bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamic Effects among Patients' Treatment Needs, Beliefs, and Utilization: A Prospective Study of Adolescents in Drug Treatment
Authors: Schell Terry L. , Orlando Maria , Morral Andrew R. 
Published: July 2005

Objective. To document the prospective, reciprocal relationships among substance use problems, utilization of drug treatment, and predisposing beliefs thought to increase treatment utilization.Data Source. Persistent Effects of Treatment Study‐Adolescent (PETS‐A), conducted by the Center on Substance Abuse Treatment. This was a longitudinal study of youths originally participating in one of two CSAT studies; one sample included 476 youths receiving residential drug treatment, and the other included 519 youths receiving outpatient treatment.Study Design. This study uses five waves of data collected over a 12‐month period to examine the temporal relationships among four variables: treatment dose, substance use problems, drug resistance self‐efficacy, and perceived need for treatment (PNT). Data from this longitudinal study were analyzed using cross‐lagged panel models, and structural equation modeling techniques were used to estimate the prospective, reciprocal relationships among these four variables in each of the two samples, while controlling for several covariates.Principal Findings. Both PNT and low drug resistance self‐efficacy led to higher levels of subsequent treatment. However, low self‐efficacy presaged increases in drug problems while PNT predicted decreases.Conclusions. Understanding the role of psychological variables in the utilization of health services is complicated for psychological disorders because beliefs that affect treatment can also influence the disorder itself. Efforts to keep adolescents in drug treatment should focus on convincing youth that treatment can help them with their problems, rather than convincing them that they cannot resist drugs on their own. While both messages increase treatment utilization, the latter belief undermines the effects of treatment.
The Quality of the Quality Indicator of Pain Derived from the Minimum Data Set
Authors: Wu Ning , Miller Susan C. , Lapane Kate , Roy Jason , Mor Vincent 
Published: July 2005

Objective. To examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs).Data Source. Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On‐line Survey Certification and Reporting data of 2000, Medicare Claims data of 2000 and the MDS of 2000–2002.Study Design. Using the same assessment protocol, NH staff and study nurses independently assessed 3,469 nonhospice residents. Study nurses' assessments being gold standard, we quantified and compared quality of NH staff's pain rating across NHs with high, medium, or low hospice use. Multilevel models were built to assess the effect of NH hospice use levels on the occurrence of false positive (FP) and false negative (FN) errors in NH‐rated “severe pain.”Principal Findings. Of 178 NHs, 25 had medium and 41 high hospice use. NHs with higher hospice use had lower sensitivities. In multilevel analysis, we found a significant facility‐level variation in the probability of FP and FN errors in facility‐rated “severe pain.” Resident characteristics only explained 4 and 0 percent of the facility variation in FP and FN, respectively; characteristics and locations (state) of NHs further explained 53 and 52 percent of the variance. After controlling for resident and NH characteristics, staff in NHs with medium or high hospice use were less likely to have FP or FN errors in their MDS documentation of pain than were staff in NHs with low or no hospice use.Conclusions. The examination of data quality of pooled MDS data from multiple NHs is insufficient. Multilevel analysis is needed to elucidate sources of heterogeneity in the quality of MDS data across NHs. Facility characteristics, e.g., hospice use or NH location, are systematically associated with overrated/underrated pain and may bias pain quality indicator (QI) comparisons. To ensure the integrity of QI comparison in the NH setting, the government may need to institute regular audits of MDS data quality.
An Educational Intervention to Enhance Nurse Leaders' Perceptions of Patient Safety Culture
Authors: Ginsburg Liane , Norton Peter G. , Casebeer Ann , Lewis Steven 
Published: July 2005

Objective. To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture.Study Setting. Three hundred and fifty‐six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi‐site teaching hospitals (study and control).Study Design. A prospective evaluation of a patient safety training intervention using a quasi‐experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6‐month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop.Extraction Methods. Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated‐measures analysis of variance and paired t‐tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture.Principal Findings. A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R2 for the three full hierarchical regression models ranged from 0.338 and 0.554.Conclusions. Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.
More May Be Better: Evidence of a Negative Relationship between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
Authors: Laditka James N. , Laditka Sarah B. , Probst Janice C. 
Published: July 2005

Objective. To conduct an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions (ACSH).Data Sources/Study Setting. A data set of county ACSH rates compiled by the Safety Net Monitoring Initiative of the Agency for Healthcare Research and Quality (AHRQ). The analytical data set consists of 642 urban counties and 306 rural counties. We supplemented the AHRQ data with data from the Area Resource File and the Environmental Protection Agency.Study Design. Ordinary least squares regression estimated ACSH predictors. Physician supply, the independent variable of interest in this analysis, was measured as a continuous variable (MDs/100,000). Urban and rural areas were modeled separately. Separate models were estimated for ages 0–17, 18–39, and 40–64.Data Extraction Methods. Data were limited to 20 states having more than 50 percent of counties with nonmissing data.Principal Findings. In the urban models for ages 0–17, standardized estimates indicate that, among the measured covariates in our model, physician supply has the largest negative adjusted relationship with ACSH (p<.0001). For ages 18–39 and 40–64, physician supply has the second largest negative adjusted relationship with ACSH (p<.0001, both age groups). Physician supply was not associated with ACSH in rural areas.Conclusions. Physician supply is positively associated with the overall performance of the primary health care system in a large sample of urban counties of the United States.
The Impact of an Innovative Reform to the South Carolina Dental Medicaid System
Authors: Nietert Paul J. , Bradford W. David , Kaste Linda M. 
Published: July 2005

Objective. To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina.Data Sources/Study Setting. South Carolina Medicaid enrollment data and dental services utilization data from 1998, 1999, and 2000.Study Design. The study was observational and retrospective in nature. Quarterly data were used in general linear regression models to examine time trends in the percent of Medicaid enrollees ages 21 and younger who received dental services. Trends in the total number of dental procedures provided per Medicaid enrollee were also analyzed, with sub‐analyses performed on the four most frequent categories of procedures.Data Collection/Extraction Methods. Data were provided by the state's Quality Improvement Organization.Principal Findings. From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000.Conclusions. The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.
Physician Visits, Hospitalizations, and Socioeconomic Status: Ambulatory Care Sensitive Conditions in a Canadian Setting
Authors: Roos Leslie L. , Walld Randy , Uhanova Julia , Bond Ruth 
Published: July 2005

Objective.To determine whether rates of physician visits for ambulatory care sensitive (ACS) conditions are lower for people of low‐socioeconomic status than of high‐socioeconomic status in an urban population with universal health care coverage.Data Sources/Study Setting.Physician claims and hospital discharge abstracts from fiscal years 1998 to 2001 for urban residents of Manitoba, Canada. The 1996 Canadian Census public use database provided neighborhood household income information. The study included all continuously enrolled urban residents in the Manitoba Health Services Insurance Plan.Study Design.Twelve ACS conditions definable using 3‐digit ICD‐9‐CM codes permitted cross‐sectional and longitudinal comparison of ambulatory visits and hospitalizations. Neighborhood household income data provided a measure of socioeconomic status.Data Collection/Extraction Methods.Files were extracted from administrative data housed at the Manitoba Centre for Health Policy.Principal Findings.All conditions showed a socioeconomic gradient with residents of the lowest income neighborhoods having both more visits and more hospitalizations than their counterparts in higher income areas. Six of nine conditions with a sufficientNshowed individuals living in the lowest income neighborhoods to have significantly more ambulatory visits before hospitalization for an ACS condition than did those in the most affluent neighborhoods. Many conditions showed a gradient in rate of hospitalization even after controlling for the number of ambulatory care visits.Conclusions.In the Canadian universal health care plan, the poor have reasonable access to ambulatory care for ACS conditions. Ambulatory care may be more effective in preventing hospitalizations among relatively affluent individuals than among the less well off.
Increasing Health Insurance Costs and the Decline in Insurance Coverage
Authors: Chernew Michael , Cutler David M. , Keenan Patricia Seliger 
Published: July 2005

Objective. To determine the impact of rising health insurance premiums on coverage rates.Data Sources & Study Setting. Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989–1991 and 1998–2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer‐Sponsored Health Benefits.Study Design. Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates.Principal Findings. More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9–6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1–3 percentage points, holding all else constant.Conclusions. Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs.
Somatostatin inhibits pro‐inflammatory cytokine secretion from rat hepatic stellate cells
Authors: Lang Alon , Sakhnini Emad , Fidder Herma H. , Maor Yaakov , Bar‐Meir Simon , Chowers Yehuda 
Published: July 2005

Abstract: Background/aims: Activated hepatic stellate cells (HSCs) have been implicated in hepatic fibrosis. Somatostatin (SOM) has an immunomodulatory role. The aim of this study was to assess the secretion of pro‐inflammatory cytokines by HSCs and to determine the effect of SOM on the secretion of these mediators.Methods:
Activated rat HSCs were evaluated for their secretion of IL‐1β, IL‐8, and TNF‐α using ELISA. RNA protection assay was used to determine cytokine mRNA levels. The expression of chemokine and cytokine mRNA and the secretion of these mediators were assessed following incubation with SOM or octreotide.Results: HSCs spontaneously secreted IL‐1β, IL‐8, and TNF‐α. This secretion was augmented following stimulation by IL‐1β and TNF‐α. SOM inhibited the spontaneous and TNF‐α‐induced secretion of IL‐1β, IL‐8, and TNF‐α and suppressed the expression of IL‐1β and TNF‐α mRNA. Octreotide suppressed the secretion of IL‐1β and IL‐8.Conclusions: These observations indicate that SOM exerts an inhibitory immunomodulatory effect on HSCs.
Diffuse expression of heparan sulfate proteoglycan and connective tissue growth factor in fibrous septa with many mast cells relate to unresolving hepatic fibrosis of congenital hepatic fibrosis
Authors: Ozaki Satoru , Sato Yasunori , Yasoshima Mitsue , Harada Kenichi , Nakanuma Yasuni 
Published: July 2005

Abstract: Background and Aims: Congenital hepatic fibrosis (CHF) is characterized by dense portal/septal fibrosis and bile duct proliferation and tortuosity. In this study, the roles and significance of fibrosis‐related cells and molecules in the process of progressive and unresolving fibrosis of CHF were examined in comparison with other fibrotic liver diseases.Methods: Seven CHF livers were examined, and a total of 74 control livers (chronic viral hepatitis (CVH), alcoholic fibrosis/cirrhosis (F/C), extrahepatic biliary obstruction and livers showing non‐specific reactive changes) were used as controls. All of these livers were wedge biopsied or surgically resected ones, and were formalin fixed and paraffin embedded. In addition to histologic observations, expression of heparan sulfate proteoglycan (HSPG), connective tissue growth factor (CTGF), mast cell‐specific tryptase, α‐smooth muscle actin for activated hepatic stellate cells (HSC) or myofibroblasts (MF) were immunohistochemically surveyed. HSPG and CTGF at mRNA were also examined by in situ hybridization.Results: Portal/septal fibrosis of CHF were mature collagenous and elastic fiber poor, when compared with controls. HSPG and CTGF were diffusely abundant in fibrous portal tracts/septa in CHF, while they were more or less accentuated at periportal areas in alcoholic F/C and CVH. In CHF, the number of interface and portal/septal MF was increased from mild‐to‐moderate degree, while their increase was moderate to marked in alcoholic F/C and CVH, particularly F3/F4. While activated HSC were frequent in alcoholic F/C and CVH and they were continuous with interface MF, activated HSC in CHF were scanty. Instead, mast cells were increased in portal/septal fibrosis of CHF. Portal mononuclear cells and endothelial cells were positive for HSPG mRNA, and mononuclear cells for CTGF mRNA, and such cells were accentuated around proliferated bile ducts and ductules in CHF.Conclusions: Abundant CTGF retained diffusely in HSPG in the fibrous portal tracts/septa may be responsible for non‐resolving hepatic fibrosis in CHF, and many mast cells and portal MF not related to HSC may causally relate to such characteristic finding in CHF.
Coordinated expression of cyclin D1 and LEF‐1/TCF transcription factor is restricted to a subset of hepatocellular carcinoma
Authors: Schmitt‐Graeff Annette , Ertelt‐Heitzmann Viktoria , Allgaier Hans‐Peter , Olschewski Manfred , Nitschke Roland , Haxelmans Sabine , Koelble Konrad , Behrens Jürgen , Blum Hubert Erich 
Published: July 2005

Abstract: Background: While the Wnt pathway has been widely implicated in hepatocarcinogenesis, the role of cyclin D1 as a direct downstream target gene of β‐catenin‐lymphoid enhancer factor‐1 (LEF‐1)/T‐cell factor (TCF) signaling is controversely discussed.Methods: By immunohistochemical analyses we studied the subcellular localization of LEF‐1/TCF and cyclin D1 in 162 hepatocellular carcinoma (HCC). Single‐ and double‐label imaging by brightfield and confocal laser scanning microscopy was quantitated and correlated with β‐catenin, the Ki67+ proliferation fraction (PF), tumor size, grade, the Okuda stage and patient survival.Results: The frequency of nuclear cyclin D1 expression was 28% and closely correlated with LEF‐1/TCF (P<0.0001) and the Ki67+ PF (P=0.03). Nuclear LEF‐1/TCF expression was observed in 52% of all cases, but was also present in 42% of cyclin D1− cases. Nuclear β‐catenin was identified in 37% of all HCCs and correlated with LEF‐1/TCF (P=0.04). The expression of cyclin D1, LEF‐1/TCF or β‐catenin did not correlate with other clinico‐pathological data.Conclusions: A large proportion of HCCs does not appear to be linked to a deregulation of cyclin D1. However, the coordinated expression of cyclin D1 and LEF‐1/TCF in some cases suggests the role of cyclin D1 as a Wnt target gene in a subset of HCCs.
Preconditioning by extracorporeal liver support (MARS) of patients with cirrhosis and severe liver failure evaluated for living donor liver transplantation – a pilot study
Authors: Choi Jong Young , Bae Si Hyun , Yoon Seung Kew , Cho Se Hyun , Yang Jin Mo , Han Joon Yeol , Ahn Byung Min , Chung Kyu Won , Sun Hee Sik , Kim Dong Goo 
Published: July 2005

Abstract: Purpose: The aim of this prospective study was to evaluate the effectiveness of preconditioning molecular adsorbent recirculating system (MARS) treatment on patients with acute‐on‐chronic liver failure (AoCLF), who were awaiting living donor liver transplantation (LDLT).Patients and methods: Between January and December 2001, 10 consecutive AoCLF patients (with progressive hyperbilirubinemia (>20 mg/dl) and hepatic encephalopathy grade ≥2) were studied. MARS was used in eight of these patients who were evaluated for LDLT during 2001. Three AoCLF patients who received LDLT before clinical use of MARS were used as historical controls.Results: Because of a shortage of donors, only five out of 10 patients considered for LDLT could receive transplants. Three patients were treated with MARS for 8 h the day before receiving LDLT, and all three survived. The remaining two patients who received transplants, and who were not pretreated with MARS, died from sepsis and multi‐organ failure within 2 weeks. Four of the patients who did not receive transplants because of donor shortage died despite 1 or 3 MARS treatments, however bilirubin levels and grade of encephalopathy were significantly reduced in these patients.Conclusions: Results of this small pilot study suggest that MARS, by reducing the severity of jaundice and encephalopathy, might be effective as a bridging option in AoCLF patients awaiting LDLT.
Treatment of experimental hepatic fibrosis by combinational delivery of urokinase‐type plasminogen activator and hepatocyte growth factor genes
Authors: Lin Yong , Xie Wei‐Fen , Chen Yue‐Xiang , Zhang Xin , Zeng Xin , Qiang Hui , Chen Wei‐Zhong , Yang Xiu‐Jiang , Han Ze‐Guang , Zhang Zhong‐Bing 
Published: July 2005

Abstract:Purpose: To investigate the effect of combinational delivery of urokinase‐type plasminogen activator (uPA) and hepatocyte growth factor (HGF) genes on hepatic fibrosis.Methods: Replication‐deficient adenoviral vectors expressing either human HGF (AdHGF) or uPA (AduPA) were generated. HGF gene was transferred into primary cultured hepatocytes and uPA gene to hepatic stellate cell (HSC) to investigate the effect on the biological character of cells. Combinational adenoviruses were infused into hepatic fibrosis rats. Serum markers as well as histological and immunohistochemical examination were carried out to test the reversal of hepatic fibrosis.Results: Transfection of exogenous HGF gene induced expression of c‐met/HGF receptor and stimulated hepatocyte proliferation. uPA gene delivered into HSC decreased the amount of collagen types I and III accompanied with the increased expression of matrix metalloproteinase‐2. In vivo, the area of extracellular matrix in the fibrotic liver decreased to 72% in AdHGF‐treated rats (P<0.01), 64% in the AduPA‐treated group (P<0.01), and 51% in bi‐genes transfection (P<0.01), compared with that of the controls. Moreover, immunohistochemical staining of collagen types I and III revealed that combinational genes delivery exerted more effect on reversal of hepatic fibrosis than mono‐gene transfection.Conclusions: Our study indicated that simultaneous delivery of two antifibrotic genes could confer synergistic effect on hepatic fibrosis.