bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost‐effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy
Authors: Price D. , Wirén A. , Kuna P. 
Published: September 2007

Background:  Budesonide/formoterol (Symbicort®) Maintenance and Reliever Therapy (SMART) is an effective asthma‐management approach that treats symptoms with rapid increases in budesonide/formoterol. The cost‐effectiveness of SMART vs higher fixed‐dose budesonide/formoterol or salmeterol/fluticasone is unknown.Methods:  This 6‐month, double‐blind study randomized patients with asthma uncontrolled by inhaled corticosteroids alone (n = 3335; age ≥12 years) to budesonide/formoterol 160/4.5 μg b.i.d. plus additional doses as needed (SMART), budesonide/formoterol 320/9 μg b.i.d. plus as‐needed terbutaline, or salmeterol/fluticasone 50/250 μg b.i.d. plus as‐needed terbutaline. Economic analysis, assuming health care and societal perspectives, applied 2004 UK and Australian unit costs to pooled resource‐use data. The effectiveness variable was the rate of severe exacerbations/patient/6 months.Results:  Patients treated using the SMART approach experienced fewer severe exacerbations than fixed‐dose budesonide/formoterol and salmeterol/fluticasone patients (0.12 vs 0.16 and 0.19 events/patient/6 months, respectively; P ≤ 0.0048). Budesonide/formoterol (Symbicort®) Maintenance and Reliever Therapy provided similar improvements in other markers of asthma control at a lower overall daily inhaled corticosteroid dose compared with fixed‐dose treatment. Study drug costs accounted for a majority of both direct costs (DC; 78–87%) and total costs (TC; 50–63%) for all treatments, and were significantly lower in the SMART group compared with the fixed‐dose groups (P ≤ 0.0014). Direct and TC per patient/6 months were lower for SMART vs salmeterol/fluticasone (DC:–AUS$154, P < 0.0001; TC:–AUS$163, P = 0.0036;–£87, P = 0.0026) and vs budesonide/formoterol using UK costs (DC:–£73, P < 0.0001; TC:–£91, P = 0.0014). Costs tended to be lower for SMART vs budesonide/formoterol using Australian costs (DC:–AUS$35, P = 0.16; TC:–AUS$70, P = 0.20). Results were stable under sensitivity testing. Indirect resource use and cost were not significantly different between groups.Conclusion:  Compared with higher fixed‐dose budesonide/formoterol and salmeterol/fluticasone, SMART reduces the incidence of severe exacerbations at a lower or similar overall cost and can be considered a cost‐effective treatment regimen.
Asthma definitions, relative validity and impact on known risk factors in young Brazilians
Authors: Vianna E. O. , García C. A. , Bettiol H. , Barbieri M. A. , Rona R. J. 
Published: September 2007

Background:  An asthma score was proposed in the European Community Respiratory Health Survey (ECRHS) framework, as dichotomous definitions could be less appropriate in the study of chronic diseases. The aims of this study were to assess the value of this asthma score in comparison with other definitions of asthma in another population setting, using as criteria bronchial hyperresponsiveness (BHR) to methacholine and diagnosed asthma, and the association of these definitions to known risk factors of asthma.Methods:  We used the ECRHS questionnaire on 2063 Brazilians, aged 23–25 years, and measured their BHR. We assessed the positive and negative likelihood ratios (PLR and NLR) of the asthma score (0–8), a three question score (ECRHS definition) and single asthma symptoms in relation to BHR and diagnosed asthma.Results:  The PLR were relatively low for all asthma definitions with odd ratios varying from 1.47 for asthma score to 5.50 for wheeze and waking with breathlessness without a cold. The NLR were near 1. The PLR were lower for assessments using the score than for dichotomous assessments or the ECRHS definition. The PLR increased with asthma scores, but the prevalence with higher scores was too low for useful analysis. The asthma score was slightly better for identifying associations from a set of known risk factors than the other two approaches.Conclusion:  Our study provided little support for a greater validity of this asthma score over other asthma definitions, and only marginal advantage for identifying risk factors.
Association between obesity and asthma in a twin cohort
Authors: Thomsen S. F. , Ulrik C. S. , Kyvik K. O. , Sørensen T. I. A. , Posthuma D. , Skadhauge L. R. , Steffensen I. , Backer V. 
Published: September 2007

Background:  Obesity is linked to asthma in a yet poorly understood manner. We examined the relationship between obesity and asthma in a population‐based sample of twins.Methods:  From the cohorts born between 1953 and 1982, who were enrolled in The Danish Twin Registry, a total of 29 183 twin individuals participated in a nationwide questionnaire study, where data on height, weight and asthma were collected. Latent factor models of genetic and environmental effects were fitted using maximum likelihood methods.Results:  The age‐adjusted risk of asthma was increased both in obese females, OR = 1.96 (1.45–2.64), P ≤ 0.001 and in obese males, OR = 1.59 (1.08–2.33), P = 0.02. According to best‐fitting models, the heritability for obesity was 81% in males and 92% in females, whereas the heritability for asthma was 78% and 68% in males and females respectively. The age‐adjusted genetic liabilities to obesity and asthma were significantly correlated only in females, r = 0.28 (0.16–0.38).Conclusions:  Obese subjects have an increased risk for asthma, which in females seems partly because of common genes.
The polymorphisms of Eotaxin 1 and CCR3 genes influence on serum IgE, Eotaxin levels and mild asthmatic children in Taiwan
Authors: Wang T.‐N. , Chiang W. , Tseng H.‐I. , Chu Y.‐T. , Chen W.‐Y. , Shih N.‐H. , Ko Y.‐C. 
Published: September 2007

Background:  Asthma is a complex disorder, which is known to be affected by interactions between genetic and environmental factors. The human Eotaxin 1 and CCR3 attract eosinophils and Th2‐lymphocytes to migrate to the inflammatory foci that could represent a key mechanism in allergy and asthma.Objective:  We hypothesized that Eotaxin1 gene Ala23Thr and A‐384 G, and CCR3 gene T51C polymorphisms are associated with plasma Eotaxin levels and predispose individuals to asthma pathogenesis.Methods:  One hundred seventy‐eight hospital‐based asthmatic children and 277 community‐based controls aged from 5 to 12 years were recruited in southern Taiwan. Whole blood samples and questionnaires were collected. In this study, we addressed genetic effects of Eotaxin 1 and CCR3 genes on asthma, plasma IgE and Eotaxin 1 levels.Results:  In comparison with subjects with Ala23Ala genotype, Ala23Thr polymorphism of the Eotaxin 1 gene showed a significant protective effect on asthma (AOR = 0.58, 95% CI = 0.37–0.92). We demonstrated that the mean Eotaxin 1 concentration was significantly higher in subjects with Ala23Ala than in subjects with Thr23Thr (P = 0.005) or Ala23Thr (P = 0.07), which showed a gene‐dose dependent relationship. But, we observed that the A‐384G polymorphism of Eotaxin 1 gene and T51C polymorphism of CCR3 gene are not associated with asthma.Conclusion:  This study finding provide a strong evidence that Eotaxin 1 Thr23Thr homozygote has a protective effect on asthma and significantly decreases plasma Eotaxin 1 concentrations in asthmatics in Taiwan.
Impact of gender on asthma in childhood and adolescence: a GA2LEN review
Authors: Almqvist C. , Worm M. , Leynaert B. ,   for the working group of GALEN WP 2.5 ‘Gender’
Published: September 2007

A number of studies have shown gender differences in the prevalence of wheeze and asthma. The aim of this review was to examine published results on gender differences in childhood and adolescent asthma incidence and prevalence, define current concepts and to identify new research needs.A Medline search was performed with the search words (gender OR sex) AND (child OR childhood OR adolescence) AND (asthma). Articles that reported on abscence or prescence of gender differences in asthma were included and reviewed, and cross‐references were checked. Boys are consistently reported to have more prevalent wheeze and asthma than girls. In adolescence, the pattern changes and onset of wheeze is more prevalent in females than males. Asthma, after childhood, is more severe in females than in males, and is underdiagnosed and undertreated in female adolescents. Possible explanations for this switch around puberty in the gender susceptibility to develop asthma include hormonal changes and gender‐specific differences in environmental exposures. This aspect needs consideration of the doctors and allergists who diagnose and treat asthmatic individuals.In conclusion, sex hormones are likely to play an important role in the development and outcome of the allergic immune response and asthma in particular. By obtaining functional data from appropriate models, the exact underlying mechanisms can be unravelled. To examine the effect of gender‐specific differences in environmental exposures and changes of asthma prevalence and severity in puberty, larger populations may need to be investigated.
Post‐traumatic stress disorder among adolescents with bipolar disorder and its relationship to suicidality
Authors: Dilsaver Steven C , Benazzi Franco , Akiskal Hagop S , Akiskal Kareen K 
Published: September 2007

Objectives:  The aims of this cross‐sectional pilot study were to ascertain the rates of post‐traumatic stress disorder (PTSD) among adolescents with bipolar disorder (BPD) and major depressive disorder (MDD) relative to a comparison group comprised of non‐affectively ill patients, and to determine whether PTSD is related to suicidal ideation and attempts. The impetus for the study was born of clinical impressions derived in the course of routine clinical practice.Methods:  Patients were screened by a single interviewer for BPD, MDD and PTSD, panic disorder, obsessive–compulsive disorder (OCD) and social phobia using the apposite modules from the Structured Clinical Interview for DSM‐IV (SCID) and histories of suicidal ideation and attempts. The data were subjected to analysis using a logistic regression model.Results:  The database included 34 patients with BPD, 79 with MDD and 26 with a non‐affective disorder. The risk for PTSD for a patient with BPD significantly exceeded that for a patient with MDD [odds ratio (OR) = 4.9, 95% confidence interval (CI) = 1.9–12.2, p = 0.001]. Patients with PTSD had an insignificantly increased risk for suicidal ideation (OR = 2.8, 95% CI = 0.9–8.9, p = 0.069), and a 4.5‐fold significantly increased risk of having had a suicide attempt (OR = 4.5, 95% CI = 1.7–11.7, p = 0.002). The relationship between PTSD and suicide attempts remained significant even after controlling for the confounding effects of concurrent panic disorder, OCD and social phobia (OR = 3.4, 95% CI = 1.1–10.0, p = 0.023).Conclusions:  Patients with BPD have a greater risk for PTSD than those with MDD. Post‐traumatic stress disorder is significantly related to history of suicide attempts.
Adherence to medication in bipolar disorder: a qualitative study exploring the role of patients’ beliefs about the condition and its treatment
Authors: Clatworthy Jane , Bowskill Richard , Rank Tim , Parham Rhian , Horne Rob 
Published: September 2007

Objectives:  Patients’ perceptions of illness and treatment have been found to predict adherence to medication in many chronic conditions. This has not yet been fully explored in bipolar disorder (BD). The aim was to use a qualitative methodology to explore in depth the beliefs about BD and its treatment that are associated with adherence to medication prescribed for BD.Methods:  Sixteen adults prescribed prophylactic treatment for BD completed semi‐structured interviews about their perceptions of BD and its treatment and their adherence to medication. Interviews were recorded and transcribed verbatim. Two researchers identified perceptions associated with non‐adherence in the transcripts.Results:  Thirteen participants (81%) reported some degree of intentional or unintentional medication non‐adherence. Intentional non‐adherence was associated with patients’ concerns about the prescribed medication, arising from the experience of side effects, but also from beliefs that regular use could lead to adverse effects in the future. Intentional non‐adherence was also associated with doubts about the personal need for medication, which were related to perceptions of BD (e.g., not accepting diagnosis, believing the condition is not controllable, believing it is not a chronic condition).Conclusions:  This study has identified some of the salient beliefs about BD and its treatment that should be elicited and addressed in interventions to facilitate adherence to medication. Further quantitative work is justified to explore the utility of this approach in the development of interventions.
Is bipolar disorder overdiagnosed among patients with substance abuse?
Authors: Stewart Christopher , El‐Mallakh Rif S 
Published: September 2007

Background:  Bipolar illness is frequently misdiagnosed. Several studies have focused on the underdiagnosis of this condition and the frequent long delay in its recognition. However, the illness is difficult to diagnose and many of its symptoms are shared by other conditions. In order to determine the accuracy of the diagnosis of bipolar illness among subjects with substance abuse, we carried out a study in patients with a previous diagnosis of bipolar disorder (BD) and known history of substance abuse or dependence, who were currently engaged in treatment for substance abuse.Methods:  Individuals participating in a community‐based substance treatment program and who had a previous diagnosis of BD were invited to undergo a structured clinical interview for diagnosis performed by a psychiatrist. In addition to the interview, previous hospital records were reviewed whenever possible. Diagnosis was made following strict DSM‐IV criteria.Results:  Only 9 of 21 (42.9%) subjects met diagnostic criteria for BD. Seven were BD type II and two were BD I.Conclusions:  Bipolar disorder is frequently misdiagnosed following strict DSM‐IV criteria. Among subjects with substance abuse, it may be overdiagnosed by psychiatrists.
A placebo‐controlled, random‐assignment, parallel‐group pilot study of adjunctive topiramate for patients with schizoaffective disorder, bipolar type
Authors: Roy Chengappa KN , Kupfer David J , Parepally Haranath , John Vineeth , Basu Ranita , Buttenfield Joan , Schlicht Patricia , Houck Patricia , Brar Jaspreet S , Gershon Samuel 
Published: September 2007

Objectives:  This pilot study evaluated the efficacy and safety of adjunctive topiramate compared with placebo in the treatment of patients with a diagnosis of schizoaffective disorder, bipolar type (SAD‐BT).Methods:  A sample of 48 adult patients with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM‐IV‐TR) diagnosis of SAD‐BT (supported by the Structured Clinical Interview for DSM‐IV Axis I Disorder, Patient Edition) were randomly assigned in a 2:1 ratio (favoring topiramate) to 8 weeks of double‐blind treatment with topiramate (100–400 mg/day) or placebo. Patients who had achieved a ≥20% decrease from baseline in their Positive and Negative Syndrome Scale (PANSS) total scores were given the opportunity to continue for an additional 8 weeks of double‐blind treatment. The dosage of the study medicine was continued unchanged from the earlier 8‐week study period. At the end of the study period, the study medicine was tapered and discontinued over a 2‐week period. Primary efficacy was assessed at 8 weeks using the mean change between treatment groups of the PANSS total scores in the intent‐to‐treat population of randomized patients. Several secondary measures were also assessed. Safety analyses included monitoring of adverse events, vital signs, electrocardiogram (ECG) and laboratory values.Results:  Even though both treatments reduced scores on various psychopathology rating scales, adjunctive topiramate treatment (nearly 275 mg/day) did not show increased efficacy relative to placebo on the primary outcome measure (PANSS scale) or any of the secondary outcome measures. Topiramate‐treated patients lost significantly more body weight than placebo‐treated patients, which led to a significant reduction in body mass index (BMI). Relative to adjunctive placebo, topiramate‐treated patients experienced higher rates of paresthesia, sedation, word‐finding difficulty, sleepiness, and forgetfulness, but these differences were not statistically significant. There were no clinically significant abnormalities in either the ECG or laboratory results. There were no serious adverse events in the study. Further, there was no worsening of the PANSS total scores (to ≥10% from baseline), and no significant differences between the treatments on worsening of total Montgomery–Asberg Depression Rating Scale (MADRS) scores [1/13 (7.7%) for placebo; 1/25 (4.0%) for topiramate].Conclusions:  This pilot study did not support clinical efficacy for adjunctive topiramate treatment in patients with SAD‐BT. There were no major safety or tolerability issues in this study. Confirming the results of other studies, topiramate‐treated patients did experience greater body weight loss and reduction in BMI.
Agomelatine adjunctive therapy for acute bipolar depression: preliminary open data
Authors: Calabrese Joseph R , Guelfi Julien Daniel , Perdrizet‐Chevallier Catherine ,   the Agomelatine Bipolar Study Group
Published: September 2007

Objectives:  Agomelatine has been shown to be safe and efficient in the treatment of major depressive disorder at 25 mg daily. The aim of this study was to gather preliminary data regarding the antidepressant efficacy of agomelatine in patients with bipolar I disorder experiencing a major depressive episode.Methods:  Bipolar I patients on lithium (n = 14) or valpromide (n = 7), with a Hamilton Rating Scale for Depression (HAM‐D‐17) total score ≥ 18, were given adjunctive open‐label agomelatine at 25 mg/day for a minimum of 6 weeks followed by an optional extension of up to an additional 46 weeks.Results:  Using intent‐to‐treat data, 81% of patients met criteria for marked improvement (>50% improvement from baseline in HAM‐D score) at study endpoint. Patients were severely depressed at study entry (HAM‐D of 25.2) and 47.6% responded as early as at one week of treatment. Nineteen patients entered the optional extension period for a mean of 211 days (range 6–325 days). Eleven patients completed the one‐year extension on agomelatine. There were no dropouts due to adverse events during the acute phase of treatment (6 weeks). Six patients experienced serious adverse events during the one‐year period. Three lithium‐treated patients experienced manic or hypomanic episodes during the optional extension period, one of which was treatment‐related.Conclusions:  These results indicate the effectiveness of agomelatine 25 mg in the treatment of depressed bipolar I patients co‐medicated with lithium or valpromide. A randomized controlled trial is planned to confirm these results.
Phenotypic plasticity of immune defence linked with foraging activity in the ant Cataglyphis velox
Authors: BOCHER A. , TIRARD C. , DOUMS C. 
Published: September 2007

AbstractBecause immune defences are costly, life‐history theories predict a modulation of immune investment according to its potential benefits. Social insects provide interesting models since infection risk may vary among individuals within a colony. In particular, the foraging workers, that have to leave the nest, suffer a higher infection risk and can contaminate their nest, which may favour high immune investments. However, evolutionary theories of aging predict that foragers should reduce their immune investment when they suffer high extrinsic mortality. To test these two predictions, we investigated the levels of phenoloxidase (PO) and prophenoloxidase, two important enzymes of the insect immune system, in workers of the ant Cataglyphis velox. We found a higher PO activity in foragers than in intra‐nidal workers. This could result from an adaptive upregulation of the harmful PO (an enzyme potentially leading to autoimmune reactions) only when the risk of infection and wounding is high.
EXERCISE PERFORMANCE AND VENTILATORY EFFICIENCY IN PATIENTS WITH MILD AND MODERATE LIVER CIRRHOSIS
Authors: Terziyski K , Andonov V , Marinov B , Kostianev S 
Published: September 2007

SUMMARY

The impact of ventilatory efficiency on reduced exercise capacity and recovery oxygen kinetics has not been addressed in cirrhotic patients. The aim of the present study was to investigate exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis (LC).
Nineteen male non‐hypoxic patients with LC (age 51.3 ± 9.1 years; body mass index (BMI) 25.6 ± 3.6 kg/m2) classified by the Child‐Pugh score as class A (n = 7) and class B (n = 12) and 19 age‐ and BMI‐matched controls participated in the study. Subjects undertook maximal incremental exercise testing on a treadmill using the Bruce protocol.
Patients with LC showed a reduced diffusion capacity (DL,CO%) compared with controls (74.6 ± 15.2 vs 95.6 ± 12.9%, respectively; P < 0.001), but a comparable volume standardized diffusion coefficient (1.33 ± 0.22 vs 1.45 ± 0.18 mmol/min per kPa per L, respectively; P = 0.74). Patients with LC had a significantly lower exercise capacity compared with controls (VO2max 23.8 ± 3.8 vs 30.6 ± 4.4 mL/min per kg, respectively; P < 0.001).  Recovery oxygen kinetics were also impaired in LC patients compared with controls (104.6 ± 19.3 vs 84.4 ± 22.7 s, respectively; P = 0.012). The chronotropic index was significantly lower in the LC group compared with controls (0.67 ± 0.19 vs 0.82 ± 0.17, respectively; P = 0.030) and LC patients showed higher ventilatory equivalents (30.4 ± 3.8 vs 26.3 ± 2.3, respectively; P < 0.001) and lower oxygen uptake efficiency slope values (2187 ± 445 vs 2745 ± 473 mL/min per log10L, respectively; P < 0.001) compared with controls, which is indicative of decreased ventilatory efficiency. Patients with LC also had a higher standardized maximal exercise perception score (SMEPS) compared with controls (0.62 ± 0.18 vs 0.46 ± 0.15, respectively; P = 0.011). Moderate negative correlations were found between Child‐Pugh score and VO2max% (r = –0.496; P = 0.031).
In conclusion, patients with mild and moderate LC have reduced exercise capacity, which correlates with Child‐Pugh score, as well as reduced chronotropic index and prolonged recovery oxygen uptake kinetics. The results suggest worsened ventilatory efficiency during exercise and cardiopulmonary reasons for the higher SMEPS in these patients.