tbuckley/cabot-search huggingface dataset:
Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database
Authors: J. M M Evans, R. W Newton, D. A Ruta, T. M MacDonald, R. J Stevenson, A. D Morris
Journal: BMJ (1999)

<h3>Abstract</h3> <b>Objectives:</b> To investigate patterns of self monitoring of blood glucose concentration in diabetic patients who use insulin and to determine whether frequency of self monitoring is related to glycaemic control. <b>Setting:</b> Diabetes database, Tayside, Scotland. <b>Subjects:</b> Patients resident in Tayside in 1993-5 who were using insulin and were registered on the database and diagnosed with insulin dependent (type 1) or non-insulin dependent (type 2) diabetes before 1993. <b>Main outcome measures:</b> Number of glucose monitoring reagent strips dispensed (reagent strip uptake) derived from records of prescriptions. First recorded haemoglobin A<sub>1c</sub> concentration in the study period, and reagent strips dispensed in the previous 6 months. <b>Results:</b> Among 807 patients with type 1 diabetes, 128 (16%) did not redeem any prescriptions for glucose monitoring reagent strips in the 3 year study period. Only 161 (20%) redeemed prescriptions for enough reagent strips to test glucose daily. The corresponding figures for the 790 patients with type 2 diabetes who used insulin were 162 (21%; no strips) and 131 (17%; daily tests). Reagent strip uptake was influenced both by age and by deprivation category. There was a direct relation between uptake and glycaemic control for 258 patients (with recorded haemoglobin A<sub>1c</sub> concentrations) with type 1 diabetes. In a linear regression model the decrease in haemoglobin A<sub>1c</sub> concentration for every extra 180 reagent strips dispensed was 0.7%. For the 290 patients with type 2 diabetes who used insulin there was no such relation. <b>Conclusions:</b> Self monitoring of blood glucose concentration is associated with improved glycaemic control in patients with type 1 diabetes. Regular self monitoring in patients with type 1 and type 2 diabetes is uncommon. <h3>Key messages</h3> Several studies have indicated the importance of self monitoring of blood glucose concentration for prevention of complications in patients with diabetes Uptake of reagent strips for self monitoring of blood glucose among diabetic patients who used insulin was low, with only 20% of patients with type 1 diabetes and 17% of those with type 2 diabetes obtaining enough strips to test blood glucose concentration once daily Reagent strip uptake depends on characteristics such as age and social deprivation category, and patient groups with low uptake should be identified and targeted There was a direct association between strip uptake in the previous 6 months and glycaemic control in patients with type 1 diabetes but not in those with type 2 diabetes
Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients?
Authors: Florence Dumas, Wulfran Bougouin, Guillaume Geri, Lionel Lamhaut, Adrien Bougle, Fabrice Daviaud, Tristan Morichau-Beauchant, Julien Rosencher, Eloi Marijon, Pierre Carli, Xavier Jouven, Thomas D. Rea, Alain Cariou
Journal: Journal of the American College of Cardiology (2014)
Racial Disparities in Antipsychotic Prescription Patterns for Patients With Schizophrenia
Authors: Eri Kuno, Aileen B. Rothbard
Journal: American Journal of Psychiatry (2002)

OBJECTIVE: This study aimed to examine the extent and type of variation in antipsychotic prescription patterns between African American and Caucasian patients with schizophrenia. METHOD: Subjects were 2,515 adult Medicaid recipients treated for schizophrenia in 1995 with one of four types of antipsychotic medication (traditional antipsychotics, clozapine, risperidone, or depot antipsychotics). Prescription and mental health service use data were collected from Medicaid claims files for the 12 months following the first filled antipsychotic prescription. Patterns of antipsychotic prescription were compared for African American (N=1,538, 61%) and Caucasian (N=977, 39%) subjects. RESULTS: African American subjects were significantly younger and more likely to receive Supplemental Security Income than were the Caucasian subjects, who received mental health services more continuously. African American subjects were less likely than Caucasian subjects to receive clozapine (8% versus 15%, respectively) and risperidone (25% versus 31%) and more likely to receive depot antipsychotics (26% versus 14%). The likelihood of receiving clozapine or risperidone remained significantly different after demographic and service use characteristics were controlled. CONCLUSIONS: This study found ethnic disparities in antipsychotic prescription patterns among a large number of publicly insured clients treated for schizophrenia. Given the rapidly changing pharmacological treatment environment, these findings have significant implications for differential quality of care for African American patients. Future studies employing client and provider characteristics are urgently needed to test alternative explanations for ethnic disparities.
Cell-Mediated Immune Responses in Tuberculosis
Authors: Andrea M. Cooper
Journal: Annual Review of Immunology (2009)

Tuberculosis is primarily a disease of the lung, and dissemination of the disease depends on productive infection of this critical organ. Upon aerosol infection with Mycobacterium tuberculosis (Mtb), the acquired cellular immune response is slow to be induced and to be expressed within the lung. This slowness allows infection to become well established; thus, the acquired response is expressed in an inflammatory site that has been initiated and modulated by the bacterium. Mtb has a variety of surface molecules that interact with the innate response, and this interaction along with the autoregulation of the immune response by several mechanisms results in less-than-optimal control of bacterial growth. To improve current vaccine strategies, we must understand the factors that mediate induction, expression, and regulation of the immune response in the lung. We must also determine how to induce both known and novel immunoprotective responses without inducing immunopathologic consequences.
Increased exhaled nitric oxide in active pulmonary tuberculosis due to inducible NO synthase upregulation in alveolar macrophages
Authors: CH Wang, CY Liu, HC Lin, CT Yu, KF Chung, HP Kuo
Journal: European Respiratory Journal (1998)

Nitric oxide (NO) plays an important role in resistance to Mycobacterium tuberculosis infection. Our aim was to determine whether inducible NO synthase (iNOS) expression and generation of reactive nitrogen intermediates (RNI) by alveolar macrophages (AM) are increased in patients infected with M. tuberculosis. NO levels in the exhaled air of 19 active pulmonary tuberculosis (TB) and 14 control subjects were measured using a chemiluminescence NO analyser. The expression of iNOS on AM was studied by labelling AM with anti-mac iNOS polyclonal antibody analysed with a flow cytometer. The spontaneous generation of RNI by cultured AM was also measured. Data are presented as mean+/-SEM. The level of NO in exhaled air was higher in patients with active TB (16.2+/-1.2 parts per billion (ppb)) compared to control subjects (6.5+/-0.9 ppb), p&lt;0.0001. Exhaled NO decreased with anti-TB treatment. Compared to control subjects (29.0+/-4.5 fluorescence intensity (FI)), iNOS expression on AM was upregulated in TB patients (86.3+/-12.5 FI) p&lt;0.001 and the capacity for spontaneous generation of nitrite was enhanced. Nitrite production was inhibited by N(G)-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of iNOS. The expression of iNOS on AM was related to the concentration of exhaled NO (r=0.66, p&lt;0.001) and the nitrite generation capacity of AM (r(s)=0.77, p&lt;0.001). We conclude that the increase in exhaled nitric oxide observed in patients with active pulmonary tuberculosis is due to an upregulation of inhaled NO synthase expression in alveolar macrophages which have an enhanced capacity for nitric oxide production.
Effect of Restricting Contact Between Pharmaceutical Company Representatives and Internal Medicine Residents on Posttraining Attitudes and Behavior
Authors: Brendan B. McCormick
Journal: JAMA (2001)

The long-term effect of policies restricting contact between residents and pharmaceutical company representatives (PCRs) during internal medicine training is unknown. The McMaster University Department of Medicine in Hamilton, Ontario, implemented a policy restricting PCR contact with trainees in 1992, whereas the Department of Medicine at the University of Toronto, Toronto, Ontario, has no such policy.To determine if the presence of a restrictive policy and the frequency of contact with PCRs during internal medicine training predict attitudes and behavior several years after completion of training.Retrospective analysis of the attitudes and behavior of 3 cohorts of physicians: University of Toronto trainees, prepolicy McMaster trainees, and postpolicy McMaster trainees. Surveys were mailed to 242 former University of Toronto and 57 former McMaster trainees who completed their internal medicine training between 1990 and 1996, with response rates of 163 (67%) and 42 (74%), respectively.Physician attitude, assessed by a question about the perceived helpfulness of PCR information, and behavior, assessed by whether physicians met with PCRs in the office and the frequency of contacts with PCRs (current contact score, consisting of conversations with PCRs, PCR-sponsored events attended, gifts, honoraria, and consulting fees received).In both the unadjusted and multiple regression analyses, postpolicy McMaster trainees were less likely to find information from PCRs beneficial in guiding their practice compared with Toronto and prepolicy McMaster trainees, with unadjusted odds ratios (ORs) of 0.44 (95% confidence interval [CI], 0.20-0.94) and 0.39 (95% CI, 0.13-1.22), respectively. All 3 groups were equally likely to report that they met with PCRs in their office in the past year (88%). Postpolicy McMaster trainees had a lower current contact score compared with Toronto (9.3 vs 10.9; P =.04) and prepolicy McMaster trainees (9.3 vs 10.8; P =.18). In multiple regression models, greater frequency of contact with PCRs during training was a predictor of increased perceived benefit of PCR information (OR, 1.29; 95% CI, 1.13-1.47) and was positively correlated with the current contact score (partial r = 0.49; P<.001). Number of PCR-sponsored rounds attended during training was not a consistent predictor of attitudes or behavior.Policies restricting PCR access to internal medicine trainees and the amount of contact during residency appear to affect future attitudes and behavior of physicians.
Serum Total Homocysteine Concentrations and Risk of Stroke and Its Subtypes in Japanese
Authors: Hiroyasu Iso, Yuri Moriyama, Shinichi Sato, Akihiko Kitamura, Takeshi Tanigawa, Kazumasa Yamagishi, Hironori Imano, Tetsuya Ohira, Tomonori Okamura, Yoshihiko Naito, Takashi Shimamoto
Journal: Circulation (2004)

To date, no prospective studies have examined the association between serum homocysteine levels and the risk of stroke and stroke subtypes in Asian populations.A prospective, nested, case-control study of Japanese subjects 40 to 85 years of age was conducted by using frozen serum samples from 11 846 participants in cardiovascular risk surveys collected from 1984 to 1995 for one community and 1989 to 1995 for the other two communities. By the end of 2000, we identified 150 incident strokes, the subtypes of which were confirmed by imaging studies. Three control subjects per case were selected by matching for sex, age, community, year of serum storage, and fasting status. Serum total homocysteine levels were measured by high-performance liquid chromatography. Compared with control subjects, total (n=150), hemorrhagic (n=52), and ischemic (n=98) strokes had higher geometric mean values of total homocysteine and higher proportions of homocysteine > or =11.0 micromol/L. The multivariate odds ratios (95% CI) for highest (> or =11.0 micromol/L) versus lowest quartiles (<7.0 micromol/L) of homocysteine after adjustment for body mass index, smoking, alcohol intake, hypertension, serum total cholesterol, and other cardiovascular risk factors were 2.99 (1.51 to 5.93) for total stroke, 3.89 (1.60 to 9.46) for ischemic stroke, 3.36 (1.27 to 8.90) for lacunar infarction, and 1.63 (0.44 to 6.00) for hemorrhagic stroke. The respective multivariate odds ratios associated with a 5-micromol/L increase in homocysteine were 1.40 (1.09 to 1.80), 1.52 (1.07 to 2.14), 1.48 (1.01 to 2.18), and 1.10 (0.76 to 1.59). The excess risk of total and ischemic strokes did not vary significantly according to sex, age, smoking status, or hypertensive status.High total homocysteine concentrations were associated with the increased risk of total stroke, more specifically ischemic stroke and lacunar infarction, among Japanese men and women.
Airflow limitation, lung volumes and systemic inflammation in a general population
Authors: S. Gläser, T. Ittermann, B. Koch, H. Völzke, H. Wallaschofski, M. Nauck, C. Warnke, C. Vogelmeier, H. Schulz, S.B. Felix, R. Ewert, C. Schäper
Journal: European Respiratory Journal (2011)

Although several levels of evidence have suggested an association between systemic inflammation and spirometric lung volumes, data addressing the potential interrelationship between airflow limitation and inflammatory markers are sparse and remain controversial. Potential associations between high-sensitivity C-reactive protein (hsCRP), fibrinogen and lung function were investigated in 1,466 individuals aged 25–85 yrs, representing a general population. Within this cross-sectional population, data on body plethysmography, spirometry, helium dilution and diffusing capacity of the lung for carbon monoxide ( D L,CO ) were analysed. After adjustment for potential confounding factors, such as smoking, obesity and cardiorespiratory fitness, there was an inverse association of hsCRP with forced expiratory and static lung volumes. In neither apparently healthy nor the entire population was inflammation associated with airflow limitation in central airways. In smokers only, higher hsCRP and fibrinogen were associated with an impaired D L,CO . This study shows that higher levels of hsCRP are associated with decreased lung volumes in a general population over a wide age range. A consistent interrelationship of central airflow limitation and inflammation was not verifiable. Smoking is related to an impaired D L,CO in association with an increase in systemic inflammation.
Genome Scan of Han Chinese Schizophrenia Families From Taiwan: Confirmation of Linkage to 10q22.3
Authors: Stephen V. Faraone, Hai-Gwo Hwu, Chih-Min Liu, Wei J. Chen, Ming-Ming Tsuang, Shih-Kai Liu, Ming-Hsien Shieh, Tzung-Jeng Hwang, Wen-Chen Ou-Yang, Chun-Ying Chen, Chwen-Cheng Chen, Jin-Jia Lin, Frank Huang-Chih Chou, Ching-Mo Chueh, Wei-Ming Liu, Mei-Hua Hall, Jessica Su, Paul Van Eerdewegh, Ming T. Tsuang
Journal: American Journal of Psychiatry (2006)

Objective: Genome-wide linkage analyses of schizophrenia have identified several regions that may harbor schizophrenia susceptibility genes, but given the complex etiology of the disorder, it is unlikely that all susceptibility regions have been detected. To address this issue, the authors ascertained 606 Han Chinese families comprising 1,234 affected members. Method: Probands with schizophrenia were recruited from six data collection field research centers in Taiwan. Each proband underwent a diagnostic screen with supplemental medical records and a semistructured interview. Following this screen, the authors administered the Mandarin Chinese version of the Diagnostic Interview for Genetic Studies. Best-estimate final diagnoses were made by two board-certified psychiatrists. The genotyping was conducted by the Center for Inherited Disease Research, with 386 markers spaced at an average of 9-centimorgan (cM) intervals. Empirical simulations were generated to determine genome-wide significance. Results: The authors found five regions with nonparametric linkage z scores 2.0 or greater. These were the following: 2.08 was reached for D1S551 (113.7) cM at 1p31.1 and 2.31 for D2S410 (125.2 cM) at 2q14.1; 2.00 was reached for D4S2361 (93.5 cM) at 4q21.23, and 2.07 for D15S1012 (36 cM) at 15q14, the largest nonparametric linkage z score was 2.88 for D10S2327 (100.92 cM) at 10q22.3. Conclusions: Our 10q22.3 finding at 100.9 cM is consistent with a previously reported nonparametric linkage score of 4.27 at 107.2 cM on chromosome 10, although it did not attain genome-wide significance in this study.
Effect of an inhaled neutral endopeptidase inhibitor, thiorphan, on airway responsiveness to leukotriene D4 in normal and asthmatic subjects
Authors: Z Diamant, MC Timmers, H van der Veen, P Booms, JK Sont, PJ Sterk
Journal: European Respiratory Journal (1994)

Cysteinyl leukotrienes are potent inflammatory mediators that are considered to play a role in the pathophysiology of asthma. It can be postulated that leukotrienes exert their bronchoconstricting effects, in part, through secondary release of endogenous neuropeptides. We examined the effect of inhaled thiorphan, an inhibitor of a neuropeptide degrading enzyme, on the concentration-response curve to leukotriene D4 (LTD4) in a two-period, double-blind, cross-over and placebo-controlled study, in 16 nonasthmatic and 12 asthmatic subjects. Thiorphan or placebo were aerosolized and administered in two 0.5 ml doses of 1.25 mg.ml-1 each, 10 min prior to LTD4 inhalation. The airway response was measured by forced expiratory volume in one second (FEV1) and partial expiratory flow-volume curves (expiratory flow at 40% of forced vital capacity; V40p), and expressed as % fall from baseline. Complete concentration-response curves to inhaled LTD4 were recorded and characterized by their position (provocative concentration producing a 20% fall in FEV1 and a 40% fall in V40p; PC20FEV1 and PC40 V40p) and, in the nonasthmatics, also by the maximal-response plateau (MFEV1, MV40p). Post-pretreatment baseline values of FEV1 and V40p were not different between thiorphan and placebo pretreatment. In both groups of subjects, there was no significant difference in lnPC40V40p or lnPC20FEV1 to LTD4 between the two pretreatments mean difference +/- SD (in doubling concentrations): 0.12 +/- 0.73 and -0.19 +/- 1.23, respectively, in asthmatics; and 0.17 +/- 0.95 and -0.99 +/- 1.95, respectively, in nonasthmatics. The maximal-response plateau could not be obtained in the majority of the asthmatic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Science, a weapon of peace
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2013)

Can science be a route to peace? The way scientists across the world’s many religious, racial and cultural divides collaborate, you might imagine that it can. Science favours no God, colour or creed. Facts are sacred, commentary is free. But many of the advances in science are propelled by the machinery of war, the technologies of self-defence, and the treatments of the battlefield. When a medical student or doctor is revealed as a bomber, murderer or torturer, the higher ethics of science and medicine are wounded by their treachery. Advancements in science are no protection against violence or cruelty in any society. A more intuitive hypothesis is that neglect of science damages society – facts become irrelevant and bigotry seems sacred. The starkest example, from my experience, is the scientific decline of Arab and Muslim nations. Once the world considered Arab and Muslim science, including medical science, to be the pinnacle of knowledge and discovery; but few of today’s scientists would seek answers to the mysteries of the universe in the once-mighty seats of learning of Baghdad, Lahore and Timbuktu. The reasons for this decline are complex although a systematic erosion of education, science and intellectual debate played an important role. Hence, a second reasonable hypothesis is that restoring the status of these disciplines encourages peace. There are no quick wins – the Arab Spring has demonstrated that clearly enough. But there is a move among Arab and Muslim nations, in particular in the Middle East, Iran and Turkey, to reinvigorate science in their societies. Centres of science and technology are beginning to appear. Research papers are more frequently submitted to international medical journals and increasingly published; science may not yet be mainstream but it has become a work stream, not least because the health needs of the region have grown great. These initiatives are to be encouraged. In this context, Ismail and colleagues assess the state of health research in the Eastern Mediterranean Region of WHO, which covers the Middle East – a difficult task, since defining which countries are included in the region is problematic enough. In a separate paper, Haworth and others explain why the Hajj pilgrimage offers a unique opportunity to test the effectiveness of influenza prevention strategies that require a large sample size. These issues may seem distant but focusing on advances in science and improvements in health can be a unifying force. As such, encouraging a culture of research and science in Arab and Muslim nations may prove to be the greatest contribution to world peace that any medical journal can make.
Association of a Continuous Quality Improvement Initiative With Practice and Outcome Variations of Contemporary Percutaneous Coronary Interventions
Authors: Mauro Moscucci, Eva Kline Rogers, Cecelia Montoye, Dean E. Smith, David Share, Michael O’Donnell, Ann Maxwell-Eward, William L. Meengs, Anthony C. De Franco, Kirit Patel, Richard McNamara, John G. McGinnity, Sandeep M. Jani, Sanjaya Khanal, Kim A. Eagle
Journal: Circulation (2006)

The objective of this study was to evaluate the association of a continuous quality improvement program with practice and outcome variations of percutaneous coronary intervention (PCI).Data on consecutive PCI were collected in a consortium of 5 hospitals; 3731 PCIs reflected care provided at baseline (January 1, 1998, to December 31, 1998), and 5901 PCIs reflected care provided after implementation of a continuous quality improvement intervention (January 1, 2002, to December 31, 2002). The intervention included feedback on outcomes, working group meetings, site visits, selection of quality indicators, and use of bedside tools for quality improvement and risk assessment. Postintervention data were compared with baseline and with 10,287 PCIs from 7 hospitals added to the consortium in 2002. Quality indicators included use of preprocedural aspirin or clopidogrel, use of glycoprotein IIb/IIIa receptor blockers and postprocedural heparin, and amount of contrast media per case. Outcomes selected included emergency CABG, contrast nephropathy, myocardial infarction, stroke, transfusion, and in-hospital death. Compared with baseline and the control group, the intervention group at follow-up had higher use of preprocedural aspirin and glycoprotein IIb/IIIa blockers, lower use of postprocedural heparin, and a lower amount of contrast media per case (P<0.05). These changes were associated with lower rates of transfusions, vascular complications, contrast nephropathy, stroke, transient ischemic attack, and combined end points (all P<0.05).Our nonrandomized, observational data suggest that implementation of a regional continuous quality improvement program appears to be associated with enhanced adherence to quality indicators and improved outcomes of PCI. A randomized clinical trial is needed to determine whether this is a "causal" or a "casual" relationship.
Charting the landscape of priority problems in psychiatry, part 2: pathogenesis and aetiology
Authors: Klaas E Stephan, Elisabeth B Binder, Michael Breakspear, Peter Dayan, Eve C Johnstone, Andreas Meyer-Lindenberg, Ulrich Schnyder, Xiao-Jing Wang, Dominik R Bach, Paul C Fletcher, Jonathan Flint, Michael J Frank, Andreas Heinz, Quentin J M Huys, P Read Montague, Michael J Owen, Karl J Friston
Journal: The Lancet Psychiatry (2015)