bluuebunny/crossref_metadata_2025 huggingface dataset:
Are significant others able accurately to assess fatigue, exertion fatigue and types of fatigue in domiciliary heart patients?
Authors: Tiesinga Lucas J. , Dassen Theo W.N. , Halfens Ruud J.G. , Bernink Peter J.L.M. , Niemeijer Menco G. , van der Heijden Marion Y. , van den Heuvel Wim J.A.
Published: March 2003

Although fatigue is recognized as a subjective and person‐related diagnosis both in patients and in healthy subjects, there have been no studies performed to show whether ‘significant others’ surrounding fatigued subjects are able to assess accurately the level of fatigue that exists in patients. The aim of this study is to investigate this issue.

The following research questions are formulated: (i) To what degree do the assessments of fatigue and exertion fatigue given by significant others and patients agree? and (ii) To what degree do the assessments of types of fatigue given by significant others and patients agree?

The method adopted employed a cross‐sectional design approach applied to domiciliary heart patients and their significant others. Data was gathered by questionnaire. Data collected from 64 selected patients and their significant others are used in the analyses. Measurement instruments used are the Dutch fatigue scale (DUFS), the Dutch exertion fatigue scale (DEFS), numerical rating scales for fatigue and exertion fatigue, types of fatigue and sociodemographic variables.

The main conclusion of this study is that significant others are able to assess accurately patients' fatigue and exertion fatigue. At all three levels of measurement and analyses in this study — item‐level, scale‐level and assessment‐level — the paired absolute mean differences between patients and significant others for both the DUFS and DEFS are low. The measures of agreement —κ or Spearman's rank correlation coefficient and percentage agreement — are good and this degree of consensus increases from item‐level (DUFS & DEFS: moderate), scale‐level (DUFS & DEFS: substantial) to assessment‐level (DUFS: substantial; DEFS: almost perfect).

Another conclusion of this study is that significant others are able to accurately estimate different types of fatigue. The measures of agreement among the indicators referring to the different types of fatigue ranged from moderate agreement (predominance and pattern) to substantial agreement (specificity and explicability) to almost perfect agreement (intensity).

Furthermore, it may be concluded that both cohabiting significant others and noncohabitee family, friends and acquaintances may be seen as a potential and reliable human resource, providing professionals with fundamental information concerning patients' fatigue and exertion fatigue which may be used in their diagnostic process and treatment.
Effects of an implemented care policy on patient and personnel experiences of care
Authors: Lövgren G. , Eriksson S. , Sandman P.‐O.
Published: March 2003

Effects of an implemented care policy on patient and personnel experiences of care

A care policy was implemented within health care in the county of Västerbotten, Sweden. A questionnaire was administered before and after the implementation of the care policy to assess its effects. Patients within hospital care and primary health care described their experiences in a base‐line study (n=3950) in 1994 and a follow‐up study (n=2941) in 1996. On the same occasions personnel (n=2362 and 2310, respectively) answered the same questionnaire assessing what they thought their patients experienced. No significant positive effects of the implementation were seen by the patients. Fewer patients felt that they were understood when they talked about their problems, dared to express criticism or denied they were treated nonchalantly in the follow‐up study. The experiences of the personnel were in line with those of the patients concerning nonchalant treatment in the follow‐up study. Furthermore, fewer staff members thought that their patients felt they had adequate help with hygiene whilst more thought that their patients felt they were responded to in a loving way. One interpretation of the negative outcome is that organizational changes, strained resources and cuts in staffing during the 90s may have reduced the possibility of integrating the care policy in spite of an ambitious and extensive intervention.
Breast cancer patients' satisfaction with a spontaneous system of check‐up visits to a specialist nurse
Authors: Koinberg Inga‐Lill , Holmberg Lars , Fridlund Bengt
Published: March 2003

Breast cancer patients' satisfaction with a spontaneous system of check‐up visits to a specialist nurse

Aim: To describe breast cancer patients' satisfaction with a spontaneous system of check‐up visits to a specialist nurse.

Background: There is little evidence that routine follow‐up visits after breast cancer surgery influence survival or patient satisfaction. Consequently, there is a need to evaluate alternative follow‐up programmes.

Sample: A strategic sample of 19 breast cancer patients, who were not involved in a routine follow‐up system but who had the possibility of contacting a specialist nurse when necessary, were interviewed.

Method: A qualitative descriptive design inspired by the method of phenomenographic analysis was used.

Findings: Five description categories and 606 statements showing similarities and differences in conceptions were obtained. The patients satisfaction with the knowledgeable and professional skills of the nurses was high.Confirmationandtrustwere important and necessary in order for the women with breast cancer to feel secure. Patients had a need forinformationandself‐care education.Accessibilityand early assessment by professional personnel or an oncology nurse were essential in a system without routine follow‐ups.

Discussion: This study identifies key issues in a specialist nurse‐led check‐up system. The findings can be used for developing an education programme for women who have undergone breast cancer surgery. Additionally, the findings emphasize the need to introduce more flexible solutions to the follow‐up programmes, one alternative being specialist nurse‐led check‐ups.
Implementing assertive community care for patients with schizophrenia
Authors: Falk Kristin , Allebeck Peter
Published: March 2003

Implementing assertive community care for patients with schizophrenia. A case study of co‐operation and collaboration between mental health care and social services

The aim of this study was to describe the personal experiences of collaboration and co‐operation between staff from the community mental health and social services programmes in their daily work with schizophrenic patients. An additional aim was to generate the first step in a theory of how staff in the field of health care and social services manages to integrate their efforts on an individual and organizational level.

The study group consisted of five members of a multidisciplinary team who had been working for 2 years with assertive outreach intensive clinical case management. Verbatim‐transcribed thematic interviews were analysed according to the comparative method for grounded theory. The analysis was focused on quality of interpersonal interaction between practitioners, representing different professions in community‐based mental health care, as well as the professional relationship to the patients/clients and their relatives. In the light of an individual and organizational perspective, different typologies of interpersonal interactions appeared. Three main variables were identified: collaborative relationship, co‐operative partnership and professional‐amateurism. Our findings on these qualitative differences in interpersonal relations should be taken into account in the continuing reorganization of the community health care services. This knowledge can also help in overcoming barriers between patients, professionals and organizations in the mental health services.
Comparison of user assessed needs for care between psychiatric inpatients and supported community residents
Authors: Brunt D. , Hansson L.
Published: March 2003

The aim of the present study was to compare user assessed needs for care for psychiatric patients in inpatient settings with that of residents in supported community residences. The Camberwell Assessment of Need was administered to 75 patients and residents in different housing settings. Residents in supported community settings had more needs for care (8.1), than patients in inpatient settings (5.8), partly because of differences in duration of illness. A greater proportion of those living in supported community residences reported needs in the areas of psychotic symptoms, accommodation, food, daytime activities, sexual expression and looking after the home. There were no differences in numbers of unmet needs. Relatives and friends provided emotional and social support predominantly in the areas of company and psychological distress. In conclusion, living in supported community residences does not imply more unmet needs, or less adequate response to needs from services, despite a greater number of needs being reported. In some areas of need, relatives and friends play an important role in the provision of support.
Characterization of 14 tetranucleotide microsatellite loci derived from Pacific herring
Authors: Olsen J. B. , Lewis C. J. , Kretschmer E. J. , Wilson S. L. , Seeb J. E.
Published: March 2003

Spawning aggregations of Pacific herring (Clupea pallasi) often exhibit significant interannual variation in allele frequencies of neutral gene markers. We isolated 14 tetranucleotide microsatellites to examine hypothetical processes that may produce this unique genetic signal. We developed and tested primer pairs for each locus and then estimated locus variability in samples (n = 60) from two populations. The number of alleles per locus ranged from five to 49. The expected heterozygosity across loci and populations ranged from 0.20 to 0.96. These microsatellites will be useful for estimating genetic variation in herring on a fine geographical scale.
Characterization of 10 microsatellite loci for the deep‐sea coral Lophelia pertusa (Linnaeus 1758)
Authors: Le Goff M. C. , Rogers A. D.
Published: March 2003

The scleractinian coral, Lophelia pertusa, is distributed globally on continental slopes, mid‐oceanic ridges and in fjords. This species forms cold‐water reefs, which are associated with a diverse animal community. These communities are poorly understood but are currently under threat from human activities. Molecular markers are required to assess the spatial genetic population structure of this key species for management and conservation purposes. Ten polymorphic microsatellite loci were isolated for Lophelia pertusa using an enriched partial library technique. Nine loci showed significant differences from Hardy–Weinberg expected genotype frequencies, eight of which showed heterozygote deficiencies.
Isolation and characterization of seven tetranucleotide microsatellite loci from Atlantic northern bluefin tuna Thunnus thynnus thynnus
Authors: McDowell J. R. , Diaz‐Jaimes P. , Graves J. E.
Published: March 2003

Microsatellite‐enriched genomic libraries were obtained from the Atlantic northern bluefin tuna, Thunnus thynnus thynnus and seven tetranucleotide markers were successfully isolated and characterized from this library. These markers were found to have between 1 and 17 alleles in Atlantic northern bluefin tuna and heterozygosity ranged from 0 to 0.85. No deviations from the expectation of Hardy‐Weinburg equilibrium were found for any marker. Several of these markers amplify reliably in other tuna species.
Isolation of microsatellite loci from a rainforest tree, Elaeocarpus grandis (Elaeocarpaceae), and amplification across closely related taxa
Authors: Jones R. C. , McNally J. , Rossetto M.
Published: March 2003

Elaeocarpus grandis (Blue Quandong) is a common rainforest tree with a widespread distribution across northeastern Australia, while the related species E. sp. Rocky Creek and E. williamsianus are more restricted in their distribution. Highly polymorphic markers are required to provide genetic information on these species, which will aid in developing effective conservation and management strategies. Eight microsatellite loci were isolated and characterized in E. grandis, and tested in the rare species and other species of the Elaeocarpaceae. Cross‐species transferability was most successful within Elaeocarpus, with six and eight loci transferring to E. sp. Rocky Creek and E. williamsianus, respectively.
Microsatellite loci from the Cunningham's Skink (Egernia cunninghami)
Authors: Stow A. J.
Published: March 2003

Social structuring and within‐group genetics are rarely studied in lizards, but are of considerable conservation importance. In particular, the impact of anthropogenic habitat fragmentation upon fine‐scale genetic patterns is largely unknown. This is being investigated for Egernia cunninghami, a species with generally low dispersal and high levels of within‐group relatedness. Estimating parentage in wild populations in which close relatives may be candidate parents requires high levels of exclusionary power. The five characterized loci possess 13–29 alleles, and high polymorphic information contents (0.800–0.917) and add greatly to the markers, cloned from related skinks, currently available.
Isolation and characterization of microsatellite markers from Zale galbanata (Lepidoptera: Noctuidae) and amplification in other members of the genus
Authors: Caldas A. , Hawthorne D. J. , Barbosa P.
Published: March 2003

The noctuid moth Zale galbanata is described as feeding on maples (Acer sp.) in general, but its primary food plant is box elder (Acer negundo). We isolated five microsatellite loci to investigate the association of food plant use and the genetic similarity of populations in these moths. These markers are polymorphic to various degrees (5–13 alleles), and are presented here. Our initial tests show that some of these loci also work on other Zale species.
Isolation of polymorphic microsatellite loci from the red‐billed gull (Larus novaehollandiae scopulinus) and amplification in related species
Authors: Given A. D. , Mills J. A. , Baker A. J.
Published: March 2003

We describe the isolation and characterization of seven dinucleotide microsatellite loci developed from the red‐billed gull (Larus novaehollandiae scopulinus). Locus‐specific primers were used to genotype individuals from 13 populations of this subspecies as well as individuals from closely related subspecies from Australia and New Caledonia. The primers were tested successfully on other species of gulls and shorebirds. The number of alleles observed within the red‐billed gull ranged from three to 17, and observed heterozygosity varied from 0.359 to 0.787. These microsatellites are likely to be useful for studies of mating systems and population genetics in a wide range of gull species.
Polymorphic microsatellite loci in global populations of the marine coccolithophorid Emiliania huxleyi
Authors: Iglesias‐Rodríguez M. Débora , Sáez Alberto G. , Groben René , Edwards Keith J. , Batley Jacqueline , Medlin Linda K. , Hayes Paul K.
Published: March 2003

The marine coccolithophorid Emiliania huxleyi is an important component of the marine carbon cycle because bloom development results in the export of calcium carbonate from the ocean surface to the abyss. Laboratory and field studies demonstrate significant biogeographical, ecological, physiological and morphological plasticity in E. huxleyi and suggest high underlying genetic variability. Here we describe seven polymorphic microsatellite loci from the E. huxleyi genome and their degree of polymorphism in clonal isolates of different geographical origin. Our results indicate a high degree of genetic diversity within E. huxleyi.
Microsatellite loci in the Japanese subterranean termite, Reticulitermes speratus
Authors: Hayashi Yoshinobu , Kitade Osamu , Kojima Jun‐Ichi
Published: March 2003

Reticulitermes
termites have such a cryptic life style and complex colony structure that polymorphic microsatellite markers are desired to investigate their population and colony structures. We successfully isolated seven microsatellite loci in
R. speratus
, the Japanese subterranean termite, five of which were polymorphic. These polymorphic loci had 2–8 alleles per locus and their observed heterozygosities ranged from 0.059 to 0.438. These five loci were also polymorphic in
R
.
kanmonensis
, distributed sympatrically with
R. speratus in the Kanmon Region, western Japan; the number of alleles per locus was 2–5, and observed heterozygosity was 0.176–0.625.
proseq: A software for preparation and evolutionary analysis of DNA sequence data sets
Authors: Filatov Dmitry A.
Published: March 2003

proseq

is an integrated user‐friendly

windows
based program for convenient sequence editing and evolutionary analysis. It is designed to simplify preparation and analysis of DNA sequence data sets in population genetic, phylogenetic and molecular ecology studies. Sequence editor features include editing of chromatogram files, contig assembly, sequence alignment, translation and other utilities. Analysis features include calculation of genetic diversity, divergence, population subdivision and gene flow with permutation‐based significance testing and various tests of neutrality. A tool for coalescent simulations implements models with intragenic recombination, population subdivision and population growth.
Isolation and characterization of microsatellites inDrosophila virilisand their cross species amplification in members of theD. virilisgroup
Authors: Huttunen S. , Schlötterer C.
Published: March 2003

We report the isolation and cross species amplification of 42Drosophila virilismicrosatellite loci. Nine loci were isolated from mapped P1 bacteriophage clones and 33 were obtained from genomic DNA or GenBank searches. Cross species amplification was tested for all members of theD. virilisgroup. The amplification success was high (varying from 45% to 100%) and most of the loci were polymorphic. This set of loci can be applied for several genetic studies such as mapping behavioural quantitative trait loci (QTL) and for studying population structure in a phylogeographical framework inD. virilisgroup species.
Microsatellite variation in the freshwater snail Physa acuta
Authors: Sourrouille P. , Debain C. , Jarne P.
Published: March 2003

We present data for seven new markers isolated from a microsatellite‐enriched DNA library from the freshwater snail Physa acuta. Six of them appear to be conserved in Physa cubensis. These loci might be useful for analysing population structure and reconstructing the story of invasion of freshwaters on a worldwide scale by P. acuta.
Five microsatellite DNA markers for the ground beetleAbax parallelepipedus(Coleoptera, Carabidae)
Authors: Keller I. , Largiadèr C. R.
Published: March 2003

We characterized five microsatellite loci fromAbax parallelepipedus,one of the most common forest ground beetles in central Europe. The polymorphism of the loci was assessed in 30 individuals from one population. The number of alleles ranged between two and 19 and the observed heterozygosities between 0.10 and 0.97. No deviations from Hardy–Weinberg equilibrium were detected for any of the markers.
The Large‐billed Reed Warbler Acrocephalus orinus revisited
Authors: Bensch Staffan , Pearson David
Published: March 2003

The Large‐billed Reed Warbler Acrocephalus orinus is known only from the type specimen, collected in Himachal Pradesh, India, in 1867. The specimen is poorly prepared, and it has been suggested that it could represent an isolated form of the Clamorous Reed Warbler A. stentoreus or an aberrant Blyth’s Reed Warbler A. dumetorum. We tested the affinity of A. orinus by (1) re‐examining the morphology of the type specimen and (2) amplifying and sequencing a portion of its mitochondrial cytochrome b gene. Both the morphological and the mitochondrial analyses showed the specimen to be similar to dumetorum, but distinct enough to qualify as a species of its own. Relative to dumetorum, it has a more rounded wing, longer bill, longer and more graduated tail with more pointed tail feathers, and larger claws. The divergence in mitochondrial DNA between orinus and dumetorum was 7.8%, well above the value expected between subspecies. A. orinus is smaller than any of the forms of A. stentoreus or the related Australian Reed Warbler A. australis. It has a somewhat longer first primary, more pointed tail feathers and paler, less robust feet and claws. DNA comparison places it in the clade of small unstreaked Acrocephalus warblers, and apart from the clade of large unstreaked warblers that contains stentoreus and australis.
Ocular signs of systemic hypertension: A review
Authors: Hurcomb Peter G. , Wolffsohn James S. , Napper Genevieve A.
Published: March 2003

Cardiovascular disease and stroke continue to be the chief causes of death in developed countries and one of the leading causes of visual impairment. The individual with systemic hypertension may remain asymptomatic for many years. Systemic mortality and morbidity are markedly higher for hypertensives than normotensives, but can be significantly reduced by early diagnosis and then efficient management. However, the ability of Optometrists to detect and appropriately refer systemic hypertensives remains generally poor. This review examines the disease, its effects and detection by observation of the retinal signs, particularly those considered to be pre‐malignant. Previous methods of classifying retinal hypertensive signs are discussed along with more recent image analysis techniques. The role of the optometrist in detecting, monitoring and appropriate referral of systemic hypertensives is discussed in relation to current research.
A Review of Creatine Supplementation: Side Effects and Improvements in Athletic Performance
Authors: Andres L. P. Andy , Sacheck Jennifer , Tapia Santiago
Published: March 2003

Abstract Creatine is a popular ergogenic aid that is sold as a nutrition supplement. Research has shown that creatine supplementation may improve performance during intermittent bouts of high‐intensity exercise, while there do not appear to be any benefits during endurance‐type athletic events. Information on the risks associated with this product is scarce. Although there are anecdotal reports of gastrointestinal distress associated with creatine supplementation, there have been no peer‐reviewed studies of high‐dose creatine supplementation lasting longer than ten weeks in healthy subjects. However, it is recommended that children, adolescents, pregnant women, and people with diabetes or renal disease avoid creatine supplementation due to its unknown effects on these special populations. This review includes a description of the metabolic role of creatine and the effects of supplemental doses on skeletal muscle, as well as an examination of the potential physiological mechanisms, effectiveness, and side effects of creatine supplementation.
Disease Prevention: Broadening the Definition of Folate Nutrition
Authors: Mason Joel B. , Selhub Jacob
Published: March 2003

Abstract An adequate dietary intake of folate has traditionally been defined by the amount of folate required to prevent anemia. However, a rapidly expanding body of research has suggested broader roles for folate in the preservation of health. Based on scientific evidence that has found this B vitamin to be associated with risk of neural tube defects, cardiovascular disease, and colorectal cancer, many experts now believe that optimal levels of folate intake are substantially higher than was previously advised. The recently proposed Dietary Reference Intakes by the Institute of Medicine recommend that all adults consume 400 micrograms of folate per day. Intervention trials presently underway will provide further guidance on optimal levels of folate intake in disease prevention. This paper presents a brief review of the research that has lead to the expanding interest in folate and disease, as well as information on food sources of folate that is useful when counseling patients about their folate intake.
A Review of the Selective Serotonin Reuptake Inhibitors in Bulimia Nervosa
Authors: Kirby Kelly P. , Dietz Brenda , Arnold Alana D.
Published: March 2003

Successful treatment of eating disorders often includes drug therapy along with psychotherapy and nutritional counseling. Selective serotonin reuptake inhibitors are attractive agents for use in eating disorders due to their favorable side effect profiles. Currently, fluoxetine is the only FDA approved agent for treatment of bulimia nervosa; however, fluvoxamine has also been studied for use in this disorder. This review examines the evidence for the use of selective serotonin reuptake inhibitors in bulimia, and summarizes the pharmacokinetics, side effects, and drug interactions of selective serotonin reuptake inhibitors available in the United States.
Potential Benefits of Soy Protein in Managing Patients with Hypercholesterolemia
Authors: Lichtenstein Alice H.
Published: March 2003

The Food and Drug Administration (FDA) recently added foods containing soy protein to the list of foods—including those with low saturated fat, low cholesterol, and high fiber—that can carry a health claim for decreasing the risk of developing coronary heart disease (CHD). This ruling is based on an assumption of a total dietary soy protein intake of 25 g per day; any food bearing the claim must contain at least 6.25 g of soy protein per serving. The FDA concluded that the scientific evidence supporting the claim for soy protein and CHD was consistent but not universal. Overall, benefits of soy include reductions in total and low‐density lipoprotein cholesterol, but not decreased triglycerides or increased high‐density lipoprotein cholesterol levels. The FDA further stated that the evidence associating the effect of soy protein with constituent isoflavones (weakly estrogenic and antiestrogenic compounds naturally present in soybeans) was not sufficient to support a health claim. Foods can bear a health claim regarding soy protein and CHD only if they are low in saturated fat and cholesterol. It is important for patients to understand that the addition of foods containing soy protein to the diet, rather than substituting these foods for others, may result in increased caloric intake. In that case, the expected outcome regarding blood lipid and lipoprotein levels may not result.
A Review of Niaspan, an Extended‐Release Niacin
Authors: Abourjaily Heather M.
Published: March 2003

Niacin is an effective lipid‐lowering therapy that has been available for more than 40 years. Many studies have proven niacin's effectiveness in decreasing morbidity and mortality and improving the entire lipid profile. However, one of the major drawbacks to niacin therapy has been its side effects—most commonly, flushing and abdominal discomfort. Recently, however, newer formulations of niacin have become available, particularly Niaspan, an extended‐release niacin preparation taken once daily, at bedtime, (as opposed to the controlled‐release niacin taken twice a day). To date, 5 trials have evaluated Niaspan specifically. All have shown Niaspan to be effective in decreasing total cholesterol, low‐density lipoprotein (LDL), triglycerides, and apolipoprotein, and increasing high‐density lipoprotein (HDL). Flushing is still a major side effect with Niaspan therapy; however, taking aspirin 30 minutes prior to the dose and taking the dose at bedtime may alleviate this side effect. In a survey of patients who had taken both the controlled‐release preparation of niacin (not Niaspan) and the immediate‐acting niacin, the majority of the patients preferred the controlled‐release formulation. The extended‐release preparation should now be considered a realistic option in patients who have hypercholesterolemia.
Xerostomia: Etiology and Clinical Management
Authors: Stack Kathleen M. , Papas Athena S.
Published: March 2003

Xerostomia, or dry mouth, is a serious oral health problem that, when left untreated, leads to deterioration and disease in the oral cavity. Patients with dry mouth include those on xerogenic medications (including many elderly patients), those undergoing chemotherapy and radiation, and individuals with Sjögren syndrome, an autoimmune disease. Common complaints with dry mouth include difficulty in speaking, chewing, and tasting and swallowing foods. Patients with dry mouth will also complain of food sticking to the teeth, taste alterations, foods burning the oral tissues, and a burning tongue. The lack of saliva may lead to such complications as fungal infections (eg, candidiasis), atrophy of the filiform papillae of the tongue, mucosal ulcerations, salivary gland enlargement, an increase in the number of cariogenic, aerobic organisms Streptococcus and Lactobacillus, and rapidly progressing caries. Recommended therapy for patients with xerostomia includes regular dental visits, fluoride therapy, nutritional counseling, and patient education regarding oral home care to manage the high risk for dental decay. Some patients may also benefit from the use of artificial salivas or Pilocarpine, which is effective in increasing salivary flow in patients with functional salivary glands. Salivary stimulants and increased water intake are also recommended.
Medication‐Induced Taste Disturbances
Authors: Nolan Nicole M.
Published: March 2003

Taste involves a complex interaction among food or drink, taste receptors, and the central nervous system. Taste distortion or loss involves an impairment of this interaction and may be defined as dysgeusia (taste distortion), hypogeusia (reduced ability to taste), or ageusia (complete inability to taste). Medications have been reported to induce reversible and persistent taste disturbance in many patients. The mechanism by which medications alter taste is unknown, but there are many hypotheses. Patients may react to taste disturbances with decreased appetite, decreased dietary and nutrient intake, and/or increased use of salt or sugar. Management of taste disorders often includes discontinuation of the suspected offending agent. Clinicians should be proactive in identifying patients with taste alterations and in responding with appropriate interventions.
Less Exercise Now, More Disease Later? The Critical Role of Childhood Exercise Interventions in Reducing Chronic Disease Burden
Authors: Economos Christina D.
Published: March 2003

Abstract

An astounding number of children these days are overweight, physically inactive, and consuming sub‐optimal diets, placing the future health status of our nation in jeopardy. These unhealthy lifestyle behaviors are known to influence the development of many debilitating and life‐threatening diseases. Physical inactivity alone increases the incidence of at least 17 unhealthy conditions—either chronic diseases or risk factors for chronic diseases. It is desirable for children to spend at least 60 minutes, and up to several hours per day, engaged in age‐ and developmentally appropriate activity. Regrettably, few children meet this recommendation. Interventions aimed at increasing physical activity in children have used a variety of strategies: enhancing physical education, increasing active commuting, decreasing television viewing, and risk‐factor‐specific training. Successful interventions have reported positive results ranging from increased time spent in physical education class, to decreased hypertension, to increased bone density. These interventions should serve as models to provide replicable elements for widespread implementation. However, more research is needed to identify and understand the modifiable behavioral and environmental variables that can have a substantial impact on physical inactivity. Healthcare providers can make a difference by providing clear and consistent messages that guide children and their caregivers toward achieving the recommendations for physical activity and the development of recreational skills that support lifetime activity.
Assessing Magnesium Status: A Persisting Problem
Authors: Martini Ligia A. , Wood Richard J.
Published: March 2003

Magnesium plays an essential role in a wide range of fundamental biological reactions. Although diets consumed by healthy Americans usually do not lead to clinically significant magnesium depletion, epidemiological and clinical studies have suggested an association between low magnesium status and increased risk of cardiovascular diseases, hypertension, osteoporosis, diabetes, and other chronic diseases. In acutely or chronically ill hospitalized patients, the prevalence of hypomagnesemia has been reported to be as high as 11%. Hypomagnesemia resulting from underlying disease can be due to decreased gastrointestinal absorption or increased renal magnesium losses. Magnesium is principally an intracellular cation. Tissue magnesium status is difficult to accurately estimate with non‐invasive measures due to poor correlations between serum or RBC or WBC magnesium levels and magnesium concentration in major tissue stores in muscle and the skeleton. At present, a comprehensive evaluation of a patient's risk of magnesium deficiency should include consideration of known risk factors and disease conditions possibly contributing to magnesium depletion, estimates of dietary magnesium intake, and clinical observations. The evaluation also should include laboratory measures of magnesium status, including analysis of both extracellular (serum magnesium) and intracellular (RBC, WBC or muscle magnesium) magnesium concentration, if available. Researchers should continue efforts to find a simple, reliable, and useful technique to accurately estimate magnesium status.
Nutrition Counseling in the Physician's Office: How Do I Bill for Advising My Patient?
Authors: Sanford Jennifer A. , Ccs‐P
Published: March 2003

In addition to diagnosing and treating illnesses, physicians often provide nutrition counseling services. Billing and obtaining appropriate reimbursement for these services present a unique challenge. This article utilizes 4 hypothetical scenarios as a basis for examining common categories of service that involve nutrition counseling. These categories are: routine physicals that include nutrition counseling, nutrition counseling alone, nutrition counseling as a small part of a problem‐oriented “evaluation and management” (E/M) service, and nutrition counseling as the bulk of a problem‐oriented E/M service. The basics of procedure (CPT) and diagnosis (ICD‐9) coding are described, and specific billing instructions for each scenario are provided. Although this article provides an introduction to the topic of billing, healthcare providers and their office staff should inform themselves on general coding and billing practices, as well as local payors' guidelines.
Becaplermin gel in the treatment of pressure ulcers: a phase II randomized, double‐blind, placebo‐controlled study
Authors: Rees Riley S , Robson Martin C , Smiell Janice M , Perry Barbara H ,   THE PRESSURE ULCER STUDY GROUP
Published: March 2003

Pressure ulcers are associated with significant rates of morbidity and mortality, particularly in the geriatric and spinal cord–injured populations. Newer pharmacologically active therapies include the use of topically applied recombinant human platelet‐derived growth factor‐BB (becaplermin), the active ingredient in REGRANEX® (becaplermin) Gel 0.01%, which has been approved in the United States for treatment of lower extremity diabetic neuropathic ulcers that extend into the subcutaneous tissue or beyond and have an adequate blood supply. In this study, the efficacy of becaplermin gel in the treatment of chronic full thickness pressure ulcers was compared with that of placebo gel. A total of 124 adults (≥ 18 years of age) with pressure ulcers were assigned randomly to receive topical treatment with becaplermin gel 100 μg/g (n = 31) or 300 μg/g (n = 32) once daily alternated with placebo gel every 12 hours, becaplermin gel 100 μg/g twice daily (n = 30), or placebo (sodium carboxymethylcellulose) gel (n = 31) twice daily until complete healing was achieved or for 16 weeks. All treatment groups received a standardized regimen of good wound care throughout the study period. Study endpoints were the incidence of complete healing, the incidence of ≥ 90% healing, and the relative ulcer volume at endpoint (endpoint/baseline). Once‐daily treatment of chronic pressure ulcers with becaplermin gel 100 μg/g or 300 μg/g significantly increased the incidences of complete and ≥ 90% healing and significantly reduced the median relative ulcer volume at endpoint compared with that of placebo gel (p < 0.025 for all comparisons). Becaplermin gel 300 μg/g did not result in a significantly greater incidence of healing than that observed with 100 μg/g. Treatment with becaplermin gel was generally well tolerated and the incidence of adverse events was similar among treatment groups. In conclusion, once‐daily application of becaplermin gel is efficacious in the treatment of chronic full thickness pressure ulcers.
Efficacy and safety of becaplermin (recombinant human platelet‐derived growth factor‐BB) in patients with nonhealing, lower extremity diabetic ulcers: a combined analysis of four randomized studies
Authors: Smiell Janice M , Wieman T. Jeffery , Steed David L , Perry Barbara H , Sampson Allan R , Schwab Barry H
Published: March 2003

The results of a combined analysis and separate analyses of four multicenter, randomized, parallel group studies that evaluated the effects of once‐daily topical administration of becaplermin gel for the treatment of chronic, full thickness, lower extremity diabetic ulcers are presented. The four studies included a total of 922 patients with nonhealing lower extremity diabetic ulcers of at least 8 weeks' duration. Following initial complete sharp debridement of the ulcer, patients were randomized to receive a standardized regimen of good ulcer care alone, good ulcer care plus placebo gel, or good ulcer care plus becaplermin gel‐30 μg/g, or good ulcer care plus becaplermin gel‐100 μg/g, with various combinations of regimens used in the four studies. Safety was assessed by monitoring adverse events and by clinical laboratory evaluations. Meta‐analytic statistical techniques were used in the combined analysis to establish homogeneity of treatment comparisons across studies. Based on an analysis of patients with baseline ulcer area common to all trials (≤ 10 cm2), representing 95% of all patients, becaplermin gel‐100 μg/g significantly increased (p = 0.007) the probability of complete healing compared with placebo gel. It was determined that for the median ulcer area of these patients, which was 1.5 cm2, the becaplermin gel‐100 μg/g treatment group showed a 39% increase in complete healing compared with that of the placebo gel treatment group (50% vs. 36%, respectively, p = 0.007). Becaplermin gel‐100 μg/g significantly decreased (p = 0.01) the time to complete healing compared with placebo gel, with the 35th percentile of time to complete healing being reduced by 30% (14.1 weeks vs. 20.1 weeks, respectively). In patients with ulcers ≤ 5 cm2 at baseline (a more homogeneous group), becaplermin gel‐100 μg/g also significantly increased the incidence of complete healing with a similar decrease in the time to healing. Adverse events reported during treatment or during a 3‐month follow‐up period were not unexpected for this patient population and were similar in nature and incidence across all treatment groups. We therefore conclude that treatment with becaplermin gel at a dose of 100 μg/g once daily, in conjunction with good ulcer care, is effective and well tolerated in patients with full thickness lower extremity diabetic ulcers.
Dynamic forces in the cell cycle affecting fibroblasts in pressure ulcers
Authors: Vande Berg Jerry S , Smith Paul D , Haywood‐Reid Patricia L , Munson Alivia B , Soules Kelly A , Robson Martin C
Published: March 2003

Utilizing specific cell cycle markers of gene activity, temporal changes in the equilibrium of proliferating and non proliferating fibroblasts were shown in pressure ulcers after 36 days of quality care. Average cell counts from multiple tissue sections showed that fibroblast nuclei were stained in decreasing order by antibodies to p21, p21/proliferating cell nuclear antigen (PCNA) and PCNA. P21 labeling suggested that the majority of ulcer fibroblasts were senescent. Fibroblast nuclei showing PCNA staining identified those fibroblasts that were capable of synthesizing DNA and contributing to pressure ulcer repair. Increased rates of wound closure were correlated with a decreasing number of p21 positive cells and an increasing portion of PCNA labeled cells. While the proportion of antigens appeared to correlate with the status of wound closure after 36 days of quality care, they did not always appear to reflect the final outcome of the pressure ulcer. No significant differences were observed in ulcer fibroblasts labeled with p21 at 0 and 10 days, however, the differences were significant after 36 days of quality care (p= 0.05, analysis of variance, post hoc Tukey test). The cellular contribution to pressure ulcer repair appeared to occur from ulcer fibroblasts that were ca‐pable of division, of emerging from quiescence, and that were successful in repairing their DNA.
Modulation of macrophage recruitment into wounds by monocyte chemoattractant protein‐1
Authors: Dipietro Luisa A , Reintjes Mark G , Low Quentin E. H , Levi Benjamin , Gamelli Richard L
Published: March 2003

Previous studies suggest that normal wound repair requires the regulated production of monocyte and macrophage chemoattractants. The current study examines the role of monocyte chemoattractant protein‐1 (MCP‐1) in coordinating monocyte recruitment into sites of injury. MCP‐1 protein was detected in both incisional and excisional murine wounds, with a peak concentration occurring slightly before maximum macrophage infiltration. Compared to wounds treated with control antibody, wounds treated with a neutralizing monoclonal anti‐MCP‐1 antibody contained significantly fewer macrophages (8.2 ± 0.9 vs. 14 ± 1.7 macrophages per high power field, p < 0.05). Conversely, the addition of recombinant MCP‐1 to wounds resulted in a substantial increase in the number of macrophages (107% to 124% increase over untreated wounds, p < 0.01). Because macrophages promote wound healing, the effect of recombinant MCP‐1 on the wound healing process was examined. Incisional wounds (n= 12) were either left untreated or treated with vehicle alone, 5 ng recombinant MCP‐1 in vehicle, or 50 ng recombinant MCP‐1 in vehicle. Wound disruption strength was determined on days 7, 14, 21, and 28 for each group. Wounds treated with MCP‐1 exhibited a slight increase in wound disruption strength at nearly all time points but this increase did not reach statistical significance. Addition of 100 ng of MCP‐1 to excisional wounds did not have any significant effect on wound reepithelialization. Taken together, the results show that MCP‐1 is produced within wounds at physiologic concentrations, and is an important positive regulator of macrophage recruitment into sites of injury. Addition of exogenous MCP‐1 to wounds of normal mice yields only modest enhancement of the repair process.
THE PIG AS A MODEL FOR HUMAN WOUND HEALING
Authors: Sullivan Tory P , Eaglstein William H , Davis Stephen C , Mertz Patricia
Published: March 2003

The medical literature describes numerous in vitro and in vivo wound‐healing models. The selection of an animal model depends on a number of factors including availability, cost, ease of handling, investigator familiarity, and anatomical/functional similarity to humans. Small mammals are frequently used for wound healing studies, however, these mammals differ from humans in a number of anatomical and physiological ways. Anatomically and physiologically, pig skin is more similar to human skin. The many similarities between man and pig would lead one to believe that the pig should make an excellent animal model for human wound healing. The purpose of this paper is to review the existing literature for evidence of this supposition and determine how well the various models correlate to human wound healing. Studies of wound dressings, topical antimicrobials, and growth factors are examined. Over 180 articles were utilized for this comparative review. Our conclusion is that the porcine model is an excellent tool for the evaluation of therapeutic agents destined for use in human wounds.
Analysis of mucosal regeneration and the expression profile of heat shock protein 70 in the isolated small bowel segment
Authors: Moriyama Hatsuo , Noguchi Tsuyoshi , Takeno Shinsuke , Harada Katsuhisa , Kudo Tetsuji , Uchida Yuzo
Published: March 2003

To investigate the mechanisms underlying the regeneration of the denervated small bowel segment from ischemic injury, we examined the heat shock protein 70 (HSP70) expression profile and compared it to the histopathological and proliferative changes seen in an isolated bowel segment using a rabbit model. Two weeks following the small bowel segment transplantation to the subcutaneous space, the vascular pedicle was sectioned. Next, the rabbits were divided into three groups based on the collection time of the isolated bowel segment (3, 7, and 14 days for Groups A, B, and C, respectively). The unsectioned small bowel segment was utilized as a control for each group. Histological studies showed that no experimental group recovered from mucosal injury. The bromodeoxyuridine labeling index showed that the more severe mucosal injury group had the highest bromodeoxyuridine incorporation. In the experimental groups, HSP70 immunoreactivity was intensely seen in the regenerating epithelial cells and inflammatory cells. In the control mucosa, HSP70 immunoreactivity was weakly seen in the subepithelial stromal tissue, crypt cells and not in epithelial cells. The present study shows that the isolated bowel segment requires longer periods for regeneration from ischemic injury and HSP70 may play an important role during the regeneration process. (WOUND REP REG 2002;10:320–327)
Regulation of cutaneous pigmentation by titration of human melanocytes in cultured skin substitutes grafted to athymic mice
Authors: Swope Viki B. , Supp Andrew P. , Boyce Steven T.
Published: March 2003

Pigmentation of healed cultured skin substitutes in burn patients is frequently irregular and unpredictable which compromises solar protection and the patient's self‐image. To address these morbidities, human fibroblasts were inoculated on a collagen‐glycosaminoglycan substrate followed 1 day later by the addition of keratinocytes at 1.1 × 106/cm2 combined with either 0, 1.1 × 102, 1.1 × 103, or 1.1 × 104 melanocytes/cm2. The skin substitutes were incubated in vitro for 3 weeks and grafted to athymic mice. In vitro, the number of L‐Dopa–positive melanocytes in the skin substitutes increased proportionately to the number of melanocytes inoculated. The melanocytes localized to the basal epidermis when labeled for MEL‐5. The skin substitutes with 1.1 × 104 melanocytes/cm2 were significantly darker than other groups in vitro by chromameter evaluation. By 12 weeks after grafting, the cultured skin ranged from no pigment in the control group, to 75% pigmented area in the 1.1 × 103 melanocytes/cm2 group, to complete pigmentation in the 1.1 × 104 melanocytes/cm2 group. In vivo, the mean chromameter values were significantly darker for the grafts with 1.1 × 103 and 1.1 × 104 melanocytes/cm2. These results suggest that complete restoration of cutaneous pigmentation can be accomplished by addition of between 0.1 and 1.0 × 104 melanocytes/cm2 to skin substitutes. (WOUND REP REG 2002;10:378–386)