bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influenza and Pneumococcal Vaccination Demand Responses to Changes in Infectious Disease Mortality
Authors: Li Ying‐Chun , Norton Edward C. , Dow William H. 
Published: July 2004

Objective. To test the hypothesis that individuals are more likely to receive a vaccination against influenza or pneumonia as the perceived disease threat increases.Data Sources. This study uses two different national datasets. Individual‐level information about the vaccination rates of 38,768 elderly persons are from the Behavioral Risk Factor Surveillance System, 1993–1998. Information on the combined influenza and pneumonia state mortality rates are measured from the Compressed Mortality File.Study Design. Using both cross‐sectional and state fixed‐effects panel data estimators, we model an individual's probability of having an influenza or pneumococcal vaccination as a function of the lagged state mortality rate. Multiyear lags are specified in order to estimate the duration of the effect of disease mortality on individual vaccination behavior.Principal Findings. Results support our hypothesis that influenza vaccination behavior responds positively to disease mortality, even after a one‐year lag. We further find that cross‐sectional estimators used in previous work yield downward‐biased estimates, although even for our preferred panel data models, the estimated effects are small.Conclusions. The findings indicate that behavioral demand responses can help to limit infectious disease epidemics, and suggest further research on how public awareness campaigns can mediate this disease threat responsiveness behavior.
Hospice Use by Hispanic and Non‐Hispanic White Cancer Decedents
Authors: Lackan Nuha A. , Ostir Glenn V. , Freeman Jean L. , Kuo Yong‐Fang , Zhang Dong D. , Goodwin James S. 
Published: July 2004

Objective. To investigate rates of hospice use between Hispanic and non‐Hispanic white Medicare beneficiaries diagnosed with cancer using data from a large, population‐based study.Data Sources. Secondary data from the linked SEER‐Medicare database including the SEER areas of Los Angeles, San Francisco, and San Jose–Monterey, California, and the state of New Mexico. All subjects were Hispanic or non‐Hispanic whites, aged 67 and older, had a cancer diagnosis of breast, colorectal, lung, or prostate cancer from 1991–1996, and died of cancer from 1991–1998.Study Design. This study employed a retrospective cohort design to compare rates of hospice use between Hispanics and non‐Hispanic whites across patient characteristics and over time.Principal Findings. Rates of hospice use were similar for Hispanics (39.2 percent) and non‐Hispanic whites (41.5 percent). In a bivariate logistic regression model, Hispanics were significantly less likely to use hospice than non‐Hispanic whites (OR 0.91; 95 percent CI 0.85–0.97). However, after adjusting for age, marital status, sex, educational attainment, income, urban versus rural residence, and type of insurance using multivariate logistic regression analysis, the estimated odds for being a hospice user among Hispanics is similar to the odds of being a hospice user among non‐Hispanic whites (OR 1.05; 95 percent CI 0.98–1.13). Stratified analyses revealed significant differences between ethnic groups in the use of hospice by type of insurance and SEER area, indicating interactions between ethnicity and these variables.Conclusions. Our findings indicate similar rates of hospice use for Hispanics and non‐Hispanic whites diagnosed with one of the four leading cancers. Additional studies from other national registries may be necessary to confirm these findings.
Tales from the New Frontier: Pioneers' Experiences with Consumer‐Driven Health Care
Authors: Lo Sasso Anthony T. , Rice Thomas , Gabel Jon R. , Whitmore Heidi 
Published: July 2004

Objective. To conduct site visits to study the early experiences of firms offering consumer‐driven health care (CDHC) plans to their employees and firms that provide CDHC products.Data Sources/Study Setting. A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers.Study Design. We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer‐driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC.Principal Findings. The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost‐savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll.Conclusions. Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web‐based information and tools actually make patients become better consumers.
Employee Choice of Consumer‐Driven Health Insurance in a Multiplan, Multiproduct Setting
Authors: Parente Stephen T. , Feldman Roger , Christianson Jon B. 
Published: July 2004

Objective. To determine who chooses a Consumer‐Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool.Study Design. We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans—a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system.Principal Findings. Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher‐income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out‐of‐pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price‐sensitive.Conclusions. This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out‐of‐pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy.
Evaluation of the Effect of a Consumer‐Driven Health Plan on Medical Care Expenditures and Utilization
Authors: Parente Stephen T. , Feldman Roger , Christianson Jon B. 
Published: July 2004

Objective. To compare medical care costs and utilization in a consumer‐driven health plan (CDHP) to other health insurance plans.Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi‐experimental pre–post design is used to assign employees to three cohorts: (1) enrolled in a health maintenance organization (HMO) from 2000 to 2002, (2) enrolled in a preferred provider organization (PPO) from 2000 to 2002, or (3) enrolled in a CDHP in 2001 and 2002, after previously enrolling in either an HMO or PPO in 2000. Using this approach we estimate a difference‐in‐difference regression model for expenditure and utilization measures to identify the impact of CDHP.Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO plans.Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new health plan is a viable alternative to existing health plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource‐intensive hospital admissions after an initially favorable selection.
Percutaneous ethanol injection treatment of severe hyperparathyroidism in maintenance dialysis: Risks and benefits
Authors: Guebre‐Egziabher Fitsum , Easy Firas , Juillard Laurent , Valette Pierre‐Jean , Fouque Denis 
Published: July 2004

AbstractRenal hyperparathyroidism is one of the main and serious complications that occur in chronic kidney disease and particularly during long‐term maintenance dialysis. Several recent trials indicate that a high calcium phosphorus product is correlated with high cardiovascular morbidity and mortality and poor outcome. Thus, it is important to improve the control of hyperparathyroidism in chronic renal failure patients. Several methods have been reported for treating severe hyperparathyroidism resistant to medical therapy. Total parathyroidectomy and transplantation or excision of tumor is considered as the treatment of choice. More recently, interventional methods with percutaneous ethanol or calcitriol injection have been developed. These latter techniques have been reported as an alternative to surgical treatment for patients with high perioperative risk. We report the occurrence of laryngeal recurrent nerve palsy, vocal fold paralysis, and hemiplegia after a successful injection of ethanol in a left parathyroid adenoma in a maintenance hemodialysis patient and discuss the restrictions of the procedure and alternative treatments in view of the available studies.
Serum matrix metalloproteinase‐3 in hemodialysis patients with dialysis‐related amyloidosis
Authors: Ishizaki Makoto , Matsunaga Tomohito , Adachi Kuniaki , Miyashita Eishi 
Published: July 2004

AbstractBackground:  Matrix metalloproteinase‐3 (MMP‐3) has been linked to osteoarticular destruction in rheumatic arthritis. To investigate the role of MMP‐3 in dialysis‐related amyloidosis (DRA), we determined serum MMP‐3 in long‐term hemodialysis (HD) patients with and without clinical manifestations of DRA.Methods:  Thirty‐three subjects (63% female, 3% diabetic) enrolled in the study between September 2001 and June 2003. All patients underwent standard HD three times per week, using high‐flux dialyzers. Four patients had active DRA complications (DRA patients), whereas the others (n = 29) had no evidence of DRA. We determined serum concentrations of MMP‐3, C‐reactive protein (CRP), β2‐microglobulin (β2M), and interleukin‐6 (IL‐6). We also studied the effects of hemodiafiltration (HDF) on inflammatory measures by transferring the DRA patients from regular HD to predilution HDF.Results:  The DRA group had been on dialysis significantly longer than the control group. Significant positive correlations were observed between MMP‐3 and IL‐6 (R2 = 0.5143, p < 0.0001) and MMP‐3 and CRP (R2 = 0.6492, p < 0.0001). IL‐6 levels increased after a single dialysis treatment, but this effect was minimal with predilution HDF (the increment of IL‐6 levels did not exceed 10 pg/mL). Serum MMP‐3 levels decreased in parallel with the decrease of IL‐6.Conclusions:  MMP‐3 serum levels increase in accordance with clinical manifestations of DRA and elevated circulating levels of IL‐6. For the evaluation of the pathophysiologic state of DRA, serum MMP‐3 may be a useful predictor indicative of chronic inflammation and osteoarticular disorders in DRA patients.
Timely referral to the nephrologist: Essential to optimizing patient outcomes
Authors: Sułowicz Władysław , Stompór Tomasz P. 
Published: July 2004

AbstractAnnual mortality on renal replacement therapy is about 10% in Western Europe and reaches 20% in the United States. The reasons responsible for this excess mortality include among others advanced age, high prevalence of diabetes and comorbid conditions, susceptibility to infections, and cancer. An additional cause that should be considered is late referral to overall renal care and for renal replacement therapy. It has been demonstrated recently that early referral may provide many advantages for the patient, such as prevention of organ damage secondary to uremia and even delay the onset of end‐stage renal disease. These benefits prompted numerous recommendations for timely referral, both for dialysis and for long‐term renal follow‐up. Despite available guidelines for nephrology referral the current practice is still suboptimal, resulting in delayed initiation of dialysis and clinical outcomes that are not ideal. There is an urgent need in the renal community to change the current practice of referral. Beyond the benefits for patients, society may also expect potential cost effectiveness from early renal care.
Erythropoietic agents, iron and hemoglobin—What happens beyond the trial setting: Observational data from the ANZDATA Registry
Authors: McDonald Stephen P , Marshall Mark R , Kerr Peter G , Russ Graeme R 
Published: July 2004

AbstractBackground:  The issues surrounding anemia management in patients receiving dialysis therapy are complex and widely debated. Although numerous trials have been published, clinical practice patterns may differ, particularly in the presence of uncertainty about the optimal management of anemia in this setting.Methods:  We examined data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) regarding use of erythropoietic agents (EA), hemoglobin, and ferritin concentrations and transferrin saturation in 8476 prevalent dialysis patients in Australia and New Zealand during the 6 months preceding March 31, 2001. From this cross‐sectional survey, we examined the distribution of reported hemoglobin concentration, transferrin saturation, and ferritin concentration. Among hemodialysis patients, other predictors of hemoglobin examined included urea reduction ratio (URR), age, sex, and the presence of comorbidities.Results: In Australia, 87% of dialysis patients received an EA; in contrast, only 42% of New Zealand patients received an EA. Hemoglobin concentrations were significantly higher in Australia, where 16% of reported values were <100 g/L, compared to New Zealand where 37% reported values were <100 g/L. Transferrin saturation and serum ferritin concentrations were significantly correlated, but less strongly among those receiving EA than those not receiving these agents. Both transferrin saturation and serum ferritin were significantly and independently associated with hemoglobin concentration, as were age and sex. The association with ferritin was inverse: higher serum ferritin concentrations were associated with lower hemoglobin concentrations. There was poor agreement (κ = 0.15) between categories of low transferrin saturation (<20%) and low ferritin concentrations (<200 ng/mL). Among the Australian hemodialysis patients, there was no significant variation in Hb between categories where reported URR was ≥65%, whereas the group with a reported URR <65% had a significantly lower hemoglobin concentration.Conclusions:  There was a wide variation in reported hemoglobin concentrations in this population. Potential contributing factors include variable patient responsiveness to EA and iron, differing regulations in Australia and New Zealand regarding government subsidy of EA, and the lack of consensus among physicians regarding hemoglobin target values. Although a cross‐sectional study cannot directly address the predictive value of iron indices for iron deficiency, it appears likely that transferrin and ferritin have different relationships with hemoglobin, and measurement of both may have greater clinical utility than either parameter alone.
The advanced practice nurse–nephrologist care model: Effect on patient outcomes and hemodialysis unit team satisfaction
Authors: Harwood Lori , Wilson Barbara , Heidenheim A Paul , Lindsay Robert M 
Published: July 2004

AbstractThe tertiary care nurse practitioner/clinical nurse specialist (NP/CNS) is an advanced practice nurse with a relatively new role within the health‐care system. It is stated that care provided by the NP/CNS is cost‐effective and of high quality but little research exists to document these outcomes in an acute‐care setting. The clinical coverage pattern by nephrologists and NP/CNS of a hemodialysis unit in a large academic center allowed such a study. Two NP/CNS plus a nephrologist followed two of three hemodialysis treatment shifts per day; only a nephrologist followed the third shift. The influence of this care pattern of patients was examined using a cross‐sectional review of outcomes such as adequacy of delivered dialysis, anemia management, phosphate control, hospitalizations, etc. In addition, the level of satisfaction of the dialysis team and perceptions of care delivered with the care models was assessed. The care model staff‐to‐patient‐number ratio was similar in both groups (1:27 for NP/CNS plus nephrologist; 1:29 for nephrologist alone). Patient demographics were similar in both groups but the NP/CNS–nephrologist group had patients with more comorbidities. No statistically significant (p < 0.05) differences existed between the groups in patient laboratory data, adherence to standards, medications, inter‐ and intradialytic blood pressure, achievement of target postdialysis weights, and hospitalizations or emergency room visits. Significantly more adjustments were made to target weights and medications and more investigations were ordered by the NP/CNS–nephrologist team. Team satisfaction and perceptions of care delivery were higher with the NP/CNS–nephrologist model. It is concluded that the NP/CNS–nephrologist care model may increase the efficiency of the care provided by nephrologists to chronic hemodialysis patients. The model may also be a solution to the problem of providing nephrologic care to an ever‐growing hemodialysis population.
Early readmission and length of hospitalization practices in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Authors: Lopes Antonio Alberto , Leavey Sean F , McCullough Keith , Gillespie Brenda , Bommer Juergen , Canaud Bernard J , Saito Akira , Fukuhara Shunichi , Held Philip J , Port Friedrich K , Young Eric W 
Published: July 2004

AbstractBackground:  Rising hospital care costs have created pressure to shorten hospital stays and emphasize outpatient care. This study tests the hypothesis that shorter median length of stay (LOS) as a dialysis facility practice is associated with higher rates of early readmission.Methods:  Readmission within 30 days of each hospitalization was evaluated for participants in the Dialysis Outcomes and Practice Patterns Study, an observational study of randomly selected hemodialysis patients in the United States (142 facilities, 5095 patients with hospitalizations), five European countries (101 facilities, 2281 patients with hospitalizations), and Japan (58 facilities, 883 patients with hospitalizations). Associations between median facility LOS (estimated from all hospitalizations at the facility and interpreted as a dialysis facility practice pattern) and odds of readmission were assessed using logistic regression, adjusted for patient characteristics and the LOS of each index hospitalization.Results:  Risk of readmission was directly and significantly associated with LOS of the index hospitalization (adjusted odds ratio [AOR] 1.005 per day in median facility LOS, p = 0.007) and inversely associated with median facility LOS (AOR = 0.974 per day, p = 0.016). This latter association was strongest for US hemodialysis centers (AOR = 0.954 per day, p = 0.015).Conclusions:  Dialysis facilities with shorter median hospital LOS for their patients have higher odds of readmission, particularly in the United States, where there is greater pressure to shorten LOS. The determinants and consequences of practices related to hospital LOS for hemodialysis patients should be further studied.
Clinical isolation and functional characterization of cord blood CD133+ hematopoietic progenitor cells
Authors: Bonanno Giuseppina , Perillo Alessandro , Rutella Sergio , De Ritis Daniela Giovanna , Mariotti Andrea , Marone Maria , Meoni Franco , Scambia Giovanni , Leone Giuseppe , Mancuso Salvatore , Pierelli Luca 
Published: July 2004

BACKGROUND:  Human cord blood is a relevant source of CD133+ HPCs. Clinical‐scale isolation of human umbi‐lical cord blood (UCB) CD133+ HPCs using immunomag‐netic microbeads and the CliniMACS clinical cell isolator is reported. CD133+ HPCs isolated after large‐scale pro‐cessing were functionally characterized.STUDY DESIGN AND METHODS:  Closed disposable sets were used to process nine different samples of RBC‐reduced UCB nucleated cells. In‐vitro hematopoietic assays and human xenografts in NOD/SCID mice were performed to assess the functional properties of isolated CD133+ cells. Different mixtures of human cytokines were tested for the ability to expand nascent CD133+ HPCs. Furthermore, freshly isolated CD133+ cells were conditioned in culture medium specifically tested to support in‐vitro myogenesis or osteogenesis.RESULTS:  Isolation procedures yielded the recovery of an average of 2.53 × 106 CD133+ HPCs with a mean recovery of 96 percent (referred to as RBC‐reduced samples) and a final sample purity of 82 percent. Purified CD133+ cells had high cloning efficiency, had relevant long‐term activity, and were capable of repopulating irradiated NOD/SCID mice. In 10‐day stroma‐free cultures, a 2‐fold and 8.3‐fold expansion of colony‐forming cells (CFCs) and extended long‐term culture‐initiating cells, respectively, was obtained. Freshly isolated CD133+ cells differen‐tiated into large nucleated cells expressing either myosin D or osteopontin (as revealed by RT‐PCR and immuno‐cytochemistry), with a protein/mRNA expression compar‐able to or even higher than that observed in UCB CD133– nucleated cells in identical culture conditions.CONCLUSION:  Collectively, clinical‐scale isolation of UCB CD133+ cells provides a relevant amount of primi‐tive HPCs with high hematopoietic activity and in‐vitro mesenchymal potential.