bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and socioeconomic associations of asthma and allergic rhinitis in northern Africa
Authors: Georgy V. , Fahim H. I. , El Gaafary M. , Walters S.
Published: June 2006

The aims of the current study were to ascertain the prevalence of asthma and allergic rhinoconjunctivitis symptoms in Cairo, Egypt (northern Africa), and to elucidate the socioeconomic factors associated with symptom prevalence and severity.

A translated and adapted version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed to a sample of 2,645 11–15-yr-olds in state and fee-paying schools in Cairo.

The overall prevalences of wheeze ever, wheeze during the last year and physician-diagnosed asthma were 26.5% (697 out of 2,631), 14.7% (379 out of 2,570) and 9.4% (246 out of 2,609), respectively. The prevalence of rhinoconjunctivitis was 15.3% (399 out of 2,616). Asthma symptoms were independently associated with attendance at a state school, parental asthma, age, history of rhinitis and owning a pet cat. Rhinoconjunctivitis was independently associated with attendance at a state school, father's education, parental history of asthma, asthma symptoms and owning a pet cat. In spite of a higher prevalence of severe asthma symptoms in state schools prevalence of physician diagnosis of asthma was the same in both school types, suggesting inequalities in access to healthcare.

In conclusion, the prevalence of physician-diagnosed asthma in Cairo was 9.4%, while the prevalence of rhinoconjunctivitis was 15.3%. There is a higher prevalence and increased severity of asthma symptoms in children of lower socioeconomic groups, as defined by state school attendance in Cairo.
Altered apoptosis in bronchoalveolar lavage lymphocytes after allergen exposure of atopic asthmatic subjects
Authors: Müller M. , Grunewald J. , Olgart Höglund C. , Dahlén B. , Eklund A. , Stridh H.
Published: June 2006

The increased number of lymphocytes in airways during an asthmatic response is believed to be the result of increased recruitment of these cells. However, it is possible that a decreased apoptotic rate could also contribute to the increased number. The aim of the present study was to investigate whether allergen airway provocation influences the apoptotic phenotype of lung and peripheral blood lymphocytes (PBL) in subjects with atopic asthma.

Bronchoalveolar lavage (BAL) lymphocytes and PBL from 12 asthmatic subjects previously challenged with allergen (n = 7) or saline (n = 5) were exposed to the apoptotic stimulus tributyltin (TBT)in vitroand assayed for apoptosis.

Airway allergen provocation resulted in decreased sensitivity of BAL lymphocytes to TBT-induced apoptosis, with 42.2% (range 33.9–62.5%) apoptotic cells before challengeversus23.5% (range 15.3–42.4%) after challenge, while PBL were unaffected. The increased apoptosis resistance correlated with higher numbers of Bcl-2-expressing lymphocytes. Interestingly, baseline caspase-3-like activity was significantly elevated in viable BAL lymphocytes compared with viable PBL, and was unaltered by allergen exposure.

In conclusion, allergen inhalation renders bronchoalveolar lavage lymphocytes more resistant to apoptosis while peripheral blood lymphocytes were not influenced at all, indicating that the apoptotic phenotype of airway lymphocytes may play a role in asthmatic inflammation.
Inhaled fluticasone propionate and adrenal effects in adult asthma: systematic review and meta-analysis
Authors: Masoli M. , Weatherall M. , Holt S. , Shirtcliffe P. , Beasley R.
Published: June 2006

The dose–response relationship of inhaled fluticasone propionate (FP) for adrenal suppression in adults with asthma is not clear.

The current authors carried out a systematic review and meta-analysis of placebo-controlled randomised dose–response studies of ≥4 weeks’ duration, which assessed the adrenal effects of FP by cosyntropin stimulation tests in adult asthma. The main outcome measure was the proportion of subjects with adrenal function below the lower limit of the normal range.

Five studies, with a total of 732 subjects with asthma, met the inclusion criteria. Data on daily doses >1,000 μg were limited to one study. The proportion of subjects with adrenal function below the lower limit of the normal range on placebo was 3.9%; for a 500-μg per day increase in FP dose the odds of an abnormality increased by 1.38 (95% confidence interval 1.01–1.59). The continuous secondary outcome measures showed an inverse linear relationship with the FP dose up to 2,000 μg·day-1.

In conclusion, for routine prescribing within the established therapeutic dose–response range (50–500 μg·day-1), fluticasone propionate has minimal effects on adrenal function. This conclusion is limited by the paucity of long-term studies of daily doses of fluticasone propionate >1,000 μg and by the considerable individual variability in the response.
Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients
Authors: El Solh A. A. , Aquilina A. , Pineda L. , Dhanvantri V. , Grant B. , Bouquin P.
Published: June 2006

Current recommendations for management of obese patients post-extubation are based on clinical experience and expert opinions. It was hypothesised that the application of noninvasive ventilation (NIV) during the first 48 h after extubation in severely obese patients would reduce post-extubation failure and avert the need for reintubation.

Following protocol-driven weaning trials, 62 consecutive severely obese patients (body mass index ≥35 kg·m-2) were assigned to NIVvianasal mask immediately post-extubation and compared with 62 historically matched controls who were treated with conventional therapy. The primary end-point was the incidence of respiratory failure in the first 48 h post-extubation.

Compared with conventional therapy, the institution of NIV resulted in 16% (95% confidence interval 2.9–29.3%) absolute risk reduction in the rate of respiratory failure. There was a significant difference in the intensive care unit and lengths of hospital stay between the two groups. Subgroup analysis of hypercapnic patients showed reduced hospital mortality in the NIV group compared with the control group.

In conclusion, noninvasive ventilation may be effective in averting respiratory failure in severely obese patients when applied during the first 48 h post-extubation. In selected patients with chronic hypercarbia, early application of noninvasive ventilation may confer a survival benefit.
CpG DNA modulates interleukin 1β-induced interleukin-8 expression in human bronchial epithelial (16HBE14o-) cells
Authors: Parilla N William , Hughes Valerie S , Lierl Kristin M , Wong Hector R , Page Kristen
Published: June 2006

Background

Recognition of repeat unmethylated CpG motifs from bacterial DNA through Toll-like receptor (TLR-9) has been shown to induce interleukin (IL)-8 expression in immune cells. We sought to investigate the role of CpG oligodeoxynucleotides (ODN) on a human bronchial epithelial cells.

Methods

RT-PCR and Western blot analysis were used to determine expression of TLR-9 in human bronchial epithelial cells (16HBE14o-). Cells were treated with CpG ODN in the presence or absence of IL-1β and IL-8 protein was determined using ELISA. In some cases cells were pretreated with chloroquine, an inhibitor of TLR-9 signaling, or SB202190, an inhibitor of the mitogen activated protein kinase p38, prior to treatment with IL-1β and CpG. TLR9 siRNA was used to silence TLR9 prior to treatment with IL-1β and CpG. IκBα and p38 were assessed by Western blot, and EMSA's were performed to determine NF-κB activation. To investigate IL-8 mRNA stability, cells were treated with IL-1β in the absence or presence of CpG for 2 h and actinomycin D was added to induce transcriptional arrest. Cells were harvested at 15 min intervals and Northern blot analysis was performed.

Results

TLR-9 is expressed in 16HBE14o- cells. CpG synergistically increased IL-1β-induced IL-8 protein abundance, however treatment with CpG alone had no effect. CpC (a control ODN) had no effect on IL-1β-induced IL-8 levels. In addition, CpG synergistically upregulated TNFα-induced IL-8 expression. Silencing TLR9 using siRNA or pretreatment of cells with chloroquine had little effect on IL-1β-induced IL-8 levels, but abolished CpG-induced synergy. CpG ODN had no effect on NF-κB translocation or DNA binding in 16HBE14o- cells. Treatment with CpG increased phosphorylation of p38 and pretreatment with the p38 inhibitor SB202190 attenuated the synergistic increase in IL-8 protein levels. Analysis of the half-life of IL-8 mRNA revealed that IL-8 mRNA had a longer half-life following the co-treatment of CpG and IL-1β compared to treatment with IL-1β alone.

Conclusion

Together, these data demonstrate that CpG modulates IL-8 synthesis in the presence of a pro-inflammatory mediator utilizing TLR9 and post-transcriptional mechanisms involving the activation of p38 and stabilization of IL-8 mRNA.
Susceptibility to ozone-induced airway inflammation is associated with decreased levels of surfactant protein D
Authors: Kierstein S , Poulain FR , Cao Y , Grous M , Mathias R , Kierstein G , Beers MF , Salmon M , Panettieri RA , Haczku A
Published: June 2006

Background

Ozone (O3), a common air pollutant, induces exacerbation of asthma and chronic obstructive pulmonary disease. Pulmonary surfactant protein (SP)-D modulates immune and inflammatory responses in the lung. We have shown previously that SP-D plays a protective role in a mouse model of allergic airway inflammation. Here we studied the role and regulation of SP-D in O3-induced inflammatory changes in the lung.

Methods

To evaluate the effects of O3exposure in mouse strains with genetically different expression levels of SP-D we exposed Balb/c, C57BL/6 and SP-D knockout mice to O3or air. BAL cellular and cytokine content and SP-D levels were evaluated and compared between the different strains. The kinetics of SP-D production and inflammatory parameters were studied at 0, 2, 6, 12, 24, 48, and 72 hrs after O3exposure. The effect of IL-6, an O3-inducible cytokine, on the expression of SP-D was investigatedin vitrousing a primary alveolar type II cell culture.

Results

Ozone-exposed Balb/c mice demonstrated significantly enhanced acute inflammatory changes including recruitment of inflammatory cells and release of KC and IL-12p70 when compared with age- and sex-matched C57BL/6 mice. On the other hand, C57BL/6 mice had significantly higher levels of SP-D and released more IL-10 and IL-6. Increase in SP-D production coincided with the resolution of inflammatory changes. Mice deficient in SP-D had significantly higher numbers of inflammatory cells when compared to controls supporting the notion that SP-D has an anti-inflammatory function in our model of O3exposure. IL-6, which was highly up-regulated in O3exposed mice, was capable of inducing the expression of SP-Din vitroin a dose dependent manner.

Conclusion

Our data suggest that IL-6 contributes to the up-regulation of SP-D after acute O3exposure and elevation of SP-D in the lung is associated with the resolution of inflammation. Absence or low levels of SP-D predispose to enhanced inflammatory changes following acute oxidative stress.
Noise-injected neural networks show promise for use on small-sample expression data
Authors: Hua Jianping , Lowey James , Xiong Zixiang , Dougherty Edward R
Published: June 2006

Background

Overfitting the data is a salient issue for classifier design in small-sample settings. This is why selecting a classifier from a constrained family of classifiers, ones that do not possess the potential to too finely partition the feature space, is typically preferable. But overfitting is not merely a consequence of the classifier family; it is highly dependent on the classification rule used to design a classifier from the sample data. Thus, it is possible to consider families that are rather complex but for which there are classification rules that perform well for small samples. Such classification rules can be advantageous because they facilitate satisfactory classification when the class-conditional distributions are not easily separated and the sample is not large. Here we consider neural networks, from the perspectives of classical design based solely on the sample data and from noise-injection-based design.

Results

This paper provides an extensive simulation-based comparative study of noise-injected neural-network design. It considers a number of different feature-label models across various small sample sizes using varying amounts of noise injection. Besides comparing noise-injected neural-network design to classical neural-network design, the paper compares it to a number of other classification rules. Our particular interest is with the use of microarray data for expression-based classification for diagnosis and prognosis. To that end, we consider noise-injected neural-network design as it relates to a study of survivability of breast cancer patients.

Conclusion

The conclusion is that in many instances noise-injected neural network design is superior to the other tested methods, and in almost all cases it does not perform substantially worse than the best of the other methods. Since the amount of noise injected is consequential, the effect of differing amounts of injected noise must be considered.
Mesenteric desmoid tumor of the interposed jejunal pouch after total gastrectomy
Authors: Tamura Koichi , Tani Masaji , Kinoshita Hiroyuki , Yamaue Hiroki
Published: June 2006

Background

Desmoid tumor is a rare entity, and most desmoid tumors are located in abdominal wall or extra-abdominal tissues. Occurrence of desmoid tumor in mesentry is extremely rare.

Case presentation

we report a mesenteric desmoid tumor in a 73-years-old woman who had undergone total gastrectomy reconstructed with jejunal pouch interposition for gastric carcinoma. After 1 year, a tumor was originating from mesentery of the interposed jejunal pouch was identified, and the patient underwent resection of the large mass which was found to invade pancreas. Histological examination revealed desmoid tumor.

Conclusion

Desmoid tumor is rare, and it was difficult for the differential diagnosis of desmoid tumor or recurrent tumor.
Public sector nurses in Swaziland: can the downturn be reversed?
Authors: Kober Katharina , Van Damme Wim
Published: June 2006

Background

The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.

Methods

We visited Swaziland twice within 18 months in order to capture the HRH situation as well as the responses to it in 2004 and in 2005. Using semi-structured interviews with key informants and group interviews, we obtained qualitative and quantitative data on the HRH situation in the public and mission health sectors. We complemented this with an analysis of primary documents and a review of the available relevant reports and studies.

Results

The public health sector in Swaziland faces a serious shortage of health workers: 44% of posts for physicians, 19% of posts for nurses and 17% of nursing assistant posts were unfilled in 2004. We identified emigration and attrition due to HIV/AIDS as major factors depleting the health workforce. The annual training output of only 80 new nurses is not sufficient to compensate for these losses, and based on the situation in 2004 we estimated that the nursing workforce in the public sector would have been reduced by more than 40% by 2010. In 2005 we found that new initiatives by the Swazi government, such as the scale-up of ART, the introduction of retention measures to decrease emigration and the influx of foreign nurses could have the potential to improve the situation. A combination of such measures, together with the planned increase in the training capacity of the country's nursing schools, could even reverse the trend of a diminishing health workforce.

Conclusion

Emigration and attrition due to HIV/AIDS are undermining the health workforce in the public sector of Swaziland. Short-term and long-term measures for overcoming this HRH crisis have been initiated by the Swazi government and must be further supported and increased. Scaling up antiretroviral treatment (ART) and making it accessible and acceptable for the health workforce is of paramount importance for halting the attrition due to HIV/AIDS. To this end, we also recommend exploring ways to make ART delivery less labour-intensive. The production of nurses and nursing assistants must be urgently increased. Although the migration of HRH is a global issue requiring solutions at various levels, innovative in-country strategies for retaining staff must be further explored in order to stem as much as possible the emigration from Swaziland.
Cost of illness of hyponatremia in the United States
Authors: Boscoe Audra , Paramore Clark , Verbalis Joseph G
Published: June 2006

Background

Hyponatremia is a disorder of fluid and electrolyte balance characterized by a relative excess of body water relative to body sodium content. It is the most common electrolyte disorder encountered in clinical medicine and is associated with negative outcomes in many chronic diseases. However, there is limited information in the literature about health care resource use and costs attributable to the effects of the condition. The purpose of this analysis was to estimate the annual cost of illness of hyponatremia in the United States.

Methods

The study utilized a prevalence-based cost of illness framework that incorporated data from publicly available databases, published literature and a consensus panel of expert physicians. Panel members provided information on: classification of hyponatremia patients, treatment settings for hyponatremia (i.e., hospital, emergency room, doctor's office), and health care resource use associated with the diagnosis and treatment of hyponatremia. Low and high prevalence scenarios were estimated and utilized in a spreadsheet-based cost of illness model. Costs were assigned to units of resources and summarized across treatment settings.

Results

The prevalence estimate for hyponatremia ranged from 3.2 million to 6.1 million persons in the U.S. on an annual basis. Approximately 1% of patients were classified as having acute and symptomatic hyponatremia, 4% acute and asymptomatic, 15%–20% chronic and symptomatic, and 75–80% chronic and asymptomatic. Of patients treated for hyponatremia, 55%–63% are initially treated as inpatients, 25% are initially treated in the emergency room, and 13%–20% are treated solely in the office setting. The direct costs of treating hyponatremia in the U.S. on an annual basis were estimated to range between $1.6 billion and $3.6 billion.

Conclusion

Treatment of hyponatremia represents a significant healthcare burden in the U.S. Newer therapies that may reduce the burden of hyponatremia in the inpatient setting could minimize the costs associated with this condition.
Pathogenesis and vertical transmission of a transplacental rat cytomegalovirus
Authors: Loh Hwei-San , Mohd-Lila Mohd-Azmi , Abdul-Rahman Sheikh-Omar , Kiew Lik-Jun
Published: June 2006

Background

Cytomegalovirus (CMV) congenital infection is the major viral cause of well-documented birth defects in human. Because CMV is species-specific, the main obstacle to developing animal models for congenital infection is the difference in placental architecture, which preludes virus transmission across the placenta. The rat placenta, resembling histologically to that of human, could therefore facilitate the study of CMV congenital infection in human.

Results

In this report, we present clear evidences of the transplacental property of a new rat CMV (RCMV), namely ALL-03, which had been isolated from placenta and uterus of the house rat. Our study signifies the detection of infectious virus, virus particles, viral protein and DNA as well as immune response to demonstrate a natural model of acute CMV infection including the immunocompetent and immunocompromised host associated with or without pregnancy. It is characterized by a full range of CMV related clinical signs; lesions and anatomical virus distribution to uterus, placenta, embryo, fetus, neonate, lung, kidney, spleen, liver and salivary gland of the infected rats in addition to the virus-specific seroconversion. The preference of the virus for different organs mimics the situation in immunocompromised man. Most interestingly, the placenta was observed to be involved in the maternofetal infection and hence confirmed the hypothesis that the RCMV strain ALL-03 is capable to cross the placenta and infect the offsprings congenitally.

Conclusion

The maternal viremia leading to uterine infection which subsequently infecting to the fetus through the placenta is the most likely phenomenon of CMV vertical transmission in our study.
Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting
Authors: Ghotkar Sanjay V , Grayson Antony D , Fabri Brian M , Dihmis Walid C , Pullan D Mark
Published: June 2006

Objective

Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG).

Methods

5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB) was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004). The area under the receiver operating characteristic (ROC) curve was calculated to assess the performance of the prediction tool.

Results

475(9.2%) patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively.

Conclusion

A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.
Case report: Acute unintentional carbachol intoxication
Authors: Schulz Martin , Graefe Thomas , Stuby Klaus , Andresen Hilke , Kupfermann Nikolai , Schmoldt Achim
Published: June 2006

Introduction

Intoxications with carbachol, a muscarinic cholinergic receptor agonist are rare. We report an interesting case investigating a (near) fatal poisoning.

Methods

The son of an 84-year-old male discovered a newspaper report stating clinical success with plant extracts in Alzheimer's disease. The mode of action was said to be comparable to that of the synthetic compound 'carbamylcholin'; that is, carbachol. He bought 25 g of carbachol as pure substance in a pharmacy, and the father was administered 400 to 500 mg. Carbachol concentrations in serum and urine on day 1 and 2 of hospital admission were analysed by HPLC-mass spectrometry.

Results

Minutes after oral administration, the patient developed nausea, sweating and hypotension, and finally collapsed. Bradycardia, cholinergic symptoms and asystole occurred. Initial cardiopulmonary resuscitation and immediate treatment with adrenaline (epinephrine), atropine and furosemide was successful. On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg/l.

Conclusion

This case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure.
Brain volume in first-episode schizophrenia
Authors: Steen R. Grant , Mull Courtney , Mcclure Robert , Hamer Robert M. , Lieberman Jeffrey A.
Published: June 2006

Background

Studies of people with schizophrenia assessed using magnetic resonance imaging (MRI) usually include patients with first-episode and chronic disease, yet brain abnormalities may be limited to those with chronic schizophrenia.

Aims

To determine whether patients with a first episode of schizophrenia have characteristic brain abnormalities.

Method

Systematic review and meta-analysis of 66 papers comparing brain volume in patients with a first psychotic episode with volume in healthy controls.

Results

Atotal of 52 cross-sectional studies included 1424 patients with a first psychotic episode; 16 longitudinal studies included 465 such patients. Meta-analysis suggests that whole brain and hippocampal volume are reduced (bothP< 0.0001) and that ventricular volume is increased (P< 0.0001) in these patients relative to healthy controls.

Conclusions

Average volumetric changes are close to the limit of detection by MRI methods. It remains to be determined whether schizophrenia is a neurodegenerative process that begins at about the time of symptom onset, or whether it is better characterised as a neurodevelopmental process that produces abnormal brain volumes at an early age.
Hospital morbidity and alcohol consumption in less severe psychiatric disorder: 7-year outcomes
Authors: Tait Robert J. , Hulse Gary K.
Published: June 2006

Background

Substance use by people with severe psychiatric morbidity is associated with negative outcomes.

Aims

To assess in adults with less severe psychiatric morbidity the relationship between alcohol consumption and subsequent 7-year hospital admissions, and the development and recurrence of alcohol use disorders.

Method

Follow-up data were assembled via a population-based hospital record-linkage system.

Results

Baseline alcohol use groups were: dependent (n=31), harmful (n=114), moderate (n=621) and abstinent (n=249). The moderate but not the abstinent group had fewer mental health admissions and a longer time to first admission than the harmful and dependent groups. Both the moderate and the abstinent groups had longer times to ‘all-cause’ admissions than the dependent group. Many of those with alcohol use disorders at baseline relapsed (66%) but few (14%) developed a first-time alcohol use disorder.

Conclusions

Overall, moderate alcohol consumption among those with less severe psychiatric morbidity was not associated with more mental health admissions; those with alcohol dependence had poorer health outcomes than the remaining categories.
Economic cost of severe antisocial behaviour in children - and who pays it
Authors: Romeo Renee , Knapp Martin , Scott Stephen
Published: June 2006

Background

Persistent antisocial behaviour is the most common mental health problem in childhood and has widespread effects, yet little is known about what it costs.

Aims

To identify the costs incurred by children with antisocial behaviour in the UK, and who pays these costs.

Method

Eighty children aged 3–8 years referred to mental health services were studied using the Client Service Receipt Inventory for Childhood.

Results

The mean annual total cost was $ 5960 (median 4597, range 48–19 940). The services used were mainly the National Health Service, education and voluntary agencies, but the greatest cost burden, $4637, was borne by the family Higher cost was predicted by more severe behaviour and being male.

Conclusions

The annual cost of severe antisocial behaviour in childhood in the UK is substantial and widespread, involving several agencies, but the burden falls most heavily on the family Wider uptake of evidence-based interventions is likely to lead to considerable economic benefits in the short term, and probably even more in the long term.
Mental health needs of young offenders in custody and in the community
Authors: Chitsabesan Prathiba , Kroll Leo , Bailey Sue , Kenning Cassandra , Sneider Stephanie , MacDonald Wendy , Theodosiou Louise
Published: June 2006

Background

Research has revealed high levels of mental health needs in young offenders but many studies have been small, focusing on specific populations.

Aims

To evaluate the mental health and psychosocial needs of a nationally representative sample of juvenile offenders in England and Wales, including female offenders and those from Black and minority ethnic groups.

Method

A cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, was conducted in six geographically representative areas across England and Wales. Each young person was interviewed to obtain demographic information, mental health and social needs, and psychometric data.

Results

Young offenders were found to have high levels of needs in a number of different areas including mental health (31%), education/work (36%) and social relationships (48%). Young offenders in the community had significantly more needs than those in secure care and needs were often unmet. One in five young offenders was also identified as having a learning disability (IQ < 70).

Conclusions

Needs for young offenders were high but often unmet. This emphasises the importance of structured needs assessment within custody and community settings in conjunction with a care programme approach that improves continuity of care.
Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness
Authors: Spauwen Janneke , Krabbendam Lydia , Lieb Roselind , Wittchen Hans-Ulrich , Van Os Jim
Published: June 2006

Background

The reported link between psychological trauma and onset of psychosis remains controversial.

Aims

To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness).

Method

At baseline, 2524 adolescents aged 14–24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms.

Results

Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR 1.89, 95% CI 1.16–3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032).

Conclusions

Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.
Self-reported psychotic symptoms in the general population
Authors: Wiles Nicola J. , Zammit Stanley , Bebbington Paul , Singleton Nicola , Meltzer Howard , Lewis Glyn
Published: June 2006

Background

Scarce longitudinal data exist on the occurrence of psychotic symptoms in the general population.

Aims

To estimate the incidence of, and risk factors for, self-reported psychotic symptoms in Great Britain.

Method

Data from the 18-month follow-up of a national survey were used. Incident cases were those who endorsed one or more items on the Psychosis Screening Questionnaire at follow-up, but not at baseline. The association between factors recorded at baseline and incident self-reported symptoms was examined.

Results

At follow-up, 4.4% of the general population reported incident psychotic symptoms. Six factors were independently associated with incident symptoms: living in a rural area; having a small primary support group; more adverse life events; smoking tobacco; neurotic symptoms; and engaging in a harmful pattern of drinking.

Conclusions

A small but not insignificant percentage of the population of Great Britain reported incident psychotic symptoms over 18 months. The risk factors for psychotic symptoms showed some similarities with risk factors for schizophrenia, but there were also some striking differences. The relationship between such risk factors and the factors that perpetuate psychotic symptoms remains to be ascertained.
Chromosomal abnormalities and psychosis
Authors: Muir Walter J. , Pickard Benjamin S. , Blackwood Douglas H. R.
Published: June 2006

The search for susceptibility genes for schizophrenia and severe affective disorder has been enhanced by the study of cytogenetic abnormalities that disrupt genes directly. One such gene is DISCI and there is increasing evidence that it may be an important modulator of risk of psychosis.
Survey of psychotherapy experience and interest among psychiatric specialist registrars
Authors: Pretorius Werner , Goldbeck Rainer
Published: June 2006

Aims and Method

A postal survey was conducted to determine what proportion of psychiatric specialist registrars working in Scotland (n=119, excluding those specialising in psychotherapy) met the requirements for experience in psychotherapy. Since 2004, this has been a compulsory part of eligibility criteria for the MRCPsych part II examination.

Results

Two-thirds of those surveyed responded. One-third of respondents met the Royal College of Psychiatrists' requirements for psychotherapy experience. Half the respondents reported competence in at least one modality of psychotherapy. Four-fifths of respondents were interested in gaining further experience and training, two-thirds in developing a special interest and one-quarter in dual training, in at least one modality of College psychotherapy. There was no significant association between adherence to the requirements and self-perceived competence, qualification or the wish to gain further training and experience in psychotherapy.

Clinical Implications

The majority of trainees, even those interested in psychotherapy, still fail to meet College requirements. Many trainees would appreciate an opportunity to gain greater depth of psychotherapy experience, in addition to gaining broad experience of various aspects of psychotherapy as required by the College.
The International Fellowship Scheme: from Silicon Valley to the Potteries and back
Authors: Chaturvedi Santosh K.
Published: June 2006

I was one of the initial applicants to the NHS International Fellowship Scheme and joined the North Staffs Combined Healthcare NHS Trust in November 2003 as a consultant at the Greenfield Centre, Stoke on Trent. It had always been my dream to work in the UK as a consultant. I always wondered how similar it was to the consultant/ faculty position I held at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Here I describe my experiences.
The International Fellowship Scheme for consultant psychiatrists: trainees' perspective
Authors: George Sanju , Calthorpe Bill , Khandelwal Sudhir
Published: June 2006

The NHS International Fellowship Scheme for consultants offers overseas consultants, in specialties including psychiatry, an opportunity to work in the UK (Goldberg, 2003). This was launched by the Department of Health in 2002 and so far over 100 consultant psychiatrists have been recruited. However, there are several aspects of the project that are unclear. How long will this recruitment continue? Are there any arrangements in place to encourage overseas consultants to return to their home country at the end of their fellowship? Are they eligible to train senior house officers (SHOs) and specialist registrars (SpRs)? Will the recruitment under the scheme have an impact on job opportunities for SpRs currently training in the UK? Why is membership of the Royal College of Psychiatrists being granted to the newly recruited consultants without an examination? These and many more concerns have arisen in the wake of this scheme. In this article, we evaluate the scheme, discuss its implications and suggest possible ways forward.
Differences between specialist community adolescent mental health teams and generic child and adolescent mental health services: training issues for specialist registrars
Authors: Pinto Carmen
Published: June 2006

Following the National Service Framework (Department of Health, 2004) recommendation of extending the age range of child and adolescent mental health services to 18 years there is an increasing expectation that these generic services will provide the comprehensive care for severe mental health problems in areas where specialist teams do not exist. Services have responded to this with a variety of teams from generic adolescent teams to smaller first-onset psychosis or assertive outreach teams.
Teledentistry in inner-city child-care centres
Authors: Kopycka-Kedzierawski Dorota T , Billings Ronald J
Published: June 2006

In Rochester, NY, telehealth centres were established in six inner-city elementary schools and seven child-care centres. The teledentistry project complemented the existing telehealth model. Using an intraoral camera, telehealth assistants record digital images of children's teeth (768 × 494 pixels) and send the images to a computer at the expert dental site (the Eastman Department of Dentistry at the University of Rochester). The paediatric dentist at the expert site reviews the images, and provides referral and treatment recommendations. Subsequently, the telehealth assistant contacts the child's parents or guardians and assists them to obtain appropriate dental care for their child. In the pilot study, we screened 50 children. In the first nine months of 2005, we screened 123 children. The results of our initial teledental screenings of children aged 12–48 months attending inner-city child-care centres revealed that almost 40% had active dental caries, mainly early childhood caries (ECC). For the first time, many children attending inner-city child-care centres have had their teeth examined at an early age and been given prompt feedback on the need for dental care.
Telegenetic medicine: improved access to services in an underserved area
Authors: Stalker H J , Wilson R , McCune H , Gonzalez J , Moffett M , Zori R T
Published: June 2006

We used telemedicine to improve genetics services to patients in the rural northwestern region of Florida. Patients were first seen via videoconference by a genetic counsellor, who obtained family and medical history. A local paediatrician then performed the physical examination, and a plan for evaluation was established. The videoconferencing equipment was connected at a bandwidth of 384 kbit/s, using three ISDN lines. During the first three telemedicine clinics, seven patients were evaluated and then returned to the centre for a face-to-face consultation with the clinical geneticist. No new diagnoses were made face-to-face that had not been identified by telemedicine. No diagnoses made by telemedicine were judged to be wrong when the child was evaluated face-to-face. During a two-year study of patient satisfaction with 12 telegenetics clinics, the 50 families evaluated via videoconferencing were asked to complete surveys; 40 surveys were returned (a response rate of 80%). All individuals either strongly agreed or agreed that the evaluation of their child was appropriate, sufficient and sufficiently protective of their child's privacy. The waiting time for a new patient consultation with the clinical genetics team was 16.9 months (SD 1.9) at the start and 3.0 months (SD 1.0) at the end of the trial period. The difference was significant ( t-test, P<0.0001). Telegenetics allows more rapid assurance that a genetic syndrome has not been identified, or a quicker initial evaluation and diagnosis for children who do have an identifiable genetic syndrome.
Rhythm of daily living and detection of atypical days for elderly people living alone as determined with a monitoring system
Authors: Suzuki Ryoji , Ogawa Mitsuhiro , Otake Sakuko , Izutsu Takeshi , Tobimatsu Yoshiko , Iwaya Tsutomu , Izumi Shin-Ichi
Published: June 2006

We have developed a system for monitoring the health of elderly people living at home. Infrared and other sensor outputs are collected using a monitoring program installed on a personal computer (PC) in the home at a sampling rate of 1 Hz. Once each day, the data are transferred to a server through the Internet using a cable television (TV) connection. An elderly subject was monitored for a 12-day baseline period and completed a daily questionnaire about her activities. This enabled us to identify the rhythm of daily living (sleeping, 23:00–04:59; getting up/breakfast, 05:00–08:59; indoor activities/going out, 09:00–16:59; and dinner/going to bed, 17:00–22:59) and the average outputs from the sensors in the rooms. The subject was then monitored for a further six months. By identifying sensor output counts outside the limits of mean ±3SD, we were able to detect atypical days. During the six-month monitoring period, 29 atypical days were detected. We suggest that the monitoring system may be effective in tele-rehabilitation.
Information and communication technology in supporting people with serious chronic illness living at home – an intervention study
Authors: Nilsson Carina , Öhman Marja , Söderberg Siv
Published: June 2006

We studied the experiences of two people with serious chronic illness who used information and communication technology (ICT) to communicate with their district nurse. The study was a qualitative case study. The intervention was performed using an electronic messaging program. The program was accessible to any computer with an Internet connection. The programme consisted of different virtual rooms, where people could communicate using text messages. The participants used the program 2–4 times each week from the beginning of November 2003 to February 2004. Semistructured interviews were performed before, during and after the intervention and were analysed using thematic content analysis. The results showed that the participants' communication with the district nurse was improved because of easy accessibility and that they felt increased security. They also felt there were fewer limitations and that their everyday life was improved, which can also be seen as an improvement in care.
Searching the Internet for medical information: frequency over time and by age and gender in an outpatient population in the UK
Authors: Larner A J
Published: June 2006

The frequency of home Internet access and use to search for medical information was measured by questioning consecutive new patients referred to the neurology outpatient department for three-month periods in five consecutive years (2001–05). In a cohort of over 1000 patients, 40% reported home access to the Internet, and 11% had undertaken searches for medical information prior to clinic attendance. The frequency of Internet searches was consistent over time and by patient gender, but varied by patient age, being higher in the younger age groups. Of the 114 patients undertaking Internet searches, 45 (39%) were judged to have accessed information or reached conclusions inappropriate to the final neurological diagnosis. However, no patient was judged to have come to physical harm as a result of accessing information inappropriate to the final neurological diagnosis. Data on health-information-seeking behaviour through Internet searching are relevant not only to clinical consultation, but also to the possibilities of targeting health-related information and to email consultation.
EQUAL-quant: An International External Quality Assessment Scheme for Real-Time PCR
Authors: Ramsden Simon C , Daly Sarah , Geilenkeuser Wolf-Jochen , Duncan Graeme , Hermitte Fabienne , Marubini Ettore , Neumaier Michael , Orlando Claudio , Palicka Vladimir , Paradiso Angelo , Pazzagli Mario , Pizzamiglio Sara , Verderio Paolo
Published: June 2006

Background: Quantitative gene expression analysis by real-time PCR is important in several diagnostic areas, such as the detection of minimum residual disease in leukemia and the prognostic assessment of cancer patients. To address quality assurance in this technically challenging area, the European Union (EU) has funded the EQUAL project to develop methodologic external quality assessment (EQA) relevant to diagnostic and research laboratories among the EU member states. We report here the results of the EQUAL-quant program, which assesses standards in the use of TaqMan™ probes, one of the most widely used assays in the implementation of real-time PCR.

Methods: The EQUAL-quant reagent set was developed to assess the technical execution of a standard TaqMan assay, including RNA extraction, reverse transcription, and real-time PCR quantification of target DNA copy number.

Results: The multidisciplinary EQA scheme included 137 participating laboratories from 29 countries. We demonstrated significant differences in performance among laboratories, with 20% of laboratories reporting at least one result lacking in precision and/or accuracy according to the statistical procedures described. No differences in performance were observed for the >10 different testing platforms used by the study participants.

Conclusions: This EQA scheme demonstrated both the requirement and demand for external assessment of technical standards in real-time PCR. The reagent design and the statistical tools developed within this project will provide a benchmark for defining acceptable working standards in this emerging technology.