bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardized infection ratio: the next generation of risk-adjusted wound infection measures
Authors: Gustafson T L , Haley R W
Published: December 2004

Background

The scientific literature overwhelmingly supports the value of surgical site infection (SSI) surveillance with feedback of infection rates to surgeons. Recognizing that feedback has little value without some form of adjustment for patient factors, surgeons long ago developed the four-level wound classification system. In the 1980s the SENIC multivariate risk index was introduced, followed by the National Nosocomial Infection Surveillance multivariate risk index which is the currently recommended US standard.

Methods

To address recent advances in surgical technology, ambulatory surgery, and differences between the USA and other countries, newer risk-adjustment methods were explored. The ideal approach would overcome the following common practical problems encountered in generating SSI rates such as: (1) new patient-level risk factors, (2) technology-specific factors, (3) small monthly denominators and (4) postdischarge surveillance. Despite increased mathematical complexity, an acceptable risk-adjustment technique must still provide easily interpretable results.

Results

The standardized infection ratio (SIR) is proposed as the next generation in epidemiological approaches for monitoring and feeding back risk-adjusted SSI rates to surgeons. The SIR is a single monthly number for each surgeon, calculated by dividing the observed number of SSIs by the expected number predicted from a complex statistical model of patient-level and technology-specific risk factors. Like the well known standardized mortality ratio, the SIR offers the advantage of providing one generalizable quality index regardless of the mix of operations performed. In addition, the SIR is well suited to control chart techniques and for providing valid interhospital comparisons.

Conclusion

The SIR model offers simple data input and easily interpretable output suitable for application in all healthcare settings worldwide.
Renal arginine synthesis is impaired after experimental ischaemia–reperfusion
Authors: Prins H A , Nijveldt R J , Rauwerda J A , van Lambalgen A A , Teerlink T , van Leeuwen P A M
Published: December 2004

Background

Endogenous arginine synthesis is important for maintaining normal plasma levels of arginine. Recently it was shown that low plasma levels of arginine are the drive for renal arginine synthesis. In chronic renal insufficiency low plasma levels of arginine are common. To evaluate renal arginine synthesis in acute renal injury, as seen after periods of ischaemia during major vascular surgery, ischaemia–reperfusion of one kidney was performed in a rat model.

Methods

In this model of unilateral renal ischaemia–reperfusion male Wistar rats were used. Arginase infusion (ASE) was used to lower arginine plasma levels to 50 per cent of normal and control rats received saline infusion (SAL). After an ischaemic period of 90 min, the kidney was perfused for 150 min (IR kidney). The contralateral kidney was left in situ and served as a control (CL kidney). Blood flow measurement was performed at the end of the experiment using radiolabelled microspheres. Blood samples were taken for amino acid analysis (high-pressure liquid chromatography). Uptake or release of arginine (flux) was calculated from flow and the arteriovenous concentration difference.

Results

Infusion of arginase efficiently decreased arginine plasma levels (ASE: mean(s.d.) 45·3(4·8) μmol/dm3 versus SAL: 107·5(6·0); P < 0·0001). In SAL rats, in both IR and CL kidneys a net uptake of arginine was observed (arginine flux CL kidney: + 12·5(4·9), IR kidney: + 23·6(5·8) μmol/dm3; P not significant). Lowering arginine plasma levels by arginase resulted in production of arginine in the (non-ischaemic) CL kidney. In contrast, in the IR kidney a net uptake of arginine was seen (arginine flux CL kidney: − 5·3(2·2) μmol/dm3, IR kidney: + 10·3(3·7) μmol/dm3; P < 0·01).

Conclusion

Synthesis of arginine by the kidney was impaired after a period of acute ischaemia–reperfusion. Ischaemia–reperfusion injury of the kidney is a condition often seen after major vascular reconstruction and impaired arginine synthesis might limit substrate for the l-arginine nitric oxide pathway.
Tumour necrosis factor α and interleukin 1β mediate lipopolysaccharide-induced endothelial monolayer permeability in whole blood
Authors: Nooteboom A , Hendriks T , van der Linden C J
Published: December 2004

Background

Overproduction of cytokines may be responsible for irreversible and systemic vascular damage observed among patients suffering from the sepsis syndrome. The resultant excessive fluid loss from the circulation may cause tissue hypoperfusion, organ failure and death. A whole blood assay and an in vitro endothelial model have been used to simulate permeability changes during the acute phase of Gram-negative infection.

Methods

Freshly drawn heparinized human blood from healthy volunteers was treated with bacterial lipopolysaccharide (LPS; Escherichia coli B55: 05). Plasma was then collected and incubated on human umbilical vein endothelial cell (HUVEC) monolayers cultured on semipermeable Transwell COL membranes. The permeability of the monolayers was determined using fluorescein isothiocyanate (FITC) albumin and rhodamine-β-isothiocyanate (RITC) dextran. The production of tumour necrosis factor (TNF) α and interleukin (IL) 1β in whole blood was measured using radioimmunossay.

Results

Incubation of whole blood with as little as 10 pg ml−1 LPS was sufficient to yield plasma that significantly increased endothelial permeability. This effect was dose dependent up to 10 ng ml−1 LPS, at which the permeability exceeded about seven times the permeability of control monolayers. In contrast, significant stimulation of endothelial permeability by LPS alone (i.e. without prior incubation in blood) required more than 50 ng ml−1 LPS. The effect of LPS pretreatment on endothelial permeability was also time dependent: at least 2–4 h of LPS preincubation was required, while maximum permeability was reached at longer preincubations (8–24 h). At these amounts and incubation times LPS was also capable of inducing TNF-α and IL-1β in whole blood. When antibodies directed against TNF-α and IL-1β were added to LPS-conditioned plasma before incubation on HUVEC monolayers the permeability increase was partly inhibited. However, almost complete inhibition was achieved when anti-TNF-α and anti-IL-1β were both added to LPS-conditioned plasma. Similar effects of LPS-conditioned plasma and anti-TNF-α and anti-IL-1β treatment were observed on the expression of E-selectin and intracellular adhesion molecule 1 by endothelial cells.

Conclusion

Whole blood potentiates the inflammatory response of endothelial cells to physiologically relevant doses of LPS. This potentiation is achieved by the production of both TNF-α and IL-1β. If this in vitro endothelial model represents the events observed in patients suffering from Gram-negative sepsis, these data indicate that protection requires simultaneous administration of inhibitors to TNF-α and IL-1β.
Determination of 2-keto-3-deoxyoctanate: a simple method for the quantitative comparison of cytokine induction by meningococcal lipopolysaccharide and that of other bacteria
Authors: Sprong T , van der Ley P , van der Meer J W M , van Deuren M
Published: December 2004

Background

Lipopolysaccharide (LPS), or endotoxin, is considered to be the toxic element in Gram-negative septic shock. There is increasing evidence that the pathogenic properties of LPS differ from species to species but, to date, exact comparison between the biological activities of LPS has been difficult.

Methods

With the aim of quantitatively comparing the cytokine-inducing capacities of Neisseria meningitidis LPS and Escherichia coli LPS in human peripheral blood mononuclear cells on a molar basis, 2-keto-3-deoxyoctanate (KDO) spectrophotometry was used.

Results

Since the KDO region of LPS is a preserved part of the LPS molecule, unlike the saccharide tail, and the molecular weight of this region is known, KDO measurement can provide accurate information about the molarity of an LPS suspension. On a molar basis, the cytokine-inducing capacity of meningococcal LPS was at least ten times higher than that of E. coli LPS.

Conclusion

KDO spectrophotometry is a simple method of making a quantitative comparison between the biological effects of different endotoxins. N. meningitidis LPS is a more potent inducer of cytokine production than E. coli LPS. This may, in part, explain the more fulminant course of meningococcal sepsis compared with E. coli sepsis.
Aneurysm-related mortality during late follow-up after endovascular aneurysm repair of infrarenal aorta
Authors: Vallabhaneni S R , Harris P L , Gilling-Smith G L , Laheij R
Published: December 2004

Background

Aneurysm-related mortality (ARM) accounts for around 1·5 per cent of all deaths following open aneurysm repair. The incidence of ARM following endovascular aneurysm repair (EVAR) is unknown. The aim was to examine all causes of death, including ARM, during late follow-up after EVAR. ARM was defined as death resulting directly from rupture of the repaired aneurysm or another complication of the aneurysm, more than 30 days after repair, or death within 30 days of a secondary intervention undertaken solely to rectify a complication of repair.

Methods

Preoperative and follow-up data on 2194 patients from 88 European centres were collected prospectively on to a database. Survival up to 48 months after EVAR was analysed by means of Kaplan–Meier survival analysis. The causes of death during this period were noted.

Results

There were 161 deaths between 1 and 48 months after EVAR. The cumulative rate of secondary intervention for this cohort at 4 years was 33 per cent. The causes of death were: cardiac 28·6 per cent, malignancy 18·6 per cent, cerebrovascular 6·8 per cent, respiratory 3·1 per cent, renal 1·8 per cent, other 22·3 per cent and ARM 11·8 per cent. There were 19 deaths from aneurysm-related causes. Nine patients died following proven rupture of the aneurysm, three died from presumed rupture of the aneurysm and a further seven died following late conversion (three patients), graft sepsis (two) and secondary intervention (two). Sudden death of uncertain cause occurred in ten patients in whom rupture of AAA was a possibility.

Conclusion

Non-aneurysm-related causes of death were comparable to those in published reports of survival after open repair. However, the proportion of aneurysm-related deaths (11·8 per cent) was appreciably higher than that reported after open repair. These results may reflect the learning curve experience of the teams involved in the study, but continued caution is advisable regarding expectations of outcome following EVAR.
Chronic venous insufficiency in the general population: clinical and duplex correlations
Authors: Ruckley C V , Evans C J , Allan P L , Lee A J , Fowkes F G R
Published: December 2004

Background

If operations for chronic venous insufficiency (CVI) are to be rational and cost effective, the natural history needs to be understood and patients with early disease who will progress to advanced CVI and leg ulcer need to be identified. Published data have derived largely from selected referred hospital patients. The pattern of venous disease in the general population is unknown. The aim was to determine the prevalence of CVI in the general population and to correlate clinical features with the findings on duplex ultrasonography.

Methods

A cross-section of men and women aged 18–64 years randomly selected from 12 general practices were surveyed. Subjects were screened by questionnaire, examination, photography, blood tests and continuous-wave Doppler ultrasonography. Eight segments of the deep and superficial veins were assessed for reflux by means of duplex ultrasonography.

Results

Some 1566 patients were screened (867 women of mean age 44·8 years and 699 men of mean age 45·8 years), of whom 134 were diagnosed as having CVI (Basle classification): grade 1, 95; grade 2, 19; grade 3, ten. The age-adjusted prevalence for the whole series was 3·1 per cent (2·6 per cent in men, 3·4 per cent in women). The prevalence of CVI correlated closely with age, being 15·2 per cent in men aged over 50 years and 9·0 per cent in women aged above 50 years. Heaviness, tension, swelling, aching and itching were significantly commoner in patients with CVI than in the general population. CVI was significantly associated with reflux in all deep and superficial segments. The frequency of reflux in both superficial and deep segments increased with the clinical severity of disease (P = 0·01). In 48·1 per cent reflux was limited to the superficial system and was thus potentially remediable.

Conclusion

CVI was common in this relatively young population. Having established the frequency of CVI and its related pattern of reflux in the general population, this cohort provides a benchmark for clinical studies and will form the basis of further longitudinal epidemiological studies.
Jugular venous neurone-specific enolase and s-100 levels after carotid endarterectomy under local or general anaesthesia
Authors: Wijeyaratne S M , Cruickshank J , Collins M , Barth J , Homer Vanniasinkam S , Mavor A I D , Gough M J
Published: December 2004

Background

Previous studies using near infrared spectroscopy have indicated that carotid endarterectomy (CEA) performed under local anaesthesia (LA) preserves cerebral cytochrome oxidase and autoregulation compared with surgery under general anaesthesia (GA). The hypothesis that LA offers a degree of protection against ischaemic cerebral injury has thus been investigated by measuring ipsilateral jugular venous neurone-specific enolase (NSE; a glycolytic enzyme released from injured neurones) and s-100 (a protein released from glial cells) during and after CEA.

Methods

Sixteen patients with symptomatic 70–99 per cent carotid stenosis were randomized (with ethics committee approval) to CEA with either LA (n = 7; mean stump pressure 48·5 (range 37–80) mmHg; none of seven shunted) or GA (n = 9; mean stump pressure 49·1 mmHg; five of nine shunted). Jugular venous samples were assayed for NSE and s-100 concentration (immunoluminometric assay) before carotid clamping, 5 min before and 5 min, 2, 4, 6, 8, 12 and 24 h after clamp release.

Results

There were no neurological complications. Median (range) levels of s-100 were low and did not increase from baseline levels (GA 0·10 (0·08–0·11) μg l−1, LA 0·13 (0·12–0·17) μg l−1) in either group. Preclamp NSE levels were similar in both groups (LA 17·6 (15·2–20·7) μg l−1versus GA 21·5 (11·3–26·2) μg l−1; P = 0·37). Peak levels occurred at 2 h and were significantly higher in patients having GA (48·2 (31·4–61·3) versus 25·5 (16·6–27·8) μg l−1; P = 0·05, Mann–Whitney U test). Furthermore, the increase from baseline in patients having GA was also significant (P = 0·04) and NSE levels were higher at all time points up to 12 h, returning to baseline at 24 h.

Conclusion

These results suggest that CEA performed under LA is associated with reduced cerebral ischaemic injury compared with GA, and are consistent with niroscopic data indicating improved cerebral oxygenation in these patients. Furthermore, NSE would seem to be a more sensitive marker of cerebral injury than s-100.
Outcome after septic complications in J pouch procedures
Authors: Heuschen U A , Allemeyer E H , Hinz U , Lucas M , Herfarth C , Heuschen G
Published: December 2004

Background

Despite the wide range of surgical approaches for pouch salvage, septic complications are among the main causes of pouch failure.

Methods

This study analysed the mode and outcome of various therapeutic approaches for pouch salvage and the impact of time of diagnosis, localization and form of septic complications on the risk of pouch failure in 131 patients with septic complications of a total of 706 patients undergoing a J pouch procedure.

Results

Septic complications consisted of 76·3 per cent fistulas, 15·3 per cent anastomotic breakdowns and 8·4 per cent pelvic abscesses. A total of 107 patients (81·7 per cent) with septic complications required a mean of 2·2 surgical procedures. The frequency of permanent defunctioning and excision of the pouch in the 131 patients with septic complications was 23·7 and 6·1 per cent respectively. The estimated cumulative 3-, 5- and 10-year rate of pouch failure in patients with septic complications was 19·6, 31·1 and 39·2 per cent respectively. The risk of pouch failure was significantly affected by the site of origin of septic complications (P = 0·02). The 5-year pouch failure rate increased in a subgroup of patients with septic complications at the pouch–anal anastomosis when the anal sphincter was involved (50·1 versus 29·2 per cent; P = 0·18).

Conclusion

Pouch failure as a result of septic complications may occur several years after ileal pouch–anal anastomosis. For prevention of pouch failure, surgery for septic complications is required in a high percentage of patients and repeated attempts are justified. Follow-up studies are required for further analysis of pouch failure.
Long-term results of antireflux surgery indicate the need for a randomized clinical trial
Authors: Sandbu R , Khamis H , Gustavsson S , Haglund U
Published: December 2004

Background

Well conducted, comparative trials of laparoscopic versus open antireflux surgery with an adequate patient enrolment are few and they do not demonstrate obvious advantages for the laparoscopic approach except for a marginal gain in shorter hospital stay. The aim of this study was to compare the effectiveness of laparoscopic and open procedures.

Methods

Two unselected groups of 230 patients were identified through a register of all inpatient public care in Sweden. Outcomes of laparoscopic and open antireflux surgery were compared using a disease-specific questionnaire 4 years after operation.

Results

Failure and dissatisfaction were significantly more common in the laparoscopy group than among patients having conventional open surgery. Treatment failure rates were 29·0 and 14·6 per cent respectively (P = 0·004). Dissatisfaction rates were 15·0 and 7·0 per cent respectively (P = 0·005). There was no other questionnaire item for which the proportion of failures differed significantly between the two groups.

Conclusion

This study does not support the presumption that laparoscopic antireflux surgery is to be preferred to the open procedure. It is strongly recommended that a randomized controlled trial be conducted.
Endoscopic ultrasonography in the diagnosis and management of suspected upper gastrointestinal submucosal tumours
Authors: Shen E F , Arnott I D R , Plevris J , Penman I D
Published: December 2004

Background

‘Submucosal’ lesions in the upper gastrointestinal tract are often difficult to evaluate. Endoscopic ultrasonography (EUS) provides high-quality information about the nature of these lesions and may assist management. This study assessed the use of EUS in the evaluation and management of upper gastrointestinal submucosal tumours.

Methods

Forty-four consecutive patients were referred with suspected upper gastrointestinal submucosal lesions for EUS. All examinations were performed by one of two experienced endosonographers.

Results

Most patients were referred for EUS with a suspected gastrointestinal stromal tumour. The pre-EUS diagnosis did not correlate with the EUS diagnosis in 25 of 44 patients. Pathological correlation was possible in 16 patients, and the EUS diagnosis was confirmed in each case. Based on the findings at EUS, 12 patients underwent resection. Pathology confirmed the ultrasonographic findings in these patients. Follow-up EUS to monitor lesions was recommended in a further three patients.

Conclusion

EUS is safe and provides useful information in many patients with suspected submucosal tumours. EUS may reveal unsuspected findings and can increase physician certainty, allowing accurate diagnosis and facilitation of the management process.
Systematic review of dynamic graciloplasty in the treatment of faecal incontinence
Authors: Chapman A E , Geerdes B , Hewett P , Young J , Eyers T , Kiroff G , Maddern G J
Published: December 2004

Background

The aim of this systematic review was to compare the safety and efficacy of dynamic graciloplasty with colostomy for the treatment of faecal incontinence.

Methods

Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase and Cochrane Library databases up until November 1999. Inclusion of papers depended on a predetermined protocol, independent assessments by two reviewers and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials and case series. Forty papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance.

Results

No high-level evidence was available and there were no comparative studies. Mortality rates were around 2 per cent for both graciloplasty and colostomy. Morbidity rates reported for graciloplasty appear to be higher than those for colostomy. Dynamic graciloplasty was clearly effective at restoring continence in between 42 and 85 per cent of patients, whereas colostomy is, by its design, incapable of restoring continence. However, dynamic graciloplasty is associated with a significant risk of reoperation.

Conclusion

While dynamic graciloplasty appears to be associated with a higher rate of complications than colostomy, it is clearly a superior intervention for restoring continence in some patients. It is recommended that a comparative, but non-randomized, study be undertaken to evaluate the safety of dynamic graciloplasty in comparison to colostomy, and that the procedure should be performed only in centres where it is carried out routinely.
A dynamic model of proliferation and differentiation in the intestinal crypt based on a hypothetical intraepithelial growth factor
Authors: Gerike T. G. , Paulus U. , Potten C. S. , Loeffler M.
Published: December 2004

A widely accepted model of the temporal and spatial organization of proliferation and differentiation in intestinal epithelia is based on a cellular pedigree with all cells descending from a few active stem cells and undergoing a sequence of transitory divisions until the non‐proliferating maturing cell stages develop. Model simulations have shown that such a pedigree concept can explain a large variety of data. However, so far there is neither a direct experimental proof for the existence of an intrinsic age structure in the transitory proliferative cell stages nor for the distinction between stem and transitory cells. It is our objective to suggest an alternative model which is based on evidence for intercellular communications such as might be mediated through gap junctions. We consider the diffusion of a hypothetical intraepithelial growth factor in a chain of cells which are connected via gap junctions. Individual cells can divide if a critical growth factor concentration is exceeded. Simulation studies show that the model is consistent with many observed features of the small intestinal crypt in steady state and after perturbation.
Managing sexually abused and/or abusing children in substitute care
Authors: Farmer Elaine , Pollock Sue
Published: December 2004

This paper reports on research on the characteristics, management and therapeutic treatment of sexually abused and/or abusing children in substitute care. Of the 40 sexually abused and/or abusing young people aged 10 or over in the interview sample, two‐thirds showed sexual behaviours in the placement studied but one‐third did not. The range of sexual behaviours shown by the young people is described. Analysis of the findings shows that four key components of effective management are supervision, adequate sex education, modification of inappropriate sexual behaviour and therapeutic attention to the needs that underlie such behaviour. Supervision includes planning for safe care before placement, preparing other children in the setting, teaching young people how to keep themselves safe when out on their own, and careful monitoring of contact with birth family members. The need for a proactive approach to sex education is stressed. Effective management approaches to masturbation, sexualized behaviour and sexually abusing behaviour are discussed but the processes of denial and minimization of sexual abuse and the development of high thresholds for action when looked after children are abused or at risk are shown to present obstacles to effective care. Finally, the importance of addressing children's deeper needs is emphasized, including the importance of regular review of their need for counselling. At the end of the article two case examples from the study are given.
Positive Connections: a programme for children who have a parent with a mental illness
Authors: Orel Nancy A. , Groves Patricia A. , Shannon Leona
Published: December 2004

Mental health professionals working with parents who suffer from a mental illness often overlook the children within the family. Children whose parents are mentally ill face numerous obstacles to their own emotional development and these children are at higher risk for developing mental illnesses than other children. These risks can be decreased if protective or positive interventions are available for the children. This article will describe the development and implementation of Positive Connections, an effective intervention programme specifically designed for children whose parents have been diagnosed with a mental disorder. The effectiveness of this programme has been evaluated using both qualitative and quantitative research strategies, and the results are presented.
A personal reflective account: The impact of the collation and sharing of information during the course of a child protection investigation
Authors: Richardson M.
Published: December 2004

This paper provides a subjective, personal account of the impact and effect which the collation and sharing of information had and continues to have on my family during the course of a child protection investigation. By sharing my story I hope to preserve my unique, subjective experience in the midst of an impersonal and highly invasive bureaucratic process in an attempt to bridge the power divide between the professional and parent. I do not attempt to analyse theory but rather feelings, and identify the differing perceptions of those involved. The importance of the professional maintaining an open mind and challenging any preconceived assumptions or judgements about a family is also stressed. Child protection work must ensure that policies and practice comply with the rights laid down in the Human Rights Act (1998) and the professionals involved must be seen to promote and protect the rights of all vulnerable individuals.
Infant–mother interaction as a predictor of child's chronic health problems
Authors: Mäntymaa M. , Puura K. , Luoma I. , Salmelin R. , Davis H. , Tsiantis J. , Ispanovic‐Radojkovic V. , Paradisiotou A. , Tamminen T.
Published: December 2004

Background   Psychological stress is associated with physical illnesses like asthma or infections. For an infant, situations perceived as stressful are highly dependent on the relationship with the caregiver. Constantly poor mother–infant interaction increases the child's vulnerability to stressful conditions and experiences. The aim of the study was to investigate the impact of the quality of early mother–infant interaction on the subsequent physical health of the child. Poor mother–infant interaction was hypothesized to be associated with chronic or recurrent health problems in the child.

Participants   Fifty‐seven mother‐infant dyads from families at risk of psychosocial problems and 63 from non‐risk families, altogether 120 dyads, participated in the study. Families were drawn from normal population, from well‐baby clinics in the city of Tampere, Finland. Infants were full‐term and healthy, families with severe risks like psychotic illnesses of the parents or a history of child protection concerns were excluded from the study.

Methods   After the initial interview with the mother, the mother–infant interaction was videotaped when the infants were 8–11 weeks of age and the interaction was assessed using the Global Rating Scale for Mother–Infant Interaction (Murray et al. 1996a). After the 2‐year follow‐up mothers were interviewed again and the health problems of the child were elicited.

Results   Poor dyadic mother–infant interaction and infant's poor interactive behaviour assessed at two months were separately associated with the physical health of the child during the two‐year follow‐up. After adjusting for other factors in the logistic regression analysis infant's poor interactive behaviour remained as a significant predictor of chronic or recurrent health problems in the child. Infant's health problems at the time of the initial interview and day care centre attendance were also significant predictors.

Conclusions   The results suggest that interactional issues between a mother and her infant are related to the child's subsequent physical health. Children with recurrent or chronic health problems may have relationship difficulties with which they need help. Also, early avoidant behaviour of the infant should be regarded as an indicator of the infant's distress with possibly adverse outcomes in the child's physical health, among other consequences.
When adolescents disagree with their mothers: CBCL‐YSR discrepancies related to maternal depression and adolescent self‐esteem
Authors: Berg‐Nielsen T. S. , Vika A. , Dahl A. A.
Published: December 2004

Objective  To facilitate understanding of disagreement between mothers and adolescents when they report on adolescents’ mental symptoms, discrepancy of reports were studied in relation to depressive symptoms of mothers and self‐esteem of adolescents.

Participants  Sixty‐eight mother–adolescent pairs participated. All the adolescents (11–17 years) were referred to child and adolescent psychiatric outpatient clinics in Norway for emotional or behavioural disorders.

Methods  The adolescents completed the questionnaire Youth Self Report (YSR), and mothers completed the corresponding Child Behaviour Checklist (CBCL). Maternal depression was measured with the Hospital Anxiety and Depression Scales and adolescent self‐esteem was measured with Self‐Perception Profile for Adolescents.

Results  Mothers’ level of depression emerged as a significant variable (P < 0.001) predicting CBCL‐YSR discrepancy on internalizing disorders, explaining 41% of the variance. With increased levels of depression mothers tended to report more internalizing problems compared to the adolescents. For mother–adolescent discrepancy on externalizing problems, adolescents’ age was the most significant variable. With increasing age the adolescents were more in agreement with their mothers when reporting their externalizing problems. But also self‐esteem problems concerning their looks made adolescents inclined to admit more externalizing problems, thus being more in agreement with their mothers.

Conclusions  Subjective, psychological variables such as mothers’ level of depression and self‐esteem of adolescents may be useful to consider when interpreting informant discrepancy concerning the mental problems of adolescents.
Current Literature: 2
Authors: Reading Richard
Published: December 2004

An examination is made of a meta‐analysis by Attewell et al. (Attewell R, Glase K and McFadden M. (2001) Bicycle helmet efficacy: a meta‐analysis. Accident Analysis and Prevention,33, 345–352), which concludes that bicycle helmets prevent serious injury, to the brain in particular, and that there is mounting scientific evidence of this. The Australian Transport Safety Bureau (ATSB) initiated and directed the meta‐analysis of 16 observational studies dated 1987–98. This examination concentrates on injury to the brain and shows that the meta‐analysis and its included studies take no account of scientific knowledge of its mechanisms. Consequently, the choice of studies for the meta‐analysis and the collection, treatment and interpretation of their data lack the guidance needed to distinguish injuries caused through fracture of the skull and by angular acceleration. It is shown that the design of helmets reflects a discredited theory of brain injury. The conclusions are that the meta‐analysis does not provide scientific evidence that such helmets reduce serious injury to the brain, and the Australian policy of compulsory wearing lacks a basis of verified efficacy against brain injury.
Current Literature: 4
Authors: Ni Bhrolchain Cliona
Published: December 2004

Background  The Clifton area of Nottingham with a total population of nearly 20 000 and a child population of 4500.

Aim  To track the changes in clinical services provided by community paediatricians in Clifton from 1983 to 1999.

Methods  The paper tracks changes through a series of reports produced over time by the paediatricians working in the Clifton area. The 5 reports are dated 1983, 1985, 1989–91, 1995, 1999–2000.

Results  The child population in Clifton dropped somewhat from 4700 to 3900 during the study period. A child health clinic (CHC) with no appointment system and providing Child Health Surveillance was staffed by a senior community paediatric trainee in 1983. This had transformed into a referral clinic with an appointment system by 1995 (still staffed by the trainee). By 2000, the clinic had added a consultation element for GPs, HVs, school nurses and school support teachers for a session a week and added a clinical psychologist to its staff. Trainees staff the clinics still (a lecturer and an SHO) but an Associate Specialist session has been added to provide better continuity of care.

In 1983, each infant was seen 26.7 times (range 9–51): 61% at the CHC (mostly for weighing), 31% at the GP surgery. By 1991, GPs had taken on CHS and the clinic had a formal appointment system but with a ‘drop in’ period when necessary. Total attendances dropped by almost a half between 1989 and 1991, as did those attending for immunizations. Primary care referrals accounted for 15.5% of those seen in 1991. Major diagnostic categories included weight and feeding, development, behaviour and ‘minor problems’. By 2000, there were 3 referral clinics a week with the additional consultation clinic. No CHS was provided. Developmental difficulties (61) and behaviour difficulties (60) now top the list of referral categories and the latter include self‐harm, anorexia, Tourette’s, ADHD and conduct disorder, with 8 of these excluded from school. Medical diagnoses (49) such as short stature, epilepsy and various syndromes come next with child protection referrals (28) and weight and feeding (26) following on behind. Hospital consultants had referred some children to be managed by the community paediatricians.

Conclusions  The authors point out the invisibility of the changes in community paediatric services compared with the more apparent hospital changes. The lack of regular reporting of community data reinforces this invisibility. However they also sound a hopeful note that the community services have shown a constant ability to innovate and respond to changing demand and that this should stand us in good stead in the future.
Current Literature: 5
Authors: Ni Bhrolchain Cliona
Published: December 2004

Background  A tertiary neurodisability centre at a major London teaching hospital (Guy's and Thomas’).

Aim  To review the outcome after 4 years of a cohort of children with severe language delay/disorder and some features of autism, but not sufficient at the time to confirm a diagnosis of autism.

Methods  The notes of 227 children assessed at the centre between the age of 2 and 5 were examined to select cases. This resulted in 40 children with severe receptive language delay as the primary diagnosis and a nonverbal IQ above 70. One hundred and eight children were excluded as another diagnosis, including autism, had been made and in 79 cases original clinical notes were insufficient for re‐analysis. However further exclusions due to lack of formal IQ scores, changed addresses, refusals and re‐assessment delays left a total of 18 children who participated in the study.

Standard measures of performance were used to assess intellectual and language functioning, in addition to clinical evaluation.

Results   Follow‐up at a mean age of 8 years and 7 months showed that five children now showed sufficient language and social impairments for a diagnosis of childhood autism and the other 13 met criteria for atypical autism although nine of these showed some recovery in their language skills. The severity of social communication impairments and repetitive behaviours in the original notes were associated with the severity of autism when re‐assessed.

From parental questionnaires, none of the children was considered to have developed ‘true friendships’ with reciprocal interaction, sharing and coinitiation of activities. Some tried but didn’t succeed while others were ‘loners’ who preferred their own company. All 18 children had a statement. Ten children attended specialist educational provision (six in a language unit, two in an MLD school and two in an autism unit) and the others had help in mainstream.

Conclusions   The authors thought they would find two groups of children at follow‐up: one with ‘true autism’ and one where improvement had occurred; ‘true language delay’. Instead, they found that all could be given a diagnosis of autism when re‐assessed. They discuss the continuing difficulties of defining childhood developmental disorders at an early age and the difficulties of separating autism from ‘a receptive language disorder with secondary socio‐emotional problems’ as required by ICD‐10.

They comment on the apparent importance of repetitive behaviours and the prognosis of children who show impairments in all three ASD areas in the preschool years, even if they are not sufficient to diagnose an ASD at the time. They also comment on the risk to effective education and health support if a diagnosis of autism is not given.
Current Literature: 6
Authors: Reading Richard
Published: December 2004

Aims  To evaluate the effect of site specific advice from a school travel coordinator on school travel patterns.

Methods  Cluster randomised controlled trial of children attending 21 primary schools in the London boroughs of Camden and Islington. A post‐intervention survey measured the proportion of children walking, cycling, or using public transport for travel to school, and the proportion of parents/carers very or quite worried about traffic and abduction. The proportion of schools that developed and implemented travel plans was assessed.

Results  One year post intervention, nine of 11 intervention schools and none of 10 control schools had travel plans. Proportions of children walking, cycling, or using public transport on the school journey were similar in intervention and control schools. The proportion of parents who were very or quite worried about traffic danger was similar in the intervention (85%) and control groups (87%). However, after adjusting for baseline and other potential confounding factors we could not exclude the possibility of a modest reduction in parental concern about traffic danger as a result of the intervention.

Conclusions  Having a school travel coordinator increased the production of school travel plans but there was no evidence that this changed travel patterns or reduced parental fears. Given the uncertainty about effectiveness, the policy of providing school travel coordinators should only be implemented within the context of a randomised controlled trial.
Expression of the neutrophil‐activating CXC chemokine ENA‐78/CXCL5 by human eosinophils
Authors: Persson T. , Monsef N. , Andersson P. , Bjartell A. , Malm J. , Calafat J. , Egesten A.
Published: December 2004

Background Eosinophils are seen at sites of inflammation in diseases such as helminthic infestation, asthma, ulcerative colitis and some neoplastic diseases. They are also associated with connective tissue remodelling, for example in longstanding asthma. In the present study, we investigated whether eosinophils express the CXC chemokine epithelial cell‐derived neutrophil activating peptide (ENA‐78/CXCL5), a chemokine that can activate neutrophils and in addition possesses angiogenic properties.

Immunocytochemistry detected CXCL5 in eosinophils and the peptide was localized in the specific granules by immunoelectron microscopy.

Methods and Results In eosinophil lysates, 12 ± 2 pg (mean ± SEM) of CXCL5 was detected per 106 cells by enzyme‐linked immunosorbent assay (ELISA). Weak constitutive expression of CXCL5, as well as the related CXC chemokine IL−8/CXCL8, could be detected in freshly isolated eosinophils by RT–PCR. However, during prolonged incubation of eosinophils, a strong increase in both CXCL5 and IL‐8/CXCL8 expression was seen, as detected by RT‐PCR, and increasing amounts of CXCL5 peptide with time were detected in the incubation medium by ELISA. Addition of TNF‐α neutralizing antibodies during prolonged incubation significantly inhibited CXCL5 production, demonstrating involvement of auto‐ and paracrine effects from TNF‐α produced by eosinophils themselves. Addition of IFN‐γ showed a strong inhibitory effect on CXCL5 synthesis.

Conclusion These findings suggest that, through expression of CXCL5, eosinophils can recruit and activate CXC receptor 2 (CXCR2)‐bearing cells such as neutrophils at sites of inflammation. Eosinophils may also promote connective tissue remodelling through release of this peptide.
Retrospective assessment of seasonal allergic symptoms: over‐rating but useful
Authors: Bodtger U. , Poulsen L. K. , Malling H.‐J.
Published: December 2004

Background The history of the severity of seasonal allergic symptoms is often obtained post‐seasonally as a retrospective assessment. Correct rating is essential when determining the efficacy of pharmaceutical treatment, indications for allergen‐specific immunotherapy (SIT), or inclusion into controlled clinical studies.

Objectives To investigate the agreement between in‐ and post‐seasonal ratings of seasonal symptoms, and to investigate whether the effect of SIT could be detected retrospectively.

Material and methods Thirty‐five birch pollen‐allergic patients were allocated to SIT or placebo in a double‐blind study. Assessment of severity of symptoms from the nose, eyes and lungs were performed daily during the season 2000, and post‐seasonally 6 months after the season in 1999 and 2000. A four‐point verbal descriptor scale (VDS‐4) was used at all occasions. A mean in‐seasonal symptom rating was calculated for four periods: the day, the week and the 2 weeks with the highest symptoms score, and the arithmetic season (the period covering the mid‐90% of the accumulated pollen count). In‐ and post‐seasonal ratings were compared with Cohen's weighted kappa (κw).

Results Agreement between in‐seasonal and retrospective ratings was fair to moderate (κw: 0.30–0.60). Post‐seasonal ratings were most related to symptoms experienced in the week with the highest symptom scores, and least related to the arithmetic season. The post‐seasonal ratings were significantly skewed towards higher symptom scores than the mean of in‐seasonal ratings in periods ≥ 2 weeks. Despite being comparable before intervention, only in the SIT‐treated group was a significant decrease in post‐season ratings of severity of rhinoconjunctivitis apparent (P < 0.05). Asthma scores were not reduced but fewer patients in the SIT group reported lung symptoms (P < 0.001).

Conclusion Post‐seasonal assessment of seasonal allergic symptoms generally describes a shorter period than the arithmetic season. Post‐season assessment tends to over‐rate average symptom severity, but appears sufficiently sensitive to detect treatment efficacy.
House‐dust mite sublingual‐swallow immunotherapy in perennial conjunctivitis: a double‐blind, placebo‐controlled study
Authors: Mortemousque B. , Bertel F. , De Casamayor J. , Verin P. , Colin J.
Published: December 2004

Background The safety and the efficacy of sublingual‐swallow immunotherapy (SLIT) in perennial conjunctivitis caused by house dust mite were evaluated in a double‐blind, placebo‐controlled study including 60 patients for 24 months.

Methods Patients received either placebo or SLIT with standardized Dermatophagoides pteronyssinus (D.pt.) and D. farinae (D.f.) 50/50 extract. The evaluation of the efficacy of the SLIT was obtained by using standardized D. pteronyssinus (D.pt.) extracts on the antigen‐specific conjunctival provocation test (CPT). Specific CPT, skin sensitivity and serum‐specific IgE were performed before starting treatment and 6, 12, 18 and 24 months.

Results Of the 60 patients included, only 45 completed the study (26 in the active group and 19 in the placebo group, P < 0.05). Two out of 30 (6.6%) patients dropped out because of insufficient efficacy in the active group compared to eight out of 30 (26.6%) in the placebo group (P < 0.05). There was a significant increase in the antigen threshold required to obtain a positive CPT from 8.2 IR [95% confidence interval (CI) 5.9–11.4] at baseline to 21.7 IR (95% CI 15.4–30.4) at 2 years (M24) in the active group, compared to 8.1 IR (95% CI 5.4–12.1) at baseline to 8.1 IR (95% CI 5.1–12.4) at M24 in the placebo group (P < 0.04 for overall treatment difference, P < 10−7 for the time–treatment interaction; repeated measures ANOVA). Differences between groups at individual time points were significant from 18 months on. Despite increased antigen concentrations, CPT scores were lower overall in the active than in the placebo group (P < 0.001). No serious adverse effects were reported.

Conclusion SLIT effectively increased the antigenic threshold required to obtain a positive CPT to house‐dust mite antigen. Tolerance to and innocuity of SLIT were comparable to previous studies. This could justify recommending SLIT for the preventive treatment of perennial conjunctivitis caused by house dust mites.