bluuebunny/crossref_metadata_2025 huggingface dataset:
ADHD Symptoms and Associated Psychopathology in a Community Sample of Adolescents From the European North of Russia
Authors: Ruchkin Vladislav , Lorberg Boris , Koposov Roman , Schwab-Stone Mary , Sukhodolsky Denis G.
Published: August 2007

Objective: To assess the prevalence of ADHD symptoms and their relationship to psychopathology in adolescents from the European North of Russia. Method: The prevalence of ADHD symptoms is assessed by teacher reports in 536 adolescents. Internalizing and externalizing problems are assessed by teacher ratings and student self-reports. Results: Prevalence of individual ADHD symptoms ranges between 3.3% and 35%. Only 8.9% of boys and 3.6% of girls have positive ratings on six items in either inattention or hyperactivity subtype. These adolescents fare significantly worse regarding externalizing but not internalizing problems. Compared to girls with ADHD, boys with ADHD report higher levels of violent and nonviolent delinquency and are described by teachers as having more conduct problems. Possible ADHD status is associated with depressive symptoms in boys but not in girls. Conclusion: The estimates of ADHD prevalence rates obtained in this study are similar to those of other countries, suggesting the need for identification and treatment of the disorder. Evaluation of associated disruptive behavior disorders and depression, particularly in boys, is warranted. (J. of Att. Dis. 2008; 12(1) 54-63)
Clinical decision making and the expected value of information
Authors: Willan Andrew R.
Published: August 2007

Background The results of the HOPE study, a randomized clinical trial, provide strong evidence that 1) ramipril prevents the composite outcome of cardiovascular death, myocardial infarction or stroke in patients who are at high risk of a cardiovascular event and 2) ramipril is cost-effective at a threshold willingness-to-pay of $10 000 to prevent an event of the composite outcome. In this report the concept of the expected value of information is used to determine if the information provided by the HOPE study is sufficient for decision making in the US and Canada.

Methods and results Using the cost-effectiveness data from a clinical trial, or from a meta-analysis of several trials, one can determine, based on the number of future patients that would benefit from the health technology under investigation, the expected value of sample information (EVSI) of a future trial as a function of proposed sample size. If the EVSI exceeds the cost for any particular sample size then the current information is insufficient for decision making and a future trial is indicated. If, on the other hand, there is no sample size for which the EVSI exceeds the cost, then there is sufficient information for decision making and no future trial is required. Using the data from the HOPE study these concepts are applied for various assumptions regarding the fixed and variable cost of a future trial and the number of patients who would benefit from ramipril.

Conclusions Expected value of information methods provide a decision-analytic alternative to the standard likelihood methods for assessing the evidence provided by cost-effectiveness data from randomized clinical trials. Clinical Trials 2007; 4: 279—285. http://ctj.sagepub.com
Perspectives of clinical research coordinators on disclosing financial conflicts of interest to potential research participants
Authors: Friedman Joëlle Y , Sugarman Jeremy , Dhillon Jatinder K , DePuy Venita , Pierre Christine K , Dinan Michaela A , Allsbrook Jennifer S , Schulman Kevin A , Weinfurt Kevin P
Published: August 2007

Background Disclosing financial interests to potential research participants during the informed consent process is one strategy for managing conflicts of interest. Given that clinical research coordinators are typically charged with administering the informed consent process, it is critical to understand their experiences, attitudes and beliefs regarding the disclosure of financial interests in research.

Purpose To understand the role of clinical research coordinators in disclosing financial interests in research, and potential barriers to such disclosures.

Methods We developed a survey designed to measure clinical research coordinators' awareness of financial interests in clinical research, previous experience with disclosing financial interests, comfort with answering questions about financial interests and barriers to disclosing financial interests to potential research participants. Next we conducted cognitive interviews with 10 clinical research coordinators to assess understandability and content validity and to further refine the survey. We then administered the survey to clinical research coordinators attending the 2006 Global Conference of the Association of Clinical Research Professionals.

Results Among 300 clinical research coordinators who completed the survey, there was a general awareness of financial interests in research. Forty-one percent reported disclosing such financial interests to potential research participants, and 28% reported being asked about them. Greater comfort in responding to questions about financial interests was associated with previous experience with disclosure, previous experience answering questions about financial interests, and greater length of time obtaining informed consent. Respondents indicated that there were barriers to disclosure, including lack of information (76%) and that participants would not understand disclosures (26%).

Limitations Possible sample bias due to using a convenience sample.

Conclusions Making information about financial interests in research readily available to clinical research coordinators, as well as providing education and training, should facilitate the disclosure of financial interests in research to potential research participants during the informed consent process. Clinical Trials 2007; 4: 272—278. http://ctj.sagepub.com
Monitoring and reporting of the Women's Health Initiative randomized hormone therapy trials
Authors: Anderson Garnet L. , Kooperberg Charles , Geller Nancy , Rossouw Jacques E. , Pettinger Mary , Prentice Ross L.
Published: August 2007

Background The Women's Health Initiative (WHI) randomized trial of estrogen plus progestin (E + P) was terminated early based on an assessment of harms exceeding benefits for disease prevention. The results contravened prevailing wisdom and a large body of literature regarding benefits of menopausal hormone therapy. The results and their interpretation have been the subject of considerable debate.

Purpose/methods To describe the process of developing a trial monitoring plan, the key interim and final data, and to explain the choice of statistical methods used in trial monitoring and reporting.

Results A formalized monitoring plan was developed using statistical methods that acknowledged protocol-defined design and analysis plans, input of monitoring board members especially regarding the role of various study outcomes, and multiple comparisons. Major early departures from design assumptions concerning treatment effects indicated a need for additional flexibility in safety monitoring. When the trials were stopped early, questions arose as to how closely the statistical methods in published reports should correspond to those defined by protocol or used in monitoring. Methods were selected to provide a simple and transparent summary of the primary results, with a cautious interpretation promoted by acknowledgement of multiple testing.

Conclusions Developing a formal trial monitoring plan with a view towards influencing clinical practice is useful for creating consensus among DSMB members regarding the evidence that would justify stopping a trial and the framework to be used to address statistical complexities. Departures from design assumptions typically occur. These reinforce the role of the DSMB in exercising their judgment, and the judicious adaptation of these statistical guidelines in monitoring and reporting trials. In communicating the results in such circumstances, priority should be given to presenting as fair, accurate and transparent a view of the data and findings as current methods and technology allow.
Applying justice in clinical trials for diverse populations
Authors: Tilburt Jon , Ford Jean G. , Howerton Mollie W. , Gary Tiffany L. , Lai Gabriel Y. , Bolen Shari , Baffi Charles , Wilson Renee F. , Tanpitukpongse Teerath Peter , Powe Neil R. , Bass Eric B. , Sugarman Jeremy
Published: August 2007

Background Considerable attention has focused on increasing clinical trial participation for members of “underrepresented groups”. However, doing so involves clarifying how to meet the demands of justice, or fairness, which provides the ethical mandate to enhance broad trial representation.

Purpose To examine the ethical principle of justice as it applies to recruiting diverse populations to clinical trials representation.

Methods In this paper, we analyse the conceptual and practical challenges in applying the principle of justice to clinical trials representation.

Results Different facets of justice include demands for both fair outcomes and fair processes. Including both of these facets in clinical trials policy should not only promote access to trials, but also help to provide a framework to improve fairness in representation in clinical trials. Efforts to evaluate recruitment of representation should include outcome and process measures.

Limitations The suggestions offered based on this conceptual analysis need to be tested empirically.

Conclusions Those involved in the design, conduct and oversight of clinical trials should consider all of the facets of justice when assessing representation in clinical trials and attempt to balance fair access to trials with a fair process that may require protection from being unduly pressured to participate. Clinical Trials 2007; 4: 264—269; http://ctj.sagepub.com
Dose-finding in phase I clinical trials based on toxicity probability intervals
Authors: Ji Yuan , Li Yisheng , Nebiyou Bekele B.
Published: August 2007

Background Most phase I clinical trials conducted at the M. D. Anderson Cancer Center use the algorithmic 3 + 3 design, despite the availability of more advanced model-based designs such as the continual reassessment method.

Purpose Through simple statistical modeling and computing, we develop a dose-finding design that can be easily understood and implemented by non-statisticians.

Methods We propose a beta/binomial Bayesian model and a probabilistic up-and-down rule that allow all possible dose-assignment actions to be tabulated in a spreadsheet. We have developed an Excel macro (available at http://odin.mdacc. tmc.edu/~yuanj) that generates trial monitoring tables, which contain the dose-assignment actions corresponding to various toxicity outcomes.

Results The new design outperforms the 3 + 3 design and performs comparably to other model-based methods in the literature.

Limitations The proposed method assumes that the observed toxicity is a binary variable and that toxicity increases with dose level.

Conclusion The new dose-finding design enables physicians to readily determine dose assignments for new patients by referencing a trial monitoring table. Clinical Trials 2007; 4: 235—244; http://ctj.sagepub.com
Proteinase 3, the Wegener autoantigen, is externalized during neutrophil apoptosis: evidence for a functional association with phospholipid scramblase 1 and interference with macrophage phagocytosis
Authors: Kantari Chahrazade , Pederzoli-Ribeil Magali , Amir-Moazami Omid , Gausson-Dorey Valérie , Moura Ivan Cruz , Lecomte Marie-Christine , Benhamou Marc , Witko-Sarsat Véronique
Published: August 2007

Proteinase 3 (PR3), a serine proteinase contained in neutrophil azurophilic granules, is considered a risk factor for vasculitides and rheumatoid arthritis when expressed on the outer leaflet of neutrophil plasma membrane and is the preferred target of antineutrophil cytoplasm autoantibodies (ANCA) in Wegener granulomatosis. ANCA binding to PR3 expressed at the surface of neutrophils activates them. Evidence is provided that neutrophil apoptosis induced significantly more membrane PR3 expression without degranulation (but no enhanced membrane CD35, CD66b, CD63, myeloperoxidase, or elastase expression). This observation was confirmed on cytoplasts, a model of granule-free neutrophils. We hypothesized that PR3 could interact with proteins involved in membrane flip-flop (eg, phospholipid scramblase 1 [PLSCR1]). PR3-PLSCR1 interaction in neutrophils was demonstrated by confocal microscopy and coimmunoprecipitation. In the RBL-2H3 rat mast-cell line stably transfected with PR3 or its inactive mutant (PR3S203A), PR3 externalization depended on PLSCR1, as shown by less PR3 externalization in the presence of rPLSCR1 siRNA, but independently of its serine-proteinase activity. Finally, apoptosis-externalized PR3 decreased the human macrophage-phagocytosis rate of apoptotic PR3 transfectants. Therefore, in addition to ANCA binding in vasculitis, the proinflammatory role of membrane PR3 expression may involve interference with macrophage clearance of apoptotic neutrophils.
The HBS1L-MYB intergenic region on chromosome 6q23.3 influences erythrocyte, platelet, and monocyte counts in humans
Authors: Menzel Stephan , Jiang Jie , Silver Nicholas , Gallagher Joy , Cunningham Juliette , Surdulescu Gabriela , Lathrop Mark , Farrall Martin , Spector Tim D. , Thein Swee Lay
Published: August 2007

Common sequence variants situated between the HBS1L and MYB genes on chromosome 6q23.3 (HMIP) influence the proportion of F cells (erythrocytes that carry measurable amounts of fetal hemoglobin). Since the physiological processes underlying the F-cell variability are thought to be linked to kinetics of erythrocyte maturation and differentiation, we have investigated the influence of the HMIP locus on other hematologic parameters. Here we show a significant impact of HMIP variability on several types of peripheral blood cells: erythrocyte, platelet, and monocyte counts as well as erythrocyte volume and hemoglobin content in healthy individuals of European ancestry. These results support the notion that changes of F-cell abundance can be an indicator of more general shifts in hematopoietic patterns in humans.
Complete DNA sequences of the plastid genomes of two parasitic flowering plant species, Cuscuta reflexa and Cuscuta gronovii
Authors: Funk Helena T , Berg Sabine , Krupinska Karin , Maier Uwe G , Krause Kirsten
Published: August 2007

Background

The holoparasitic plant genus Cuscuta comprises species with photosynthetic capacity and functional chloroplasts as well as achlorophyllous and intermediate forms with restricted photosynthetic activity and degenerated chloroplasts. Previous data indicated significant differences with respect to the plastid genome coding capacity in different Cuscuta species that could correlate with their photosynthetic activity. In order to shed light on the molecular changes accompanying the parasitic lifestyle, we sequenced the plastid chromosomes of the two species Cuscuta reflexa and Cuscuta gronovii. Both species are capable of performing photosynthesis, albeit with varying efficiencies. Together with the plastid genome of Epifagus virginiana, an achlorophyllous parasitic plant whose plastid genome has been sequenced, these species represent a series of progression towards total dependency on the host plant, ranging from reduced levels of photosynthesis in C. reflexa to a restricted photosynthetic activity and degenerated chloroplasts in C. gronovii to an achlorophyllous state in E. virginiana.

Results

The newly sequenced plastid genomes of C. reflexa and C. gronovii reveal that the chromosome structures are generally very similar to that of non-parasitic plants, although a number of species-specific insertions, deletions (indels) and sequence inversions were identified. However, we observed a gradual adaptation of the plastid genome to the different degrees of parasitism. The changes are particularly evident in C. gronovii and include (a) the parallel losses of genes for the subunits of the plastid-encoded RNA polymerase and the corresponding promoters from the plastid genome, (b) the first documented loss of the gene for a putative splicing factor, MatK, from the plastid genome and (c) a significant reduction of RNA editing.

Conclusion

Overall, the comparative genomic analysis of plastid DNA from parasitic plants indicates a bias towards a simplification of the plastid gene expression machinery as a consequence of an increasing dependency on the host plant. A tentative assignment of the successive events in the adaptation of the plastid genomes to parasitism can be inferred from the current data set. This includes (1) a loss of non-coding regions in photosynthetic Cuscuta species that has resulted in a condensation of the plastid genome, (2) the simplification of plastid gene expression in species with largely impaired photosynthetic capacity and (3) the deletion of a significant part of the genetic information, including the information for the photosynthetic apparatus, in non-photosynthetic parasitic plants.
Dentin dysplasia type I: a challenge for treatment with dental implants
Authors: Depprich Rita A , Ommerborn Michelle A , Handschel Jörg GK , Naujoks Christian D , Meyer Ulrich , Kübler Norbert R
Published: August 2007

Background

Dentin dysplasia type I is characterized by a defect of dentin development with clinical normal appearance of the permanent teeth but no or only rudimentary root formation. Early loss of all teeth and concomitant underdevelopment of the jaws are challenging for successful treatment with dental implants.

Methods

A combination of sinus lifting and onlay bone augmentation based on treatment planning using stereolithographic templates was used in a patient with dentin dysplasia type I to rehabilitate the masticatory function.

Results

(i) a predisposition for an increased and accelerated bone resorption was observed in our patient, (ii) bone augmentation was successful using a mixture of allogenic graft material with autogenous bone preventing fast bone resorption, (iii) surgical planning, based on stereolithographic models and surgical templates, facilitated the accurate placement of dental implants.

Conclusion

Bony augmentation and elaborate treatment planning is helpful for oral rehabilitation of patients with dentin dysplasia type I.
Balancing between immunity and tolerance: an interplay between dendritic cells, regulatory T cells, and effector T cells
Authors: Cools Nathalie , Ponsaerts Peter , Van Tendeloo Viggo F I , Berneman Zwi N
Published: August 2007

Dendritic cells (DC), professional antigen-presenting cells of the immune system, exert important functions both in induction of T cell immunity, as well as tolerance. It is well established that the main function of immature DC (iDC) in their in vivo steady-state condition is to maintain peripheral tolerance to self-antigens and that these iDC mature upon encounter of so-called danger signals and subsequently promote T cell immunity. Previously, it was believed that T cell unresponsiveness induced after stimulation with iDC is caused by the absence of inflammatory signals in steady-state in vivo conditions and by the low expression levels of costimulatory molecules on iDC. However, a growing body of evidence now indicates that iDC can also actively maintain peripheral T cell tolerance by the induction and/or stimulation of regulatory T cell populations. Moreover, several reports indicate that traditional DC maturation can no longer be used to distinguish tolerogenic and immunogenic properties of DC. This review will focus on the complementary role of dendritic cells in inducing both tolerance and immunity, and we will discuss the clinical implications for dendritic cell-based therapies.
Enhancement of natural killer (NK) cell cytotoxicity by fever-range thermal stress is dependent on NKG2D function and is associated with plasma membrane NKG2D clustering and increased expression of MICA on target cells
Authors: Ostberg Julie R , Dayanc Baris E , Yuan Min , Oflazoglu Ezogelin , Repasky Elizabeth A
Published: August 2007

Circulating NK cells normally experience temperature gradients as they move about the body, but the onset of inflammation can expose them and their targets to febrile temperatures for several hours. We found that exposure of human peripheral blood NK cells and target cells to fever-range temperatures significantly enhances lysis of Colo205 target cells. A similar effect was not observed when NK cell lines or IL-2-activated peripheral blood NK cells were used as effectors, indicating that thermal sensitivity of effectors is maturation or activation state-dependent. Use of blocking antibodies revealed that this effect is also dependent on the function of the activating receptor NKG2D and its ligand MHC class I-related chain A (MICA). On NK cells, it was observed that thermal exposure does not affect the total level of NKG2D surface expression, but does result in its distinct clustering, identical to that which occurs following IL-2-induced activation. On tumor target cells, a similar, mild temperature elevation results in transcriptional up-regulation of MICA in a manner that correlates with increased sensitivity to cytolysis. Overall, these data reveal that NK cells possess thermally responsive regulatory elements, which facilitate their ability to capitalize on reciprocal, stress-induced changes simultaneously occurring on target cells during inflammation and fever.
Anticlastogenic Effect of Ginkgo Biloba Extract in Graves’ Disease Patients Receiving Radioiodine Therapy
Authors: Dardano A. , Ballardin M. , Ferdeghini M. , Lazzeri E. , Traino C. , Caraccio N. , Mariani G. , Barale R. , Monzani F.
Published: August 2007

Background: Chromosomal damage, as assessed by clastogenic factors (CFs) and micronuclei (MN) appearance, after radioiodine therapy of Graves’ disease has been reported.

Objective and Methods: Our objective was to evaluate the effect of Ginkgo biloba extract (EGb 761) supplementation on the time course (up to 120 d) of CFs and MN appearance in lymphocytes from patients with Graves’ disease after iodine-131 (131I) therapy. Patients were randomly assigned to EGb 761 or placebo, in a blinded manner.

Results: In the placebo group, MN increased early (P < 0.001) after 131I, peaking at the 21st day (P = 0.0003) and declining thereafter. In EGb 761-treated patients, MN increased early (P < 0.05), while returning toward baseline value thereafter. Therefore, mean MN increment was significantly higher in the placebo group as compared with EGb 761-treated patients (P < 0.01). Moreover, an early (P < 0.0001) and sustained (up to 35 d; P < 0.001) MN increase induced by CFs was observed in the placebo group. Conversely, in EGb 761-treated patients, MN increase induced by CFs never reached the statistical significance; therefore, the mean of the MN increments was significantly lower than in placebo (P < 0.05). A significant positive correlation between MN maximum increment and the bone marrow dose was observed in the placebo group only (P = 0.03). No significant difference was observed in clinical outcome between the two groups.

Conclusions: EGb 761 supplementation neutralized genotoxic damage induced by radioiodine treatment, without affecting the clinical outcome. Although 131I therapy is generally safe, our data suggest that Gingko biloba extracts may prevent genetic effects of radioiodine therapy for hyperthyroid Graves’ disease.
Metabolic Effects of Oral Versus Transdermal Estrogen in Growth Hormone-Treated Girls with Turner Syndrome
Authors: Mauras Nelly , Shulman Dorothy , Hsiang Helen Y. , Balagopal Prabhakaran , Welch Susan
Published: August 2007

Background: Transdermal (TD) estrogen is often preferred over the oral route in postmenopausal and GH-deficient women taking estrogen, but this has not been studied in detail in girls.

Objective: Our objective was to study the metabolic effects of oral vs. TD estrogen in GH-treated girls with Turner syndrome.

Design and Methods: Eleven girls with Turner syndrome, mean age 13.4 ± 0.5 (se) yr, on GH for at least 6 months were recruited. Studies included [13C]leucine and d5-glycerol infusions, indirect calorimetry, dual-emission x-ray absorptiometry, and hormone and substrate measurements. They received, in random order, 17β-estradiol orally (0.5, 1, and 2 mg for 2 wk each) and TD (0.025, 0.0375, and 0.05 mg for 2 wk each), and studies were repeated after each 6-wk course with 4 wk washout in between.

Results: Rates of whole-body protein turnover, oxidation and synthesis, lipolysis, lipid and carbohydrate oxidation, and resting energy expenditure were unaffected by either form of estrogen; nor were lipids, insulin, and fibrinogen concentrations affected. Plasma IGF-I concentrations did not change clinically significantly with either form of estrogen, despite higher estrogen concentrations after oral estrogen. Estradiol concentrations did not correlate with any variables measured.

Conclusions: In GH-treated girls with Turner syndrome, neither oral nor TD estrogen adversely affected rates of protein turnover, lipolysis, and lipid oxidation rates or plasma lipids, fibrinogen, or fasting insulin concentrations. There was no clinically significant change in IGF-I concentrations after either form of estrogen. In aggregate, these data suggest that the route of delivery of estrogen does not adversely affect these metabolic effects of GH in young girls with Turner syndrome.
Aurora-A: the maker and breaker of spindle poles
Authors: Barr Alexis R. , Gergely Fanni
Published: August 2007

The gene encoding the Aurora-A protein kinase is located in the 20q13 breast cancer amplicon and is also overexpressed in colorectal, pancreatic and gastric tumours. Although Aurora-A may not be a bona fide oncoprotein in humans, it is a promising drug target in cancer therapy. Thus, it is surprising that so little is known of its role in normal cells. The primary function of Aurora-A is to promote bipolar spindle assembly, but the molecular details of this process remained obscure until recently. The discovery of several novel Aurora-A-binding proteins and substrates has implicated Aurora-A in centrosome maturation and separation, acentrosomal and centrosomal spindle assembly, kinetochore function, cytokinesis and in cell fate determination. Here we discuss recent advances in determining the early mitotic role of Aurora-A, with a strong emphasis on its function at the mitotic spindle poles.
The utility of screening for parasitic infections in HIV-1-infected Africans with eosinophilia in London
Authors: Sarner Liat , Fakoya Ade O , Tawana Cheryl , Allen Elizabeth , Copas Andrew J , Chiodini Peter L , Fenton Kevin A
Published: August 2007

The presence of asymptomatic eosinophilia in HIV patients has been demonstrated to have a wide variety of causes. Untreated parasitic infections in immunocompromised individuals can have potentially serious consequences. The utility of screening for parasitic infections in immigrant HIV-positive Africans with eosinophilia was investigated in a UK-based HIV clinic. HIV-positive African patients with eosinophilia were matched with HIV-positive African controls without eosinophilia. More than half of African HIV patients with eosinophilia had positive parasitic serology, and were significantly more likely to have positive serology compared with African HIV patients without eosinophilia. This study shows that asymptomatic eosinophilia in HIV-1-infected Africans is strongly suggestive of underlying parasitic infection. Individuals with eosinophilia should thus be screened for parasitic infections according to the infections prevalent in the countries they have lived in or visited for substantial periods of time.
UK national audit of sexual health care for people with HIV infection: clinic policies
Authors: McClean Hugo , Carne Chris , Bunting Paul , Wilkins Ed , Tucker Linda , Baguley Steve , Daniels David ,   The National Audit Group of the British Association for Sexual Health and HIV
Published: August 2007

A national audit of the sexual health care for people with HIV infection (PWHIV) was conducted in genitourinary medicine clinics and other clinics providing care for PWHIV in the UK in the summer of 2006. Data were aggregated by region and clinic, allowing practice to be compared between regions, as well as to national averages and against various guidelines. In this, the first of two papers, clinics were surveyed on their local policies. In total, 126 clinics participated. Only 38 clinics (30%, regional range 0–60%) had written local care pathways on management of sexually transmitted infection in PWHIV, while 73 (58, 20–100%) had unwritten policies. This compares with the national standard that 100% of service providers should be able to provide documentation of local care pathways for sexually transmitted diseases in people with HIV. Clinics should consider creating policies especially where standards are not being met.
The features of patients attending walk-in compared with booked clinics for sexually transmitted infections
Authors: Manavi K
Published: August 2007

Few data are available on the comparison of access of patients at risk of sexually transmitted infections (STIs) to different models of genitourinary (GU) medicine services. The aim of this study was to compare the characteristics and STIs results of patients attending walk-in clinics with those of patients attending booked-in clinics in a department of GU medicine. The study was carried out at the Department of GUM at Walsall Manor Hospital. This was a prospective study on consecutive new patients attending first come first served walk-in and booked clinics between 1 January and 1 April 2006. Patients' demography, sexual behaviour and results of screening for STIs were recorded. During the study period, 346 and 234 patients attended walk-in and booked clinics, respectively. Default rate for booked clinics was 27%. Significantly higher proportions of patients attending walk-in clinics were screened for an STI. All patients with HIV ( n = 2) or with trichomonal ( n = 4) infections attended walk-in clinics. In regression analysis, patients with genitourinary symptoms were more likely to attend walk-in clinics (odds ratio [OR]: 2.371; [95% confidence interval [CI]: 1.545–3.639; P = 0.0005). There was no difference between the prevalence of STIs among patients attending either service model. In conclusion, there was no significant difference between the proportion of patients with or at-risk of STIs who attended booked and walk-in clinics.
Chronic genital herpes and disclosure…. The influence of stigma
Authors: Bickford J , Barton S E , Mandalia S
Published: August 2007

The objectives of this study were to assess the nature and effect of stigma on disclosure of diagnosis to sexual partners among those with problematic disease. Data from questionnaires and semistructured interviews were collected and analysed. Data regarding anxiety were also collected using a validated tool. Ethical approval was received from the Chelsea and Westminster Healthcare National Health Service (NHS) Trust. Disclosure of diagnosis tended to occur in the context of established relationships. Herpes-related stigma was associated with non-disclosure of diagnosis to sexual partners. The point prevalence of moderate to severe anxiety in this sample was 32%. The use of suppressive medication did not affect anxiety scores. In conclusion, the reaction to a diagnosis of genital herpes is influenced by a socially constructed understanding and the decision to disclose or not is influenced by this. Stigma is a barrier to disclosure of genital herpes diagnosis. Management strategies aimed at encouraging disclosure to partners must address perceived stigma.
State of the (positive) nation: findings from the fourth national Australian HIV futures survey
Authors: Grierson J W , Pitts M K , Thorpe R D
Published: August 2007

This paper characterises the health and wellbeing of people living with HIV/AIDS (PLWHA) in Australia. The HIV Futures 4 Survey is a self-complete anonymous questionnaire distributed through multiple sites. Data were collected on health, clinical and social variables. There were 1059 responses, approximately 8% of the estimated HIV-positive population. Respondents were aged between 18 and 92 years and 77% were homosexual men. In total, 60% reported a viral load of <500 copies/mL and 83% a CD4 count of over 250 cells/ μL. A total of 44% reported another major health condition and 35% a mental health condition. A total of 71% were using antiretroviral therapy. More than half of the respondents had stopped working because of HIV and 25% were living in poverty. In conclusion, adequate planning for the future of our response to HIV/AIDS relies in no small part on our access to detailed information about how the epidemic affects those with the virus.
The incidence of sexually related conditions in asymptomatic versus symptomatic patients
Authors: Markos A R
Published: August 2007

We studied, retrospectively, 400 consecutive case-notes (200 for each sex) for patients who presented with or without complaints of urethral or vaginal discharge. The incidence of sexually related conditions was identified for each of the four patients subgroups to objectively inform the process of triage. In all, 60% of asymptomatic female and 40% of asymptomatic male patients in the study had a condition of genitourinary (GU) medicine significance. Two-thirds of female patients had a condition of GU medicine significance whether they were symptomatic or asymptomatic. Some 16% of asymptomatic males would have had a delay in treatment of chlamydia, with a 19% loss of identifying non-specific urethritis, if they were triaged on the basis of lack of symptoms, and microscopy tests were abandoned for this group of patients.
Does partner notification of men with asymptomatic non-gonococcal non-chlamydial urethritis identify chlamydia-positive women?
Authors: McCathie R P , Carlin E M
Published: August 2007

The objective of this study was to identify the proportion of female contacts of men diagnosed with non-gonococcal non-chlamydial urethritis (NGNCU) who had chlamydial infection, muco-purulent cervicitis (MPC), pelvic inflammatory disease (PID) or other genital infections, and to determine whether chlamydial rates are higher in women who are contacts of men with NGNCU. A retrospective case-note review of men with NGNCU and their traced female contacts was performed. Seventy-five men were included in the study, of whom 75% were caucasian and 49% were asymptomatic. Twenty-four women were successfully traced equating to 0.32 contacts per index man. In total, 46% of the women were contacts of asymptomatic men. Overall, 26% of women were identified with chlamydial infection, increasing to 36% in the contacts of asymptomatic men. The diagnosis and partner notification of men with asymptomatic NGNCU does identify female contacts with high chlamydial infection rates. However, such targeting is resource-intensive and invasive urethral screening may deter asymptomatic men from attending. It is likely that the needs of the whole health community will be better served by screening a greater number of men and operating an active partner notification system.
Prevalence of sexual difficulties among female sex workers and clients attending a sexual health service
Authors: Munasinghe Thiloma , Hayes Richard D , Hocking Jane , Verry Jocelyn , Fairley Christopher K
Published: August 2007

The objective of this study was to determine the proportion of sex workers and non-sex workers with sexual difficulties. Consenting female sex workers (93) and non-sex worker clients (178) attending the Melbourne Sexual Health self-answered an anonymous questionnaire about demographic characteristics, sexual behaviour, prevalence of sexual difficulties with private partners, distress regarding one's sex life, and physical pleasure, emotional satisfaction with sex and overall satisfaction with life. The demographic characteristics, sexual behaviours, prevalence of painful sex (34% versus 42%), orgasmic difficulty (43% versus 40%), vaginal dryness (45% versus 36%) and performance anxiety (28% versus 37%), physical pleasure and emotional satisfaction with sex and overall life satisfaction among sex workers was similar to that of non-sex workers, respectively. Sex workers were more likely to experience sexual disinterest (odds ratio 1.9, (95% confidence interval 1.1, 3.2) and less likely to report being distressed about their sex life ( P = 0.04). The prevalence of sexual difficulties, other than desire was similar to those of non-sex workers. These findings may be relevant only to sex workers operating in a highly regulated sex industry.
The Indian Ocean paradox revisited: HIV and sexually transmitted infections in the Comoros
Authors: Dada Yasmina , Milord François , Frost Eric , Manshande Jean-Pierre , Kamuragiye Aloys , Youssouf Jean , Khelifa Mejdi , Pépin Jacques
Published: August 2007

The combination of high sexually transmitted infection (STI) prevalence and low HIV prevalence has been described as the Indian Ocean paradox. To investigate current epidemiology of HIV and STI in the Comoros, we conducted cross-sectional surveys of a representative sample of the adult population, and convenience samples of female sex workers and male STI patients. Only one (0.025%) of 3990 community participants was HIV-infected, while 142 (3.6%) had treponemal antibodies. Treponemal antibodies were not associated with past genital ulcers, number of sexual partners or adverse outcomes of pregnancies; their prevalence did not increase with age and there was no concordance within couples. Thus, most individuals with treponemal antibodies were probably infected during childhood with a non-venereal treponematosis. Only 1/70 (1.4%) and 0/83 sex workers sampled in 2004 and 2005 were HIV-infected. The Comoros have been protected by their insular status, male circumcision and paucity of syphilis. HIV control should focus on sex workers.
Papulonecrotic tuberculid in an HIV-positive patient
Authors: Akhras Victoria , McCarthy Gill
Published: August 2007

We present a 33-year-old HIV-positive man who presented with a two-year history of a non-itchy papular eruption, associated with night sweats, headaches, poor memory and weight loss. On examination, he had erythematous papular lesions with necrotic centres on the face, arms and torso with no systemic abnormalities. A skin biopsy eventually led to the diagnosis of papulonecrotic tuberculid, and treatment with quadruple therapy resulted in resolution of his rash and systemic symptoms. Papulonecrotic tuberculid is thought to be a immunological response to Mycobacterium bacillus components in a previously sensitized patient following haematogenous spread from a focus of infection elsewhere. Cultures from the skin are typically negative and there are no acid-fast bacilli seen, but mycobacterial DNA can be detected using polymerase chain reaction. This case is an example of the paradoxical activation of the immune system seen in patients with HIV. It highlights the importance of skin biopsy in patients with unexplained systemic symptoms and a rash, as the differential diagnosis can be wide in HIV.
The price of life: law, policy and ethics in wrongful existence claims
Authors: Troke Ben
Published: August 2007

Autonomy and the sanctity of life are key ethical principles in many medicolegal dilemmas, and the tension between them is particularly evident where damages are claimed for negligence leading to the birth of a child. Although often the judiciary have been reluctant to ascribe their decisions in this field explicitly to ethical or policy considerations, this is rather disingenuous. Other jurisdictions, dealing with the same issues, have come to varying conclusions, but almost always expressly based on policy or ethical grounds. Using a detailed review of the development of case law on 'wrongful existence' claims, this paper discusses the underlying issues of judicial policy making and the ethical conflict between the sanctity of life and autonomy, and considers the implications for the future. It examines the increasing prominence of policy considerations in our jurisprudence more generally, often dressed as 'distributive justice', and the apparent trend toward preference for autonomy over more traditional views of the sanctity of life in recent years. A second article will describe the development of case law on 'wrongful existence' in some detail and will look briefly at the solutions in other jurisdictions. The third article will pick out the key elements of the leading authority (McFarlane, 1999), and ask whether any predictions can be made in this specific field or more widely.
The price of life: wrongful existence case law and international comparisons
Authors: Troke Ben
Published: August 2007

This is the second of a three-part review of the development of case law on 'wrongful existence' claims. A previous article examined the increasing prominence of policy considerations in our jurisprudence more generally, often dressed as 'distributive justice', and considered the apparent trend toward preference for autonomy over more traditional views of the sanctity of life in recent years. This second article will describe the development of case law on 'wrongful existence' in some detail and will look briefly at the solutions in other jurisdictions. A third article will pick out the key elements of the leading authority (McFarlane, 1999), and ask whether any predictions can be made in this specific field or more widely.
Who do I sue? Liability for the treatment of NHS patients by outside providers
Authors: Grace John
Published: August 2007

The following paper was presented by John Grace QC at the AVMA conference in Glasgow on 29 June 2007. Many practitioners have expressed concern at the difficulties they have encountered in locating the correct Defendant when their client has received NHS treatment in a private hospital or a foreign country or when treated by overseas medical teams flown in. This article examines the different situations which may arise and considers a practical solution to claims which arise in England where the CNST (Clinical Negligence Scheme for Trusts) apply. It should be noted that the CNST does not apply in Wales or Scotland.
From object to subject: including marginalised citizens in policy making
Authors: Lister Ruth
Published: August 2007

English

The article begins with an account of the values that might underpin an inclusive model of citizenship. It then discusses such a model in terms of participation in policy making. It does so with particular reference to two groups who are the named objects of policy making but who are marginalised in the policy-making process: people living in poverty and children. These examples are also used to draw out some general lessons and themes. The article concludes by linking the discussion to the idea of social justice understood as embodying relations of recognition as well as distribution.
Sensitivity of Patient Outcomes to Pharmacist Interventions. Part I: Systematic Review and Meta-Analysis in Diabetes Management
Authors: Machado Márcio , Bajcar Jana , Guzzo Giovanni C , Einarson Thomas R
Published: August 2007

Background:

Pharmacists participate in managing diabetes therapy. Despite many reviews, few have quantified the impact of pharmacists' interventions.

Objectives:

TO identity outcomes sensitive to pharmacists' interventions and quantify their impact through critical literature review.

Methods:

All original research describing the impact of pharmacists' interventions in the management of diabetic pharmacotherapy was sought in International Pharmaceutical Abstracts, MEDLINE, Embase, Cochrane Register, and Cumulative Index to Nursing & Allied Health Literature from inception through 2006. Two independent reviewers identified articles, compared results, and settled differences through consensus. The Downs-Black scale was used to assess quality. Data included intervention type, patient numbers, demographics, study characteristics, instruments used, data compared, and outcomes reported. A random-effects meta-analysis combined amenable results.

Results:

Of 302 articles identified, 108 involved pharmacists' interventions; 36 addressed diabetes (14 medical clinics, 11 community pharmacies, 7 ambulatory care clinics, 4 hospital wards, 1 physician's office, 1 prison, and 3 in both medical clinics and community pharmacies; 1 did not describe its practice site). Research designs included randomized (n = 18) and nonrandomized (n = 9) controlled trials, pre- and postobservational cohorts (n = 2), retrospective cohort study (n = 1), chart reviews (n = 5), and database study (n = 1). Diabetes education (69%) and medication management (61%) were the most frequently used Interventions. Mean ± SD quality was 62 ± 11% (fair). Fifty-one (69%) study results were sensitive, Meta-analysis of data from 2247 patients in 16 studies found a significant reduction in hemoglobin A1C (A1C) levels in the pharmacists' intervention group (1.00 ± 0.28%; p < 0.001) but not in controls (0.28 ± 0.29%; p = 0.335). Pharmacists' interventions further reduced A1C values 0.62 ± 0.29% (p = 0.03) over controls.

Conclusions:

A1C is sensitive to pharmacists' interventions. Several potentially sensitive outcomes were identified, but too few studies were available for quantitative summaries. More research is needed.
Preprocedural Statin Therapy in Percutaneous Coronary Intervention
Authors: Cahoon William D , Crouch Michael A
Published: August 2007

Objective:

To review the published literature regarding the effectiveness or preprocedural statin therapy for the prevention of cardiac events after percutaneous coronary intervention (PCI).

Data Sources:

Searches of MEDLINE (1966–May 2007) and Cochrane Database (1993–May 2007) were conducted using the search terms statins, HMG-CoA reductase inhibitors, percutaneous coronary intervention, and myocardial necrosis. Limits included articles written in English with human subjects. Additional data were identified through bibliographic reviews.

Study Selection and Data Extraction:

All English-language articles identified from the data sources were evaluated. Trials and studies were eligible for Inclusion if they evaluated the effectiveness of preprocedural statin therapy for the prevention of cardiac events after PCI.

Data Synthesis:

Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) provide benefits relative to morbidity and mortality as primary and secondary prevention of cardiovascular events. In addition to lowering concentrations of low-density lipoprotein cholesterol, statins have documented pleiotropic effects including plaque stabilization as well as reductions in inflammation, platelet activation/adhesion, thrombosis, and oxidative stress. One retrospective analysis, 4 prospective observational studies, and 3 randomized controlled trials evaluating preprocedural statin therapy for the prevention of cardiac events after PCI were reviewed. Included studies were limited by small sample sizes (N = 153–5052), short durations of follow-up (24 h-21 mo), use of surrogate markers of myocardial necrosis, various degrees of coronary disease and procedure-specific factors, and lack of consistent choice of agent, dose, and duration of statin therapy. Despite these limitations, the data suggest reduced post-PCI myocardial necrosis with preprocedural statin therapy when given before elective PCI in stable patients, as well as when given before PCI in patients with recent acute coronary syndrome.

Conclusions:

There is growing evidence that preprocedural statin therapy reduces the incidence of post-PCI myocardial necrosis. The appropriate regimen (drug, dose, duration of treatment before the procedure), as well as the predictive role of concomitant disease states (eg, hyperiipidemia), requires further Investigation.