Do journals and corporate sponsors back certain views in topics where disagreement prevails?

The article focuses on scientific disagreement about the use of statin-related drugs in the prevention of cardiovascular events. The study forms part of an exploration of the broader principle of research polarization, foremost in medicine. The hypothesis is that statin-positive and statin-critical researchers publish in different committed central journals, and that they are financially supported by different dedicated corporate sources. Methodologically we use Web of Science (WoS) analytic tools to perform publication analysis of a time series covering 1998-2018 in three seven-year windows. For each window data is captured based on sets of known statin-positive and statin-critical articles and researchers, and their primary and secondary co-authors. Standard deviation is used as a focused normalization and visual instrument together with Spearman's correlation coefficient in order to compare frequency distributions of statin-positive and critical journal and sponsor articles. Z-test p-values are used to assess the probability of error concerning the distributions. Findings at general topical level showed that a few journals consistently and significantly occupied top positions, 2 of which, American Journal of Cardiology and Circulation, published articles from both positions. Besides, Journal of the American College of Cardiology served as a major publisher of statin-positive research from 2005, as did European Heart Journal from 2012, replacing American Journal of Cardiology at the top. From 2012 Atherosclerosis and European Journal of Preventive Cardiology served as top-publishers of statin-critical articles. Two central US funding agencies, US Department of Health Human Services and National Institutes of Health (NIH), operated at general topical level across the time series, but the agencies played only a minor role in the divergent research positions. From 2005 statin-positive as well as statin-critical research was mainly sponsored by multinational pharmaceutical companies, predominantly Merck, AstraZeneca and Pfizer. In conclusion, the initial hypothesis about dedicated journals and sponsors was entirely substantiated at the general topical level and at the journal level of research disagreement, but not at sponsor level. Distinct dedicated journals were extracted separately from the 2 divergent statin positions. Since the WoS coverage of sponsor data 1998-2004 was sporadic sponsor data are analyzed from 2005. Only from 2012 the WoS sponsor coverage of the topic is consistently at 60%.

FindZebra: a search engine for rare diseases.

BACKGROUND: The web has become a primary information resource about illnesses and treatments for both medical and non-medical users. Standard web search is by far the most common interface to this information. It is therefore of interest to find out how well web search engines work for diagnostic queries and what factors contribute to successes and failures. Among diseases, rare (or orphan) diseases represent an especially challenging and thus interesting class to diagnose as each is rare, diverse in symptoms and usually has scattered resources associated with it. METHODS: We design an evaluation approach for web search engines for rare disease diagnosis which includes 56 real life diagnostic cases, performance measures, information resources and guidelines for customising Google Search to this task. In addition, we introduce FindZebra, a specialized (vertical) rare disease search engine. FindZebra is powered by open source search technology and uses curated freely available online medical information. RESULTS: FindZebra outperforms Google Search in both default set-up and customised to the resources used by FindZebra. We extend FindZebra with specialized functionalities exploiting medical ontological information and UMLS medical concepts to demonstrate different ways of displaying the retrieved results to medical experts. CONCLUSIONS: Our results indicate that a specialized search engine can improve the diagnostic quality without compromising the ease of use of the currently widely popular standard web search. The proposed evaluation approach can be valuable for future development and benchmarking. The FindZebra search engine is available at http://www.findzebra.com/.

Specialized tools are needed when searching the web for rare disease diagnoses.

In our recent paper, we study web search as an aid in the process of diagnosing rare diseases. To answer the question of how well Google Search and PubMed perform, we created an evaluation framework with 56 diagnostic cases and made our own specialized search engine, FindZebra (findzebra.com). FindZebra uses a set of publicly available curated sources on rare diseases and an open-source information retrieval system, Indri. Our evaluation and the feedback received after the publication of our paper both show that FindZebra outperforms Google Search and PubMed. In this paper, we summarize the original findings and the response to FindZebra, discuss why Google Search is not designed for specialized tasks and outline some of the current trends in using web resources and social media for medical diagnosis.

[Diagnosis coding of the musculoskeletal system in general practice]. / Diagnosekodning i almen praksis af lidelser i bevaegeapparatet.

INTRODUCTION: Danish general practitioners are encouraged to code diagnoses according to the Danish version of ICPC. In order to evaluate feasibility, we aimed to estimate sensitivity of ICPC coding of patients with symptoms from the musculoskeletal system (ICPC L01-20 and 83-99) in general practice compared to health information from other sources. MATERIALS AND METHODS: We identified patients connected to one general practice in July 2005. We retrieved information on referred care by specialists in neurology, rheumatology, and orthopaedic surgery as well as treatments by physiotherapists from the Danish Health Insurance. We received ICD10 codes within chapter 8 (diseases of the musculoskeletal system and connective tissue) from the Danish Hospital Register. Sensitivity was calculated according to criteria based on whether the patients had received an ICD10 code or other public health services. RESULTS: Of 2649 patients registered in the general practice, 496 had recorded an ICPC code in chapter L (the musculoskeletal system). Sensitivity was calculated to 0.83. Of all patients with musculoskeletal diseases 82.5% were identified by ICPC codes, but only 45% by other health sources. CONCLUSION: The coding of ICPC in a general practice had an acceptable sensitivity and constitutes a useful opportunity to identify a group of patients with musculoskeletal diseases. An optimal identification of specific patient subgroups, by using ICPC coding, requires the construction of a national registry of the ICPC coding made in all Danish general practices.

[Research activity in clinical biochemistry]. / Forskningsaktiviteten for speciallaeger i klinisk biokemi.

BACKGROUND: Quantitative bibliometric measurements of research activity are frequently used, e.g. for evaluating applicants for academic positions. The purpose of this investigation is to assess research activity within the medical speciality of Clinical Biochemistry by comparing it with a matched control group from other medical specialities in Denmark. MATERIALS AND METHODS: A list of all physicians registered in Denmark (23,127 persons) was drawn from the database "Laeger.dk". Of these, 5,202 were generalists (not included) while 11,691 were from other specialities. Of the 126 specialists from Clinical Biochemistry, 57 fulfilled the inclusion criteria. Each of these 57 was matched according to medical title with two randomly chosen specialists from other specialities, totaling 114. Using Medline and the Web of Science, the number of publications and the number of citations were then ascertained. RESULTS: 25% of the 11,691 specialists held a PhD degree or doctoral degree, DMSci, (Clinical Biochemistry: 61%). The 171 specialists included in the study had 9,823 papers in Medline and 10,140 papers in the Web of Science. The number of Medline papers per specialist was 71 for Clinical Biochemistry compared to 51 for the control group. The number of citations per specialist was 1,844 for Clinical Biochemistry compared to 816 for the control group. The top ten H-indices (of which 8 were in Clinical Biochemistry) ranged from 30 to 69. CONCLUSION: Both the number of papers and the number of citations were higher for Clinical Biochemistry than for the control group. The difference was most pronounced among professors.

Transport of amino acids and GABA analogues via the human proton-coupled amino acid transporter, hPAT1: characterization of conditions for affinity and transport experiments in Caco-2 cells.

The objective of this study was to investigate transepithelial amino acid transport as a function of Caco-2 cell culture time. Furthermore, the objective was to investigate apical uptake characteristics of hPAT1-mediated transport under various experimental conditions. Apical amino acid uptake and transport studies were conducted in Caco-2 monolayers cultured for 4-28 days. Transepithelial transport of the prototypic hPAT1 (SLC36A1) substrates l-proline and glycine were maximal after 21-28 days in culture. Based on proton-dependency and substrate kinetics the major apical uptake and transport of Gly and Pro in Caco-2 cell monolayers is hPAT1-mediated. The apical uptake of Pro is decreased at apical hyperosmolarity conditions. Furthermore we identified the two GABA-analogues, muscimol and THPO as novel hPAT1 substrates. THPO had an affinity for hPAT1 of 11.3mM, whereas muscimol had one of the highest affinities for hPAT1 (1.7mM) reported. Our findings illustrate the suitability of the Caco-2 model for studying hPAT1-mediated transport. Furthermore, the affinity of THPO and muscimol underlines the possible importance of hPAT1 as a transporter for heterocyclic compounds consisting of a 3-isoxazolol moiety, which has been shown to function as a carboxylic acid bioisostere for substrates of the GABA receptor and transport systems.

Health care in the circumpolar world: Greenland.

Greenland is part of the Kingdom of Denmark and it is the world's largest island. An ice cap covers 85% of its territory. The population is about 57,000 inhabitants, with 14,000 living in the capital Nuuk, and 10,000 in villages and other small settlements. There are pronounced regional variations in lifestyle and living conditions. The Greenland Home Rule Government assumed responsibility, for health care on 1 January 1992. Greenland's territory is divided into 16 health care districts. Queen Ingrid's Hospital in Nuuk is the national hospital and has 156 beds and numerous specialist physicians associated with it. Each health district has a health care centre with one or more physicians, nurses and other health care personnel appropriate for the number of people living in the district. Each district health centre is responsible for primary health care in towns, villages and other small settlements, and the health centres treat all common illnesses. The health centres handle uncomplicated births, minor surgery, common treatment in internal medicine and community mental health services. The centres have a number of inpatient beds proportional to the number of people in the health district. People with more complicated illnesses are referred to Queen Ingrid's Hospital in Nuuk or to specialised treatment in Denmark.

Respiratory tract infections in Greenland: results of an audit project.

OBJECTIVES: To elucidate and improve quality of diagnosis and treatment of respiratory tract infections in Greenland. STUDY DESIGN: All district medical officers and nursing staff in the Greenlandic coastal health services were invited to participate in the study. Twenty-five district medical officers and the nursing staff from nine districts completed the project and registered in a 3-week period 1,163 contacts involving respiratory tract infections. METHODS: Self-registration according to the Audit Project Odense (APO) method on a simple APO registration chart. All contacts involving respiratory tract infections were registered with regard to sex, type of contact, contact form, infection focus, diagnosis and treatment, origin of infection, antibiotic treatment, choice of antibiotics and possible sick-leave. RESULTS: Of the 1,163 registered contacts lung infections represented 26%, throat infections 22% and otitis media 16%. Paraclinical tests were performed in 32% of the cases, 47% of the cases were treated with antibiotics, in 2/3 of the cases with penicillin V. The use of paraclinical tests was somewhat lower and the use of antibiotics was higher than in Denmark. CONCLUSION: The study showed that it is possible to carry out an APO audit in Greenland, and that there was a moderate difference in the diagnosis and treatment between Greenland and Denmark. An increased use of paraclinical tests may result in quality improvement.

Changes in causes of death and mortality rates among children in Greenland from 1987 - 91 to 1992 - 99.

AIMS: This study analysed the spontaneous trends in mortality among children in Greenland from 1987 - 91 to 1992 - 99 and describes the changes in the causes of death, mortality rates, and variation between regions. METHODS: The data are based on the Greenland Registry of Causes of Death and the birth registry of the Medical Office of Health in Greenland. The causes of death and relevant mortality rates, the trends over time and the differences between regions were analysed epidemiologically for 1992 - 99 and compared with those for 1987 - 91. RESULTS: From 1992 to 1999, 8709 children were born in Greenland. The data include information on 313 child deaths during this period: 64 stillbirths, 158 deaths before one year of age (infants) and 91 deaths between one and 14 years of age. There were fewer stillbirths due to placenta previa, abruptio placentae, and prematurity, fewer infants died from birth asphyxia and infectious diseases and fewer children aged 1 - 14 years died from accidents in 1992 - 99 compared with 1987 - 91. Infant mortality in Greenland declined from 25.2 per 1000 live births to 18.3 and mortality among children 1 - 14 years old from 122.7 per 100000 person-years to 80.4 between 1987 - 91 and 1992 - 99. Mortality dropped proportionally more in East Greenland. CONCLUSION: The decline in child mortality in all age groups probably resulted from general societal trends and general improvement in the healthcare system. Child mortality is still unacceptably high, and it is recommended that sectors other than healthcare become aware of their responsibility for preventing the high rate of child mortality.