bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for adverse events
Authors: Karson Andrew S. , Bates David W.
Published: March 2003

Abstract: Adverse events (AEs) in medical patients are common, costly, and often preventable. Development of quality improvement programs to decrease the number and impact of AEs demands effective methods for screening for AEs on a routine basis. Here we describe the impact, types, and potential causes of AEs and review various techniques for identifying AEs. We evaluate the use of generic screening criteria in detail and describe a recent study of the sensitivity and specificity of individual generic screening criteria and combinations of these criteria. In general, the most sensitive screens were the least specific and no small sub‐set of screens identified a large percentage of adverse events. Combinations of screens that were limited to administrative data were the least expensive, but none were particularly sensitive, although in practice they might be effective since routine screening is currently rarely done. As computer systems increase in sophistication sensitivity will improve. We also discuss recent studies that suggest that programs that screen for and identify AEs can be useful in reducing AE rates. While tools for identifying AEs have strengths and weaknesses, they can play an important role in organizations’ quality improvement portfolios.
Economic evaluations of community‐based care: lessons from twelve studies in Ontario
Authors: Browne Gina , Roberts Jacqueline , Gafni Amiram , Byrne Carolyn , Weir Robin , Majumdar Basanti , Watt Susan
Published: March 2003

A series of 12 studies (five historic cohort and seven randomized trials) examined clients in community settings in Southern Ontario suffering from a variety of chronic physical and mental health conditions. These studies are appraised using a framework for evaluating possible outcomes of economic evaluation. In the 12 studies, sample composition and size varied. Each study was designed to quantify the well‐being outcomes and expenditures associated with different community‐based approaches to care provided in the context of a system of national health insurance. As a collective, these studies represent increasing methodological rigour. Multiple‐perspective client well‐being outcome measures were used. In two studies, caregiver burden also was analysed. A common approach to quantification and evaluation of expenditures for service consumption was used in all 12 studies. The nature of community‐based health services (health vs. disease care orientation) was found to have direct and measurable impact on total expenditures for health service utilization and client well‐being outcomes. In most cases, a recurring pattern of equal or better client outcomes, yet lower expenditures for use of community based health services, was associated with well‐integrated health oriented services. Integrated services aimed at factors which determine health are superior when compared to individual, fragmented, disease oriented, and focused approaches to care. The main lessons from the 12 studies are that it is as or more effective and as or less expensive to offer complete, proactive, community health services to persons living with chronic circumstance than to provide focused, on‐demand, piecemeal services. Complete services would have a psychosocial and mental health focus included with the physical care approach. Furthermore, people with coexisting risk factors (age, living arrangements, mental distress and problem‐solving ability) are the ones who most benefit at lower expense from health oriented, proactive interventions.
DISCUSSION PAPER: Public trust and accountability for clinical performance: lessons from the national press reportage of the Bristol hearing
Authors: Davies Huw Talfryn Oakley , Shields Adam Valentine
Published: March 2003

Abstract: The General Medical Council hearing into events at the Bristol Royal Infirmary resulted in verdicts of serious professional misconduct against three senior doctors. After the longest‐running hearing in the GMC’s history the press response was fierce. This paper reviews the reporting of the Bristol case (and issues arising from it) in the main broadsheet and tabloid national newspapers (dailies and Sundays) in the 5‐week period around the GMC’s delivery of the verdicts and subsequent sentencing. The aim was to describe the main themes emerging from the press coverage and to assess the implications for future debates over clinical performance and accountability. Media interest in the Bristol case was intense (184 published items in 5 weeks). The reporting was emotive and largely hostile, raising doubts about not just isolated lapses of care but also the possibility of more systematic failings. Diminished trust and reduced public confidence were recurrent themes, powerfully expressed. Professional self‐regulation received scathing criticism, with calls for more public access to individual performance data. Future debates about clinical governance will need to take account of the new public context in the wake of Bristol. Arguments about the relative merits of self‐regulation or data‐driven performance management systems now need to be played out for a knowing and openly sceptical print media.
In the eye of the beholder: problems of perception in designing a strategy to promote evidence‐based clinical policy
Authors: Humphrey Charlotte , Berrow Diane
Published: March 2003

Independent qualitative evaluation of a project designed to ensure that clinical policy in specific areas of care in three obstetric units within one English health district was based on authoritative evidence. Data from non‐participant observation, interviews, questionnaires and documents were combined to generate a description of what the project involved and analyses from the perspectives of two key groups of stakeholders: the project proponents and the unit staff whose policies the project was intended to address. Key aspects of the project are examined from these perspectives to elucidate the assumptions of those involved in the project design and assess the adequacy of their attempts to facilitate success. Attempts were made to meet many of the accepted criteria for effective implementation. Nevertheless, the majority of unit staff retained significant doubts about the validity of the project's starting point and the approach adopted. The project process was followed as anticipated. After one year the intended work programme had been completed. The proponents saw the project as quite successful; they were unaware of the extent of the reservations still held by unit staff. The proponents focused on potential barriers that ‘made sense’ in the light of their own values and priorities. Failure to recognize the actual causes of concern was due to not hearing or listening to unit staff. Intended strengths of the project design were viewed quite differently by staff because they did not share the proponents' basic premises. Approaches to promoting evidence‐based practice which take account of the views of all parties regarding problems and solutions are more likely to succeed.
Physicians’ practice profiles and the patient’s right to know
Authors: W. Kluge Eike‐Henner
Published: March 2003

Recent legislation has made physician practice profiles publicly available in many states of the United States. This paper examines the ethical reasoning underlying such a move. It concludes that, on balance, such an initiative is ethically appropriate and should be followed by other jurisdictions.
Conflict of interests, vested interests and health research
Authors: Little Miles
Published: March 2003

This paper examines conflict of interest as it may arise in the activities of research advisory committees and ethical review committees. It distinguishes between vested interests and true conflict of interest. It also examines the ways in which stakeholdings differ from vested interests and conflicting interests differ from conflicts of interest. It explores the overlapping terrain of corruption and conflict of interest. The paper further examines the ways in which scientists, communities and the subjects of medical research all have legitimate stakeholdings in medical research. Each group thus has differently vested interests in the outcomes of the research. The vested interests of medical scientists are particularly complex because scientists have moral commitments to the welfare of patients that may compete with professional and personal interests in the outcome of research performed on those patients as research subjects. The more these interests diverge, the more opportunity will arise for conflict of interest. These observations have implications for the constitution of research advisory and ethical review committees, and the ways in which their discussions are conducted. Some practical help with protocols of discussion can be gained from philosophical and management writings.
Measuring improved patient choice
Authors: Holmes‐Rovner Margaret , R. Rovner David
Published: March 2003

Patient decision support (PDS) tools or decision aids have been developed as adjuncts to the clinical encounter. Their aim is to support evidence‐based patient choice. Clinical trials of PDS tools have used an array of outcome measures to determine efficacy, including knowledge, satisfaction, health status and consistency between patient choice and values. This paper proposes that the correlation between ‘subjective expected utility’ (SEU) and decision may be the best primary endpoint for trials. SEU is a measure usually used in behavioural decision theory. The paper first describes how decision support tools may use decision analysis to structure the presentation of evidence and guide patient decision‐making. Uses of expected utility (EU) are suggested for evaluating PDS tools when improving population health status is the objective. SEU is the theoretically better measure when internal consistency of patient choices is the objective.
Cost‐effectiveness of ancrod treatment of acute ischaemic stroke: results from the Stroke Treatment with Ancrod Trial (STAT)
Authors: PhD Gregory P. Samsa , MD David B. Matchar , ScD G. Rhys Williams , MD David E. Levy
Published: March 2003

Rationale, aims and objectives This paper describes a recent randomized
controlled trial in which 42% of patients receiving ancrod attained a favourable
outcome in comparison with 34% of controls. Although the above effect size
corresponds to a number needed to treat (to achieve a favourable outcome) of approximately
13, intuition does not necessarily suggest what would be the overall impact of a
treatment with this level of efficacy. Methods The objective was to evaluate
the cost‐effectiveness of ancrod. Cost‐effectiveness analysis of data from the Stroke
Treatment with Ancrod Trial (STAT) trial was carried out. The participants were 495
patients with data on functional status at the conclusion of follow‐up. Short‐term
results were based upon utilization and quality of life observed during the trial;
these were merged with expected long‐term results obtained through simulation using
the Stroke Policy Model. The main outcome measure was incremental cost‐effectiveness
ratio. Results Ancrod treatment resulted in both better quality‐adjusted life
expectancy and lower medical costs than placebo as supported by sensitivity analysis.
The cost differential was primarily attributable to the long‐term implications of
ancrod’s role in reducing disability. Conclusions If ancrod is even modestly effective, it will probably be cost‐effective (and, indeed, cost‐saving) as well. The net population‐level impact of even modestly effective stroke treatments can be substantial.
A preliminary study for the development of a scale to assess perceptions about physicians
Authors: MD Tacettin Inandi , MD Nalan Sahin , MD Asuman Guraksin
Published: March 2003

Rationale, aims and objectives This study aimed to develop a scale that
can be used to assess the perceptions of the community about physicians and their
medical practice. Methods A Likert‐type scale was developed and applied to
220 subjects twice within a 7–10 day interval. Internal consistency reliability
and test–retest reliability were used as indicators of the reliability of
the scale. Results Chronbach’s alpha values obtained from two reliability
tests were 0.82 and 0.83, respectively, and correlation coefficient between the two
tests was 0.61. The mean value of items indicated that perceptions about physicians
were between ‘negative’ and ‘neutral’. Conclusions The reliability of this scale was found to be at acceptable levels and therefore it can be used to assess the perceptions of people from different social classes about physicians.
The effectiveness of cognitive‐behavioural interventions provided at Outlook: a disfigurement support unit
Authors: Kleve Liv , Rumsey Nichola , Wyn‐Williams Menna , White Paul
Published: March 2003

Rationale, aims and objectives The establishment and evaluation of a disfigurement support unit (Outlook), based in a district general hospital is described.

Methods The effectiveness of cognitive‐behavioural interventions provided for 36 adults referred from a range of specialties was evaluated through the use of semistructured interviews, and standardized and visual analogue scales completed at initial assessment, at the end of intervention and at 6 months follow‐up.

Results There were significant improvements on all measures at the end of intervention, which were maintained at 6‐month follow‐up, including social anxiety, appearance‐related distress, general anxiety and depression. Clients also reported significant improvements in positive affect and satisfaction with life. They felt more confident with strangers and in dealing with new social situations. In addition, their perceptions of the noticeability of their condition, both to themselves and to others, had significantly reduced. Dendograms revealed two distinct groupings of clients, with one group showing greater improvements following intervention.

Conclusions The results suggest that Outlook represents a valuable addition to the current provision of surgical and medical care.
Democratic deficit and communication hyper‐inflation in health care systems
Authors: PhD Peter Andras , MD Bruce G Charlton
Published: March 2003

There is a widespread perception of poor performance and reduced trust in relation to health care systems. The roots of this problem are interpreted in terms of the democratic deficit and communication hyper‐inflation. The democratic deficit is characterized as a persistent but chronically unsatisfied demand for complete public authority over all significant societal institutions – including the health care system. However, such professional institution systems necessarily perform their functions using specialized internal languages, which are not transparent to external scrutiny. Furthermore, professional institution systems tend to eliminate all subjective and imprecise criteria, such as individual moral values. This situation encourages communication inflation, which describes the large and unpredictable divergence between the real and nominal informational content of communications. Hyper‐inflation is generated by the development of morality‐free information management subsystems (specifically public relations and advertising) to the extent that ‘official’ communications convey almost zero reliable information. Reduction of the democratic deficit and control of communication inflation depends upon successful penetration of the health care system by representative public values, including individual morality.
What criteria do patients use when judging the effectiveness of psoriasis management?
Authors: Ersser Steven J. , Surridge Heidi , Wiles Anne
Published: March 2003

Judgements on the effectiveness of psoriasis management are based on clinical criteria employed by dermatologists, and how they take account of patients’ experiences in the process of history taking. In this study the aim was to gain the in‐depth patients’ perspective and investigate the criteria that they employ when making judgements about the effectiveness of their therapy. These findings were then compared with the clinical and research literature on the clinical effectiveness of psoriasis treatments. The study design is exploratory‐descriptive, using a qualitative ethnographic approach. In‐depth interviews were undertaken in an outpatient department dermatology clinic. A purposive sample of 20 adult patients currently attending represented the following types of psoriasis: guttate, chronic plaque and scalp. A key comparable finding between the literature and the interview data is that dermatologists emphasize observable criteria of effectiveness, such as clearance of the lesion, whereas patients emphasis focuses on the subjective concerns, such as suppleness, softness and alleviation of itch. This discrepancy needs to be considered during history taking, in relation to its impact on therapy concordance and in the use and development of outcome measures used for clinical assessment and evaluations of psoriasis therapy.
The influence of Gyrodactylus salaris Malmberg 1957 (Monogenea) on the epidermis of Atlantic salmon, Salmo salar L., and brook trout, Salvelinus fontinalis (Mitchill): experimental studies
Authors: Sterud  , Harris  , Bakke
Published: March 2003

The effect of Gyrodactylus salaris on the epidermal structure of hatchery‐reared brook trout parr and Norwegian Atlantic salmon parr was evaluated. Both species were initially susceptible to this parasite, but whereas populations on salmon increased until the host died, brook trout responded to, and eventually eliminated, their infections. Salmon skin samples taken 14 days p.i. showed a reduced mucous cell concentration (less than 1500 cells mm–2 on the head compared with 2000 cells mm–2 in controls; the same trend was also seen in other sites) and the epidermis was thinner (48 μm compared with 60 μm on pectoral fins; similar trend seen in other sites) than in uninfected controls kept under identical conditions. Brook trout skin samples were taken 50 days p.i., when the hosts had responded to, and almost eliminated, their infections. No change was then observed in mucous cell density, while the number of epidermal cell layers and the epidermal thickness of brook trout had increased slightly following infection. These results are related to the nature of the host response, and the thinning of the epidermis and loss of mucous cells may in some way be related to the inability of Norwegian salmon parr to respond to the parasite.
The phylogeny of Anguillicola crassus and A. globiceps based on partial 18S ribosomal RNA sequences
Authors: Hirose  , Yabu  , Hirono  , Aoki
Published: March 2003

The parasitic nematodes Anguillicola crassus and A. globiceps infect the swimbladder of eels. To investigate the relationship of these species at the molecular level, the small subunit ribosomal RNA (18S rRNA) genes of A. crassus and A. globiceps were cloned and their nucleotide sequences determined. The 18S rRNA gene of A. crassus and A. globiceps were found to have similar lengths (886 and 888 base pairs, respectively) and demonstrated extensive similarity in their nucleotide sequences, showing 98.8% homology. However, the sequence homology of the 18S rRNA gene of A. crassus with that of other nematodes was found to be in the range of 72.7–89.0% homology, whilst that of A. globiceps was in the range of 73.1–89.4% homology. A phylogenetic reconstruction showed A. crassus to be closely related to A. globiceps. The analysis of nucleotide sequences of the 18S rRNA gene of fish parasites has proven useful in supporting species status and phylogenetic relationships.
Pseudomonas fluorescens, infectious pancreatic necrosis virus and environmental stress as potential factors in the development of vaccine related adhesions in Atlantic salmon, Salmo salar L.
Authors: Colquhoun D. J. , Skjerve E. , Poppe T. T.
Published: March 2003

The possible influences of contaminant bacteria, Pseudomonas fluorescens, infectious pancreatic necrosis virus (IPNV) and environmental stress on the development of vaccine‐related peritoneal adhesions in Atlantic salmon, Salmo salar L., pre‐smolts were investigated. Groups of 50 fish (≈ 30 g) vaccinated with a commercial, triple valent, metabolizable oil‐adjuvanted vaccine were pre‐injected with IPNV, co‐injected with Pseudomonas fluorescens or subjected to routine stress both solely and in combination. Fish from each group were sampled monthly over 3 months. Vaccine side‐effects were scored macroscopically and examined histologically. Fibrous adhesions were apparent in all groups from the first sampling date. Treatments including co‐injection of P. fluorescens and additional environmental stress were found to confer significantly higher degrees of adhesion than vaccine alone. The findings are discussed in relation to vaccination procedures. Persistent or covert IPNV infection could not be confirmed in subsequent samplings.
Induction of apoptosis and secondary necrosis by infectious pancreatic necrosis virus in fish embryonic cells
Authors: Hong J‐R , Lin T‐L , Hsu Y‐L , Wu J‐L
Published: March 2003

Infectious pancreatic necrosis virus (IPNV) causes an acute, contagious disease in a number of economically important fish species (Pilcher & Fryer 1980). It is a member of the Birnaviridae (Brown 1986). In this study, the present authors first characterized the process of fish cell damage caused by IPNV infection in cultured cells, and found that it induced fragmentation of chromosomal DNA into oligonucleosomes and also caused nuclear fragmentation by secondary necrosis.
Evaluation of a rapid coagglutination (COA) test for the detection of infectious pancreatic necrosis virus (IPNV) in tissue samples of Atlantic salmon, Salmo salar L.
Authors: Taksdal T. , Thorud K.
Published: March 2003

The field use of a staphylococcal coagglutination (COA) test for the detection of infectious pancreatic necrosis virus (IPNV) in tissue samples from Atlantic salmon, Salmo salar L., was evaluated. The COA test was compared with an immunohistochemical (IHC) method for the detection of clinical outbreaks of infectious pancreatic necrosis (IPN). The present paper describes the evaluation of 320 COA test results performed at local fish health laboratories in Norway from 1994 to 1996, and COA test results from two infection trials with IPNV. The agreement between the COA test and the IHC was very good. The agreement beyond chance, measured as kappa values, was 0.74 in individuals and 0.90 in pooled samples. Thus, the COA test was suited for the detection of outbreaks of IPN. Covert infections with IPNV remained undetected by the COA test. The minimum IPNV titre needed to obtain a positive COA test was ≈ 105 TCID50 mL–1.
Gill filament necrosis in farmed Japanese eels, Anguilla japonica (Temminck & Schlegel), infected with Herpesvirus anguillae
Authors: Lee N‐S. , Kobayashi J. , Miyazaki T.
Published: March 2003

A herpesviral gill disease accompanied by mass mortality occurred in Japanese eels, Anguilla japonica (Temminck & Schlegel), reared in warm water ponds from 1993 to 1995. Diseased fish displayed marked haemorrhage and congestion within gill filaments and destruction at the tips of affected filaments with necrosis and inflammation in the central connective tissue and the central sinus. Electron microscopy revealed herpesvirus particles in infected fibrocytes within the filamental connective tissue. The isolate was identified as Herpesvirus anguillae by a neutralization test. Infectivity experiments with the isolates revealed that the virus was pathogenic.
Production of salmonid amoebic gill disease by exposure to Paramoeba sp. harvested from the gills of infected fish
Authors: Zilberg D , Gross A , Munday B L
Published: March 2003

Atlantic salmon, Salmo salar L., were exposed to different concentrations of Paramoeba sp. The lowest concentration which induced amoebic gill disease (AGD) was 230 Paramoeba sp. L–1 and the severity of infection increased with increasing concentration. The concentration of Paramoeba sp. positively correlated with the number of gill lesions (R2 > 0.7). This study provides evidence that Paramoeba sp. is the causative agent of AGD and describes an experimental model that enables the severity of the induced disease to be controlled.
Clinical and aetiological aspects of a summer enteritic syndrome associated with the sporulating segmented filamentous bacterium ‘Candidatus Arthromitus’ in farmed rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Michel C , Bernardet J‐F , Daniel P , Chilmonczyk S , Urdaci M , De Kinkelin P
Published: March 2003

An enteritic syndrome affecting farmed rainbow trout and occurring predominantly in summer has recently been described and related to the massive accumulation of a segmented filamentous bacterium (SFB), ‘Candidatus Arthromitus’, in the digestive tract of fish. Details of the clinical manifestations, the characteristics of the bacterium and the possible aetiology of the disease are presented in this paper. No other bacterial pathogen than ‘Candidatus Arthromitus’ was characterized in trout undergoing the enteritic syndrome. From clinical and histopathological observations, a toxin or toxic product accumulation was suspected in affected trout, and could account for the massive destruction of the intestinal mucosa. However, the origin and aetiological role of the SFB could not be clearly elucidated, although most of the filaments appeared to beviable and to produce and release strings of endospores in the lumen of the gut. The organism could not be cultured in the conditions tested, shared several morphological and structural characteristics with related bacteria described in the intestinal microflora of different vertebrate species, but no attachment structure was definitively recognized. All attempts to detect similar SFB in the fish diet orin the environment of affected fish farms were unsuccessful. It is unclear whether this organism represents a normal and not previously detected inhabitant of the intestine of trout stressed after environmental perturbation, or whether it results directly from external sources of contamination.
Vaccination trials of sea bass, Dicentrarchus labrax (L.), against Photobacterium damsela subsp. piscicida, using novel vaccine mixtures
Authors: Bakopoulos V , Volpatti D , Gusmani L , Galeotti M , Adams A , Dimitriadis G J
Published: March 2003

Bacterial cells of the marine fish pathogen Photobacterium damsela subsp. piscicida were grown in novel culture media. A mixture of whole cells and extracellular components was inactivated and used in bath, intraperitoneal (i.p.) and oral vaccination of sea bass, Dicentrarchus labrax, employing two sizes of fish. A commercial vaccine was used for comparative purposes. Control and immunized fish were either bath or intraperitoneally challenged 6 and 12 weeks post‐vaccination. Small fish had significantly higher relative percentage survival with the novel vaccine mixture both at 6 and 12 weeks post‐vaccination by bath, in comparison with the commercial vaccine. No protection was afforded at 6 or 12 weeks post‐immunization by either vaccine after challenge via i.p. injection. Sea bass (1.5–2 g) intraperitoneally vaccinated with various adjuvanted vaccine mixtures were not protected against pasteurellosis. In contrast, larger sea bass (20 g) benefited from vaccination with the novel vaccine mixtures. Intraperitoneal challenge with the pathogen resulted in protection in both fish groups vaccinated with novel vaccine mixtures, whereas control fish suffered high mortalities (>80%). Orally vaccinated fish were immersion challenged with the pathogen. At 6 and 12 weeks post‐vaccination the control fish had a high mortality and the fish vaccinated with the novel vaccine mixture achieved good protection.
A review of the textured diets developed for the management of dysphagia
Authors: Penman J. P. , Thomson M.
Published: March 2003

Background: Dysphagia from whatever cause is a major source of morbidity. A diverse range of modified food consistencies and dysphagia diets have been developed to provide safe meals for the management of people with eating, drinking and swallowing disorders. In this paper the current literature on this topic is reviewed and areas for further study are highlighted.Methods: An initial review of the literature was carried out using the MEDLINE database. Covering the years 1981–96 we used the following key words: dysphagia, swallowing disorders, dysphagia diets. We also reviewed textbooks, back issues of the British Dietetic Associations’Dietetics Today and consulted with colleagues with a special interest in dysphagia.Results and conclusions: Swallowing disorders occur in all age groups, as a result of problems occurring in the preparatory, oral and pharyngeal stages of the swallow. Swallowing disorders at the oesophageal level are not amenable to techniques of swallowing therapy, however, it should be noted that these patients benefit from alteration of diet consistency. The importance of providing suitable and nutritionally adequate meals for individuals with neurological dysphagia is clear, but selection of a textured diet to implement is not. National guidelines are needed for the development and implementation of textured diets for the management of dysphagia.
‘The Sugar Buddies’: an intervention programme for ‘obese’ patients with poorly controlled diabetes
Authors: Hughes  , Todorovic  , Kemp
Published: March 2003

Background: Within the Bassetlaw Diabetes Clinic population a group of obese patients with poorly controlled diabetes were identified, who appeared to be resistant to standard intervention. An alternative approach, the ‘Sugar Buddies’ programme, was developed, focusing on gradual weight loss and improved glycaemic control. Development of self‐care behaviours such as healthy eating, following prescribed testing and medication routines was encouraged. Programme participants attended either individual sessions or a combination of individual sessions and group sessions provided jointly by a diabetes specialist dietitian and diabetes specialist nurse.

Aims: To evaluate the effectiveness of the ‘Sugar Buddies’ programme in achieving weight loss and/or improved glycaemic contol in a group of obese patients with poorly controlled diabetes.

Method: Measurements of weight and glycosylated haemoglobin (HbA1c)were made at 6, 12 and 18 months on 50 patients participating in the pilot programme. The programme included patients with Type 1 and Type 2 diabetes. All patients had an initial body mass index (BMI) > 30 kg/m2 and HbA1c > 7%.

Outcome measures: The proportion of patients who were able to achieve gradual weight loss (a minimum of 2.5 kg over 6 months) and sustain this minimum weight loss over 6, 12 and 18 months. The proportion of patients who were able to achieve a reduction in HbA1c of at least 1% against individual baseline measurements over 6 months, and sustain this reduction over 6, 12 and 18 months.

Results: Patients who achieved an initial minimum weight loss of 2.5 kg at 6 months were likely to sustain this weight loss at 12 and 18 months. Patients attending group sessions were more likely to achieve weight loss. Some of the patients who did not achieve weight loss at 6 months but continued in the programme achieved the minimum weight loss goal at 12 and/or 18 months. Patients who achieved a reduction in HbA1c at 6 months were likely to sustain these improvements at 12 and 18 months. Patients attending group sessions were more likely to sustain improvements in HbA1c values. Length of participation in sessions had no impact on HbA1c improvements. At 6 months, three patients (6%) had achieved both a weight loss 2.5 kg and a reduction of at least 1% in HbA1c.

Conclusions: The programmes focus on making lifestyle changes achieved a measure of success in weight loss and/or improved glycaemic control among patients previously resistant to intervention.
Feeding problems in young children: report of three cases and review of the literature
Authors: Hutchinson H.
Published: March 2003

Background: Feeding problems are common in young children. Standard procedures for identifying, assessing or treating these problems are not available at present. This paper describes three case reports of children attending a joint feeding clinic run by a dietitian and a clinical psychologist. The feeding problems included selective eating, slow eating, difficult behaviour at mealtimes and a preference for food of an inappropriate texture for the children's ages.

Results: One of the three children improved after 4 months, one after 9 months, but the third child has not progressed after 2 years.

Conclusion: A joint clinic can help the management of feeding problems by standardizing treatment. The management of these children should be audited and the use of a classification system and assessment tool would improve care. A parent support group should be established.
Types of drinks consumed by infants at 4 and 8 months of age: sociodemographic variations
Authors: North K. , Emmett P. , Noble S. ,   and the ALSPAC Study Team
Published: March 2003

Aim To investigate the variations in sociodemographic characteristics of mothers in relation to the types of milk and supplementary drinks consumed by their infants at 4 and 8 months of age.

Study design The carers of a randomly chosen population sample of over 1000 infants from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were asked to record all foods and drinks consumed by the child in a 24‐h period at both 4 and 8 months of age. Self‐completion postal questionnaires were used to ascertain sociodemographic characteristics of the mothers and their infants.

Methods Significant differences in the types of milks and supplementary drinks consumed within sociodemographic groups were identified. Infants were also grouped according to the types of milks they were receiving at each age and further differences in sociodemographic characteristics were investigated.

Results Highly significant differences existed among various sociodemographic characteristics with regard to the types of drinks used at both ages. Maternal educational level was the most influential of the sociodemographic variables in explaining the differences in consumption of all types of drinks given at 4 months, in particular for breast milk use. Maternal age was also significantly associated with breast feeding. The use of fruit drinks was significantly associated with the presence of older siblings in the family and the use of herbal drinks with the duration of breast feeding. At 8 months of age maternal educational level was again the most highly associated of the sociodemographic variables, being significantly associated with the use of most of the drinks. The presence of older siblings also had a significant independent effect as did duration of breast feeding. The feeding of cows’ (or animal) milk as a main drink at 8 months, contrary to recommendation, was most likely in the group of mothers with vocational education, those in council accommodation, those with two or more children and those with difficulty affording food.

Conclusion We have identified certain characteristics of mothers who were more likely than others not to follow current recommendations on infant feeding. The educational level of mothers appears to be of major significance in the choices made about the types of drinks given to infants. It may be possible to target information about infant feeding to certain groups of mothers thus improving weaning patterns.
Thyroid dysfunction – weight problems and the psyche: the patients’ perspective
Authors: O’Malley B. , Hickey J. , Nevens E.
Published: March 2003

Objective To establish the extent to which individuals with thyroid dysfunction consider weight as a problem and the relevance of psychological factors.

Design Cross‐sectional study of individuals with thyroid dysfunction.

Participants Members of the British Thyroid Foundation.

Main outcome measures Two self‐administered questionnaires, tailored for hypothyroid and hyperthyroid patients, respectively, and circulated to all members of the British Thyroid Foundation. These questionnaires specifically targeted views on weight and the experiencing of psychological symptoms.

Results Twenty‐five per cent of hypothyroid individuals regained normal body weight on adequate treatment with Thyroxine but 75% did not. Only 19% of subjects had received dietary advice from their doctor. Eighty‐seven per cent of hypothyroid individuals felt depressed prediagnosis and 80% remained so on adequate treatment. Thirty‐nine per cent felt weight was a contributing factor. Fifty‐five per cent of thyrotoxic subjects reported a weight problem on or after treatment, 69% exceeding their pretoxic weight. Only 28% had received dietary advice from their doctor.

Seventy‐eight per cent of thyrotoxic individuals reported mood problems when the thyroid was over active and of these 77% improved with therapy. Twenty‐three per cent did not. In excess of 60% of individuals had persistent symptoms after treatment. Thirty‐four per cent of these blamed a weight problem.

Conclusion Weight is a major concern to the majority of patients with thyroid dysfunction, sometimes contributing to significant mood disturbance. All patients with thyroid dysfunction, particularly if over weight, should receive dietary advice. This must emphasize that thyroid hormone manipulation does not always solve the problem. Furthermore, the associated psychological problems of thyroid disease do not always settle with treatment to euthyroidism and may require therapy in their own right.
Use of ‘light’ foods and drinks in French adults: biological, anthropometric and nutritional correlates
Authors: Bellisle F. , Altenburg de Assis M. A. , Fieux B. , Preziosi P. , Galan P. , Guy‐Grand B. , Hercberg S.
Published: March 2003

Background

A population of over 12 000 mature subjects participated in a longitudinal study (8 years) of nutrition and health (the Su.Vi.Max Study). In this context, a specific cross‐sectional study was carried out in a randomly selected subpopulation.

Aim

To identify anthropometric, nutritional and biochemical correlates of spontaneous use of ‘light’ foods and drinks in a free‐living population.

Design

Men (n=2299) and women (n=1979), 45–60 years, reported their food intakes over six non‐consecutive days. Consumers of low‐fat and low‐sugar foods and drinks, and artificial sweeteners, were compared with non‐consumers.

Results

Users of low‐sugar products were heavier than non‐users; female consumers of low‐fat products, but not males, had higher body weight and BMI than non‐consumers. Users of low‐sugar products had higher triacylglycerols and glycaemia than non‐users while biochemical parameters were not different in users and non‐users of low‐fat products. Use of low‐sugar products led to increased diet density of a few micronutrients, including cholesterol. Low‐fat product selection was associated with increased intake of most micronutrients, both in absolute value and in density.

Conclusions

In mature adults, selection of fat‐reduced products was associated with improved quality of the diet, while anthropometric and biological parameters appeared less favourable in consumers of low‐sugar products vs. non‐consumers. The longitudinal follow‐up of the cohort in future years will help determine cause‐and‐effect relationships among these parameters.
Framing of nutrition education messages in persuading consumers of the advantages of a healthy diet
Authors: Van Assema P. , Martens M. , Ruiter R. A. C. , Brug J.
Published: March 2003

Background

Educational dietary messages can stress either the positive consequences of performing a recommended dietary behaviour (positive frame) or the negative consequences of not performing a recommended dietary behaviour (negative frame). From studies on other health behaviours, there is evidence that positive frames have a stronger impact in encouraging preventive behaviours than negative frames. The main hypothesis of the present study was therefore that positively framed messages on eating a low‐fat diet and eating enough fruit and vegetables (F & V) are more persuasive than negatively framed messages.

Methods

In a 2 (Frame: positive vs. negative) × 2 (Dietary behaviour: fat vs. F & V) design, 152 adult respondents randomly received one of four messages. Subsequently, they completed a questionnaire measuring cognitive attitude, affective attitude and intention to change the dietary behaviours.

Results

No significant differences in attitudes and intentions were found between the positive frame conditions and the negative frame conditions.

Conclusions

Based on the current study no advice can be given yet to dietitians and other nutrition educators about whether they should emphasize the positive consequences of a dietary change or the negative consequences of not making the dietary change.
Cultural differences in assessing dietary intake and providing relevant dietary information to British African–Caribbean populations
Authors: Sharma S. , Cruickshank J. K.
Published: March 2003

Diet can play a key role in the management of disorders such as obesity, diabetes and hypertension, conditions highly prevalent in the British African Caribbean population.

In this paper, information not previously available is provided on the dietary habits and foods consumed by a British African–Caribbean population representative of the local community. Food frequency questionnaires were obtained from 255 randomly selected subjects in Manchester (78% of Jamaican origin), the nutrient intake results of which are available elsewhere. Here, suggestions are given to ensure that complete and valid dietary assessments (by diet history) are obtained, and the need for the approach to be somewhat different to that used in the White European population, highlighted with examples. Suggestions have also been listed for methods of dietary modification for obesity, diabetes and hypertension, taking into account differences in cultural understanding and food practices. People of Caribbean origin are not from just one territory: food habits and cultural context play an important role in every island, with clear differences between each which persist in first and later generations in Britain. In this paper, we attempt to integrate experience of learning from patients themselves during consultations and from participants in this study, with direct quantitative data on types of foods and their frequency in the local African–Caribbean diet.
Breast‐feeding knowledge and attitudes of teenage mothers in Liverpool
Authors: Dewan N. , Wood L. , Maxwell S. , Cooper C. , Brabin B.
Published: March 2003

Objectives

To determine the knowledge and attitudes of teenage mothers towards breast‐feeding.

Design

A questionnaire of teenage (< 20 years) and non‐teenage (≥ 20 years) primigravidae attending the antenatal care services at the Liverpool Women's Hospital, during the period April–May 2000.

Results

Forty teenage primigravidae and 40 non‐teenage primigravidae registered for the survey. Teenagers had poorer knowledge about breast‐feeding than the non‐teenagers, and fewer teenagers considered breast milk the best food for their baby. More teenagers than non‐teenagers planned to bottle feed [23 (57.5%) vs. 9 (22.5%), P=0.002]. Only one teenager had knowledge about colostrum. Teenagers were more often single, had a lower level of education, higher unemployment, higher smoking frequency and less contact with a person who had previously breast‐fed.

Conclusion

Teenage primigravidae have poor knowledge regarding breast‐feeding compared with non‐teenage primigravidae. A greater proportion of teenagers opted not to breast‐feed compared with non‐teenagers. Health education classes stressing the importance of breast‐feeding should be emphasized in antenatal teenage clinics. More research is needed to understand how to improve the knowledge and motivation of adolescent girls to breast feed.
Gluten and casein free diets in autism: a study of the effects on food choice and nutrition
Authors: Cornish E.
Published: March 2003

Background  There is growing interest in possible dietary involvement in the aetiology and treatment of Autistic Spectrum Disorders (ASD). Research has focused on the physiological and behavioural effects of dietary change but has not examined the effect of exclusion diets on nutritional intake.

Aims  The aim of this study was to examine whether the removal of major dietary staples placed children with autism at risk of nutrient deficiency and compares their food choice with ASD children not following gluten and/or casein free diets.

Methods  A postal questionnaire was sent to parents of children aged 3–16 years, diagnosed with ASD belonging to the National Autistic Society in Leicestershire and southern Derbyshire. Detailed dietary information and a 3‐day food diary were collected. The sample size was small: those using gluten/casein free diets (n = 8) and those not following diet (n = 29).

Results  Nutrient intakes fell below the Lower Reference Nutrient Intake (LRNI) in 12 children (32%) for zinc, calcium, iron, vitamin A, vitamin B12 and riboflavin in the nondiet group and four children (50%) for zinc and calcium in the diet group. Fruit and vegetable intakes were higher and cereal, bread and potato consumption were lower in those children using gluten and/or casein free diets.

Conclusion  No significant differences in the energy, protein and micronutrient intakes were found between the two groups of children. A longitudinal prospective study is suggested to examine whether differences in food choice are the result of dietary intervention or the prerequisite for the successful application of diet in this special group of children.
The Checklist of Challenging Behaviour and its relationship with the Psychopathology Inventory for Mentally Retarded Adults
Authors: Jenkins R. , Rose J. , Jones T.
Published: March 2003

The Checklist of Challenging Behaviour (CCB) was developed to survey the prevalence of challenging behaviour among people with intellectual disability. It describes 32 behaviours, and data are collected on the frequency, management difficulty and severity of these states. The present paper reports on the relationship between challenging behaviour (as measured by the CCB) and mental health (as measured by the Psychopathology Inventory for Mentally Retarded Adults). In addition, it discusses the differences between the two groups of clients used in the study, i.e. hospital and community subject groups, in terms of challenging behaviour and mental health.