bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-Administered Medication-Risk Questionnaire in an Elderly Population
Authors: Levy Hedva Barenholtz 
Published: May 2003

OBJECTIVE: To evaluate and validate a 10-item self-administered questionnaire for use by elderly patients to identify who is at increased risk of potentially experiencing a medication-related problem (MRP). METHODS: Forty participants aged ≥60 years who took ≥2 prescription drugs regularly completed the questionnaire. Data collection was based on patient interviews, review of pharmacy or medical records, and drug regimen reviews (DRRs). Outcome measures included feasibility, inter-rater reliability, test–retest reliability, internal consistency, and validity of the questionnaire. DRR severity scores were determined for each participant based on published guidelines for appropriate use. RESULTS: The questionnaire was easily administered to this group of older adults. Overall inter-rater reliability was high (r = 0.847). Nine of 10 individual questions matched well between the investigator and participants (κ 0.4–0.6 for 3 questions; >0.6 for 6 questions). Test–retest reliability was significant for all 10 questions (κ > 0.6). Internal consistency was acceptable (a = 0.69). DRR severity scores were correlated with questionnaire responses to determine validity. The number of yes answers correlated significantly with higher DRR severity scores (p < 0.001). Furthermore, 5 individual questions significantly correlated with DRR severity scores. CONCLUSIONS: This study suggests that a self-administered questionnaire can be used in an older adult population to identify patients potentially at increased risk of MRPs. Clinicians in ambulatory care settings with similar patient populations can use a modified form of the questionnaire to screen for patients who should receive a medication review.
Dapsone-Induced Sulfone Syndrome
Authors: Lee Kimberly B , Nashed Trisha B 
Published: May 2003

OBJECTIVE: To report a patient with dapsone-induced sulfone syndrome. CASE SUMMARY: A 42-year-old HIV-infected African American man developed fever, lymphadenopathy, exfoliative dermatitis, hepatitis, and methemoglobinemia 4 weeks after starting dapsone. Complete resolution of symptoms and laboratory abnormalities occurred with cessation of dapsone therapy. DISCUSSION: Sulfone syndrome is not a well-known sequela of dapsone therapy. It is not dose-related, usually occurs in doses of 50–300 mg/d, all cases occur within 2 months of starting dapsone, all patients have fever, and most patients will develop rash and evidence of hepatic injury. The temporal relationship between dapsone therapy and onset of clinical symptoms and objective data led us to believe that dapsone caused sulfone syndrome in our patient. An objective causality assessment revealed that the adverse drug event was probable. CONCLUSIONS: Although sulfone syndrome appears to be relatively uncommon, healthcare practitioners must be aware of the potentially fatal syndrome associated with dapsone use.
Improving Adherence and Reducing Medication Discrepancies in Patients with Diabetes
Authors: Grant Richard W , Devita Nicole G , Singer Daniel E , Meigs James B 
Published: May 2003

OBJECTIVE: To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens. DESIGN: Prospective, randomized, controlled trial. SETTING AND PARTICIPANTS: A single academically affiliated community health center. Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the study. INTERVENTION: A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider. MEASUREMENTS: Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview. Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months. RESULTS: Rates of self-reported medication adherence were very high and did not improve further at 3 months (6.9 of 7 d, with all medicines taken as prescribed; p = 0.3). Medical regimen discrepancies were identified in 44% of intervention patients, involving 45 doses of medicines. At 3-month follow-up, 60% of discrepancies were resolved by corrections in the medical record, while only 7% reflected corrections by patients. CONCLUSIONS: In this community cohort, patients reported few adherence barriers and very high medication adherence rates. Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence. The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.
Bupropion Overdose: QTc Prolongation and its Clinical Significance
Authors: Isbister Geoffrey K , Balit Corrine R 
Published: May 2003

OBJECTIVE: To investigate the cardiotoxicity of bupropion hydrochloride in deliberate self-poisoning. METHODS: A prospective study was conducted in a national poisons information center (PIC) of cases of adult deliberate self-poisoning with medical record follow-up of the patients. Fifty-nine cases of bupropion deliberate self-poisoning managed in the hospital, in which the New South Wales PIC was contacted for advice, were evaluated from November 2000 through July 2001. Clinical effects and electrocardiographic (ECG) parameters (QRS, QT, QTc) were the main outcome measures. RESULTS: ECGs were available for 17 of the 59 patients for analysis, 9 patients (53%) were women, and median patient age was 28 years (interquartile range 22–37). The mean ± SD ingested bupropion dose was 3.8 ± 3.1 g. Tachycardia occurred in 13 patients (76%; 95% CI 50 to 93) and hypertension in 8 patients (47%). There were no reports of hypotension or arrhythmias. There was a significantly increased QTc of 461 ± 34 msec in the patients with bupropion overdose compared with previously developed controls; 13 of the 17 cases had a QTc >440 msec (76%; 95% CI 50 to 93). The uncorrected QT interval did not differ from that of controls. CONCLUSIONS: A moderately prolonged QTc (>440 msec) is common in bupropion overdose. However, this may not be a result of intrinsic cardiac toxicity, but overcorrection of the QTc due to the tachycardia that occurs. It is important that the QTc is interpreted with caution in overdoses of agents that cause significant tachycardia (>100 beats/min).
Valsartan-Induced Angioedema
Authors: Irons Brian K , Kumar Ashwani 
Published: May 2003

OBJECTIVE: To report a case of dose-dependent angioedema secondary to the use of the angiotensin-receptor blocker (ARB) valsartan. CASE SUMMARY: A 64-year-old Hispanic woman presented with swelling of the lips shortly after an increase in her valsartan dose for uncontrolled hypertension. Other potential causes were not identified. The angioedema subsequently resided after a dosage reduction and observation. Use of the Naranjo probability scale indicated a probable relationship between the angioedema and valsartan therapy in this patient. DISCUSSION: Drug-induced angioedema is often associated with the use of angiotensin-converting enzyme (ACE) inhibitors and is probably secondary to their effects on bradykinin levels. ARBs are thought to produce few, if any, cases of angioedema if excess bradykinin levels are the root cause of angioedema secondary to ACE inhibitor use. Several potential ARB-induced cases of angioedema have been reported. The exact mechanism of angioedema induced by drugs in both of these classes is unknown. Animal data suggest that there may be a relationship between ARB use and increased tissue bradykinin levels secondary to stimulation of angiotensin II AT2 receptors. CONCLUSIONS: This is the third reported case of valsartan-induced angioedema and the first thought to be dose dependent. Practitioners should be aware of this potential adverse effect of valsartan, although the underlying cause is still not known.
The 10 Å to 7 Å Halloysite Transition in a Tropical Soil Sequence, Costa Rica
Authors: Kautz Christopher Q. , Ryan Peter C. 
Published: May 2003

AbstractSoils developed on Pleistocene andesitic lava flows and fluvial detritus in the Atlantic coastal plain of Costa Rica display a clay mineral assemblage that includes 10 Å and 7 Å halloysite and lesser amounts of kaolinite and dioctahedral vermiculite. Other secondary minerals include gibbsite, goethite, hematite, maghemite, allophane and amorphous Al hydroxides. Active floodplain soils are dominated by 10 Å halloysite and contain less allophane, while soil clays from Pleistocene terraces consist of a mixture of 10 Å and 7 Å halloysite as well as less dioctahedral vermiculite, kaolinite, and amorphous Al hydroxides. Residual soils formed on Pleistocene lava flows are dominated by 7 Å halloysite with less abundant kaolinite, dioctahedral vermiculite, 10 Å halloysite and amorphous Al hydroxides. This sequence suggests transformations of 10 Å halloysite to 7 Å halloysite and allophane to amorphous Al hydroxides with time. The presence of 10 Å halloysite in Pleistocene terrace soils implies slow reaction rates or metastability.Quantitative X-ray diffraction (QXRD) analysis indicates a decrease in the amount of plagioclase feldspar from 34 wt.% in the 1–2 year floodplain to 0–1.6% in terrace and residual soils. Plagioclase weathering is paralleled by the formation of dioctahedral clay, allophane and Al hydroxides. Analysis by QXRD also indicates that crystalline minerals comprise 70–95% of the soil fraction, implying 5–30% X-ray-amorphous material. These data are verified by selective extraction using ammonium oxalate, which indicates 8–30% amorphous material. Chemical analysis of the extractant by inductively coupled plasmaatomic emission spectrometry indicates that allophane (Al:Si ratios of 0.92–3.82) occurs in floodplain and some terrace soils while amorphous Al hydroxides appear to coexist with allophane in Pleistocene terrace and residual soils with Al:Si ratios of 6.53–8.53. Retention of Mg to a greater extent than Na, Ca and K suggests Mg incorporation into hydroxide sheets in dioctahedral vermiculite as well as substitution into hydroxides.
Structural Transformations of Clay Minerals in Soils of a Climosequence in an Italian Alpine Environment
Authors: Mirabella Aldo , Egli Markus 
Published: May 2003

AbstractClays of a soil sequence with five profiles in the Val Genova (northern Italy) along an elevation gradient with climate ranging from moderate to Alpine were investigated with XRD using several diagnostic treatments. Smectites developed in the surface horizons of podzolic soils either from chlorite through the removal of hydroxy interlayers or from mica, which weathers in a first step to regularly or irregularly interstratified clay minerals. Citrate treatment allowed the detection of low-charge expandable minerals in the Bhs or Bs horizons. Therefore, the reduction of the charge of 2:1 clay minerals occurred before the removal of hydroxy polymers by fulvic acids and low-weight organic acids. Due to the more intense podzolization process near the tree line, the d060 region showed a temporal evolution of trioctahedral to dioctahedral mineral structures in the well developed Podzols. The pedogenic smectites of the E or Bhs horizons generally included one or several populations with various charges. In most cases, smectite was a heterogeneous mixture of montmorillonite and interstratified beidellite-montmorillonite. A pure beidellite phase could not be detected. The soils near the tree line, where weathering processes were most intense, had two main components: one with a charge >0.75, representing vermiculite-like minerals, and the other with a charge near 0.25, representing smectite. The charges of the beidellitic component and montmorillonite were almost equal. The higher the weathering state of the investigated soils, the lower was the layer charge of smectites.
Measurement of Illite Particle Thickness using a Direct Fourier Transform of Small-Angle X-ray Scattering Data
Authors: Shang Chao , Rice James A. , Eberl Dennis D. , Lin Jar-Shyong 
Published: May 2003

AbstractIt has been suggested that interstratified illite-smectite (I-S) minerals are composed of aggregates of fundamental particles. Many attempts have been made to measure the thickness of such fundamental particles, but each of the methods used suffers from its own limitations and uncertainties. Small-angle X-ray scattering (SAXS) can be used to measure the thickness of particles that scatter X-rays coherently. We used SAXS to study suspensions of Na-rectorite and other illites with varying proportions of smectite. The scattering intensity (I) was recorded as a function of the scattering vector, q = (4 π/λ) sin(θ/2), where λ is the X-ray wavelength and θ is the scattering angle. The experimental data were treated with a direct Fourier transform to obtain the pair distance distribution function (PDDF) that was then used to determine the thickness of illite particles. The Guinier and Porod extrapolations were used to obtain the scattering intensity beyond the experimental q, and the effects of such extrapolations on the PDDF were examined. The thickness of independent rectorite particles (used as a reference mineral) is 18.3 Å. The SAXS results are compared with those obtained by X-ray diffraction peak broadening methods. It was found that the power-law exponent (α) obtained by fitting the data in the region of q = 0.1–0.6 nm−1 to the power law (I = I0q−α) is a linear function of illite particle thickness. Therefore, illite particle thickness could be predicted by the linear relationship as long as the thickness is within the limit where α <4.0.
The Visible Diffuse Reflectance Spectrum in Relation to the Color and Crystal Properties of Hematite
Authors: Torrent José , Barrón Vidal 
Published: May 2003

AbstractHematite (α-Fe2O3) possesses distinct spectral properties which facilitate its identification in mineral mixtures. This paper reports the relationships between the visible diffuse reflectance (DR) spectrum and the color and crystal properties of a group of 81 natural and synthetic hematites. The visible DR spectra for powdered hematite samples diluted to 4 wt.% with BaSO4 white standard were recorded and used to calculate the corresponding Munsell colors. The second derivative of the Kubelka-Munk function of the DR was used to estimate the position and intensity of the main absorption bands, which occurred at ∼435, ∼485 and ∼545 nm. The Munsell hue ranged from 9.5P to 5.3YR and was negatively correlated with the position of the ∼545 nm band, so it became yellower as the band shifted to shorter wavelengths (higher energies). The Munsell value, which ranged from 4.9 to 8.6, and chroma, which ranged from 1.4 to 8.3, were negatively and positively correlated, respectively, with the intensity of the ∼545 nm band, the position of which exhibited a weak negative correlation with the degree of Al substitution (x). The position and intensity of this band also exhibited a weak negative correlation with the specific surface area (SSA); both, however, were uncorrelated with domain shape as measured by the ratio between the X-ray mean coherence lengths (MCLs) in the [110] and [104] directions. The properties of the ∼435 and ∼485 nm bands were unrelated to x, SSA or MCL110/MCL104. The negative relationship between the position of the ∼545 nm band and x does not support the assignment of this band to the 2(6A1) → 2(4T1g(4G)) electron pair transition (EPT), which relates to the to Fe3+−Fe3+ magnetic coupling between face-sharing octahedra. The ∼485 nm band might reflect a ‘goethitic’ structural component in Fe-defective hematites as it appears at the same wavelength as the hypothetical EPT related to Fe3+−Fe3+ magnetic coupling between edge-sharing octahedra in goethite (α-FeOOH).
Anionic Polyacrylamide Polymer Adsorption by Pyrophyllite and Montmorillonite
Authors: Heller Hadar , Keren Rami 
Published: May 2003

AbstractThe mechanism by which the anionic polymers interact with platelets of 2:1 clay minerals is not fully understood. The objective of the present study was to evaluate the effect of the electric field associated with the basal and edge surfaces of the clay minerals on the adsorption of anionic polymers. Two negatively charged polymers, PAM90 and ACC86, of the same molecular weig ht (2 × 105 g mol−1) but with different degrees of hydrolysis (90 and 20%, respectively), were used. The effect of pH (6, 10), NaCl concentration (0, 10 mmolC L−1) and clay particle size on PAM90 adsorption by pyrophyllite and the effect of NaCl concentration on the adsorption of these polymers by Na-montmorillonite in aqueous suspensions were studied. Adsorption of PAM90 on pyrophyllite was greater at pH 6 than at pH 10 and greater in 10 mmol L−1 NaCl than in distilled water. Adsorption of PAM90 on pyrophyllite increased with decreasing particle size. On pyrophyllite the high-charge-density PAM90 was adsorbed to a greater extent than the low-charge-density ACC86; by contrast, ACC86 adsorption was greater than that of PAM90 on Na-montmorillonite. These results were attributed to the repulsive forces which develop between the negatively charged extended-chain polymer and the extended negative electric field associated with the basal surfaces, around the Na-montmorillonite platelets. The results may suggest that the edge surfaces play a major role in PAM adsorption.
Indirect lead exposure among children of radiator repair workers
Authors: Aguilar‐Garduño C. , Lacasaña M. , Tellez‐Rojo M.M. , Aguilar‐Madrid G. , Sanin‐Aguirre L.H. , Romieu I. , Hernandez‐Avila M. 
Published: May 2003

AbstractBackgroundSecondary exposure to lead has been identified as a public health problem since the late 1940s; we investigate the risk of lead exposure among families of radiator repair workers.MethodsA sample of the wives and children, aged 6 months to 6 years (exposed children) (n = 19), of radiator repair workers and a sample of children whose parents were not occupationally exposed to lead (non‐exposed children) (n = 29) were matched for age and residence; their geometric mean blood lead levels are compared. Blood samples were obtained by the finger stick method and environmental dust samples by the wipe method; both were analyzed using a portable anodic stripping voltameter.ResultsDust lead levels were significantly higher in the houses of exposed children (143.8 vs. 3.9 μg/g; P < 0.01). In crude analyses, the highest lead levels were observed among children whose fathers worked in home‐based workshops (22.4 μg/dl)(n = 6). Children whose fathers worked in an external workshop (n = 13) also had high levels (14.2 μg/dl) (P < 0.01), while blood lead levels in non‐exposed children were significantly lower (5.6 μg/dl)(P < 0.01). The observed differences remained significant after adjustment for age and gender.ConclusionsThis study confirms that children of radiator repair workers are at increased risk of lead exposure and public health interventions are needed to protect them. Am. J. Ind. Med. 43:662–667, 2003. © 2003 Wiley‐Liss, Inc.
Occupational asthma in the city of São Paulo, 1995–2000, with special reference to gender analysis
Authors: Mendonça Elizabete Medina Coeli , Algranti Eduardo , Freitas Jefferson Benedito Pires de , Rosa Edna Aparecida , Freire José Antônio dos Santos , Santos Ubiratan de Paula , Pinto Jarina , Bussacos Marco Antônio 
Published: May 2003

AbstractBackgroundOccupational asthma (OA) is the leading occupational respiratory disease in the area of São Paulo Municipality. Understanding its characteristics can provide useful information for better interventions.MethodsFrom a joint registry of OA from five outpatient public clinics for occupational respiratory diseases, data on occupation, with job titles corrected by an expert evaluation, agents, exposure and symptom duration, and spirometry were analyzed by gender. Data on employment for São Paulo Municipality were used to calculate expected ratios for men/women in broad economical sectors.ResultsThree hundred and ninety four OA cases were reported with a ratio of men/women of 1.5. Women had significantly shorter exposure duration (5.6 ± 5.2 vs. 8.9 ± 9.0 years, P = 0.0005), shorter symptoms duration (2.6 ± 3.7 vs. 3.2 ± 3.5 years, P = 0.1270), and higher prevalence of previous atopy (27.0 vs. 18.4%, P = 0.0485). The main occupations related to OA cases were cleaning activities, working in plastics manufacture and in chemical and pharmaceutical plants. Women reported significantly more exposures to cleaning products, biologic agents, and textile fibers, whereas men reported more exposures to isocyanates, metal dusts and fumes, oil mists, wood dusts and anhydrides. Women presented an increased risk of OA in the service sector (odds ratio (OR) = 1.77, confidence interval (CI) = 1.61–1.96).ConclusionsCleaning services was the main reported occupation and cleaning products the main reported agents. Women had significantly shorter exposure duration possibly due to difference in exposures, previous atopy, and behavior. There was an excess of cases of women in the service sector. Am. J. Ind. Med. 43:611–617, 2003. © 2003 Wiley‐Liss, Inc.
Environmental risk factors and work‐related lower respiratory symptoms in 80 office buildings: An exploratory analysis of NIOSH data
Authors: Mendell Mark J. , Naco Gina M. , Wilcox Thomas G. , Sieber W. Karl 
Published: May 2003

AbstractBackgroundWe evaluated relationships between lower respiratory symptoms and risk factors for microbiological contamination in office buildings.MethodsThe National Institute for Occupational Safety and Health collected data from 80 office buildings during standardized indoor environmental health hazard evaluations. Present analyses included lower respiratory symptom‐based outcome definitions and risk factors for potential microbiologic contamination. Multivariate logistic regression models for selected outcomes identified key risk factors.ResultsAdjusted odds ratios (95% confidence intervals) for “at least three of four work‐related lower respiratory symptoms” were, for debris in ventilation air intake, 2.0 (1.0–3.9), and for poor drainage in air‐conditioning drip pans, 2.6 (1.3–5.2). Adjusted associations with risk factors were consistently stronger for outcomes requiring both multiple symptoms and improvement away from work, and somewhat stronger among diagnosed asthmatics.ConclusionsMoisture and debris in ventilation systems, possibly by supporting microbiologic growth, may increase adverse respiratory effects, particularly among asthmatics. Data from more representative buildings are needed to confirm these findings. Am. J. Ind. Med. 43:630–641, 2003. Published 2003 Wiley‐Liss, Inc.