bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Hospital Length of Stay and Staffing Ratio Affect Elderly Patients' Risk of Readmission? A Nation‐wide Study of Norwegian Hospitals
Authors: Heggestad Torhild 
Published: March 2003

Objective. To test whether there is an association between hospital operating conditions such as average length of stays (LOS) and staffing ratio, and elderly patients' risk of readmission.Data Sources. The main data source was a national patient database of admissions to all acute‐care Norwegian hospitals during the year of 1996.Study Design. It is a cross‐sectional study, where Cox' regression analysis was used to test the factors acting on the probability of early unplanned readmission (within 30 days), and later occurring ones. The principal hospital variables included average hospital LOS and staffing ratio (discharges per man‐years of personnel). Adjusting patient variables in the model included age, gender, and cost‐weights of the Diagnosis Related Groups (DRGs).Data Extraction Methods. The selected material included discharges from 59 hospitals, and 113,055 elderly patients (≥67 years). Multiple admissions to the same hospital were linked together chronologically, and additional hospital data were matched on. To maximize the association between the index stay and the defined outcome (unplanned readmission), no intervening planned admission was accepted.Principal Findings. Being admitted to a hospital with relatively short average LOS increased the patient's risk of early readmission significantly. In addition it was found that more intensive care (more staff) could have a compensatory effect. Furthermore, the predictive factors were shown to be time dependent, as hospital variables had much less impact on readmissions occurring late (within 90–180 days).Conclusions. The results give support to the assumption of a link between hospital operating conditions and patient outcome.
The Effect of Capitation on Switching Primary Care Physicians
Authors: Sorbero Melony E. S. , Dick Andrew W. , Zwanziger Jack , Mukamel Dana , Weyl Nancy 
Published: March 2003

ObjectiveTo examine the relationship between patient case‐mix, utilization, primary care physician (PCP) payment method, and the probability that patients switch their PCPs.Data Sources/Study SettingAdministrative enrollment and claims/encounter data for 1994–1995 from four physician organizations.Study DesignWe developed a conceptual model of patient switching behavior, which we used to guide the specification of multivariate logistic analyses focusing on interactions between patient case‐mix, utilization, and PCP reimbursement methods.Data Collection/Extraction MethodsClaims data were aggregated to the encounter level; a switch was defined as a change in PCP since the previous encounter. The PCPs were reimbursed on either a capitated or fee‐for‐service (FFS) basis.Principal FindingsPatients with stable chronic conditions (Ambulatory Diagnostic Groups [ADG] 10) and capitated PCPs were 36 percent more likely to switch PCPs than similar patients with FFS PCPs, controlling for patient age and sex and physician fixed effects. When the number of previous encounters was included in the model, this relationship was no longer significant. Instead high utilizers with capitated PCPs were significantly more likely to switch PCPs than were similar patients with FFS PCPs.ConclusionsA patient's demographics and utilization are associated with the probability that the patient will switch PCPs. Capitated PCP payment was associated with higher rates of switching among high utilizers of health care resources. These findings raise concerns about the continuity and quality of care experienced by vulnerable patients in an era of changing financial incentives.
Medigap Premiums and Medicare HMO Enrollment
Authors: McLaughlin Catherine G , Chernew Michael , Taylor Erin Fries 
Published: March 2003

Objective. Markets for Medicare HMOs (health maintenance organizations) and supplemental Medicare coverage are often treated separately in existing literature. Yet because managed care plans and Medigap plans both cover services not covered by basic Medicare, these markets are clearly interrelated. We examine the extent to which Medigap premiums affect the likelihood of the elderly joining managed care plans.Data Sources. The analysis is based on a sample of Medicare beneficiaries drawn from the 1996–1997 Community Tracking Study (CTS) Household Survey by the Center for Studying Health System Change. Respondents span 56 different CTS sites from 30 different states. Measures of premiums for privately‐purchased Medigap policies were collected from a survey of large insurers serving this market. Data for individual, market, and HMO characteristics were collected from the CTS, InterStudy, and HCFA (Health Care Financing Administration).Study Design. Our analysis uses a reduced‐form logit model to estimate the probability of Medicare HMO participation as a function of Medigap premiums controlling for other market‐ and individual‐level characteristics. The logit coefficients were then used to simulate changes in Medicare participation in response to changes in Medigap premiums.Principal Findings. We found that Medigap premiums vary considerably among the geographic markets included in our sample. Measures of premiums from different insurers and for different types of Medigap policies were generally highly correlated across markets. Our models consistently indicate a strong positive relationship between Medigap premiums and HMO participation. This result is robust across several specifications. Simulations suggest that a one standard deviation increase in Medigap premiums would increase HMO participation by more than 8 percentage points.Conclusions. This research provides strong evidence that Medigap premiums have a significant effect on seniors’ participation in Medicare HMOs. Policy initiatives aimed at lowering Medigap premiums will likely discourage enrollment in Medicare HMOs, holding other factors constant. Although the Medigap premiums are just one factor affecting the future penetration rate of Medicare HMOs, they are an important driver of HMO enrollment and should be considered carefully when creating policy related to seniors’ supplemental coverage. Similarly, our results imply that reforms to the Medicare HMO market would influence the demand for Medigap policies.
Internalization of the thrombopoietin receptor is regulated by 2 cytoplasmic motifs
Authors: Dahlen Debra D. , Broudy Virginia C. , Drachman Jonathan G. 
Published: March 2003

Abstract
Receptor-mediated internalization appears to be the primary mean of regulating the plasma level of thrombopoietin (TPO). However, the processes that regulate Mpl internalization have not previously been described. Using the cytokine-dependent cell line BaF3, we have identified 2 distinct motifs within the cytoplasmic domain of Mpl that underlie ligand-dependent internalization. Removal of the fourth cytoplasmic tyrosine residue by deletion or truncation results in a significant decrease in maximal internalization. The remaining receptor internalization is abrogated by deletion of cytoplasmic residues 54-69, which include the core box2 region (L54L55E56I57L58) and the only dileucine motifs (L54L55 and I57L58) within the cytoplasmic domain of Mpl. Receptor internalization mediated by this latter subdomain does not require Jak2 activation. Furthermore, TPO-stimulated cellular proliferation appears to be directly correlated with receptor internalization, indicating that internalization of the TPO/Mpl complex may be essential for normal signal transduction. Finally, we have demonstrated that upon removal of TPO from the supernatant, Mpl promptly reappears on the cell surface, suggesting that a pool of intracellular Mpl can be rapidly recycled to the cell surface. These data help identify the receptor motifs involved in TPO-induced internalization of Mpl and suggest that Mpl translocation may be necessary for normal cellular proliferation. (Blood. 2003;102:102-108)
Sensitization to airborne and food allergens in Reykjavík (Iceland) and Uppsala (Sweden) – a comparative study
Authors: Gislason D. , Björnsson E. , Gislason T. , Janson C. , Boman G. , Sjöberg O. , Elfman L. 
Published: March 2003

Background: The aim of this study was to compare the prevalence of atopic sensitization and possible risk factors for allergies in two ethnically similar but geographically widely separated urban populations. Methods: Data from two centers of the European Community Respiratory Health Survey, Reykjavík, Iceland, and Uppsala, Sweden, were utilized. This included a structured interview, skin prick tests, and blood samples for total and specific IgE for common aeroallergens. Additional measurements of specific IgE antibodies to common food antigens were performed. Furthermore, data on social environment, lifestyle, air pollution, and meteorologic variables were compared. Results: Skin prick tests were done on 540 individuals in Reykjavík and 527 in Uppsala. The overall prevalence of at least one positive prick test was 20.5% in Reykjavík and 34.2% in Uppsala (P<0.001). Total and specific IgE were measured in serum from 521 subjects in Reykjavík and 472 in Uppsala. The geometric mean value for total IgE was significantly lower in Reykjavík (13.4 kU/l) than in Uppsala (24.7 kU/l) (P<0.001). Similarly, the overall prevalence of at least one specific IgE to airborne allergens was 23.6% in Reykjavík and 32.3% in Uppsala (P<0.01). Specific IgE to a food panel (fx5) was measured in 502 subjects in Reykjavík, and 434 in Uppsala. In Reykjavík, 20 individuals (4.0%) were positive to one or more of the allergens in the food panel compared to 27 (6.0%) in Uppsala. When the single allergens present in the food panel were measured, altogether 16 positive reactions were found in Reykjavík compared to 47 in Uppsala (P<0.05). Conclusions: The prevalence of sensitization to both airborne and food allergens was lower in Reykjavík than in Uppsala. The difference may be due to environmental and/or dietary differences or to some yet undefined factor.
Airway mast‐cell activation in asthmatics is associated with selective sputum eosinophilia
Authors: Bettiol J. , Radermecker M. , Sele J. , Henquet M. , Cataldo D. , Louis R. 
Published: March 2003

Background: Tryptase is a serine endoprotease selectively released from mast cells. Although mast cells are known to be activated after experimental allergic provocation, their role in naturally occurring asthma is still debated. Methods: We have investigated the levels of tryptase in the whole induced sputum collected from 51 asthmatics (31 atopic and 20 intrinsic) seen in our outpatient clinic and 22 normal nonatopic healthy volunteers. Tryptase was measured by a new immunoassay based on B12 monoclonal antibody recognition of total tryptase (UniCAP System, Pharmacia) with a sensitivity of 1 ng/ml. Results: While being below the threshold of detection in all normal volunteers, tryptase was detectable in the sputum from 9/51 asthmatics (18%) including five atopic and four intrinsic asthma cases. In these patients, among whom three were asymptomatic asthmatics, the values ranged between 1 and 6.1 ng/ml. The asthmatics with detectable sputum tryptase had greater sputum eosinophil counts (P<0.05) but lower neutrophil counts (P<0.05) than those in whom tryptase was undetectable. When compared to control subjects, asthmatics without tryptase had still greater eosinophil counts (P<0.0001) but also raised neutrophil counts (P<0.05). No significant difference could be found between asthmatics with tryptase and those without tryptase with respect to the age, the baseline lung function, the methacholine bronchial responsiveness, and the frequency of treatment with inhaled steroids. Conclusions: With the UniCAP System, tryptase was detectable in the sputum from 18% of asthmatics irrespective of atopy and current symptoms. Asthmatics with tryptase appeared to have a selective increase in sputum eosinophil counts while those without tryptase displayed a mixed sputum granulocyte infiltration with raised eosinophil and neutrophil counts.
Latex allergy in Saudi children with spina bifida
Authors: Kattan H , Harfi Ha , Tipirneni P 
Published: March 2003

Background: Children with spina bifida (SB) are exposed to latex soon after birth during bladder catheterization, rectal disimpaction, and multiple surgical procedures. IgE‐mediated latex‐allergic reactions have been reported recently in these children. Our study was designed to assess the prevalence of allergic reactions to latex products in a group of Saudi Arabian children with SB in a tertiary care hospital.Methods: Fifty‐nine patients, aged 1–20 years, with SB were evaluated by a questionnaire on type of latex reactions; family and personal history of other allergic disorders, such as asthma, rhinitis, and urticaria; type and number of surgical procedures; and frequency of bladder catheterization and manipulation with latex materials. Confirmation of latex sensitivity was measured by skin prick test (SPT), CAP test, and latex skin challenge.Results: Allergy to latex was detected in 25% of the study group. There was a significant variation in allergic reaction by sex (males 42%, females 12%) (P<0.01), use of catheters (yes 38%, no 13%) (P<0.05), and urologic surgery (yes 60%, no 18%) (P<0.01). The number of surgical procedures, age of patient, and V–P shunt were not significantly related to allergic reactions.Conclusions: Our findings support previous studies indicating a high prevalence of latex allergy among SB patients. The CAP test was a more sensitive measure of latex allergy in SB patients than SPT or latex challenge. There was significant correlation with urologic procedures and the use of urethral catheters.
A 17‐kDa allergen detected in pine nuts
Authors: García‐Menaya J. M. , Gonzalo‐Garijo M. A. , Moneo I. , Fernández B. , García‐González F. , Moreno F. 
Published: March 2003

Background: Few cases of allergy to pine nuts have been described. We report a case of anaphylactic reaction to pine nuts. The patient needed to be treated in the emergency room due to a systemic reaction immediately after eating pine nuts. Methods: The patient was studied by prick tests and prick by prick tests. Specific IgE was measured by CAP and by SDS–PAGE/immunoblotting by a diffusion method. Results: The patient showed positive prick by prick tests to pine nuts (12 mm of maximum wheal diameter). Specific IgE was positive (0.79 kU/l). The patient's serum recognized several proteins by immunoblot. However, a 17‐kDa allergen band was detected with high intensity. This protein was found to be sensitive to reducing agents, losing its IgE‐binding properties after reduction. Conclusions: The patient presented an IgE‐mediated reaction and detected a 17‐kDa protein from pine nuts not previously described.
Allergen‐specific immunotherapy in birch‐ and grass‐pollen‐allergic rhinitis. I. Efficacy estimated by a model reducing the biasof annual differences in pollen counts
Authors: Winther L. , Malling H‐J. , Moseholm L. , Mosbech H. 
Published: March 2003

Background: Evaluation of the efficacy of allergen‐specific immunotherapy (IT) with pollen extracts is complicated by annual variation in pollen intensity. Our study aimed to evaluate the efficacy of birch and grass IT, taking into consideration these variations. Methods: After 1 year of observation, 52 patients with rhinoconjunctivitis and allergy to birch as well as grass pollen were allocated to double‐blinded clustered IT with aluminum‐adsorbed extract produced from either birch (Betula verrucosa) pollen or grass (Phleum pratense) pollen. After 1 year of treatment, the patients continued IT with their original extract and also received the other extract. During the three consecutive pollen seasons, the rhinoconjunctivitis symptom score and the use of antihistamines, eye‐drops, and oral prednisolone were recorded. Longitudinal data analysis was used to investigate the relation between different pollen counts and the magnitude of clinical efficacy. Results: An effect of IT was found on symptom score, antihistamine intake, and eye‐drop use for both birch and grass (P values <0.05). The mean reduction in symptom score/medication by IT ranged from 24% to 95%, depending on mean seasonal pollen counts. A minimum mean seasonal grass‐pollen count of 20–30 pollen grains m3 was required for the efficacy of grass IT to emerge. Conclusions: A model was developed for evaluation of efficacy in longitudinal IT studies, taking the differences in annual pollen counts into consideration. The model showed a significant beneficial role of pollen IT in rhinoconjunctivitis patients allergic to birch and grass pollen.
Comparison of antibody responses to hen's egg and cow's milk proteins in orally sensitized rats and food‐allergic patients
Authors: Knippels L.M.J. , Van Der Kleij H.P.M. , Koppelman S. J. , Houben G. F. , Penninks A. H. , Knippels L.M.J. , Penninks A. H. , Felius A.A. 
Published: March 2003

Background: No adequate enteral sensitization models are available to study food allergy and the allergenicity of food proteins. To further validate a enteral brown Norway (BN) rat sensitization model under development, we studied specific protein recognition to determine whether a comparable pattern of proteins is recognized by the rat immune system and the human immune system. Methods: The animals were exposed to either ovalbumin as a positive reference control, hen's egg‐white‐protein extract, or a cow's milk preparation by daily gavage dosing (0.5, 1, 2.5, 5, 10, or 15 mg protein per rat/day) for 9 weeks. No adjuvants were used during the sensitization studies. The specificities of antibodies against hen's egg‐white proteins or cow's‐milk proteins in sera from orally sensitized rats and food‐allergic patients were studied and compared by immunoblotting. Results: The IgG and IgE antibodies to hen's egg‐white proteins and cow's‐milk proteins present in sera from orally sensitized rats and food‐allergic patients showed a comparable pattern of protein recognition. Conclusions: Upon daily intragastric exposure to food allergens, the specificities of the induced antibody responses in the BN rat resemble those found in food‐allergic patients. These studies add further support to the hypothesis that the BN rat may provide a suitable animal model for food allergy research and research on the allergenicity of food proteins.
Expression of the American cockroach Per a 1 allergen in mammalian cells
Authors: Wu C.H. , Lee M.F. , Wang N.M. 
Published: March 2003

Background: Cockroach allergens are one of the major etiologic risk factors for developing IgE‐mediated allergic respiratory illness throughout the world. Per a 1 is a cross‐reactive allergen of American and German cockroaches. This study aimed to investigate the expression of a recombinant American cockroach (Periplaneta americana) Per a 1, C42, allergen in mammalian COS‐1 cells. Methods: The COS‐1 cells and Escherichia coli were used to express the P. americana C42 allergen. Recombinant proteins were purified with hydroxylapatite and DE52 chromatography. Biologic reactivities of recombinant proteins were examined by direct IgE binding and IgE inhibition studies with the enzyme‐linked immunosorbent assay (ELISA). Results: C42 was successfully expressed in the mammalian COS‐1 cell as a 50‐kDa secreted protein, and purified from the culture medium. The specific human IgE antibodies against recombinant C42 from either E. coli (C42‐E. coli) or COS‐1 (C42‐COS‐1) were compared by ELISA with 12 sera from Per a 1 and C42 skin‐test‐positive patients. All atopic sera contained specific IgE antibodies to C42 from either E. coli or COS‐1. Moreover, recombinant C42‐COS‐1 bound higher levels of serum IgE than recombinant C42‐E. coli among C42‐sensitive atopic patients, and a statistically significant difference (P<0.01) was found between them. In addition, recombinant C42‐COS‐1 as an inhibitor revealed higher inhibition of IgE binding to natural Per a 1 than recombinant C42‐E. coli. Conclusions: The biologically highly reactive recombinant C42 produced in the COS‐1 cell provides an alternative expression system and will facilitate studies on the immune response of asthma patients to cockroach allergens.
Loratadine in the treatment of mosquito‐bite‐sensitive children
Authors: Karppinen A. , Kautiainen H. , Reunala T. , Petman L. , Reunala T. , Brummer‐Korvenkontio H. 
Published: March 2003

Background: Children frequently experience harmful whealing and delayed papules from mosquito bites. Whealing is mediated by antisaliva IgE antibodies and histamine, but the effect of antihistamines on mosquito‐bite symptoms has not been evaluated in children. Methods: The effect of loratadine (0.3 mg/kg) was examined in 28 mosquito‐bite‐sensitive children (aged 2–11 years). The double‐blind, placebo‐controlled, crossover study was performed with exposure to Aedes aegypti laboratorymosquitoes. The size of the bite lesion and the intensity of pruritus (visual analog scale) were measured at 15 min and at 2, 6, and 24 h. Results: Loratadine decreased the size of the wheals by 45% (P<0.001, 25 children) and accompanying pruritus by 78% (P=0.011, 12 children) at 15 min compared to placebo. The size of the 24‐h delayed bite lesion also decreased significantly (P=0.004), but there was no change at 2 or 6 h. Loratadine was well tolerated and no marked side‐effects were recorded. Conclusions: This study in children shows that prophylactically given loratadine decreases significantly the whealing and pruritus caused by mosquito bites and also reduces the size of the 24‐h bite lesions. Therefore, the therapeutic profile of loratadine extends from immediate to delayed allergic symptoms in mosquito‐bite‐sensitive children.
Comparison of the effects of levocetirizine and loratadine on histamine‐induced wheal, flare, and itch in human skin
Authors: Clough G. F. , Boutsiouki P. , Church M. K. 
Published: March 2003

Background: This randomized, double‐blind, crossover study compared the effects of the R‐enantiomer of cetirizine, levocetirizine, with those of loratadine on the wheal, flare, and itch response to histamine in human skin. Methods: Levocetirizine (5 mg), loratadine (10 mg), or placebo was taken orall_y 4 h before the intradermal injection of histamine (20 µl, 100 µM) or the control vehicle into the forearm skin of healthy volunteers. Flare areas were assessed by scanning laser Doppler imaging before and at 30‐s intervals for a period of 9 min. Wheal areas were measured by planimetry at 10 min. Itch was scored every 30 s with a visual analogue scale. Results: After placebo administration, the mean peak flare area was 23.01±1.94 cm2, the wheal area 248±27 mm2, and the cumulative itch score 28.8±4.6% (mean±SEM). Levocetirizine reduced the flare, wheal, and itch by 60%, 68%, and 91%, respectively (all_ P<0.001, Student's t‐test for paired data). The effects of loratadine were variable and not statisticall_y significant. Conclusions: Levocetirizine (5 mg) is a potent inhibitor of the effects of histamine in human skin with an efficacy that exceeded that of loratadine (10 mg) when single doses of the drugs were administered 4 h before the test.