bluuebunny/crossref_metadata_2025 huggingface dataset:
Family members’ experiences of the intensive care unit waiting room
Authors: Kutash Mary , Northrop Linda
Published: September 2007

Title.  Family members’ experiences of the intensive care unit waiting room

Aim.  This paper is a report of a study to explore family members’ perspectives and experiences of waiting rooms in adult intensive care units.

Background.  Waiting to visit family members who are hospitalized in intensive care units can be very stressful. Although flexible and or open visiting is practised in many hospitals, family members may spend a great deal of time in the waiting room.

Method.  A qualitative design using semi‐structured interviews was used and the data were collected in 2004. A convenience sample of six visitors was recruited from waiting rooms of three different adult intensive care units. Data collection and analysis were concurrent.

Findings.  Six categories emerged from the data that included structural and subjective aspects of waiting: ‘close proximity’ referred to the importance of a close physical distance to their family member; ‘caring staff’ captured the comfort family members felt when staff showed caring behaviours towards relative; ‘need for a comfortable environment’ represented the impact of the design of the waiting room on family members well‐being; ‘emotional support’ referred to the waiting room as a place where comfort was found by sharing with others; ‘rollercoaster of emotions’ captured the range of emotions experienced by family members; ‘information’ referred to the importance of receiving information about their relative.

Conclusion.  Future research should focus on the impact of the interior design of waiting rooms on the comfort and welfare of family members and on identifying needs of family members across different cultures.
Determinants of perceived barriers to condom use among HIV‐infected middle‐aged and older African‐American men
Authors: Coleman Christopher Lance , Ball Katherine
Published: September 2007

Title.  Determinants of perceived barriers to condom use among HIV‐infected middle‐aged and older African‐American men

Aim.  This paper is a report of a study to describe which determinants best predict perceived barriers to condom use during sexual encounters among human immunodeficiency virus human immunodeficiency virus‐infected African‐American men, middle‐aged and older, living in the United States of America.

Background.  While the global epidemic of acquired immunodeficiency syndrome infection is a well‐documented phenomenon with national and international implications, prevalence statistics indicate that middle‐aged and older African‐American (non‐Hispanic) men have not benefited from the prevention efforts implemented during the past two decades.

Method.  A cross‐sectional design using a survey and convenience sampling was adopted between September 2003 and July 2004 to recruit n = 130 middle‐aged human immunodeficiency virus‐infected African‐American men from infectious disease clinics from the Mid‐Atlantic region in the United States of America. The survey covered demographics, perceived health beliefs, spiritual well‐being and symptoms related to human immunodeficiency virus.

Findings.  Stepwise multiple regression showed having fewer human immunodeficiency virus‐related symptoms associated with the human immunodeficiency virus (P = 0·004) and being single (P = 0·05) were perceived as barriers to condom use during sexual encounters (R2 = 0·029, P = 0·046).

Conclusion.  Tailored interventions are needed for African‐American men, middle‐aged and older, infected with human immunodeficiency virus nationally and worldwide that are designed to decrease perceived barriers in order to increase condom use.
Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa
Authors: Frohlich J.A. , Abdool Karim Q. , Mashego M.M. , Sturm A.W. , Abdool Karim S.S.
Published: September 2007

Title.  Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa

Aim.  This paper is a report of a study to determine the aetiological distribution of sexually transmitted infections and prevalence of human immunodeficiency virus infection in selected primary health care clinic attendees.

Background.  South Africa has a high prevalence of human immunodeficiency virus and other sexually transmitted infections. Sexually transmitted infections are managed syndromically in the public sector as part of the essential nurse‐driven primary care services provided at no cost to the client.

Method.  This cross‐sectional study was conducted in a rural community in South Africa between September and November 2002. A total of 277 consenting women were recruited. Vulvo‐vaginal swabs were collected for screening for Neisseriae gonorrheae, Chlamydia trachomatis and Trichomonas vaginalis using DNA amplification methods and Gram stain with Nugent’s score for the diagnosis of bacterial vaginosis. Seroprevalence of syphilis and human immunodeficiency virus infection were determined.

Findings.  The overall prevalence of human immunodeficiency virus in the study was 43·7% (95% confidence interval 37·6–50·0) with the prevalence in family planning clinic attendees 45·5% (95% confidence interval 38·9–52·3) and antenatal clinic attendees 33·3% (95% confidence interval 19·6–50·3). The prevalence of sexually transmitted infections amongst both the antenatal clinic and family planning attendees accounted for at least 70% of cases. Fifty per cent of women had one recognized sexually transmitted infection with 17·9% of the family planning and 14·5% of the antenatal clinic attendees having infections from two recognized pathogens. All infections were asymptomatic.

Conclusion.  Nurse‐driven antenatal and family planning services provide a useful opportunity for integrating reproductive health services, human immunodeficiency virus voluntary counselling and testing and treatment of sexually transmitted infections.
Understanding how nurse practitioners estimate patients' risk for coronary heart disease: a judgment analysis
Authors: Beckstead Jason W. , Stamp Kelly D.
Published: September 2007

Title. Understanding how nurse practitioners estimate patients' risk for coronary heart disease: a judgment analysis

Aim. This paper is a report of a study to examine how nurse practitioners combine information when estimating patient risk of coronary heart disease.

Background. In the United States of America and other countries, nurse practitioners are increasingly working alongside physicians in primary healthcare settings. Given this role, nurse practitioners represent an important resource in early detection of numerous diseases. Understanding how nurse practitioners use patient characteristics (cues) to form estimates of patient risk for disease may improve general disease prevention efforts.

Method. Social judgment theory and its lens model analysis are concerned with the correspondence between a person’s judgments and the environment. This approach was applied to examine how 15 nurse practitioners weighted eight risk factors for coronary heart disease, how accurate practitioners were in assessing patient risk for coronary heart disease, and how much self‐insight practitioners had into their own risk estimation processes. The data were collected in 2006.

Results. Nurse practitioners showed moderate to high accuracy and evinced a variety of cue‐weighting strategies. Insight into their own judgment policies was modest. The lens model analysis revealed that most practitioners had lower values on knowledge of the ecology than they did on cognitive control.

Conclusion. Educational efforts aimed at improving detection of patients at risk for diseases might do better to target increasing clinicians’ understanding of cue‐criteria relationships, than to stress themes of consistency in evaluating patients.
Genetic structure and gene flow in French populations of two Ostrinia taxa: host races or sibling species?
Authors: MALAUSA T. , DALECKY A. , PONSARD S. , AUDIOT P. , STREIFF R. , CHAVAL Y. , BOURGUET D.
Published: September 2007

Most models of ecological speciation concern phytophagous insects in which speciation is thought to be driven by host shifts and subsequent adaptations of populations. Despite the ever‐increasing number of studies, the current evolutionary status of most models remains incompletely resolved, as estimates of gene flow between taxa remain extremely rare. We studied the population genetics of two taxa of the Ostrinia genus — one feeding mainly on maize and the other on mugwort and hop — occurring in sympatry throughout France. The actual level of divergence of these taxa was unknown because the genetic structure of populations had been investigated over a limited geographical area and the magnitude of gene flow between populations had not been estimated. We used 11 microsatellite markers to investigate the genetic structure of populations throughout France and the extent of gene flow between the two Ostrinia taxa at several sites at which they are sympatric. We observed clear genetic differentiation between most populations collected on the typical respective hosts of each taxon. However, populations displaying intermediate allelic frequencies were found on hop plants in southern France. Individual assignments revealed that this result could be accounted for by the presence of both taxa on the same host. Gene flow, estimated by determining the proportion of hybrids detected, was low: probably < 1% per generation, regardless of site. This indicates that the two Ostrinia taxa have reached a high level of genetic divergence and should be considered sibling species rather than host races.
Sulphur accumulation afterVerticillium dahliaeinfection of two pepper cultivars differing in degree of resistance
Authors: Novo M. , Gayoso C. M. , Pomar F. , Lucas M. M. , Ros Barceló A. , Merino F.
Published: September 2007

Elemental sulphur levels, sulphur localization in stems, and levels of sulphate, glutathione and cysteine were studied in pepper (Capsicum annuum) cvs Yolo Wonder (higher resistance) and Luesia (lower resistance) after inoculation withVerticillium dahliae, the cause of vascular wilt. Accumulation of elemental sulphur (S0) was first detected 10 days after inoculation in Yolo Wonder (mean S0level 7·3 µg g−1DW), and 15 days after inoculation in Luesia (mean S0level 3·3 µg g−1DW). The maximum level was reached 21 days after inoculation in Yolo Wonder (14·1 µg g−1DW). In control plants, elemental sulphur was not detected. SEM‐EDX (scanning electron microscopy‐energy dispersive X‐ray microanalysis) indicated that the sulphur was not restricted to a specific location, but was dispersed throughout the vascular tissue. Sulphate levels showed a decline at the end of the experiment in inoculated plants, possibly related to the increase in sulphur levels seen in the two cultivars. The differences in sulphate levels between the two cultivars may be due to faster sulphate breakdown in cv. Yolo Wonder.
New applications of the Poisson distribution in micropalaeontology: relationships between environmental variables and the Ammonia tepida distribution in the south‐western Spanish estuaries
Authors: Ruiz Francisco , González‐Regalado María Luz , Abad Manuel , Muñoz Juan Manuel , Pino Rafael
Published: September 2007

The application of the Poisson regression to the populations of the benthic foraminifer Ammonia tepida collected in three south‐western Spanish estuaries permits to obtain a quantitative approach between some environmental variables and the number of individuals of this species. Although the three general models are unsatisfactory to predict the observed abundance of this micro‐organism, a partial statistical analysis permits to detect quantitatively the impact of each variable. This analysis indicates an increasing abundance from the high‐salt marshes to the subtidal channels and higher densities in those samples subjected to very euryhaline conditions. Increasing sand percentages show negative effects on the A. tepida abundance, whereas the silt contents do not affect significantly to this species and increasing organic carbon percentages have a small positive effect on the A. tepida densities.
Analysis of barley (Hordeum vulgare) grain development using three‐dimensional digital models
Authors: Gubatz Sabine , Dercksen Vincent J. , Brüß Cornelia , Weschke Winfriede , Wobus Ulrich
Published: September 2007

Analysis of gene expression in the developing barley caryopsis requires effective instruments for visualization of the grain and the 3D expression patterns. Digital models of developing barley (Hordeum vulgare) grains were reconstructed from serial sections to visualize the complex three‐dimensional (3D) grain anatomy, to generate and analyse 3D expression patterns, and to quantify tissues during growth. The models provide detailed spatial descriptions of developing grains at anthesis, at the syncytial stage of endosperm development and at the onset of starch accumulation, visualizing and quantifying 18 tissues or tissue complexes. Total caryopsis volumes and volume changes of specific tissues between the stages were determined, and proportions of ovule‐ and non‐ovule‐tissues and ratios of filial to maternal tissues were calculated from the model data. To generate and analyse 3D expression patterns, data from mRNA localization by in situ hybridizations were integrated into the models. At the onset of starch accumulation, cell‐wall invertase (HvCWINV1) mRNA is mainly localized in the transfer cells and to a lesser degree in zones of the starchy endosperm. Using the model, an expression gradient across the grain was visualized. The expression pattern in the upper region of the caryopsis resembles that found in the median region at an earlier stage, indicating the presence of a developmental gradient. At anthesis, mRNA of the protease nucellin was visualized in a distinct zone of the nucellus near the antipodal cells.
Repeatability and reproducibility of numerical rating scales and visual analogue scales for canine pruritus severity scoring
Authors: Plant Jon D.
Published: September 2007

Although they are used frequently in veterinary dermatology, the reliability of canine pruritus severity scales has not been reported. The objective of this study was to evaluate the reliability of pruritus severity numerical rating scales (NRS) and pruritus severity visual analogue scales (VAS). Videos of 16 dogs were evaluated for pruritus severity by 24 observers utilizing three NRS and three VAS. Intraobserver repeatability and interobserver reproducibility were evaluated with Cohen's kappa and Kendall's rank correlation statistics, respectively. The repeatability of pruritus severity NRS was fair, with mean Cohen's weighted kappa (κw) values ranging from 0.49 to 0.60. The mean Kendall's rank correlation coefficient (t) for the three VAS ranged from 0.62 to 0.73. The reproducibility of mid‐range pruritus severity ranks was poor with both scale types. Scales describing overall pruritus severity were found to be reliable most consistently. Neither NRS nor VAS displayed the degree of reliability desired in a health measurement scale. Interpretation of research results evaluating canine pruritus severity with NRS and VAS scales should account for suboptimal reliability.
Malassezia spp. overgrowth in allergic cats
Authors: Ordeix Laura , Galeotti Franca , Scarampella Fabia , Dedola Carla , Bardagí Mar , Romano Erica , Fondati Alessandra
Published: September 2007

A series of 18 allergic cats with multifocal Malassezia spp. overgrowth is reported: atopic dermatitis was diagnosed in 16, an adverse food reaction in another and one was euthanized 2 months after diagnosis of Malassezia overgrowth. All the cats were otherwise healthy and those tested (16 out of 18) for feline leukaemia or feline immunodeficiency virus infections were all negative. At dermatological examination, multifocal alopecia, erythema, crusting and greasy adherent brownish scales were variably distributed on all cats. Cytological examination revealed Malassezia spp. overgrowth with/without bacterial infection in facial skin (n = 11), ventral neck (n = 6), abdomen (n = 6), ear canal (n = 4), chin (n = 2), ear pinnae (n = 2), interdigital (n = 1) and claw folds skin (n = 1). Moreover, in two cats Malassezia pachydermatis was isolated in fungal cultures from lesional skin. Azoles therapy alone was prescribed in seven, azoles and antibacterial therapy in eight and azoles with both antibacterial and anti‐inflammatory therapy in three of the cats. After 3–4 weeks of treatment, substantial reduction of pruritus and skin lesions was observed in all 11 cats treated with a combined therapy and in five of seven treated solely with azoles. Malassezia spp. overgrowth may represent a secondary cutaneous problem in allergic cats particularly in those presented for dermatological examination displaying greasy adherent brownish scales. The favourable response to treatment with antifungal treatments alone suggests that, as in dogs, Malassezia spp. may be partly responsible for both pruritus and cutaneous lesions in allergic cats.
Multiple cutaneous ganglioneuromas in a dog
Authors: Hermeyer K. , Kühn M. , Kuchelmeister K. , Laik C. , Baumgärtner W. , Wohlsein P.
Published: September 2007

A 3‐year‐old male Labrador retriever dog was presented with multifocal small cutaneous nodules, distributed mainly over the thoracic wall, the flank and the scrotum. The dog was otherwise in good health and had no significant past medical history. Radio‐ and sonographic examination revealed no evidence of internal tumours, including endocrine tumours. Histological examination of two excised samples revealed round, non‐ulcerated nodules in the superficial corium, characterized by two different neoplastic cell components and mild inflammation. The first tumour cell population showed histomorphological characteristics of mature ganglion cells; the second featured small, spindle‐shaped tumour cells with scant cytoplasm. Both neoplastic cell components expressed vimentin, neurofilament protein, pan‐neuronal neurofilament, amyloid‐precursor protein and chromogranin A. In addition, the spindle‐shaped tumour cells were positive for 2′, 3′‐cyclicnucleotide 3′‐phosphodiesterase. The findings had many histological and immunohistochemical features in common with primary cutaneous ganglioneuromas in humans, enabling the canine tumours to be also classified as multiple cutaneous ganglioneuromas.
Skin fragility syndrome in a cat with feline infectious peritonitis and hepatic lipidosis
Authors: Trotman Tara K. , Mauldin Elizabeth , Hoffmann Vickie , Del Piero Fabio , Hess Rebecka S.
Published: September 2007

A 6‐year‐old spayed female domestic shorthair cat with a 3‐week history of inappetence, weight loss, and hiding was examined. A palpable abdominal fluid wave, dehydration, and a small tear on the left flank were noted during initial examination. When the cat was gently restrained for blood sampling, the skin on the dorsal neck tore, leaving a 15 cm × 7 cm flap of skin. Clinicopathological abnormalities included nonregenerative anaemia, hypoalbuminaemia, increased globulin concentration, and mildly elevated aspartate aminotransferase and alkaline phosphatase activities. Abdominal fluid was viscous and had a total protein of 5.3 g dL−1with 316 cells µL−1, consistent with a modified transudate. Cytology of the abdominal fluid revealed 86% nondegenerate neutrophils, 13% macrophages, and 1% small lymphocytes. Histopathological evaluation and indirect immunohistochemistry confirmed a diagnosis of feline infectious peritonitis, hepatic lipidosis and feline skin fragility syndrome. Feline skin fragility syndrome has not previously been reported in association with feline infectious peritonitis (FIP). Its inclusion as a clinical sign associated with FIP may facilitate a diagnosis.
Participation preferences of patients with acute and chronic conditions
Authors: Hamann Johannes , Neuner Bruno , Kasper Jürgen , Vodermaier Andrea , Loh Andreas , Deinzer Anja , Heesen Christoph , Kissling Werner , Busch Raymonde , Schmieder Roland , Spies Claudia , Caspari Cornelia , Härter Martin
Published: September 2007

Background  There is little knowledge as to whether the chronicity of a disease affects patients’ desire for participation.

Aim  To study whether participation preferences vary according to the type of disease.

Design, participants and methods  Data of 1393 patients from six trials with different medical conditions (hypertension, depression, breast cancer, schizophrenia, multiple sclerosis, minor traumas) were pooled and analysed, using multiple regression analysis controlling for socio‐demographic variables.

Results  Younger age, better education as well as female gender accounted for a small but statistically significantly greater desire to participate. Patients suffering from multiple sclerosis (MS) exhibited significantly higher participation preferences than the other diagnostic groups. There were no major differences between the other diagnostic groups. Age, gender, education and diagnosis explained only 14% of the variance.

Conclusions  We found no clear differences between chronic and acute conditions. However, patients suffering from MS, a chronic condition, were clearly different from all other diagnostic groups. The reasons for this difference remain unclear. The predictive value of socio‐demography and type of illness is low.
Air pollution and seasonal asthma during the pollen season. A cohort study in Puertollano and Ciudad Real (Spain)
Authors: Feo Brito F. , Mur Gimeno P. , Martínez C. , Tobías A. , Suárez L. , Guerra F. , Borja J. M , Alonso A. M
Published: September 2007

Background:  Many studies have demonstrated a positive association between air pollutants and emergency visits for asthma. However, few studies have included pollen when analysing this relationship in mild–moderate asthmatic patients.

Objective:  To determine the importance of the pollutants such as ozone (O3), particles (PM10), nitrogen dioxide (NO2) and sulphur dioxide (SO2) in the clinical course of mild–moderate pollen‐allergic asthmatic patients from two Spanish towns in La Mancha: Puertollano (high pollution levels) and Ciudad Real (low pollution levels).

Methods:  We used a Poisson regression model to study a cohort of 137 patients from Puertollano and Ciudad Real during two pollen seasons (2000–2001) and analysed the relationship between air pollutant and pollen levels and daily symptoms, the medication used and peak‐flow measurements.

Results:  The number of asthma symptoms and the mean values of the PM10, SO2 and NO2 levels were higher in Puertollano than in Ciudad Real. In Puertollano, the risk of asthma increased by 6% with a 3‐day lag for PM10, by 8% with a 3‐day lag for O3, by 4% with a 1‐day lag for SO2 and by 15% with a 3‐day lag for O3 when its values exceeded the health threshold (P < 0.05).

Conclusions:  The air pollution levels in Puertollano were associated with an increased risk of asthma symptoms in pollen‐allergic asthmatic patients com pared with a similar group from Ciudad Real.
Cost‐effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy
Authors: Price D. , Wirén A. , Kuna P.
Published: September 2007

Background:  Budesonide/formoterol (Symbicort®) Maintenance and Reliever Therapy (SMART) is an effective asthma‐management approach that treats symptoms with rapid increases in budesonide/formoterol. The cost‐effectiveness of SMART vs higher fixed‐dose budesonide/formoterol or salmeterol/fluticasone is unknown.

Methods:  This 6‐month, double‐blind study randomized patients with asthma uncontrolled by inhaled corticosteroids alone (n = 3335; age ≥12 years) to budesonide/formoterol 160/4.5 μg b.i.d. plus additional doses as needed (SMART), budesonide/formoterol 320/9 μg b.i.d. plus as‐needed terbutaline, or salmeterol/fluticasone 50/250 μg b.i.d. plus as‐needed terbutaline. Economic analysis, assuming health care and societal perspectives, applied 2004 UK and Australian unit costs to pooled resource‐use data. The effectiveness variable was the rate of severe exacerbations/patient/6 months.

Results:  Patients treated using the SMART approach experienced fewer severe exacerbations than fixed‐dose budesonide/formoterol and salmeterol/fluticasone patients (0.12 vs 0.16 and 0.19 events/patient/6 months, respectively; P ≤ 0.0048). Budesonide/formoterol (Symbicort®) Maintenance and Reliever Therapy provided similar improvements in other markers of asthma control at a lower overall daily inhaled corticosteroid dose compared with fixed‐dose treatment. Study drug costs accounted for a majority of both direct costs (DC; 78–87%) and total costs (TC; 50–63%) for all treatments, and were significantly lower in the SMART group compared with the fixed‐dose groups (P ≤ 0.0014). Direct and TC per patient/6 months were lower for SMART vs salmeterol/fluticasone (DC:–AUS$154, P < 0.0001; TC:–AUS$163, P = 0.0036;–£87, P = 0.0026) and vs budesonide/formoterol using UK costs (DC:–£73, P < 0.0001; TC:–£91, P = 0.0014). Costs tended to be lower for SMART vs budesonide/formoterol using Australian costs (DC:–AUS$35, P = 0.16; TC:–AUS$70, P = 0.20). Results were stable under sensitivity testing. Indirect resource use and cost were not significantly different between groups.

Conclusion:  Compared with higher fixed‐dose budesonide/formoterol and salmeterol/fluticasone, SMART reduces the incidence of severe exacerbations at a lower or similar overall cost and can be considered a cost‐effective treatment regimen.
Asthma definitions, relative validity and impact on known risk factors in young Brazilians
Authors: Vianna E. O. , García C. A. , Bettiol H. , Barbieri M. A. , Rona R. J.
Published: September 2007

Background:  An asthma score was proposed in the European Community Respiratory Health Survey (ECRHS) framework, as dichotomous definitions could be less appropriate in the study of chronic diseases. The aims of this study were to assess the value of this asthma score in comparison with other definitions of asthma in another population setting, using as criteria bronchial hyperresponsiveness (BHR) to methacholine and diagnosed asthma, and the association of these definitions to known risk factors of asthma.

Methods:  We used the ECRHS questionnaire on 2063 Brazilians, aged 23–25 years, and measured their BHR. We assessed the positive and negative likelihood ratios (PLR and NLR) of the asthma score (0–8), a three question score (ECRHS definition) and single asthma symptoms in relation to BHR and diagnosed asthma.

Results:  The PLR were relatively low for all asthma definitions with odd ratios varying from 1.47 for asthma score to 5.50 for wheeze and waking with breathlessness without a cold. The NLR were near 1. The PLR were lower for assessments using the score than for dichotomous assessments or the ECRHS definition. The PLR increased with asthma scores, but the prevalence with higher scores was too low for useful analysis. The asthma score was slightly better for identifying associations from a set of known risk factors than the other two approaches.

Conclusion:  Our study provided little support for a greater validity of this asthma score over other asthma definitions, and only marginal advantage for identifying risk factors.
Association between obesity and asthma in a twin cohort
Authors: Thomsen S. F. , Ulrik C. S. , Kyvik K. O. , Sørensen T. I. A. , Posthuma D. , Skadhauge L. R. , Steffensen I. , Backer V.
Published: September 2007

Background:  Obesity is linked to asthma in a yet poorly understood manner. We examined the relationship between obesity and asthma in a population‐based sample of twins.

Methods:  From the cohorts born between 1953 and 1982, who were enrolled in The Danish Twin Registry, a total of 29 183 twin individuals participated in a nationwide questionnaire study, where data on height, weight and asthma were collected. Latent factor models of genetic and environmental effects were fitted using maximum likelihood methods.

Results:  The age‐adjusted risk of asthma was increased both in obese females, OR = 1.96 (1.45–2.64), P ≤ 0.001 and in obese males, OR = 1.59 (1.08–2.33), P = 0.02. According to best‐fitting models, the heritability for obesity was 81% in males and 92% in females, whereas the heritability for asthma was 78% and 68% in males and females respectively. The age‐adjusted genetic liabilities to obesity and asthma were significantly correlated only in females, r = 0.28 (0.16–0.38).

Conclusions:  Obese subjects have an increased risk for asthma, which in females seems partly because of common genes.
The polymorphisms of Eotaxin 1 and CCR3 genes influence on serum IgE, Eotaxin levels and mild asthmatic children in Taiwan
Authors: Wang T.‐N. , Chiang W. , Tseng H.‐I. , Chu Y.‐T. , Chen W.‐Y. , Shih N.‐H. , Ko Y.‐C.
Published: September 2007

Background:  Asthma is a complex disorder, which is known to be affected by interactions between genetic and environmental factors. The human Eotaxin 1 and CCR3 attract eosinophils and Th2‐lymphocytes to migrate to the inflammatory foci that could represent a key mechanism in allergy and asthma.

Objective:  We hypothesized that Eotaxin1 gene Ala23Thr and A‐384 G, and CCR3 gene T51C polymorphisms are associated with plasma Eotaxin levels and predispose individuals to asthma pathogenesis.

Methods:  One hundred seventy‐eight hospital‐based asthmatic children and 277 community‐based controls aged from 5 to 12 years were recruited in southern Taiwan. Whole blood samples and questionnaires were collected. In this study, we addressed genetic effects of Eotaxin 1 and CCR3 genes on asthma, plasma IgE and Eotaxin 1 levels.

Results:  In comparison with subjects with Ala23Ala genotype, Ala23Thr polymorphism of the Eotaxin 1 gene showed a significant protective effect on asthma (AOR = 0.58, 95% CI = 0.37–0.92). We demonstrated that the mean Eotaxin 1 concentration was significantly higher in subjects with Ala23Ala than in subjects with Thr23Thr (P = 0.005) or Ala23Thr (P = 0.07), which showed a gene‐dose dependent relationship. But, we observed that the A‐384G polymorphism of Eotaxin 1 gene and T51C polymorphism of CCR3 gene are not associated with asthma.

Conclusion:  This study finding provide a strong evidence that Eotaxin 1 Thr23Thr homozygote has a protective effect on asthma and significantly decreases plasma Eotaxin 1 concentrations in asthmatics in Taiwan.
Impact of gender on asthma in childhood and adolescence: a GA2LEN review
Authors: Almqvist C. , Worm M. , Leynaert B. ,   for the working group of GALEN WP 2.5 ‘Gender’
Published: September 2007

A number of studies have shown gender differences in the prevalence of wheeze and asthma. The aim of this review was to examine published results on gender differences in childhood and adolescent asthma incidence and prevalence, define current concepts and to identify new research needs.

A Medline search was performed with the search words (gender OR sex) AND (child OR childhood OR adolescence) AND (asthma). Articles that reported on abscence or prescence of gender differences in asthma were included and reviewed, and cross‐references were checked. Boys are consistently reported to have more prevalent wheeze and asthma than girls. In adolescence, the pattern changes and onset of wheeze is more prevalent in females than males. Asthma, after childhood, is more severe in females than in males, and is underdiagnosed and undertreated in female adolescents. Possible explanations for this switch around puberty in the gender susceptibility to develop asthma include hormonal changes and gender‐specific differences in environmental exposures. This aspect needs consideration of the doctors and allergists who diagnose and treat asthmatic individuals.

In conclusion, sex hormones are likely to play an important role in the development and outcome of the allergic immune response and asthma in particular. By obtaining functional data from appropriate models, the exact underlying mechanisms can be unravelled. To examine the effect of gender‐specific differences in environmental exposures and changes of asthma prevalence and severity in puberty, larger populations may need to be investigated.
A disease causing deletion of 29 base pairs in intron 15 in the MKS1 gene is highly associated with the campomelic variant of the Meckel–Gruber syndrome
Authors: Auber B , Burfeind P , Herold S , Schoner K , Simson G , Rauskolb R , Rehder H
Published: September 2007

Meckel–Gruber syndrome (MKS) is an autosomal recessive disorder causing severe defects in the developing central nervous system and other organs. Recently, mutations in the MKS1 gene have been identified as disease causing in individuals of Finnish MKS families. The primary aim of the present study was to assess the frequency of the ‘Finnish founder mutation’ (29 bp IVS15‐7_35) in the MKS1 gene in 20 aborted fetuses with a diagnosis of MKS. The secondary aim was to screen for novel mutations in the coding sequence of the MKS1 gene of MKS fetuses and to obtain genotype–phenotype correlations where possible. Furthermore, we evaluated the carrier rate of a deletion of 29 bp in intron 15 of the MKS1 gene in a German population. To identify and characterize mutations in the MKS1 gene, sequence analyses and quantitative real time polymerase chain reaction studies were performed. We could identify the same type of mutation, a deletion of 29 bp in intron 15 of the MKS1 gene, in 8 out of the 20 cases studied. Six out of the eight cases with such a mutation displayed the campomelic variant of MKS. The carrier frequency among 519 healthy German individuals was 1:260. This deletion in the MKS1 gene is highly associated with a distinct subtype of the MKS, namely the campomelic variant. In individuals of European origin suffering from the campomelic MKS variant, the described deletion is highly likely to be causative. Regarding the results of our study, the incidence of MKS in Germany can be estimated as 1:135,000. In families with a known mutation in the MKS1 gene, it is now possible to offer an early prenatal testing, for example with chorionic villus sampling and mutation analysis.
Post‐traumatic stress disorder among adolescents with bipolar disorder and its relationship to suicidality
Authors: Dilsaver Steven C , Benazzi Franco , Akiskal Hagop S , Akiskal Kareen K
Published: September 2007

Objectives:  The aims of this cross‐sectional pilot study were to ascertain the rates of post‐traumatic stress disorder (PTSD) among adolescents with bipolar disorder (BPD) and major depressive disorder (MDD) relative to a comparison group comprised of non‐affectively ill patients, and to determine whether PTSD is related to suicidal ideation and attempts. The impetus for the study was born of clinical impressions derived in the course of routine clinical practice.

Methods:  Patients were screened by a single interviewer for BPD, MDD and PTSD, panic disorder, obsessive–compulsive disorder (OCD) and social phobia using the apposite modules from the Structured Clinical Interview for DSM‐IV (SCID) and histories of suicidal ideation and attempts. The data were subjected to analysis using a logistic regression model.

Results:  The database included 34 patients with BPD, 79 with MDD and 26 with a non‐affective disorder. The risk for PTSD for a patient with BPD significantly exceeded that for a patient with MDD [odds ratio (OR) = 4.9, 95% confidence interval (CI) = 1.9–12.2, p = 0.001]. Patients with PTSD had an insignificantly increased risk for suicidal ideation (OR = 2.8, 95% CI = 0.9–8.9, p = 0.069), and a 4.5‐fold significantly increased risk of having had a suicide attempt (OR = 4.5, 95% CI = 1.7–11.7, p = 0.002). The relationship between PTSD and suicide attempts remained significant even after controlling for the confounding effects of concurrent panic disorder, OCD and social phobia (OR = 3.4, 95% CI = 1.1–10.0, p = 0.023).

Conclusions:  Patients with BPD have a greater risk for PTSD than those with MDD. Post‐traumatic stress disorder is significantly related to history of suicide attempts.
Adherence to medication in bipolar disorder: a qualitative study exploring the role of patients’ beliefs about the condition and its treatment
Authors: Clatworthy Jane , Bowskill Richard , Rank Tim , Parham Rhian , Horne Rob
Published: September 2007

Objectives:  Patients’ perceptions of illness and treatment have been found to predict adherence to medication in many chronic conditions. This has not yet been fully explored in bipolar disorder (BD). The aim was to use a qualitative methodology to explore in depth the beliefs about BD and its treatment that are associated with adherence to medication prescribed for BD.

Methods:  Sixteen adults prescribed prophylactic treatment for BD completed semi‐structured interviews about their perceptions of BD and its treatment and their adherence to medication. Interviews were recorded and transcribed verbatim. Two researchers identified perceptions associated with non‐adherence in the transcripts.

Results:  Thirteen participants (81%) reported some degree of intentional or unintentional medication non‐adherence. Intentional non‐adherence was associated with patients’ concerns about the prescribed medication, arising from the experience of side effects, but also from beliefs that regular use could lead to adverse effects in the future. Intentional non‐adherence was also associated with doubts about the personal need for medication, which were related to perceptions of BD (e.g., not accepting diagnosis, believing the condition is not controllable, believing it is not a chronic condition).

Conclusions:  This study has identified some of the salient beliefs about BD and its treatment that should be elicited and addressed in interventions to facilitate adherence to medication. Further quantitative work is justified to explore the utility of this approach in the development of interventions.
Is bipolar disorder overdiagnosed among patients with substance abuse?
Authors: Stewart Christopher , El‐Mallakh Rif S
Published: September 2007

Background:  Bipolar illness is frequently misdiagnosed. Several studies have focused on the underdiagnosis of this condition and the frequent long delay in its recognition. However, the illness is difficult to diagnose and many of its symptoms are shared by other conditions. In order to determine the accuracy of the diagnosis of bipolar illness among subjects with substance abuse, we carried out a study in patients with a previous diagnosis of bipolar disorder (BD) and known history of substance abuse or dependence, who were currently engaged in treatment for substance abuse.

Methods:  Individuals participating in a community‐based substance treatment program and who had a previous diagnosis of BD were invited to undergo a structured clinical interview for diagnosis performed by a psychiatrist. In addition to the interview, previous hospital records were reviewed whenever possible. Diagnosis was made following strict DSM‐IV criteria.

Results:  Only 9 of 21 (42.9%) subjects met diagnostic criteria for BD. Seven were BD type II and two were BD I.

Conclusions:  Bipolar disorder is frequently misdiagnosed following strict DSM‐IV criteria. Among subjects with substance abuse, it may be overdiagnosed by psychiatrists.
A placebo‐controlled, random‐assignment, parallel‐group pilot study of adjunctive topiramate for patients with schizoaffective disorder, bipolar type
Authors: Roy Chengappa KN , Kupfer David J , Parepally Haranath , John Vineeth , Basu Ranita , Buttenfield Joan , Schlicht Patricia , Houck Patricia , Brar Jaspreet S , Gershon Samuel
Published: September 2007

Objectives:  This pilot study evaluated the efficacy and safety of adjunctive topiramate compared with placebo in the treatment of patients with a diagnosis of schizoaffective disorder, bipolar type (SAD‐BT).

Methods:  A sample of 48 adult patients with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM‐IV‐TR) diagnosis of SAD‐BT (supported by the Structured Clinical Interview for DSM‐IV Axis I Disorder, Patient Edition) were randomly assigned in a 2:1 ratio (favoring topiramate) to 8 weeks of double‐blind treatment with topiramate (100–400 mg/day) or placebo. Patients who had achieved a ≥20% decrease from baseline in their Positive and Negative Syndrome Scale (PANSS) total scores were given the opportunity to continue for an additional 8 weeks of double‐blind treatment. The dosage of the study medicine was continued unchanged from the earlier 8‐week study period. At the end of the study period, the study medicine was tapered and discontinued over a 2‐week period. Primary efficacy was assessed at 8 weeks using the mean change between treatment groups of the PANSS total scores in the intent‐to‐treat population of randomized patients. Several secondary measures were also assessed. Safety analyses included monitoring of adverse events, vital signs, electrocardiogram (ECG) and laboratory values.

Results:  Even though both treatments reduced scores on various psychopathology rating scales, adjunctive topiramate treatment (nearly 275 mg/day) did not show increased efficacy relative to placebo on the primary outcome measure (PANSS scale) or any of the secondary outcome measures. Topiramate‐treated patients lost significantly more body weight than placebo‐treated patients, which led to a significant reduction in body mass index (BMI). Relative to adjunctive placebo, topiramate‐treated patients experienced higher rates of paresthesia, sedation, word‐finding difficulty, sleepiness, and forgetfulness, but these differences were not statistically significant. There were no clinically significant abnormalities in either the ECG or laboratory results. There were no serious adverse events in the study. Further, there was no worsening of the PANSS total scores (to ≥10% from baseline), and no significant differences between the treatments on worsening of total Montgomery–Asberg Depression Rating Scale (MADRS) scores [1/13 (7.7%) for placebo; 1/25 (4.0%) for topiramate].

Conclusions:  This pilot study did not support clinical efficacy for adjunctive topiramate treatment in patients with SAD‐BT. There were no major safety or tolerability issues in this study. Confirming the results of other studies, topiramate‐treated patients did experience greater body weight loss and reduction in BMI.
Agomelatine adjunctive therapy for acute bipolar depression: preliminary open data
Authors: Calabrese Joseph R , Guelfi Julien Daniel , Perdrizet‐Chevallier Catherine ,   the Agomelatine Bipolar Study Group
Published: September 2007

Objectives:  Agomelatine has been shown to be safe and efficient in the treatment of major depressive disorder at 25 mg daily. The aim of this study was to gather preliminary data regarding the antidepressant efficacy of agomelatine in patients with bipolar I disorder experiencing a major depressive episode.

Methods:  Bipolar I patients on lithium (n = 14) or valpromide (n = 7), with a Hamilton Rating Scale for Depression (HAM‐D‐17) total score ≥ 18, were given adjunctive open‐label agomelatine at 25 mg/day for a minimum of 6 weeks followed by an optional extension of up to an additional 46 weeks.

Results:  Using intent‐to‐treat data, 81% of patients met criteria for marked improvement (>50% improvement from baseline in HAM‐D score) at study endpoint. Patients were severely depressed at study entry (HAM‐D of 25.2) and 47.6% responded as early as at one week of treatment. Nineteen patients entered the optional extension period for a mean of 211 days (range 6–325 days). Eleven patients completed the one‐year extension on agomelatine. There were no dropouts due to adverse events during the acute phase of treatment (6 weeks). Six patients experienced serious adverse events during the one‐year period. Three lithium‐treated patients experienced manic or hypomanic episodes during the optional extension period, one of which was treatment‐related.

Conclusions:  These results indicate the effectiveness of agomelatine 25 mg in the treatment of depressed bipolar I patients co‐medicated with lithium or valpromide. A randomized controlled trial is planned to confirm these results.
Phenotypic plasticity of immune defence linked with foraging activity in the ant Cataglyphis velox
Authors: BOCHER A. , TIRARD C. , DOUMS C.
Published: September 2007

Because immune defences are costly, life‐history theories predict a modulation of immune investment according to its potential benefits. Social insects provide interesting models since infection risk may vary among individuals within a colony. In particular, the foraging workers, that have to leave the nest, suffer a higher infection risk and can contaminate their nest, which may favour high immune investments. However, evolutionary theories of aging predict that foragers should reduce their immune investment when they suffer high extrinsic mortality. To test these two predictions, we investigated the levels of phenoloxidase (PO) and prophenoloxidase, two important enzymes of the insect immune system, in workers of the ant Cataglyphis velox. We found a higher PO activity in foragers than in intra‐nidal workers. This could result from an adaptive upregulation of the harmful PO (an enzyme potentially leading to autoimmune reactions) only when the risk of infection and wounding is high.
EXERCISE PERFORMANCE AND VENTILATORY EFFICIENCY IN PATIENTS WITH MILD AND MODERATE LIVER CIRRHOSIS
Authors: Terziyski K , Andonov V , Marinov B , Kostianev S
Published: September 2007

The impact of ventilatory efficiency on reduced exercise capacity and recovery oxygen kinetics has not been addressed in cirrhotic patients. The aim of the present study was to investigate exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis (LC).

Nineteen male non‐hypoxic patients with LC (age 51.3 ± 9.1 years; body mass index (BMI) 25.6 ± 3.6 kg/m2) classified by the Child‐Pugh score as class A (n = 7) and class B (n = 12) and 19 age‐ and BMI‐matched controls participated in the study. Subjects undertook maximal incremental exercise testing on a treadmill using the Bruce protocol.

Patients with LC showed a reduced diffusion capacity (DL,CO%) compared with controls (74.6 ± 15.2 vs 95.6 ± 12.9%, respectively; P < 0.001), but a comparable volume standardized diffusion coefficient (1.33 ± 0.22 vs 1.45 ± 0.18 mmol/min per kPa per L, respectively; P = 0.74). Patients with LC had a significantly lower exercise capacity compared with controls (VO2max 23.8 ± 3.8 vs 30.6 ± 4.4 mL/min per kg, respectively; P < 0.001).  Recovery oxygen kinetics were also impaired in LC patients compared with controls (104.6 ± 19.3 vs 84.4 ± 22.7 s, respectively; P = 0.012). The chronotropic index was significantly lower in the LC group compared with controls (0.67 ± 0.19 vs 0.82 ± 0.17, respectively; P = 0.030) and LC patients showed higher ventilatory equivalents (30.4 ± 3.8 vs 26.3 ± 2.3, respectively; P < 0.001) and lower oxygen uptake efficiency slope values (2187 ± 445 vs 2745 ± 473 mL/min per log10L, respectively; P < 0.001) compared with controls, which is indicative of decreased ventilatory efficiency. Patients with LC also had a higher standardized maximal exercise perception score (SMEPS) compared with controls (0.62 ± 0.18 vs 0.46 ± 0.15, respectively; P = 0.011). Moderate negative correlations were found between Child‐Pugh score and VO2max% (r = –0.496; P = 0.031).

In conclusion, patients with mild and moderate LC have reduced exercise capacity, which correlates with Child‐Pugh score, as well as reduced chronotropic index and prolonged recovery oxygen uptake kinetics. The results suggest worsened ventilatory efficiency during exercise and cardiopulmonary reasons for the higher SMEPS in these patients.