bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them
Authors: Henderson Amanda , Van Eps Mary Ann , Pearson Kate , James Catherine , Henderson Peter , Osborne Yvonne
Published: September 2007

Title. ‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them

Aim.  This paper is a report of a study to explore what constitutes nurse–patient interactions and to ascertain patients’ perceptions of these interactions.

Background.  Nurses maintain patient integrity through caring practices. When patients feel disempowered or that their integrity is threatened they are more likely to make a complaint. When nurses develop a meaningful relationship with patients they recognize and address their concerns. It is increasingly identified in the literature that bureaucratic demands, including increased workloads and reduced staffing levels, result in situations where the development of a ‘close’ relationship is limited.

Method.  Data collection took two forms: twelve 4‐hour observation periods of nurse–patient interactions in one cubicle (of four patients) in a medical and a surgical ward concurrently over a 4‐week period; and questionnaires from inpatients of the two wards who were discharged during the 4‐week data collection period in 2005.

Findings.  Observation data showed that nurse–patient interactions were mostly friendly and informative. Opportunities to develop closeness were limited. Patients were mostly satisfied with interactions. The major source of dissatisfaction was when patients perceived that nurses were not readily available to respond to specific requests. Comparison of the observation and survey data indicated that patients still felt ‘cared for’ even when practices did not culminate in a ‘connected’ relationship.

Conclusion.  The findings suggest that patients believe that caring is demonstrated when nurses respond to specific requests. Patient satisfaction with the service is more likely to be improved if nurses can readily adapt their work to accommodate patients’ requests or, alternatively, communicate why these requests cannot be immediately addressed.
Burnout: co‐workers’ perceptions of signs preceding workmates’ burnout
Authors: Ericson‐Lidman Eva , Strandberg Gunilla
Published: September 2007

Title. Burnout: co‐workers’ perceptions of signs preceding workmates’ burnout

Aim. This paper is a report of a study to describe co‐workers’ perceptions of signs preceding workmates’ burnout.

Background. Burnout engenders emotional and economic suffering, both individual and societal. It is therefore important to learn to recognize early signs to prevent burnout and co‐workers, who have opportunities to recognize such signs, are valuable resources in this context.

Method. Fifteen interviews were conducted with nursing and medical staff in Sweden who had worked with a person who developed burnout. The interviews took place in 2004 and were analysed using a thematic content analysis. The narratives were obtained when co‐workers already knew that their workmates were on sick leave because of burnout or had left their employment after sick leave because of burnout.

Findings. The findings show that co‐workers retrospectively recalled a multiplicity of signs. They perceived that the people concerned were struggling to manage alone, showing self‐sacrifice, struggling to achieve unattainable goals, becoming distanced and isolated, and showing signs of falling apart.

Conclusions. Some of the signs preceding workmates’ burnout may be difficult to interpret as signs of burnout, because they may be regarded as qualities which are to some extent encouraged in the prevailing culture. The findings provide a complex picture of these signs that will hopefully increase our awareness of and ability to recognize such signs to facilitate the possibilities of our helping in time. The sub‐themes and themes in the present study may also serve as a basis for supervisors involved in supporting clinical staff.
Operational efficiency of health care in police custody suites: comparison of nursing and medical provision
Authors: Bond Patricia , Kingston Paul , Nevill Alan
Published: September 2007

Title. Operational efficiency of health care in police custody suites: comparison of nursing and medical provision

Aim.  This paper is a report of a study to examine the operational impact of a police custody nursing service on healthcare delivery in one police service in the north of England.

Background.  Medical practitioners, trained specifically for the role of forensic medical examiner, have traditionally provided forensic and custodial medical services. However, there is a trend for police authorities in the United Kingdom to replace forensic medical examiners with custody nurses. Restructuring health care in police custody suites to a multidisciplinary team approach is a practical response to the challenges faced by an overburdened service. However, very few evaluations of the impact of a nursing addition to forensic medical services have been published.

Method.  One nursing service was evaluated by comparing performance indicators over a 6‐months period with retrospective data from records of the traditional forensic medical examiner service. Data were extracted from 9000 calls made by the police for medical assistance across five police stations, and analysed for response and consultation times. Five custody nurses, 20 custody officers and six forensic medical examiners were also interviewed, and the study was conducted in 2003.

Findings.  In comparison to the traditional service, nurses demonstrated faster response times, comparable consultation times, and were perceived by custody staff as more approachable than their medical colleagues in providing handover information.

Conclusion.  As nurses take on the roles previously performed by medical colleagues, so it will become increasingly important to define role boundaries and assess the impact on the quality of care of detainees.
Caries management: technical solutions to biological problems or evidence‐based care?
Authors: Baelum V.
Published: September 2007

Summary  Caries‐related clinical decision‐making remains a centrepiece of clinical dentistry. However, the oral disease patterns are rapidly changing towards the better among major sections of the populations, most notably in the high‐income countries. The caries decline is well documented among children and younger adults, and is gradually seen to trickle into middle and old age as well. Although it is tempting for the dental profession to take the credit for this development, the evidence points in a different direction. The major contribution of dentistry seems primarily related to changes in the treatment philosophies towards a less interventionist approach. This review aims to spur a further change in the diagnostic and treatment criteria used in the management of dental caries for the benefit of the oral health status of our patients. We must come to terms with the fact that our traditional core skills, our manual dexterity and technical competence, have less to offer to oral health than we have been accustomed to think. The dental schools and the professional dental organizations must carry the responsibility for promoting the necessary changes in the caries related clinical decision‐making strategies to allow practicing dentists to provide appropriate oral health care to our populations.
Evolutionary consequences of human disturbance in a rainforest bird species from Central Africa
Authors: SMITH THOMAS B. , MILÁ BORJA , GRETHER GREGORY F. , SLABBEKOORN HANS , SEPIL IREM , BUERMANN WOLFGANG , SAATCHI SASSAN , POLLINGER JOHN P.
Published: September 2007

Relatively little attention has been directed towards understanding the impacts of human disturbance on evolutionary processes that produce and maintain biodiversity. Here, we examine the influence of anthropogenic habitat changes on traits typically associated with natural and sexual selection in the little greenbul (Andropadus virens), an African rainforest bird species. Using satellite remote‐sensing and field survey data, we classified habitats into nonhuman‐altered mature and human‐altered secondary forest. Mature rainforest consisted of pristine rainforest, with little or no human influence, and secondary forest was characterized by plantations of coffee and cacao and high human impacts. Andropadus virens abundance was higher in secondary forest, and populations inhabiting mature rainforest were significantly larger in wing and tarsus length and bill size; characters often correlated with fitness. To assess the extent to which characters important in sexual section and mate choice might be influenced by habitat change, we also examined differences in plumage colour and song. Plumage colour and the variance in plumage luminance were found to differ between forest types, and song duration was found to be significantly longer in mature forest. The possible adaptive significance of these differences in traits is discussed. Despite relatively high levels of gene flow across habitats, amplified fragment length polymorphism analysis revealed that a small proportion of high‐FST loci differentiated mature from secondary forest populations. These loci were significant outliers against neutral expectations in a simulation analysis, suggesting a role for divergent selection in differentiation across habitats. A distance‐based redundancy analysis further showed that forest type as defined by remote‐sensing variables was significantly associated with genetic dissimilarities between habitats, even when controlling for distance. The observed shifts in morphology, plumage and song were consistent with divergent selection on heritable variation, but a role for plasticity cannot be ruled out. Results suggest that anthropogenic habitat changes may have evolutionary consequences, with implications for conservation and restoration.
Plant reproductive systems and evolution during biological invasion
Authors: BARRETT SPENCER C. H. , COLAUTTI ROBERT I. , ECKERT CHRISTOPHER G.
Published: September 2007

Recent biological invasions provide opportunities to investigate microevolution during contemporary timescales. The tempo and scope of local adaptation will be determined by the intensity of natural selection and the amounts and kinds of genetic variation within populations. In flowering plants, genetic diversity is strongly affected by interactions between reproductive systems and stochastic forces associated with immigration history and range expansion. Here, we explore the significance of reproductive system diversity for contemporary evolution during plant invasion. We focus in particular on how reproductive modes influence the genetic consequences of long‐distance colonization and determine the likelihood of adaptive responses during invasion. In many clonal invaders, strong founder effects and restrictions on sexual reproduction limit opportunities for local adaptation. In contrast, adaptive changes to life‐history traits should be a general expectation in both outbreeding and inbreeding species. We provide evidence that evolutionary modifications to reproductive systems promote the colonizing ability of invading populations and that reproductive timing is an important target of selection during range expansion. Knowledge of the likelihood and speed at which local adaptation evolves in invasive plants will be particularly important for management practices when evolutionary changes enhance ecological opportunities and invasive spread.
Co‐phylogeography and comparative population genetics of the threatened Galápagos hawk and three ectoparasite species: ecology shapes population histories within parasite communities
Authors: WHITEMAN NOAH K. , KIMBALL REBECCA T. , PARKER PATRICIA G.
Published: September 2007

Comparative microevolutionary studies of multiple parasites occurring on a single host species can help shed light on the processes underlying parasite diversification. We compared the phylogeographical histories, population genetic structures and population divergence times of three co‐distributed and phylogenetically independent ectoparasitic insect species, including an amblyceran and an ischnoceran louse (Insecta: Phthiraptera), a hippoboscid fly (Insecta: Diptera) and their endemic avian host in the Galápagos Islands. The Galápagos hawk (Aves: Falconiformes:Buteo galapagoensis) is a recently arrived endemic lineage in the Galápagos Islands and its island populations are diverging evolutionarily. Each parasite species differed in relative dispersal ability and distribution within the host populations, which allowed us to make predictions about their degree of population genetic structure and whether they tracked host gene flow and colonization history among islands. To control for DNA region in comparisons across these phylogenetically distant taxa, we sequenced ~1 kb of homologous mitochondrial DNA from samples collected from all island populations of the host. Remarkably, the host was invariant across mitochondrial regions that were comparatively variable in each of the parasite species, to degrees consistent with differences in their natural histories. Differences in these natural history traits were predictably correlated with the evolutionary trajectories of each parasite species, including rates of interisland gene flow and tracking of hosts by parasites. Congruence between the population structures of the ischnoceran louse and the host suggests that the ischnoceran may yield insight into the cryptic evolutionary history of its endangered host, potentially aiding in its conservation management.
Phylogeography of the tree lizard,Urosaurus ornatus: responses of populations to past climate change
Authors: HAENEL G. J.
Published: September 2007

Isolation due to both geological barriers and range contractions during the Pleistocene glacial maxima has been an important cause of diversification of arid‐adapted species in the North American deserts. Tree lizards,Urosaurus ornatus, are distributed across much of the southwestern arid regions and can tolerate a wide range of environments. Thus, they may have avoided large‐scale shifts in distribution caused by Pleistocene climate change and any subsequent evolutionary impacts. Cytochromebsequences were sampled fromU. ornatusacross the northern part of their range to test if current structure of these populations resulted from post‐Pleistocene range expansion and habitat fragmentation, or prior geological isolation. Phylogenetic analyses found geographical structuring of populations consistent with a model of long‐term geographical isolation corresponding to each of the desert regions. The two post‐Pleistocene hypotheses were not well supported as estimated times of divergence predated the retreat of the last continental ice sheet. Populations in different regions were impacted by different processes. Southern populations ofU. ornatusappear to have remained largely independent of more derived northern and eastern populations during Pleistocene climate change, while populations in regions containing more derived populations showed evidence of more recent range expansion (Colorado Plateau). As populations ofU. ornatusattest to, the complex and dynamic history of the southwestern USA has left a deep‐rooted and multifaceted imprint on genetic and phylogeographical structure of the species living there.
Extreme population subdivision throughout a continuous range: phylogeography of Batrachoseps attenuatus (Caudata: Plethodontidae) in western North America
Authors: MARTÍNEZ–SOLANO IÑIGO , JOCKUSCH ELIZABETH L. , WAKE DAVID B.
Published: September 2007

Low‐vagility species with deep evolutionary histories are key to our understanding of the biogeographical history of geologically complex areas, such as the west coast of North America. We present a detailed study of the phylogeography of the salamander Batrachoseps attenuatus (Caudata: Plethodontidae) using sequences of the mitochondrial gene cob from 178 individuals sampled from throughout the species’ range. Sequences of three other mitochondrial genes (16S, cox1, nad4) and a nuclear gene (RAG‐1) were used to investigate the deeper evolutionary history of the species. We found high levels of genetic diversity and deep divergences within a mostly continuous distribution, with five genetically well‐differentiated and geographically structured mitochondrial DNA clades. Significant association between geographical and genetic distances within these clades suggests demographic stability, whereas Fu's FS tests suggest demographic expansions in three of them. Mantel tests identify two biogeographical barriers, the San Andreas Fault and the Sacramento–San Joaquin Delta, as important in the diversification of lineages. The timing of the main splitting events between intraspecific lineages was estimated by applying relaxed molecular clock methods combining several mutation rates and a fossil calibration. The earliest splitting events are old (Pliocene/Miocene), with more recent (Pleistocene) subdivisions in some clades. Disjunct populations distributed along the western foothills of the Sierra Nevada colonized this area relatively recently from a single refugium east of San Francisco Bay. The combination of fine‐scale, comprehensive sampling with phylogenetic, historical demographic and hypothesis‐based tests allowed delineation of a complex biogeographical scenario with general implications for the study of codistributed taxa.
Effects of cultivar mixtures on scab control in apple orchards
Authors: Didelot F. , Brun L. , Parisi L.
Published: September 2007

The effects of two mixtures of resistant and susceptible apple cultivars on the development of scab caused byVenturia inequaliswere observed in an experimental orchard over four years, initially for two years without fungicides against scab, and subsequently for two years with a moderate fungicide schedule. The row‐by‐row and within‐row mixtures included a susceptible cultivar and a resistant cultivar in equal proportions. Without fungicides, the results showed a significant reduction of disease incidence over both years (7·3 to 21·3%), and severity in the second year (35·4%) in the within‐row mixtures, compared to the monoculture of the susceptible cultivar. The best results were obtained when the within‐row mixture was associated with moderate fungicide treatments; in this case the reduction in disease incidence reached 75·1% on leaves and 69·7% on fruits during the growth phase. The characteristics of theVenturia inaequalis/Malus × domesticapathosystem and the results obtained in this experiment suggest a moderate but not negligible ability of cultivar mixtures for reducing epidemics of the disease.
PTPN22 gene polymorphism in Behçet’s disease
Authors: Sahin N. , Bicakcigil M. , Atagunduz P , Direskeneli H. , Saruhan‐Direskeneli G.
Published: September 2007

A functional single nucleotide polymorphism (SNP) of PTPN22 gene encoding the protein tyrosine phosphatase has been reported to be associated with autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus and type I diabetes. PTPN22 R620W polymorphism has a wide variation of allelic frequencies among different populations. This polymorphism is investigated in Turkish patients with Behçet’s disease (BD), a systemic vasculitis with immune activation. DNA samples from 134 patients with BD and 177 healthy controls are genotyped by polymerase chain reaction (PCR)–restriction fragment length polymorphism method for the SNP (rs2476601, A/G) of PTPN22 gene. Polymorphic region was amplified by PCR and digested with XcmI enzyme. The frequency of heterozygous genotype (AG) was 5.1% (9/177) in control group, whereas polymorphic allele was not present in the whole BD group (P = 0.012, OR 0.65, 95% confidence interval 0.0–1.1). Both the lower prevalence in the general population and the absence in BD show the limited role of PTPN22 polymorphism in the pathogenesis of autoimmunity in Turkey.
Bone marrow transplantation without conditioning regimen in Omenn syndrome: A case report
Authors: Mellouli Fethi , Torjmen Lamia , Ksouri Habib , Abdelkefi Abdelrahmen , Ladab Saloua , Barbouche Ridha , Othman Tarek Ben , Hassen Assia Ben , Bejaoui Mohamed
Published: September 2007

Abstract:  OS is a non‐SCID immunodeficiency characterized by a poor outcome even after BMT. We report here a case of BMT without preparative conditioning regimen, and with a successful engraftment in a five‐month‐old infant with OS. The patient was transplanted with 15 × 108 bone marrow mononuclear cells/kg, from his HLA matched brother, without preparative regimen and GVHD prophylaxis. Immunological status was assessed before and after the BMT, and the engraftment was monitored with microchimerism analysis. Six days after BMT, an acute GVHD involving first the skin, then the liver and gut, complicated the post‐transplantation course. An excellent engraftment was confirmed by donor chimerism over 95% respectively at day post‐transplantation 30, 60, 90, and 150. The cellular immunity of the patient was restored, and infectious complications decreased after BMT. Later the patient experienced chronic GVHD, and he died on day post‐transplantation 246 from GVHD. BMT without conditioning regimen for OS is feasible, but there must be a megadose cell transplantation, and appropriate prophylactic immunosuppressive treatment to prevent acute GVHD.
Increased Resistance of a Maize Mutant Lacking the 9‐Lipoxygenase Gene, ZmLOX3, to Root Rot Caused by Exserohilum pedicellatum
Authors: Isakeit T. , Gao X. , Kolomiets M.
Published: September 2007

Plant oxylipins, produced via the lipoxygenase (LOX) pathway, function as signals in defence and development. Previous research showed that maize (Zea mays L.) mutants lacking function of one of their 9‐LOX genes, ZmLOX3, had decreased levels of susceptibility to several fungal foliar pathogens. In this study, lox3‐4 mutants of maize displayed less root and mesocotyl necrosis caused by Exserohilum pedicellatum, when compared with the corresponding wild type near isogenic lines in three parent lines (B73, FR2128B and CML176B). These results further support the hypothesis that a specific plant 9‐LOX isoform mediates susceptibility of maize to fungal pathogens.
Cytoprotective effect of tauroursodeoxycholate on hepatocyte apoptosis induced by peroxisome proliferator‐activated receptor gamma ligand
Authors: Nonaka Michihiro , Tazuma Susumu , Hyogo Hideyuki , Kanno Keishi , Chayama Kazuaki
Published: September 2007

Background and Aim:  Peroxisome proliferator‐activated receptor gamma (PPARγ) ligands inhibit cell growth and induce apoptosis in various cancer cells. Bile acids are also known to cause hepatocyte apoptosis through nuclear receptor‐mediated mechanisms. The aim of this study was to examine the effect of two different bile acid species on the inhibitory action of PPARγ in cell growth with paying attention to the role of the mitogen‐activated protein kinase pathway as an underlying mechanism.

Methods:  Immortalized human hepatocytes (OUMS‐29) and hepatoma cells (HepG2 and Huh7) were incubated with troglitazone (TGZ), a PPARγ ligand with or without pre‐incubation of either hydrophobic glycochenodeoxycholate (GCDC) or hydrophilic tauroursodeoxycholate (TUDC).

Results:  TGZ induced cell apoptosis in all cell types, resulting in the reduction of cell viability. While pre‐incubation with GCDC enhanced the apoptotic effects of TGZ, TUDC significantly attenuated it. Both bile acids enhanced p38 and c‐Jun N‐terminal kinase (JNK) phosphorylation in a similar way, whereas there was more drastic enhancement of extracellular signal‐regulated kinase (ERK) 1/2 phosphorylation in the presence of TUDC compared to GCDC. In addition, ERK inhibitors suppressed the action of TUDC against apoptotic effect of TGZ.

Conclusion:  This study demonstrates that TUDC exhibits anti‐apoptotic and cytoprotective effects against TGZ‐induced cell apoptosis, presumably through the ERK signaling pathway. We speculate that the administration of TUDC might be one of the potential strategies for the hepatotoxicity caused by TGZ.
Prophylaxis with mesna prevents oxidative stress induced by ischemia reperfusion in the intestine via inhibition of nuclear factor‐κB activation
Authors: Ypsilantis Petros , Tentes Ioannis , Lambropoulou Maria , Anagnostopoulos Konstantinos , Papadopoulos Nikolaos , Kortsaris Alexandros , Simopoulos Constantinos
Published: September 2007

Background and Aim:  Mesna (2‐mercaptoethane‐sulfonate) has been shown to attenuate oxidative injury induced by ischemia reperfusion (I/R) in the kidneys, the liver, and the intestine; however, its mechanism of action has not been fully elucidated. We sought to determine a prophylactic admininstration schedule of mesna that would confer optimal antioxidant protection on the intestinal mucosa following I/R and to investigate whether mesna's action is mediated via inhibition of nuclear factor‐κB (NF‐κB) activity.

Methods:  Wistar rats were subjected to one of the following: (a) induction of 30 min ischemia followed by 60 min reperfusion (I30/R60) of the intestine, (b) pretreatment with intraperitoneal or oral mesna at various time‐ and dose‐ administration schedules plus I30/R60, (c) sham operation, (d) no operation (controls), or (e) oral mesna alone. At the end of the reperfusion period or at various time points after mesna alone administration, the oxidative state of the intestinal mucosa was assessed in terms of glutathione to glutathione disulfide ratio, malondialdehyde concentration, and superoxide dismutase activity. In addition, NF‐κB activity in the intestinal mucosa was assessed immunohistochemically in the oral mesna plus I/R and in the oral mesna alone groups.

Results:  Sham operation caused mild stress, while I/R caused substantial oxidative stress in the intestinal mucosa. Mesna pretreatment had an antioxidant effect which varied from attenuation to prevention of oxidative stress. Over the two routes of administration, the oral proved to be more effective and had a time‐ and dose‐ dependent effect. The antioxidant action of mesna was not related to enhancement of the intestinal mucosa oxidative state. Furthermore, I/R induced NF‐κB activation in the intestinal mucosa which was inhibited by mesna pretreatment. In the absence of oxidative damage, mesna led to downregulation of activated NF‐κB.

Conclusions:  Prophylaxis with mesna prevents oxidative stress induced by I/R in the intestine via inhibition of NF‐κB activation.
Adverse impact of pretransplant polyoma virus infection on renal allograft function
Authors: HAYAT ASHIK , MUKHOPADHYAY RATNA , RADHIKA SRINIVASAN , SACHDEVA MANUPDESH S , NADA RITAMBHRA , JOSHI KUSUM , SAKHUJA VINAY , JHA VIVEKANAND
Published: September 2007

Background:  BK polyoma virus (BKV) has emerged as an important cause of acute and chronic allograft injury in renal transplant recipients. Reactivation of latent infection requires reduction in cell‐mediated immunity. We hypothesized that BKV could get reactivated in the urinary tract of patients with end‐stage renal disease (ESRD) and impact the allograft function after these individuals undergo transplantation.

Methods:  We prospectively examined the urine specimens of 68 ESRD patients and their donors for BKV inclusion containing decoy cells with Papanicoulau staining and immunohistochemistry. Polymerase chain reaction was carried out to confirm the presence of viral DNA. Urine examination was repeated 3–9 months after transplantation and during episodes of graft dysfunction. All graft dysfunction episodes were investigated by biopsy. BKV‐associated nephropathy was confirmed by immunoperoxidase staining. Graft loss and doubling of serum creatinine were the study end‐points.

Results:  Decoy cells were detected in 22 ESRD patients and four donors (P < 0.0001). All 22 continued decoy cell excretion after transplantation and two fresh excreters were noted. Patients exhibiting decoy cells had more frequent graft dysfunction episodes (67% vs 30%, P = 0.003) and higher serum creatinine value (P < 0.001). About 33% patients achieved the combined end‐points in the BK viruria group, compared with 11% in the non‐decoy cell excreters (P = 0.03). Histologically proved BKV nephropathy was noted in 7% cases; all decoy cell excreters.

Conclusion:  We conclude that reactivation of latent BKV infection can occur in ESRD and confers an increased risk of graft dysfunction after transplantation. The mechanism of graft dysfunction in decoy cell excreters who do not develop overt nephropathy needs more studies.
Symptom dimensions and needs of care among patients with schizophrenia in hospital and the community
Authors: NAKANISHI MIHARU , SETOYA YUTARO , KODAKA MANAMI , MAKINO HAZUKI , NISHIMURA AKIO , YAMAUCHI KEITA , MIMURA MASARU , SATO HISAO , ARATA HIROSHI , YUKUMI HIDEFUMI , AMAGASA TAKASHI , UENO HIDEKI , MIYAMOTO YUKI , SUGIE TAKUYA , ANZAI NOBUO
Published: September 2007

Abstract  The purpose of the present paper was to examine the psychiatric symptom dimensions related to needs of care among patients with schizophrenia in hospital and in the community. Subjects were 217 patients with F2 ICD‐10 diagnoses. Hospital patients included 102 inpatients (47.0%) in psychiatric long‐term care units. Community patients included 115 outpatients (53.0%) living in their homes or residential facilities. Psychiatrists used the Brief Psychiatric Rating Scale (BPRS) to assess patients' psychiatric symptoms. Formal care providers assessed needs of care using a scale developed by the Committee on Case Management Guidelines for People with Mental Disabilities in Japan. Instrumental Activities of Daily Living (IADL) self‐performance and difficulty were also measured using a scale from the Minimum Data Set–Home Care (MDS‐HC). Multiple regression analyses were applied, using the symptom dimensions as dependent variables and needs of care as independent variables. Patient group (hospital or community) was also used as an independent variable. Hospital patients demonstrated more severe psychiatric symptoms and greater needs of care than community patients. Multiple regression analyses showed that the total needs of care were greater among male patients (B = 0.142, P = 0.005), hospital patients (B = 0.310, P < 0.001), patients with poor IADL self‐performance (B = 0.217, P = 0.047), and patients with severe negative symptoms (B = 0.240, P = 0.002; R2 = 0.515). The present results suggested an association between negative symptoms and needs of care in schizophrenia. Hospital patients had greater needs of care, even though their psychiatric symptoms were controlled for. Further research should examine the relationships between psychiatric symptoms and needs of care in a cohort study following patients when hospitalized and when living in the community.
Effects of loss from suicide, accidents, acute illness and chronic illness on bereaved spouses and parents in Japan: Their general health, depressive mood, and grief reaction
Authors: MIYABAYASHI SACHIE , YASUDA JIN
Published: September 2007

Abstract  To evaluate how the suddenness and unnaturalness of death affect general health, depression, and grief, a total of 215 responses to a questionnaire from the bereaved were analyzed. The respondents were divided into five groups: bereaved by suicide, accident, acute illness (<1 day from onset), shorter illness (<1 year from onset), and longer illness. Every sudden‐death group indicated averages higher than the clinical threshold on general health scale and depression scale. After statistically controlling for respondents' age, the deceased's age at death, and the months spent with the deceased, differences among groups appeared on all but the subscales of somatic symptoms and of anxiety and insomnia. The difference seemed more apparent on emotional reaction than on physical distress. On pairwise tests suicide was found to be the most distinctive bereavement.
Residential program for long‐term hospitalized persons with mental illness in Japan: Randomized controlled trial
Authors: CHAN HONG , INOUE SHIMPEI , SHIMODERA SHINJI , FUJITA HIROKAZU , FUKUZAWA KAE , KII MASARU , KAMIMURA NAOTO , KATO KUNIO , MINO YOSHIO
Published: September 2007

Abstract  Research on the merits of long‐term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO‐QOL) and General Health Questionnaire 12‐item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free‐time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one‐third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).
Birth order and sibling sex ratio in homosexual transsexual South Korean men: Effects of the male‐preference stopping rule
Authors: ZUCKER KENNETH J. , BLANCHARD RAY , KIM TAE‐SUK , PAE CHI‐UN , LEE CHUL
Published: September 2007

Abstract Two biodemographic variables – birth order and sibling sex ratio – have been examined in several Western samples of homosexual transsexual men. The results have consistently shown that homosexual transsexuals have a later birth order and come from sibships with an excess of brothers to sisters; the excess of brothers has been largely driven by the number of older brothers and hence has been termed the fraternal birth order effect. In the present study the birth order and sibling sex ratio were examined in an Asian sample of 43 homosexual transsexual men and 49 heterosexual control men from South Korea. Although the transsexual men had a significantly late birth order, so did the control men. Unlike Western samples, the Korean transsexuals had a significant excess of sisters, not brothers, as did the control men, and this was largely accounted for by older sisters. It is concluded that a male‐preference stopping rule governing parental reproductive behavior had a strong impact on these two biodemographic variables. Future studies that examine birth order and sibling sex ratio in non‐Western samples of transsexuals need to be vigilant for the influential role of stopping rules, including the one identified in the present study.
Sitting balance as an early predictor of functional improvement in association with depressive symptoms in stroke patients
Authors: HAMA SEIJI , YAMASHITA HIDEHISA , SHIGENOBU MASAYA , WATANABE ATSUKO , HIRAMOTO KEIKO , TAKIMOTO YASUO , ARAKAWA RYOZO , KURISU KAORU , YAMAWAKI SHIGETO , KITAOKA TAMOTSU
Published: September 2007

Abstract  The aim of the present study was to assess the relationship between sitting balance at an early stage and activities of daily living (ADL) function in 452 stroke patients. The effect of sitting balance on the two core elements of depression (apathy and depressive mood) was also examined. The ability to maintain a sitting position for 10 min (10‐min sitting balance) was assessed, along with ADL using the Functional Independence Measurement, and psychological status using the Zung Self‐rating Depression Scale (depressive mood), Apathy Scale (apathy) and Neuropsychiatric Inventory. Proportional‐hazards analysis was used to determine the independent effect of post‐stroke depression on functional outcome. Comparisons between sitting balance and psychological status were performed using logistic multiple regression analysis. Cox multiple regression analysis showed that significant differences were obtained for the sitting balance (P < 0.0002) and Mini‐Mental State Examination scores (P < 0.02) in all six ADL subscales, and for age in four of the six ADL subscales (Dressing–Upper Body and Dressing–Lower Body, Toileting, Walking). Kaplan–Meier survival curves for reaching independence in ADL subscales showed highly significantly differences in achievement rate and time to reach goal for each subgroup on 10‐min sitting balance (with or without assistance) and on age (young, <65; elderly, ≥65 years). Ten‐minute sitting balance correlated with depressive mood and apathy. A rapid and simple screening method, 10‐min sitting balance was related to scores for two core depressive symptoms, lowered mood and apathy, and was predictive of post‐stroke ADL outcomes in the rehabilitation unit along with age.
Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome
Authors: HAYASHIDA KENICHI , INOUE YUICHI , CHIBA SHINTARO , YAGI TOMOKO , URASHIMA MITSUYOSHI , HONDA YUTAKA , ITOH HIROSHI
Published: September 2007

Abstract  The aim of the present paper was to clarify the factors influencing subjective daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). Subjects included 230 adult male OSAS patients aged 20–73 years. Single and multiple linear regression analyses were performed to estimate the association between the Epworth Sleepiness Scale (ESS) and the following variables: Minnesota Multiphasic Personality Inventory (MMPI), Self‐Rating Depression Scale (SDS), age, body mass index (BMI), sleep duration during the preceding month and apnea–hypopnea index (AHI). Single linear regression analysis showed that age had a negative association with ESS score, while BMI, AHI, SDS, hypochondriasis (Hs), hysteria, psychopathic deviant, psychasthenia, schizophrenia and hypomania on the MMPI had a positive association with ESS score. However, the other remaining parameters such as nocturnal sleep duration during the preceding month, depression, masculinity–femininity, paranoia, social introversion on the MMPI had no statistical association with ESS score. Multiple linear regression analysis with stepwise elimination method was applied to choose the significant factors associated with ESS. It was found that three variables including age, AHI and Hs scores were independent factors influencing ESS score. The R2 for the model was 0.14, suggesting that these factors account for 14% of possible variance of subjective daytime sleepiness of OSAS patients. These results suggest that subjective daytime sleepiness in patients with OSAS may be influenced not only by the severity of respiratory disorder indices but also by certain personality characteristics affecting Hs score and by age.
Incessant non‐sustained ventricular tachycardia after stimulus of electroconvulsive therapy with atropine premedication?
Authors: KIM CHOL , YOKOZUKA MOTOI , SATO CHIYO , NAKANISHI KAZUHIRO , KITAMURA AKIRA , SAKAMOTO ATSUHIRO
Published: September 2007

Abstract  Electroconvulsive therapy (ECT) is an effective and safe treatment for a variety of neuropsychiatric disorders. Premedication with atropine has been recommended in order to avoid bradycardia and transient asystole induced by ECT. In contrast, some other arrhythmias can happen such as atrial flutter and fibrillation. But ventricular tachycardia is rare. Reported herein is a case of incessant non‐sustained ventricular tachycardia, possibly triggered by atropine premedication.
Fast onset of effect of budesonide/formoterol versus salmeterol/fluticasone and salbutamol in patients with chronic obstructive pulmonary disease and reversible airway obstruction
Authors: LINDBERG Anne , SZALAI Zsuzsanna , PULLERITS Teet , RADECZKY Eva
Published: September 2007

Background and objectives:  Data on the onset of action of COPD medications are lacking. This study compared the onset of bronchodilation following different inhaled therapies in patients with moderate‐to‐severe COPD and reversible airway obstruction.

Methods:  In this double‐blind, double‐dummy, crossover study, 90 patients (aged ≥40 years; FEV1 30–70% predicted) were randomized to a single dose (two inhalations) of budesonide/formoterol 160/4.5 μg, salmeterol/fluticasone 25/250 μg, salbutamol 100 μg or placebo (via pressurized metered‐dose inhalers) on four visits. The primary end‐point was change in FEV1 5 min after drug inhalation; secondary end‐points included inspiratory capacity (IC) and perception of onset of effect.

Results:  Budesonide/formoterol significantly improved FEV1 at 5 min compared with placebo (P < 0.0001) and salmeterol/fluticasone (P = 0.0001). Significant differences were first observed at 3 min. Onset of effect was similar with budesonide/formoterol and salbutamol. Improvements in FEV1 following active treatments were superior to placebo after 180 min (all P < 0.0001); both combinations were better than salbutamol at maintaining FEV1 improvements (P ≤ 0.0001) at 180 min. Active treatments improved IC at 15 and 185 min compared with placebo (P < 0.0001). Maximal IC was greater with budesonide/formoterol than salmeterol/fluticasone (P = 0.0184) at 65 min. Patients reported a positive response to the perceptions of the onset of effect question shortly after receiving active treatments (median time to onset 5 min for active treatments vs 20 min for placebo), with no significant difference between active treatments.

Conclusion:  Budesonide/formoterol has an onset of bronchodilatory effect in patients with COPD and reversible airway obstruction that is faster than salmeterol/fluticasone and similar to salbutamol.
Pulmonary lymphoma developed during long‐term methotrexate therapy for psoriasis
Authors: SUZUKI Manabu , HIRANO Satoshi , ITO Hideyuki , MATSUBARA Daisuke , KUBOTA Kazuo , TAKEDA Yuichiro , SUGIYAMA Haruhito , KOBAYASHI Nobuyuki , KUDO Koichiro
Published: September 2007

Low dose weekly administration of methotrexate has been thought to be effective for both rheumatoid arthritis (RA) and psoriasis. However, there is a possibility that methotrexate therapy may be oncogenic. This report presents a case of pulmonary lymphoma developed during long‐term methotrexate therapy for psoriasis. Physicians should be aware that Epstein–Barr virus‐associated lymphoproliferative disorders that occur during treatment with methotrexate are not specific to patients with RA.
Role of hemoglobin A1c, duration and puberty on bone mineral density in diabetic children
Authors: ÇAMURDAN M. ORHUN , CİAZ PEYAMİ , BİDECİ AYSUN , DEMİREL FATMA
Published: September 2007

Background: The aim of the present was to determine bone mineral density (BMD) in type 1 diabetic children and the roles of hemoglobin A1c, disease duration and pubertal stage on BMD changes.

Methods: Fifty‐eight patients were investigated: 16 had been newly diagnosed (DiabetesNew) and 42 were already on follow up (DiabetesFollow up). BMD of the lumbar vertebrae, HbA1c(HbA1clast), Ca, P, Mg were measured. Mean HbA1c of the previous year (HbA1c1year), the whole duration of diabetes (HbA1cwhole), and diabetic impact index (HbA1cwhole× diabetes duration) were calculated in the DiabetesFollow up group.

Results: Mean BMD‐Z score (−0.61 ± 0.99 g/cm2) of the whole group was significantly lower than zero. Osteopenia was present in 14 (24.1%), and osteoporosis in three (5.2%). HbA1cwhole was the most important determinant effecting BMD‐Z (r = −0.35, P < 0.05) with the cut‐off for osteopenia and osteoporosis being 9.8% and 12.1%, respectively. The cut‐off of diabetes duration for osteopenia was 3.6 years and it was more predictive for osteopenia compared to HbA1cwhole. In the DiabetesNew group, the BMD‐Z score of the early pubertal group was significantly lower than those in other pubertal groups.

Conclusion: BMD is affected in diabetic children, and HbA1cwhole and diabetes duration are the most important determinants. Pubertal stage is another determinant of BMD, especially in newly diagnosed patients.
Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland
Authors: GHARAVI BAHMAN , SCHOTT CLAUS , NELLE MATHIAS , REITER GERNOT , LINDERKAMP OTWIN
Published: September 2007

Background:  Painful invasive procedures are frequently performed on preterm infants admitted to a neonatal intensive care unit (NICU). The aim of the present study was to investigate current pain management in Austrian, German and Swiss NICU and to identify factors associated with improved pain management in preterm infants.

Methods:  A questionnaire was sent to all Austrian, German and Swiss pediatric hospitals with an NICU (n = 370). Pain assessment and documentation, use of analgesics for 13 painful procedures, presence of written guidelines for pain management and the use of 12 analgesics and sedatives were examined.

Results:  A total of 225 units responded (61%). Pain assessment and documentation and frequent analgesic therapy for painful procedures were performed more often in units using written guidelines for pain management and in those treating >50 preterm infants at <32 weeks of gestation per year. This was also the case for the use of opioid analgesics and sucrose solution. Non‐opioid analgesics were used more often in smaller units and in units with written guidelines. There was a broad variation in dosage of analgesics and sedatives within all groups.

Conclusion:  Pain assessment, documentation of pain and analgesic therapy are more frequently performed in NICU with written guidelines for pain management and in larger units with more than 50 preterm infants at <32 weeks of gestation per year.
Central corneal thickness among Aboriginal people attending eye clinics in remote South Australia
Authors: Durkin Shane R , Tan Edwin WH , Casson Robert J , Selva Dinesh , Newland Henry S
Published: September 2007

Abstract

Purpose:  To determine the central corneal thickness (CCT) and its demographic associations among Aboriginal people attending eye clinics in remote South Australia.

Methods:  A clinic‐based cross‐sectional study was conducted involving opportunistic sampling of patients. Eligible participants underwent measurement of CCT by ultrasound pachymetry. The results were compared with a group of Caucasian control patients.

Results:  All patients (189) who were invited to participate in the study had their CCT measured. The mean age was 44.8 ± 14.5 years, and women comprised 57.7% of the sample. The control group consisted of 115 Caucasian participants. The mean age was 47.1 ± 14.8 years, and women accounted for 55.7% of the sample. Mean CCT for Aboriginal participants was 514.9 ± 30.5 μm in the right eye and 515.6 ± 30.5 μm in the left eye (t = 1.1, P = 0.3). Mean right CCT for Caucasian participants was 544.6 ± 31.9 μm and mean left CCT in this group was 547.1 ± 32.2 μm (t = 4.6, P < 0.001). There was a significant difference between the right (t = 8.4, P < 0.001) and left (t = 8.8, P < 0.001) CCT of Aboriginal and Caucasian participants.

Conclusions:  The CCT among Aboriginal patients attending eye clinic in remote South Australia was significantly thinner than that of a Caucasian control group. Thinner corneas among this group of Aboriginal patients may indicate a need to adjust intraocular pressure according to CCT and to be more vigilant for glaucoma.