bluuebunny/crossref_metadata_2025 huggingface dataset:
Convergence and divergence in plant community trajectories as a framework for monitoring wetland restoration progress
Authors: Matthews Jeffrey W. , Spyreas Greg
Published: August 2010

1. Environmental policies that use ecological restoration to offset the destruction of natural ecosystems assume that restorations readily compensate for the losses because they progress reliably and predictably over time, following deterministic successional trajectories. However, succession and restoration are spatially and historically contingent processes, often characterized by divergent trajectories that deviate from expectations.

2. We develop a framework for monitoring restorations that integrates two ideas from succession theory: convergence vs. divergence in species composition among successional sites, and progression towards vs. deviation from an expected community state. We apply this framework to short‐ and long‐term monitoring data from 11 restored wetlands in Illinois, USA, by comparing plant species composition among restored wetlands over time and between restored wetlands and two sets of reference wetlands (high integrity, ‘target’ wetlands and low integrity, degraded wetlands).

3. Over the first 4 years, restored wetlands that were initially similar in species composition diverged, progressing towards different high integrity target states. Planting a large number of native species in restorations increased their similarity to reference wetlands.

4. Over longer time scales (5–11 years post‐restoration), however, restored wetlands deviated from the ideal trajectory and converged upon the species composition of degraded wetlands, mainly because of non‐native species invasion.

5. Synthesis and applications. Framing restoration trajectories in terms of compositional convergence/divergence and progression towards/deviation from an acceptable range of reference sites is useful for monitoring restoration progress, identifying constraints to success and predicting restoration outcomes. Barriers to restoration, including non‐native species and a lack of native propagules, can limit long‐term progression towards target communities and constrain restoration to undesirable outcomes. Furthermore, convergence of restored wetlands on an undesirable community state limits the effectiveness of wetland mitigation policies.
Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland
Authors: Saarnio Reetta , Isola Arja
Published: August 2010

Aims and objectives.  To describe the perceptions of nursing staff on the use of physical restraints in institutional care of older people.

Background.  Physical restraint of older people is a common practice in institutional care in many countries, including Finland. As the nursing staff plays a major role in deciding on physically restraining older patient and in the care the patient receives, new research information is needed on the nursing staff’s attitudes towards the use of physical restraints.

Design.  A qualitative study.

Method.  The data consisted of focus group interviews with staff and supervisors. There were four focus groups: nurses, practical nurses, institutional assistants and care supervisors.

Results.  In addition to traditional methods of restraint, such as belts and locked doors, the nursing staff also used indirect restraint by removing the patient’s mobility aid. Factors contributing to the use of restraints included requests by the patient’s family members to use restraint to ensure the patient’s safety and social reasons, in the form of lack of legislation on the use of restraint. The use of restraints caused feelings of guilt among the nursing staff, but on the other hand, it was seen as a way of making older patient feel more secure.

Conclusions.  There is a need for official guidelines on the use of physical restraints in care of older people. This would require the entire nursing team to make a joint decision on the use of restraints and constant reassessment of the need of using restraints.

Relevance to clinical practice.  The results of the study provide nursing staff and supervisors a chance to ethically deliberate and evaluate their own work. Alternative practices for physical restraint can also be directly applied to practical care of older people.
Process of ambivalent normalisation: experience of family caregivers of elders with mild cognitive impairment in Taiwan
Authors: Kuo Li‐Min , Shyu Yea‐Ing L
Published: August 2010

Aims and objectives.  To conceptualise the caregiving process in Taiwanese families caring for elders with mild cognitive impairment.

Background.  Family caregivers play an essential role in the lives of elders with mild cognitive impairment by dealing with their cognitive status and daily function. Little is known, however, about the development of the caregiving trajectory, particularly in Asian countries.

Design and methods.  Grounded theory methodology was used. Data were collected via in‐depth interviews with 10 family caregivers of patients with mild cognitive impairment and living at home in northern Taiwan. Data were analysed by constant comparative analysis.

Results.  The process most used by family caregivers to adjust to conflicts and changes in relationships with elders with mild cognitive impairment was ‘ambivalent normalisation’. This dynamic process included three components: subtle changes, optimistic appraisal and ambivalent anticipation. Family caregivers who had developed this process were more likely to adopt multiple effective behavioural approaches to avoid conflict in their daily life and to begin outlining future caregiving tasks.

Conclusions.  The process of ambivalent normalisation can sensitise healthcare providers to family caregivers’ needs and provide a basis for developing frameworks for future substantive theory and possible future research.

Relevance to clinical practice.  This study’s findings may help healthcare providers understand family caregivers’ needs and effective patterns for taking care of elders with mild cognitive impairment. Interventions can be developed to facilitate family caregivers’ awareness of the changes in their loved one in the initial stage of diagnosis and adopt multiple effective strategies to prevent conflicts in their lives. Healthcare providers can actively examine the cognitive function of older people in general outpatient departments, provide well‐timed treatments and minimise caregiver burden.
Diabetes as a risk factor for myocardial infarction: population and gender perspectives
Authors: LUNDBERG V. , STEGMAYR B. , ASPLUND K. , ELIASSON M. , HUHTASAARI F.
Published: August 2010

Abstract. Lundberg V, Stegmayr B, Asplund K, Eliasson M, Huhtasaari F (Kalix Hospital, Umel University Hospital and Lulei‐Boden Hospital, Sweden). Diabetes as a risk factor for myocardial infarction: population and gender perspectives.

Objectives: To investigate diabetes as a risk factor for acute myocardid infarction (AMI) from a population perspective in a region with high cardiovascular disease (CVD) risk.

Design: Population screenings for diabetes and a population‐based AMI register.

Setting: Northern Sweden MONICA area.

Subjects: Representative sample (Norrbotten and Vasterbotten counties) of 2432 men and women 35–64 years was investigated 1990 and 1994. All patients with AMI aged 35–64 years were included, in total 3031 between 1989 and 1993.

Results: The prevalence of diabetes was 5% in men and 4.4% in women. The relative risk (RR) in diabetic men was 2.9; 95% coniidence interval (CI) 2.6‐3.4, and in diabetic women, RR 5.0: CI 3.9‐6.3. The risk for re‐infarction was about twice as large in patients with diabetes as in patients without diabetes. In both sexes the overall 28 day case fatality (CF) was significantly higher in diabetic compared to nondiabetic subjects. When compared to the non‐diabetic population, the overall mortality from AM1 in the diabetic population was 4 times higher among men and 7 times higher among women. The population attributable risk (PAR), a crude estimate of all AMIs attributable risk (PAR), a crude estimate of all AMIs women.

Conclusions: Diabetes increases the risk for AM1 attack rate, incidence, case‐fatality, recurrence and mortality and is an important contributor to all AMIs in middle‐aged people.
Enhancement of B‐cell secretion by blood glucose normalization in type 2 diabetes is associated with fasting C‐peptide levels
Authors: CLAUSON P. , ALVARSSON M. , GRILL V.
Published: August 2010

Abstract. Clauson P, Alvarsson M, Grill V (Karolinska Hospital, Stockholm, Sweden). Enhancement of B‐cell secretion by blood glucose normalization in type 2 diabetes is associated with fasting Cpeptide levels.

Objectives: To investigate (i) the variability of beneficial effects achieved by short‐term near‐normalization of blood glucose in type 2 diabetes patients, and (ii) the relationship of beneficial effects to individual characteristics of diabetes.

Design: Arginine‐induced insulin and glucagon release tested at two glucose levels before and alter 3 days of intensive insulin treatment.

Setting: The Department of Endocrinology and Diabetology, Karolinska Hospital, Stockholm, Sweden. bolic control sampled from an area‐based population of diabetes patients.

Results: Levels of fasting blood glucose declined from 15.0 f 0.9 to 8.5 k 0.7 mmol L‐‘, Cpeptide from 0.81 f 0.06 to 0.49 & 0.05 nmol L‐’ and percent proinsulin (of total IRI) from 7.8 & 1.0 to 3.2 f 0.6%. At comparable glucose levels arginine‐induced insulin secretion was enhanced 46.3+19.5% (range ‐36 to 220%). Enhancement correlated with extent of blood glucose normalization and also with fasting Gpeptide levels and with overweight. Arginineinduced glucagon secretion was nonsignificantly depressed (17.2 f 7.4%, range ‐ 59 to 29%). Insulin sensitivity assessed by M: I ratio was increased by a median of 95 %.

Conclusions: In type 2 diabetes patients reversibility type 2 diabetes patients reversibility function is variable. Variability is related to B‐cell mass in individual patients with type 2 diabetes.
Adults with childhood‐onset growth hormone deficiency: effects fo growth harmone treatment on cardiac structure
Authors: SARTORIO A. , FERRERO S. , CONTI A. , BRAGATO R. , MALFATTO G. , LEONETTI G. , FAGLIA G.
Published: August 2010

Abstract. Sartorio A, Perrero S, Conti A, Bragato R, Malfatto G, Leonetti G, Faglia G. (Laboratorio Sperimentale di Ricerche Endocrinologiche, Istituto AuxoIogico Italiano, Milano, Italy). Adults with childhood‐onset growth hormone deficiency: effects of growth hormone treatment on cardiac structure.

Objectives: To evaluate the effects of growth hormone deficiency (GHD) and of growth hormone (GH) therapy on cardiac structure in adults with child‐hood‐onset GHD.

Settiig: Out‐patient clinic in the Italian Institute for Auxology, Milan.

Subjects: Eight adults with childhood‐onset GHD and eight healthy controls, matched for sex, age, exercise and body mass index.

Interventions: Recombinant GH (Saizen Serono, Italy), administered in a conventional dose of 0.5 IU kg‐1 week‐1 for 6 months.

Main outcome measures: Cardiac structure parameters, evaluated by two‐dimensional, M‐mode and Doppler echocardiograms, and stress test, by means of a modified Bruce protocol with a bicycle ergometer, were determined before and after 6 months GH therapy.

Results: Before treatment, mean (±SE) intraventricular septal thickness (IVST: 7.1 ± 0.2 mm), LV posterior wall thickness (LVPT: 5.2± 0.1 mm), LV mass(LVM: 94.6 ± 5.0 g), LV massindex (LVM/body surface area, LVMI: 65.1 ± 3.0 g m‐2) and left ventricular end‐diastolic diameter (LVED 41.4 ± 0.6 mm) of patients were significantly lower (P< < 0.01) than in controls, whilst LV end‐systolic diameter (LVES) of patients (25.5 ± 0.7 mm) was similar to controls (27.5 ± 0.7). GH treatment significantly (P < 0.01) increased LWT (6.8 ± 0.2 mm), LVM (111.6 ± 4.6 g) and LVMI (80.5 ± 3.5 gm‐2): no sigdcant changes were observed in LVED, LVES and IVST values. The stress test showed a significant improvement of cardiac performance, as demonstrated by the reduction of blood pressure x heart rate product at the same workload (basal: 32722.5 ± 897.4 vs. after: 25574.6 ± 439.7).

Conclusions: GH plays a role in the maintenance of a normal cardiac structure in adulthood. The present study suggests that GH treatment might be able to improve the cardiac structure of patients with childhood‐onset GHD.
New Principles for the treatment of diffuse Pulmonary emphysema
Authors: HILLERDAL G.
Published: August 2010

Abstract. Emphysema is due to destruction of lung tissue but the main cause of the dyspnoea is a diminished elasticity of the lungs. Medical therapy, such as bronchodilation, corticosteroids, and treatment of intercurrent infections, can give temporary relief. Long‐term oxygen treatment can improve and prolong life in patients with severe epmphysema. Lung transplantation is a final option in selected patients. Rehabilitation including excercise training will cause increase in maximal excercise tolerance and decrease of dyspnoea, and thereby an improvement of quality of life. In recent years surgical reduction of the lung volume has been reintroduced and in selected cases given dramatic results. The goal is to reduce the volume in both lungs with about 30% depending on the distribution of the emphysema, pieces of the upper or lower lobes will be removed. Sternotomy or bilateral thoracoscopy, using staplers, are the most common methods. short‐term results are good, with an improvement of FEV1 of 22–96%, improved arterial oxygen pressure, and a radical improvement of life quality. The impact on the daily life of the patient can be dramatic. The long‐term results are still not well known, and many questions remain before volume reduction surgery can be regarded as an established from of treatment for emphysema, and randomized studies are badly needed.
No difference in blood thiamine diphosphate levels between Swedish Caucasian patients with congestive heart failure treated with furosemide and patients without heart failure
Authors: YUE Q.‐Y. , BEERMANN B. , LINDSTRÖM B. , NYQUIST O.
Published: August 2010

Abstract. Yue Q‐Y, Beermann B, Lindstrom B, Nyquist 0 (Huddinge University Hospital, Huddinge, and the Medical Product Agency, Uppsala, Sweden). No difference in blood thiamine diphosphate levels between Swedish Caucasian patients with congestive heart failure treated with furosemide and patients without heart failure. Intern Med 1997; 242:49 1‐49 5.

Objectives: To determine whether furosemide treatment in congestive heart failure (CHF) patients is associated with thiamine deficiency.

Design: Patients without heart failure and without diuretic treatment were included to compare with patients with CHF belonging to New York Heart Association (NYHA) functional class I1 and 111‐IV, respectively, and receiving furosemide therapy.

Setting: All patients were recruited from the emergency ward of the cardiology section, Huddinge University Hospital, where they were admitted due to CHF or acute myocardial infarction.

Subjects: Ninety‐nine patients were included from whom a blood sample was taken, as well as routine admission blood samples for the analysis of thiamine diphosphate (TPP)

concentrations: Patients taking vitamin preparations were excluded.

Main outcome measures: Blood TPP concentrations were measured by high performance liquid chromatography (HPLC) and compared between the patient groups by the use of ANOVA.

Results: No significant difference was found between the groups in blood TPP concentrations.

Conclusions: Thiamine deficiency may not be a complication of furosemide treatment in the studied Swedish patient population.
Bone mass and riks factors for bone los in perimenopausal Danish women
Authors: BROT C. , JENSEN L. B. , SØRENSEN O. H.
Published: August 2010

Abstract. Brot C, Jensen LB, Smensen OH (Copenhagen Municipal Hospital, Copenhagen, Denmark). Bone mass and risk factors for bone loss in perimenopausal Danish women

Objectives: To determine risk factors for low bone mass at menopause and risk factors for subsequent bone loss in the following period.

Design: A cross‐sectional study and a 2‐year prospective follow‐up.

Setting: The catchment area of Sundby Hospital in Copenhagen.

Subjects: Four hundred and thirty‐three women aged 45–58 years, with amenorrhea for 3–24 months, of whom 87 were followed for a 2‐year period.

Measurements: Registration of life‐style and anthropometric variables, reproductive history, and family history of fractures. Total body bone mineral content (BMC) was measured with dual energy X‐ray absorptiometry.

Results: By means of multiple regression analysis height, body weight, and length of reproductive period were found to be positively related to whole body BMC (P < 0.001), whilst a negative relationship was found to age (P < 0.001), smoking (P < 0.001), and family history of fractures (P < 0.005).

In the longitudinal study, only body weight at the inclusion (P = 0.005) and subsequent changes in body weight and fat mass (P < 0.001) were related to the changes in bone mass.

Conclusion: The most significant predictors for bone loss were changes in body weight and fat mass. Hence, weight loss is a risk factor for bone loss in the early postmenopausal period, whereas weight gain seems to preserve bone.
Ethical aspects of clinical trials: the attitudes of participants in two non‐cancer trials
Authors: Madsen S. M. , Holm S. , Davidsen B. , Munkholm P. , Schlichting P. , Riis P.
Published: August 2010

Abstract. Madsen SM, Holm S, Davidsen B, Munkholm P, Schlichting P, Riis P (Copenhagen University Hospital in Herlev, Slagelse County Hospital, Slagelse, Hvidovre Hospital, University of Copenhagen, Denmark and University of Manchester, UK). Ethical aspects of clinical trials: the attitudes of participants in two non‐cancer trials. J Intern Med 2000; 248: 463–474.

Objectives. To investigate attitudes to clinical trials in non‐cancer trial participants.

Design. Questionnaires at entry, during, and after participation in a clinical study.

Setting. Participants in: (i) ROC: a clinical study comparing systemic interferon‐α‐2A treatment vs. prednisolone enemas in ulcerative colitis; and (ii) MRCRUC: a clinical study investigating low‐field magnetic resonance imaging as a new modality for the evaluation of patients with inflammatory bowel disease.

Subjects. Thirty‐two patients in ROC and 47 patients in MRCRUC.

Outcome measures. Attitudes towards different aspects of clinical research.

Results. The majority found scientific testing of clinical methods necessary, having positive attitudes towards both participation by themselves and others. The creation of a personal moral problem by denying participation was rejected by a large majority, and still both personal and altruistic motives for participation were highly rated. An important motive for accepting inclusion was the expectation of being ‘a special patient’ during the trial. The presence of research ethics committees controlling clinical research had a significant positive impact on decisions to participate, and drawing lots and blinding were found problematic by only a minority. Patients valued their satisfaction with participation in the trials highly, and would almost all accept a request to participate in future trials. The most important reason for this was a feeling of receiving better care and information than expected outside a trial setting, primarily determined by the patients seeing only one physician during the trials. A pronounced wish to obtain follow‐up information was expressed.

Conclusion. Attitudes towards medical research are positive with both altruistic and nonaltruistic motives for participation. Expectations of being treated as ‘a special patient’ in the trial were important in accepting to participate. Seeing the same physician at control visits was an important factor for satisfaction with participation.
Cardiovascular disease and risk factors in persons with  type 2 diabetes diagnosed in a large population screening:  The Nord‐Trøndelag Diabetes Study, Norway
Authors: Claudi T. , Midthjell K. , Holmen J. , Fougner K. , Krüger Ø. , Wiseth R.
Published: August 2010

Abstract. Claudi T, Midthjell K, Holmen J, Fougner K, Krüger Ø, Wiseth R (University of Tromsø/Rønvik Health Center, Bodø; National Institute of Public Health, Community Medicine Research Unit, Verdal; University Hospital of Trondheim; and Norwegian University of Science and Technology, Trondheim, Norway). Cardiovascular disease and risk factors in persons with type 2 diabetes diagnosed in a large population screening: The Nord‐Trøndelag Diabetes Study, Norway. J Intern Med 2000; 248: 493–501.

Objective. To study cardiovascular status and risk factors in persons with newly diagnosed type 2 diabetes and controls in a large population.

Design. Case–control study.

Setting. Population screening

Subjects. The screening of 74 499 individuals (88.1%), aged 20 years and older, in Nord‐Trøndelag County, Norway, during 1984–86 detected 428 persons with undiagnosed diabetes according to the 1980 WHO criteria, of whom 205 attended a clinical follow‐up examination assessing cardiovascular status and risk factors.

Methods. For each of 205 cases, one control person matched by age and sex underwent the same clinical examination. Lipids, body mass index, waist/hip ratio, blood pressure, pulse rate, blood pressure medication, kidney function, cardiovascular disease, family history and lifestyle were recorded.

Results. At the screening prior to the diagnosis of diabetes, those with diabetes reported poorer general health, less physical activity, more siblings with diabetes and more frequent use of antihypertensive medication. They had higher body mass index, systolic and diastolic blood pressure and pulse rate compared with controls. At the clinical evaluation, diabetics had higher urine albumin levels, increased waist/hip ratio, and higher total cholesterol/HDL cholesterol ratios than the controls. They also reported a greater incidence of angina pectoris and had more ECG changes.

Conclusions. Diabetics presented with more cardiovascular risk factors, angina pectoris and ECG changes than the controls, and they had an established metabolic syndrome more often than controls. These results suggest that prevention of cardiovascular disease in diabetics requires earlier diagnosis of the diabetes.
A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome
Authors: Zakynthinos E. G. , Vassilakopoulos T. , Kontogianni D. D. , Roussos C. , Zakynthinos S. G.
Published: August 2010

Abstract Zakynthinos EG, Vassilakopoulos T, Kontogianni DD, Roussos C, Zakynthinos SG (Department of Critical Care and Pulmonary Services, University of Athens Medical School, ‘Evangelismos’ Hospital, Athens, Greece). A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome (Case Report). J Intern Med 2000; 248: 521–526.

We describe a previously healthy 28‐year‐old woman who presented with the clinical picture of large vessel occlusions (stroke with left hemiparesis, myocardial infarction) and developed multi‐organ failure (i.e. kidneys, heart, brain, liver, blood, skin) over a very short period of time. Peripheral blood smear was consistent with thrombotic thrombocytopenic purpura. Transesophageal echocardiogram was supportive of the diagnosis of catastrophic antiphospholipid syndrome (CAPS), revealing Libman–Sacks endocarditis. Blood cultures were negative, anticardiolipin antibodies were highly increased and lupus anticoagulant was positive. Cerebral and coronary angiograms were negative, suggesting possible microthrombotic occlusive disease in the setting of CAPS.
Prevention of cardiovascular disease and diabetes: lessons from the Malmö Preventive Project
Authors: Nilsson P. , Berglund G.
Published: August 2010

Abstract. Nilsson P, Berglund G (University Hospital, Malmö, Sweden). Prevention of cardiovascular disease and diabetes – lessons from the Malmö Preventive Project (Review). J Intern Med 2000; 248: 455–462.

Major public health problems such as cardiovascular disease and type 2 diabetes pose a challenge to both the medical profession and the health care system of most Western countries. In spite of widespread knowledge about risk factors and pathophysiological processes, it has been difficult to find effective preventive mass strategies based on evidence from controlled clincial trials. In the Malmö Preventive Project, Sweden, 33 346 subjects were screened for risk factors between 1974 and 1992, and a quarter of them were offered preventive help for cardiovascular disease risk or alcohol abuse. The overall finding of the project was that benefits of screening and prevention on mortality risk could only be shown in certain subgroups of younger men and women, not in the total screened cohort, as compared with a nonscreened reference population. These findings therefore question the effectiveness of preventive methods and drugs used during previous decades. New preventive methods are therefore needed and should be properly evaluated to form a basis for evidence‐based prevention (EBP) in cardiovascular medicine.
Cardiovascular disease in type 2 diabetes: challenge for treatment and prevention
Authors: Laakso M.
Published: August 2010

Abstract. Laakso M (University of Kuopio, Kuopio, Finland). Cardiovascular disease in type 2 diabetes: challenge for treatment and prevention (Review). J Intern Med 2001; 249: 225–235.

Type 2 diabetes increases the risk of cardiovascular disease (CVD) two‐ to fourfold compared with the risk in non‐diabetic subjects. Although type 2 diabetes is associated with a clustering of risk factors (small, dense low‐density lipoprotein [LDL] particles, low high‐density lipoprotein [HDL] cholesterol, high triglycerides, elevated blood pressure, obesity, central obesity, hyperinsulinaemia, hyperglycaemia, etc.), the cause for an excess risk of CVD remains unknown. Recent drug treatment trials have indicated that the lowering of total and LDL cholesterol and blood pressure is similarly beneficial in diabetic and non‐diabetic subjects. The treatment of hyperglycaemia reduces micro‐ and macrovascular complications in type 2 diabetic patients. Beta‐blocking agents, angiotensin‐converting enzyme inhibitors, aspirin, and thrombolytic therapy are also effective in the treatment of CVD amongst diabetic patients.
Blood pressure in diabetic nephropathy – current controversies
Authors: Ritz E. , Rychlík I. , Schömig M. , Wagner J.
Published: August 2010

Abstract. Ritz E, Rychlík I, Schömig M, Wagner J (Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany). Blood pressure in diabetic nephropathy – current controversies (Review). J Intern Med 2001; 249: 215–223.

Hypertension has been recognized as an early and constant feature of diabetic nephropathy, but recent studies also suggest that a genetic predisposition to hypertension is an important risk factor for diabetic nephropathy. Antihypertensive treatment attenuates progression in diabetic nephropathy, but there is increasing evidence that very early treatment and very low target blood pressures should be implemented. There is also evidence for local activation of the renin system in the kidney as a result of hyperglycaemia. Apart from blood pressure, proteinuria should be monitored and dosing of ACE inhibitors should be guided, also by reduction of protein excretion.
Metaiodobenzylguanidine (MIBG) scintigraphy and computed tomography (CT) in clinical practice. Primary and secondary evaluation for localization of phaeochromocytomas
Authors: Berglund A. Scott , Hulthén U. L. , Manhem P. , Thorsson O. , Wollmer P. , Törnquist C.
Published: August 2010

Abstract. Scott Berglund A, Lennart Hulthén U, Manhem P, Thorsson O, Wollmer P, Törnquist C (Malmö University Hospital, Malmö, Sweden). Metaiodobenzylguanidine scintigraphy and computed tomography in clinical practice. Primary and secondary evaluation for localization of phaeochromocytomas. J Intern Med 2001; 249: 247–251.

Objective. To determine the diagnostic value of metaiodobenzylguanidine (MIBG) scintigraphy compared with computed tomography (CT) for the localization of phaeochromocytomas in clinical practice.

Design. Retrospective comparison between MIBG scintigrams and CT for localization of phaeochromocytomas in all patients successively examined with MIBG scintigraphy in Malmö from 1984 until January 1997.

Setting. Malmö University Hospital, Sweden.

Subjects. Sixty‐four patients with clinically suspected phaeochromocytomas.

Main outcome measures. MIBG scintigrams and CTs classified as positive or negative based on original interpretations (primary evaluation) and in a secondary evaluation by one blinded examiner are assessed through histological confirmation or clinical rule out of phaeochromocytomas.

Results. Twenty‐five patients had surgically removed phaeochromocytomas. The remaining 39 patients had no proof of phaeochromocytomas. In the secondary evaluation, sensitivity for MIBG scintigraphy was 88% (22/25) and for CT was 100% (25/25). The specificity for MIBG scintigraphy was 89% (35/39) but only 50% for CT (18/36). Two out of a total of six extra‐adrenal tumours were amongst the false‐negative MIBG scintigrams.

Conclusions. MIBG scintigraphy for the localization of phaeochromocytomas is superior to CT as far as specificity, whereas CT has a higher sensitivity. After biochemical diagnosis, CT will detect most phaeochromocytomas. MIBG scintigraphy can be of value in patients who show inconclusive results with biochemical testing and CT.
Should patients with hypertension receive antithrombotic therapy?
Authors: Lip G. Y. H. , Edmunds E. , Beevers D. G.
Published: August 2010

Abstract. Lip GYH, Edmunds E, Beevers DG (City Hospital, Birmingham, UK). Should patients with hypertension receive antithrombotic therapy? (Review). J Intern Med 2001; 249: 205–214.

The main complications of hypertension, i.e. coronary heart disease, ischaemic strokes and peripheral vascular disease (PVD), are usually related to thrombosis. Increasing evidence also suggests that hypertension fulfils the components of Virchow’s triad, thus conferring a prothrombotic or hypercoagulable state, as evident by abnormalities of haemostasis, platelets and endothelial function. It therefore seems plausible that use of antithrombotic therapy may help prevent these thrombosis‐related complications of hypertension.

Indeed, hypertensive patients with an estimated 10‐year CHD risk ≥ 15% will have their cardiovascular risk reduced by 25% using antihypertensive treatment, but the addition of aspirin further reduces major cardiovascular events by 15%. Recent guidelines recommend the use of aspirin 75 mg daily for hypertensive patients who have no contraindication to aspirin, in one of the following categories: (i) secondary prevention – cardiovascular complications (myocardial infarction, angina, non‐haemorrhagic stroke, peripheral vascular disease or atherosclerotic renovascular disease); and (ii) primary prevention – those with blood pressure controlled to < 150/90 mmHg and one of: (a) age ≥ 50 years and target organ damage (e.g. LVH, renal impairment, or proteinuria); (b) a 10‐year CHD risk ≥ 15%; or (c) type II diabetes mellitus. However, some of the risks of aspirin administration, namely increased incidence of major bleeding events, may possibly outweigh the benefits, especially in low‐risk individuals.
Heart failure in the general population of men – morbidity, risk factors and prognosis
Authors: Wilhelmsen L. , Rosengren A. , Eriksson H. , Lappas G.
Published: August 2010

Abstract. Wilhelmsen L, Rosengren A, Eriksson H, Lappas G (Göteborg University, Göteborg, Sweden). Heart failure in the general population of men – morbidity, risk factors and prognosis.J Intern Med2001;249:253–261.

Aims. To analyse the prevalence, aetiology and prognosis of heart failure.

Methods and results. A random population sample of men (n=7495) was examined at baseline in 1970–73 and followed until 1996. During up to 27 years, 937 men were hospitalized for heart failure. For the statistical analysis, odds ratios and 95% confidence intervals, multivariate logistic regression and time‐dependent Cox analysis were used. The incidence rate was 2.1, 9.1 and 11.5 per 1000 person‐years in the age groups 55–64, 65–74 and 75–79, and the prevalences were 0.6, 2.8 and 6.2%, respectively. Valvular heart disease was the aetiology in 5.8%, coronary heart disease only or in combination with hypertension in 58.8%, and hypertension only in 20.3%, and various combinations with diabetes in 4.5%. Of the remaining 12.1%, 96% were smokers and 64% were registered for alcohol abuse. Risk factors were increasing age, myocardial infarction in the family, diabetes mellitus, chest pain, tobacco smoking, high coffee consumption, alcohol abuse, high body mass index, high blood pressure as well as treatment for hypertension, but not high total cholesterol or psychological stress. Mortality after the diagnosis was increased eight times.

Conclusions. Coronary heart disease and hypertension were the most common concomitant diseases. Risk factors were similar to those in coronary heart disease, and also alcohol abuse, but not high total cholesterol, low physical activity or psychological stress. Mortality was high.
Effective blood pressure treatment improves LDL‐cholesterol susceptibility to oxidation in patients with essential hypertension
Authors: Quiñones‐Galvan A. , Pucciarelli A. , Fratta‐Pasini A. , Garbin U. , Franzoni F. , Galetta F. , Natali A. , Cominacini L. , Ferrannini E.
Published: August 2010

Abstract. Quiñones‐Galvan A, Pucciarelli A, Fratta‐Pasini A, Garbin U, Franzoni F, Galetta F, Natali A, Cominacini L, Ferrannini E (University of Pisa; and Istituto di Semeiotica Medica, University of Verona, Italy). Effective blood pressure treatment improves LDL‐cholestrol susceptibility to oxidation in patients with essential hypertension. J Intern Med 2001; 250: 322–326.

Objectives. LDL‐cholesterol particles from hypertensive patients exhibit enhanced susceptibility to in vitro oxidation, an abnormality thought to increase cardiovascular risk. We tested whether blood pressure (BP) normalization can reverse this abnormality.

Design. Double‐blind, randomized pharmacological intervention trial.

Setting. Clinical research centre.

Subjects. A total of 29 nondiabetic, normolipidaemic patients with essential hypertension (BP= 151 ± 3/99 ± 1 mmHg) and 11 normotensive controls (BP=125 ± 3/85 ± 1 mmHg) matched for gender, age, obesity, glucose tolerance and lipid profile.

Intervention. Anti‐hypertensive treatment for 3 months with a calcium‐antagonist in randomized combination with either an ACE inhibitor or a β‐blocker.

Main outcome measures. Lag phase of copper‐induced LDL oxidation, cell‐mediated (human umbilical vein endothelium) generation of malondialdehyde (MDA) by LDL and vitamin E content in LDL.

Results. At baseline in hypertensives versus controls, lag phase was shorter (89 ± 3 vs. 107 ± 6 min, P < 0.04), MDA generation was higher (5.8 ± 0.1 vs. 5.1 ± 0.2 nmol L–1, P=0.002), and vitamin E was reduced (6.40 ± 0.05 vs. 6.67 ± 0.11 μg mg–1, P=0.03). At 3 months, BP was normalized (124 ± 3/81 ± 1, P < 0.0001 vs. baseline, P=ns versus controls), lag phase was prolonged (to 98 ± 3 min, P=0.0005), MDA generation was reduced (5.6 ± 0.1 nmol L–1, P = 0.001), and vitamin E was increased (6.53 ± 0.05 μg mg–1, P=0.003), with no significant differences between the randomized groups.

Conclusions. In nondiabetic, nonobese, normolipidaemic patients with essential hypertension, LDL susceptibility to copper‐ and cell‐mediated oxidation is increased. BP normalization is associated with a significant improvement, but not a full reversal, of this abnormality.
Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives
Authors: Bornschein S. , Förstl H. , Zilker T.
Published: August 2010

Abstract. Bornschein S, Förstl H, Zilker T (Technische Universität München, München, Germany). Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives. J Intern Med 2001; 250: 309–321.

Idiopathic environmental intolerances (IEI)/multiple chemical sensitivity (MCS) is characterized by various somatic symptoms which cannot be explained organically, but are attributed to the influences of toxic environmental chemicals in low, usually harmless doses. In the absence of a widely accepted definition of IEI, contradictory aetiological hypotheses and therapeutic suggestions are discussed. Some authors doubt the existence of IEI/MCS as a disease entity of its own. The label IEI does not implicate neither a diagnosis of somatic disease nor that it is caused by an avoidable exposure. Many IEI patients suffer from psychiatric diseases. A majority of them can be diagnosed as somatoform disorders. Consequently, psychiatric therapies could be effective. This review describes the current knowledge about IEI/MCS, outlines a diagnostic algorithm and a psychotherapeutic concept for variants of IEI understood as a somatoform disorder.
Factors influencing the relation between alcohol and mortality – with focus on wine
Authors: GRØNBÆK M.
Published: August 2010

Abstract. Grønbæk M (Kommunehospitalet, Copenhagen, Denmark). Factors influencing the relation between alcohol and mortality – with focus on wine (Review Article). J Intern Med 2001; 250: 291–308.

The impact of alcohol intake on mortality has been described in a large number of prospective population studies from many countries. Most have shown a J‐shaped relation between alcohol intake and subsequent mortality, indicating that there are both beneficial and harmful effects of ethanol on health. In exploring the French paradox, it has been suggested that wine may have beneficial effects additional to that of ethanol. Recently, several prospective population studies have supported this idea. However, it is also likely that the apparent additional beneficial effect of wine on health is confounding.
Fatal adverse drug events: the paradox of drug treatment
Authors: Buajordet I. , Ebbesen J. , Erikssen J. , Brørs O. , Hilberg T.
Published: August 2010

Abstract. Buajordet I, Ebbesen J, Erikssen J, Brørs O, Hilberg T (The Norwegian Medicines Agency, Oslo; Central Hospital of Akershus, Nordbyhagen; Ullevaal University Hospital and National Institute of Forensic Toxicology, Oslo, Norway). Fatal adverse drug events: the paradox of drug treatment. J Intern Med 2001; 250: 327–341.

Objective. Study patient characteristics, morbidity patterns and drug regimens associated with fatal adverse drug events (FADEs) amongst medical department inpatients.

Design. An observational, descriptive study using aggregated medical records, autopsies and pre and postmortem drug analyses.

Setting. A department of internal medicine at a Norwegian county hospital.

Subjects. All patients dying in the department over a 2‐year period.

Results. The incidence of FADEs were 18.2% (133/732). Compared with non‐FADE cases, FADE cases were older, used more drugs both on admission and at death, and had higher comorbidity (P < 0.001). Drugs suspected to cause or contribute to fatal outcome were mainly those used for treating chronic pulmonary diseases (terbutaline, theophylline), antithrombotic drugs (aspirin, warfarin, heparines) and drugs for treating coronary heart disease and heart failure (e.g. diuretics, nitrates, angiotensin converting enzymes (ACE) inhibitors, calcium channel blockers). Bronchodilatory drugs, antithrombotic drugs and cardiovascular drugs account for 26, 31 and 30 FADE cases, respectively. Patients dying from gastrointestinal diseases had the highest relative FADE occurrence (42%), cancer patients the lowest occurrence (4%). Serious drug–drug and drug–disease interactions were frequently suspected. Various degrees of inappropriateness in choice of drug, dosage or administration route were seen in 50% of FADE cases.

Conclusions. This study shows a high incidence of FADEs associated with high age, high comorbidity and polypharmacy, and partly to inappropriate drug prescribing or use. Treatments frequently associated with FADEs were bronchodilatory treatment of patients with both chronic obstructive lung disease and coronary heart disease, vasodilatory treatment in patient with endstage heart failure and the combination of several antithrombotic drugs. A systematic strategy is needed to avoid unnecessary adverse drug events (ADEs).
Prevalence of undiagnosed coeliac syndrome in osteoporotic women
Authors: Nuti R. , Martini G. , Valenti R. , Giovani S. , Salvadori S. , Avanzati A.
Published: August 2010

Abstract. Nuti R, Martini G, Valenti R, Giovani S, Salvadori S, Avanzati A (Institute of Internal Medicine, Metabolic Disease Unit, University of Siena, Siena, Italy). Prevalence of undiagnosed coeliac syndrome in osteoporotic women. J Intern Med 2001; 250: 361–366.

Objectives. The aims of the study were to quantify the prevalence of asymptomatic coeliac disease (CD) in a cohort of osteoporotic females, and to investigate the features of bone loss.

Design and subjects. We studied 255 women (mean age 66.6 ± 8.5 SD) with primary osteoporosis (WHO diagnostic criteria). After the first CD screening with the measure of serum IgG antigliadin antibodies (IgG‐AGA), 53 women showed a positive test: antibodies to tissue transglutaminase (TG‐ab) were subsequently determined to confirm the diagnosis of CD. Bone metabolism was evaluated by: serum and urinary calcium, serum and urinary phosphate, serum alkaline phosphatase, urinary crosslaps, serum 25(OH)D and serum parathyroid hormone.

Results. High levels of IgG‐AGA and TG‐ab were observed in 24 patients with a prevalence of serological disease of 9.4%. These women were characterized, in comparison with the other patients, by a statistically significant reduction in serum 25(OH)D (17.8 ± 7.2 vs. 55.1 ± 20.3 nmol L−1, P < 0.01) together with a significant increase of iPTH (65.1 ± 29.7 vs. 35.1 ± 20.0 pg mL−1; P < 0.01). Patients with high TG‐ab levels showed also slightly raised values of urinary crosslaps (288 ± 88 vs. 270 ± 90 μm mol−1 Cr). In IgG‐AG positive patients a statistically significant inverse correlation was found between 25(OH)D serum levels and log‐transformed TG‐ab values (r: –0.95, P < 0.001). Intestinal biopsies were obtained in 10 TG‐ab positive women and verified CD in six patients.

Conclusions. These data support the hypothesis that patients with undiagnosed celiac disease develop high remodelling processes related to calcium malabsorption, secondary hyperparathyroidism and unavailability of vitamin D with a consequent more marked bone loss.
Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement
Authors: CHOPARD P. , DÖRFFLER‐MELLY J. , HESS U. , WUILLEMIN W. A. , HAYOZ D. , GALLINO A. , BACHLI E. B. , CANOVA C. R. , ISENEGGER J. , RUBINO R. , BOUNAMEAUX H.
Published: August 2010

Aim of the study.  To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalized in eight Swiss medical hospitals.

Methods.  A cross‐sectional study of 1372 patients from eight Swiss hospitals was carried out. After exclusion of patients (275) given therapeutic anticoagulation, 1097 patients were audited. The adequacy of thromboprophylaxis was assessed by comparison with predefined explicit criteria.

Results.  Of 1097 patients, 542 (49.4%) received thromboprophylaxis. According to the explicit criteria, 644 (58.7%) should have been on prophylaxis (P < 0.001, when compared with the rate observed). The rate of prevention differed widely between hospitals (from 29.4 to 88.6%) with no difference between teaching and nonteaching hospitals. According to the explicit criteria, a substantial proportion (44.9%) of the patients who should have been treated were not. Conversely, 41.3% of the patients were unnecessarily treated.

Conclusions.  Even though the appropriateness of the explicit criteria used could be challenged, our data suggest that the current practice is associated with important uncertainty leading to both overuse and underuse of thromboprophylaxis in patients hospitalized in medical wards. More efforts are urgently needed to develop new or endorse existing explicit, evidence‐based criteria and guidelines for thromboprophylaxis in this population of patients.
Dietary habits after myocardial infarction – results from a cross‐sectional study
Authors: WALLSTRÖM P. , MATTISSON I. , TYDÉN P. , BERGLUND G. , JANZON L.
Published: August 2010

Objective.  Comparing habitual nutrient intakes in persons with a history of acute myocardial infarction (AMI), and age‐matched controls.

Design.  Cross‐sectional study.

Subjects.  Men and women (525 cases and 1890 matched controls), aged 47–73 years, of the population‐based Malmö Diet and Cancer cohort.

Methods.  Nutrient intakes were assessed by a validated modified diet history method. Body fatness was assessed by bioimpedance analysis. Case ascertainment was provided by national and regional registries. Men and women were analysed separately. Median time since AMI was 5.5 years in men and 3.8 years in women. Cases reported lower energy intakes (EIs) than controls, despite having similar basal metabolic rates. After adjustment for total EI, both male and female cases had lower fat intake and higher intake of several micronutrients, such as ascorbic acid, folate, and vitamin E, than controls, the difference being largest in men. Most of the cases reporting dietary change quoted ‘disease’ as their main reason for change. They had lower EI and lower energy‐adjusted intake of fat than other cases.

Conclusions.  Survivors of AMI reported dietary habits more in line with current recommendations, particularly those who afterwards reported having changed their dietary habits. The possible bias introduced by social desirability is discussed.
Homocysteine levels are not associated with cardiovascular autonomic function in elderly Caucasian subjects without or with type 2 diabetes mellitus: the Hoorn Study
Authors: SPOELSTRA‐DE MAN A. M. E. , SMULDERS Y. M. , DEKKER J. M. , HEINE R. J. , BOUTER L. M. , NIJPELS G. , STEHOUWER C. D. A.
Published: August 2010

Objective.  Homocysteine and cardiovascular autonomic function are both predictors of cardiovascular disease and death, particularly in patients with diabetes. The mechanism by which homocysteine causes disease is unknown. The objective of our study was to determine whether hyperhomocysteinaemia is associated with impaired cardiovascular autonomic function in an age‐, sex‐, and glucose tolerance‐stratified sample of an elderly Caucasian population.

Methods.  We studied 609 subjects, 252 with normal glucose metabolism, 173 with impaired glucose metabolism, and 184 with type 2 diabetes. Cardiac cycle duration (RR interval) and continuous finger arterial pressure were measured under three conditions: during (i) spontaneous breathing, (ii) six deep breaths over 1 min, and (iii) an active change in position from lying to standing. From these readings, 10 parameters of autonomic function were assessed (three Ewing tests, six heart rate variability tests and one test of baroreflex sensitivity). These 10 measurements were summarized in a single cardiovascular autonomic dysfunction score (CADS).

Results.  Comparing values of autonomic function measures in the lowest versus the highest quartile of homocysteine revealed no significant association between homocysteine level and autonomic function in the whole study group, nor in the individual glucose tolerance groups. Multiple adjustment for age, sex, waist‐to‐hip ratio, serum creatinine, use of antihypertensives and fasting insulin, confirmed this result. We found no evidence of effect modification of glucose tolerance status on the association between homocysteine and autonomic dysfunction (P for interaction for CADS = 0.79).

Conclusions.  There is no evidence for an association between homocysteine levels and cardiovascular autonomic function in either diabetic or nondiabetic subjects. Cardiovascular autonomic dysfunction does not help explain why hyperhomocysteinaemia is related to cardiovascular mortality.