tbuckley/cabot-search huggingface dataset:
Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study
Authors: Caroline K Mbuba, Anthony K Ngugi, Greg Fegan, Fredrick Ibinda, Simon N Muchohi, Christopher Nyundo, Rachael Odhiambo, Tansy Edwards, Peter Odermatt, Julie A Carter, Charles R Newton
Journal: The Lancet Neurology (2012)

Many people with epilepsy in low-income countries do not receive appropriate biomedical treatment. This epilepsy treatment gap might be caused by patients not seeking biomedical treatment or not adhering to prescribed antiepileptic drugs (AEDs). We measured the prevalence of and investigated risk factors for the epilepsy treatment gap in rural Kenya.All people with active convulsive epilepsy identified during a cross-sectional survey of 232,176 people in Kilifi were approached. The epilepsy treatment gap was defined as the percentage of people with active epilepsy who had not accessed biomedical services or who were not on treatment or were on inadequate treatment. Information about risk factors was obtained through a questionnaire-based interview of sociodemographic characteristics, socioeconomic status, access to health facilities, seizures, stigma, and beliefs and attitudes about epilepsy. The factors associated with people not seeking biomedical treatment and not adhering to AEDs were investigated separately, adjusted for age.673 people with epilepsy were interviewed, of whom 499 (74%) reported seeking treatment from a health facility. Blood samples were taken from 502 (75%) people, of whom 132 (26%) reported taking AEDs, but 189 (38%) had AEDs detectable in the blood. The sensitivity and specificity of self-reported adherence compared with AEDs detected in blood were 38·1% (95% CI 31·1-45·4) and 80·8% (76·0-85·0). The epilepsy treatment gap was 62·4% (58·1-66·6). In multivariable analysis, failure to seek biomedical treatment was associated with a patient holding traditional animistic religious beliefs (adjusted odds ratio 1·85, 95% CI 1·11-2·71), reporting negative attitudes about biomedical treatment (0·86, 0·78-0·95), living more than 30 km from health facilities (3·89, 1·77-8·51), paying for AEDs (2·99, 1·82-4·92), having learning difficulties (2·30, 1·29-4·11), having had epilepsy for longer than 10 years (4·60, 2·07-10·23), and having focal seizures (2·28, 1·50-3·47). Reduced adherence was associated with negative attitudes about epilepsy (1·10, 1·03-1·18) and taking of AEDs for longer than 5 years (3·78, 1·79-7·98).The sensitivity and specificity of self-reported adherence is poor, but on the basis of AED detection in blood almost two-thirds of patients with epilepsy were not on treatment. Education about epilepsy and making AEDs freely available in health facilities near people with epilepsy should be investigated as potential ways to reduce the epilepsy treatment gap.Wellcome Trust.
Effects of Tamoxifen vs Raloxifene on the Risk of Developing Invasive Breast Cancer and Other Disease Outcomes&lt;SUBTITLE&gt;The NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 Trial&lt;/SUBTITLE&gt;
Authors: Victor G. Vogel
Journal: JAMA (2006)

ContextTamoxifen is approved for the reduction of breast cancer risk, and raloxifene has demonstrated a reduced risk of breast cancer in trials of older women with osteoporosis.ObjectiveTo compare the relative effects and safety of raloxifene and tamoxifen on the risk of developing invasive breast cancer and other disease outcomes.Design, Setting, and PatientsThe National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene trial, a prospective, double-blind, randomized clinical trial conducted beginning July 1, 1999, in nearly 200 clinical centers throughout North America, with final analysis initiated after at least 327 incident invasive breast cancers were diagnosed. Patients were 19 747 postmenopausal women of mean age 58.5 years with increased 5-year breast cancer risk (mean risk, 4.03% [SD, 2.17%]). Data reported are based on a cutoff date of December 31, 2005.InterventionOral tamoxifen (20 mg/d) or raloxifene (60 mg/d) over 5 years.Main Outcome MeasuresIncidence of invasive breast cancer, uterine cancer, noninvasive breast cancer, bone fractures, thromboembolic events.ResultsThere were 163 cases of invasive breast cancer in women assigned to tamoxifen and 168 in those assigned to raloxifene (incidence, 4.30 per 1000 vs 4.41 per 1000; risk ratio [RR], 1.02; 95% confidence interval [CI], 0.82-1.28). There were fewer cases of noninvasive breast cancer in the tamoxifen group (57 cases) than in the raloxifene group (80 cases) (incidence, 1.51 vs 2.11 per 1000; RR, 1.40; 95% CI, 0.98-2.00). There were 36 cases of uterine cancer with tamoxifen and 23 with raloxifene (RR, 0.62; 95% CI, 0.35-1.08). No differences were found for other invasive cancer sites, for ischemic heart disease events, or for stroke. Thromboembolic events occurred less often in the raloxifene group (RR, 0.70; 95% CI, 0.54-0.91). The number of osteoporotic fractures in the groups was similar. There were fewer cataracts (RR, 0.79; 95% CI, 0.68-0.92) and cataract surgeries (RR, 0.82; 95% CI, 0.68-0.99) in the women taking raloxifene. There was no difference in the total number of deaths (101 vs 96 for tamoxifen vs raloxifene) or in causes of death.ConclusionsRaloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer and has a lower risk of thromboembolic events and cataracts but a nonstatistically significant higher risk of noninvasive breast cancer. The risk of other cancers, fractures, ischemic heart disease, and stroke is similar for both drugs.Trial Registrationclinicaltrials.gov Identifier: NCT00003906Published online June 5, 2006 (doi:10.1001/jama.295.23.joc60074).
Health Inequalities: Trends, Progress, and Policy
Authors: Sara N. Bleich, Marian P. Jarlenski, Caryn N. Bell, Thomas A. LaVeist
Journal: Annual Review of Public Health (2012)

Health inequalities, which have been well documented for decades, have more recently become policy targets in developed countries. This review describes time trends in health inequalities (by sex, race/ethnicity, and socioeconomic status), commitments to reduce health inequalities, and progress made to eliminate health inequalities in the United States, United Kingdom, and other OECD countries. Time-trend data in the United States indicate a narrowing of the gap between the best- and worst-off groups in some health indicators, such as life expectancy, but a widening of the gap in others, such as diabetes prevalence. Similarly, time-trend data in the United Kingdom indicate a narrowing of the gap between the best- and worst-off groups in some indicators, such as hypertension prevalence, whereas the gap between social classes has increased for life expectancy. More research and better methods are needed to measure precisely the relationships between stated policy goals and observed trends in health inequalities.
Ku80 Deletion Suppresses Spontaneous Tumors and Induces a p53-Mediated DNA Damage Response
Authors: Valerie B. Holcomb, Francis Rodier, YongJun Choi, Rita A. Busuttil, Hannes Vogel, Jan Vijg, Judith Campisi, Paul Hasty
Journal: Cancer Research (2008)

Ku80 facilitates DNA repair and therefore should suppress cancer. However, ku80(-/-) mice exhibit reduced cancer, although they age prematurely and have a shortened life span. We tested the hypothesis that Ku80 deletion suppresses cancer by enhancing cellular tumor-suppressive responses to inefficiently repaired DNA damage. In support of this hypothesis, Ku80 deletion ameliorated tumor burden in APC(MIN) mice and increased a p53-mediated DNA damage response, DNA lesions, and chromosomal rearrangements. Thus, contrary to its assumed role as a caretaker tumor suppressor, Ku80 facilitates tumor growth most likely by dampening baseline cellular DNA damage responses.
The promise of electronic data capture in respiratory medicine
Authors: N. Johnston, P. O'Byrne, M. Kolb
Journal: European Respiratory Journal (2011)

In the 17th century the English physician John Floyer, himself severely asthmatic, used symptom diaries to record his own and his patients’ symptoms to understand the determinants of asthma exacerbations, and inform disease management 1. If long-term serial data on designated patients with chronic lung disease were available to physicians, it could fundamentally change clinical practice and influence the design of clinical research studies. However, methods of symptom diary data collection that frustrate patients and which require analysis by physicians before interpretation are unlikely to achieve broad success. A recent editorial in the European Respiratory Journal 2 drew attention to the emphasis, in current guidelines for asthma management 3 and in the conduct of clinical trials in asthma 4, of the importance of estimating “future risk” to patients. The concept has equal relevance in other chronic lung diseases. Guidances issued by both the European Medicines Agency and the US Food and Drug Administration 5, 6 have contemplated and encouraged the adoption of patient reported outcomes (PROs) in chronic disease research.

The report by Liu et al. 7 in the current issue of the European Respiratory Journal describes the experimental evaluation of a mobile telephone-based system compared with a paper diary for monitoring the management of adult asthmatics, and found significant clinical improvements in the electronically monitored patients. As noted in a recent meta-analysis of studies of electronic patient-reported symptom monitoring in respiratory disease 8, there are as yet an inadequate number of published reports of studies with robust designs and formal evaluation in this area, and the study by Liu et al. 7 is a welcome addition. The approach taken to symptom diary data collection was inexpensive and used technologies that are becoming almost universally available.

Importantly, this study also showed good patient …
Selective ET <sub>A</sub> Receptor Antagonism Reduces Neointimal Hyperplasia in a Porcine Coronary Stent Model
Authors: Charles J. McKenna, Sandra E. Burke, Terry J. Opgenorth, Robert J. Padley, LaDonna J. Camrud, Allan R. Camrud, Jodi Johnson, Paula J. Carlson, Amir Lerman, David R. Holmes, Robert S. Schwartz
Journal: Circulation (1998)

Background —As endothelin binds to ET A receptors, it stimulates vascular smooth muscle cell proliferation and may thus be pivotally involved in the pathogenesis of restenosis. This study assessed the ability of a potent and selective ET A antagonist to reduce neointimal hyperplasia in a porcine coronary artery stented injury model. Methods and Results —Fifty-five pigs were randomized to receive placebo or the oral ET A -selective antagonist ABT147627 twice daily for 28 days in one of three doses: 0.75 mg/kg (low), 3.75 mg/kg (mid), and 10.0 mg/kg (high). Each underwent oversized stent deployment in two randomly assigned major epicardial coronary arteries. Three animals (5.5%) died as a consequence of stent thrombosis within 24 hours of the procedure. The remaining 52 animals (13 pigs per group) survived without complication until predetermined euthanasia at 28 days. In the placebo group, mean injury score was 1.73±0.80, with a mean neointimal response of 0.45±0.24 mm. By comparison, the low-dose group had a similar mean injury score of 1.79±0.75 with reduced neointimal response, 0.36±0.22 mm ( P &lt;0.01). Mean injury score in the mid-dose animals was significantly greater than in the placebo group (1.94±0.92; P &lt;0.05). The neointimal hyperplasia associated with this injury was less than with placebo, although the difference did not reach statistical significance (0.40±0.25 mm; P =0.05). In the high-dose pigs, mean injury score was also significantly greater than in the placebo arm (1.93±0.73; P &lt;0.05). Despite this, neointimal response was also significantly less (0.37±0.37 mm; P &lt;0.01). Conclusions —Oral, selective ET A receptor antagonism significantly reduced neointimal hyperplasia forming over porcine coronary stented injuries in the first 28 days. This strategy may have clinical potential for the limitation and treatment of coronary restenosis after percutaneous revascularization.
Radiotherapy As Primary Treatment for Stage IE and IIE Nasal Natural Killer/T-Cell Lymphoma
Authors: Ye-Xiong Li, Bo Yao, Jing Jin, Wei-Hu Wang, Yue-Ping Liu, Yong-Wen Song, Shu-Lian Wang, Xin-Fan Liu, Li-Qiang Zhou, Xiao-Hui He, Ning Lu, Zi-Hao Yu
Journal: Journal of Clinical Oncology (2005)

PURPOSE The optimal therapy remains unclear for nasal natural killer (NK)/T-cell lymphoma. The purpose of this study is to analyze the outcome of radiotherapy as the primary treatment for localized stage IE and IIE diseases.One hundred five patient cases were reviewed. There were 83 stage IE and 22 stage IIE patients. All except three patients received radiotherapy (RT) alone or RT combined with chemotherapy (CT; combined-modality therapy [CMT]). Overall, 31 patients were treated with RT alone, 34 with RT followed by CT, 37 with CT followed by RT, and three with CT alone.Five-year overall survival (OS) and progression-free survival (PFS) for all patients were 71% and 59%, respectively. The 5-year OS and PFS were 78% and 63% for stage IE, and 46% and 40% for stage IIE, respectively. Complete response (CR) was achieved in 91 patients (87%) after RT and/or CT. Initial RT resulted in a superior CR as compared with initial CT, with 54 (83%) of 65 patients achieving CR with initial RT, versus only eight (20%) of 40 after initial CT. For 102 patients who received RT with or without CT, the outcome of primary treatment with RT alone was compared with that of CMT. Five-year OS and PFS was 66% and 61% for RT alone, and 76% and 61%% for CMT, respectively (OS, P = .6433; PFS, P = .8391).RT as primary therapy resulted in good outcome in early-stage disease, and the addition of CT to RT was not accompanied by an improvement in survival.
Drugs-Herbals Workshop
Authors: Lester M. Crawford, Jr
Journal: JAMA (2002)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Regulation of the Interleukin (IL)-12R β2 Subunit Expression in Developing T Helper 1 (Th1) and Th2 Cells
Authors: Susanne J. Szabo, Anand S. Dighe, Ueli Gubler, Kenneth M. Murphy
Journal: The Journal of Experimental Medicine (1997)

The developmental commitment to a T helper 1 (Th1)- or Th2-type response can significantly influence host immunity to pathogens. Extinction of the IL-12 signaling pathway during early Th2 development provides a mechanism that allows stable phenotype commitment. In this report we demonstrate that extinction of IL-12 signaling in early Th2 cells results from a selective loss of IL-12 receptor (IL-12R) beta 2 subunit expression. To determine the basis for this selective loss, we examined IL-12R beta 2 subunit expression during Th cell development in response to T cell treatment with different cytokines. IL-12R beta 2 is not expressed by naive resting CD4+ T cells, but is induced upon antigen activation through the T cell receptor. Importantly, IL-4 and IFN-gamma were found to significantly modify IL-12 receptor beta 2 expression after T cell activation. IL-4 inhibited IL-12R beta 2 expression leading to the loss of IL-12 signaling, providing an important point of regulation to promote commitment to the Th2 pathway. IFN-gamma treatment of early developing Th2 cells maintained IL-12R beta 2 expression and restored the ability of these cells to functionally respond to IL-12, but did not directly inhibit IL-4 or induce IFN-gamma production. Thus, IFN-gamma may prevent early Th cells from premature commitment to the Th2 pathway. Controlling the expression of the IL-12R beta 2 subunit could be an important therapeutic target for the redirection of ongoing Th cell responses.
Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study)
Authors: Michel Marre, Michel Lievre, Gilles Chatellier, Johannes F E Mann, Philippe Passa, Joël Ménard
Journal: BMJ (2004)

<h3>Abstract</h3> <b>Objective</b> To investigate whether a low dose of the angiotensin converting enzyme (ACE) inhibitor ramipril lowers cardiovascular and renal events in patients with type 2 diabetes who have microalbuminuria or proteinuria. <b>Design</b> Randomised, double blind, parallel group trial comparing ramipril (1.25 mg/day) with placebo (on top of usual treatment) for cardiovascular and renal outcomes for at least three years. <b>Setting</b> Multicentre, primary care study conducted mostly by general practitioners in 16 European and north African countries. <b>Participants</b> 4912 patients with type 2 diabetes aged <b>&gt;</b> 50 years who use oral antidiabetic drugs and have persistent microalbuminuria or proteinuria (urinary albumin excretion 20 mg/l in two consecutive samples), and serum creatinine ≤ 150 μmol/l. <b>Main outcome measures</b> The primary outcome measure was the combined incidence of cardiovascular death, non-fatal myocardial infarction, stroke, heart failure leading to hospital admission, and end stage renal failure. <b>Results</b> Participants were followed for 3 to 6 (median 4) years. There were 362 primary events among the 2443 participants taking ramipril (37.8 per 1000 patient years) and 377 events among the 2469 participants taking placebo (38.8 per 1000 patient years; hazard ratio 1.03 (95% confidence interval 0.89 to 1.20, P = 0.65)). None of the components of the primary outcome was reduced. Ramipril lowered systolic and diastolic blood pressures (by 2.43 and 1.06 mm Hg respectively after two years) and favoured regression from microalbuminuria (20-200 mg/l) or proteinuria (&gt; 200mg/l) to normal level (&lt; 20 mg/l) or microalbuminuria (P &lt; 0.07) in 1868 participants who completed the study. <b>Conclusions</b> Low dose (1.25 mg) ramipril once daily has no effect on cardiovascular and renal outcomes of patients with type 2 diabetes and albuminuria, despite a slight decrease in blood pressure and urinary albumin. The cardiovascular benefits of a daily higher dose (10 mg) ramipril observed elsewhere are not found with an eightfold lower daily dose.
HEMOGLOBIN REGENERATION IN THE CHRONIC HEMORRHAGIC ANEMIA OF DOGS (WHIPPLE)
Authors: Cyrus C. Sturgis, George E. Farrar
Journal: The Journal of Experimental Medicine (1935)

1. A group of dogs on a standard salmon bread diet with a slowly regenerating anemia were studied. The addition of liver to this diet during a 2 week period promoted a definitely greater regeneration of hemoglobin than did the addition of an amount of inorganic iron which was equivalent to that contained in the added liver. The more effective result attained with liver cannot, therefore, be attributed solely to the iron intake. 2. The greater response to liver is not due to its content of amino acids which are present in casein, since a diet containing an exactly similar amount of calories, iron and protein nitrogen, made up of inorganic iron and casein does not cause a greater response than that obtained by the addition of that amount of inorganic iron alone to the standard basal diet. 3. Furthermore, the salmon bread diet does not produce a deficiency of the amino acids represented in casein, since dogs eating the high protein (casein) Cowgill dog ration show the same basal hemoglobin regeneration rate and a similar greater response to liver than to inorganic iron. The Cowgill ration, however, supplies some non-ferrous factor involved in hemoglobin regeneration which is not contained, to as great a degree at least, in the salmon bread. 4. Whipple's chronic hemorrhagic anemia of dogs serves as an accurate assay method for measuring the hemoglobin producing power of a substance. Quantitatively reproducible responses can be obtained.
Osteoprotegerin Is Associated With Silent Coronary Artery Disease in High-Risk but Asymptomatic Type 2 Diabetic Patients
Authors: Antoine Avignon, Ariane Sultan, Christophe Piot, Stéphane Elaerts, Jean Paul Cristol, Anne Marie Dupuy
Journal: Diabetes Care (2005)

Osteoprotegerin (OPG) is an inhibitor of osteoclastogenesis, which has been recently involved in atherosclerosis. The relationship between coronary atherosclerosis and OPG has never been studied in asymptomatic type 2 diabetic patients.This is a nested case-control study; 162 asymptomatic type 2 diabetic patients were evaluated for silent myocardial ischemia using stress myocardial perfusion imaging; of 50 patients with positive results, 37 underwent coronary angiography, 20 of whom showed significant coronary artery disease (CAD group). Of 112 patients without silent myocardial ischemia, 20 subjects (NO-CAD group) were selected and matched by age and sex to patients with CAD. OPG, C-reactive protein, adiponectin, lipoprotein(a), albuminuria, and classical risk factors were measured.The percentages of subjects with OPG levels above median and with nephropathy were higher in the CAD group than in the NO-CAD group (70 vs. 25%, P = 0.004 and 50 vs. 5%, P = 0.001, respectively). LDL cholesterol levels were higher and HDL cholesterol levels lower in the CAD compared with the NO-CAD group (P = 0.033 and P = 0.005, respectively). No other variables were associated with CAD. Logistic regression analysis showed that OPG values above median (odds ratio 8.31 [95% CI 1.18-58.68], P = 0.034) and nephropathy (21.98 [1.24-388.36], P = 0.035) were significant independent predictors of asymptomatic CAD in type 2 diabetic patients.Our investigation reports the first evidence of an independent association of OPG with asymptomatic CAD in type 2 diabetic patients. The results of this nested case- control study with 20 cases need to be confirmed in a larger population.