bluuebunny/crossref_metadata_2025 huggingface dataset:
Crohn's disease affects diet and growth in children
Authors: Laiho  , Nuutinen  , Malin  , Isolauri
Published: March 2003

Background: Thirteen (eight girls, five boys) patients, aged 9.8–15.4 years, and 13 controls matched for age and sex were studied to identify foods that might aggravate the symptoms of children with Crohn's disease, to examine the adequacy of nutrient intake and to assess nutritional status.

Methods: The link between symptoms and food intake was determined by 48‐h dietary recall on two separate occasions and by a dietary questionnaire. Nutritional status was assessed using growth charts and biochemical values.

Results: Patients with Crohn's disease identified several foods that aggravate symptoms. The intakes of bread, cereals and fat were greater in patients than in controls. The mean relative (% energy) intake of protein was lower, but the mean absolute intake of carbohydrates was higher in patients than in controls. The intakes of vitamin D, calcium, iron and zinc by the patients were below the respective recommended dietary allowances (RDAs). Nutritional status was good in the majority of the patients. However, the mean height‐for‐age was lower in the patients than in the controls, and 38% of the patients had serum albumin concentrations below the reference value.

Conclusions: Symptoms and foods that aggravate symptoms may restrict diet and thus decrease nutrient intake. The diet of children with Crohn's disease may contain insufficient amounts of nutrients. In some children, Crohn's disease markedly retards growth. These results substantiate the need for coordinated dietetic follow‐up.
Evidence of nutrient dilution with high sugar intakes in older South Africans
Authors: Charlton  , Wolmarans  , Lombard
Published: March 2003

Aims: To investigate the association between added sugar intake and (i) micronutrient intake, (ii) energy profiles and (iii) body mass index (BMI) of a sample of older South Africans.

Methods: A sample of 200 free‐living South Africans of mixed ancestry, aged 65 years and older and resident in Cape Town, was randomly drawn using a two‐stage cluster design. Dietary intake was assessed using an interviewer‐administered quantified food frequency questionnaire.

Statistical analyses: Spearman correlation coefficients were used to investigate the associations between (i) sugar intake and (ii) total energy intake, and macro‐ and micronutrient intakes and BMI. Differences between the subgroups according to either tertiles of sugar or total energy intake were tested for significance at the
P=0.05 level using analysis of variance (ANOVA ). Age was controlled for in the ANOVA models, according to two groups: 65–74 years and >75 years.

Results: For both men and women, the proportion of energy provided by sugars did not differ across the tertiles of energy intake, suggesting that subjects with the highest energy intakes consumed greater quantities of all foods, rather than selecting foods high in sugar. An inverse association was found between the proportion of total energy provided by sugar and (i) the proportion of food energy provided by fat (
r=−0.53; P< 0.0001) and (ii) dietary fibre intake per 4.18 MJ/day (
r=−0.48; P<0.0001). In men the intake of thiamin, vitamin E, iron, zinc, copper and magnesium per 4.18 MJ significantly decreased (
P<0.05) as sugar intake as a percentage of total energy intake (%E) rose. In women, micronutrient intake expressed per 4.18 MJ showed a significant negative trend with sugar intakes as %E for all of the micronutrients investigated, except for vitamins D and E. Body mass index tended to decrease as sugar intake rose, but this difference did not reach significance.

Conclusion: The findings of this study did not demonstrate an association between sugar intake and obesity in older South Africans. However, a nutrient‐diluting effect of sugar intake on both micronutrient and fibre intake was observed and needs to be addressed in nutrition intervention strategies for this age group.
Efficacy of an assessment instrument to measure affective and cognitive learning domains of students enrolled in food or nutrition courses
Authors: Silagyi‐Rebovich J. , Brooks G. , Peterson E.
Published: March 2003

The purpose of the project was to evaluate the feasibility of using a public domain instrument, the Motivated Strategies for Learning Questionnaire (MSLQ), to assess affective and cognitive learning domains among volunteer students (n=44) enrolled in food and nutrition courses. Using SAS and alpha 0.01, significant Pearson's Product Moment Correlation Coefficients were calculated between the MSLQ scale, intrinsic motivation, and the following MSLQ scales: task value (r=0.55), metacognition (r=0.5) and time management (r=0.54). Correlations between task value and metacognition, students’ effort, rehearsal or elaboration learning strategies were r=0.48, 0.51, 0.55 and 0.58, respectively. Correlations between students’ effort and time management, metacognition and sense of self‐efficacy were r=0.71, 0.73 and 0.48, respectively. Significant inverse correlations were identified between students’ fear of tests and their sense of self‐efficacy (r=−0.50) or the effort expended to master learning (r=−0.40). Multiple regression analysis revealed that a three predictor variable model including metacognition, peer help and seeking help from the instructor explained 51.6% of the variance in scores of the first course exam (F =14.22, P=0.0001). Educators need to consider how cognitive and affective differences in learning processes influence curricular and instructional decisions in human nutrition and dietetics.
Reliability of a qualitative screening tool versus physical measurements in identifying undernutrition in an elderly population
Authors: Pattison R. , Corr J. , Ogilvie M. , Farquhar D. , Sutherland D. , Davidson H. I. M. , Richardson R. A.
Published: March 2003

Background: This study aimed to assess the validity of a qualitative score derived from a nutritional screening tool when used by a dietitian or nurse against physical markers of nutritional status.

Methods: A screening tool designed for elderly patients in use at St John's Hospital was evaluated. Using this, scores derived by dietitian and nurse were compared with physical measurements used in nutritional assessment. The agreement between scores in each of the five categories of the tool (clinical condition, body weight, dietary intake, ability to eat and mental condition) was determined.

Results: Sixty‐six subjects (19 male, 47 female, mean age 78.5 years) were recruited. Undernutrition was found in 23% (n=15) of the patient population (≤80% of reference values for one or more physical measurements of nutritional status). A significant correlation between the qualitative score derived by the dietitian using the screening tool and physical markers of nutritional status was evident (body weight expressed as ideal body weight r=0.36, P< 0.005 and arm muscle circumference r=0.53, P< 0.001). Using the screening tool 85% of the under‐nourished patients were correctly classified as nutritionally ‘at risk’ by the dietitian; however, only 58% were correctly identified by the nurse. There was no agreement between scores from the dietitian and nurse in any of the five scoring categories.

Conclusion: These results show that the nurse failed to identify over 40% of at‐risk patients when using the screening tool. The lack of agreement between dietitian and nurse within each scoring category may suggest fundamental differences in assessing factors contributing to nutritional risk by these two professions.
Impact of stepped verbal and written reinforcement of fluid balance advice within an outpatient haemodialysis unit: a pilot study
Authors: Casey J. , Johnson V. , McClelland P.
Published: March 2003

Background

The present pilot study assesses a programme of verbal and written fluid balance advice within an out‐patient haemodialysis unit.

Methods

Twenty‐one haemodialysis patients were followed over three separate 6‐week periods. Each 6‐week period assessed dietetic and nursing educational input using a stepped approach with interdialytic weight gain (IDWG) as a barometer of patient compliance. Weight gain was statistically examined using the non‐parametric Friedman test.

Results

Forty‐eight per cent of the sample group demonstrated an overall improvement in mean weight gain; however, this was not statistically significant (P=0.504).

Conclusion

The pilot study suggests that further studies with greater numbers and a control group would have a useful contribution to make in this field.
A community survey of children with severe intellectual disability and their families: psychological adjustment, carer distress and the effect of respite care
Authors: Hoare P. , Harris M. , Jackson P. , Kerley S.
Published: March 2003

The present paper describes a cross‐sectional study of the psychosocial adjustment of 143 children with severe disability and their families identified from a regional case register for children with special needs. Thirty‐eight per cent of the children had significant psychiatric morbidity. By contrast, the overall level of distress in carers was not that different from probable community prevalence figures. Nevertheless, distress among carers was consistently associated with increased disability in the child. Although respite care is a valuable resource for many carers, its use is indicative of underlying distress in the carer.
Health screening for people with Down's syndrome
Authors: Piachaud J. , Rohde J. , Pasupathy A.
Published: March 2003

All adults over the age of 18 years with Down's syndrome living in a borough of London, England, were identified through a case register. A questionnaire seeking information on health status and screening was sent to their carers. The reply rate was 70%. The attendance for general health care is reasonable, but there are some gaps in screening. The implications for primary health care and health promotion are discussed.
Stress and coping in families of children with Smith‐Magenis syndrome
Authors: Hodapp R. M. , Fidler D. J. , Smith A. C. M.
Published: March 2003

To describe stress and coping in families of children with Smith‐Magenis syndrome, the present authors interviewed and received questionnaires from families of 36 children with this disorder. For measures of total stress, and of parent and family problems, the best predictors were the family's number of friends and the child's degree of impairment on the Vineland socialization domain; the single best predictor of parental pessimism was the child's degree of maladaptive behaviour. Although the stress levels of the families of children with Smith‐Magenis syndrome are comparable to the levels shown by the families of children with Prader‐Willi and 5p‐ syndromes, these levels are much higher than the stress levels reported by families of children with mixed or non‐specific developmental disabilities. Stress levels may be similar across aetiologies involving high levels of maladaptive behaviour, but the correlates of family stress—particularly the moderating role of family friends—seem specific to Smith‐Magenis syndrome.
Direct service staff and their perceptions of psychotropic medication in non‐institutional settings for people with intellectual disability
Authors: Christian L. , Snycerski S. M. , Singh N. N. , Poling A.
Published: March 2003

Previous studies have surveyed a variety of service providers in school and institutional settings, and reported a pervasive lack of education and training with regard to the use of psychotropic medication in people with intellectual disability. Because an increasing number of people with intellectual disability are living in the community and since many of these people receive psychotropic medications, the present study extended research in this area by surveying direct service staff to determine their perceptions, knowledge and opinions with regard to the use of psychotropic medication in non‐institutional settings for individuals with developmental disabilities. Consistent with the findings of previous studies, a majority of the 334 respondents in the present study reported that they had not received adequate training in the area of drug treatment. The knowledge and skills deficits of direct service staff appear to represent a significant barrier to the appropriate monitoring and management of pharmacotherapy for individuals with intellectual disability. Therefore, a systematic training programme to educate direct service staff about psychotropic medication needs to be designed, implemented and disseminated on a broad scale.
Difficulty in writing Japanese semantic characters in a 9‐year‐old boy with Williams syndrome
Authors: Nakamura M. , Hara K. , Watamaki T. , Nishimura B. , Kumagai T. , Matsumoto A. , Miura K. , Yamanaka T. , Hayakawa C. , Miyazaki S.
Published: March 2003

A 9‐year‐old boy diagnosed as having Williams syndrome was evaluated using psychological test batteries in order to clarify his ability in language and visual cognition. The subject had difficulty in writing some of the Japanese semantic characters (called Kanji) which he could otherwise read and understand. Although he could write the small components of which the Kanji characters were composed, he could not locate these correctly. This phenomenon is considered to be very similar to the difficulty in copying a figure observed clinically. The Kaufmann Assessment Batteries for Children clearly revealed that the boy had difficulty with the sub‐test of spatial memory compared to his average score for simultaneous processing. This result is considered to be closely related to the difficulty in copying figures or writing Kanji characters. On the Illinois Test of Psycholinguistic Abilities, the present authors found that the subject’s vocabulary was relatively good, although semantic and pragmatic problems remained. Clarifying the strong and weak points of the abilities of such patients will help to determine the most appropriate mode of education for them.
The relationship between the effect of setting a goal on standing broad jump performance and behaviour regulation ability in children with intellectual disability
Authors: Kokubun M.
Published: March 2003

The objectives of the present study were to investigate the differences in standing broad jump performance between two task conditions (with and without goal) and to clarify the relation of verbal behaviour regulation to this difference in children with intellectual disability. The subjects were 30 children with intellectual disability with an average age of 16.2 years. In the without‐goal condition, subjects were instructed to jump as far as possible. In the with‐goal condition, on the other hand, subjects were given a goal set 20 cm away from the distance of the first trial in the without‐goal condition and instructed to jump for the goal. Verbal behaviour regulation ability was measured by three tasks on Garfield's motor impersistence test: keeping eyes closed, protruding tongue with eyes open and keeping mouth open. The mean performance of the with‐goal condition was 108 cm, while that of the without‐goal condition was 102 cm. The difference between these results was significant, thus indicating the effectiveness of setting a goal to improve jumping performance. Among three independent variables (chronological age, IQ and behaviour regulation score), only the behaviour regulation score was found to be significantly related to the condition difference. It was more effective to demonstrate the goal when the behaviour regulation abilities of the children were lower, but giving the children a goal was not effective for subjects with Down's syndrome. Children with Down's syndrome were considered to have a deficiency in the motor ability itself, not in the system for expressing the motor ability.
Changes in skills for people with intellectual disability: a follow‐up of the Camberwell Cohort
Authors: Beadle‐Brown J. , Murphy G. , Wing L. , Gould J. , Shah A. , Holmes N.
Published: March 2003

The skills of a total population of children with severe intellectual disability and/or autism from Camberwell, South London, UK, and the initial follow‐up data, taken when the subjects were adolescents and young adults ( Shah 1986), are described in the present study. Changes in skills over time are presented within the categories of communication, self‐care, and educational and cognitive skills, as assessed by the Handicaps, Behaviours and Skills schedule. The results indicated that skills had improved in many areas between times 1 and 2, but that this improvement was more noticeable for the children who had been youngest at time 1. The implications of these results and predictions for a further follow‐up study are discussed.
Predictors of admission to a high‐security hospital of people with intellectual disability with and without schizophrenia
Authors: Doody G. A. , Thomson L. D. G. , Miller P. , Johnstone E. C.
Published: March 2003

Admission to secure hospital facilities is a rare outcome for people with intellectual disability with or without concomitant psychosis. The present study compares people with mild intellectual disability with and without schizophrenia resident in the Scottish and Northern Irish State Hospital, Carstairs, to matched mild intellectual disability controls, also with and without schizophrenia, in the community. It is hoped that this study may identify socio‐demographic, clinical or historical predictors which may lead to admission to secure hospital facilities for people with mild intellectual disability. One hundred and eight subjects were identified from two previous studies which concerned State Hospital patients and patients with intellectual disability with and without schizophrenia. Four experimental groups were derived: (1) 14 individuals with comorbid intellectual disability and schizophrenia who had been resident in the State Hospital; (2) 34 comorbid community control subjects; (3) 33 individuals with intellectual disability and no psychosis who had been resident in the State Hospital; and (4) 27 community control subjects with mild intellectual disability. The four groups were compared on a range of socio‐demographic, historical and clinical variables obtained from case records and subject interviews. Relative to community controls, people with intellectual disability and no psychosis in the State Hospital are likely to be single, to have a later age of first psychiatric hospital admission, and to have a history of previous suicide attempts, alcohol abuse or drug misuse. Subjects with comorbid intellectual disability and schizophrenia in the State Hospital are more likely to be male, to have an early age of first psychiatric admission, and to have no family history of either schizophrenia or intellectual disability. Strategies aimed at addressing suicidal behaviour, alcohol and drug misuse amongst people with intellectual disability may facilitate a reduction in the number of admissions to high‐security hospitals in the UK. In people with comorbid intellectual disability and schizophrenia, males with an early age of onset and no known family history are more likely to require care and treatment in a secure psychiatric setting. Such comorbid subjects may be suffering from a particular malignant form of schizophrenia, manifesting in childhood as cognitive impairment prior to the early onset of psychosis in teenage years.
Beyond ethical individualism
Authors: Clegg J.
Published: March 2003

Contemporary ethical debate about clinical practice centres primarily on the individual resolution of dilemmas, an approach which is incompatible with the social constructionist focus on human interdependence. Many constructionists argue that virtue ethics (VE) offers a more useful perspective on ethics than either consequentialism or deontology. From this perspective, the purpose of ethics is not to specify the right act in a particular situation, but to understand ethical and unethical practices conceptually, i.e. how these are learned, and how these contribute to and develop the ethical life in an ethical environment. Criticisms of VE are considered alongside discussion of its implications for clinical practice with people who have intellectual disability.
Working memory and everyday cognition in adults with Down's syndrome
Authors: Numminen H. , Service E. , Ahonen T. , Ruoppila I.
Published: March 2003

A number of previous studies have suggested that young people with Down's syndrome (DS) have a specific deficit of the phonological loop component of the working memory. However, there have also been studies which have proposed a specific deficit of the central executive component of working memory and suggested similarities of working memory functioning with patients with Alzheimer's disease. Fifteen middle‐aged people with DS were matched for their individual scores of non‐verbal intelligence to 15 individuals with mixed aetiology of intellectual disability. A versatile range of tasks was used in order to evaluate the functioning of working memory components. In addition, several everyday cognition skills were assessed. The subjects with DS performed significantly more poorly in all tasks assessing the phonological loop. Performance in other working memory tasks and compound variables representing different working memory components was equal in the groups. In addition, both groups had equal everyday cognition skills. The functioning of the phonological loop seems to be clearly deficient in people with DS. Interestingly, the deficit does not seem to affect the vocabulary or other everyday cognition skills in individuals with DS. No signs of specific deficit of the central executive component of working memory were found.
Behavioural knowledge, causal beliefs and self‐efficacy as predictors of special educators’ emotional reactions to challenging behaviours
Authors: Hastings R. P. , Brown T.
Published: March 2003

Background Theoretical models and emerging empirical data suggest that the emotional reactions of staff to challenging behaviours may affect their responses to challenging behaviours and their psychological well‐being. However, there have been few studies focusing on factors related to staff emotional reactions.

Methods Seventy staff working in educational environments with children with intellectual disability and/or autism completed a self‐report questionnaire that measured demographic factors, behavioural causal beliefs, behavioural knowledge, perceived self‐efficacy, and emotional reactions to challenging behaviours.

Results Regression analyses revealed that behavioural causal beliefs were a positive predictor, and self‐efficacy and behavioural knowledge were negative predictors of negative emotional reactions to challenging behaviours. Staff with formal qualifications also reported more negative emotional reactions. No other demographic factors emerged as significant predictors.

Conclusions The results suggest that behavioural causal beliefs, low self‐efficacy and low behavioural knowledge may make staff vulnerable to experiencing negative emotional reactions to challenging behaviours. Researchers and clinicians need to address these issues in staff who work with people with challenging behaviours.
Understanding challenging behaviour in people with severe and profound intellectual disability: a stress‐attachment model
Authors: Janssen C. G. C. , Schuengel C. , Stolk J.
Published: March 2003

Background

Advances in our knowledge of attachment, stress and coping may foster new explanations for the development of challenging behaviour in people with intellectual disability (ID).

Method Research on stress and coping among people with ID was reviewed initially, and then studies on the security of the attachment relationships of people with ID with their caregivers were analysed.

Results

There is evidence that people with ID are more vulnerable to stress and use less effective coping strategies. Furthermore, the body of studies on attachment indicates that people with ID are at risk for developing insecure, especially disorganized attachment. There is evidence from other populations that the combination of stress, and insecure or disorganized attachment may put people at risk for developing behaviour problems.

Conclusion

A stress‐attachment model of the development of challenging behaviour among people with ID shows promise as an explanatory framework. The uncovering of these developmental mechanisms may be particularly useful for the prevention of behavioural problems.
Word‐length effect in verbal short‐term memory in individuals with Down's syndrome
Authors: Kanno K. , Ikeda Y.
Published: March 2003

Background Many studies have indicated that individuals with Down's syndrome (DS) show a specific deficit in short‐term memory for verbal information. The aim of the present study was to investigate the influence of the length of words on verbal short‐term memory in individuals with DS.

Methods Twenty‐eight children with DS and 10 control participants matched for memory span were tested on verbal serial recall and speech rate, which are thought to involve rehearsal and output speed.

Results Although a significant word‐length effect was observed in both groups for the recall of a larger number of items with a shorter spoken duration than for those with a longer spoken duration, the number of correct recalls in the group with DS was reduced compared to the control subjects. The results demonstrating poor short‐term memory in children with DS were irrelevant to speech rate. In addition, the proportion of repetition‐gained errors in serial recall was higher in children with DS than in control subjects.

Conclusions The present findings suggest that poor access to long‐term lexical knowledge, rather than overt articulation speed, constrains verbal short‐term memory functions in individuals with DS.
Evaluation of communicative and functional abilities in Wolf–Hirshhorn syndrome
Authors: Sabbadini M. , Bombardi P. , Carlesimo G. A. , Rosato V. , Pierro M. M.
Published: March 2003

Background

Wolf–Hirschhorn syndrome (WHS) is a genetic condition characterized by many clinical disorders, learning difficulties, dysphagia, neuromotor deficits and communicative deficits. Up until now, no studies in the literature have described the development of communicative and functional abilities in subjects with WHS.

Method

In the present study of 11 patients with WHS, a descriptive analysis was made of several abilities and three groups of patients were identified on the basis of the severity of their functional deficit.

Results

A non‐homogeneous picture of impairment emerged in various areas of development. Overall, the neuromotor abilities of these patients were more adequate than their abilities related to autonomy in personal life, alimentary function, and cognitive and communicative‐linguistic aspects.

Conclusion

Based on the identification of specific patterns of communicative and functional impairment in subjects with WHS, rehabilitative intervention strategies can be planned to increase their communicative opportunities, and possibilities for active and autonomous participation in various life contexts (e.g. home, school and the social environment).
Parotid salivary immunoglobulins, recurrent respiratory tract infections and gingival health in institutionalized and non‐institutionalized subjects with Down's syndrome
Authors: Chaushu S. , Yefe Nof E. , Becker A. , Shapira J. , Chaushu G.
Published: March 2003

Background The purpose of the present study was to evaluate the possible correlation between recurrent respiratory infections (RRIs), gingival health and the secretion rates of salivary immunoglobulins (Igs) in institutionalized (I) and non‐institutionalized (NI) individuals with Down's syndrome (DS).

Methods Stimulated parotid saliva was collected from nine I and 14 NI subjects with DS. Salivary flow rate, secretion rates of total salivary IgM, IgG and IgA, and the incidence of RRIs were determined. Gingival health was recorded by using the plaque index, the gingival index and the percentage of bleeding surfaces (BS).

Results The mean salivary flow rate and parotid Ig secretion rates in the I group were 25% of those of the NI group. The prevalence of RRIs in the I group was more than twice that in the NI group. Oral hygiene and gingival health were significantly better in the NI group.

Conclusions The lower parotid Ig secretion rates in I individuals with DS might be a possible factor involved in their susceptibility to recurrent infections compared to NI subjects with DS.
Assessment and diagnosis of depression in people with intellectual disability
Authors: McBrien J. A.
Published: March 2003

Background  Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic.

Method  The present paper reviews the progress in this field since three reviews, all published in the mid‐1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales.

Results  Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID.

Conclusions  It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large‐scale, collaborative, prospective studies are called for.
The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis
Authors: Intragumtornchai  , Rojnukkarin  , Swasdikul  , Israsena
Published: March 2003

Intragumtornchai T, Rojnukkarin P, Swasdikul D, Israsena S (Division of Haematology, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand). The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. J Intern Med 1998; 243: 233–41.

Objectives

.To determine the diagnostic values of serum ferritin and other conventional laboratory tests in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis.

Design

.Cross‐sectional study for diagnostic tests.

Setting

.University hospital.

Subjects

.Seventy‐two consecutive patients with liver cirrhosis in whom the haemoglobin level was less than 13.0 g dL−1 for men and 12.0 g dL−1 for women. The diagnosis of liver cirrhosis was based on characteristic clinical and hepatic ultrasonographic findings.

Main outcome measures

.By using absence of bone marrow iron as the standard criterion, the diagnostic powers of mean corpuscular volume, transferrin saturation, serum ferritin and the presence of hypochromic red cells in the diagnosis of iron deficiency were compared by analysing the likelihood ratios, the area under the receiver operating curves (ROC) and the stepwise logistic regression associated with each test.

Results.<

> Twenty‐nine patients (40.3%) demonstrated no stainable iron in the bone marrow. The likelihood ratios, the area under the ROC and the stepwise logistic regression indicated that serum ferritin was the most powerful test predictive of iron deficiency. Other tests added little further diagnostic values. The likelihood ratios associated with the serum ferritin levels were as follows: <50 μg L−1, 22.3; 51–200 μg L−1, 1.5–1.8; 201–400 μg L−1, 1.0; > 400 μg L−1, <1. These results indicate that serum ferritin level <50 μg L−1 depict a very high probability of iron deficiency anaemia (0.83–0.99) irrespective of the patient's pre‐test probability.

Conclusion

.Serum ferritin is the most powerful non‐invasive test for the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. It should be the primary test of choice in patients suspected of having the disease. When the level was less than 50 μg L−1, iron supplement may be prescribed without necessitating bone marrow aspiration.
The frequency and severity of retinopathy are related to HbA1c values after, but not at, the diagnosis of NIDDM
Authors: Henricsson  , Gottsäter  , Jeppsson  , Fernlund  , Sundkvist
Published: March 2003

Henricsson M, Gottsäter A, Jeppsson J‐O, Fernlund P, Sundkvist G (Lund University, Malmö University Hospital, Malmö, Sweden). The frequency and severity of retinopathy are related to HbA1c values after, but not at, the diagnosis of NIDDM. J Intern Med 1998; 244: 149–54.

Objectives

To examine the relationship between previous glycaemic exposure and prevalence of retinopathy 8 years after diagnosis of diabetes in 58 islet cell antibodies (ICA)‐negative noninsulin‐dependent diabetes mellitus (NIDDM) patients and in a group of 14 ICA‐positive ‘NIDDM’ and insulin‐dependent diabetes mellitus (IDDM) patients.

Design and methods

The Wisconsin retinopathy scale was used to assess the retinopathy which was graded into mild, moderate and severe nonproliferative diabetic retinopathy (NPDR), or proliferative retinopathy (PDR). The frequency and severity of retinopathy was related to HbA1c levels at diagnosis, and 3 and 5 years later.

Results

Thirty of the 58 ICA‐negative NIDDM patients (52%) but only 2 of the 14 ICA‐positive ‘NIDDM’ or IDDM patients (14%) had mild–moderate–severe NPDR 8 years after diagnosis (P= 0.02). None had PDR. Retinopathy 8 years after diagnosis in NIDDM (= 58 ICA‐negative patients) was correlated with the degree of glycaemic control (HbA1c levels) at 3 and 5 years after diagnosis, but not to HbA1c levels at diagnosis. The relative risk for a higher average HbA1c (per percentage) at 3 and 5 years was 1.56 for any retinopathy vs. no retinopathy (95% confidence interval 1.1–2.2; P= 0.01) and 1.68 for moderate to severe NPDR in comparison with no DR and mild NPDR (95% confidence interval 1.0–2.8; P= 0.04).

Conclusions

Retinopathy after 8 years of diabetes in NIDDM patients was associated with impaired glycaemic control during previous years but not with glycaemic control at baseline. Good glycaemic control may prevent retinopathy in patients with NIDDM.
The importance of serum lipoprotein (a) as an independent risk factor for premature coronary artery disease in middle‐aged black and white women from the United States
Authors: Dahlén  , Srinivasan  , Srinivasan  , Stenlund  , Wattigney  , Wall  , Berenson
Published: March 2003

Abstract. Dahlén GH, Srinivasan SR, Stenlund H, Wattigney WA, Wall S, Berenson GS (Umeå University Hospital and University of Umeå, Umeå, Sweden; and Tulane School of Public Health and Tropical Medicine, New Orleans, LO, USA). The importance of serum lipoprotein (a) as an independent risk factor for premature coronary artery disease in middle‐aged black and white women from the United States. J Intern Med 1998; 244: 417–24.

Objective

To determine the association of serum levels of lipoprotein (a) (Lp(a)) with coronary artery disease (CAD) in relation to other risk factor variables in black and white women.

Design

Retrospective case–control study.

Setting

Community of Bogalusa, Louisiana and Cardiac Catherization Laboratory at the Medical Center of Louisiana, New Orleans, USA.

Subjects

The study included 47 female cases (52% black; mean ± SD age: 50.8 ± 6.3 years) with confirmed myocardial infarction (MI) or at least 75% blockage of one or more major epicardial coronary arteries determined by angiography, and 55 controls (60% black; mean ± SD age: 49.6 ± 7.9 years) with no high grade obstructive lesion (<50% blockage) and no history of CAD.

Main outcome measures

Lipoprotein variables, homocysteine, body mass index and cigarette smoking.

Results

In the whole group, mean values of Lp(a), total cholesterol, low‐density lipoprotein cholesterol (LDL‐C), apolipoprotein B (apoB) and very‐low‐density lipoprotein cholesterol (VLDL‐C) were higher (P < 0.05–0.001) and apoA‐I was lower (P < 0.05) in cases than in controls. The multivariate logistic regression analysis showed elevated levels of Lp(a) (>500 mg L−1) and LDL‐C (>3.36 mmol L−1) as strong independent risk factors, with odds ratios (with 95% confidence intervals) of 13.6 (4.00–46.30) and 4.64 (1.31–16.49), respectively. ApoA‐I, with an odds ratio of 0.11 (0.02—0.64), was a protective factor only at high levels (>53.6 μmol L−1). Between races, significant odds ratios were noted in the black women for Lp(a) (OR = 15.98; P < 0.01) and LDL‐C (OR = 7.69; P < 0.05) and in the white women for only Lp(a) (OR = 15.23; P < 0.01).

Conclusions

Lp(a) is an important risk factor for CAD both in black and in white women.
Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated type 1 diabetes subjects
Authors: Axelsen M. , Wesslau C. , Lönnroth P. , Lenner R. Arvidsson , Smith U.
Published: March 2003

Abstract. Axelsen M, Wesslau C, Lönnroth P, Arvidsson Lenner R, Smith U (Sahlgrenska University Hospital, Göteborg University, Sweden). Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated IDDM subjects. J Intern Med 1999; 245: 229–36.

Objectives. The present study tests two interrelated hypotheses: (1) that bedtime ingestion of uncooked cornstarch exerts a lower and delayed nocturnal blood glucose peak compared with a conventional snack; (2) that bedtime carbohydrate supplement, administered as uncooked cornstarch, prevents nocturnal hypoglycaemia without altering metabolic control in intensively treated type 1 diabetes (IDDM) patients.

Design  and subjects. The above hypotheses were tested separately (1) by pooling and analysing data from two overnight studies of comparable groups of patients with non‐insulin dependent diabetes mellitus (NIDDM) (14 and 10 patients, respectively), and (2) by a double‐blind, randomized 4‐week cross‐over study in 12 intensively treated IDDM patients.

Setting. Sahlgrenska University Hospital, Göteborg, Sweden.

Interventions. (1) Ingestion of uncooked cornstarch and wholemeal bread (0.6 g of carbohydrates kg−1 body weight) and carbohydrate‐free placebo at 22.00 h. (2) Intake of uncooked cornstarch (0.3 g kg−1 body weight) and carbohydrate‐free placebo at 23.00 h.

Main outcome measures. (1) Nocturnal glucose and insulin levels; (2) frequency of self‐estimated hypoglycaemia (blood glucose [BG] levels < 3.0 mmol L−1) at 03.00 h, HbA1c and fasting lipids.

Results. Bedtime uncooked cornstarch ingestion led to a lower (2.9 ± 0.5 vs. 5.2 ± 0.6 m
m, P = 0.01) and delayed (4.3 ± 0.6 vs. 2.0 ± 0.0 h, P < 0.01) BG peak, compared with a conventional snack, in NIDDM patients. Four weeks of bedtime uncooked cornstarch supplement, as compared with placebo, led to a 70% reduction in the frequency of self‐estimated hypoglycaemia at 03.00 h (P < 0.05), without affecting HbA1c or fasting lipids in IDDM patients.

Conclusions. Uncooked cornstarch, ingested at bedtime, mimicked the nocturnal glucose utilization profile following insulin replacement, with a peak in blood glucose after 4 h. In IDDM patients, bedtime uncooked cornstarch supplement diminished the number of self‐estimated hypoglycaemic episodes, without adversely affecting HbA1c and lipid levels. Hence, bedtime uncooked cornstarch ingestion may be feasible to prevent a mid‐nocturnal glycaemic decline following insulin replacement in IDDM and, based on the nocturnal blood glucose profile, may also be preferable compared with conventional snacks.
Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing
Authors: Korpilahti K. , Engblom E. , Hämäläinen H. , Syvänne M. , Hietanen E. , Arstila M. , Puukka P. , Rönnemaa T.
Published: March 2003

Abstract.  Korpilahti K, Engblom E, Hämäläinen H, Syvänne M, Hietanen E, Arstila M, Puukka P, Rönnemaa T (Central Hospital of Vaasa, Turku University Central Hospital, Research and Development Centre of the Social Insurance Institution, Turku and Helsinki University Central Hospital, Finland). Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing. J Intern Med 1999; 245: 545–552.

Objective.  To evaluate the relative importance of graft occlusions and progression of atherosclerosis in coronary arteries as causes of the occurrence of angina pectoris and impairment of physical performance 5 years after coronary artery bypass surgery.

Design.  A 5‐year follow‐up study.

Setting.  University hospital in south‐western Finland.

Subjects.  Altogether, 174 consecutive electively operated bypass patients.

Main outcome measures.  Serial clinical evaluation and bicycle exercise tests (pre‐operatively, at 6 months, and at 1 and 5 years). Quantitative coronary angiography pre‐operatively and 5 years after the surgery.

Results.  Subjects with patent grafts had fewer angina pectoris symptoms at the 5‐year follow‐up (24 vs. 52%, P = 0.001) and were treated less frequently with long‐acting nitrates (3 vs. 15%, P = 0.037) than subjects with graft occlusions. Fewer of them were in classes II–III of the functional classification of the Canadian Cardiovascular Society (39 vs. 74%, P = 0.001). The exercise test was interrupted less often because of chest pain (23 vs. 41%, P = 0.03) and improvement in exercise test variables during the follow‐up period was significantly greater in subjects with patent grafts (P < 0.002). Amongst patients without graft occlusions, those with new ≥ 50% diameter stenoses in coronary arteries were more often in functional classes II–III (59 vs. 32%, P = 0.03) than those without new stenoses, but the groups were similar with respect to angina pectoris and exercise tests variables. In patients with graft occlusions, those with and without new ≥ 50% diameter stenoses were similar with respect to functional class, angina pectoris and exercise test variables.

Conclusions.  Angina pectoris and impairment of physical capacity 5 years after coronary artery bypass grafting are mainly due to occlusion of bypass grafts and not to progression of atherosclerosis in coronary arteries.
Streptokinase antibodies inhibit reperfusion during thrombolytic therapy with streptokinase in acute myocardial infarction
Authors: Juhlin P , Boström P.‐Å , Torp A , Bredberg A
Published: March 2003

Objectives. To evaluate the influence of pretreatment IgG against streptokinase on the outcome of streptokinase treatment in acute myocardial infarction.

Setting. Coronary care unit.

Design. From 88 patients admitted to the coronary care unit due to chest pain, blood samples were taken for determination of the pre‐existing titre of antibodies against streptokinase. The patients were treated and monitored according to standard protocols. Fifty of the patients received thrombolytic therapy with streptokinase due to acute myocardial infarction and were monitored with continuous dynamic vectorcardiography, making possible the continuous analysis of ST‐ and QRS‐vector changes and determination of the event of reperfusion. None of these 50 patients had been given streptokinase therapy previously.

Results. According to the vectorcardiographic criteria 21(42%) patients had signs of early (within 2 h) reperfusion after streptokinase therapy. These patients had lower pre‐existing antibody titres than patients without signs of reperfusion (mean values 0.20 and 0.45 arbitrary units, P = 0.01). None of the patients with a titre higher than 0.50 arbitrary units (nine patients) had signs of early reperfusion. Of the 41 patients with a titre lower than 0.50 arbitrary units 52.5% had signs of early reperfusion.

Conclusion. The present investigation indicates that pre‐existing streptokinase antibodies play an important role in reperfusion failure during thrombolytic therapy with streptokinase in acute myocardial infarction. Therefore, the determination of streptokinase antibodies may differentiate between those patients who may benefit from streptokinase treatment and those who should be treated with some other regime.
No increase in fracture incidence in patients treated for thyrotoxicosis in Malmö during 1970–74. A 20‐year population‐based follow‐up *
Authors: Hallengren B. , Elmståhl B. , Berglund J. , Christensen S. B. , Elmståhl S. , Johnell O. , Thorngren K.‐G.
Published: March 2003

Hallengren B, Elmståhl B, Berglund J, Christensen SB, Elmståhl S, Johnell O, Thorngren K‐G (Malmö University Hospital, Malmö, and University Hospital, Lund, Lund University, Sweden). No increase in fracture incidence in patients treated for thyrotoxicosis in Malmö during 1970–74. A 20‐year population‐based follow‐up. J Intern Med 1999; 246: 139–144.

Objectives. To study whether there is an increased fracture incidence following thyrotoxicosis.

Design. A case–control study.

Setting. Malmö University Hospital, Malmö, Sweden.

Subjects: All patients (n = 333) from the population of Malmö who were treated for thyrotoxicosis for the first time during the 5‐year period 1970–74. A total of 618 controls were selected from the local municipality registry in Malmö. For each case the aim was to randomly select two age‐ and gender‐specific controls, alive in 1993 and born the same year and month as the case.

Main outcome measures. Fracture incidence

Results.  Comparing survivors, there were no differences in the percentage of individuals with fractures (all, fragility, non‐fragility) between the patients and the controls. Comparing all individuals and including all fractures, the percentage of individuals with fractures in the entire female patient group (24.6%) was lower (P < 0.05) than in female controls (33.1%). There was a similar but non‐significant pattern between male patients and controls. The mean number of all fractures was lower in male patients than in controls (P < 0.05), but no significant difference was noted between female patients and controls. For fragility fractures, there were no significant differences in the percentage of individuals with fractures or in the mean number of fractures between female or male patients and controls.

Conclusion. In conclusion we found no increased incidence of fragility fractures in patients with previous thyrotoxicosis as compared with controls. Our results do not support the suggestion that screening for osteoporosis should be performed in patients with previous thyrotoxicosis.
Long‐term effect of a new oral prostacyclin analogue, beraprost sodium, in isolated peripheral pulmonary artery stenosis in the adult
Authors: Yoshitomi Y. , Kojima S. , Kuramochi M.
Published: March 2003

Yoshitomi Y, Kojima S, Kuramochi M, (Tohsei National Hospital, Shizuoka, Japan). Long‐term effect of a new oral prostacyclin analogue, beraprost sodium, in isolated peripheral pulmonary artery stenosis in the adult (Case Report). J Intern Med 1999; 246: 227–230.

A 20‐year‐old woman was admitted with increasing breathlessness on exertion. A diagnosis of isolated peripheral pulmonary artery stenosis (PPS) was confirmed by right‐sided cardiac catheterization and pulmonary angiography. We tried treatment with a newly developed oral prostacyclin analogue, beraprost sodium. Her symptoms gradually improved 1 month after treatment. After 1 year, we observed a decrease in pulmonary arterial pressure (from 118/16 [mean 59] to 87/13 [mean 40] mmHg) and systolic right ventricular pressure (from 125 to 90 mmHg). This is the first report to describe the chronic effect of oral prostacyclin analogue on isolated peripheral pulmonary artery stenosis.