bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitric oxide‐related compounds in patients with congenital heart defects and pulmonary hypertension
Authors: Kotake Fumiaki , Kobayashi Jun , Sonoda Masaru
Published: March 2003

Abstract Background: The relationship between blood levels of nitric oxide (NO)‐related compounds in patients with congenital heart defects (CHD) and degree of pulmonary hypertension (PH) has not yet been described.

Methods
: Thirty‐six patients (aged 6 months to 19 years) with CHD were divided into three groups on the basis of their hemodynamic characteristics: group 1 (control, n=5), left‐to‐right shunt (–) without PH (pulmonary to systemic artery peak pressure ratio, Pp/Ps<0.4); group 2 (n=14), left‐to‐right shunt (+) without PH; group 3 (n=17), left‐to‐right shunt (+) with PH (Pp/Ps>0.4). Blood samples were obtained from the right atrium, pulmonary artery, left atrium or pulmonary capillary wedge and aorta during cardiac catheterization. All NO‐related compounds in whole blood were measured by chemiluminescent assay using Sievers NO analyzer.

Results
: The sampling site had no significant impact on NO‐related compound levels. However, the patients with PH (group 3) had significantly higher (P<0.01) blood levels of NO‐related compounds (117.3~14.7 μmol/L) than the patients without PH (groups 1 and 2, 23.9~3.2 and 38.4~4.8 μmol/L, respectively). In addition, pulmonary artery resistance (Rp) values of less than 6 Wood U/m
2 were directly correlated with levels of NO‐related compounds, whereas Rp values greater than 6 Wood U/m
2 were inversely correlated with blood levels of NO‐related compounds.

Conclusion
: The present results suggest that the hemodynamic status of the pulmonary circulation in CHD affects, at least partly, blood levels of NO‐related compounds.
Psychosocial factors affecting psychosomatic symptoms in Japanese schoolchildren
Authors: Tanaka Hidetaka , Tamai Hiroshi , Terashima Shigenori , Takenaka Yoshito , Tanaka Toshitaka
Published: March 2003

Abstract Background: In a previous study we reported the prevalence of psychosomatic symptoms in 1619 Osaka elementary schoolchildren using our original general health questionnaire assessed by their parents. We found that psychosomatic symptoms were increasing with age. This study was designed to investigate psychosocial factors responsible for increasing psychosomatic symptoms with age.

Methods
: We calculated a correlation coefficient between the physical complaints score (PCS) and these psychosocial variables using quantitation I of multiple regression analysis separately in the older (10–12 years, n=860) and the younger age group (7–9 years, n=759).

Results
: A stronger relationship between PCS and psychosocial problems was found in the older (r=0.719, P<0.0001) than in the younger age group (r=0.570, P<0.0001). Further analysis demonstrated that difficulties in school performance and increasing psychological conflicts with human relationships were major causes of somatic complaints in the older age group. In the younger age group, however, immaturity of social skills seems to be a primary problem. In addition, poor parental interaction and the playing of computer games were found to increase somatic complaints in children.

Conclusion
: Children in the older age reflect the closer bio–psycho–socio interaction compared with their younger counterparts. This may give rise to a high incidence of psychosomatic disorders and school refusal in Japanese children. We emphasize that psychological support by parents in daily life is necessary to reduce psychosomatic symptoms in children.
Investigation of the relationship between low Apgar scores and early neonatal thyroid function
Authors: Sak Erbil , Akin Mehmet , Aktürk Zekeriya , Akin Fulya , Atay Enver , Aydoğdu Cavit , Yüzkollar Erdoğan
Published: March 2003

Abstract Background: The aim of the present study was to assess the effects of low Apgar scores on perinatal thyroid function.

Methods
: Forty full‐term infants delivered by the normal spontaneous vaginal route were enrolled into the study. All babies had 1 and 5 min Apgar scores below 4. The control group consisted of 26 full‐term healthy neonates. Cord blood and serum tri‐iodothyronine (T3), thyroxine (T4), reverse tri‐iodothyronine (rT3), free thyroxine (FT4), thyroid‐stimulating hormone (TSH) and thyroid‐binding globulin (TBG) determinations were performed by an enzyme immunoassay method.

Results
: The mean values of FT4 and T4 observed in the cord blood of the study group were significantly lower compared with matched controls, whereas the mean TSH values were significantly higher. There were no differences in concentrations of T3, rT3 and TBG between the two groups.

Conclusions
: These results demonstrate the existence of transient hypothyroidism at birth in babies with Apgar scores below 4 delivered by the spontaneous vaginal route.
Transient hypogammaglobulinemia of infancy: Clinical and immunologic features of 40 new cases
Authors: Kiliç S Şebnem , Tezcan İlhan , Sanal Özden , Metin Ayşe , Ersoy Fügen
Published: March 2003

Background
: Transient hypogammaglobulinemia of infancy (THI) results from a delay in the maturation of immunoglobulin production.

Methods
: The clinical and immunologic data of 40 patients with THI are presented. Clinically, the majority of patients presented with recurrent respiratory infections and otitis media, bronchitis and/or bronchial asthma and recurrent gastroenteritis.

Results
: Ten of 40 children had isolated low IgG; isolated low IgA and isolated low IgM were detected in one and three patients, respectively. At initial evaluation, levels of all three immunoglobluins were low in nine patients. Ten patients had diminished IgG and IgA levels, six had diminished IgA and IgM levels and one had low IgG and IgM levels. Two patients were given intravenous immunoglobulin replacement therapy for 1 year. None of the patients has experienced serious infections during their follow‐up period.

Conclusions
: Prospective evaluation of patients (age range 5–60 months) revealed that immunoglobulin levels in 33 patients recovered before 36 months of age. Seven patients still had low immunoglobluin levels at 40–57 months of age. Three of these patients had low levels of both IgG and IgA, while two patients had low IgM levels and a further two patients had low IgA levels.
Correlation between neuroimaging and neurological outcome in periventricular leukomalacia: Diagnostic criteria
Authors: Hashimoto Kazuhiro , Hasegawa Hisaya , Kida Yoshikazu , Takeuchi Yutaka
Published: March 2003

Abstract
 

Background
: Periventricular leukomalacia (PVL) is the most important factor in cerebral palsy in preterm infants.

Methods
: In the present study, we investigated 747 preterm infants of less than 36 weeks gestation who were repeatedly examined by cranial ultrasonography and computed tomography (CT) scanning at around 40 weeks of corrected post‐menstrual age. The clinical course of these infants was followed for more than 3 years and they were examined by magnetic resonance imaging (MRI) between 12 and 18 months of age.

Results
: Single examinations in early infancy were not sufficient to diagnose PVL, but the combination of ultrasonography, CT and MRI examinations allowed the clinical diagnosis of PVL. In preterm infants, clinical PVL could be predicted from cystic PVL and periventricular echogenicity (PVE) 3 or PVE 2 prolonged over 3 weeks on ultrasonography and confirmed by MRI after 11 months of corrected age.

Conclusions
: We tried to determine diagnostic criteria for PVL by neuroimaging. Such criteria from neuroimaging for PVL may be useful for determining the exact occurence rate of and clinical risk factors for PVL.
Contingent negative variation in children with orthostatic dysregulation
Authors: Torigoe Katsumi , Numata Osamu , Ogawa Youhei , Kaneko Utako , Usuda Touhei , Imamura Masaru , Takeuchi Kazuo , Suzuki Hiroshi , Endo Hikosato
Published: March 2003

Abstract

Background
: Children with orthostatic dysregulation (OD) appear to have hypodynamia, as well as the symptoms described in the OD criteira. Hypodynamia, which is greatly influenced by motivation, volition and concentration, is unexceptionally recognized in their everyday life. It has been suggested that the symptoms and hypodynamia aggravate considerably the quality of life (QOL) of children with OD. The purpose of this study was to distinguish the characteristics of contingent negative variation (CNV) and post imperative negative variation, which may reflect the level of attention and motivation in children with OD.

Methods
: Twelve patients with OD aged 10–15 years and 23 age‐matched healthy children were included. The CNV was recorded from Fz, Cz and Pz linked to earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval (ISI) of 2 s and an intertrial interval (ITI) of 10 s. The imperative stimulus of each trial required a button to be pressed.

Results
: The untreated children with OD did not have a significantly smaller CNV amplitude than healthy children. Children with OD treated with midodrine and autonomic training had a significantly larger CNV amplitude than the untreated children, in the area of early, late and total CNV at the three sites.

Conclusion
: The present study confirms that children with OD have diminished motivation and deterioration of concentration, which cause hypodynamia in everyday life. Treatment for OD improves the symptoms, diminished motivation and deterioration of concentration, consequently restoring dynamia. Treatment for OD should be recommended to ameliorate QOL of children with OD.
Child behavior problems: Prevalence and correlates in rural minority areas of China
Authors: Li Yan , Shi Anping , Wan Ying , Hotta Masanaka , Ushijima Hiroshi
Published: March 2003

Abstract

Background
: Ethnicity may possibly associate with different maternal child‐rearing practices and child developmental problems. The aim of this study was to better understand epidemiological features and correlates of child behavior problems in a large sample of children in economically disadvantaged rural minority areas of China and to provide reference data for subsequent intervention of child developmental problems.

Methods
: A total of 1222 rural mother‐child pairs belonging to Hani, Yi, Hui, Miao and Han were drawn from four economically disadvantaged minority counties in Yunnan Province of China. Well‐trained investigators completed child physical examination and measurements (height and weight) in village clinics and interviews of mothers at respondents’ homes using a structured questionnaire.

Results
: Child behavior problems were prevalent in children aged 2–6 years: 71.4% for temper tantrums; 48.2% for swearing; 36.0% for nocturnal bed‐wetting; 29.9% for disobedience; 29.5% for difficulty initiating sleep; and 17.0% for picky eating. Child behavior problems significantly differed across Hani, Yi, Hui, Miao and Han ethnic groups. Logistic regression indicated that ethnicity of Hui compared with Han, younger children, prenatal risk factors, being a twin, ineffective child‐rearing behaviors, such as pampering, corporal punishment, swaddling, family disagreement among child‐rearing contributed independently to the risk for child behavior problems.

Conclusions
: The child behavior problems were prevalent in children aged 2–6 years in rural minority children of China. Ineffective family child‐rearing practices increase risk for child behavior problems.
Betaine and homocysteine concentrations in infant formulae and breast milk
Authors: Sakamoto Akiko , Ono Hiroaki , Mizoguchi Nobuyuki , Sakura Nobou
Published: March 2003

Abstract

Background
: Early diagnosis and treatment of homocystinuria with methionine‐free or low methionine formulae significantly improve prognosis in children found by newborn screening and treated soon after birth. Betaine (Bet) supplementation is also an effective strategy for dietary treatment of homocystinuria. However, previous reports on diet therapy have only examined methionine and cysteine concentrations but not those of Bet and homocysteine (Hcy) in infant diets.

Methods
: We measured Bet and Hcy concentrations in three methionine‐free formulae, five infant starter formulae, and 33 samples of human breast milk from 10 mothers.

Results
: In methionine‐free formulae, Hcy but not Bet was isolated. However, in human breast milk and infant starter formulae, both Bet and Hcy were detected. However, the Bet concentration was not sufficient for the treatment.

Conclusions
: Our study suggests that methionine‐free formulae should have Hcy eliminated and be fortified with Bet to the concentration of 150 mg/dL for the treatment of homocystinuria.
Association between birthweight and body mass index at 3 years of age
Authors: Tanaka Tamami , Matsuzaki Akinobu , Kuromaru Ryuichi , Kinukawa Naoko , Nose Yoshiaki , Matsumoto Toshimichi , Hara Toshiro
Published: March 2003

Abstract

Background
: Obesity in children is one of the risk factors for adulthood obesity, which then leads to the development of chronic diseases such as hypertension, hyperlipidemia and diabetes. In this study, we identified significant factors associating with the body mass index (BMI) at 3 years of age from the perinatal characteristics of children.

Methods
: A total of 588 children were included in the study. The BMI at 3 years of age was examined in conjuction with the possible variables such as parents’ smoking status during pregnancy, parents’ age at birth, gestational age, sibling number and live birth order, sex, birthweight, BMI at 1 month of age, weight gain during the first month of life and feeding method at 1 month of age.

Results
: Univariate analysis showed that birthweight (P<0.0001), weight gain during the first month of life (P=0.0012) and BMI at 1 month of age (P<0.0001) were significantly associated with the BMI at 3 years of age. Of these factors, birthweight and weight gain during the first month of life were the independent factors correlating with the BMI at 3 years by multivariate analysis (P<0.0001 and P=0.0095, respectively).

Conclusions
: Infants with higher birthweight and/or greater weight gain during the first month of life may have a risk of being overweight at 3 years of age.
Natural coagulation inhibitors (protein C, protein S, antithrombin) in patients with sickle cell anemia in a steady state
Authors: Bayazit Aysun Karabay , Kilinç Yurdanur
Published: March 2003

Abstract

Background
: Patients with sickle cell anemia (SCA) run the risk of having decreased levels of natural coagulation inhibitors. This may be due to either hemostatic abnormalities or hepatic dysfunction. This study is designed to evaluate coagulation profiles of patients with SCA in a steady state and to determine whether hypercoagulable state is present or not.

Methods
: Seventeen children with SCA in a steady state were included in this study. The routine hematological evaluation was done with a coulter‐counter. Reticulocyte percentage and blood coagulation tests were also determined. The coagulation inhibitors such as protein C (as activated partial thromboplastine time prolongation time), protein S (as Factor V inhibition) and antithrombin (colorimetric assay) were measured in all cases.

Results
: In the coagulation profile, mean euglobuline lysis time and mean fibrin degradation product levels were both significantly higher in the patient group than in the control group (P<0.05), although other parameters were within normal limits. The values for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and indirect reacting bilirubin were significantly higher in the patient group than in the control group (P<0.001, P<0.005, P<0.0001, respectively). The serum protein levels were normal. Mean factor V level was significantly lower and mean factor VIII level was found significantly higher in the patient group than in the control group (P<0.05 and P<0.005, respectively). Protein C and AT levels were lower in patients with SCA than in control subjects (P<0.001). Protein S levels were also lower in the patient group than in the control group, but the difference between the two groups was not significant (P>0.05).

Conclusion
: It is indicated that antithrombotic functions of patients with SCA are handicapped even in a steady state; and both hemostatic abnormalities and hepatic dysfunction contribute to low levels of natural coagulation inhibitors.
Unexplained subdural hematoma in young children: Is it always child abuse?
Authors: Fung Eva Lai Wah , Sung Rita Yn Tz , Nelson Edmund Anthony Severn , Poon Wai Sang
Published: March 2003

Background
: In the published reports of the developed society, subdural hematoma and/or retinal hemorrhages, in the absence of documented history of major trauma, should be considered diagnostic of child abuse. Many people used the above criteria for diagnosis, but subsequently found that retinal hemorrhages were more common in non‐accidental injuries (NAI). To what extent is the proposed pathognomonic association between unexplained subdural hematoma/retinal hemorrhages and child abuse a self‐fulfilling prophecy?

Methods
: Clinical details of nine children under 2 years with unexplained subdural hematoma admitted to Prince of Wales Hospital between 1995 and 1998 were reviewed.

Results
: Four had no other physical signs
of injury, five had retinal hemorrhages and one had multiple bruises over
the body. Following multidisciplinary case conferences for seven
children, a diagnosis of NAI was concluded in four cases, but in
no case could the abuser be definitely identified. Clinical outcome
was poor with seven children showing either profound disability
(n = 5) or evidence of developmental
delay (n = 2).

Conclusion
: In this series, NAI were not established in three of the seven cases. Did we underdiagnose child abuse in these cases? Despite a magnitude of opinion to the contrary, the issue of whether ‘trivial’ head injury can cause subdural hemorrhages and/or retinal hemorrhages is yet unresolved. Clearly much more information on this very sensitive and serious issue is required and these data should be collected with an open mind.
Bone mineral status in ambulatory pediatric patients on long‐term anti‐epileptic drug therapy
Authors: Tsukahara Hirokazu , Kimura Kouki , Todoroki Yukiko , Ohshima Yusei , Hiraoka Masahiro , Shigematsu Yosuke , Tsukahara Yasuyo , Miura Masakazu , Mayumi Mitsufumi
Published: March 2003

Background
: For ambulatory pediatric outpatients, reports of abnormalities of bone metabolism associated with anti‐epileptic drugs are inconsistent and may be difficult to interpret.

Methods
: The effects of long‐term anti‐epileptic therapy (mainly valproic acid and/or carbamazepine) on bone mineral status were evaluated in ambulatory epileptic patients (seven males and 11 females) aged 5.5−15.9 years. Bone mineral density (BMD) at the lumbar spine was measured by dual‐energy X‐ray absorptiometry and markers of bone and mineral metabolism were determined.

Results
: The mean BMD was decreased by 9% in our patients relative to the control, and five patients (all males)
showed osteopenia, defined as BMD SD scores less than − 1.5. Serum levels of minerals, intact parathyroid hormone and 1α,25 (OH)2 vitamin D were within the normal ranges. In most patients, serum levels of intact osteocalcin, carboxyterminal propeptide of type I procollagen
and pyridinoline cross‐linked telopeptide of type I collagen were reduced relative to the corresponding mean control values. The BB genotype
by BsmI restriction fragment length polymorphism, associated with low BMD, was not found in our patients. The dietary calcium intake in the osteopenic patients was significantly lower than that of the non‐osteopenic patients.

Conclusions
: Our results indicate that long‐term anti‐epileptic treatment induces a state of decreased bone turnover in children, resulting in osteopenia preferentially in males. The alterations may be due, at least in part, to direct effects of the drugs on bone cells; and that low calcium intake could be an aggravating factor for anti‐epileptic‐associated osteopenia.
Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia
Authors: Demir Aysin , Yarali Nese , Fisgin Tunc , Duru Feride , Kara Abdurrahman
Published: March 2003

Background
: Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common forms of microcytic anemia. Some discrimination indices calculated from red blood cell indices are defined and used for rapid discrimination between TT and IDA. However, there has been no study carried out in which the validity of all of the defined indices are compared in the same patient groups. Youden's index is the most reliable method by which to measure the validity of a particular technique, because it takes into account both sensitivity and specificity.

Methods
: We calculated eight discrimination indices (Mentzer Index, England and Fraser Index, Srivastava Index, Green and King Index, Shine and Lal Index, red blood cell (RBC) count, red blood cell distribution width and red blood cell blood distribution width index (RDWI)) in 26 patients with IDA and in 37 patients with beta TT (βTT). We determined the number of correctly identified patients by using each discrimination index. We also calculated sensitivity, specificity, positive and negative predictive value and Youden's index of each discrimination index.

Results
: None of the discrimination indices showed a sensitivity and specificity of 100%. Youden's indices of RBC count and RDWI were the highest with the value of 82 and 80%, respectively. Ninety percent and 92% of the patients were correctly identified with RBC and RDWI, respectively.

Conclusion
: Red blood cell count and RDWI are the most reliable discrimination indices in differentiation between βTT and IDA.
Healthcare system in Japan
Authors: Yamauchi Toyoaki
Published: March 2003

In Japan, each person is obligated to enroll in a national health insurance plan. Based on egalitarianism, the system is managed by the government and it finances almost the entire healthcare needs. However low the total healthcare expenditure in Japan is compared with other major countries, the statisticscause concern for the Japanese population for the future growth of its health care. Even though the Japanese healthcare system faces many problems at present, it provides everyone with a sense of security. The key to its success is the sense of and art of balance in healthcare policy making.
The meaning of public health nursing: Creating 24 hour care in a community in Japan
Authors: Murashima Sachiyo , Asahara Kiyomi , White Caroline M. , Ryu Shuhei
Published: March 2003

Abstract This case study describes the strategies and activities of public health nurses to increase the availability of services in a municipality of 36 000 and to transform community attitudes so that those needing services would feel free to use them. Strategies and activities are seen in the context of Japan, Minakuchi Town and the leadership of the chief public health nurse. Practicing in partnership with members of the community, strategies of public health nurses include technical activities (conducting needs assessment and framing program alternatives) and information sharing and health education (e.g. 75 meetings organized with health promoters for residents in the districts of the town). On the basis of the results of Minakuchi Town, viewed as an example of expert public health nursing practice, a general model for public health nursing practice is presented.
Challenges of the grounded theory approach to a novice researcher
Authors: Backman Kaisa , Kyngäs Helvi A.
Published: March 2003

The grounded theory approach has been used in nursing research since 1970. The latest methodological books describe the research process in detail. However, there are many problems involved in the grounded theory approach, which especially need to be considered by a novice researcher. One of these problems is the question of how deeply and widely the researcher should familiarize her‐ or himself with the research topic before the empirical study. The problems also include the need to focus the research problem and to choose the sampling method. Data analysis is a multistage process, which demands from the researcher both sensitivity and time to work out the findings which emerge from the data. In this paper, the grounded theory approach is described as a process undertaken by the novice researcher. The purpose of this paper is to discuss the challenges of the grounded theory approach and the problems encountered by a researcher using the method for the first time.
Thoughts and feelings of in‐patients with advanced terminal cancer: Implications for terminal care improvement
Authors: Tanaka Aiko , Iwamoto Teruyo , Kaneyasu Hisae , Petrini Marcia A.
Published: March 2003

The purpose of this study was to clarify how terminally ill patients think and feel while hospitalized, thereby providing some insight into improving the quality of terminal care. The subjects of the study were eight terminally ill patients with cancer. The researchers obtained the patients’ consent and their doctors’ permission prior to conducting the interviews. Individual, semi‐structured interviews were conducted. The patients’ thoughts and feelings were extracted and then categorized according to particular themes. As a result, we came up with four major categories: maintaining pain control, living an ordinary life, hoping for improvement of physical condition, and having family nearby. The desire to live life to its fullest given their situation, as well as to maintain a hopeful attitude about their future proved very important. The presence of family also played a crucial role. These factors must be taken into consideration in achieving better care for terminally ill patients.
The implementation of Bachelor’s of Science in Nursing education in Pakistan
Authors: Upvall Michele J. , Rehmatullah Shamsah , Hashwani Saleema , Khan Shehla , Husain Perviz , Jan Rafat
Published: March 2003

Currently nursing education at the Aga Khan University in Karachi, Pakistan consists of a 3 year diploma program, a 2 year post‐registered nurse (RN) of Bachelor’s of Science in Nursing (BScN) completion program and a new 4 year generic Bachelor’s of Science in Nursing program. The purpose of this paper is to describe the evaluation process and findings of the newly implemented BScN program. The program is unique, as it is the first and only BScN program throughout Pakistan. Therefore, it has the responsibility of setting the standards for university nursing education for the entire country. Sampling for this qualitative evaluation study included the first class admitted into the BScN program, nursing faculty, and nursing staff involved in clinical experiences of the BScN students. The sample was divided into homogeneous focus groups to elicit the data. Focus groups were audio‐taped with results being categorized into themes. Findings from this evaluation study support a typology of learning discussed in the literature related to nursing education. In addition, faculty experiences of implementing the new program mirror those of faculty from other countries.
ESL undergraduate nursing students in Australia: Some experiences
Authors: Shakya Anita , Horsfall Jan M.
Published: March 2003

Abstract This study explored some experiences of nine English as a second language (ESL)/international nursing students during 1 year of their studies at a large Australian university. From the student narratives, two broad categories emerged to describe the nature of their experiences, namely, challenges and supports. First, the challenges encompassed the themes of: language, which included the technical aspects of language, speaking and listening, and interaction in tutorial group situations; perceptions of ethnocentrism; and lack of orientation. Second, the supports included: University‐related support; support from friends and family; and the students' own personal strengths and strategies. The participants of this study faced various challenges and also struggled to overcome their difficulties through diverse means. Suggestions arising from this research include improving student support systems and increasing awareness of cultural differences among the nursing faculty and registered nurses.
Leg clubs: A new approach to patient‐centred leg ulcer management
Authors: Lindsay Ellie
Published: March 2003

Abstract Loneliness is a significant health‐care issue for many elderly patients in the community. The correlation between social isolation, poor compliance to treatment, and low healing rates for patients suffering from leg ulcers is well documented. Pain, odour, bandages etc. contribute to low self‐esteem, depression and social stigma. Home visits by community nurses cannot provide the social and psychological support required by these patients. Responding to the holistic needs of this client group, the author set up Debenham Leg Club in 1995 to provide leg ulcer management in an informal, non‐medical setting, where the emphasis is on social interaction, participation, empathy and peer support. This social model was conceived as a unique partnership between the district nurses and the local community, in which patients are empowered, through a sense of ownership, to become stakeholders in their own treatment. The value of the ‘club’ concept is evident in the happy, welcoming, uninhibited atmosphere that characterizes the clinic. Non‐compliance to treatment has been virtually eliminated and evidence of greater healing rates has been illustrated through many patients whose long‐standing ulcers have healed or greatly improved as a direct result of this change in approach. Patients' willingness to attend for systematic ‘well leg’ checks and ongoing health education has dramatically reduced the incidence of recurrence.
Center of Health Promotion Program for Elderly, Faculty of Nursing Mahidol University, Bangkok, Thailand
Authors: Pasunant Nitaya
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Factors Affected the Adjustment of Elders in the Health Promotion Center of the Elders at Boromarajonani College of Nursing Buddhachinaraj
Authors: Kraungkumhang Panchit , Maliwan Vanda
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Dementia: Insights from Patients
Authors: Ostwald Sharon K.
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Literature review of role stress/strain on nurses: An international perspective
Authors: Lambert Vickie A. , Lambert Clinton E.
Published: March 2003

Abstract The presence of role stress/strain among nurses has been of concern throughout the world. However, to date, no one has conducted, from an international perspective, a literature review of research on the topic. This article assesses research from 17 countries, identifies the major areas of focus in the studies, compares and contrasts the findings, summarizes the state of the science on role stress/strain on nurses and makes recommendations for future research.
Alcohol consumption among 11–16 year olds: ‘Getting around’ structural barriers?
Authors: Hyde Abbey , Treacy Margaret , Boland Jennie , Whitaker Teresa , Abaunza Pilar Santos , Knox Barbara
Published: March 2003

Abstract This paper presents qualitative data from Irish children and adolescents on their experiences in relation to alcohol consumption. A sample of 78 participants (average age 11.5 years) was selected. A proportion of this initial sample were interviewed at intervals over a period of 3 years. The participants’ consumption patterns were analyzed and four categories were generated: covert unsanctioned, overt unsanctioned, overt sanctioned, and peer unsanctioned. As the children got older, peer drinking became a stronger feature of the data; however, it mediated other patterns of behavior. Although the children displayed agency in circumventing adult rules relating to alcohol consumption, the participants were subjected to structural constraints by virtue of their status as children. Moreover, the agentic powers of the participants were procured through their social network rather than arising from an essentialist agency possessed by each individual child. The impact of childhood as a structural dimension weakened to some extent as the participants got older and had more freedom to circumvent adult‐defined barriers to alcohol consumption.
Evaluation of a training program for the prevention of lower back pain among hospital employees
Authors: Fanello S. , Jousset N. , Roquelaure Y. , Chotard‐Frampas V. , Delbos V.
Published: March 2003

Abstract An evaluation of a training program for the prevention of lower back pain (LBP) was conducted over a two‐year period in the Regional Hospital of Le Mans, which is located in the west of France and employs 2400 staff. The training program was based on a multidisciplinary approach to worker training in the prevention of LBP and in ergonomic efforts in the workplace. Workers received theoretical training on LBP, patient handling and ergonomics, and on‐the‐job ergonomics instruction to help them to implement participative ergonomics in their working groups. A cohort of 136 employees attended classes on safe posture and patient handling, then received advice from instructors who observed them while they performed their typical workday tasks.
Prospective study of fall risk assessment among institutionalized elderly in Japan
Authors: Izumi Kiyoko , Makimoto Kiyoko , Kato Mayumi , Hiramatsu Tomoko
Published: March 2003

Abstract The purpose of the present study was to identify risk factors for falls among institutionalized elderly, using the standardized risk assessment tool developed by Izumi. We examined 746 patients from three types of facilities: rehabilitation wards in four general hospitals, three long‐term care facilities, and three nursing homes, for up to three months. The incidence of falls within all facilities was 12.5%. Patterns of relative risks of falling differed among types of facilities. The highest relative risk of fall in long‐term care facilities and nursing homes was nurses’ prediction, followed by history of fall and altered mentation. In contrast, that in general hospitals was mobility. In long‐term care facilities, history of falls (odds 3.68, 95CI: 1.47–9.23) and interaction (history of falls and assistance with toileting) (odds 3.13, 95CI: 1.48–6.64) showed significance on adjusted‐odds ratios for fall. History of falls, altered mentation, and assistance with toileting may be used to screen patients at a high risk for fall at admission.
Initiating and sustaining breastfeeding in Hong Kong: Contextual influences on new mothers’ experiences
Authors: Tarrant Marie , Dodgson Joan E. , Tsang Fei Shirley
Published: March 2003

Abstract The research reported in the present paper was conducted as part of a larger longitudinal infant feeding study examining the relationship between motivational and situational variables, and primaparas’ infant feeding behaviors. The aim of this investigation was to identify contextual factors that influenced first‐time mothers’ breastfeeding practices in the immediate postpartum period. Employing an exploratory, qualitative design, data were collected through unstructured in‐depth interviews with 19 primiparous mothers at one‐month postpartum. Thematic analysis revealed two main themes: sociocultural and environmental influences, and lactation management. Although the participants wanted to succeed at breastfeeding, they faced many impediments in a society that was not supportive of lactating mothers. Health professionals’ mixed messages, life stresses (short maternity leaves and lack of work place support for breastfeeding) and the participants’ poor understanding of the physiological process of lactation presented obstacles for continued breastfeeding.
Early results of radical prostatectomy and adjuvant endocrine therapy for prostate cancer with or without preoperative androgen deprivation
Authors: Homma Yukio , Akaza Hideyuki , Okada Kiyoki , Yokoyama Masao , Moriyama Nobuo , Usami Michiyuki , Hirao Yoshihiko , Tsushima Tomoyasu , Sakamoto Atsuhiko , Ohashi Yasuo , Aso Yoshio
Published: March 2003

Background: The effects of preoperative androgen deprivation were explored in the patients who received radical prostatectomy and subsequent adjuvant endocrine therapy for prostate cancer.

Methods: Stage A2, B or C prostate cancers were randomized to one of two groups: (i) group I (n = 90), who received androgen deprivation (leuploride and chlormadinone acetate) for 3 months preoperatively followed by radical prostatectomy and adjuvant endocrine therapy (leuploride only); and (ii) group II (n = 86), who underwent the surgery followed by 3 month androgen deprivation and subsequent adjuvant endocrine therapy. The effects of preoperative androgen deprivation on clinical relapse (serum prostate specific antigen (PSA) > 1.98 ng/mL, local recurrence or distant metastasis) and PSA relapse (PSA > 0.2 ng/mL) were evaluated at 2 years after randomization.

Results: There was no significant difference in clinical or PSA relapse‐free survival and quality of life measures between the two groups, although relapses occurred significantly more frequently in patients who had more advanced stages, higher pretreatment PSA values or lower histologic differentiation in either group. Subgroup analysis indicated that clinical relapse‐free survival in stage C cancer tended to be better in patients with preoperative androgen deprivation than in those patients without it (P < 0.1).

Conclusions: Preoperative androgen deprivation may be beneficial for stage C prostate cancer patients receiving radical prostatectomy and adjuvant endocrine therapy over the 2 year observation period. A longer follow up is needed to clarify the exact extent of benefit in terms of survival and quality of life.
The effect of papaverine on morphologic differentiation, proliferation and invasive potential of human prostatic cancer LNCaP cells
Authors: Goto Toshitaka , Matsushima Hisashi , Kasuya Yutaka , Hosaka Yoshio , Kitamura Tadaichi , Kawabe Kazuki , Hida Akino , Ohta Yasuyuki , Simizu Takahisa , Takeda Ken
Published: March 2003

Background: Intracellular cyclic adenosine monophosphate (AMP) level changes are thought to play an important role in inhibiting cell proliferation and inducing differentiation in several types of cells. It has been reported that cyclic AMP analogs induce terminal differentiation in human prostate cancer cells. Consequently, phosphodiesterase inhibitors may be useful in delineating the role of cyclic AMP in the differentiation of these cells. Therefore, the effect of phosphodiesterase inhibitors on morphologic differentiation, proliferation and invasive potential of human prostate cancer cells was investigated.

Methods: Three human prostate cancer cell lines PC‐3, DU145 and LNCaP were treated with one of the phosphodiesterase inhibitors, papaverine, 3‐isobutyl‐1‐methylxanthine (IBMX) or theophylline, for 6 days. Morphologic changes of these cells induced by phosphodiesterase inhibitors were observed by microscopy. Intracellular cyclic AMP levels in LNCaP cells were measured by radioimmunoassay using a cyclic AMP assay kit. The effect of papaverine on the proliferation and invasive potential of LNCaP cells were measured by cell counting and the MatrigelTM invasion chamber assay.

Results: Of the three agents, examined papaverine (10–5 mol/L) is the most effective inducer of morphologic change and also raised intracellular cyclic AMP levels in LNCaP cells. However, unlike LNCaP cells, PC‐3 and DU145 cells treated with phosphodiesterase inhibitors, including papaverine, showed little change in morphology. Additionally, proliferation and invasive potential of LNCaP cells were significantly inhibited by papaverine.

Conclusion: The results suggest that papaverine induces terminal differentiation in LNCaP cells, which is correlated with an intracellular cyclic AMP‐mediated pathway.
Neurogenic bladder dysfunction due to Behçet’s disease
Authors: Theodorou Ch , Floratos D , Hatzinicolaou P , Vaiopoulos G.
Published: March 2003

Background
: Behçet’s disease is a chronic multisystem condition of unknown origin. Genitourinary tract involvement with genital apthous ulcers, epididymitis, urethritis and recurrent cystitis is encountered commonly. Neurogenic bladder dysfunction due to neural involvement of the syndrome, has been reported extremely rarely.

Methods

: A case of neurogenic bladder dysfunction due to Behçet’s disease is presented. The patient was 17‐year‐old young male with a long history of the disease and neurological affection, but with neglected lower urinary tract symptoms and urinary incontinence. The patient was diagnosed urodynamically to have hyperreflexic detrusor.

Results/Discussion
: After failure of medical treatment (oxybutynin chloride) the patient submitted to augmentation clam‐type sigmoidocystoplasty. Four years postoperatively, the patient is dry, on clean intermittent self catheterization twice daily and he is practically asymptomatic from lower urinary tract symptoms.
Diagnosis and treatment of pelvic lymph node metastasis in bladder cancer
Authors: Hoshi Senji , Orikasa Seiichi , Suzuki Ken‐Ich , Takahashi Toshiko , Ohyama Chikara , Sato Katsuko , Ono Kunio
Published: March 2003

Background and Methods
: Bipedal lymphography and percutaneous fine needle aspiration biopsy (FNAB) of pelvic lymph node was done in 200 patients with bladder cancer.

Results
: A diagnosis of metastasis to the pelvic lymph node was obtained by this method in 34 patients. Of these 34 patients, only 12 (35%) were positive or suspected of having pelvic lymph node metastasis by computed tomography. Sixteen patients (47%) had unequivocally positive or highly suspicious lymphogram and 18 patients (53%) had normal lymphogram. Seventy‐eight cases, including eight FNAB‐positive cases, were treated by radical cystectomy and regional lymph node dissection. Sensitivity, specificity, positive predictive value and negative predictive value of FNAB were 57, 100, 100 and 91%, respectively. Thirteen FNAB‐positive M0 patients could be treated by multimodality therapy and evaluated after neoadjuvant therapy by repeated lymphography and FNAB. All were changed to N0 by FNAB after neoadjuvant therapy. In eight patients treated by total cystectomy and lymph node dissection, four had down staged to pN0 but four had one positive node. In five follow‐up cases without surgery, one had recurrent pelvic lymph node metastasis 35 months later. Cause‐specific survival of these patients was 76% at 5 years and 57% at 8 years.

Conclusions
: Pretreatment diagnosis of pelvic lymph node metastasis and multimodality therapy may improve the prognosis of regional lymph node‐positive bladder cancer. Because it is difficult to diagnose pN1 using FNAB, radical operation should be performed even if neoadjuvant therapy is effective and down staging is obtained.
Patient‐reported quality of life after radical prostatectomy for prostate cancer
Authors: ARAI YOICHI , OKUBO KAZUTOSHI , AOKI YOSHITAKA , MAEKAWA SHINYA , OKADA TAKASHI , MAEDA HIROSHI , OGAWA OSAMU , KATO TETSURO
Published: March 2003

Background: Increasingly, quality of life (QOL) assessments are receiving greater attention in the management of malignancies, including prostate cancer. We evaluated the impact of radical prostatectomy on patient QOL 12 months or longer after surgery.

Patients and Methods: We evaluated the impact of radical prostatectomy on QOL in 60 patients with prostate cancer. The patients comprised two groups: the first group (n = 32) was evaluated 12 months or longer after radical prostatectomy; the second group (n = 28) was evaluated while awaiting radical prostatectomy. General health‐related QOL was measured with the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire. Sexual function was assessed with the Sapporo Medical University Sexual Function Questionnaire. A newly developed instrument assessing urinary function was prepared only for the postoperative group.

Results: No differences between the two groups were seen in comparisons of general health‐related QOL subscales. Men who underwent surgery reported significant deterioration in sexual function (decreased quality of erection, decreased sexual activity and decreased satisfaction with sex life) than those awaiting surgery. Of the 32 postoperative patients, 26 (81%) did not use pads at all, five (16%) used one or fewer pads per day due to occasional spotting and only one patient (3%) used two to four pads per day to deal with urine dripping. Twenty‐six postoperative patients (81%) stated that, given the choice, they would undergo radical prostatectomy again.

Conclusions: General health‐related QOL does not appear to be compromised following radical prostatectomy. Patients are willing to accept some morbidity for a perceived survival benefit. Although minimal urinary dysfunction was reported, most patients were dissatisfied with postoperative sexual function. In preoperative counselling, greater emphasis should be placed on the risk of postoperative impotence.
Case of gonadoblastoma in a 9‐year‐old boy without physical abnormalities
Authors: HATANO TAKASHI , YOSHINO YASUMASA , KAWASHIMA YOSHIO , SHIRAI HIROSHI , IIZUKA NORIO , MIYAZAWA YOSHIO , SAKATA AKIHIKO , ONISHI TETSURO
Published: March 2003

Background: A 9‐year‐old boy was admitted to Jikei University Hospital complaining of gradual enlarging of the left scrotal contents.

Methods/Results: Physical examination was significant for bilateral descended testicles. No abnormalities were detected in the testicles or along the spermatic cords. Scrotal ultrasound showed that hyperechoic shadows were recognized in the central area of the left testicle. Subsequent testicular biopsy and histopathological examination showed intratubular malignant germ cells in the testicular tubules. One week later, left orchiectomy was performed.

Conclusions: Histopathological evaluation revealed gonadoblastoma. Gonadoblastoma, a rare gonadal neoplasm, is composed of germ cells and sex cord derivatives and usually occurs in phenotypically female patients with gonadal dysgenesis. To date, only three cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testicles. We report on a case of gonadoblastoma unaccompanied by a germ cell tumor in a physically normal male.
Optimization of orthotopic colonic bladder: Implantation of tubularized mucosal flap from colonic segment into demucosalized urethra
Authors: Iizuka Keiji , Igawa Yasuhiko , Kato Haruaki , Kiyokawa Hideo , Nishizawa Osamu
Published: March 2003

If the urethral mucosa of a female could be replaced by another mucosa, one could augment the indication for orthotopic reconstruction of the bladder. A mucosal replacement technique for the female urethra is reported. A colonic mucosal flap formed from a colonic bladder was used in a patient with bladder cancer for whom cystectomy was indicated. For 3 years after the surgery, the patient has maintained satisfactory voiding and urethral function. There has been no evidence of a recurrence. The orthotopic bladder with the mucosal replacement technique can be applied to female patients who have a bladder cancer with a high risk of urethral recurrence.