bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of climate and traffic‐related NO2 on the prevalence of asthma and allergic rhinitis in Italy
Authors: De Marco R. , Poli A. , Ferrari M. , Accordini S. , Giammanco G. , Bugiani M. , Villani S. , Ponzio M. , Bono R. , Carrozzi L. , Cavallini R. , Cazzoletti L. , Dallari R. , Ginesu F. , Lauriola P. , Mandrioli P. , Perfetti L. , Pignato S. , Pirina P. , Struzzo P. 
Published: March 2003

SummaryBackground Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies.Aim To evaluate to what extent climate and outdoor NO2 pollution can explain the geographical variation in the prevalence of asthma and allergic rhinitis, and to estimate the relative risk for exposure to different levels of these two factors.Methods The impact of climate and long‐term exposure to nitrogen dioxide (NO2) pollution on asthma and allergic rhinitis was assessed in a cross‐sectional study, carried out during 1998 to 2000 on young adults aged 20 to 44 years (n = 18 873), living in 13 areas from two different Italian climatic regions (subcontinental and Mediterranean).Results Mediterranean areas had a significantly higher prevalence of asthma‐like symptoms (P < 0.001), higher annual mean temperature (16.2 °C vs. 12.9 °C), lower temperature range (16.0 C° vs. 22.1 C°) and lower NO2 levels (31.46 µg/m3 vs. 57.99 µg/m3) than subcontinental ones. Mediterranean climate was associated with an increased risk of wheeze (OR = 1.23; 95% CI 1.13 to 1.35), tightness in the chest (OR = 1.21; 95% CI 1.11 to 1.33), shortness of breath (OR = 1.21; 95% CI 1.08 to 1.36) and asthma attacks (OR = 1.19; 95% CI 1.07 to 1.31). After adjusting for climate, an increase of 18.3 µg/m3 in NO2 levels moderately increased the risk of asthma attacks (OR = 1.13; 95% CI 0.98 to 1.32), tightness in the chest (OR = 1.11; 95% CI 0.98 to 1.26) and wheeze (OR = 1.11; 95% CI 0.96 to 1.28). When the levels of outdoor NO2 exposure rose, the prevalence of allergic rhinitis increased significantly in the Mediterranean region (OR = 1.38; 95% CI 1.12 to 1.69), but not in the subcontinental one (OR = 1.03; 95% CI 0.83 to 1.28).Conclusion Our results show that the prevalence of asthma increases when annual mean temperature increases and temperature range decreases. Furthermore, climate interacts with NO2 outdoor exposure, increasing the risk for allergic rhinitis in people exposed to high stable temperatures. A long‐term role for the effect of traffic pollution on asthma is also suggested.
Are Ca2+‐binding motifs involved in the immunoglobin E‐binding of allergens? Olive pollen allergens as model of study
Authors: Ledesma A. , González E. , Pascual C. Y. , Quiralte J. , Villalba M. , Rodríguez R. 
Published: March 2003

SummaryBackground Several Ca2+‐binding proteins, which possess EF‐hand sites with a high sequence similarity, have been found to be able to induce Type‐I allergy.Objective To study whether the common EF‐hand sequential motifs can be involved in the IgE‐reactivity of these proteins, thus being responsible of a degree of cross‐reactivity among different Ca2+‐binding proteins.Methods Two olive pollen allergens, Ole e 3 and Ole e 8, have been used in the study. Parvalbumin and calmodulin were included in immunological analyses. Sera from patients allergic to olive pollen, as well as Ole e 3‐ and Ole e 8‐specific rabbit antisera were used in indirect enzyme‐linked immunosorbent assay (ELISA), ELISA inhibition assays and immunobloting. Conformational analyses (circular dichroism spectra and thermal stability) and specific immunodetection assays were performed in the presence and the absence of Ca2+. Chemical breakdown and high‐performance liquid chromatography (HPLC) was used to obtain fragments from Ole e 3 containing a single EF‐hand motif.Results Thirty‐four (17%) and 16 (8.2%) out of 195 sera from patients allergic to olive pollen contained specific IgE against Ole e 3 and Ole e 8, respectively. The IgE‐binding of 12 allergic sera diminished up to 22% for Ole e 3 and to 82% for Ole e 8, when depleted Ca2+. A pool of these sera recognized the two olive allergens and parvalbumin, but at very different extent. Inhibition of the IgE‐binding was only achieved between two olive allergens. No structural relationships between Ole e 3 and Ole e 8 were established when specific polyclonal antisera against both proteins were used.Conclusion EF‐hand Ca2+‐binding sites can not be considered as general allergenic motifs responsible for the cross‐reactivity between Ca2+‐binding allergens. Different families of Ca2+‐binding allergens have specific epitopes that could be involved in the cross‐reactivity among members of the same family.
Household characteristics and mite allergen levels in Manchester,UK
Authors: Simpson A. , Simpson B. , Custovic A. , Cain G. , Craven M. , Woodcock A. 
Published: March 2003

SummaryBackground Mite allergen levels vary enormously between different homes in the same geographical area. No large scale studies of mite levels in Manchester homes has been conducted to identify factors associated with higher levels.Objectives To quantify exposure to mite allergens and to identify characteristics associated with higher Der p 1 levels in a large sample of homes in Manchester, UK.Methods Der p 1 was measured in dust from the living room floor, sofa, bedroom floor and mattress in 564 homes. Data on household characteristics were collected by administering a questionnaire. Univariate and multivariate analyses were performed to identify household characteristics associated with higher mite allergen levels.Results Der p 1 levels were highest in the mattress (GM 1.19 µg/g, 95% CI 0.98–1.45, P < 0.001). Two‐thirds of homes contained Der p 1 levels > 2 µg/g in at least one dust reservoir, and 40.3% contained Der p 1 greater than 10 µg/g. There was a large range in Der p 1 levels between homes (> 103‐fold). Damp and condensation were common findings in homes. In the multivariate analyses, factors associated with higher Der p 1 levels in more than one dust reservoir were older homes, older living room carpets, damp, condensation and mixed glazing. Older mattresses were associated with higher mite allergen levels in the mattress where the age of the mattress was recorded. Twenty‐four homes contained no detectable mite allergen, six of which reported damp.Conclusions Mite allergen levels are high enough in two of every three homes to be associated with an increase in the risk of sensitization to mite. Factors such as older homes, carpets and mattresses, damp and condensation are associated with higher mite allergen. However, mite allergen levels are occasionally unpredictably very low in homes with risk factors for high levels.
The proteolytic activity of the major dust mite allergen Der p 1 conditions dendritic cells to produce less interleukin‐12: allergen‐induced Th2 bias determined at the dendritic cell level
Authors: Ghaemmaghami A. M. , Gough L. , Sewell H. F. , Shakib F. 
Published: March 2003

SummaryBackground The proteolytic activity of the house dust mite allergen Der p 1 has recently been shown to bias Th cell subset development in favour of Th2. Apart from its direct effect on T cells, it is conceivable that the proteolytic activity of Der p 1 may induce the generation of dendritic cells (DCs) that favour a Th2 response.Objective To study the effect of the proteolytic activity of Der p 1 on DC functions; namely cell surface phenotype, IL‐12 production and ability to favour a Th2 response.Methods We have generated immature DCs from peripheral blood monocytes, matured them with LPS in the presence of either proteolytically active or inactive Der p 1 and compared their functions using flow cytometric analysis.Results Here we demonstrate for the first time that DCs that have been matured in the presence of proteolytically active Der p 1 produce significantly less IL‐12, compared to DCs that have been matured in the presence of proteolytically inactive Der p 1. The suppression of IL‐12 production was due to the cleavage of CD40 by the proteolytic activity of Der p 1, hence rendering the DCs less responsive to stimulation through the CD40L‐CD40 pathway. Furthermore, we demonstrate that DCs that have been matured in the presence of proteolytically active Der p 1 induce the production of significantly less IFN‐γ and more IL‐4 by CD4 T cells, compared to DCs that have been matured in the presence of proteolytically inactive Der p 1.Conclusions Collectively, our data provide compelling evidence for the role of the proteolytic activity of Der p 1 in directing DCs to induce Th2 subset development.
Clinical and immunologic parameters during thalidomide treatment of lupus erythematosus
Authors: Walchner Monika ,   md, Meurer Michael ,   md, Plewig Gerd ,   md, Messer Gerald ,   md
Published: March 2003

Abstract Background Thalidomide is used as an experimental drug for the treatment of chronic inflammatory diseases with an autoimmune or infectious background. The pharmacologic action involves the downregulation of the pro‐inflammatory cytokine tumor necrosis factor‐α (TNF‐α) and inhibition of basic fibroblast growth factor (bFGF)‐induced angiogenesis; however, not much is known about thalidomide's effect on immunologic parameters in lupus erythematosus (LE). Method This is an open study of a group of five consecutive systemic lupus erythematosus (SLE) patients treated with thalidomide (100 mg/day) and five consecutive cutaneous LE patients not responsive to conventional therapy. The clinical and immunologic parameters (C‐reactive protein, immunoglobulin, and complement serum levels, lymphocyte counts) were investigated during thalidomide treatment for up to 2 years in both patient groups. Results An increase in the absolute peripheral lymphocyte count was observed beginning after 2 weeks of systemic thalidomide treatment in nine out of 10 LE patients, and remained stable throughout thalidomide treatment. Elevated serum levels of C‐reactive protein and titers of autoantibodies to double‐stranded (ds) DNA decreased in SLE patients. No significant changes were detected in the serum levels of the complement components C3 and C4 and immunoglobulins in all LE patients. Regression of inflammatory skin lesions and regrowth of hair were recorded. As a side‐effect, polyneuropathy was observed in four out of 10 patients, with the earliest onset at 3 weeks of thalidomide treatment. Conclusions Thalidomide is a potent anti‐inflammatory drug in patients with SLE and cutaneous LE, possibly interacting with the recruitment of lymphocytes. It leads to the regrowth of hair in LE‐related alopecia and effluvium. Early symptoms of polyneuropathy should be registered and the drug should be withdrawn. Thalidomide should be restricted to patients who show no response to standard therapeutic regimens and should only be used under strict precautions with regard to its known teratogenic risk.
Do we need to devalue Amazonia and other large tropical forests?
Authors: Bates John M. , Demos Terrence C. 
Published: March 2003

AbstractAttempts to determine global priorities for conservation and studies aimed at highlighting the conservation value of one continental region over another often devalue specific regions. Amazonia has been a particular recipient of this treatment in a number of recent studies. We suggest that this type of approach is not necessary at this scale, and we argue that the consequences could be devastating for the largest forests of the world. Among our concerns about the treatment of these forests (Amazonia, the Congo Basin and New Guinea) is that there seems to be a lack of appreciation for, or sufficient study of, important biogeographic subdivisions within these regions. In Amazonia, the south‐eastern portion of the basin (the Belém/Pará region) has not been considered a global conservation priority, despite the fact that it is experiencing by far the highest deforestation rates. Parsimony Analyses of Endemicity and genetic data suggest that many Amazonian forest taxa are comprised of numerous regionally distinct units, and this may also be true in other large tropical forests. Such patterns need to be documented for adequate conservation of tropical biodiversity, but this might not happen if these regions are not recognized as priorities for conservation at a global scale.
Quality of care from the patients' perspective: from theoretical concept to a new measuring instrument
Authors: Sixma Herman J. , Kerssens Jan J. , Campen Crétien van , Peters Loe 
Published: March 2003

IntroductionPatient views on quality of care are of paramount importance with respect to the implementation of quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary.ObjectiveTo develop a conceptual framework for measuring quality of care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health care and business research.ResultsPatient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or `needs') and experiences. A conceptual framework – based on the sequence performance, importance, impact – and quality judgements of different categories of patients derived from importance and performance scores of different health care aspects, is elaborated upon and illustrated with empirical evidence.ConclusionsThe new conceptual model, with quality of care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting quality of care aspects, a category‐specific approach is recommended including the use of focus group discussions.
Eliciting patients’ preferences for adjuvant chemotherapy in breast cancer: development and validation of a bedside decision‐making instrument in a French Regional Cancer Centre
Authors: Carrère Marie‐Odile , Moumjid‐Ferdjaoui Nora , Charavel Marie , Brémond Alain 
Published: March 2003

IntroductionIn developed countries, the physician‐patient relationship is moving from a paternalistic model to new decision‐making models that take patient preferences into account.ObjectivesOur aim was to develop a Decision Board (DB) and to test its acceptability in a French Regional Cancer Centre regarding the decision on whether or not to use chemotherapy after surgery in postmenopausal women with breast cancer. This paper presents the development process for this instrument and reports the pretesting phase, as well as the corresponding results.MethodsA working group was created with oncologists, psychologists and economists. Following the first phase, i.e. the development process, a first version of the instrument was presented to health professionals. Their feedback led to important modifications of the instrument. The DB was then presented to experienced patients, which resulted in slight changes. The second phase consisted of pretesting the comprehension, internal and across‐time consistency of the DB on healthy volunteers.ResultsThe DB was pretested in a group of 40 healthy volunteers. Eighteen respondents chose chemotherapy and 22 chose not to have chemotherapy. Comprehension rates were very high (≥87.5%). Internal consistency was assessed considering option attitudes based on outcomes and option attitudes based on process. Women shifted their choices in a predictable way. Across‐time consistency was appraised using the test‐retest method with Visual Analog Scales. The Intraclass Correlation Coefficient was 0.97.Discussion‐conclusionDue to cultural differences, the DB developed in our French Cancer Centre is quite different from the DBs previously developed elsewhere. Our instrument showed good comprehension and consistency properties, which are corroborated by the DB literature. Whether our DB is acceptable for patients with breast cancer must still be tested. Patients’ reactions will tell us which type of decision‐making model is at work. Further research is needed in order to explore the shared decision‐making process and clarify the concept.
Eliciting patients’ values by use of ‘willingness to pay’: letting the theory drive the method
Authors: Donaldson Cam 
Published: March 2003

Objective To describe the three different ways in which ‘willingness to pay’ (WTP) has been used to elicit patients’ values of alternative interventions. Design For each of the three approaches a survey of patients or the public was undertaken. Setting, participants and interventions studied For two surveys, the setting was Aberdeen Maternity Hospital, where pregnant women were asked about their WTP for different methods of prenatal screening for cystic fibrosis. In the third survey, parents of primary and secondary schoolchildren were asked about their WTP for different ways of providing child health services. Main outcome measures Ability of WTP to discriminate between options (i.e. to say whether one option is ‘better’ than another) and the consistency of WTP with stated preferences. Results Experience with some methods shows that, despite the apparent logic of the technique, it is difficult to elicit consistent responses whereby WTP values derived match the rankings of interventions compared. The most promising technique, the ‘marginal approach’, happens to conform more with economic theory than other approaches. Potential limitations of WTP, such as its association with ability to pay, are discussed, as are approaches to dealing with such problems. Finally, if patients prefer an intervention that is more costly than the status quo, logic dictates that those extra resources will have to be obtained from another health‐care programme. In such contexts, to aid decision‐making, values derived from members of the community for different programmes may be more relevant than values derived from patients. Initial studies in the use of WTP in this broader context of eliciting community values are also outlined. Conclusions WTP has potential, but its application, and interpretation, are not straightforward. More testing of the ‘marginal approach’ is required and greater use of qualitative research, to assess the validity of the approach, should be made in this area.
Increasing informed uptake and non‐uptake of screening: evidence from a systematic review
Authors: Jepson Ruth G. , Forbes Carol A. , Sowden Amanda J. , Lewis Ruth A. 
Published: March 2003

Objective To report data relating to the informed uptake of screening tests. Search strategy Electronic databases, bibliographies and experts were used to identify relevant published and unpublished studies up until August 2000. Inclusion criteria RCTs, quasi‐RCTs and controlled trials of interventions aimed at increasing the informed uptake of screening. All participants were eligible as defined by the entry criteria of individual programmes. Studies had to report actual uptake and meet three out of four criteria used to define informed uptake. Data extraction and synthesis Relevant studies were identified, data extracted and their validity assessed by two reviewers independently. Outcome data included screening uptake, knowledge, informed decision‐making and attitudes to screening. A random‐effects model was used to calculate individual relative risks and 95% confidence intervals. Main results Six controlled trials (five RCTs and one quasi‐RCT), focusing on antenatal and prostate specific antigen screening, were included. All reported risks/benefits of screening and assessed knowledge. Two also assessed decision‐making. Two reported risks/benefits to all randomized groups and evaluated different ways of presenting information. Neither found that interventions such as videos, information leaflets with decision trees, or touch screen computers conveyed any additional benefits over well‐prepared leaflets. Conclusions There is some evidence to suggest that changing the format of informed choice interventions in screening does not alter knowledge, satisfaction or decisions about screening. It is not clear whether informed choice in screening affects uptake. More well‐designed RCTs are required and further research should also be directed towards the development of a valid instrument for measuring all components of informed choice in screening.
Consequences of surveying folate awareness
Authors: Watson Lyndsey F. , Watson Maxwell J. , Halliday Jane L. , Bell Robin J. 
Published: March 2003

Objectives To assess women's concerns when interviewed about the association between folate and neural tube defects (NTDs) and to determine how this is affected by time, being folate aware, having seen folate promotional material or being pregnant. Design As part of a community randomized trial outcomes evaluation, independent cross‐sectional follow‐up surveys were carried out in 1997 and 2000. Setting and participants Six local government areas in the state of Victoria, Australia; 2431 women aged between 15 and 44 years. Main variables studied Whether or not women knew of the association between folate and NTDs (i.e. were folate aware), whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them. Results In the 1997 survey, 36% of women said that the interview had raised concerns and this decreased to 26% in 2000. Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware (ORadj= 0.38, 95% CI 0.24–0.60). In general, women who had seen promotional material were less likely to feel concern about the interview than those who had not, although this varied with whether or not the promotional material had raised concerns. These effects were greater in women who were pregnant. Conclusions Women had increased concerns having seen folate promotional material and after being interviewed about it. These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health‐related behaviour change.