCA affects patients in a smaller, more remote Canadian community. Methods: A cross-sectional survey of patients ≥18 years was conducted in 8 primary care practices in Prince George, BC. Main outcome measures were past and present requests for advertised and non-advertised prescription medications. Results: Of 435 eligible patients, 217 (49.8%) agreed to be surveyed; 209 questionnaires were included in the final analysis. Patients with high exposure to DTCA were significantly more likely to be under the age of 50 ( p = 0.016). A total of 1.6% of patients with high DTCA exposure versus 0% with low exposure requested advertised medications during the study ( p = 0.26), and 4.8% versus 0%, respectively, had requested advertised medications in the past ( p = 0.052). The percentage of patients requesting any prescription medication, advertised or non-advertised, was 10.2% in the high DTCA exposure group, compared to 4.9% in the low exposure group. (OR = 2.18, 95% CI 0.69-6.93). Discussion: The rate of requests for advertised prescription medications in this northern Canadian community was lower than rates reported from larger, less-remote centres. However, exposure to DTCA remained surprisingly high, especially in younger patients. Results suggest that patients with higher self-reported exposure to DTCA may be more likely to request both advertised and non-advertised prescription medications. Conclusions: All health care professionals with a prescribing role should be aware of the potential impact of DTCA and ensure that patients are receiving objective, evidence-based information that will enable them to make fully informed decisions.
Opportunities for Medication-Related Support after Discharge from Hospital
Authors: Flanagan Priti S. , Pawluk Shane , Bains Sanjeev 
Published: September 2010

Background: Despite documentation of the need for and benefit of medication-related support for patients who have been discharged from hospital, such support is not consistently available. This gap in care represents an opportunity for community pharmacists. Objective: To detail the types of drug-related issues identified for patients after discharge from hospital. Methods: The study entailed review of medication assessments performed by a Medication Management Program pharmacist for patients discharged from a community hospital over a 1-year period, in order to identify the number and type of drug-related problems, the number of discrepancies and the medications most commonly implicated in these problems. Results: Records were reviewed for 110 patients discharged during the study period. For these patients, the pharmacist identified a total of 259 drug-related problems (median 2 per patient) and 135 medication discrepancies (median 1 per patient) shortly after discharge. The most commonly implicated medications were calcium-vitamin D supplements, acetylsalicylic acid, furosemide and ramipril. Conclusion: With information about the types of drug-related problems and discrepancies commonly identified for patients discharged from hospital, community pharmacists are ideally positioned to respond to this gap in care.
Perspectives and Experiences of Health Care Professionals and Patients with Diabetes regarding Self-Monitoring of Blood Glucose in Canada
Authors: McIntosh Brendan , Gauthier Bernard , Lal Avtar , Singh Sumeet R. , Virani Adil 
Published: September 2010

Objective: To explore the current perspectives and experiences of Canadian health care professionals and patients with diabetes regarding self-monitoring of blood glucose (SMBG). Design: Qualitative analysis of focus groups in Ottawa, Vancouver and Edmonton. Methods: Seventeen focus groups involving 59 health care professionals (19 pharmacists, 18 certified diabetes educators and 22 physicians) and 40 patients with type 1 or type 2 diabetes were held, using separate moderator's guides. Thematic analysis was used to analyze responses. Results: Health care professionals reported recommending SMBG to most patients with diabetes, regardless of insulin use. They also reported periodically reviewing glucometer results, providing education on interpreting the results and proper use of SMBG devices. The majority of patients with diabetes indicated that they regularly monitored their blood glucose levels and recorded their results. Advantages of SMBG cited by health care professionals included a sense of control over diabetes, the ability to make lifestyle and treatment choices and increased patient confidence. Patients listed expense, discomfort and inconvenience as disadvantages to SMBG. Although patients discussed SMBG readings with their health care professionals, many reported that treating physicians were often uninterested in SMBG results. Physicians tended to refer to SMBG in the context of disease-specific benefits, while certified diabetes educators more often cited the psychological and educational benefits of SMBG. Compared with physicians, pharmacists focused more on the lifestyle and educational benefits of SMBG rather than on changes to medications. Conclusion: SMBG is commonly recommended by health care professionals and regularly performed by most patients with diabetes. Pharmacists and other health care professionals play an important role in educating patients on the appropriate use of SMBG and interpretation of results. To ensure optimal use, pharmacists and other health care providers should review the desired outcomes of SMBG with patients on a regular basis.
Pharmacy Student Attitudes to Patient Education: A Longitudinal Study
Authors: Taylor Jeff , Smith Amy 
Published: September 2010

Background: A significant level of interest in patient-centredness, one of the components required for effective interaction with patients, is being shown in health communication circles. By adopting a patient-centred approach in the process of patient consultation, pharmacists strive to ensure safe and effective medicine use. The purpose of this study was to explore pharmacy student attitudes toward patient education and patient-centredness as they progressed through a 4-year program. Methods: One class year of pharmacy students at the University of Saskatchewan volunteered to complete a self-administered survey each year of their program to longitudinally assess their confidence in and difficulty with patient consultation, their level of patient empathy and their orientation toward patient-centredness. Results: Noticeable changes were seen in all constructs, especially from first to second year. Gender appeared to influence 2 of the constructs: patient-centredness and empathy. Conclusion: A combination of overall life experience, pharmacy undergraduate training and practice site experience likely contributed to the observed results. While attempting to quantify such constructs is of interest and may turn out to be a useful monitoring component, observation of student behaviour during objective structured clinical exams likely will continue to be the most valuable tool.
Canadian Variation by Province in Rheumatoid Arthritis Initiating Anti–Tumor Necrosis Factor Therapy: Results from the Optimization of Adalimumab Trial
Authors: PEASE CHRISTOPHER , POPE JANET E. , THORNE CARTER , HARAOUI BOULOS PAUL , TRUONG DON , BOMBARDIER CLAIRE , WIDDIFIELD JESSICA , PSARADELLIS ELIOFOTISTI , SAMPALIS JOHN S. , BONNER ASHLEY 
Published: September 2010

Objective.We compared variations among Canadian provinces in rheumatoid arthritis (RA) initiating anti-tumor necrosis factor (TNF) therapy.Methods.Data were obtained from the Optimization of Humira trial (OH) and from the Ontario Biologics Research Initiative (OBRI). Baseline characteristics were compared between regions: Ontario (ON), Quebec (QC), and other provinces (OTH). We compared Ontario OH to OBRI patients who were initiating anti-TNF therapy.Results.In 300 OH patients, mean age was 54.8 years (13.3). There were 151 (50.3%) ON patients, 57 from QC (19%), and 92 from OTH (30.7%). Regional differences were seen in the number of disease-modifying antirheumatic drugs (DMARD) ever taken (ON: 3.8 ± 1.4, QC: 3.1 ± 1.1, OTH: 3.3 ± 1.4; p < 0.001); swollen joint count (SJC; ON: 10.9 ± 5.9, QC: 9.0 ± 4.4, OTH: 11.3 ± 5.6; p = 0.033); tender joint count (TJC; ON: 12.2 ± 7.5, QC: 10.3 ± 5.7, OTH: 14.4 ± 7.6; p = 0.003); 28-joint Disease Activity Score (DAS28; ON: 5.8 ± 1.2, QC: 5.6 ± 1.0, OTH: 6.0 ± 1.1; p = 0.076); and Health Assessment Questionnaire (ON: 1.4 ± 0.7, QC: 1.7 ± 0.7, OTH: 1.5 ± 0.7; p = 0.060). DMARD-ever use differed: methotrexate (ON: 94.7%, QC: 93%, OTH: 84.8%; p = 0.025); leflunomide (ON: 74.8%, QC: 21.1%, OTH: 51.1%; p < 0.001); sulfasalazine (ON: 51%, QC: 38.6%, OTH: 25%; p < 0.001); myochrysine (ON: 9.3%, QC: 0%, OTH: 15.2%; p = 0.008); and hydroxychloroquine (ON: 67.5%, QC: 86%, OTH: 66.3%; p = 0.018). In comparison to ON OH patients, 95 OBRI patients initiating first anti-TNF had lower SJC (p = 0.017), TJC (p = 0.008), and DAS28 (p = 0.05).Conclusion.In Quebec, where access to anti-TNF is less restrictive, patients had lower SJC and TJC. ON used more DMARD, especially leflunomide, as mandated by the provincial government. Both provincial funding criteria and prescribing habits may contribute to differences. Canadian rheumatologists may vary in treatment decisions, but patients generally have similar DAS28 when initiating anti-TNF therapy.
Interleukin 6 Gene Polymorphisms Are Associated with Systemic Lupus Erythematosus in Koreans
Authors: JEON JA-YOUNG , KIM HYOUN-AH , KIM SEUNG-HYUN , PARK HAE-SIM , SUH CHANG-HEE 
Published: September 2010

Objective.Interleukin 6 (IL-6) gene polymorphisms are known to play a role in chronic inflammatory disorders. We searched for polymorphisms in theIL-6gene and described their pathogenic role in Korean patients with systemic lupus erythematosus (SLE).Methods.Genomic DNA was extracted from 151 patients with SLE and 151 controls, and about 1.4 kb-sizedIL-6genes located between promoter region and exon 2 region were amplified by polymerase chain reaction. The promoter activity was analyzed by luciferase reporter assay in Hep3B cells and HeLa cells.Results.We identified 4 single-nucleotide polymorphisms (SNP; −572 C > G, −278 A > C in the promoter, and 330 T > G, and 334 A > T in exon 2) and a −373 AnTntract polymorphism in theIL-6gene. The genotype frequency, −373 A10T11, −278 C, and 334 T allele were significantly associated with SLE (p < 0.001, p = 0.03 and p = 0.005, respectively). Patients with SLE carrying the −572 G allele had anti-dsDNA more frequently (p = 0.007). In addition, thrombocytopenia was significantly more common in patients carrying the −278 C allele (p = 0.006). In the haplotype analysis, patients with SLE had more frequently haplotype HT3 (CA10T11ATA, dominant model, p = 0.012) that was associated with arthritis, leukopenia, anti-dsDNA, and hypocomplementemia. Promoter reporter structures carrying the −278 C allele displayed significantly higher promoter activity than the −278 A allele in Hep3B cells (p < 0.001) and HeLa cells (p < 0.001).Conclusion.These data suggest thatIL-6gene polymorphisms are associated with disease susceptibility and phenotype of SLE. In addition, promoter polymorphisms may be involved in regulation ofIL-6expression.