ABSTRACT
BACKGROUND AND AIM: To provide a first-time report on the health care utilization and costs of gastro-oesophageal reflux disease and dyspepsia in Iran. METHODS: A consecutive sample of 501 patients referred for upper endoscopy to an outpatient gastroenterology clinic in central Tehran (May 2005 to January 2006) was investigated using two interview-assisted questionnaires for gastro-oesophageal reflux disease (i.e. heartburn or regurgitation on a weekly basis for at least the past 3 months, and symptom onset at least 12 months prior to the study) or dyspepsia symptom (based on Rome II criteria). The frequency of health resource utilization (i.e. physician visit, hospitalization, laboratory tests, instrumental studies, and medications) and productivity loss (days off work) due to gastro-oesophageal reflux disease/dyspepsia-related symptoms in the past 12 months were recorded. Societal perspective was used, and cost of illness per person per year was estimated in purchasing power parity dollars (PPP$). RESULTS: The cost of illness per person per year for patients with gastro-oesophageal reflux disease, and dyspepsia alone were around PPP$195 and PPP$215, respectively. There was no statistically significant difference in the cost of illness between the two patient groups. The direct costs of disease comprised 88%, and 82% of the total costs in gastro-oesophageal reflux disease and dyspepsia patients, respectively with the costs of medications being the dominant component. There was also no statistically significant difference in the cost of disease between the gastro-oesophageal reflux disease patients with and without oesophagitis (based on Los Angeles criteria). CONCLUSION: As drugs cost was found to be a dominant cost component, cost-minimization studies to find the best medication therapy strategies considering the regional factors is suggested.
Subject(s)
Cost of Illness , Delivery of Health Care/statistics & numerical data , Dyspepsia/economics , Gastroesophageal Reflux/economics , Health Care Costs , Adult , Costs and Cost Analysis , Developing Countries , Dyspepsia/therapy , Female , Gastroesophageal Reflux/therapy , Humans , Iran , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
Involucrin is a major protein of the cornified envelope of keratinocytes that provides much of the structural integrity of the skin. The gene expression of this differentiation marker is induced by elevated extracellular calcium in cultured human keratinocytes. A 3.7-kilobase fragment of this gene contains the necessary elements to drive a luciferase reporter in a calcium-dependent manner. We have sequenced the upstream region of the involucrin promoter and localized a calcium response element that contains an activating protein-1 (AP-1) site (TGAGTCA). Mutation of this site abolished the promoter activation by calcium. Compared with cells grown in 0.03 mm calcium, the binding activity of factors within nuclear extracts from keratinocytes for this AP-1 site was enhanced 3-fold in cells grown in 1.2 mm calcium. Immunoelectrophoretic mobility shift (supershift) assays identified JunD, Fra1, and Fra2 as the major factors that bind to the AP-1 element. Western analysis of the proteins in the nuclear extracts showed that the levels of c-Jun, JunB, JunD, FosB, and Fra2 increased and the levels of c-Fos and Fra1 decreased slightly with calcium treatment. The effect of calcium on the involucrin promoter was enhanced synergistically by phorbol 12-myristate 13-acetate (PMA) in a protein kinase-dependent manner. In conclusion, calcium-regulated involucrin gene expression is mediated at least in part by AP-1 transcription factors.
