bluuebunny/crossref_metadata_2025_split huggingface dataset:
Central and Peripheral Timing Variability in Children With Heavy Prenatal Alcohol Exposure
Authors: Simmons Roger W. , Levy Susan S. , Riley Edward P. , Madra Naju M. , Mattson Sarah N. 
Published: December 2008

Background:  The study examined whether prenatal alcohol exposure is associated with increased motor timing variability when the timing response is partitioned into central clock variability, which indexes information processing at the central nervous system (CNS) level and motor delay variability, which reflects timing processes at the level of the peripheral nervous system.Methods:  Eighteen children with histories of prenatal alcohol exposure and 22 control children were assigned to young (7 to 11 years) or older (12 to 17 years) groups. Children tapped a single response key with the index finger in synchrony with a series of externally generated tones (the paced phase). At the conclusion of these tones, children continued tapping (the continuation phase) while attempting to maintain the same rate of tapping imposed by the paced phase. Two blocks of tapping were completed with inter‐tone‐intervals set at either 400 or 900 milliseconds. Inter‐response interval, central clock variability, and motor delay variability produced during the continuation phase were the dependent variables.Results:  Mean inter‐response interval for the 4 groups did not differ for either time interval. Central clock variability produced by the young alcohol‐exposed group was significantly greater than the two older groups for the 400 millisecond interval and all other groups for the 900 millisecond interval. Motor delay variability produced by the young alcohol‐exposed group was significantly greater than the other three groups for both time intervals. Central and motor delay variability in children with and without alcohol exposure was directly related to the duration of the interval to be reproduced.Conclusions:  Central and peripheral timing variability was significantly greater for the young alcohol‐exposed children. This atypical timing may be related to the teratogenic effects of alcohol, although the negative effects are limited to younger alcohol‐exposed children since there were no differences in central and peripheral timing variability between the older alcohol‐exposed children and controls.
Area‐Level Poverty Is Associated with Greater Risk of Ambulatory–Care–Sensitive Hospitalizations in Older Breast Cancer Survivors
Authors: Schootman Mario , Jeffe Donna B. , Lian Min , Deshpande Anjali D. , Gillanders William E. , Aft Rebecca , Sumner Walton 
Published: December 2008

OBJECTIVES: To estimate the frequency of ambulatory care–sensitive hospitalizations (ACSHs) and to compare the risk of ACSH in breast cancer survivors living in high‐poverty with that of those in low‐poverty areas.DESIGN: Prospective, multilevel study.SETTING: National, population‐based 1991 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States.PARTICIPANTS: Breast cancer survivors aged 66 and older.MEASUREMENTS: ACSH was classified according to diagnosis at hospitalization. The percentage of the population living below the U.S. federal poverty line was calculated at the census‐tract level. Potential confounders included demographic characteristics, comorbidity, tumor and treatment factors, and availability of medical care.RESULTS: Of 47,643 women, 13.3% had at least one ACSH. Women who lived in high‐poverty census tracts (≥30% poverty rate) were 1.5 times (95% confidence interval (CI)=1.34–1.72) as likely to have at least one ACSH after diagnosis as women who lived in low‐poverty census tracts (<10% poverty rate). After adjusting for most confounders, results remained unchanged. After adjustment for comorbidity, the hazard ratio (HR) was reduced to 1.34 (95% CI=1.18–1.52), but adjusting for all variables did not further reduce the risk of ACSH associated with poverty rate beyond adjustment for comorbidity (HR=1.37, 95% CI=1.19–1.58).CONCLUSION: Elderly breast cancer survivors who lived in high‐poverty census tracts may be at increased risk of reduced posttreatment follow‐up care, preventive care, or symptom management as a result of not having adequate, timely, and high‐quality ambulatory primary care as suggested by ACSH.
Effect of Computerized Provider Order Entry with Clinical Decision Support on Adverse Drug Events in the Long‐Term Care Setting
Authors: Gurwitz Jerry H. , Field Terry S. , Rochon Paula , Judge James , Harrold Leslie R. , Bell Chaim M. , Lee Monica , White Kathleen , LaPrino Jane , Erramuspe‐Mainard Janet , DeFlorio Martin , Gavendo Linda , Baril Joann L. , Reed George , Bates David W. 
Published: December 2008

OBJECTIVES: To evaluate the efficacy of computerized provider order entry with clinical decision support for preventing adverse drug events in long‐term care.DESIGN: Cluster‐randomized controlled trial.SETTING: Two large long‐term care facilities.PATIENTS: One thousand one hundred eighteen long‐term care residents of 29 resident care units.INTERVENTION: The 29 resident care units, each with computerized provider order entry, were randomized to having a clinical decision support system (intervention units) or not (control units).MEASUREMENTS: The number of adverse drug events, severity of events, and whether the events were preventable.RESULTS: Within intervention units, 411 adverse drug events occurred over 3,803 resident‐months of observation time; 152 (37.0%) were deemed preventable. Within control units, there were 340 adverse drug events over 3,257 resident‐months of observation time; 126 (37.1%) were characterized as preventable. There were 10.8 adverse drug events per 100 resident‐months and 4.0 preventable events per 100 resident‐months on intervention units. There were 10.4 adverse drug events per 100 resident‐months and 3.9 preventable events per 100 resident‐months on control units. Comparing intervention and control units, the adjusted rate ratios were 1.06 (95% confidence interval (CI)=0.92–1.23) for all adverse drug events and 1.02 (95% CI=0.81–1.30) for preventable adverse drug events.CONCLUSION: Computerized provider order entry with decision support did not reduce the adverse drug event rate or preventable adverse drug event rate in the long‐term care setting. Alert burden, limited scope of the alerts, and a need to more fully integrate clinical and laboratory information may have affected efficacy.
The Effect of Transitioning to Medicare Part D Drug Coverage in Seniors Dually Eligible for Medicare and Medicaid
Authors: Shrank William H. , Patrick Amanda R. , Pedan Alex , Polinski Jennifer M. , Varasteh Laleh , Levin Raisa , Liu Nan , Schneeweiss Sebastian 
Published: December 2008

OBJECTIVES: To evaluate medication use, out‐of‐pocket spending, and medication switching during the transition period for patients dually eligible for Medicaid and Medicare (dual eligibles).DESIGN: Time‐trend analysis, using segmented linear regression.SETTING: Patient‐level pharmacy dispensing data from January 2005 to December 2006 from a large pharmacy chain with stores in 34 states.PARTICIPANTS: Dual eligibles aged 65 and older.MEASUREMENTS: Changes in utilization, patient copayments, and medication switching were analyzed using interrupted time trend analyses. Utilization and spending were evaluated for five study drugs: clopidogrel, proton pump inhibitors (PPIs), warfarin, and statins (essential drugs covered by Part D plans) and benzodiazepines (not covered through Part D but potentially covered through Medicaid).RESULTS: Drug use for 13,032 dual eligibles was evaluated. There was no significant effect of the transition to Medicare Part D on use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in copayments for all covered drugs after implementation of Part D, ranging from 25% annually for PPIs to 53% for warfarin, but there was a larger increase in copayments, 91% annually, for benzodiazepines after the transition. The rate of switching medications was 3.0 times as great for the PPIs after implementation of Part D than before implementation, but there was no significant change in the other study drug classes.CONCLUSION: These findings in a single, large pharmacy chain indicate that the transition plan for dual eligibles led to less medication discontinuation and switching than many had expected. The substantially greater cost sharing for benzodiazepines highlights the importance of implementing a thoughtful transition plan when executing such a national policy.
Setting the Stage for a New Strategic Plan for Geriatrics and Extended Care in the Veterans Health Administration: Summary of the 2008 VA State of the Art Conference, “The Changing Faces of Geriatrics and Extended Care: Meeting the Needs of Veterans in the Next Decade”
Authors: Shay Kenneth , Burris James F. ,   for the State of the Art Planning Committee
Published: December 2008

The Department of Veterans Affairs (VA) assumed an early leadership role in focusing on care of elderly adults. In 1998, the Federal Advisory Committee on the Future of VA Long‐Term Care, appointed by the VA Undersecretary for Health, recommended redirection of VA's extended care programs toward noninstitutional forms. A decade later, VA's Office of Geriatrics and Extended Care (GEC) initiated a strategic planning process by convening experts in geriatrics and health care, policy, and finance in Virginia on March 25 to 27, 2008, to present to VA clinicians and clinical managers the “State of the Art” of VA GEC.Recurring clinical themes included rising numbers and complexity of aging veterans, recent addition of younger veterans to VA's extended care mix, challenges that dementia and mental illness exert throughout GEC, and need for seamlessness in delivery of care across multiple venues. Ongoing research efforts quantifying demand and resources and validating models of care will remain indispensible for meeting clinical challenges.Serious undersupply of clinicians of all disciplines with general or specialty geriatrics knowledge persists. Much of VA's healthcare workforce and leadership are approaching retirement age, driving the need for new educational approaches, recruitment and retention strategies, and innovative delivery systems. Growing dependence on informal caregivers highlights the need for supporting these partners.VA's healthcare budget allocation illustrates how national policy dictates systemic, regional, and local clinical decisions. Rehabilitation of the newest veterans is resulting in systemwide efficiencies. Educating and empowering patients and families results in optimized utilization of health resources.
Prevalence and implications of psychopathological non‐cognitive symptoms in dementia
Authors: Saz P. , López‐Antón R. , Dewey M. E. , Ventura T. , Martín A. , Marcos G. , De La Cámara C. , Quintanilla M. A. , Quetglas B. , Bel M. , Barrera A. , Lobo A. 
Published: December 2008

Objective:  Clinical experience and recent population studies suggest that psychopathological, non‐cognitive symptoms are both frequent and relevant in dementia.Method:  A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two‐phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM‐IV‐TR criteria.Results:  The prevalence of non‐cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative‐type symptoms were most frequently found. A GMS ‘apathy‐related symptom cluster’ (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non‐cases (0.7%; specificity = 99.2%). In both dementia of Alzheimer’s type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed.Conclusion:  Non‐cognitive, negative‐type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non‐cases, and might change current concepts of dementia.
The non‐inherited maternal HLA haplotype affects the risk for type 1 diabetes
Authors: Åkesson K. , Carlsson A. , Ivarsson S.‐A. , Johansson C. , Weidby B.‐M. , Ludvigsson J. , Gustavsson B. , Lernmark Å. , Kockum I. 
Published: December 2008

SummaryThe aim was to test the hypothesis that the human leucocyte antigen (HLA) haplotype that is not inherited from the mother, that is, the non‐inherited maternal antigen (NIMA) affects the risk for type 1 diabetes (T1D). A total of 563 children with T1D and 286 non‐diabetic control children from Sweden were genotyped for DRB1, DQA1 and DQB1 alleles. The frequency of positively (DR4‐DQA1*0301‐B1*0302 and DR3‐DQA1*0501‐B1*0201), negatively (DR15‐DQ A1*0102‐B1*0602) or neutrally (all other) T1D associated HLA haplotypes were compared between NIMA and non‐inherited paternal antigen (NIPA). All comparisons were carried out between HLA‐matched patients and controls. The frequency of positively associated NIMA was higher among both DR4/X‐positive healthy individuals compared wit DR4/X‐positive patients (P < 0.00003) and DR3/X‐positive healthy individuals compared with DR3/X‐positive patients (P < 0.009). No such difference was observed for NIPA. High‐risk NIMA was increased compared to NIPA among healthy DR3/X‐ and DR4/X‐positive children (P < 0.05). There was no difference in frequency of positively associated haplotypes between patient NIMA and NIPA. The NIMA but not the NIPA affects the risk for T1D, suggesting that not only the inherited but also non‐inherited maternal HLA haplotypes, perhaps through microchimerism or other mechanisms, may influence the risk for the disease.
NRAMP1 (SLC11A1) gene polymorphisms that correlate with autoimmune versus infectious disease susceptibility in tuberculosis and rheumatoid arthritis
Authors: Ates Ö. , Dalyan L. , Müsellim B. , Hatemi G. , Türker H. , Öngen G. , Hamuryudan V. , Topal‐Sarıkaya A. 
Published: December 2008

SummaryNRAMP1 gene has multiple pleiotropic effects on macrophage activation pathways. These pleiotropic effects may increase resistance to infections such as tuberculosis (TB), but may also lead to susceptibility of autoimmune diseases such as rheumatoid arthritis (RA). It has been hypothesized that allele 3 would be associated with autoimmune diseases, whereas allele 2 would be associated with infectious diseases, and genetic factors that enhanced survival in the epidemics of TB might have led to susceptibility for the development of RA. We analysed four NRAMP1 gene polymorphisms including 5′ promoter (GT)n (rs34448891), INT4 (469 + 14G/C) (rs3731865), 3′UTR (1729 + 55del4) (rs17235416) and D543N (codon 543, Asp to Asn) (rs17235409) in 112 patients with TB, 98 patients with RA, 80 healthy controls for TB and 122 healthy controls for RA using ARMS‐PCR and PCR‐RFLP. We found a significant association between INT4 and RA (P = 0.004, odds ratio: 2.06, 95% CI: 1.24–3.41), but no significant differences between 5′ promoter, D543N, 3′UTR polymorphisms and RA. There were no associations between NRAMP1 gene polymorphisms and TB. Similarly, no significant differences were observed between NRAMP1 polymorphisms and rheumatoid factor positivity and erosive disease in RA and localization of TB. INT4 polymorphism may be associated with RA in Turkish patients.
MCP‐1 and CCR2 gene polymorphisms in Czech patients with allergic disorders
Authors: Izakovicova Holla L. , Mrazek F. , Petrek M. 
Published: December 2008

SummarySeveral lines of evidence suggest that chemokines play an important role in asthma and allergy. We analysed polymorphisms at –2518A/G and –2076A/T of MCP‐1 and V64I of CCR2 gene in healthy subjects (n = 306) and allergic patients (n = 332). Allele and genotype frequencies did not differ significantly between groups. Nevertheless, MCP‐1 variants were associated with allergen sensitization. The results suggest that MCP‐1, but not CCR2 gene variants, may participate in the pathogenesis of allergic phenotypes at least in the Caucasian population.
Analysis of ERCC2/XPD functional polymorphisms in systemic lupus erythematosus
Authors: Wan L. , Lin Y. J. , Sheu J. J. , Huang C. M. , Tsai Y. , Tsai C. H. , Wong W. , Tsai F. J. 
Published: December 2008

SummarySunlight/ultraviolet (UV) irradiation has been recognized as an important risk factor for developing systemic lupus erythematosus (SLE). However, the interpretation of genetic variations involved in UV‐light sensitivity is largely unknown. Recent studies indicated that two genetic variations of ERCC2/XPD gene (rs1799793 in exon 10 and rs13181 in exon 23) have been found to exert negative influences on nucleotide excision repair system. To analyse the possible contribution of the ERCC2/XPD functional single nucleotide polymorphisms in genetic susceptibility to SLE, the rs13181 and rs1799793 SNPs in ERCC2/XPD were genotyped by polymerase chain reaction followed by restriction fragment length polymorphism analysis. Association was studied by case–control analyses using samples from 172 SLE patients and 160 healthy controls. Haplotype analysis was performed to detect the association with genetic predisposition to SLE and the clinical features. Although these two functional genetic variations are linked to several immune dysfunction‐induced diseases, no statistically significant differences in allele or genotype frequencies were observed between SLE patients and controls. Haplotype analysis showed that none of ERCC2/XPD haplotypes was associated with the incidence of SLE disease, nor the preference of clinical features. In conclusion, the ERCC2/XPD functional polymorphisms analysed in this study showed no association in genetic susceptibility to SLE.
CRP and FCGR2A genes have an epistatic effect on carotid artery intima‐media thickness: the Cardiovascular Risk in Young Finns Study
Authors: Pessi T. , Eklund C. , Huhtala H. , Raitakari O. T. , Juonala M. , Kähönen M. , Viikari J. S. A. , Lehtimäki T. , Hurme M. 
Published: December 2008

SummaryThe role of the inflammatory mediator C‐reactive protein (CRP) in atherosclerosis is recognized although its specific functions are not entirely clear. CRP binds to the Fcγ receptor2A (FcγR2A) and its polymorphism, FCGR2A (Arg131His), strongly influences the binding. We wanted to evaluate the CRP‐mediated proatherogenic process on early atherosclerosis and investigated whether CRP and FCGR2A show an interactive effect on carotid intima‐media thickness (IMT). Polymorphisms of FCGR2A (Arg131His) and CRP (–717A > G, –286C > T > A, +1059G > C, +1444C > T and +1846G > A) were genotyped and their effects on IMT were analyzed in 2260 young adults participating in the Cardiovascular Risk in Young Finns Study. CRP haplotypes were constructed based on the CRP polymorphisms. The FCGR2A(Arg131His) polymorphism did not have an independent effect on IMT but a significant gene‐gene interaction, epistasis, between FCGR2A and CRP genetics on IMT was found. The epistatic effect was seen in men at haplotype and genotypic level; both CRP haplotype GCGCG (–717, –286, +1059, +1444 and +1846) and CRP–717A > G polymorphism interacted with FCGR2A(Arg131His) on IMT. After adjustment with classical risk factors the P‐values for interaction were P = 0.013 and P = 0.010, respectively. No associations were observed in women. In conclusion, this study showed that the effect of CRP genetics on early atherosclerotic changes is modulated by the FCGR2A genetics.
The Relationship of Household Routines to Morbidity Outcomes in Childhood Asthma
Authors: Peterson‐Sweeney Kathleen 
Published: December 2008

PURPOSE.  The major purpose of this study was to explore the effect of routines on asthma management and morbidity outcomes for children with asthma and their parents. DESIGN AND METHODS.  This study is a secondary data analysis in a sample of 150 children, which was originally used for an intervention study. RESULTS.  Parents who had fewer routines in their homes had lower quality‐of‐life scores and higher burden of asthma scores when compared to parents in households with more routines. More routines were associated with improved asthma morbidity outcomes as measured by nurse rankings of routines. PRACTICE IMPLICATIONS.  Assisting families to establish routines may result in improved asthma morbidity outcomes.
Prospective Evaluation of a Pediatric Inpatient Early Warning Scoring System
Authors: Tucker Karen M.  , Brewer Tracy L.  , Baker Rachel B.  , Demeritt Brenda  , Vossmeyer Michael T.  
Published: December 2008

PURPOSE.  The present study evaluated the use of the Pediatric Early Warning Score (PEWS) for detecting clinical deterioration among hospitalized children. DESIGN/METHODS.  A prospective, descriptive study design was used. The tool was used to score 2,979 patients admitted to a single medical unit of a pediatric hospital over a 12‐month period. RESULTS.  PEWS discriminated between children who required transfer to the pediatric intensive care unit and those who did not require transfer (area under the curve = 0.89, 95% CI = 0.84–0.94, p < .001).IMPLICATIONS.  The PEWS tool was found to be a reliable and valid scoring system to identify children at risk for clinical deterioration.
EARLY DIAGNOSIS OF INFECTIOUS DIARRHEA USING LACTOFERRIN AND HEMOGLOBIN MARKERS
Authors: VORAVUTHIKUNCHAI S.P. , OKADA K. , IIDA T. , HONDA T. 
Published: December 2008

ABSTRACT Lactoferrin (Lf) assay has been commercial for diarrhea for several years, but some factors confused the result interpretation. An immuno‐based rapid method was developed to detect Lf and hemoglobin (Hb) present in fecal sample. The objectives were to differentiate groups of diarrhea and provide a rapid test that could be used in order to help health professionals to quickly manage patient care, taking into account the type of diarrhea that is attacking. Positive results for fecal Lf indicated an inflammatory condition of the intestines. Positive results for fecal Hb suggested the presence of occult blood in stools. It has a sensitivity of 0.156 ng/µL of Lf and 0.313 ng/µL of Hb. Liquid fecal samples were mixed with a mixture containing antibodies to Lf and Hb. These antibodies were conjugated to colored latex beads. Each test zone on the test device has immovably fixed upon it a complementary antibody that binded specifically with one of the labeled antibodies in the mixture. Positive results appeared as stripes across the corresponding test zone. It has a sensitivity of 0.156 ng/µL of Lf and 0.313 ng/µL of Hb. Diagnostic evaluation of 156 patients with diarrhea was carried out to determine the accuracy of this test. Lf assay combined with Hb assay can increase specificity and sensitivity for invasive pathogens causing diarrhea. The test could be used to guide the diagnostic workup in order to identify patients who are likely to benefit from empirical antibiotic therapy. PRACTICAL APPLICATIONSThe results described here demonstrate the practical feasibility of using lactoferrin (Lf)/hemoglobin (Hb) latex agglutination for presumptive determination of inflammatory diarrhea as simple markers of invasive organisms. In addition to a quick guideline to doctors to manage efficiently, it would greatly reduce costly, unnecessary routine cultural process. A big advantage of this present communication is to include the second marker in order to precisely distinguish false Lf+ from true inflammatory diarrhea as blood that is always present in these patients and that can be detected by Hb marker. The results clearly demonstrated that Lf and Hb titers are consistently present in the inflammatory process.