bluuebunny/crossref_metadata_2025_split huggingface dataset:
Partial restoration of GH responsiveness to ghrelin in Cushing's disease after 6 months of ketoconazole treatment: comparison with GHRP-6 and GHRH
Authors: Correa-Silva Silvia R , Nascif Sérgio O , Molica Patrícia , Sá Larissa B P C , Vieira José G , Lengyel Ana-Maria J 
Published: August 2009

ObjectiveIn Cushing's disease (CD), GH responsiveness to several stimuli, including ghrelin, GHRP-6, and GHRH, is blunted. Recovery of GH secretion after remission of hypercortisolism after transsphenoidal surgery, radiotherapy, or adrenalectomy is controversial. There are no studies evaluating the effect of primary clinical treatment with ketoconazole on GH secretion in CD. The aim of this study is to compare ghrelin-, GHRP-6-, and GHRH-induced GH release before and after ketoconazole in CD.DesignGH responses to ghrelin, GHRP-6, and GHRH of eight untreated patients with CD (mean age: 33.8±3.1 years; body mass index: 28.5±0.8 kg/m2) were evaluated before and after 3 and 6 months of ketoconazole treatment, and compared with 11 controls (32.1±2.5; 25.0±0.8).MethodsSerum GH was measured by an immunofluorometric assay and urinary free cortisol (UFC) by liquid chromatography and tandem mass spectrometry.ResultsAfter ketoconazole use, mean UFC decreased significantly (before: 222.4±35.0 μg/24 h; third month: 61.6±10.1; sixth month: 39.1±10.9). Ghrelin-induced GH secretion increased significantly after 6 months (peak before: 6.8±2.3 μg/l; sixth month: 16.0±3.6), but remained lower than that of controls (54.1±11.2). GH release after GHRP-6 increased, although not significantly, while GH responsiveness to GHRH was unchanged.ConclusionsGhrelin-induced GH release increases significantly after 6 months of ketoconazole treatment in CD. This could suggest that a decrease in cortisol levels during this time period can partially restore glucocorticoid-induced GH suppression in CD. GH-releasing mechanisms stimulated by ghrelin/GHS could be more sensitive, as no changes in GHRH-induced GH release were observed.
Mortality Risk in Patients Receiving Drug Regimens with Theophylline for Chronic Obstructive Pulmonary Disease
Authors: Lee Todd A. , Schumock Glen T. , Bartle Brian , Pickard A. Simon 
Published: August 2009

Study Objective. To evaluate outcomes associated with six treatment regimens with theophylline versus each regimen without theophylline in patients with chronic obstructive pulmonary disease (COPD).Design. Retrospective cohort study.Setting. Veterans Affairs health care system.Patients. A total of 183,573 patients aged 45 years or older who had a diagnosis of COPD and were receiving respiratory drug therapy.Measurements and Main Results. Patients' treatment regimens were identified by using data from October 1, 2002‐March 31, 2003, and patients were followed for events by using data from April 1, 2003‐September 30, 2005. Data from October 1, 2001‐September 30, 2002, were used to define the patients' baseline characteristics. Primary outcome measures were all‐cause mortality, COPD exacerbations, and COPD‐related hospitalizations. Two approaches were used: first, treatment assignment was based on drug therapy at baseline, and second, exposure was measured as a time‐varying covariate. Treatment groups were stratified based on propensity to receive theophylline. Mortality was compared by using Cox proportional hazards models, and other outcomes were compared with use of negative binomial models. Comparisons were conducted within individual treatment regimens that were the same with the exception of theophylline. Patients treated with ipratropium plus theophylline (largest group) compared with those treated with ipratropium alone had a 1.11‐fold increase in the risk of death (95% confidence interval [CI] 1.04‐1.18). For each of the other regimens, the risk of mortality associated with theophylline was greater than that in the regimens without theophylline (hazard ratios [HRs] 1.17‐1.31). In the time‐varying exposure analysis, theophylline (HR 1.23, 95% CI 1.09‐1.39) was associated with an increased mortality risk.Conclusion. Patients receiving regimens that included theophylline had slightly increased risks of mortality, COPD exacerbations, and COPD hospitalizations compared with patients receiving the same regimens without theophylline. However, the benefits of theophylline on other factors, including symptoms, quality of life, and activities of daily living, were not measured. Clinicians should consider all of the potential benefits and harms associated with theophylline when making treatment recommendations.
Adjunctive Aerosolized Antibiotics for Treatment of Ventilator‐Associated Pneumonia
Authors: Czosnowski Quinn A. , Wood G. Christopher , Magnotti Louis J. , Croce Martin A. , Swanson Joseph M. , Boucher Bradley A. , Fabian Timothy C. 
Published: August 2009

Study Objective. To determine clinical and microbiologic success in patients receiving adjunctive aerosolized antibiotics for the treatment of ventilator‐associated pneumonia (VAP).Design. Retrospective medical record review.Setting. Level I trauma intensive care unit of a large academic medical center.Patients. Forty‐nine patients (mean ± SD age 42 ± 19 yrs) who received aerosolized antibiotics for the treatment of a total of 60 episodes of VAP caused by Pseudomonas aeruginosaand/or Acinetobacter baumanniibetween January 2001 and July 2007.Measurements and Main Results. Patients were identified by using an existing database of patients with documented VAP at the study center. To receive a diagnosis of VAP, patients had to have bacterial growth of 105 or more colony‐forming units/ml from a bronchoscopic bronchoalveolar lavage and new or changing infiltrate on chest radiograph, plus at least two of the following: abnormal body temperature (> 38°C or < 36°C), abnormal white blood cell count (> 10 or < 4 times 103/mm3, or > 10% immature bands), or macroscopically purulent sputum. By reviewing patient data, we evaluated clinical and microbiologic success using standard definitions. The median (interquartile range) Injury Severity Score and admission Acute Physiology and Chronic Health Evaluation II score were 40 (29–45) and 17 (9–21), respectively. Pseudomonas aeruginosa, A. baumannii, or both were isolated in 45, 14, and 1 episode(s), respectively. Eighteen VAP episodes included additional bacteria. Aerosolized tobramycin, amikacin, and colistimethate were used in 44, 9, and 9 episodes, respectively. Systemic antibiotics were used in 59 (98%) of the 60 episodes. Clinical success was achieved in 36 (73%) of the 49 first episodes of VAP, 8 (73%) of 11 subsequent episodes, 17 (85%) of 20 episodes that were failing intravenous monotherapy, and 30 (79%) of 38 episodes with multidrug‐resistant P. aeruginosaor A. baumannii.Microbiologic success was achieved in 29 (71%) of 41 evaluable episodes. Six patients died from VAPConclusion. Treatment with adjunctive aerosolized antibiotics was associated with a good response rate in critically ill trauma patients with VAP due to nonfermenting gram‐negative bacilli. It is noteworthy that episodes of VAP that followed intravenous therapy failure and/or that were due to multidrug‐resistant organisms responded well.
Antiproteinuric and Blood Pressure‐Lowering Effects of a Fixed‐Dose Combination of Losartan and Hydrochlorothiazide in Hypertensive Patients with Stage 3 Chronic Kidney Disease
Authors: Abe Masanori , Okada Kazuyoshi , Maruyama Takashi , Matsumoto Koichi 
Published: August 2009

Study Objective. To compare the renoprotective and blood pressure‐lowering effects of combination losartan‐low‐dose hydrochlorothiazide with losartan alone in hypertensive patients with stage 3 chronic kidney disease (CKD).Design. Prospective, open‐label, randomized, controlled study.Setting. Outpatient clinic at a university‐affiliated hospital in Japan.Patients. Sixty adults (mean age 67 yrs) with stage 3 CKD who had been receiving losartan 50 mg/day and had not achieved their target blood pressure of 130/80 mm Hg.Intervention. Patients were randomly assigned to receive combination losartan 50 mg‐hydrochlorothiazide 12.5 mg/day in addition to losartan 50 mg/day (combination therapy group, 30 patients) or to receive losartan 100 mg/day (control group, 30 patients) over a 24‐week period.Measurements and Main Results. Efficacy was determined by monitoring clinical and laboratory parameters. Mean baseline systolic and diastolic blood pressures were 158/90 mm Hg in both groups; at 24 weeks of treatment, these blood pressures significantly decreased to 133/79 mm Hg in the combination therapy group compared with both baseline and the values in the control group (145/83 mm Hg). Although serum creatinine concentration increased and the estimated glomerular filtration rate decreased significantly in both groups, the urinary protein:creatinine ratio was significantly lower in the combination therapy group. With stratification of patients on the basis of whether they had diabetes mellitus, we found that the reduction in the urinary protein:creatinine ratio was more evident in the combination therapy group. No significant increase in the occurrence of adverse metabolic effects was noted in either group.Conclusion. In these hypertensive patients with stage 3 CKD, combination therapy with the maximum recommended daily dose of losartan of 100 mg and a low dose of hydrochlorothiazide of 12.5 mg ameliorated proteinuria and reduced blood pressure more effectively than treatment with losartan 100 mg alone, irrespective of whether the patients had diabetes.
Argatroban Dosage Requirements and Outcomes in Intensive Care versus Non‐Intensive Care Patients
Authors: Smythe Maureen A. , Koerber John M. , Forsyth Lisa L. , Priziola Jennifer L. , Balasubramaniam Mamtha , Mattson Joan C. 
Published: August 2009

Study Objective. To compare the outcomes of reduced‐dose argatroban therapy in patients in the intensive care unit (ICU) with those of non‐ICU patients.Design. Retrospective medical record review.Setting. Large, academic, tertiary care hospital.Patients. Thirty‐eight ICU patients and 43 non‐ICU patients who received the institutional protocol of argatroban 0.8 μg/kg/minute and 1.2 μg/kg/minute, respectively, between March 2004 and September 2005.Measurements and Main Results. Data on patient demographics, argatroban dosing, heparin‐induced thrombocytopenia antibody results, activated partial thromboplastin times (aPTTs), new thrombotic events, and major bleeding events were extracted from medical records. Time‐weighted mean ± SD doses of argatroban were 0.82 ± 0.3 μg/kg/minute for ICU patients and 1.25 ± 0.29 μg/kg/minute for non‐ICU patients. Mean aPTT ratios were similar between groups: 2.07 ± 0.53 for ICU patients and 2.00 ± 0.45 for non‐ICU patients. More than 70% of all aPTT ratios were therapeutic. More than 95% of patients in both groups achieved a therapeutic aPTT ratio during therapy. Fewer ICU patients than non‐ICU patients had all therapeutic aPTT ratios during argatroban therapy (29% vs 51%, p=0.07). Thrombotic events occurred in six (16%) ICU patients versus none of the non‐ICU patients (p=0.009). Thrombotic events occurred in 4 (31%) of the 13 ICU patients with confirmed heparin‐induced thrombocytopenia. Major bleeding occurred in four (11%) ICU patients versus none of the non‐ICU patients (p=0.04).Conclusion. Both ICU and non‐ICU patients require less than the manufacturer‐recommended initial dosage of argatroban. However, ICU patients appear to be at an increased risk for bleeding and thrombotic events despite their attainment of therapeutic aPTTs.
Safety of Double‐Dose Transdermal Scopolamine
Authors: Bar Ronen , Gil Amnon , Tal Dror 
Published: August 2009

Study Objective.To evaluate the safety of double‐dose transdermal scopolamine patch therapy.Design.Randomized, crossover, double‐blind study.Setting.Motion sickness clinic in Haifa, Israel.Participants.Twenty male sailors aged 18–21 years whose seasickness symptoms improved only slightly or not at all with a single transdermal scopolamine patch.Intervention.Subjects received either two transdermal scopolamine patches or one scopolamine patch plus a placebo patch for 24 hours (first session). After at least 1 week from the end of the first session, they received the other treatment for 24 hours (second session).Measurements and Main Results.Plasma scopolamine concentrations, physiologic (heart rate and blood pressure), visual, and cognitive function parameters, and adverse effects were assessed before the first session (baseline) and after each 24‐hour session. Visual function was tested again 24 hours after patch removal. Subjects also completed an adverse‐effects questionnaire immediately after and 24 hours after patch removal for both treatment sessions. A significant difference was found in mean plasma scopolamine concentrations between the single‐dose and double‐dose treatments (81 vs 127 pg/ml [therapeutic level 100 pg/ml], p<0.01). No significant differences were found in heart rate, blood pressure, cognitive function, or visual function measurements. Mild blurred vision was the only adverse effect for which there was a significant difference between the single‐dose and double‐dose treatments; however, this adverse effect was judged to be not clinically significant.Conclusion.Double‐dose transdermal scopolamine may improve treatment in patients who fail to respond to a single patch by increasing the plasma scopolamine concentration, without aggravating systemic, visual, or cognitive adverse effects. Thus we recommend that a double dose can be administered safely to these patients.
Demonstrating the Importance and Feasibility of Including Sexual Orientation in Public Health Surveys: Health Disparities in the Pacific Northwest
Authors: Dilley Julia A. , Simmons Katrina Wynkoop , Boysun Michael J. , Pizacani Barbara A. , Stark Mike J. 
Published: August 2009

Objectives. We identified health disparities for a statewide population of lesbian, gay, and bisexual (LGB) men and women compared with their heterosexual counterparts. Methods. We used data from the 2003–2006 Washington State Behavioral Risk Factor Surveillance System to examine associations between sexual orientation and chronic health conditions, health risk behaviors, access to care, and preventive services. Results. Lesbian and bisexual women were more likely than were heterosexual women to have poor physical and mental health, asthma, and diabetes (bisexuals only), to be overweight, to smoke, and to drink excess alcohol. They were also less likely to have access to care and to use preventive services. Gay and bisexual men were more likely than were heterosexual men to have poor mental health, poor health-limited activities, and to smoke. Bisexuals of both genders had the greatest number and magnitude of disparities compared with heterosexuals. Conclusions. Important health disparities exist for LGB adults. Sexual orientation can be effectively included as a standard demographic variable in public health surveillance systems to provide data that support planning interventions and progress toward improving LGB health.
Association Between Adolescent Viewership and Alcohol Advertising on Cable Television
Authors: Chung Paul J. , Garfield Craig F. , Elliott Marc N. , Ostroff Joshua , Ross Craig , Jernigan David H. , Vestal Katherine D. , Schuster Mark A. 
Published: August 2009

Objectives. We examined whether alcohol advertising on cable television is associated with adolescent viewership. Methods. Using Nielsen data for every national cable alcohol advertisement from 2001 to 2006 (608 591 ads), we examined whether ad incidence in a given advertising time slot was associated with adolescent viewership (i.e., the percentage of the audience that was aged 12–20 years) after we controlled for other demographic variables. Results. Almost all alcohol ads appeared in time slots with audiences made up of 30% or fewer underage viewers. In these time slots (standardized by duration and number of viewers), each 1-percentage-point increase in adolescent viewership was associated with more beer (7%), spirits (15%), and alcopop (or low-alcohol refresher; 22%) ads, but fewer wine (−8%) ads (P < .001 for all). For spirits and alcopops, associations were stronger among adolescent girls than among adolescent boys (P < .001 for each). Conclusions. Ad placements for beer, spirits, and alcopops increased as adolescent viewership rose from 0% to 30%, especially for female viewers. Alcohol advertising practices should be modified to limit exposure of underage viewers.
Social Support and Self-Reported Health Status of Older Adults in the United States
Authors: White Ann Marie , Philogene G. Stephane , Fine Lawrence , Sinha Sarbajit 
Published: August 2009

Objectives. We determined whether a representative national probability sample of US community-dwelling older adults who reported less social support also reported poorer general health status, which is a robust predictor of prospective mortality among elders. Methods. We analyzed 2 subsamples generated via random sampling with replacement from the full analytic sample of adults aged 60 years and older in the 1999–2002 National Health and Nutrition Examination Survey (n = 3476). We built multinomial logit models with the first analytic subsample (n = 1732). Then we tested the final models on the second subsample (n = 1744) to assess the differences in odds of reporting poor, fair, or good versus very good or excellent health. We fit the cross-validated final models to the full analytic sample. Results. After we controlled for age, race, gender, and educational attainment, older persons across all analytic samples who reported that they needed more support also reported having poorer health compared with better health 2 times more often than did older persons who were satisfied with the support available to them (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.7, 3.4; P < .001). Conclusions. In the United States, older persons' satisfaction with the emotional support available to them is associated with better self-reported health status.
Individual, Social-Normative, and Policy Predictors of Smoking Cessation: A Multilevel Longitudinal Analysis
Authors: Biener Lois , Hamilton William L. , Siegel Michael , Sullivan Eileen M. 
Published: August 2009

Objectives. We assessed the prospective impact of individual, social-normative, and policy predictors of quit attempts and smoking cessation among Massachusetts adults. Methods. We interviewed a representative sample of current and recent smokers in Massachusetts by telephone in 2001 through 2002 and then again twice at 2-year intervals. The unit of analysis was the 2-year transition from wave 1 to wave 2 and from wave 2 to wave 3. Predictors of quit attempts and abstinence of longer than 3 months were analyzed using multilevel analysis. Predictors included individual, social-normative, and policy factors. Results. Multivariate analyses of 2-year transitions showed that perceptions of strong antismoking town norms were predictive of abstinence (odds ratio = 2.06; P < .01). Household smoking bans were the only policy associated with abstinence, but smoking bans at one's worksite were significant predictors of quit attempts. Conclusions. Although previous research showed a strong relation between local policy and norms, we found no observable, prospective impact of local policy on smoking cessation over 2 years. Our findings provide clear support for the importance of strong antismoking social norms as a facilitator of smoking cessation.
Association Between Socioeconomic Status and the Development of Asthma: Analyses of Income Trajectories
Authors: Kozyrskyj Anita L. , Kendall Garth E. , Jacoby Peter , Sly Peter D. , Zubrick Stephen R. 
Published: August 2009

Objectives. Using data on 2868 children born in the Western Australian Pregnancy Cohort (Raine) Study, we examined the association between changes in family socioeconomic status and childhood asthma. Methods. We determined the likelihood (odds ratio) of a child having asthma at ages 6 and 14 years for 4 family-income trajectories (chronic low, increasing, decreasing, and never low) over the child's lifetime. The trajectories were created from longitudinal latent-class models. Results. We found a 2-fold increased risk of asthma at age 14 years among children who had lived in a low-income family since birth, especially for girls. Asthma was less likely to occur in children born to single parents; income rose over time in many of these families. Compared with children in chronic low-income families, children in households with increasing incomes had a 60% lower risk of asthma. Single-point measures of low income were not found to be associated with asthma. Conclusions. Chronic exposure to a low-income environment from birth was associated with the development of persistent asthma. There was also a protective effect against asthma among those children whose families had moved out of poverty.
The Influence of Past Unemployment Duration on Symptoms of Depression Among Young Women and Men in the United States
Authors: Mossakowski Krysia N. 
Published: August 2009

Objectives. I examined whether unemployment while looking for a job and being out of the labor force while not seeking work have distinct effects on symptoms of depression among young women and men in the United States. I also investigated whether past unemployment duration predicts depressive symptoms.Methods. I used ordinary least squares regression to analyze data from the 1979–1994 National Longitudinal Survey of Youth.Results. Cross-sectional results suggested that current unemployment status and out-of-the-labor-force status were significantly associated with depressive symptoms at ages 29 through 37 years. The association between being out of the labor force and depressive symptoms was stronger for men. Longitudinal results revealed that past unemployment duration across 15 years of the transition to adulthood significantly predicted depressive symptoms, net of demographics, family background, current socioeconomic status, and prior depressive symptoms. However, duration out of the labor force did not predict depressive symptoms.Conclusions. Longer durations of unemployment predict higher levels of depressive symptoms among young adults. Future research should measure duration longitudinally and distinguish unemployment from being out of the labor force to advance our understanding of socioeconomic mental health disparities.
Reevaluating the Need for Concern Regarding Noncoverage Bias in Landline Surveys
Authors: Blumberg Stephen J. , Luke Julian V. 
Published: August 2009

Objectives. We used recent data to reexamine whether the exclusion of adults from households with no telephone or only wireless phones may bias estimates derived from health-related telephone surveys. Methods. We calculated the difference between estimates for the full population of adults and estimates for adults with landline phones; data were from the 2007 National Health Interview Survey. Results. When data from landline telephone surveys were weighted to match demographic characteristics of the full population, bias was generally less than 2 percentage points (range = 0.1–2.4). However, among young adults and low-income adults, we found greater bias (range = 1.7–5.9) for estimates of health insurance, smoking, binge drinking, influenza vaccination, and having a usual place for care. Conclusions. From 2004 to 2007, the potential for noncoverage bias increased. Bias can be reduced through weighting adjustments. Therefore, telephone surveys limited to landline households may still be appropriate for health surveys of all adults and for surveys of subpopulations regarding health status. However, for some behavioral risk factors and health care service use indicators, caution is warranted when using landline surveys to draw inferences about young or low-income adults.