bluuebunny/crossref_metadata_2025 huggingface dataset:
Serological survey of measles and rubella immunity in Sydney preschool children
Authors: Causer J , Mira M , Karr M , Hueston L , Burgess M , Alperstein G , Fett M , Cunningham A
Published: March 2003

Objectives: To estimate the prevalence of serological evidence of immunity to measles and rubella in preschool children in central and southern Sydney (NSW, Australia) and the prevalence of immunity in children with either documented or parentally reported immunization.

Methods: Geographical cluster random sampling was used to select children aged between 18 and 60 months to participate in the present study. Standardized interviews obtained information on each child’s reported (by parents) immunization status and documentary evidence of immunization was recorded from the Personal Health Record. Venous blood was collected, serum was separated and stored frozen until tested. Measles and rubella antibodies were measured using ELISA, with either immunofluorescence or haemagglutination inhibition being used to clarify equivocal results. The study was conducted from 1992 to 1994 in conjunction with surveys of blood lead concentrations, iron status and micronutrient status.

Results: Parents of 726 of 953 children identified between 9 and 60 months of age agreed to participate in the lead, immunization, iron status and micronutrient studies. Sufficient blood for antibody testing was obtained from 580 children, aged 18 to 62 months at the time of collection. Parents reported that 94.7% (95% confidence interval (CI) 92.7–96.5%) of children had received a measles–mumps or measles–mumps–rubella (MMR) immunization. General practitioners administered 72.8% of these immunizations. The prevalence of serological evidence of immunity to measles and rubella was 88.8% (95% CI 86.2–91.4%) and 91.9% (95% CI 89.6–94.2%), respectively. There was documented evidence of measles and rubella immunization for 88.4% (95% CI 85.7–91.2%) and 86.4% (95% CI 83.4–89.3%) of children, respectively. Of children with documented measles immunization, 91.6% (95% CI 89.2–94.0%) had detectable measles antibody. Of children with documented rubella immunization, 97.2% (95% CI 95.8–98.6%) had detectable rubella antibody.

Conclusions: Measles and rubella immunization rates in central and southern Sydney are relatively high and most of these immunizations are provided by the private sector. Immunity to rubella in children with documented rubella immunization is at the level that would be expected from seroconversion studies. Immunity to measles in children with documented measles immunization is slightly lower than expected from seroconversion studies, highlighting the need for the second MMR immunization in preschool children, as well as making near universal immunization imperative if this disease is to be eradicated.
Promoting secure attachment, maternal mood and child health in a vulnerable population: A randomized controlled trial
Authors: Armstrong K L , Morris J
Published: March 2003

Objective: To evaluate the efficacy of an early home‐based intervention on the quality of maternal–infant attachment, maternal mood and child health parameters in a cohort of vulnerable families.

Methodology: A total of 181 families were recruited to the study in the immediate postnatal period on the basis of a self report questionnaire relating to known family vulnerability factors. Families were assigned randomly to intervention (90), or control (91) groups. The intervention group received a series of home visits from a child health nurse (weekly to 6 weeks, fortnightly to 3 months), with a subgroup receiving home based short‐term dynamic therapy from a social worker. Parent/family function was assessed at inception and at 4 months by the Parenting Stress Index and the Edinburgh Post Natal Depression Scale. At 4 months the quality of the home environment was assessed, utilizing the Home Observation for Measurement of the Environment Inventory, as were child and family health parameters and satisfaction with the community child health service.

Results: At 4 month follow‐up, 160 families (80 intervention, 80 control) were available for assessment. The intervention improved family functioning at 4 months. All aspects of the home environment, including the quality of maternal–infant attachment and mothers’ relationship with their child, were significantly enhanced. In particular, significant and positive differences were found in parenting with the intervention group feeling less restrictions imposed by the parenting role, greater sense of competence in parenting, greater acceptability of the child, and the child being more likely to provide positive reinforcement to the parent. Early differences in maternal mood were not maintained at 4 months. Various child health parameters were enhanced including immunization status, fewer parent‐reported injuries and bruising, and researcher confirmed lack of smoking in the house or around the infant. The families were consistently more satisfied with their community health service.

Conclusions: This form of early home based intervention targeted to vulnerable families promotes an environment conducive for infant mental and general health and hence long‐term psychological and physical well‐being, and is highly valued by the families who receive it.
Paediatric walk‐out patients: Characteristics and outcomes
Authors: Browne GJ , McCaskill ME , Giles H , Lam LT , Fasher BJ , Exley B
Published: March 2003

Objective: To investigate the characteristics and outcomes of patients who walked out from a tertiary children's hospital emergency department (ED) without seeing a medical officer.

Methods: A prospective study of patients who walked‐out from the ED of a children's hospital, without seeing a medical officer. Information collected at triage included demographics, presenting problems, time of arrival, time of departure and reason for leaving. Charts were reviewed and those at high risk of serious illness or adverse outcome were contacted by telephone within 24 h. Further information collected during follow up included outcome, such as adverse events and admission to hospital. Data were analysed by comparing the walk‐out and non‐walk‐out groups with regard to demographic variables, presenting problems and outcomes.

Results: Over a 29 week period, 1037 (5.5%) patients walked out from the ED of the hospital without seeing a medical officer. Comparisons between the walk‐out and non‐walk‐out patients indicated no differences in terms of demographics. However, significant differences were found between the triage categories, presenting problems and arrival time. Of these, 829 (79.9%) were followed up by telephone. This revealed the predominant presenting problem was non‐urgent and infectious in nature and no adverse events occurred. The admission rate for walk‐out patients (1.5%) was significantly lower in comparison with the non‐walk‐out group (6.9%; odds ratio 0.2; 95% confidence interval 0.1–0.3). Walk‐out patients who were eventually hospitalized had a shorter mean length of stay than non‐walk‐out patients (20.4 vs 34.8 h, respectively; t = 17.78, P < 0.0001).

Conclusions: Medical resources are limited and, therefore, some extended waiting in the ED is necessary. Paediatric patients who walk‐out of the ED without seeing a medical officer have simple illnesses that resolve without medical intervention or adverse events.
3β‐Hydroxy‐Δ5 ‐C27‐steroid dehydrogenase deficiency: Diagnosis and treatment
Authors: Yamato Y , Kimura A , Murai T , Yoshimura T , Kurosawa T , Terazawa S , Takao A , Maeda K , Yamashita Y , Kato H
Published: March 2003

Abstract: The aim of this study was to evaluate the effects of bile acid treatment and to obtain further information about the pathway of bile acid biosynthesis in a patient with 3β‐hydroxy‐Δ5‐C27‐steroid dehydrogenase/isomerase (3β‐HSD) deficiency by gas chromatography‐mass spectrometry. Results showed that at 2 months of age, 3β‐hydroxy‐5‐cholen‐24‐oic acid (3.0 μmol/mmol Cr, 7.9%) was detected in the urine in essentially the same relative amount as 3β,7α‐dihydroxy‐ and 3β,7α,12α‐trihydroxy‐5‐cholen‐24‐oic acids (3.7 μmol/mmol Cr, 9.8%) during ursodeoxycholic acid treatment combined with prednisolone. As a result, diagnosis was delayed until 18 months of age. One month later with substitution of chenodeoxycholic acid treatment, urinary 3β,7α‐dihydroxy‐ and 3β,7α,12α‐trihydroxy‐5‐cholen‐24‐oic acids decreased significantly, and subsequent improvement of liver dysfunction was accelerated. Chenodeoxycholic acid treatment is useful in 3β‐HSD deficiency. However, in the diagnosis of this disease in early life, it should be noted that the acidic pathway may be the major route for bile acid biosynthesis in the neonatal period. Diagnosis of 3β‐HSD deficiency may have been delayed by administration of ursodeoxycholic acid, resulting in prolonged diagnostic investigation in this child with cholestasis. Further, use of prednisolone may have been contraindicated.
Should parents assess the interpersonal skills of doctors who treat their children? A literature review
Authors: O'KEEFE M
Published: March 2003

Abstract: Medical consultations in which doctors display good interpersonal skills are associated with a wide range of positive health outcomes. Obtaining the perceptions of patients, or parents in paediatric settings, regarding the interpersonal skills demonstrated by their doctors could provide feedback on doctor behaviours that influence health outcomes. It could also offer an alternative to more traditional methods of assessing interpersonal skills, such as using standardized patients. Patient perceptions of doctor interpersonal skills are most commonly obtained through patient‐completed satisfaction questionnaires. A literature review was conducted with the aim of examining the potential role of parent perceptions in the evaluation of paediatric interviews. Studies identified were reviewed for information regarding the rationale for obtaining parent perceptions, the reliability and validity of measures used, the association between parent evaluations and specific doctor interview behaviours and the acceptability and feasibility of obtaining this information. Practical applications of the information obtained from parent evaluations were also sought. There was considerable support for the inclusion of patient evaluations in the assessment of the interpersonal skills of medical students and doctors. Reliable and valid measurement of patient evaluations can be obtained and patients are willing to provide this information. A clear association between specific doctor interview behaviours and parent satisfaction ratings was demonstrated. However, the important issue of feasibility and acceptability to doctors and medical students of obtaining patient perceptions of interpersonal skills, was not addressed. Patient evaluations of the interpersonal skills displayed by their doctors should be a component of clinical skills assessments. Information obtained from parents relating to the care of children could provide feedback to doctors regarding their personal interviewing style. In order to make full use of the information obtained from parents, there is a need for further study to establish the sensitivity of parent evaluations and methods to facilitate the process of obtaining this information.
Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department
Authors: Chin R , Browne GJ , Lam LT , McCaskill ME , Fasher B , Hort J
Published: March 2003

Objective:  The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED).

Methodology:  This before‐and‐after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6‐month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short‐stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re‐presentation, length of stay, and adverse clinical events. Children in the post‐intervention group were followed up by telephone within 48 h of discharge.

Results:  There were 157 patients recruited in the pre‐intervention group and 110 in the post‐intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow‐up interviews of parents indicated that the new treatment strategy was well received.

Conclusion:  The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events.
Variant Creutzfeldt‐Jakob disease: An unfolding epidemic of misfolded proteins
Authors: Horby P
Published: March 2003

Abstract:  Variant Creutzfeldt‐Jakob disease (vCJD) is an emerging infectious disease believed to be the human manifestation of bovine spongiform encephalopathy (BSE). Variant CJD belongs to a family of human and animal diseases called transmissible spongiform encephalopathies (TSE). The pathogenesis of TSE is not fully understood, but a modified form of a normal cellular protein plays a central role. Current measures to control vCJD aim to prevent transmission of the infectious agent from animals to humans through food or pharmaceutical products and to prevent transmission from person to person via medical interventions. The anticipated development of preclinical diagnostic tests and treatments for vCJD will create new control options and difficult choices.
Drug‐induced extrapyramidal reactions
Authors: Teoh L , Allen H , Kowalenko N
Published: March 2003

Abstract: A child with psychotic symptoms and attention‐deficit hyperactivity disorder who developed extrapyramidal symptoms while on a combination of risperidone, methylphenidate, sertraline, tropisetron and ketorolac is described herein. The extrapyramidal symptoms resolved with the administration of benztropine, an anticholinergic drug. Successful treatment of his psychosis was achieved by decreasing the dose of risperidone, followed by slow upward titration.
Sudden infant death syndrome risk factors in north Queensland: A survey of infant‐care practices in Indigenous and non‐Indigenous women
Authors: Panaretto KS , Smallwood VE , Cole P , Elston J , Whitehall JS
Published: March 2003

Objective: To assess the prevalence of sudden infant death syndrome (SIDS) risk factors in the Indigenous and non‐Indigenous community of Townsville, a large remote urban centre in north Queensland, Australia.

Methods: Thirty Indigenous and 30 non‐Indigenous women with young children were surveyed using sections of the West Australian Infancy and Pregnancy Survey 1997–1998. The prevalence of SIDS risk factors was compared between the two groups and medians and univariate associations were generated where appropriate.

Results: The Indigenous women were significantly younger and more likely to be single. The median age of the infants was 8 months (range 0.3–26 months) with no difference between the two groups. Thirty‐seven per cent of Indigenous infants slept prone (cf. 17% of non‐Indigenous infants; P = 0.03), and 77% shared a bed (cf. 13% of non‐Indigenous infants; P < 0.001). The Indigenous households had significantly more members, with 57% including extended family members (cf. 20% non‐Indigenous group; P = 0.003). Fifty‐three per cent of the Indigenous women smoked during pregnancy (cf. 23% of non‐Indigenous women; P = 0.017), 60% were smokers at the time of the interview, and smoking occurred inside 40% of Indigenous houses (cf. 20% and 20% for non‐Indigenous women, respectively; P < 0.001, 0.09).

Conclusion: This small survey suggests that the prevalence of SIDS risk factors is higher in the Indigenous population, and a new approach to education is needed urgently to promote SIDS awareness among Indigenous women.
Australian Paediatric Surveillance Unit: Progress Report
Authors: Morris A , Ridley GF , Elliott EJ
Published: March 2003

Abstract: The Australian Paediatric Surveillance Unit (APSU), through active surveillance, collects information on the epidemiology of rare or uncommon childhood conditions. This research resource allows paediatricians to collaborate at State, national and international levels. The APSU sends a monthly report card to all (currently 971) paediatricians in Australia, who in turn indicate whether or not they have seen a patient in the last month with any of the conditions listed (98% response rate in 1999). Study investigators, notified by the APSU of positive case reports, obtain demographic and clinical data on the patient from the reporting doctor by postal questionnaire (90% response rate in 1999). Since 1993, the APSU has monitored 27 conditions, including conditions that are vaccine‐preventable, otherwise infectious, genetic, congenital and non‐communicable. Information collected is disseminated to paediatricians and other health professionals via an annual report, newsletters and publications and is made available to the International Network of Paediatric Surveillance Units. Information provided by the APSU has raised awareness among paediatricians of rare and uncommon childhood conditions, and has been used by health authorities for planning of prevention and intervention strategies and allocation of health resources.
Staphylococcus aureus bacteraemia in children: A 5‐year retrospective review
Authors: Suryati BA , Watson M
Published: March 2003

Objective:
 The clinical presentation of Staphyloccocus
aureus bacteraemia has been well described in adults, but there
is a paucity of published data on the presentation of S. aureus bacteraemia
in children. This review sought to compare the presentation of S.
aureus in children with that of adults.

Methods:
 We conducted a 5‐year retrospective
chart review of S. aureus bacteraemia at the Royal Alexandra Hospital for Children between 1994 and 1998.

Results:
 Of the 140 episodes of S. aureus bacteraemia,
53% were community acquired and 47% nosocomially
acquired. The clinical presentation of S. aureus bacteraemia in the children in the present study differed significantly from published studies of adult patients. Of children with community‐acquired bacteraemia without pre‐existing medical conditions, 59% had a bone or joint infection, which is higher than adult series. Endocarditis has been associated with up to 30% of community‐acquired bacteraemia in adults but was much less frequent (1.4%) in the present study. Despite the infrequent use of empiric antibiotic therapy (34% of episodes), the case fatality rate (1.4%) was significantly lower than the published literature relating to adults (11−32%).

Conclusion:
 The present study highlights the
differences between S. aureus bacteraemia in adults and children.
Symptomatic fracture incidence in those under 50 years of age in southern Tasmania
Authors: Jones G , Cooley HM
Published: March 2003

Objective:  To document symptomatic fracture incidence in those aged under 50 years of age.

Methods:  Fractures were ascertained from X‐ray reports containing the word ‘fracture’ from all radiology providers for the geographically defined population of southern Tasmania (n = 165 175) for the period 1 July 1997 to 30 June 1999.

Results:  In the 2‐year study frame there were 2943 fractures in 164 730 person years in males and 1348 fractures in 165 620 person years in females. This represents a fracture incidence of 1787 per 100 000 person years in males and 819 per 100 000 person years in females. Peak fracture incidence was 10−14 years in females and 15−19 years in males although different fracture types had varying peak incidence suggesting different fracture‐specific causes. The most common fractures were those of the hand (24%), forearm (17%), wrist (10%) and foot (9%). All fractures (including vertebral) were more common in males with relative risks ranging from 1.34 to 4.50. The estimated probability of at least one fracture between birth and 50 years of age was 59% for males and 34% for females.

Conclusion:  There are threefold as many fractures in this age group compared to those due to osteoporosis in the elderly in any given year. More research priority needs to be given to understanding the causes of these fractures so that preventive strategies can be formulated.
Congenital hypothyroidism in Western Australia 1981–1998
Authors: Kurinczuk JJ , Bower C , Lewis B , Byrne G
Published: March 2003

Objective: Newborn screening for congenital hypothyroidism began in Western Australia in 1981. We describe the epidemiology, including trends over time.

Methodology: Population‐based registers and databases were used to identify cases of congenital hypothyroidism in 1981–1998 (n = 126), a random sample of controls (n = 1260), and descriptive data on cases and controls. The prevalence of congenital hypothyroidism per 10 000 live births was calculated, and a case‐control analysis conducted.

Results: The prevalence of congenital hypothyroidism was 1.74 per 10 000 in the period 1981–1987, compared with 3.54 per 10 000 between 1988 and 1998. Infants identified with congenital hypothyroidism were significantly more likely to have other birth defects (particularly heart defects), be female, have a birthweight heavier than 4500 g, and be born either preterm or after 41 weeks gestation. No cases had cerebral palsy or intellectual disability.

Conclusions: Population‐based registers and linked databases can provide very useful information for evaluating screening programmes, and extending our knowledge of the epidemiology of congenital hypothyroidism.
The nature and extent of drug‐related hospitalisations in Australia
Authors: Roughead EE
Published: March 2003

Abstract In order to determine the nature and extent of drug‐related hospitalisation in Australia, the Australian National Hospital Morbidity Collection, the Quality in Australian Health Care Study and Australian studies assessing drug‐related hospital admissions were reviewed. The incidence figures, drugs and conditions most commonly implicated, and estimates of avoidability of medication‐related problems were compared. The three data sources were found to provide consistent results, with all sources implicating cytotoxics, antirheumatics, anticoagulants, corticosteroids, antihypertensives and cardiovascular agents in medication‐related hospitalisations. Estimates of the extent of the problem were also consistent, suggesting that at least 80 000 medication‐related hospitalisations occur in Australia each year; between 32% and 69% of these hospitalisations were considered avoidable. It was concluded that medication‐related hospitalisations are a major public health problem in Australia. The avoidability estimates suggest that much can and should be done to reduce this problem.
The development of a national agreed minimum diabetes dataset for New Zealand
Authors: Simmons David , Coppell K , Drury PL
Published: March 2003

Abstract The development of a minimum diabetes dataset (MDD) for monitoring diabetes in New Zealand was intended to facilitate diabetes quality initiatives. Existing published datasets were reviewed and a draft MDD for New Zealand was distributed to all 147 specialist, general practice and relevant community groups. Data definitions were either identical or compatible with other datasets and dataset items included if there were at least six supportive replies. All groups were followed up by letter and telephone. A total of 26 (18%) replies were received. Comments were reviewed and the recommended MDD finalised. There was agreement that this dataset would be embedded into the software of at least three commercially available patient management systems. In conclusion, developing an agreed national MDD was difficult, in spite of its potential utility for local, regional and national collation of diabetes data allowing those involved to generate a picture of diabetes and its outcomes.
Cyanobacterial blooms in Argentinean inland waters
Authors: Pizzolon L. , Tracanna B. , Prósperi C. , Guerrero J. M.
Published: March 2003

The occurrence of cyanobacterial blooms in Argentina is documented and note is made of particular water‐bodies at risk from blooms.
Role of bottom sediments in the secondary pollution of aquatic environments by heavy‐metal compounds
Authors: Linnik Peter M. , Zubenko Irina B.
Published: March 2003

The results of long‐term investigations into the concentrations of some heavy metals (Fe, Mn, Cu, Zn, Pb, Cr, and Cd) in the bottom sediments of the Dnieper reservoirs and the Dnieper–Bug estuary are considered. Maximum quantities of the metals studied are characteristic of southern water bodies located within industrial zones (the Zaporozh’e and Kakhovka reservoirs as well as the Dnieper–Bug estuary). The highest concentrations of the metals studied occurred in the clay silts (Fe, 11 600–32 400; Mn, 1504–3450; Cu, 38.9–85.5; Zn, 89.8–186.5; Cr, 48.6–193.0; and Cd, 1.9–4.4 mg kg‐1 dry weight). Accumulation of heavy metals in the bottom sediments is an important factor in the self‐purification of aquatic environments. However, this process is reversible and therefore provides a constant threat of secondary water pollution. Secondary water pollution is observed in summer and autumn when water consumption increases. The concentrations of heavy metals increase by a factor of 1.5–3 after the drawdown of the water level. The main reason for the rise in the concentrations of metals is exchange between the bottom sediments and the water column. The rate of heavy metal migration is connected with the forms of occurrence in solid substrates and pore solutions in the bottom sediments, as well as with physico‐chemical conditions arising at the sediment/water boundary. Therefore, our investigations concentrated on the study of the fractional distribution of heavy metals among solid substrates and their forms of occurrence in interstitial solutions. This distribution depends, most of all, on the chemical properties of metals as well as the chemical and mineralogical composition of the sediments and the chemical properties of pore solutions. Most of the supply of Mn, Zn, Fe, and Cd is associated with oxides and hydroxides of iron and manganese (Mn, 74–93%; Zn, 43–70%; Fe, 27–59%; and Cd, 28–41%). Most copper and chromium is bound to organic matter and to scarcely soluble minerals. In the interstitial solutions studied, metals (except manganese) are found mainly as complex compounds with dissolved organic matter of a different molecular weight. Nevertheless, the fraction of complexes with a relatively low molecular weight (500–5000 Da) prevailed (40–70%). Dissolved manganese in the pore solutions consists chiefly of free (hydrated) ions Mn2+ (80–95%). The results obtained were used for a comparative evaluation of heavy metal mobility and the exchange ability of their associated compounds in the bottom sediment–water system.
Effects of river impoundment on body condition and reproductive performance of the Australian native fish, Macquarie perch (Macquaria australasica)
Authors: Gray Scott C. , De Silva Sena S. , Ingram Brett A. , Gooley Geoff J.
Published: March 2003

This study attempts to evaluate the influence of the impounding of Lake Dartmouth (36°35′S, 147°31′E; on Mitta Mitta River in Victoria) on the Macquarie perch (Macquaria australasica, Cuvier 1830), an Australian percichthyid fish of riverine origin. In this study the yearly changes in body condition and spawning performance of adult populations in the impoundment were evaluated in relation to lake features, in particular the water level. Body condition of the spawning population of Macquarie perch in Lake Dartmouth, in year n was related to mean annual storage volume of the lake, with a time lag of one year during the post‐filling phase of the lake (1991–1997). The influence of condition on the reproductive performance of captive female Macquarie perch from Lake Dartmouth using artificial propagation techniques was evaluated over the period 1991–1997. The mean relative fecundity (mrf), expressed as the number of eggs produced per kilogram of body weight of hypophysed fish, showed a decrease over the period, but the mean weight of hypophysed fish did not decrease over the same time period. The mrf (Ymrf) was positively correlated to yearly mean relative condition factor (XRc), the relationship being:

The spawning variables, mean percentage fertilization (Yfn) (1991–1997) and mean larval production (Yln) (1992–1996) in each year (n) were also related to the mean relative condition factor (XRc) of female fish that spawned after hypophysation in each year. It is suggested that the declining success in the artificial propagation of this species is caused by a declining maternal condition of female fish collected from the impoundment, resulting from poor nutrition.
Heavy metal concentrations in fish of Lake Balaton
Authors: Farkas A. , Salánki J. , Varanka I.
Published: March 2003

The concentration of heavy metals (cadmium, copper, lead, mercury and zinc) found in muscle, gills and liver of eel, bream and pike‐perch living in Lake Balaton (Hungary) varied significantly between fish species and organs. The toxic metals in the muscle of fish, except for cadmium in bream, were below the maximum permissible level for human consumption. Cadmium concentrations above the maximum permissible level occurred in autumn in a few small individuals of bream, which, because they have poor culinary value and are seldom consumed, does not represent a risk for humans. Cadmium, copper, lead and zinc levels proved to be higher in eel and bream compared to pike‐perch, while high mercury concentrations were found in the predator fish, pike‐perch. Mercury accumulated most in the muscle in each species, while other metals were found in higher levels in the gills and liver. Seasonal differences were found for cadmium in each species and for lead in eel; the concentrations being elevated in autumn compared to spring. The fish species studied as bio‐monitors demonstrated that the overall heavy metal pollution of Lake Balaton is not significant, although, during summer an increase of cadmium and lead loading could occur at the catchment area and in the lake. Studies on the size (age) dependency of heavy metal concentrations showed that, in most cases, none or a negative relationship exists for each organ and metal in all species studied, and a positive regression coefficient was characteristic only on some occasions for mercury, cadmium and lead.
Trophic evolution of Lake Lugano related to external load reduction: Changes in phosphorus and nitrogen as well as oxygen balance and biological parameters
Authors: Barbieri Alberto , Simona Marco
Published: March 2003

Lake Lugano is located at the border between Italy and Switzerland and is divided into three basins by two narrowings. The geomorphologic characteristics of these basins are very different. The catchment area is characterized by calcareous rock, gneiss and porphyry; the population amounts to approximately 290 000 equivalent inhabitants. The external nutrient load derives from anthropogenic (85%), industrial (10%) and agricultural (5%) sources. The limnological studies carried out by Baldi et al. (1949) and EAWAG (1964) revealed early signs of eutrophication, with a phosphorous concentration of about 30–40 mg m–3 and an oxygen concentration of less than 4 g m–3 in the deepest hypolimnion. Subsequently Vollenweider et al. (1964) confirmed these data and was the first to point out the presence of a meromictic layer in the hypolimnion of the northern basin. From the 1960s, as a result of an increase in the population and internal migration, the lake became strongly eutrophic with the P concentration reaching 140 mg m–3 and the oxygen in the hypolimnion reduced to zero. Fifty‐five per cent of the P was from metabolic sources and 45% from detergents and cleaning products. In 1976, a partial diversion of waste water from the northern to the southern basin was begun, and gradually eight waste water treatment plants came into operation using mechanical, chemical and biological treatments. In 1986, Italy and Switzerland began to eliminate the P in detergents and cleaning products. Since 1995, the main sewage treatment plants have improved their efficiency by introducing P post‐precipitation, denitrification and filtration treatments. The recovery of the lake is due to be completed by the year 2005. Altogether, during the last 20 years recovery measures have reduced the external P load from about 250 to 70–80 tonnes year–1; the goal to be reached is 40 tonnes year–1. In‐lake phosphorous concentrations have decreased from 140 to 50–60 mg m–3, with the target at 30 mg m–3. Dissolved oxygen concentration is satisfactory only between the depths of 0 and 50 m, falling rapidly to zero in the deepest layers. Below a depth of 90 m, high CH4, HS–, NH4+, Fe2+ and Mn2+ concentrations exist. Primary production has decreased from 420 to 310 g Cass m–2 year–1, notwithstanding an increase in the thickness of the trophogenic layer. Structure and dynamic biomass show marked changes: phytoplankton dry weight has decreased from 16 to 7 g m–2, while zooplankton dry weight has increased from 3 to 4.5 g m–2. Chlorophyll concentration has fallen from 14 to 9 mg m–3 and Secchi disk transparency has increased from 3.5 to 5.5 m. The current sources of the external load are uncollected small urban conglomerations, storm‐water overflows from outfall sewers, and the residual load from sewage treatment plants, particularly those without P post‐precipitation.
Primary leiomyosarcoma of the cervical spine causing spontaneous compression fracture: Report of an autospy case
Authors: Ochiai Hidenobu , Yamakawa Yuzo , Fukushima Tsuyoshi , Yamada Hiroki , Hayashi Tohru
Published: March 2003

An extremely rare case of the primary leiomyosarcoma of the cervical spine presenting as a compression fracture is reported. A 69‐year‐old man complained of dysesthesia of both hands. A plain radiograph, computed tomography and magnetic resonance imaging of the cervical spine showed a compression fracture of the vertebral body at C7 without the formation of an obvious mass. From radiological findings, the fracture was considered to be caused by an infiltrative vertebral bone tumor. Biopsy of the tumor revealed a leiomyosarcoma, a metastatic tumor being ruled out by a systemic investigation. The patient died of pleural metastasis 6 months later, and an autopsy confirmed the primary site of the tumor as the cervical spine.
Calpain‐dependent proteolysis of NF2 protein: Involvement in schwannomas and meningiomas
Authors: Kimura Yoriyoshi , Saya Hideyuki , Nakao Mitsuyoshi
Published: March 2003

The neurofibromatosis type 2 (NF2) protein, known as merlin or schwannomin, is a tumor suppressor, and the NF2 gene has been found to be mutated in the majority of schwannomas and meningiomas, including both sporadically occurring and familial NF2 cases. Although the development of these tumors depends on the loss of merlin, the presence of tumors lacking detectable NF2 mutations suggests different mechanisms for inactivating merlin. Recent studies have demonstrated cleavage of merlin by calpain, a calcium‐dependent neutral cysteine protease, and marked activation of the calpain system resulting in the degradation of merlin in these tumors. Increased turnover of merlin by calpain in some schwannomas and meningiomas exemplifies tumorigenesis linked to the calpain‐mediated proteolytic pathway.
Increased frequency of the α‐1‐antichymotrypsin T allele in cerebral amyloid angiopathy
Authors: Durany Nuria , Ravid Ravka , Riederer Peter , Cruz‐Sánchez Felix F
Published: March 2003

Cerebral amyloid angiopathy (CAA) is a process of unknown etiology characterized by amyloid deposition in the wall of small cerebral and meningeal blood vessels. CAA is also a feature of Alzheimer's disease (AD) and of a subgroup of elderly people. α‐1‐Antichymotrypsin (ACT) is a serum glycoprotein frequently associated with vascular and senile plaque amyloid. The ACT gene is known to have a bi‐allele polymorphism that causes a simple amino acid substitution. In an attempt to clarify the possible role of ACT polymorphism in AD and in cases of CAA, the ACT genotype was investigated in AD, CAA, and intellectually intact controls. Representative brain areas (cerebral cortex, hippocampus, putamen, white matter, and gyrus cinguli) from all cases were studied using classical histologic staining techniques (hematoxylin–eosin (HE), Mallory's thrichromic or alkaline congo red stain), and immunohistochemistry for tau and β‐amyloid proteins. There was a significantly increased T allele and TT genotype frequency in the CAA group, but not in the AD group, suggesting a role for the ACT genotype in the development of vascular lesions. The presence of the apolipoprotein E4 allele (ApoE4) did not correlate with the ACT‐A allele, as previously reported, and appeared to be independent of the risk for developing AD.
Ultrastructural and MRI study of the substantia nigra evolving exofocal post‐ischemic neuronal death in the rat
Authors: Zhao Fengyu , Kuroiwa Toshihiko , Miyasaka Naoyuki , Nagaoka Tsukasa , Nakane Makoto , Tamura Akira , Mizusawa Hidehiro
Published: March 2003

To clarify the morphological characteristics of exofocal post‐ischemic neuronal death (EPND) in the substantia nigra (SN), we investigated the course of light‐ and electron‐microscopic changes of the SN of rats subjected to occlusion of the left middle cerebral artery (MCA) for 1, 2, 4, 7 and 12 days. To assess cellular edema, sequential magnetic resonance (MR) mapping of the apparent diffusion coefficient (ADC) and the T2 value test was performed. Histological and electron‐microscopic examination on day 1 showed dotted chromatin clumps in the nuclei of some neurons and mild swelling of the perivascular endfeet of astrocytes in the ipsilateral SN. On day 2, a few cells of the ipsilateral SN pars reticulata (SNr) revealed key morphological signs of apoptosis – apoptotic body‐like condensation and segregation of the chromatin and DNA fragmentation‐like nuclear remnants. On day 4, 38% of neurons became swollen (pale neurons) with cytoplasmic microvacuoles, which appeared to originate from rough endoplasmic reticulum (rER), mitochondria and Golgi apparatus. Twenty percent of neurons showed massive proliferation of the cisternae of the rER, some of which were fragmented or had lost their normal parallel arrangement. In addition, MR mapping revealed a transient ADC decrease with a T2 increase (signifying a phase of cellular edema), which coordinated with the phase of ultrastructural cellular swelling. Further, the total number of neurons started to decrease gradually, the perivascular endfeet of astrocytes were markedly swollen, and the neuropil became loose on day 4. On day 7, reactive astrocytes and dark neurons occurred most frequently. These results suggest that the EPND in the SN after occlusion of the MCA in adult rats is due to both apoptosis and necrosis, although necrosis seems to be the dominant mechanism of the EPND. However, the morphologic resemblances of EPND to delayed neuronal death suggest these processes have a common pathomechanism.
Factors influencing survival of diabetic patients after initiation of renal replacement therapy
Authors: Stoves John , BACZKOWSKI2 Andrew J , TURNEY1 John H
Published: March 2003

SUMMARY:The survival of diabetic patients on dialysis treatment is poor but variable. The aim of this retrospective study was to determine factors that might predict the survival of such patients in our own unit. Data from 96 patients with diabetic renal disease (biopsy proven or clinically suspected), who had commenced dialysis after 1980, were included in a retrospective survival analysis. Age, gender, ethnicity, diabetes type, co‐morbidity and factors relevant to dialysis provision and subsequent management were considered. The analysis involved the fitting of suitable Cox proportional hazards models using the S‐plus statistical software package. According to our model, continued use of angiotensin‐converting enzyme (ACE) inhibitor medication and renal replacement with peritoneal dialysis (PD) conferred a survival advantage. In addition, analysis of survival curves showed a significantly better outcome for insulin‐dependent diabetic patients, patients on PD and those treated with ACE inhibitor medication. PD may have been associated with improved survival because of its preferential use in younger and fitter diabetic patients (mean age of PD patients at initiation of dialysis 50.3 years compared with 61.6 years for haemodialysis patients). Treatment with ACE inhibitor medication appears to be beneficial and should therefore be considered in all cases.
Leptin, lipid and lipid metabolism‐related hormones in chronic renal failure in Arabia
Authors: OBINECHE Enyioma N , GILLETT Michael PT , ABDULLE Abdishakur , SULAIMAN Mustapha , AL‐ROKHAIMI Mona
Published: March 2003

SUMMARY: In patients with chronic renal failure (CRF), hyperleptinaemia has been widely reported, but the exact mechanisms leading to elevated leptin levels are unclear. Impaired renal clearance of leptin and the influence of other hormones may be important. In this study, we measured serum leptin levels in 150 patients on haemodialysis, peritoneal dialysis or in the predialysis phase of CRF. Furthermore, we measured plasma levels of insulin, growth hormone (GH) and insulin‐like growth factor 1 (IGF‐1), as well as plasma levels of triacylglycerols and total low density lipoprotein (LDL)‐ and high density lipoprotein (HDL)‐cholesterol. We observed significantly elevated levels of leptin, particularly in female patients, and leptin was shown to correlate significantly with insulin, total and LDL‐cholesterol and log triacylglycerols. Leptin was inversely correlated with GH concentrations, but was not correlated with IGF‐1 levels. Despite the multiple correlations established between leptin levels and other variables, only hyperinsulinaemia in CRF seems to be important as a determinator of leptin levels.
Impact of mesangial IgA deposits in 14th‐post operative‐day routine renal allograft biopsies
Authors: Kim Yong‐Soo , Choi Young Jin , Choi Bum Soon , Park Joo Hyun , Yang Chul Woo , Kim Suk Young , Bang Byung Kee
Published: March 2003

SUMMARY:Three hundred fourteen 14th‐postoperative‐day routine renal allograft biopsies were evaluated together with clinical data. Out of 314 biopsies, mesangial IgA deposits were positive in 122 biopsies (39%). According to Banff classification, the rate of acute rejection was significantly lower in mesangial IgA deposit‐positive (IgA(+)) patients (7.4%) than in mesangial IgA deposit‐negative (IgA(‐)) patients (19.7%) on the 14th postoperative day. Thereafter, rate of biopsy‐proven and clinical acute rejection was continuously lower for up to 12 months in IgA(+) patients than in IgA(‐) patients. The detection rate of mesangial IgA deposits was significantly higher in human leucocyte antigen (HLA)‐well‐matched (HLA mismatch number was <3) patients than in HLA‐poorly matched (HLA mismatch number was ≥3) patients. In HLA‐well‐matched patients, the serum creatinine levels were significantly lower in IgA(+) patients than in IgA(‐) patients after 3 post‐transplant months and up to 1 post‐transplant year. Follow‐up (mean interval: 13 months) allograft biopsies were performed in 34 patients out of 122 IgA(+) patients. In the follow‐up biopsies, initially detected mesangial IgA deposits had disappeared in 22 patients (65%) out of 34 patients. Twelve patients (35%) still had mesangial IgA deposits, and all of them had clinical and pathological findings consistent with IgA nephropathy. Patients with continuous mesangial IgA deposits in the follow‐up biopsies had a better renal function at 1 year and a higher 5‐year graft survival rate compared with patients who lost the initially deposited IgA. The present study demonstrates that long‐lasting mesangial IgA deposits in renal transplants prevent allografts from acute rejection, which leads to better graft outcome.
Qualitative research from a feminist perspective in the postmodern era: methodological, ethical and reflexive concerns
Authors: Seibold Carmel
Published: March 2003

Qualitative research from a feminist perspective in the postmodern era: methodological, ethical and reflexive concerns

Developing methodology is an ongoing process in certain types of qualitative research. This paper describes the process in a study of single midlife women, detailing reflexive concerns on the ethics of data collection and dissemination of research findings from a feminist postmodern perspective, as well as the way in which modification of techniques of analysis occurred as the study progressed. Beginning research questions were concerned with identifying the impact of menopausal symptoms, and the debate surrounding HRT on the lives and decision‐making processes of single midlife women. Initial analysis of data, using grounded theory techniques, indicated a need to place greater emphasis on the way the women constructed or talked about the self, including the embodied self. This led to an exploration of the literature relating to reflexivity, identity construction and embodiment, including feminist poststructuralist interpretations of the discursive and embodied construction of self, and informed both the theoretical framework and the method. The way in which a type of analysis fitting under the broad rubric of discourse analysis, that is one that gave added emphasis to gendered subjectivity, directed further analysis is discussed, as well as the influence on the women of social and scientific discourses in circulation.
Explorations of a trust approach for nursing ethics
Authors: Peter Elizabeth , Morgan Kathryn Pauly
Published: March 2003

Explorations of a trust approach for nursing ethics

Trust has long been acknowledged as central to nurse–patient relationships. It, however, has not been fully explored nor‐matively. That is, trust must be examined from a perspective that encompasses not only reliability and competence, but also good will within nursing relationships. In this paper, we explore how a trust approach, based on Annette Baier’s work on trust in feminist ethics, could help inform future developments in nursing ethics. We discuss the limitations of other approaches such as those based on contracts, paternalism, and care. By drawing out central features of Baier’s theory, we demonstrate how it can help overcome the problems of these previous models. In doing so, we emphasise the importance of combining the ethics of care and justice, acknowledging vulnerability and the potential for evil in nursing relationships, and politically situating the ethical concerns of nursing.
Academics and practitioners: nurses as intellectuals
Authors: Holmes Colin A.
Published: March 2003

Academics and practitioners: nurses as intellectuals

In the author's experience, nurse educators working in universities generally accept that they are ‘academics’, but dismiss suggestions that they are ‘intellectuals’ because they see it as a pretentious description referring to a small number of academics and aesthetes who inhabit a conceptual world beyond the imaginative capacity of most other people. This paper suggests that the concept of the ‘intellectual’, if not the word itself, be admitted into nursing discourse through the adoption of a non‐élitist Gramscian understanding, similar to the more recently formulated conception of the reflective practitioner. According to the Italian Marxist scholar Antonio Gramsci, intellectuals are those people who develop ways in which to construct the conditions of their own existence, a possibility he believed was open to all. It is suggested that, from a Gramscian perspective, all nurses are intellectuals to varying degrees, and nurse educators should not only be nurturing their own intellectualism but also the potential for intellectualism as it exists within each individual. The ways in which this project are related to Habermasian critical theory are also briefly outlined.