Medical and Economic Impact of a Free Student-Run Podiatric Medical Clinic A Preliminary Analysis

BACKGROUND

Data from the free student-run podiatric medical clinic at Clínica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. Clínica Tepati also provides an excellent teaching environment and services to the uninsured Hispanic population in the Greater Sacramento area.

METHODS

In this analysis, we retrospectively reviewed patient medical records for podiatric medical encounters during 15 clinic days between November 2010 and February 2012. The economic impact was evaluated by matching diagnoses and treatments with Medicare reimbursement rates using International Classification of Diseases codes, Current Procedural Terminology codes, and the prevailing Medicare reimbursement rates.

RESULTS

Sixty-three podiatric medical patients made 101 visits during this period. Twenty patients returned to the clinic for at least one follow-up visit or for a new medical concern. Thirty-nine different diagnoses were identified, and treatments were provided for all 101 patient encounters/visits. Treatments were limited to those within the clinic's resources. This analysis estimates that $17,332.13 worth of services were rendered during this period.

CONCLUSIONS

These results suggest that the free student-run podiatric medical clinic at Clínica Tepati had a significant medical and economic impact on the delivery of health care at the regional level, and when extrapolated, nationally as well. These student-run clinics also play an important role in medical education settings.

Central nervous system cancers, version 2.2014. Featured updates to the NCCN Guidelines

The NCCN Guidelines for Central Nervous System Cancers provide multidisciplinary recommendations for the clinical management of patients with cancers of the central nervous system. These NCCN Guidelines Insights highlight recent updates regarding the management of metastatic brain tumors using radiation therapy. Use of stereotactic radiosurgery (SRS) is no longer limited to patients with 3 or fewer lesions, because data suggest that total disease burden, rather than number of lesions, is predictive of survival benefits associated with the technique. SRS is increasingly becoming an integral part of management of patients with controlled, low-volume brain metastases.

Adherence to abiraterone among the first 86 recipients after release in Saskatchewan

Metastatic castration-resistant prostate cancer is now commonly treated with abiraterone, an orally administered chronic medication. Although abiraterone has certain advantages over docetaxel-based therapy, patients are now responsible for ensuring optimal adherence to their medication. To our knowledge, adherence to abiraterone in a real-world setting has never been described. The objective of the present study was to measure adherence to abiraterone among the first patients to receive the drug in Saskatchewan. Electronic pharmacy claims were obtained from the Saskatchewan Cancer Agency after removal of patient names and identifiers. All patients with at least 1 dispensation for abiraterone between August 2011 and October 2013 were eligible. The primary endpoint was the percentage of patients achieving optimal adherence at 6 months, defined as a medication possession ratio (mpr) of 80% or better. During the study period, 141 patients received abiraterone, among whom 86 could be followed for at least 6 months. Optimal adherence was achieved in 82.6% of patients (71 of 86) at 6 months, with 79.1% achieving a mpr of at least 90%. Of patients with available follow-up to 1 year, 81.6% (31 of 38) maintained optimal adherence during the entire period.

"Step up for foot care": addressing podiatric care needs in a sample homeless population

BACKGROUND

Studies have shown that lower-extremity problems in the homeless population have significant public health and economic implications. A combined community service and research project was performed to identify and address the foot and ankle care needs in a sample homeless population in San Francisco, California.

METHODS

A 37-question survey regarding general demographic characteristics, foot hygiene practices, associated risk factors, and self-reported lower-extremity pathologic conditions was completed by 299 homeless individuals who met the inclusion criteria. The service project included education on proper foot care and the distribution of footwear.

RESULTS

The participants demonstrated mostly good efforts regarding foot hygiene but had high-risk factors, including smoking, alcohol use, and extended hours on their feet. More than half of the homeless individuals surveyed experienced foot pain. Approximately one in five had edema and neuropathic symptoms. The most commonly reported foot problems were dermatologic, but these conditions could pose serious sequelae in the setting of risk factors. The community service project was well received by the homeless community.

CONCLUSIONS

This study demonstrates lack of resources and high-risk factors for lower-extremity complications in the homeless individuals studied. It is important in the realm of public health to keep lower-extremity health in mind because it plays an important role in preventing the spread of infection and lowering the social economic burden.

Central nervous system cancers

Primary and metastatic tumors of the central nervous system are a heterogeneous group of neoplasms with varied outcomes and management strategies. Recently, improved survival observed in 2 randomized clinical trials established combined chemotherapy and radiation as the new standard for treating patients with pure or mixed anaplastic oligodendroglioma harboring the 1p/19q codeletion. For metastatic disease, increasing evidence supports the efficacy of stereotactic radiosurgery in treating patients with multiple metastatic lesions but low overall tumor volume. These guidelines provide recommendations on the diagnosis and management of this group of diseases based on clinical evidence and panel consensus. This version includes expert advice on the management of low-grade infiltrative astrocytomas, oligodendrogliomas, anaplastic gliomas, glioblastomas, medulloblastomas, supratentorial primitive neuroectodermal tumors, and brain metastases. The full online version, available at NCCN. org, contains recommendations on additional subtypes.

Multicompartment intramuscular hemangioma of the foot: a case study

Soft-tissue tumors in the foot include a range of benign and malignant pathologies. In the clinical setting, the list of differential diagnoses can be exhausting, and the treatment plan is not always straightforward. In this article, we present a case of a 22-year-old female with a soft-tissue mass on her plantar foot that has been slowly growing since adolescence and is now causing increased pain with ambulation. Her pathology results demonstrated an intramuscular hemangioma. Intramuscular hemangiomas are rare benign tumors that tend to present in youth or early adulthood. Diagnosis is often delayed for months to years, depending on the patient's symptoms. Treatment varies from conservative to surgical, depending on size, location, and proximity to vital structures. Literature on intramuscular hemangiomas is very limited. Intramuscular hemangiomas provide a diagnostic and treatment quandary for the clinician and must be considered in the differential diagnoses when presented with a soft-tissue mass.

Do prior authorization policies discourage first-line antipsychotic use in patients newly discharged from a hospitalization for schizophrenia in Saskatchewan?

BACKGROUND

Drug benefit providers can decrease prescribing of specific medications through prior authorization policies. In Saskatchewan, certain second generation antipsychotics (SGAs) are recognized as first-line agents to manage schizophrenia; but, require prior authorization because their coverage is restricted in other conditions. We aimed to determine if the need for prior-authorization substantially diminishes prescribing of first-line SGAs in comparison to unrestricted agents.

OBJECTIVES

To conduct an ecological comparison of SGA prescribing with changes in prior- authorization policies between 1997 and 2005 using health-administrative databases in Saskatchewan, Canada.

METHOD

Eligible subjects were discharged from hospital with a first-time primary diagnosis of schizophrenia between 1997 and 2005. SGAs dispensed within 7 days of discharge were used to estimate prescribing preferences for olanzapine and quetiapine relative to risperidone. Percentages of SGA use were age and sex standardized to the 2000 cohort.

RESULTS

Out of 1,277 eligible patients, 521 (41%) received 564 SGA dispensations within 7-days of hospital discharge. Between 1997 and 1998, risperidone was the only SGA covered for first-line use and made up 72.6% (82/113) of SGA use while olanzapine made up 27.4% (31/113) for a crude preference ratio of 0.38 (27.4/72.6). Risperidone use decreased to 65.8% in 1999-2002 and to 47.4% in 2003-2005 as a percentage of SGA dispensations. Correspondingly, the preference ratios for olanzapine and quetiapine increased from 0.40 to 0.57 and from 0.12 to 0.54 in these respective periods.

CONCLUSIONS

The requirement for prior-authorization does not appear to substantially diminish prescribing of first-line SGAs for the treatment of schizophrenia in Saskatchewan, Canada.

An integrated in vitro model of perfused tumor and cardiac tissue

Cancer and cardiovascular disease remain the two leading causes of death in the United States. Progress in treatment to reduce morbidity and mortality will include the development of new drugs. Recent advances in induced pluripotent stem cell technology, tissue engineering, and microfabrication techniques have created a unique opportunity to develop three-dimensional (3D) microphysiological systems that more accurately reflect in vivo human biology when compared with two-dimensional flat systems or animal models. Our group is working to develop 3D microphysiological systems using induced pluripotent stem cell technology that simulates the microcirculation, the cardiac muscle, and the solid tumor, and then to combine these systems into an integrated microphysiological system that simulates perfused cardiac muscle and solid tumor on a single platform. The platform will be initially validated to predict anti-cancer efficacy while minimizing cardiac muscle toxicity. A critical feature will be blood flow through a human microcirculation (capillaries and larger microvessels), which is necessary to overcome diffusion limitations of nutrients and waste products in realistic 3D cultures, and serves to integrate multiple organ systems. This is a necessary and critical feature of any platform that seeks to simulate integrated human organ systems. The results of our project should produce a new paradigm for efficient and accurate drug and toxicity screening, initially for anti-cancer drugs with minimal cardiac side effects, and a platform technology that can be eventually used to integrate multiple major organ systems of the human body.

Significant progression of load on the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using the Anatoly Gravitational System, in a 10-week training period

In an age of increasing numbers of lifestyle diseases and plasticity of longevity, exercise and weight training have been increasingly recognized as both preventing and mitigating the severity of many illnesses. This study was designed to determine whether significant weight-lifting gains could be realized through the Anatoly Gravitational System. Specifically, this study sought to determine whether this once-weekly weight-training system could result in significant weekly strength gains during a 10-week training period. A total of 50 participants, ranging in age from 17 to 67 years, completed at least 10 weekly 30-minute training sessions. The results suggest participants could, on average, double their weight-lifting capacity within 10 sessions. This preliminary study, which would require further scrutiny, suggests the Anatoly Gravitational System provides a rather unique opportunity to load the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using only short weekly training sessions. More studies are warranted to scrutinize these findings.

Broken symmetry quantum Hall states in dual-gated ABA trilayer graphene

ABA-stacked trilayer graphene is a unique 2D electron system with mirror reflection symmetry and unconventional quantum Hall effect. We present low-temperature transport measurements on dual-gated suspended trilayer graphene in the quantum Hall (QH) regime. We observe QH plateaus at filling factors ν = -8, -2, 2, 6, and 10, which is in agreement with the full-parameter tight binding calculations. In high magnetic fields, odd-integer plateaus are also resolved, indicating almost complete lifting of the 12-fold degeneracy of the lowest Landau level (LL). Under an out-of-plane electric field E(perpendicular), we observe degeneracy breaking and transitions between QH plateaus. Interestingly, depending on its direction, E(perpendicular) selectively breaks the LL degeneracies in the electron-doped or hole-doped regimes. Our results underscore the rich interaction-induced phenomena in trilayer graphene.

Podiatric health needs of homeless populations as a public health concern

BACKGROUND

Foot and ankle health among the homeless is an important public health concern. There are limited studies done thus far on foot and ankle conditions and the podiatric medical needs of homeless populations. A literature review was undertaken to evaluate any studies published about the lower-extremity health needs among the homeless.

METHODS

We did a literature search through PubMed, the US National Library of Medicine's database of biomedical citations and abstracts for relevant publications from 1988 through 2008. We also searched the references cited in the articles found for any studies relevant to podiatric needs for homeless populations.

RESULTS

We found three relevant articles that addressed the needs of podiatric care for the homeless. The articles highlighted the community health importance of foot care for homeless populations, especially in helping prevent potentially limb-threatening pathologies.

CONCLUSIONS

The small number of studies published so far all emphasize the major public health need for podiatric care among homeless populations. More studies are needed to help address this important public health concern.

Les malformations congénitales de la valve tricuspide chez les carnivores domestiques: étude rétrospective de 50 cas

A retrospective study was done on 14 cats and 36 dogs diagnosed with right atrioventricular valve malformations (RAVM), either tricuspid dysplasia (n = 38) or Ebstein's anomaly (n = 12). Comparison with a large reference population including 85 250 animals allowed an epidemiologic analysis of these RAVM, demonstrating that Labrador, Boxer and Chartreux cats had a 35, 7 and 11-fold higher risk respectively to be affected by one of these heart diseases than other breeds, without sexual predisposition. In 93% of cases, cardiac auscultation revealed a heart murmur, whose grade was not significantly correlated with the echographic stages of the valvular disease. The echocardiographic examination confirmed the frequent association between RAVM and other congenital anomalies, particularly mitral dysplasia, in 84% and 20% of tricuspid dysplasia and Ebstein anomaly respectively. Last, the prognosis of RAVM was worsened by atrial fibrillation and right-sided heart failure.

Calcium- and ROS-mediated defence responses in BY2 tobacco cells by nonpathogenic Streptomyces sp

AIMS

The early molecular events underlying the elicitation of plant defence reactions by Gram-positive bacteria are relatively unknown. In plants, calcium and reactive oxygen species are commonly involved as cellular messengers of a wide range of biotic stimuli from pathogenic to symbiotic bacteria. In the present work, we checked whether nonpathogenic Streptomyces sp. strains could induce early signalling events leading to defence responses in BY2 tobacco cell suspensions.

METHODS AND RESULTS

We have demonstrated that nonpathogenic Streptomyces sp. OE7 strain induced a cytosolic Ca(2+) increase and a biphasic oxidative burst in the upstream signalling events, leading to defence responses in BY2 tobacco cell suspensions. Streptomyces sp. OE7 also elicited delayed intracellular free scopoletin production and programmed cell death. In agreement with scopoletin production, OE7 induced accumulation of PAL transcripts and increased accumulation of transcripts of EREBP1 and AOX genes that are known to be regulated by the jasmonate/ethylene pathway. Transcript levels of PR1b and NIMIN2α, both salicylic acid pathway-linked genes, were not modified. Moreover, Streptomyces sp. OE7 culture filtrates could reduce Pectobacterium carotovorum- and Pectobacterium atrosepticum-induced death of BY2 cells and soft rot on potato slices.

CONCLUSIONS

New insights are thus provided into the interaction mechanisms between Streptomyces sp. and plants; Streptomyces sp. could be sensed by plant cells, and through cytosolic Ca(2+) changes and the generation of reactive oxygen species, defence responses were induced.

SIGNIFICANCE AND IMPACT OF THE STUDY

These induced defence responses appeared to participate in attenuating Pectobacterium-induced diseases in plants. Thus, Streptomyces sp. OE7 could be a biocontrol agent against Pectobacterium sp.

HrpZ harpins from different Pseudomonas syringae pathovars differ in molecular interactions and in induction of anion channel responses in Arabidopsis thaliana suspension cells

HrpZ, a type three secretion system helper protein from the plant-pathogen Pseudomonas syringae, can be recognized by many plants as a defence elicitor. Responses of Arabidopsis thaliana suspension cells to different HrpZ variants were studied by electrophysiological methods and cell death assay. Purified HrpZ originating from a compatible pathogen P. syringae pv. tomato DC3000 (HrpZ(Pto)) and incompatible P. syringae pv. phaseolicola (HrpZ(Pph)) both promoted Arabidopsis cell death. As an early response, both HrpZ variants induced an increase in time dependent K(+) outward rectifying current. In contrast, the effects of HrpZ proteins on anion currents were different: HrpZ(Pph) had no effect, and HrpZ(Pto) induced an anion current increase. This suggests that the observed responses of the K(+) channels and anion channels resulted from different and separable interactions and that the interaction implied in anion current modulation is host-specific. HrpZ(Pto) and HrpZ(Pph) also had a different sequence preference in phage display screen for peptide-binding. These peptides presumably represent a part of a putative target protein in the host, and HrpZ proteins of different P. syringae pathovars might have different binding specificities to match the allelic variation between plant species. Supporting the idea that the peptide-binding region of HrpZ is important for interactions with host cell components, we found that a mutation in that region changed the anion channel response of Arabidopsis cells.

P1-18-01: Z-ACT1: Zometa Combined with Standard Therapy in Patients with Metastatic Breast Cancer Further Decreases the Proportion of Patients with CTC Counts of 5 or above

Introduction: Zoledronic acid (ZOL) has been shown to reduce the risk of recurrence and residual tumor size in the adjuvant/neoadjuvant setting in patients with early/intermediate-stage breast cancer (BC). In addition, ZOL combined with neoadjuvant chemotherapy reduced numbers of disseminated-tumor cells in the bone marrow compared with chemotherapy alone. However, the activity of ZOL on disseminated- or circulating-tumor cells (CTCs) in patients with metastatic breast cancer (MBC) is not well defined. Cristofanilli M, et al (J Clin Oncol. 2005; 23: 1420–30) reported that CTCs in MBC are an independent predictor of overall survival (OS) and progressionfree survival (PFS). Accordingly, this study is evaluating the potential anticancer benefit of adding ZOL to standard therapy in patients with newly diagnosed MBC as assessed by the change in CTC count from baseline to 3–5 weeks.

Methods: Eligible patients had HER2−negative MBC, newly diagnosed or at first relapse after adjuvant therapy with or without bone metastases. In this open-label 3-arm study, patients without bone metastases were randomized to standard therapy + ZOL every 3–4 weeks for the first 6 months (Arm A) or standard therapy + ZOL during month 6–12 after standard therapy initiation (Arm B). All patients with bone metastases received ZOL every 3–4 weeks (Arm C). The primary endpoint is PFS. Secondary endpoints include the proportion of patients with CTCs ≥5 or <5 per 7.5 mL of peripheral blood 3–5 weeks after standard therapy initiation. Data were compared with historical controls (patients with MBC receiving first-line standard treatment alone; Cristofanilli M, et al. 2005). CTCs were quantified using CellSearch™.

Results: In Z-ACT1, 29 previously untreated MBC patients with bone metastases were enrolled in Arm C, all of whom had ≥1 CTC at study entry (range, 1–117). 53% received hormonal therapy alone, 42% chemotherapy alone, and 5% received various combinations. In patients receiving standard therapy + ZOL, the percentage of patients with CTC ≥5 decreased from 55% to 25% at 3–5 weeks. At baseline, the median uNTX level was 46.5 (n = 10) in patients with < 5 CTCs and 57 in patients with ≥5 CTC (n = 13). At 3–5 weeks, the median decrease from baseline in uNTX was 74% (n = 10) in the < 5 CTC group and 25% (n = 5) in the ≥5 CTC group. At 3–5 weeks, the median uNTX levels in the <5 and ≥5 CTC groups were 12 and 22 nmol bce/mmol, respectively. This study has now been modified to a 2-arm study (standard therapy +/− ZOL) in MBC patients with no bone metastases. CTC, uNTX, and PFS data will be presented from this new head-to-head analysis. Changes in CTCs out to 6 months and correlation with uNTX and PFS in this original bone metastasis cohort will also be presented.

Conclusions: This preliminary analysis suggests that the addition of ZOL to standard therapy in women with bone metastases from MBC results in a further decrease in CTC numbers at 3–5 weeks after initiation of therapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-18-01.

Investigating the role of the hydroxyl groups of substrate erythrose 4-phosphate in the reaction catalysed by the first enzyme of the shikimate pathway

3-Deoxy-D-arabino-heptulosonate 7-phosphate (DAH7P) synthase catalyses the first step of the shikimate pathway, which is responsible for the biosynthesis of aromatic amino acids in microorganisms and plants. This enzyme catalyses an aldol reaction between phosphoenolpyruvate and D-erythrose 4-phosphate to generate DAH7P. Both 2-deoxyerythrose 4-phosphate and 3-deoxyerythrose 4-phosphate were synthesised and tested as alternative substrates for the enzyme. Both compounds were found to be substrates for the DAH7P synthases from Escherichia coli, Pyrococcus furiosus and Mycobacterium tuberculosis, consistent with an acyclic mechanism for the enzyme for which neither C2 nor C3 hydroxyl groups are required for catalysis. The enzymes all showed greater tolerance for the loss of the C2 hydroxyl group than the C3 hydroxyl group.

Angiokeratoma presenting as plantar verruca: a case study

One of the more frequent pathologic conditions that podiatric physicians are confronted with is plantar verrucae. Plantar verrucae have been studied extensively in terms of morphological features and incidence in the population at large and in patients with human immunodeficiency virus infection. Solitary angiokeratomas can be morphologically similar to plantar verrucae, presenting as hyperkeratotic pedunculated lesions. We present a unique case study of a 40-year-old man with human immunodeficiency virus with a painful solitary angiokeratoma masquerading as plantar verrucae. The lesion demonstrated clinical signs consistent with those highlighted in the literature for verrucae, namely, showing as red and black lacunae, punctuated hyperkeratotic epidermis. We propose that solitary angiokeratomas should be an important part of a podiatric physician's differential diagnosis in the lower extremity owing to the similarity of morphological features with plantar verrucae.

HLA B*44: protective effects in MS susceptibility and MRI outcome measures

OBJECTIVE

In addition to the main multiple sclerosis (MS) major histocompatibility complex (MHC) risk allele (HLA DRB1*1501), investigations of the MHC have implicated several class I MHC loci (HLA A, HLA B, and HLA C) as potential independent MS susceptibility loci. Here, we evaluate the role of 3 putative protective alleles in MS: HLA A*02, HLA B*44, and HLA C*05.

METHODS

Subjects include a clinic-based patient sample with a diagnosis of either MS or a clinically isolated syndrome (n = 532), compared to subjects in a bone marrow donor registry (n = 776). All subjects have 2-digit HLA data. Logistic regression was used to determine the independence of each allele's effect. We used linear regression and an additive model to test for correlation between an allele and MRI and clinical measures of disease course.

RESULTS

After accounting for the effect of HLA DRB1*1501, both HLA A*02 and HLA B*44 are validated as susceptibility alleles (p(A*02) 0.00039 and p(B*44) 0.00092) and remain significantly associated with MS susceptibility in the presence of the other allele. Although A*02 is not associated with MS outcome measures, HLA B*44 demonstrates association with a better radiologic outcome both in terms of brain parenchymal fraction and T2 hyperintense lesion volume (p = 0.03 for each outcome).

CONCLUSION

The MHC class I alleles HLA A*02 and HLA B*44 independently reduce susceptibility to MS, but only HLA B*44 appears to influence disease course, preserving brain volume and reducing the burden of T2 hyperintense lesions in subjects with MS.

Expression of the putative stem cell marker Musashi-1 in Barrett's esophagus and esophageal adenocarcinoma

The cancer stem cell theory states that cancers contain tumor-forming cells that have the ability to self-renew as well as give rise to cells that differentiate. Cancer stem cells have been identified in several solid tumors, but stem cells in normal human esophagus or in Barrett's esophagus or adenocarcinoma have not been reported. Musashi-1 is expressed by the crypt base columnar cells identified as intestinal stem cells. In other diseases of the gastrointestinal tract, local inflammation of the tunica mucosa may be an initiating factor of alteration of focal tissue 'niches,' where dormant stem cells locate. The present study investigated whether Musashi-1 is expressed in the esophagus and its relation to immune inflammation of the mucosa in Barrett's esophagus and esophageal adenocarcinoma. A total of 41 esophageal tissue specimens from 41 patients were studied. Of these, 15 were esophageal adenocarcinoma, 17 were Barrett's esophagus (10 intestinal metaplasia and 7 dysplasia), and 9 were normal squamous esophagus tissue specimens from patients without esophageal pathology. Immunohistochemistry was performed using antibodies to Musashi-1 and to a set of cell type-specific markers. A multiplexed tandem polymerase chain reaction method was used to measure the relative mRNA expression levels of Musashi-1 and the specific dendritic cell marker dendritic cell-specific intercellular molecule-3 (ICAM-3)-grabbing nonintegrin. Immunohistochemistry demonstrated the presence of small numbers of Musashi-1+ cells scattered in the connective tissue stroma and within the epithelium in cardiac-type glands in biopsies from patients without Barrett's esophagus. Musashi-1 expression was present in Barrett's intestinal metaplasia and in dysplastic Barrett's in which the majority of epithelial cells in individual glands expressed this antigen. Expression of Musashi-1 was highest in esophageal adenocarcinoma, where it was most intense in glands that displayed features of early stages of adenocarcinoma formation. In contrast, Musashi-1 staining level was weaker in glands that displayed features of advanced adenocarcinoma. Double immunostaining with proliferating cell nuclear antigen showed low proliferation in the vast majority of Musashi-1+ cells. Musashi-1 mRNA expression levels were significantly higher in esophageal adenocarcinoma than in normal esophagus or Barrett's esophagus tissues. Dendritic cell-specific intercellular molecule-3 (ICAM-3)-grabbing nonintegrin (DC-SIGN) mRNA expression levels were significantly increased in both Barrett's tissues and adenocarcinoma tissues. Expression of the putative stem cell marker Musashi-1 is absent in normal squamous epithelium, weak in esophageal cardiac-type glands and Barrett's esophagus, and markedly increased in adenocarcinoma, especially in glands displaying features of early cancer development. Musashi-1 expressing cells may be significant in the etiology of Barrett's esophagus and adenocarcinoma, and perhaps even a cell of origin for this disease. We speculate that immune inflammation occurring in Barrett's esophagus alters the mucosal microenvironment in a manner which is favorable to the activation of dormant stem cells.

Influence of variables on hemoglobin A1c values and nonheterogeneity of hemoglobin A1c reference ranges

INTRODUCTION

Hemoglobin A1c (HbA1c) values are influenced by analytical interferences such as HbF and hemoglobin variants and clinical factors such as increased red cell turnover. Although less well-known, demographic factors such as race, age, and sex also influence HbA1c values. The HbA1c reference range should be homogenous in the United States based on the use of National Glycohemoglobin Standardization Program certified methods and the recommendations in the National Academy of Clinical Biochemistry guidelines.

METHODS

Data on age, race, sex, HbA1c, and glucose values were extracted from the National Health and Nutrition Examination study for a 3 year period. A search for reference range data for laboratories in the United States was performed using the Google search engine.

RESULTS

Extracted data agree with published data on the influence of age, sex, and smoking status on HbA1c values. There is substantial heterogeneity in HbA1c reference ranges in laboratories in the United States.

CONCLUSION

Age, sex, and smoking status influence HbA1c values. Despite standardization of HbA1c methods and published recommendations, there is wide heterogeneity in HbA1c reference ranges in the United States.

Seasonal variation in hemoglobin A1c: is it the same in both hemispheres?

INTRODUCTION

There are several reports from locations in the northern hemisphere of seasonal variation in hemoglobin A1c (HbA1c) levels with higher values noted in the cooler months. The variation has been attributed to holiday seasons, temperature differences, and changes in diet. This article describes the seasonal variation in both hemispheres and in a country on the equator with minimal temperature variation.

METHODS

The mean and median HbA1c by month was calculated for a maximum of 2 years for HbA1c data from the different locations: Edmonton and Calgary, Canada; Singapore; Melbourne, Australia; and Marshfield, Wisconsin. The mean monthly temperature for each location was found from available meteorological information.

RESULTS

In both northern and southern hemispheres, the HbA1c was higher in cooler months and lower in the warmer months. In Singapore, where there is minimal temperature variation, there is also minimal variation in HbA1c values over the year. The difference in HbA1c over a year appears to be related to the difference in temperature.

CONCLUSION

Hemoglobin A1c is higher in cooler months and lower in the warmer months in both hemispheres. In a country with minimal monthly temperature variation, there is only minimal variation in HbA1c values through the year. In all locations, the mean and median HbA1c declined over the study period, possibly due to better glycemic control of patients with diabetes or an increase in use of HbA1c as a screening test for diabetes or a combination of both.

Using the National Health Interview Survey to understand and address the impact of tobacco in the United States: past perspectives and future considerations

OBJECTIVE

The National Health Interview Survey (NHIS) is a continuous, nationwide, household interview survey of the civilian noninstitutionalized population of the United States. This annual survey is conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Since 1965, the survey and its supplements have provided data on issues related to the use of cigarettes and other tobacco products. This paper describes the survey, provides an overview of peer-reviewed and government-issued research that uses tobacco-related data from the NHIS, and suggests additional areas for exploration and directions for future research.

DATA SOURCES

We performed literature searches using the PubMed database, selecting articles from 1966 to 2008. Study selection. Inclusion criteria were relevancy to tobacco research and primary use of NHIS data; 117 articles met these criteria. Data extraction and synthesis. Tobacco-related data from the NHIS have been used to analyze smoking prevalence and trends; attitudes, knowledge, and beliefs; initiation; cessation and advice to quit; health care practices; health consequences; secondhand smoke exposure; and use of smokeless tobacco. To date, use of these data has had broad application; however, great potential still exists for additional use.

CONCLUSION

NHIS data provide information that can be useful to both practitioners and researchers. It is important to explore new and creative ways to best use these data and to address the full range of salient tobacco-related topics. Doing so will better inform future tobacco control research and programs.