bluuebunny/crossref_metadata_2025 huggingface dataset:
Musculoskeletal disorders among rural Australian nursing students
Authors: Smith Derek R. , Leggat Peter A.
Published: December 2004

Aim:  To investigate the prevalence of musculoskeletal disorders (MSD) among rural Australian nursing students and compare the results with other international studies.

Method and analysis:  A self‐reporting questionnaire adapted from previous research, was administered to 260 students from all three grades of a major nursing school in regional north Queensland, Australia.

Results:  A high proportion of students reported an MSD at some body site (80.0%), with low back pain being the most common condition (59.2%). This was followed by MSD of the neck (34.6%), knee (25.0%), shoulder (23.8%), feet (16.5%), wrist (12.7%) and legs (11.9%). MSD of the shoulder was slightly more common among males when compared to females (39.3% vs 22.0%, P = 0.0424). Previous paid employment as a nurse or nursing assistant was found to increase the risk of upper arm MSD by a factor of 10.8 (odds ratio 10.8, 95% confidence interval 1.9–205.8, P = 0.0276).

Conclusion:  Overall, this investigation suggests that MSD is more frequent among rural Australian nursing students, when compared to their counterparts around the world. Their high rate of MSD is also comparable to that reported by hospital nurses in other countries.

What is already known and why the study was done:  Although musculoskeletal disorders (MSD) are known to affect nursing students at reasonably high rates, few studies have been undertaken in rural Australia. Therefore, it was considered necessary to investigate MSD among a complete cross‐section of rural Australian nursing students, using a questionnaire adapted from previous research. Findings were then compared with similar international studies.

What this study adds to the published literature:  A high proportion of students reported an MSD at some body site, with low back pain being the most common condition. Overall, this investigation suggests that MSD is more frequent among rural Australian nursing students, when compared to their counterparts around the world. Their high rate of MSD is also comparable to that reported by hospital nurses in other countries.
Invasive pneumococcal disease in the Kimberley, 1995–2001
Authors: Mak Donna B.
Published: December 2004

Objective:  To describe the epidemiology of invasive pneumococcal disease (IPD) in the Kimberley and examine whether cases could have been prevented by vaccination.

Design:  Prospective case series of IPD cases from 1 January 1995 to 31 December 2001.

Setting:  The Kimberley region of far north‐western Australia.

Subjects:  Seventy IPD cases in 37 men and 33 women aged 5 months to 90 years. Aboriginal people comprised 90% (63/70) of cases.

Main outcome measures:  Demographic, clinical and microbiological characteristics of IPD cases. Proportion of cases caused by vaccine‐preventable serotypes. IPD incidence in the Kimberley.

Results:  Pneumonia and bacteraemia were the commonest clinical presentations. Of IPD cases, 15% (children) and 67% (adults) had a risk factor for IPD. The case fatality rate was 13%. Of cases, 46% (95% confidence interval (CI) 35–58%) were caused by serotypes covered by an age‐appropriate vaccine. Of the 26 cases eligible for pneumococcal vaccination, only 4 (16%) had been appropriately vaccinated. IPD incidence in Aboriginal people aged 15 years and over declined from 97.8/100 000 person years (95% CI 56.5–139.1) in 1997 to 38.1/100 000 person years (95% CI 22.5–53.9) in 2001.

Conclusions:  The significant proportion of cases caused by vaccine‐preventable serotypes and that was, therefore, preventable underscores the importance of pneumococcal vaccination.

What this paper adds:  What is already known? IPD is a major cause of morbidity and mortality worldwide, and especially in Indigenous Australian populations; however, there is little published information about the epidemiology of this illness in the Kimberley region of Western Australia, which has a large Indigenous population. What does this study add? Many Kimberley IPD cases are caused by vaccine‐preventable serotypes and are, therefore, potentially preventable. Following the introduction of an adult pnuemococcal vaccination program in 1996, IPD incidence in Kimberley Aboriginal adults fell significantly.
Health beliefs of rural Canadians: Implications for practice
Authors: Thomlinson Elizabeth , McDonagh Meg Kathleen , Crooks Kathryn Baird , Lees Margaret
Published: December 2004

Objective:  The objective of the present study was to examine the health beliefs, values and practices of rural residents living in two geographically diverse regions of western Canada.

Design:  An ethnographic study with semistructured interviews of 55 persons was conducted with participants ranging in age from 19 to 84 years.

Results:  Being healthy was described as having balance in one's life, taking into consideration the relationship between the physical, mental, social, and spiritual aspects of the person. Health‐seeking behaviours spanned the gamut of diet, exercise, sleep, home remedies, a belief in a spiritual being, to consulting health professionals. Resources that participants valued included professionals who listened, friends, neighbours, church, music, elders, ambulance service and the internet.

Conclusions:  It is important that professionals view the person beyond the disease and take into account more than the physical manifestations of an illness. A key component is the demonstration of respect for all persons regardless of age. It is essential that health professionals develop websites providing accurate health‐care information. Participants noted the need to recruit and retain professionals in rural regions.

What this paper adds:  Canadian rural research, to date, has largely focused on the recruitment of rural health‐care providers. Nurse researchers from Montana discovered that rural dwellers have a tendency to define health from a role performance perspective that meant being able to work and meet family obligations; in contrast to urban dwellers, who tend to focus upon the comfort, cosmetic and life prolonging aspects of health. Because of the paucity of Canadian published literature on this topic, the health benefits, values and practices of rural Canadians are entirely speculative.

Data analysis revealed several themes with implications relevant to health‐care professionals. Being healthy was described as involving the physical, mental, social and spiritual aspects of a person. Health‐seeking behaviours engaged in included diet, exercise, sleep, home remedies, spiritual beliefs and consulting health professionals. Accessing accurate health information was identified as a significant resource. The development of websites by health‐care professionals to facilitate the acquisition of information that are understandable and pertinent was seen as one way of meeting this need. Those health professionals who truly listen to their patients and view them as whole persons rather than disease entities are highly valued. Health professionals need to be retained once recruited if trusting relationships are to be developed and maintained. To maintain these relationships over the long term, resources that support the elderly and infirm must be secured and further developed, such as day programs, respite care for family members and palliative care services.
Changes in seroprevalence of hepatitis A in children and adolescents in Manisa, Turkey
Authors: Tosun Selma , Ertan Pelin , Kasirga Erhun , Atman Ümit
Published: December 2004

Background
: Hepatitis A virus (HAV), being an enteric transmitting virus wide world, occurs mostly in children of developing countries. However, the virus has recently been seen in adolescents and young adults worldwide. The aim of the present study was to evaluate the seroprevalence of the HAV infection in children and adolescents in Manisa, Turkey, and to verify whether the increased incidence of HAV infection in other parts of the world and Turkey generally is also true for the area of Manisa.

Methods
: The authors studied blood samples of 1395 adolescents and children aged between 6 months and 17 years from the Manisa area in order to evaluate the existence of anti‐HAV antibodies using micro‐ELISA test.

Results
: Total seropositivity was 44.6% while age related values were as followed: 6–23 months, 47.8%; 2–6 years, 23.7%; 7–10 years, 43.4%; 11–14 years, 52.4%; and 15–17 years, 76.6%. These results suggest that the seropositivity increases significantly among children at school age and also increases parallel to age.

Conclusions
: According to these results, the authors concluded that there has been a shift of seropositivity from children to adolescents especially in families with an average or high socio‐economical level.
Intestinal parasitic infection in children in post‐disaster situations years after earthquake
Authors: Öztürk C. Elif , Şahin İdris , Yavuz Taner , Öztürk Ayhan , AkgünoĞlu Mustafa , Kaya Demet
Published: December 2004

Backround
: Two earthquakes in the north‐west region of Turkey destroyed 80% of the houses and schools in Düzce in 1999. This study was conducted to determine the parasitic infection rate associated with the post‐earthquake unhealty living conditions and related epidemiological risk factors.

Methods
: Two populations living and studying in different socioeconomic conditions as a result of the earthquake were compared: Group 1 (study group) consisted of 326 children living and studying in transitory houses and classes. Group 2 (control) consisted of 127 children living in normal houses and studying in normal school classes. Fecal samples were obtained from both groups and examined for intestinal parasites’ eggs and trofozoid forms. In addition, selotype procedure was applied to both populations. Epidemiological data determining the socioeconomic status of the populations were collected by questionnaire.

Results
: In group 1, Giardia lamblia (G. lamblia) cysts were observed in 10.4% of the fecal samples and Enterobius vermicularis (E. vermicularis) eggs were observed in 13.5% of selotype samples. In group 2, Giardia cysts were observed in 3.1% of the samples and E. vermicularis eggs were observed in 5.5% of selotype samples. The rate of Giardiasis and Enterobiasis was found to be significantly higher in children still living and studying in temporary houses and schools years after the earthquakes (P < 0.05). The following pidemiological and social factors arising after the earthquakes were associated with increased rate of G. lamblia and E. Vermicularis infections: number of communal toilets per child at school, socioeconomic level of the children, dimensions of the classrooms where the children are studying and living and frequency of hand‐washing at school. These parameters are significantly different between the groups (P < 0.05).

Conclusion
: Giardiasis should be considered as an emerging disease in postdisaster situations and adequate prevention measures should be implemented in these circumstances. It should also be known that the rate of Enterobiasis is increased in populations living in crowded unhealthy conditions.
Primary ureteroscopic treatment for obstructive ureteral stone‐causing fornix rupture
Authors: KALAFATIS PANAGIOTIS , ZOUGKAS KONSTANTINOS , PETAS ANASTASIOS
Published: December 2004

Abstract  Background:  Management of fornix rupture (FR) by obstructive stone is comprised of extravasation control and the elimination of the obstruction. For all patients, management initially remains conservative under close follow up.

Endoscopic management of FR involved with an obstructive stone of the ureter or the pelvi‐ureteric junction (UPJ) consists mainly of stenting the ureter. Our endoscopic approach to this pathological entity comprises of the sole stenting of the ureter, as well as primary ureteroscopic lithotripsy followed by ureter stenting.

Patients and methods:  In the Department of Urology at the General Hospital of Rhodos Island, Rhodos, Greece, over the last 15 years, 51 of 86 patients with FR due to an obstructive stone, were treated endoscopically. Twenty‐two patients underwent sole stenting of the ureter (option A) and 29 patients underwent primary ureteroscopic lithotripsy and stenting (option B).

Results:  The overall primary ‘successful outcome’ was achieved in nine of the 22 patients (40.9%) in the group treated with sole stenting, while the remaining 59.1% required secondary interventions. However, 27 of the 29 patients (93.1%) treated with primary ureteroscopic lithotripsy and stenting required no auxiliary treatment.

The primary successful outcome results for obstructive middle and lower ureteral stones with FR were eight out of 12 (66.6%) and 26 out of 27 (96.3%) for therapeutic options A and B, respectively. Upper obstructive ureteral stones with FR required secondary intervention in most cases, regardless of the therapeutic option chosen. (In nine out of 10 and one out of two cases for options A and B, respectively).

The mean duration of hospitalization for options A and B were 7.6 and 5.3 days, respectively. The mean duration that the ureter stent remained in situ for A and B treatment options was 30.9 and 10.2 days, respectively.

Conclusions:  Sole stenting of the ureter is reserved for infected FR or for stones of the upper ureter or the UPJ. Ureteroscopic lithotripsy followed by double‐J stenting of the ureter may offer a quick and safe therapeutic alternative for distal and middle obstructive ureteral stones with FR.
Paratesticular mucinous cystadenocarcinoma: Metastasis from pancreatic cancer
Authors: SEO ILL YOUNG , KIM SUN GOOK , HAN WON CHEOL , RIM JOUNG SIK
Published: December 2004

Abstract  We experienced a case of a paratesticular mucinous adenocarcinoma from primary pancreatic cancer. A 67‐year old man presented with a scrotal mass. Scrotal ultrasound showed a cystic mass on the testis. Radical orchiectomy was performed and the tumor was revealed as a mucinous cystadenocarcinoma separated from epididymis and testis. Metastatic cancer was suspected and abdominal computed tomography showed pancreatic cancer. We report this rare case of metastatic paratesticular cystoadenocarcinoma.
Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux
Authors: MATSUMOTO FUMI , TOHDA AKIRA , SHIMADA KENJI
Published: December 2004

Abstract  Aim:  We retrospectively reviewed the results of ureteral reimplantation in infants with primary vesicoureteral reflux (VUR) to evaluate the effect on prevention of urinary tract infection (UTI) and renal growth.

Materials and methods:  From July 1991 to December 2001, a total of 205 infants (180 boys and 25 girls) with primary VUR underwent ureteral reimplantation at the Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Indications for surgery were high‐grade reflux (grade IV–V), breakthrough UTI and non‐compliance of medical treatment. Age at surgery raged from 1 to 11 months (mean, 6.4 months). Ureteral reimplantation was performed according to Cohen's method. Only two of 336 refluxing ureters required ureteral tailoring. Follow‐up ranged from 12 to 110 months (mean, 64 months). Surgical outcome, frequency of UTI and individual renal growth measured by 99mTc‐dimercaptosuccinic acid (DMSA) scintigraphy was evaluated.

Results:   Postoperative ultrasound and voiding cystourethrography showed neither residual reflux nor ureterovesical obstruction. Contralateral low grade reflux occurred in six of 74 patients (8.1%) who had unilateral reflux preoperatively. After reimplantation, 10 patients documented 13 febrile UTI. Eleven of the 13 episodes occurred early in the postoperative period (<6 months). Frequency of febrile UTI reduced from 0.23538 before surgery to 0.00894 and 0.00081 per patient per month at 6 and 12 months after surgery, respectively. No development of renal scarring was seen in postoperative DMSA scan. Changes of differential renal function was <0.05 in all patients.

Conclusion:  The present results show ureteral reimplantation in infants is safe and very effective for the prevention of UTI. After surgical treatment in infancy, individual renal growth of children with primary VUR is stable.
Butterfly community structure in fragmented habitats
Authors: Steffan‐Dewenter I. , Tscharntke T.
Published: December 2004

We analysed effects of habitat fragmentation on the diversity, abundance, and life history traits of butterflies on 33 calcareous grasslands. Diversity of butterflies was positively correlated with habitat area (as was plant diversity), but not with habitat isolation. In contrast to expectations, butterfly densities of polyphagous and oligophagous species declined with habitat area whereas densities of monophagous species increased. The z‐values, i.e. the slope of species–area relationships, increased with food plant specialization, from 0.07 in polyphagous, 0.11 in oligophagous, 0.16 in strongly oligophagous to 0.22 in monophagous species, and were 0.14 in plant species. Significant z‐values were not only found for total species richness, based on a sample size adjusted to fragment area (z = 0.12), but also for the local density of butterfly species richness, based on equal sample size across all habitat fragments (z = 0.06). To our knowledge, this is the first study to show differential responses of monophagous, oligophagous and polyphagous species to area with respect to species richness and population density.
Islet adaptation to insulin resistance: mechanisms and implications for intervention
Authors: Ahrén B. , Pacini G.
Published: December 2004

Abstract:  Insulin sensitivity and insulin secretion are reciprocally related such that insulin resistance is adapted by increased insulin secretion to maintain normal glucose and lipid homeostasis. The relation between insulin sensitivity and secretion is curvilinear and mathematically best described as a hyperbolic relation. Several potential mediators have been suggested to be signals for the beta cells to respond to insulin resistance such as glucose, free fatty acids, autonomic nerves, fat‐derived hormones and the gut hormone glucagon‐like peptide‐1 (GLP‐1). Failure of these signals or of the pancreatic beta cells to adequately adapt insulin secretion in relation to insulin sensitivity results in inappropriate insulin levels, impaired glucose intolerance (IGT) and type 2 diabetes. Therefore, treatment of IGT and type 2 diabetes should aim at restoring the normal relation between insulin sensitivity and secretion. Such treatment includes stimulation of insulin secretion (sulphonylureas, repaglinide and nateglinide) and insulin sensitivity (metformin and thiazolidinediones), as well as treatment aimed at supporting the signals mediating the islet adaptation (cholinergic agonists and GLP‐1). Both, for correct understanding of diabetes pathophysiology and for development of novel treatment modalities, therefore, the non‐linear inverse relation between insulin sensitivity and secretion needs to be acknowledged.
Insulin detemir used in basal‐bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin
Authors: De Leeuw I. , Vague P. , Selam J.‐L. , Skeie S. , Lang H. , Draeger E. , Elte J. W. F.
Published: December 2004

Aim:  The aim of this study was to compare the long‐term safety and efficacy of twice‐daily insulin detemir or NPH insulin as the basal component of basal‐bolus therapy in people with type 1 diabetes.

Methods:  A multicentre, open‐label, parallel‐group study was conducted over 12 months and completed by 308 people (from an original randomized cohort of 428). Patients were randomized in a 2 : 1 ratio to receive insulin detemir or NPH insulin before breakfast and dinner, with insulin aspart at mealtimes.

Results:  Glycaemic control improved in both groups with HbA1c decreasing by 0.64 and 0.56% point in the insulin detemir and NPH insulin groups, reaching baseline‐adjusted final values of 7.53 ± 0.10% and 7.59 ± 0.13%, respectively. No significant difference was apparent between treatments in terms of HbA1c, fasting plasma glucose or 9‐point blood glucose profiles. Fewer hypoglycaemic events (major and minor) occurred in association with insulin detemir compared with NPH insulin, but the overall hypoglycaemic risk did not differ statistically significantly (RR for detemir, 0.78 [0.56–1.08]). However, the risk of nocturnal hypoglycaemia during the maintenance phase (month 2–12) was 32% lower in the detemir group (p = 0.02) and lower in every month. This risk reduction remained statistically significant after correction for HbA1c. After 12 months, baseline‐adjusted mean body weight was significantly lower in the insulin detemir group than in the NPH insulin group (p < 0.001).

Conclusions:  In long‐term basal‐bolus therapy, insulin detemir with insulin aspart as mealtime insulin is well tolerated and reduces the risks of nocturnal hypoglycaemia and weight gain compared to NPH insulin.
Lower within‐subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes
Authors: Haak T. , Tiengo A. , Draeger E. , Suntum M. , Waldhäusl W.
Published: December 2004

Aim:  The aim of this study was to compare the efficacy and safety of a basal‐bolus insulin regimen comprising either insulin detemir or neural protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 2 diabetes.

Methods:  This was a 26‐week, multinational, open‐label, parallel group trial with 505 patients with type 2 diabetes (mean age, 60.4 ± 8.6 years; mean BMI, 30.4 ± 5.3 kg/m2; mean HbA1c, 7.9 ± 1.3%). Patients, randomized 2 : 1 to insulin detemir or NPH insulin, received basal insulin either once or twice daily according to their pretrial insulin treatment and insulin aspart at mealtimes.

Results:  After 26 weeks of treatment, significant reductions in HbA1c were observed for insulin detemir (0.2%‐points, p = 0.004) and NPH insulin (0.4%‐points; p = 0.0001); HbA1c levels were comparable at study end (insulin detemir, 7.6%; NPH insulin, 7.5%). The number of basal insulin injections administered per day had no effect on HbA1c levels (p = 0.50). Nine‐point self‐measured blood glucose (SMBG) profiles were similar for the two treatment groups (p = 0.58), as were reductions in fasting plasma glucose (FPG) (insulin detemir, 0.5 mmol/l; NPH insulin, 0.6 mmol/l). At study end, FPG concentrations were similar for the two treatment groups (p = 0.66). By contrast, within‐subject day‐to‐day variation in fasting SMBG was significantly lower with insulin detemir (p = 0.021). Moreover, patients receiving insulin detemir gained significantly less body weight than those who were administered NPH insulin (1.0 and 1.8 kg, respectively, p = 0.017). The frequency of adverse events and the risk of hypoglycaemia were comparable for the two treatment groups.

Conclusions:  Patients with type 2 diabetes, treated for 26 weeks with insulin detemir plus insulin aspart at mealtimes, experienced comparable glycaemic control but significantly lower within‐subject variability and less weight gain compared to patients treated with NPH insulin and insulin aspart. Insulin detemir was well tolerated and had a similar safety profile to NPH insulin.
Efficacy and safety of ezetimibe co‐administered with simvastatin in thiazolidinedione‐treated type 2 diabetic patients
Authors: Gaudiani L. M. , Lewin A. , Meneghini L. , Perevozskaya I. , Plotkin D. , Mitchel Y. , Shah S.
Published: December 2004

Aim:  In patients with type 2 diabetes mellitus (T2DM), combination therapy is usually required to optimize glucose metabolism as well as to help patients achieve aggressive targets for low‐density lipoprotein cholesterol (LDL‐C) and other lipid parameters associated with cardiovascular risk. The thiazolidinediones (TZDs) are increasingly being used for both their blood glucose‐lowering properties and their modest beneficial effects on triglycerides (TG) and high‐density lipoprotein cholesterol (HDL‐C). Ezetimibe, an intestinal cholesterol absorption inhibitor, has a mechanism of action that differs from that of statins, which inhibit hepatic cholesterol synthesis. We compared the lipid‐modifying efficacy and safety of adding ezetimibe to simvastatin, vs. doubling the dose of simvastatin, in TZD‐treated T2DM patients.

Methods:  This was a randomized, double‐blind, parallel group, multicentre study in T2DM patients, 30–75 years of age, who had been on a stable dose of a TZD for at least 3 months and had LDL‐C > 2.6 mmol/l (100 mg/dl) prior to study entry. Other antidiabetic medications were also allowed. Following 6 weeks of open‐label simvastatin 20 mg/day, patients were randomized to the addition of either blinded ezetimibe 10 mg/day (n = 104) or an additional blinded simvastatin 20 mg/day (total simvastatin 40 mg/day; n = 110) for 24 weeks. Patients were stratified according to TZD type and dose (pioglitazone 15–30 vs. 45 mg/day; rosiglitazone 2–4 vs. 8 mg/day).

Results:  LDL‐C was reduced more (p < 0.001) by adding ezetimibe 10 mg to simvastatin 20 mg (−20.8%) than by doubling the dose of simvastatin to 40 mg (−0.3%). Ezetimibe plus simvastatin 20 mg also produced significant incremental reductions in non‐HDL‐C (p < 0.001), very low‐density lipoprotein cholesterol (p < 0.05) and apolipoprotein B (p < 0.001) relative to simvastatin 40 mg. There were no differences between the groups with respect to changes in TG and HDL‐C levels, and both treatments were well tolerated.

Conclusions:  Co‐administration of ezetimibe with simvastatin, a dual inhibition treatment strategy targeting both cholesterol synthesis and absorption, is well tolerated and provides greater LDL‐C‐lowering efficacy than increasing the dose of simvastatin in T2DM patients taking TZDs.
Reduction of body weight and co‐morbidities by orlistat: The XXL – Primary Health Care Trial
Authors: Wirth A.
Published: December 2004

Aim:  The aim of this postmarketing surveillance (PMS) study was to investigate the effect of an orlistat therapy under the everyday conditions of our health care system.

Methods:  11 131 women and 4418 men from Germany [mean age 48 years, mean body mass index (BMI) 34.7 kg/m2 and mean duration of obesity 13.7 years] were included. The patients were predominantly cared for by general practitioners. Four fifths of the patients reported having obesity‐associated co‐morbidities. All patients were advised to take orlistat 120 mg three times daily.

Results:  After a mean treatment duration of 7.1 months, both women and men lost 10.7% of their baseline weight (87% lost > 5% weight and 51% lost > 10% weight). All cardiovascular risk factors improved markedly, and the intake of concomitant medications was either reduced or discontinued. Compared with baseline, 65% of the patients assessed their general state of health to have improved. For more than 90% of their patients, physicians described the success of the treatment as satisfactory, and most patients (62%) were willing to continue with the treatment.

Conclusions:  The results obtained in this naturalistic PMS study were comparable with the results of randomised and placebo‐controlled studies, which were performed predominantly in special care centres. Therefore, without any risk of adversely affecting the quality of treatment provided, the treatment of obese patients with orlistat may be transferred to general practitioners.
Increased adiposity and reduced adipose tissue mRNA expression of uncoupling protein‐2 in first‐degree relatives of type 2 diabetic patients: evidence for insulin stimulation of UCP‐2 and UCP‐3 gene expression in adipose tissue
Authors: Pedersen S. B. , Nyholm B. , Kristensen K. , Nielsen M. F. , Schmitz O. , Richelsen B.
Published: December 2004

The mitochondrial uncoupling proteins (UCP‐2 and UCP‐3), which have been suggested to be involved in the development of obesity by controlling the energy expenditure (EE), were studied in 22 healthy first‐degree relatives (FDRs) of patients with type 2 diabetes and 13 body mass index (BMI)‐ and age‐matched healthy control subjects. Abdominal subcutaneous adipose tissue biopsies were obtained before and after 150‐min hyperinsulinaemic clamp (average serum insulin 250 pm). Basal adipose tissue UCP‐2 mRNA levels in the FDR group were significantly lower than that in the control group. After the hyperinsulinaemic clamp, adipose tissue UCP‐2 mRNA levels were increased by 32% in the control group (p < 0.05) and 32% in the FDR group (p < 0.05). The basal adipose tissue UCP‐3 mRNA level was similar in the two groups and increased in both the groups during hyperinsulinaemia (p < 0.001). Dual energy X‐ray absorptiometry showed that despite similar BMI the FDR group had significantly higher fat mass (FM) per cent compared to that of the control group (p < 0.01). The UCP‐2 mRNA expression was inversely correlated with the amount of adipose tissue (r = −0.53, p < 0.001), and multiple regression analysis revealed that only the amount of FM was independently correlated with basal UCP‐2 mRNA levels, whereas age, gender nor family history of type 2 diabetes contributed independently to the variation in UCP‐2 mRNA levels. No differences in EE were observed between the two groups, and no association between EE and UCP mRNA expression was found.

In conclusion, we have demonstrated that adipose tissue UCP‐2 and UCP‐3 mRNA levels are significantly increased during a 150‐min hyperinsulinaemic clamp. The UCP‐2 mRNA levels were expressed at a significantly lower level FDR to type 2 diabetes compared to control subjects. However, in multiple regression analysis controlling for amount of adipose tissue, the difference between the two groups disappeared. Thus, only the amount of adipose tissue contributed independently to the variation in UCP‐2 mRNA expression.
Grading and disease management in national screening for diabetic retinopathy in England and Wales
Authors: Harding S. , Greenwood R. , Aldington S. , Gibson J. , Owens D. , Taylor R. , Kohner E. , Scanlon P. , Leese G. ,   The Diabetic Retinopathy Grading and Disease Management Working Party
Published: December 2004

Aims  A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight‐threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false‐positive referral to the hospital eye service.

Methods  Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications.

Proposals  Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no ‘questionable’ lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight‐threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight‐threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1).

Discussion  The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality‐assured screening for people with diabetes.
Clinical inertia in the management of Type 2 diabetes metabolic risk factors
Authors: Grant R. W. , Cagliero E. , Dubey A. K. , Gildesgame C. , Chueh H. C. , Barry M. J. , Singer D. E. , Nathan D. M. , Meigs J. B.
Published: December 2004

Aims  Delays in the initiation and intensification of medical therapy may be one reason patients with diabetes do not reach evidence‐based goals for metabolic control. We assessed intensification of medical therapy over time, comparing the management of hyperglycaemia, hypertension, and hyperlipidaemia.

Methods  Prospective cohort study of 598 adults with Type 2 diabetes receiving primary care in an academic medical centre from May 1997 to April 1999. We assessed whether patients failing to achieve standard treatment goals for haemoglobin A1c (HbA1c), systolic blood pressure (SBP), or low density lipoprotein (LDL) cholesterol when last measured during 12 months (Year 1, 5/97–4/98) had increases in their corresponding medical regimen during the following 12 months (Year 2, 5/98–4/99).

Results  Among untreated patients in Year 1, seven of 12 (58%) of those above goal for HbA1c were initiated on medical therapy in Year 2, compared with 16 of 48 (34%) above SBP goal (P = 0.02) and 26 of 115 (23%) above LDL cholesterol goal (P = 0.02). Among patients on therapy and above goal, 124 of 244 (51%) patients with elevated HbA1c had their regimen increased in Year 2, compared with 85 of 282 (30%) with elevated SBP (P < 0.001) and 22 of 79 (30%) with elevated LDL cholesterol (P < 0.001). From Year 1 to Year 2 there was a decline in the overall proportion of patients above goal for LDL cholesterol (from 58% to 45%, P = 0.002) but not for HbA1c or blood pressure.

Conclusions  Greater initiation and intensification of pharmaceutical therapy, particularly for elevated blood pressure or cholesterol, may represent a specific opportunity to improve metabolic control in Type 2 diabetes.

Diabet. Med. 21, 150–155 (2004)
Trends in diabetes management practices of patients from an Australian insulin‐treated diabetes register
Authors: Sale M. M. , Hazelwood K. , Zimmet P. Z. , Shaw J. E. , Stankovich J. M. , Greenaway T. M. , Dwyer T.
Published: December 2004

Aims  To compare diabetes management practices in 2001 among individuals from Tasmania, Australia, with a previous management survey conducted in 1995–7.

Methods  Subjects were ascertained through the Tasmanian Insulin‐Treated Diabetes Register. General demographic data were collected by telephone interview, and participants mailed a questionnaire on their diabetes management practices.

Results  The response rate in 2001 was 80.8% (n = 1336). There was a trend to more frequent blood glucose self‐monitoring, notably in those less than 25 years (P < 0.001 for monitoring > 2 times/day), together with continued uptake of the pen system of insulin administration. More intensive shared management by general practitioner and diabetes specialist was noted, including a greater proportion visiting their doctor more than five times per year (P = 0.006 for those < 50 years). Most patients continue to be appropriately screened for hypertension and retinopathy. Dietitian visits declined overall (P = 0.03 for at least annual visits), and there appeared to be an inadequate level of foot examination by patients and doctors.

Conclusions  The survey indicated that most patients were taking greater responsibility for their metabolic control, and intensive management practices and more convenient methods of administration may be contributors. Two areas of possible concern are access to dietitian services, and patient and health provider education on appropriate foot care.

Diabet. Med. 21, 165–170 (2004)
Angiotensin receptor blockers as anti‐hypertensive treatment for patients with diabetes mellitus: meta‐analysis of controlled double‐blind randomized trials
Authors: Siebenhofer A. , Plank J. , Horvath K. , Berghold A. , Sutton A. J. , Sommer R. , Pieber T. R.
Published: December 2004

Aims  To assess the evidence for possible reduction of all‐cause mortality, cardiovascular morbidity and mortality, and end‐stage renal disease in diabetic patients treated with angiotensin II type 1 receptor blockers (ARBs) as an anti‐hypertensive treatment.

Methods  Systematic review and meta‐analysis of randomized, double‐blind controlled trials of at least 1 year's duration. ARBs were used in the intervention group vs. placebo or standard anti‐hypertensive treatment in the control group. The main outcome measures were all‐cause mortality, cardiovascular morbidity and mortality, and end‐stage renal disease.

Results  Three studies fulfilled the inclusion criteria. Separate analyses were conducted for comparisons of ARBs with groups given placebo and those given standard anti‐hypertensive treatment. There was no significant difference in mortality between the ARBs and placebo groups, with an estimated odds ratio (OR) of 0.99 [95% confidence interval (CI) 0.81, 1.20]. There was a non‐significant difference in patients treated with ARBs compared with standard anti‐hypertensive treatment, with an OR of 0.78 (95% CI 0.45, 1.36). No statistically significant difference in cardiovascular morbidity and mortality between the intervention and placebo groups was found, with an OR of 0.91 (95% CI 0.77, 1.08). When ARBs were compared with standard treatment, the OR was estimated at 0.85 (0.54, 1.33). Data on end‐stage renal disease were available for two studies comparing ARBs vs. placebo and showed a statistically significant advantage of ARBs, with an OR of 0.73 (95% CI 0.6, 0.89). As only one study compared end‐stage renal disease outcome for ARBs vs. standard treatment, a meta‐analysis was not possible. This study reported a considerable benefit of ARBs [OR = 0.73 (0.54, 1.01)] compared with the calcium channel blocker amlodipine.

Conclusions  ARBs failed to show significant reduction in total mortality and cardiovascular morbidity and mortality in diabetic patients. The only statistical benefit was the reduction of end‐stage renal disease compared with placebo. Therefore, at this time ARBs have not proved to be superior to standard anti‐hypertensive treatment in diabetic patients.
Zinc and nitrate in the ground water and the incidence of Type 1 diabetes in Finland
Authors: Moltchanova E. , Rytkönen M. , Kousa A. , Taskinen O. , Tuomilehto J. , Karvonen for the Spat Study Group M.
Published: December 2004

Aims  In Finland, the risk of childhood Type 1 diabetes varies geographically. Therefore we investigated the association between spatial variation of Type 1 diabetes and its putative environmental risk factors, zinc and nitrates.

Methods  The association was evaluated using Bayesian modelling and the geo‐referenced data on diabetes cases and population.

Results  Neither zinc nor nitrate nor the urban/rural status of the area had a significant effect on the variation in incidence of childhood Type 1 diabetes.

Conclusions  The results showed that although there was no significant difference in incidence between rural and urban areas, there was a tendency to increasing risk of Type 1 diabetes with the increasing concentration of NO3 in drinking water. The fact that no significant effect was found may stem from the aggregated data being too crude to detect it.
Coverage in screening for diabetic retinopathy according to screening provision: results from a national survey in England and Wales
Authors: Wilson A. , Baker R. , Thompson J. , Grimshaw G.
Published: December 2004

Aim  To assess the proportion of people with diabetes screened for retinopathy according to provision of screening services.

Methods  Twenty‐five health authorities in England and Wales were sampled after stratification by type of screening provision for diabetic retinopathy. Nine did not have a population‐based screening scheme, six had an optometry scheme, six had a camera scheme and four had schemes with more than one method of screening (‘mixed schemes’). Within each authority general practices were randomly sampled, 129 in total, and in each the records of a sample of diabetic patients examined.

Results  Of the 9200 records examined, 5812 (63.2%) had a record of one or more retinal examinations from any source in the year before the survey. This proportion did not differ significantly according to type of screening provision. The proportion of people with one or more retinal examinations by an ‘expert’ (defined as ophthalmologist, diabetologist, optometrist or screening scheme) in the last year was 44.7% where there was no screening scheme and 62.2%, 59.4%, and 61.6%, respectively, where optometry, camera and mixed schemes were present. Adjusted relative odds (95% confidence interval) for a retinal examination from any source in the last year compared with areas with no screening schemes were 1.19 (0.73, 1.93), 1.26 (0.80, 1.98), and 1.19 (0.77, 1.84) for camera, optometry and mixed schemes, respectively. Equivalent figures for an expert retinal examination were 2.30 (1.51, 3.49), 1.86 (1.25, 2.78) and 2.13 (1.32, 3.45). Coverage by schemes themselves did not differ according to type of scheme. Highest coverage rates, including examinations by screening schemes, were achieved in those treated with insulin, and the lowest rates found in those treated with diet alone.

Conclusions  Screening schemes have had a small impact on overall retinal examinations, but a higher impact on the coverage of examinations performed by experts.
Preprandial vs. postprandial insulin lispro—a comparative crossover trial in patients with Type 1 diabetes
Authors: Schernthaner G. , Wein W. , Shnawa N. , Bates P. C. , Birkett M. A.
Published: December 2004

Aims  Administration of bolus insulin after eating may be a useful therapeutic option for some patients. This 6‐month, crossover study compared metabolic effects of routine use of preprandial vs. postprandial injection of bolus insulin lispro.

Methods  Thirty‐one patients with Type 1 diabetes injected insulin lispro either preprandially or postprandially for a 3‐month period followed by the alternate regimen for a further 3 months. HbA1c, fructosamine and eight‐point self‐determined blood glucose profiles were measured and analysed using an anova model appropriate for a crossover design.

Results  Mean HbA1c decreased slightly from baseline with preprandial (−0.15 ± 0.41%) and increased slightly with postprandial (0.11 ± 0.48%) insulin lispro so that there was a significant (P = 0.008) difference between treatments in final HbA1c level. Mean fructosamine also decreased slightly with preprandial (−15 ± 31 µmol/l) but was almost unchanged (1 ± 39 µmol/l) with postprandial insulin lispro. Overall daily blood glucose was not different (P = 0.312) for preprandial compared with postprandial administration. However, mean preprandial glucose was lower (7.5 ± 2.01 vs. 6.6 ± 1.22 mmol/l; P = 0.026), whereas mean postprandial glucose was higher (7.7 ± 1.8 vs. 8.7 ± 2.1 mmol/l; P = 0.031) with postprandial insulin lispro administration. Mean blood glucose excursions were higher with postprandial compared with preprandial insulin lispro, indicating greater daily fluctuations. No difference in incidence of hypoglycaemia was observed with the two treatment regimens.

Conclusions  Postprandial insulin lispro administration appeared to be an acceptable treatment regimen and may be of benefit in certain situations. However, the benefits of postprandial administration may have to be balanced against poorer glycaemic control with continuous long‐term use.
Long‐term memory for music: infants remember tempo and timbre
Authors: Trainor Laurel J. , Wu Luann , Tsang Christine D.
Published: December 2004

We show that infants’ long‐term memory representations for melodies are not just reduced to the structural features of relative pitches and durations, but contain surface or performance tempo‐ and timbre‐specific information. Using a head turn preference procedure, we found that after a one week exposure to an old English folk song, infants preferred to listen to a novel folk song, indicating that they remembered the familiarized melody. However, if the tempo (25% faster or slower) or instrument timbre (harp vs. piano) of the familiarized melody was changed at test, infants showed no preference, indicating that they remembered the specific tempo and timbre of the melodies. The results are consistent with an exemplar‐based model of memory in infancy rather than one in which structural features are extracted and performance features forgotten.
Attention and inhibition in bilingual children: evidence from the dimensional change card sort task
Authors: Bialystok Ellen , Martin Michelle M.
Published: December 2004

In a previous study, a bilingual advantage for preschool children in solving the dimensional change card sort task was attributed to superiority in inhibition of attention (Bialystok, 1999). However, the task includes difficult representational demands to encode and interpret the task stimuli, and bilinguals may also have profited from superior representational abilities. This possibility is examined in three studies. In Study 1, bilinguals outperformed monolinguals on versions of the problem containing moderate representational demands but not on a more demanding condition. Studies 2 and 3 demonstrated that bilingual children were more skilled than monolinguals when the target dimensions were perceptual features of the stimulus and that the two groups were equivalent when the target dimensions were semantic features. The conclusions are that bilinguals have better inhibitory control for ignoring perceptual information than monolinguals do but are not more skilled in representation, confirming the results of the original study. The results also identify the ability to ignore an obsolete display feature as the critical difficulty in solving this task.
Perceptual complexity and form class cues in novel word extension tasks: how 4‐year‐old children interpret adjectives and count nouns
Authors: Sandhofer Catherine M. , Smith Linda B.
Published: December 2004

Two experiments examined the role of perceptual complexity, object familiarity and form class cues on how children interpret novel adjectives and count nouns. Four‐year‐old children participated in a forced‐choice match‐to‐target task in which an exemplar was named with a novel word and children were asked to choose another one that matched the exemplar in either shape or material. In experiment 1, 56 children were provided with lexical form class cues suggestive of adjectives. The results of Experiment 1 showed that perceptual complexity and not object familiarity determined whether children made material or shape matches. In Experiment 2, 56 children were provided with lexical form class cues suggestive of count nouns. The results of Experiment 2 showed that neither perceptual complexity nor object familiarity affected children's selections in the matching task. When provided with lexical form class cues suggestive of a count noun, children selected shape matches. Thus the results suggest that the perceptual properties of the objects presented to children coupled with the particular lexical form class cue determine which features of objects children attend to when interpreting novel words.
Scientific Research in a Democratic Culture: Or What's a Social Science For?
Authors: Willinsky John
Published: December 2004

In attempting to guide both researchers and the federal government in the development of a stronger scientific culture for education research, the National Research Council report, Scientific Research in Education, falls short in its conception of research dissemination. Rather than considering the potential of new publishing technologies to ensure much wider circulation and impact for education research as integral to both its scientific quality and public responsibilities, the report presents a highly circumscribed view of publishing, in terms of disclosing it to professional scrutiny and critique. While this scrutiny and critique are indeed necessary, they are not sufficient if education research is going to play the increased public role demanded of it in the No Children Left Behind Act of 2001. This article builds on the report's reference to education research's parallels with medical research to demonstrate how greater public access to this research has contributed to the democratic quality of people's lives, while arguing that the education research community would do well to explore open access publishing models as one means of extending the desired scientific culture represented by education research.