bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient anxiety in the accident and emergency department
Authors: BYRNE GERALDINE , HEYMAN ROBERT
Published: December 2007

Structured interviews were carried out with a sample of 96 patients to identify the sources of anxiety for patients in the accident and emergency (A & E) department.

Only two patients reported that they were not at all anxious about any aspect of being in A & E. The average number of anxieties reported was 69.

The most frequently reported anxieties were ‘not being able to carry on your usual activities’, ‘not knowing what will happen to you in the department’, ‘having to undergo an uncomfortable procedure’, ‘feeling pain’ and ‘not knowing what is wrong’.

The findings indicate that patients were as concerned with psychological and social aspects associated with admission as they were about psysical factors.

The authors suggest that it is essential for nurses in A & E to assess patients holistically and consider their psychological state and social circumstances as well as their physical condition. There is also a need for closer links to be developed between accident and emergency departments and other community health agencies and for more emphasis to be placed on referral to other bodies.
Implementation of clinical supervision in a medical department: nurses' views of the effects
Authors: BÉGAT INGRID B. E. , SEVERINSSON ELISABETH I. , BERGGREN INGELA B.
Published: December 2007

The purpose of this pilot study was to investigate nurses' views of the effects of clinical supervision in terms of its influence over their working situation, as well as their satisfaction with their working milieu.

The nurses who took part in an education programme and a clinical supervision programme worked on two wards in a medical clinic.

Nurses answered a questionnaire measuring the psychosocial environment.

Data were analysed by means of descriptive statistics.

Results showed that the nurses felt more confirmed in their work and more satisfied with the information given after 9 months of clinical supervision.

Results point to the need for further investigations concerning clinical supervision as a method of achieving job satisfaction among nurses.
Spousal caregiving in the institutional setting: visiting
Authors: ROSS MARGARET M. , ROSENTHAL CAROLYN J. , DAWSON PAMELA
Published: December 2007

The purpose of this study was to investigate the visiting experience of wives whose husbands had been admitted to a long‐term care institution.

The study employed a longitudinal and prospective design and combined qualitative and quantitative approaches.

The data were drawn from a larger study designed to explore the transition to quasi‐widowhood.

This article reports on one aspect of spousal caregiving following the admission of a husband to a long‐term care setting, i.e. visiting.

In this study, wives visited frequently. Their reasons for visiting included love and devotion, duty and obligation, the monitoring of husbands' well‐being and the provision of assistance to both husbands and staff. They engaged in task performance and social interaction during visiting. Their feelings of satisfaction and enjoyment with visiting were associated with their husbands' well‐being and feeling useful.

Over the 9‐month period of the study, two patterns of visiting and involvement emerged that were associated with different outcomes related to depression, morale and satisfaction with institutional dimensions of care.
The role of research in setting priorities for health care*
Authors: Lohr Kathleen N.
Published: December 2007

Research of all types plays a fundamental role in setting health care priorities, in part by informing the development of robust clinical practice guidelines. Today's investments in research may make tomorrow's choices about who gets what kinds of care easier, not more difficult. The converse also holds: today's investments in providing care, if made at the significant expense of research, will not make tomorrow's choices about care any easier. In making choices and balancing priorities, the centrality of health services research must be understood. The information necessary to make the hard choices about priorities in health care today may be generated as much, if not more, from investments in this field of inquiry as from equivalent investments in other arenas of scientific endeavour, because of the growing need for information about the effectiveness of health care services for use both in improving the quality of health care and in making better use of health resources.
The language of quality
Authors: Loughlin Michael
Published: December 2007

Management theorists have developed a language which, they claim, can be used to evaluate many diverse practices, including practices in health care. This language embodies conceptualizations of practice and an approach to evaluation which treat the concept of quality as foundational and which have links with free market ideology. Despite an extensive literature which attempts to apply this language to various areas of life, its fundamental conceptual assumptions remain largely unexamined. Without adequate philosophical arguments in support of these assumptions, the value of this language and the validity of the approach to practice that it embodies are unproven. Its imposition in the absence of such arguments therefore represents a form of intellectual imperialism. To understand and develop adequate responses to this situation, it is necessary to look at the broad political picture which affects the nature of debates in specific areas of practice, such as the health service, and to question the dominant paradigm governing practical debate in contemporary society.
Qualitative research in health care: I. The scope and validity of methods
Authors: Fitzpatrick Ray , Boulton Mary
Published: December 2007

It is increasingly argued that qualitative approaches have an important role in health care research. A wide range of methods are used to collect qualitative data, including in‐depth interviews, focus groups and observational methods such as participant observation. The reliability and validity of qualitative studies can be addressed by a variety of techniques. Although there is less consensus about appropriate methods of analysing qualitative data, such analyses tend to be grounded in the data, and involve iterative procedures and the development and refinement of typologies, analogies and other forms of concept to make sense of data.
The future of clinical research: from megatrials towards methodological rigour and representative sampling
Authors: Charlton Bruce G.
Published: December 2007

A powerful impetus behind the rise of the ‘megatrial’ (a large, simple, usually multi‐centred randomized controlled trial analysed by ‘intention to treat’) has been the desire for ever‐increasing precision in the measurement of therapeutic effectiveness. However, the demand for precision has been allowed to override other and more important methodological considerations. Megatrials have progressively abandoned the pursuit of scientifically rigorous experimentation, valid measurement and optimal epidemiological sampling in favour of recruiting and processing large numbers of subjects. This is a mistaken strategy which leads inevitably to error, because investigators are seeking a primarily statistical, rather than clinically or scientifically relevant, notion of exactness. We are now in a position to describe a clinical research strategy which offers many advantages over a megatrial‐led approach. Research should be planned with an awareness that the validity and applicability of estimates is more important than their numerical precision, and that this requires both an unselected denominator population database of all incident cases, and maximally controlled randomized trials and other studies. The Population‐Adjusted Clinical Epidemiology (PACE) strategy is suggested as exemplifying the twin principles of clinically useful research: rigorous science and representative epidemiology.
Judgements and processes in care decisions in acute medical and surgical wards
Authors: Lamond Dawn , Crow Rosemary A. , Chase Jonathan
Published: December 2007

The decisions which health care professionals make are the basis of treatment and care given. In order to evaluate effective care it seems logical to suggest that an awareness of the decisions which health care professionals make and how they make them is needed. This study examines the processes nurses use when making decisions about the health care needs of acutely ill patients. In stage one, 104 qualified nurses were interviewed to identify how they decide health care needs. In stage two, a ‘think aloud’ technique was used with patient simulations to obtain verbal protocols from a further 55 qualified nurses to identify the information strategies they used when making these decisions. The results suggest that nurses base their health care decisions mainly on their assessment of qualitative patient states or conditions. Initial indications are that the processes used differ from those characterized in the diagnostic reasoning model, with the context in which decisions are made being an important influence together with nurses' experience. It is suggested that, in order to develop effective predictive models and clinical guidelines which aid decision making, more research into the nature of health care professionals' decision making is carried out.
Comparison between the Health Belief Model and Subjective Expected Utility Theory: predicting incontinence prevention behaviour in postpartum women
Authors: Dolman Mary , Chase Jonathan
Published: December 2007

A small‐scale study was undertaken to test the relative predictive power of the Health Belief Model and Subjective Expected Utility Theory for the uptake of a behaviour (pelvic floor exercises) to reduce post‐partum urinary incontinence in primigravida females. A structured questionnaire was used to gather data relevant to both models from a sample of antenatal and postnatal primigravida women. Questions examined the perceived probability of becoming incontinent, the perceived (dis)utility of incontinence, the perceived probability of pelvic floor exercises preventing future urinary incontinence, the costs and benefits of performing pelvic floor exercises and sources of information and knowledge about incontinence. Multiple regression analysis focused on whether or not respondents intended to perform pelvic floor exercises and the factors influencing their decisions. Aggregated data were analysed to compare the Health Belief Model and Subjective Expected Utility Theory directly.
Assessing quality of care: what are the implications of the potential lack of sensitivity of outcome measures to differences in quality?
Authors: Mant Jonathan , Hicks Nicholas R.
Published: December 2007

Measuring outcome can be an insensitive way to detect differences in the quality of health care. This paper captures the implications of this poor sensitivity for the interpretation of studies of outcome that compare provider performance, and considers in what circumstances monitoring outcome might be useful. When interpreting studies, it is important to consider the size of the effect that a difference in the quality of care might be expected to have on outcome and whether it is likely that important differences in quality might not have been detected. It is argued that outcome measures may be of value when how you do something is as important as what you do, when process measures are invalid or impractical, and when the overall effectiveness of an intervention is critically dependent upon its complication rate.
Accuracy and reliability of assessment of severity of illness before and after an educational intervention
Authors: Shlels Christopher , Hutchlnson Allen , Eccles Martin , Gardiner Eric , Smoljanovlc Lada
Published: December 2007

Severity‐of‐illness measurement is considered to be an important factor in the risk adjustment of medical outcomes. However, for those measures that involve a high level of clinical judgment, strategies have to be developed to maximize the consistency of rating severity that can be implemented, especially when rating is based upon medical record review. A group of 25 clinicians were sent the same set of 14 patient records, and requested to use the Duke University Severity of Illness (DUSOI) checklist to rate the severity of patients' illness. Written instructions for the use of this instrument were provided. A short educational intervention was then made by the research team, and the clinicians were sent the same set of records to be rated again. Any improvement in the accuracy and reliability of severity assessment over the two ratings was then studied. The educational intervention resulted in identification of fewer irrelevant health problems. However, it had little impact upon the reliability of severity scoring itself, as measured by the intraclass correlation coefficient. Measuring severity of illness is a conceptually complex procedure. However, given its role in outcome interpretation, it may be worth pursuing strategies aimed at maximizing consistency of clinician rating. There are a number of options, including improved written instructions and more intensive training, that could be implemented.
A method of estimating tooth life expectancy
Authors: Kay Elizabeth , Locker David , Bllnkhorn Anthony
Published: December 2007

One of the most important outcome measures for dental services is the increase in tooth life expectancy which is brought about by the interventions provided. Thus, a convenient and accurate index of tooth survival is critical both to clinical decision making and to more general assessments of public dental health policies.

This paper describes a simple method of approximating tooth life expectancy (TLE). The method is based on the assumption that tooth survival follows a simple declining exponential function. Assuming a constant mortality rate, TLE is the integral of the survival function, expressed as S(t) = e‐μt, where t is time, and μ the constant mortality rate.

Using 3‐year tooth‐specific mortality rates for 491 subjects aged 50 years or more, tooth‐specific life expectancies for the population as a whole were found to range from 27 years for upper canines to 71 years for lower incisors. Individuals with a mean periodontal attachment loss greater than 4 mm and people on low incomes had significantly lower tooth life expectancies than their periodontally fit and more wealthy counterparts.

This technique can be used to obtain disease‐specific or intervention‐specific tooth life expectancies. Thus, gains in TLE for individuals with different oral, social and behavioural characteristics can be calculated. The declining exponential approximation of tooth life expectancy has the potential to become a powerful tool in the evaluation of dental services and treatments.
Medical technology assessment and the role of economic evaluation in health care
Authors: Adang E.M.M. , Ament A. , Dirksen C.D.
Published: December 2007

The growth in health care expenditure over the last few decades has necessitated the introduction of priority setting and decision making based on the results of critical evaluation. Medical technology assessment (MTA) is a valuable tool to assist policy makers in controlling existing and new medical technologies. Medical technology assessment and the role of economic evaluation as part of MTA are described, and various techniques of economic evaluation are discussed.
Using clinical audit to promote evidence‐based medicine and clinical effectiveness — an overview of one health authority's experience
Authors: Auplish Saroj
Published: December 2007

Health care purchasers are facing increasing pressure to make the best use of their limited resources and to purchase only those services known to be clinically effective. This paper describes one health authority's experience of promoting clinical effectiveness through clinical audit and clinical guidelines. It highlights the central role of public health physicians in working closely with clinicians on the one hand and managers on the other, to promote evidence‐based medicine. The recent changes in the funding arrangements for audit have allowed purchasers to have more say in what should be audited, and link audit and clinical effectiveness with contracts.
Reviewing and selecting outcome measures for use in routine practice
Authors: MPH Joanne Greenhalgh BSc , MPhil Andrew F. Long BA MSc , MSc Alison J. Brettle BA , BA Maria J. Grant
Published: December 2007

For the successful achievement of evidence‐based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re‐clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for use in routine care settings. Central features include the user‐centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence‐based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care.
Vulnerability to criminal exploitation: influence of interpersonal competence differences among people with mental retardation
Authors: Wilson C. , Seaman L , Nettelbeck T.
Published: December 2007

A study by Wilson & Brewer (1992) has indicated that people with mental retardation are at greater risk of having a crime committed against them than age‐matched cohorts from the general population. The present study was designed to test the hypothesis that this heightened vulnerability is partially explained in terms of behavioural shortcomings reflecting interpersonal competence. Twenty victims of crime and 20 nonvictims, all with mental retardation, were recruited so that means for age, adaptive behaviour and IQ were similar. Groups were compared on the Test of Interpersonal Competence and Personal Vulnerability (TICPV) developed for the present study. Results showed poorer interpersonal competence among the victims, indicating that victims had difficulty in deciding on the appropriate behaviour in some interactions. Performance on the test was shown to be internally consistent, stable over time and a valid measure of vulnerability. The study concluded with recommendations for more detailed investigation of the precise behaviours which influence risk as a first step in an attempt at remediation.
Autism in immigrants: a population‐based study from Swedish rural and urban areas
Authors: Gillberg I. C. , Gillberg C.
Published: December 2007

In a population study, 55 children aged 13 years and under were diagnosed as suffering from autistic disorder according to DSM‐III‐R criteria. Fifteen of these children (27%) were born to parents, at least one of whom had migrated to Sweden. These 15 cases were analysed in some detail with a view to finding possible background factors that could account for the relatively high prevalence of autism among some immigrant populations. In a few cases, autism or Asperger syndrome had been diagnosed in a native Swedish parent who went abroad in order to find a spouse. In several other cases, the child was the first child born in Sweden after the mother had moved there. The contribution of genetic and other prenatal factors to autism in immigrant populations is discussed.
Short‐term prognosis of depression in adults with Down's syndrome: association with thyroid status and effects on adaptive behaviour
Authors: Prasher V. P. , Hall W.
Published: December 2007

Findings for Down's syndrome adults with depression were compared to those for non–depressed Down's syndrome controls. Mean age of onset of depression was 30.1 years, the majority of subjects were female and biological more so than psychotic symptoms were presenting features. No statistically significant association between depression and thyroid dysfunction was found. For the depressed group, scores for level of adaptive functioning were significantly lower and those for maladaptive behaviour significantly higher. At one–year follow–up, although some improvement was found, the majority of depressed subjects were still symptomatic. The short‐term prognosis for depression in adults with Down's syndrome appears to be poor but possibly better the earlier the age of onset.
Ocular defects in children and adolescents with severe mental deficiency
Authors: Kwok S. K. , Ho P. C. P. , Chan A. K. H. , Gandhi S. R. , Urn D. S. C.
Published: December 2007

To assess the need for eye care in children and adolescents with severe mental deficiency, a cross‐sectional study of the prevalence and causes of ocular defects amongst these individuals was conducted. Two hundred and sixty residents in a mental handicap unit were examined from January 1992 to June 1993. It was found that there was an unusually high prevalence of severe visual impairment (25%), refractive errors (24%), squint (8%) and a number of organic ocular diseases (8%). All the patients studied were non‐verbal and 18% of them were deaf. Only 23 patients could walk. The results emphasize the need for establishing an efficient system to provide regular ophthalmic care for children with severe mental deficiency.
Comorbidity in people with Down's syndrome: a criteria‐based analysis
Authors: van Schrojenstein Lantman‐de Valk H. M. J. , Haveman M. J. , Crebolder H. F. J. M.
Published: December 2007

The aims of this study were to review what is currently known about comorbidity in people with Down's syndrome and to determine if their relative risk for certain disorders was increased. Analysis was carried out on the published literature from 1982 through 1994. In order to be included in this study, articles had to meet predetermined criteria. The strengths and weaknesses of the selected articles were considered in this review. The estimation of relative risks was done by calculating the odds ratio (OR). Odds ratios of >2 or <0.5 were found in more than one article for congenital heart defects, hypothyroidism, hearing Impairment and hepatitis B. Only one article indicated an OR within this range for all of the following disorders: obesity, epilepsy, degenerative spine disorders and a wide atlanto‐axial distance. The results were unclear in the areas of hyperthyroidism, visual disorders, dementia and psychiatric disorders. The concept of comorbidity, i.e. establishing the relationships between the various conditions in one person and understanding the implications for medical care, seems promising, especially for people with intellectual disability. Further work in this area may well improve the quality of care offered to these people.
Hepatitis C virus antibodies, viral RNA and genotypes in sera from patients on maintenance haemodialysis
Authors: Masuko K. , Okuda K. , Meguro T. , Murayama N. , Mitsui T. , Ohmori T. , Murata K. , Tsuda F. , Okamoto H.
Published: December 2007

SUMMARY. Patients on maintenance haemodialysis in four dialysis centres were tested for markers of hepatitis C virus (HCV) infection. Antibody to HCV (anti‐HCV) was detected by the second‐generation enzyme immunoassay in 142 (26%) of the 543 patients and HCV RNA in 117 (22%) of whom four were without detectable anti‐HCV in serum. Seventy‐seven (66%) were infected with HCV of genotype II/1b, 31 (27%) with genotype III/2a and eight (7%) with genotype IV/2b. in a distribution similar to that in blood donors who carried HCV asymptomatically. Haemodialysis patients had high HCV RNA titres comparable to those of patients with chronic hepatitis C. HCV RNA was detected in 96 (26%) of the 365 patients with a history of transfusion more frequently than in 21 (12%) of the 178 without previous transfusion (P<0.001). In transfused patients, frequencies of anti‐HCV and HCV RNA increased in parallel with the duration of haemodialysis. The frequency of anti‐HCV in non‐transfused patients, however, did not change appreciably with the duration of haemodialysis up to 22 years. The patients with anti‐HCV had a higher frequency of HCV RNA in serum than symptom‐free blood donors with anti‐HCV (113/142 or 80%vs 109/166 or 66%P<0.01) and the patients with HCV RNA had a lower frequency of elevated aminotransferase levels than blood donors with HCV RNA (5/113 or 4%vs 27/109 or 25%, P<0.00l). These results indicate that transfusion is a significant cause of HCV infection in patients on maintenance haemodialysis, and that these patients are prone to establish the HCV carrier state after infection.
Evidence that use of a second‐generation hepatitis C antibody assay prevents additional cases of transfusion‐transmitted hepatitis
Authors: Aoki S. K. , Kuramoto I. K. , Anderson S. , Schoening V. , Rodriguez R. , Fernando L. , Sazama K. , Holland P. V.
Published: December 2007

SUMMARY. The aim of this study was to determine if using hepatitis C antibody (anti‐HCV) enzyme immunoassay version 2.0 (EIA2) in addition to version 1.0 (EIA1) increased the safety of the blood supply. Blood non‐reactive by anti‐HCV EIA1 was transfused in 1990‐92. Stored samples from 40098 units, donated prior to 13 March 1992 were later tested by EIA2. For donor units reactive for anti‐HCV by EIA2. a recombinant immunoblot assay (RIBA2) was also carried out. In 63 cases, recipients of transfusions which were EIAZ negative or EIA2 reactive were tested for anti‐HCV and elevated alanine aminotransferase (ALT) levels 9‐1 2 months after transfusion: pretransfusion anti‐HCV status of recipients was unknown. Among these multitransfused patients receiving units that were negative by both EIA1 and EIA2, 1/26 (4%) had anti‐HCV. Among transfusion recipients of units negative by EIA1, but who received at least one unit reactive by EIA2,4/37 recipients (11%) were anti‐HCV reactive (P = 0.59). For the recipients of EIA2 reactive blood, when the donor unit was RIBA2 non‐reactive. 0/23 recipients were reactive by anti‐HCV. Among the recipients of a RIBA2 indeterminate unit, 1/10 recipients had anti‐HCV, but for patients who received at least one RIBA2 reactive unit, 3/4 recipients had anti‐HCV (P = 0.0 3). Hence. second‐generation anti‐HCV testing detected additional units capable of transmitting hepatitis C that were not detected by first‐generation testing. However, RIBA2 is a more specific method than EM2 for determining units capable of transmitting HCV.
Antibodies against hepatitis E virus in old world monkeys
Authors: Arankalle V. A. , Goverdhan M. K. , Banerjee K.
Published: December 2007

SUMMARY. To examine whether Indian monkeys are infected with hepatitis E virus (HEV) in nature, serum samples from wild rhesus (Macaca mullata), bonnet (M. radiata) and langur (Presbytes entellus) monkeys were screened for anti‐HEV IgG antibodies in recombinant antigen‐based ELISA assays. The positivity rates were 36.7%. 19.1% and 2% respectively. The protection of such antibodies against human HEV was studied in four rhesus monkeys. Of the two rhesus monkeys with anti‐HEV titres of 100 and 1000 respectively which were inoculated with the KOL‐91 strain of HEV, the former demonstrated a 10‐fold rise in anti‐HEV titres. Anti‐HEV titre in the second rhesus monkey remained unchanged. Neither of the monkeys showed any rise in serum alanine transaminase (ALT) or presence of virus in the faeces, as tested by polymerase chain reaction (PCR). Two other rhesus monkeys with anti‐HEV titres of 10000 and 100 respectively were inoculated with the AKL‐90 strain of HEV. Serum ALT levels and anti‐HEV titres remained unchanged in the first monkey. Excretion of virus in faeces was not noted (PCR). The second monkey developed a typical HEV infection. HEV infection could be produced in anti‐HEV negative control monkeys inoculated with both strains of HEV. These results show that either human or simian HEV, or a closely related agent, is circulating among Indian macaques. Titre‐dependent protection of naturally occurring anti‐HEV antibodies supports this view.
Influence of human immunodeficiency virus infection on hepatitis δ virus superinfection in chronic HBsAg carriers
Authors: Pol S. , Wesenfelde L. , Dubois F. , Roingeard P. , Carnot F. , Driss F. , Brechot C. , Goudeau A. , Berthelot P.
Published: December 2007

SUMMARY. It is generally agreed that hepatitis B virus (HBV) replication is reduced by hepatitis δ virus infection (HDV) and augmented by human immunodeficiency virus (HIV) infection. However, the precise nature of the interactions between HBV. HDV and HIV is controversial. The aim of this study was to evaluate the impact of HIV infection on HBV and HDV replication, and on histological scores during δ virus super‐infection in HDV‐positive. chronic carriers of hepatitis B surface antigen (HBsAg). We studied 38 men and six women, 15 of whom were HIV‐positive and all of whom had at least one marker of HDV infection. Serum hepatitis B e antigen (HBeAg), HBV DNA, HDV RNA, anti‐δ antigen antibodies (anti‐HD) IgM, anti‐HD IgG and hepatitis δ antigen (HDAg) were tested for in the serum and liver, respectively; anti‐hepatitis C virus (HCV) antibodies were detected using a second‐generation recombinant immunoblot assay. Histological specimens were scored blindly according to Knodell's classification for periportal and intralobular necrosis, portal inflammation and fibrosis. HBV DNA was detected more frequently in the HIV‐positive patients than in those who were HIV‐negative (25 vs 0% P = 0.01), while markers of HDV replication (serum anti‐HD IgM. serum HDV RNA and liver HDAg) were as frequent in the HIV‐positive patients (69%, 40% and 50% respectively) as in those who were HIV‐negative (75%, 52% and 30%. respectively; P>0.05). By contrast, 31% of the HIV‐positive patients were serum HDAg‐positive compared to only 6% of the HIV‐negative patients (P = 0.001). HDV antigenaemia and anti‐HD antibodies usually fluctuated in the HIV‐positive patients during follow‐up. The mean Knodell score was similar in the HIV‐positive (11.5 ± 3.2) and HIV‐negative (10.7 ± 2) subgroups, as was the mean semi‐quantitative index of hepatic necrosis, inflammation and fibrosis. Our results provide evidence that in HDV‐positive patients: (1) HIV infection counters the inhibitory effect of HDV superinfection on HBV replication; (2) serum anti‐HD IgM, HDV RNA and liver HDAg are not more frequent in HIV‐positive than in HIV‐negative patients, suggesting that HIV infection has no effect on HDV replication (although the significance of the increased frequency of HD antigenaemia remains unclear): (3) the histological severity of liver disease is not influenced by HIV status.
Comparative study of three doses of interferon‐α2a in chronic active hepatitis B
Authors: Thomas H. C. , Lok A. S. F. , Carreño V. , Farrell G. , Tanno H. , Perez V. , Dusheiko G. M. , Cooksley G. , Ryff J.‐C.
Published: December 2007

SUMMARY. To determine the efficacy of interferon‐α2a in chronic active hepatitis B, 238 patients were randomly divided, into four groups: three groups received either 2.5 MIU m‐2. 5.0 MIUm‐2 or 10.0 MIU m‐2, three times weekly by intramuscular injection for 12–24 weeks: and a control group received no treatment. Patients were followed for up to 12 months after treatment was discontinued. There was a statistically significant difference in response [clearance of hepatitis B e antigen (HBeAg) and hepatitis B viral DNA (HBV‐DNA)] between treated and untreated patients (3 7 vs 13%) but no statistically significant difference was seen between treatment groups (33% 34% and 43% for the 2.5, 5.0 and 10.0 MIU m‐2 groups, respectively). A transient rise in transaminases (seroconversion hepatitis) was seen in responders, but levels returned to within the normal range after response to treatment. In patients responding to interferon therapy there was a significant reduction in the severity of the hepatitis. Interferon‐α2a was generally well tolerated with respect to vital signs and laboratory parameters.
The seroepidemiology of hepatitis A virus infection in South African Chinese people
Authors: Song E. , Kew M. C.
Published: December 2007

SUMMARY. The age‐specific prevalence of antibody to hepatitis A virus (anti‐HAV) was determined in 949 Chinese people residing in South Africa in 1983–1985. This small community is comprised of original settlers from the mainland China province of Guandong, where hepatitis A virus infection is endemic, and their South African‐born descendants. The overall anti‐HAV prevalence (by radioimmunoassay) in South African Chinese people was 57.8%, was lowest in children aged 0–9 and 10–19 years (10.0% and 12.8%. respectively), and rose progressively with increasing age to a peak level of 96.6% in the sixth decade of life. A sharp rise in antibody prevalence to 82.9% was observed in the 30–39 year age group, suggesting a high level of child‐hood exposure at a time of socioeconomic development in South Africa. The age‐specific prevalences of anti‐HAV among young South African Chinese people are appreciably lower than those of mainland Chinese children, the majority of whom are infected by age 19 or 20 years. Their rates of infection are also much lower than those for Black South African children living under adverse sanitary conditions. This study indicates that a large proportion of South African Chinese children and adolescents are susceptible to HAV infection and should be included in a broader national vaccination programme.
Liver transplantation for acute and chronic viral hepatitis
Authors: Tibbs C. J. , Williams R.
Published: December 2007

Summary. Hepatotrophic viruses are responsible for a substantial proportion of cases of both end‐stage chronic liver disease and of acute liver failure which are treated by liver transplantation. We review here current practice in transplantation for viral‐induced liver disease addressing, in particular, the selection of patients for transplantation and the increasingly recognized problem of recurrent disease in liver grafts.
Inhibition of hepatitis B viral gene expression by antisense phosphorothioate oligodeoxynucleotides
Authors: YaO Z.‐Q. , Zhou Y.‐X. , Wang A.‐L. , Bai X.‐F. , Yang W.‐S.
Published: December 2007

Summary. The inhibitory effect of antisense phosphorothioate oligodeoxyribonucleotides (S‐oligos) on the production of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) was studied using Hep G2 cells transfected with hepatitis B virus (HBV). Synthetic antisense oligos (15‐mers) directed against the cap site of mRNA transcribed from the SP II promoter and regions of the translational initiation site of the S gene showed a sequence‐specific, dose‐dependent inhibitory effect on HBV gene expression between concentrations of 1.0 μm‐5.0 μm. Oligos directed against the middle of the S gene had little effect on HBsAg and HBeAg expression, as did non‐complementary random‐sequence control. The cells remained viable throughout the experiments and no morphological abnormalities were observed with antisense S‐oligos at concentrations below 20.0 μm. These results suggest a therapeutic potential for antisense oligonucleotides in the treatment of patients who are chronically infected with HBV.
Predictors of sustained response, relapse and no response in patients with chronic hepatitis C treated with interferon‐α
Authors: Chemello L. , Cavalletto L. , Noventa F. , Bonetti P. , Casarin C. , Bernardinello E. , Pontisso P. , Donada C. , Casarin P. , Belussi E , Frezza M. , Alberti A.
Published: December 2007

Summary. Three main patterns of response are seen when interferon‐α (IFN‐α) is used for the treatment of chronic hepatitis C:

1 sustained response with alanine‐aminotransferase (ALT) normalization that is maintained after cessation of therapy, with or without clearance of serum hepatitis C virus (HCV) RNA;

2 transient response with ALT normalization during therapy followed by relapse after its withdrawal, and

3 no response with no or only partial reduction in ALT levels.

In order to define variables that could predict each of these three types of response we studied 321 cases of chronic hepatitis C treated with IFN‐α in two consecutive trials conducted in our Unit. By univariate analysis, age < 45 years (P < 0.01), known disease duration < 60 months (P < 0.01), normal gamma‐glutamyltranspeptidase (γGT) levels (P < 0.01) and infection by HCV genotype 2 or HCV genotype 3 (P < 0.01) were found to be statistically associated with sustained response while age > 45 years (P < 0.01), body weight (P= 0.05), cirrhosis (P < 0.01) and elevated γGT levels (P < 0.01) were associated with no response. By multivariate analysis sustained response was predicted by HCV genotype 2 (P < 0.01) and HCV genotype 3 (P < 0.01), known disease duration (P < 0.01), patient's age (P < 0.05) and associated with the use of a more aggressive treatment schedule (P < 0.05). Transient response with relapse was predicted by known duration of disease (P < 0.05), HCV genotype 1 (P < 0.05) and female sex (P < 0.05). No response was statistically associated with elevated γGT levels (P < 0.01), higher body weight (P < 0.05) and with the less aggressive regimen of 3 MU of natural IFN‐α given three times weekly for 6 months (P < 0.05).

These results indicate that the HCV genotype as well as the schedule of treatment greatly affect the pattern of response to IFN in chronic hepatitis C and allow us to define criteria to predict which type of response is more likely in individual patients.
Epidemiology of hepatitis A in Valencia, Spain: public health implications
Authors: Bolumar F. , Giner‐Duran R. , Hernandez‐Aguado I. , Serra‐Desfilis M. A. , Rebagliato M. , Rodrigo J. M.
Published: December 2007

Summary. Between July 1988 and July 1989, sera from 1223 persons resident in the Valencia area of Spain were tested for antibodies against the hepatitis A virus. Sixty‐five per cent of serum samples were positive for anti‐HAV (95% confidence interval = 62.4–67.6). The prevalence of anti‐HAV increased significantly with age (odds ratio 50 years = 69.8; 95% confidence interval = 26.5–183.4) and previous history of hepatitis A (odds ratio = 2.1; 95% confidence interval = 1.4–3.2). Prevalence decreased with higher educational level (odds ratio, university studies = 0.2; 95% confidence interval = 0.1–0.5). Overall, there has been a reduction of anti‐HAV prevalence reflecting the decreasing exposure of the Spanish population to hepatitis A virus in recent years, particularly in the younger generations. The age of infection has increased, increasing the probability of future epidemics in groups previously protected by immunity acquired in early childhood. This new epidemiological pattern has strong public health implications, and universal childhood vaccination together with measures directed to improve sanitation may be the best public health strategy to protect the population.
A study of hepatitis δ virus infection in patients with acute and chronic liver disease from northern India
Authors: Singh V. , Goenka M. K. , Bhasin D. K. , Kochhar R. , Singh K.
Published: December 2007

Summary. To assess the prevalence of hepatitis 8 virus (H5V) in northern India, 204 adult patients with acute and chronic liver disease who were positive for hepatitis B virus (HBV) markers were screened for anti‐H8V antibody by enzyme‐linked immunosorbent assay (ELISA). Anti‐H8V antibodies were positive in 29 (14.2%) patients. The incidence of H8V infection was higher (21.4%) in patients with chronic liver disease when compared with those with acute viral hepatitis (10.7%) (P<0.05). HδV antibodies were positive in 16.6% of patients with fulminant hepatic failure (FHF) and in 25% of cases with hepatocellular carcinoma. Co‐infections were significantly higher in acute hepatitis (80%), while super infections predominated (66.7%) in chronic liver disease (P < 0.05). Our data show that HδV is endemic in northern India and should be considered a major health problem.
Raised levels of antibodies to human viruses at the clinical onset of autoimmune chronic active hepatitis
Authors: Kalvenes M. B. , Haukenes G. , Nysaster G. , Kalland K.‐H. , Myrmel H.
Published: December 2007

Summary. Patients with autoimmune chronic active hepatitis (AICAH) often have very high titres of antibodies to rubella and/or measles virus. In the present study a young girl at the clinical onset of AICAH exhibited very high titres of antibodies against influenza viruses A and B, parainfluenza viruses, rubella virus and varicella‐zoster virus. The titres normalized over 2 months except for rubella and varicella‐zoster antibodies. Strong reactivities were seen against the rubella structural proteins E1, E2 and C in Western blot but IgM antibodies were not demonstrated. Total IgG was increased with normal ratios of subclasses. The IgG1 was the dominant antibody to E1 and E2, while IgG4 dominated the anti‐C response. There was no significant shift in subclass reactivities over one year from onset. The polymerase chain reaction (PCR), using a nested primer set, was negative for rubella virus RNA in a liver biopsy obtained at the clinical onset and in peripheral blood mononuclear cells (PBMC) 1 year later. Co‐cultivation experiments using PBMC and permissive cell lines were also negative for rubella virus. Hence, in the very early phase of AICAH there may be a transiently enhanced antibody response to various unrelated viruses.
Absence of anti‐LKM‐1 antibody in hepatitis C viral infection in the United States of America
Authors: Reddy K. R. , Krawitt E. L. , Homberg J.‐C. , Jeffers L. J. , de Medina M. , Chastenay B. , Poupon R. , Opolon P. , Beaugrand M. , Abuaf N. , Grégeois J. , Johanet C. , Schiff E. R.
Published: December 2007

Summary. Several studies from Europe have observed a relationship between hepatitis C virus infection and anti‐liver/kidney microsome‐1 (anti‐LKM‐1) positive chronic hepatitis. It has been suggested that hepatitis C may induce an autoimmune phenomenon that leads to the development of a specific type (type II anti‐LKM‐1 positive) autoimmune chronic hepatitis. We evaluated 204 sera from patients with well‐documented hepatitis C infection from two centres in the United States of America and compared them with sera from 428 French patients from three centres. We evaluated the serological prevalence of anti‐smooth muscle antibodies, anti‐nuclear antibodies, anti‐liver cytosol antibodies, and anti‐mitochondrial antibodies subtype anti‐M2 in patients with chronic hepatitis C. The two groups were matched in their ages, gender, mode of transmission of hepatitis C infection and severity of liver disease. Anti‐LKM‐1 was not observed in the patients from the USA at a time when it was noted in 3.7% of French patients. There were no differences, however, in the expression of other auto‐antibodies, which were often in low titres. Absence of anti‐LKM‐1 in USA sera in comparison with French sera suggests that there may be differences in induction of anti‐LKM‐1 related to environmental and/or host genetic factors, and/or genomic variation in the hepatitis C virus.
The GB hepatitis viruses
Authors: Karayiannis P. , McGarvey M. J.
Published: December 2007

Summary. The genomes of three new flavi‐like viruses, GBV‐A, GBV‐B and GBV‐C have been identified. Nucleic acid molecules corresponding to the genomes of GBV‐A and GBV‐B were isolated from tamarins with hepatitis which had been infected with the GB agent. RNA sequences corresponding to GBV‐C have been shown to be present in sera from humans with non‐A‐E hepatitis. Sequence comparisons show that these three viruses are more closely related to each other and to hepatitis C virus (HCV) than to any other known viruses. Together with HCV they appear to form a discrete cluster of related viruses within the larger genus of flaviviridae. The pathological significance of these viruses and their association with hepatitis is currently emerging.
The distribution of hepatitis C virus genotypes in Turkish patients
Authors: Abacioglu Y. H. , Davidson F. , Tuncer S. , Yap P.‐L. , Ustacelebi S. , Yulug N. , Simmonds P.
Published: December 2007

Summary. The distribution of hepatitis C virus (HCV) genotypes was investigated in 89 HCV‐infected Turkish patients. Blood samples were collected from haemodialysis patients (n= 45), chronic liver disease (CLD) patients (n= 38), acute non‐A, non‐B (NANB) hepatitis patients (n= 2) and blood donors (n= 4). HCV RNA sequences were amplified in the 5″ non‐coding region and were typed by restriction fragment length polymorphism analysis. The predominant genotype was 1b (75.3%), followed by 1a (19.1%), 2 (3.4%) and 4 (2.2%). While there was no significant difference in the distribution of HCV genotypes with respect to age, sex, transfusion history, alanine aminotransferase levels or liver histology (in the CLD group), type 1a‐infected patients were younger than type 1b‐infected patients (P < 0.05) in the haemodialysis group. Serological reactivity to recombinant HCV proteins was assessed in 58 samples using the Chiron RIBA‐2 assay. The reactivity of samples from patients infected with type 1b with 5–1–1 and c100 antigens was significantly lower (P < 0.05) than the reactivity of samples from those infected with type 1a. These results, together with the results of two previous studies, indicate that HCV genotypes 1, 2, 3 and 4 are prevalent in different frequencies in the Turkish population. Determination of the genotype distribution of HCV in a geographical area may provide important clues for studying the epidemiology, transmission and pathogenesis of HCV‐related diseases and may also aid in improving serological assays to detect HCV infection.
Precore and X region mutants in hepatitis B virus infections among renal dialysis patients
Authors: Feitelson M. A. , Duan L.‐X. , Guo J. , Horiike N. , McIntyre G. , Blumberg B. S. , Thomas H. C. , Carman W.
Published: December 2007

SUMMARY. Hepatitis B virus (HBV) variants containing mutations within the X and the precore regions of the viral genome were demonstrated by polymerase chain reaction (PCR) amplification and DNA sequencing in renal dialysis patients with different serological patterns of HBV infection. Among carriers, X region deletion mutants predominated in patients who lost hepatitis B e antigen (HBeAg), or developed anti‐HBe, but not in persistently HBeAg‐positive patients. The precore region remained wild type in all carriers whether or not they seroconverted from HBeAg to anti‐HBe. The frequency of precore and X region mutants was greatest among non‐carrier patients with viral antibodies as the only indication of infection and among patients with non‐A, non‐B hepatitis (NANBH), suggesting an inverse relationship between the presence of wild type HBV markers and the presence of HBV mutants. Furthermore, the detection of one but not the other mutation in many serum samples suggests that these mutations are independently selected for during infection. Finally, the absence of HBV DNA in 21 ‘uninfected’ dialysis patients with normal transaminases and no viral serology, suggests that replication of these mutants is associated with hepatitis. These results have important implications for HBV screening and treatment, as well as for the pathogenesis of chronic infection.