bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient and Nurse-Related Implications of Remote Cardiac Telemetry
Authors: Billinghurst Fae , Morgan Beverley , Arthur Heather M.
Published: October 2003

The purposes of this study were (a) to determine the frequency of rhythm disturbance events among patients on remote cardiac telemetry, (b) to identify how many of these events were detected by the telemetry nurses, and (c) to explore the impact of managing telemetry on nurses' workload. This prospective observational study took place in a nine-bed Coronary Respiratory Care Unit (CRCU) in a tertiary Canadian University Hospital. No lethal arrhythmias were detected during 420 hours of observation. There were a high number of remote telemetry warning arrhythmias, the vast majority of which were artifact (80.2%). A warning alarm occurred every 2.1 to 6.2 minutes. Nurses detected between 60% to 100% of valid warning alarms. Remote cardiac telemetry without a dedicated monitor-watcher places unnecessary demand on CRCU nurses' time because the vast majority of arrhythmia alarms are inconsequential. The addition of monitoring remote telemetry to the CRCU nurse's workload has the potential to negatively influence the care provided to CRCU patients.
The Sex Ratio and Female Marital Opportunity as Historical Predictors of Violent Crime in England, Scotland, and the United States
Authors: Barber Nigel
Published: October 2003

The effects of sex ratios and marriage markets on violent crime were investigated by regression analysis of temporal variation in violent crime rates in England and Wales (1856 to 1980), Scotland (1871 to 1980), and homicides in the United States (1900 to 1988). Independent variables included the sex ratio of adults (15 to 44 years), marital opportunity of women (ratio of single men to women at the peak age of marriage), illegitimacy ratios, and unemployment. For England and Wales, and Scotland, violent crimes against persons increased with the sex ratio and illegitimacy ratios and were inversely related to marital opportunities for women. For the United States, homicides were inversely related to marital opportunities for women. Reduced marital opportunity for women predicts violent crime independently of the sex ratio, as does illegitimacy. These associations were contemporaneous, suggesting a role of mating competition, rather than being delayed a generation, consistent with effects of reduced parental investment.
Caring for a Spouse after Prostate Surgery: The Preparedness Needs of Wives
Authors: Giarelli Ellen , McCorkle Ruth , Monturo Cheryl
Published: October 2003

This study describes wives' self-reports of preparedness to care for their husbands' physical and emotional needs during the first 6 months after surgery for prostate cancer. The research questions addressed in this article are part of a larger study designed to test the effects of a standardized nursing intervention protocol (SNIP) on quality-of-life outcomes in men postprostatectomy. The Preparedness for Caregiving Scale (PCGS) was administered to wives, and an open-ended questionnaire solicited wives' descriptions of how they felt unprepared. The results suggest that nursing services are needed after hospital discharge to support patients and family caregivers to manage the physical and emotional effects related to the cancer diagnosis and treatment. The information gained can be used to refine a home-based nursing intervention to facilitate caregivers' preparedness to enhance patients' physical function and psychosocial adaptation, and ultimately the couple's quality of life.
Self-Perception and Family Functioning in Healthy School-Age Siblings of Children with Asthma and Diabetes, and Healthy Children
Authors: Gallo Agatha M. , Szychlinski Christine
Published: October 2003

This study examined self-perception and family functioning in healthy school-age siblings of children with asthma and diabetes. The 135 siblings completed the Family APGAR for Children and the Self-Perception Profile for Children. Results indicated that siblings of children with diabetes were at risk for self-perception problems in the areas of scholastic competence and global self-worth. Male sibling pairs in the diabetes group had lower self-perception scores than male pairs in the asthma group; whereas, female sibling pairs in the diabetes group had lower family functioning scores than female pairs in the asthma or healthy groups. For the siblings in the diabetes group, physical appearance, athletic competence, behavioral conduct, scholastic competence, and global self-worth were significantly associated with family functioning. Results support inclusion of self-perception and family functioning as important indicators of healthy sibling adjustment.
Coping Responses to Daily Life Stressors of Children who have a Sibling with a Disability
Authors: Cox Amy Harmer , Marshall Elaine S. , Mandleco Barbara , Olsen Susanne F.
Published: October 2003

Disability or chronic illness in a child creates stressors and new demands for all family members. Most research has focused on the parental perspective. There are little data from children themselves regarding daily coping responses related to living with a brother or sister with disabilities. In this study, 46 siblings of children with disabilities responded verbally to a sentence-completion activity regarding coping responses to stressful situations of everyday life. Content analysis of these reports revealed coping responses according to four categories of modes of reaction: proactive, interactive, internally reactive, and nonactive. Such recognition of siblings' daily coping responses is a first step in the promotion of positive adaptation and health.
Critical Social and Medical Constructions of Perinatal Substance Misuse: Truth in the Making
Authors: Marcellus Lenora
Published: October 2003

The care of women and newborns with prenatal drug and alcohol exposure has been widely recognized as a significant health and social issue. There are wide variations in the values, beliefs, and knowledge regarding perinatal substance misuse in health and child welfare professionals and when contrasted to the field of sociology. Sociology and critical social theory provide an alternative to a traditional medical perspective by using a contextual lens through which to move beyond the “medicalization” of health and illness toward an understanding that considers the historical, political, and social interpretations of perinatal substance misuse. However, the medical and critical social perspectives are often seen as incommensurable. This discussion of the health issues related to perinatal substance misuse and the analysis from a critical social perspective are provided as an attempt to move communities away from rhetoric and toward development of effective, supportive interventions that meet the health and social needs of substance-using women and their children.
The Impact of Community Development Corporations on Neighborhood Housing Markets
Authors: Smith Brent C
Published: October 2003

Housing investment activities of community development corporations (CDCs) can be associated with a positive impact on the residential real estate market within their respective service area. Relying on a pseudo-experimental approach, the appreciation rate of single-family housing in CDC treatment and comparison areas is tested with a traditional hedonic model with pooled data. The results suggest that the area that is served by the 12 established CDCs operating in Center Township in the city of Indianapolis experienced a higher overall appreciation in the mean residential home value from 1987 to 2000 than did a comparison area in Center Township not served by CDCs.
Mental Life and the Metropolis in Suburban America
Authors: Oliver J. Eric
Published: October 2003

Many critics argue that America's suburbs foster depression and mental distress, but researchers have not sufficiently tested whether the characteristics that actually distinguish metropolitan places (both cities and suburbs) correspond to any differences in psychological well-being. Looking beyond inaccurate city-suburb dichotomies, the author examines the relationship between six characteristics of metropolitan places (population size, density, racial composition, affluence, age, and land use) and a variety of indicators of mental health, including depression, life satisfaction, self-efficacy, and esteem. Findings from multilevel data constructed from the Americans' Changing Lives Survey and the census indicate that two characteristics of metropolitan places relate to psychological health: population density and affluence. Residents of denser places are more likely to report depressed mood and dissatisfaction with their neighborhoods; those in more affluent places are more likely to be depressed, be less satisfied with life, and feel lower levels of self-efficacy and esteem.
The Fortunes of Poor Neighborhoods
Authors: Galster George C. , Quercia Roberto G. , Cortes Alvaro , Malega Ron
Published: October 2003

The authors examine the longitudinal fortunes of the poorest fifth of U.S. metropolitan neighbor-hoods, defined as those with 20% or higher poverty rates in 1980. They employ logistic regression to identify the factors correlated with 1980-1990 increases and decreases in poverty rates across these poor neighborhoods and examine whether factors vary by predominant racial/ethnic composition. Regional economic cycles and population growth performance are the dominant determinants of neighborhood poverty change, although the neighborhood's initial poverty rate also influences it. Neighborhoods with higher poverty rates in 1980 evince less stability. Extremely poor neighborhoods are roughly as likely to experience an increase in poverty of 5 or more percentage points as a comparable decrease in poverty. The authors conclude that continued poverty is not the only or even most likely fate of poor neighborhoods; their fortunes depend on both local and regional context.
Using Housing Vouchers to Move to the Suburbs
Authors: Varady David P. , Walker Carole C.
Published: October 2003

When families with Section 8 housing vouchers move from inner-city communities to the suburbs, are they more likely to perceive difficulties and to be dissatisfied with their search for housing than families who make local moves or families who first move to the suburbs but then return to the central city? Both bivariate cross-tabular and logistic regression analysis are applied to a telephone interview sample of 300 Section 8 voucher recipients in Oakland and Berkeley, California. Although many of the movers experienced difficulty in carrying out the housing search, a vast majority were satisfied with their search. Suburban-bound movers were not more likely to perceive difficulties or to be dissatisfied with their search than were members of the two other mover groups when other background characteristics were controlled. The implications of these results for the Section 8 housing voucher program are discussed.
Women, Region, and Types of Homicide
Authors: Dewees Mari A. , Parker Karen F.
Published: October 2003

This study assesses the regional differences in the relationship between women's economic and social status and homicide offending. Specifically, this study investigates whether the status of women differs significantly in the South relative to non-South regions of the United States and if so, how these disparities translate into regional variations in female homicides by relationship type (e.g., acquaintances, family members, and nonfamily intimates). The findings show regional differences in the status of women, but these differences do not consistently reveal more traditional or lower statuses among Southern women as predicted. Moreover, the structural position of women contributes more to explained variance in types of homicide within the non-South region as compared to the South.
The Enduring Puzzle of Southern Homicide
Authors: Ellison Christopher G. , Burr Jeffrey A. , Mccall Patricia L.
Published: October 2003

The purpose of this study is to examine the issue of regional differences in homicide rates by focusing on the role of religious culture—specifically, the influence of the southern brand of conservative Protestantism in sustaining and legitimating distinctive forms of violence. A rationale for focusing on Southern religious culture is outlined and several hypotheses derived from these arguments are tested using 1980 data on homicide rates, religious concentrations, and socioeconomic and other characteristics of 247 metropolitan statistical areas (MSAs). After controlling for a number of relevant covariates, this study finds a positive relationship between percent conservative Protestant and homicide rates; the effect is significant in Southern MSAs but not in non-Southern MSAs. The findings' implications for research on regional variations in violence are discussed and promising directions for future research on this issue are outlined.
Regional Culture and Patterns of Homicide
Authors: Loftin Colin , Mcdowall David
Published: October 2003

In 1998, Cohen described a study showing that in the United States, regionally distributed culture controls the direction of the relationship between social stability and homicide rates. In the South and West, where, according to Cohen, there is a culture of honor, strong community and family bonds increase honor-related violence. Conversely, in the North, where the culture of honor is rare, strong social bonds restrain violence of all kinds. This article describes a reanalysis using Cohen's data sources that finds little association between measures of social stability and homicide rates. Cohen's findings are due to errors in the measurement of homicide that lead to an excessive number of zero values and a few extremely high values that heavily influence the slope estimates. Alternative estimates using larger counties or a logistic regression model that eliminates the impact of the extreme values lead to estimates that are inconsistent with the theory.
EthnoNotes: An Internet-Based Field Note Management Tool
Authors: Lieber Eli , Weisner Thomas S. , Presley Matthew
Published: October 2003

This report describes a field notes database management tool, EthnoNotes. Ethno-Notes makes the process of writing, sharing, and analyzing field notes easier and more systematic. Text can be indexed, coded, and integrated with quantitative data or images, all accessed from the same database system. EthnoNotes can be used by individual researchers or be fully Internet-based, accessible online by teams collaborating in empirical studies. Field notes are easily entered on the Web, then are immediately accessible to other researchers for interpretation and analyses. Built on the FileMaker Pro relational database software, EthnoNotes addresses many practical tasks of multiuser, multisite projects. EthnoNotes text and quantitative data are readily exportable to word-processing and other software for further analysis and integration into research papers.
Understanding Transnational Processes: Modeling Migration Outcomes in the Central Valleys of Oaxaca, Mexico
Authors: Cohen Jeffrey H. , Gijón-Cruz Alicia Sylvia , Reyes-Morales Rafael G. , Chick Garry
Published: October 2003

This article reviews a systematic approach to the study of transnational migration in the central valleys of Oaxaca, Mexico. The authors argue that the investigation of transnational migration should be more than an exercise in labeling outcomes. They show that it is possible to model and score transnational outcomes for individual migrants and migrant households and understand variations in sending practices of local communities. They illustrate this point using data from the investigation of eleven communities in Oaxaca.
Sample Reporting in Qualitative Studies of Women with HIV Infection
Authors: Barroso Julie , Sandelowski Margarete
Published: October 2003

A key means by which readers judge the validity of both qualitative and quantitative research findings is to consider how well these findings are supported by the sample from which they were drawn. Yet as the authors discovered in the course of a systematic review of qualitative studies of women with HIV infection, relevant features of these samples are not always adequately reported or appropriately presented. Factors impeding the creation of a summary description of these women included haphazard placement of sample information throughout a research report; the misuse of variable- and case-oriented formats for organizing sample information; lack of clarity concerning the use of the same sample in multiple reports by the same investigators; and the presentation of inconsistent, irrelevant, misleading, imprecise, and/or erroneous information. These problems direct writers of qualitative research toward better ways of portraying the people taking part in their studies.
Bridging the Gap between the Qualitative and Quantitative Worlds? A Retrospective and Prospective View on Qualitative Comparative Analysis
Authors: Rihoux Benoît
Published: October 2003

Qualitative Comparative Analysis (QCA) is both an approach and a technique launched in the late 1980s by Charles C. Ragin as a “middle road” between quantitative and qualitative strategies. This review article is an invitation to take a serious look at QCA while also attempting to correctly assess its potential and limits. First, the article presents QCA as an approach and as a specific technique (and software). Second, it offers a selective overview of QCA applications produced so far, along with an evaluation of their strengths and weaknesses. The main critiques of QCA are discussed as well as some answers to these critiques. Finally, it presents the prospects of what constitutes a very promising tool in various disciplines.
Strengthening the Role of Public Health Nurse Leaders in Policy Development
Authors: Deschaine Jennifer E. , Schaffer Marjorie A.
Published: October 2003

The purpose of this study is to identify and analyze factors that affect the ability of public health nurse (PHN) leaders to influence public health policy development. Longest's model of public policymaking provided the theoretical framework. Eight PHN leaders representing rural, suburban, and urban population areas participated in semistructured interviews. Findings suggested factors that affect the PHN leaders' abilities to influence public health policy development: existing barriers such as political factors, gender issues, a lack of public understanding, financial issues, and resource limitations; skills training in policy development; academic preparation; political competency; political power associated with policy development responsibilities; leadership competency; and the ability to use research to influence policy making. Recommendations include strengthening academic preparation in policy development and creating support for growth in leadership competency, political competency, and research skills for current PHN leaders.
Cash for Kidneys: The Use of Financial Incentives for Organ Donation
Authors: Sanford Julie Tanner , Rocchiccioli Judith Townsend
Published: October 2003

Many campaigns and programs aimed at increasing donations have not been that successful, and the overall rate of organ donation after death has remained relatively constant over the past few years. The only solution to the widening gap between the number of organs available for transplant and the number of patients waiting is to substantially increase the number of suitable organ donors. This article addresses the historical perspectives of organ transplantation, examines the scarcity of transplantable organs, examines current state and federal legislation relating to organ donation, and explores the use of financial incentives that must be considered to alleviate these issues.
Community Mapping: A Tool in the Fight Against Cigarette Smoking on American Indian Reservations
Authors: Struthers Roxanne , Hodge Felicia Schanche , Geishirt-Cantrell Betty , Casken John
Published: October 2003

Community mapping is a helpful tool for health planners and educators, policy makers, providers, and nurses. Community mapping provides a systematic process for identifying capacities, barriers, identified goals, and serves as a resource for mobilizing neighborhoods to solve problems. The Tobacco Policies Among Plains Tribes Project conducted a community mapping process at 7 Sioux, Ojibwe, and Winnebago reservations. The purpose was to document cigarette sales and smoking activity to establish environmental influences and behaviors surrounding tobacco abuse. Mixed qualitative research methods were used. Structured observations were conducted, photographs were taken, and tribal authorities were contacted regarding smoking policies. Formal policies related to cigarette-smoking sanctions were scarce. The community mapping tool provided information for tribal policy makers and health planners. Developing culturally appropriate health policies and interventions for poor, underserved, and minority communities may be accomplished via community mapping techniques.
Hotel Kalahari: “You can Check Out Any Time you Like, But you can Never Leave”
Authors: McLennan-Dodd Vanessa
Published: October 2003

This article relates the author's experience in the Kalahari, South Africa, to theory in a reflexive, self-conscious, and critical manner. With that intention, the article discusses the Bushmen as individual people rather than as a more abstract social phenomenon or problem and examines what might be done to ensure a more realistic and equitable portrayal of the people of the Kalahari to the world through the media. This article also intends to express the research process and the journey from innocence to experience through various encounters in the Kalahari.
“Dit is Die here Se Asem”: The Wind, its Messages, and Issues of Auto-Ethnographic Methodology in the Kalahari
Authors: Tomaselli Keyan G.
Published: October 2003

This article continues Tomaselli's Kalahari story on issues of representation, research methodology, and reverse cultural studies. He discusses relationships between observers and observed in terms of dependency, inclusions/exclusions, and borders and Othering. Continuing with an auto-ethnography, Tomaselli reflexively analyzes tensions and contradictions set in motion by the writing of this article within both the San communities themselves and between himself, development, and other agencies working in one of these areas. Questions addressed relate to ownership of information, the relationship between the local/particular and the national/policy, and how to ensure campfire dissemination/involvement of the written product.
See No Evil, Hear No Evil: An “Outsider's” Encounter with Cultural Tourism in South Africa
Authors: Enevoldsen Kyle
Published: October 2003

This article reflects on the author's cultural tourism experiences in South Africa in an attempt to contribute to debates concerning the academic's relationship to the tourist. Drawing on the contributions of anthropologists that have dealt with the subject before, the article takes a more general approach to add to the discussion. Goffman's notion of the outsider, as developed by MacCannell, is extended as a possible explanation of the traits shared by academics who study cultural tourism and the tourists who visit cultural tourism sites. In doing so, the article expands on distinctions and similarities already covered in the literature and adds a different perspective to the notion that the respective gazes of academics and tourists might share certain qualities.
Prior chemotherapy and allograft CD34+ dose impact donor engraftment following nonmyeloablative allogeneic stem cell transplantation in patients with solid tumors
Authors: Carvallo Cristian , Geller Nancy , Kurlander Roger , Srinivasan Ramaprasad , Mena Othon , Igarashi Takehito , Griffith Linda M. , Linehan W. Marston , Childs Richard W.
Published: October 2003

Significant engraftment variability occurs among patients following nonmyeloablative hematopoietic cell transplantation. We analyzed the impact of multiple factors on donor myeloid and T-cell engraftment in 36 patients with metastatic tumors undergoing cyclophosphamide/fludarabine-based conditioning. Higher CD34+ doses facilitated donor myeloid engraftment, while prior chemotherapy exposure facilitated both donor myeloid and T-cell engraftment. At day 30, median donor T-cell and myeloid chimerism was 98% and 76%, respectively, in those patients with prior chemotherapy versus 88% (P = .008) and 26% (P < .0001) in chemotherapy-naive patients. Donor myeloid chimerism at day 45 was predicted by prior chemotherapy exposure and the log10 of the CD34+ dose (adjusted coefficient of determination [R2] = .47; P < .0001), while chemotherapy alone impacted donor T-cell engraftment. Patients with prior chemotherapy were more likely to develop acute grades II to IV graft-versus-host disease (GVHD; 8/18) compared with chemotherapy-naive patients (2/18; P = .031). Thus, tailoring the intensity of nonmyeloablative conditioning based on prior chemotherapy exposure is an important consideration in trial design.
Total correction of hemophilia A mice with canine FVIII using an AAV 8 serotype
Authors: Sarkar Rita , Tetreault Renee , Gao Guangping , Wang Lili , Bell Peter , Chandler Randy , Wilson James M. , Kazazian Haig H.
Published: October 2003

Despite the popularity of adeno-associated virus 2 (AAV2) as a vehicle for gene transfer, its efficacy for liver-directed gene therapy in hemophilia A or B has been suboptimal. Here we evaluated AAV serotypes 2, 5, 7, and 8 in gene therapy of factor VIII (FVIII) deficiency in a hemophilia A mouse model and found that AAV8 was superior to the other 3 serotypes. We expressed canine B domain-deleted FVIII cDNA either in a single vector or in 2 separate AAV vectors containing the heavy- and light-chain cDNAs. We also evaluated AAV8 against AAV2 in intraportal and tail vein injections. AAV8 gave 100% correction of plasma FVIII activity irrespective of the vector type or route of administration.
Effect of Haemophilus influenzae endotoxin on the synthesis of IL-6, IL-8, TNF-alpha and expression of ICAM-1 in cultured human bronchial epithelial cells
Authors: Khair OA , Devalia JL , Abdelaziz MM , Sapsford RJ , Tarraf H , Davies RJ
Published: October 2003

Although studies of infective lung diseases have demonstrated that Haemophilus influenzae is a major pathogen, the mechanisms underlying pathogenesis by this organism are not clear. We have cultured human bronchial epithelial cells (HBEC) to confluency and have investigated the effect of H. influenzae endotoxin (HIE) on: 1) epithelial permeability, by movement of 14C-bovine serum albumin (14C-BSA) across HBEC and measurement of electrical resistance of HBEC; 2) release of interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-alpha) into the supernatant, by enzyme-linked immunosorbent assay (ELISA); and 3) expression of intercellular adhesion molecule-1 (ICAM-1), by immunofluorescence staining. HIE did not significantly increase the movement of 14C-BSA across HBEC. In contrast, HIE progressively increased the electrical resistance of HBEC, such that this was significant after 24 h. Compared with untreated cells, 10-100 micrograms.ml-1 HIE-treated cells released significantly greater amounts of IL-6, IL-8 and TNF-alpha, after 24 h, which was blocked by 10(-5) M hydrocortisone. Similarly, incubation of HBEC with 10-100 micrograms.ml-1 HIE, significantly increased the total number of ICAM-1 positive cells, which were significantly decreased on incubation of the cells in the presence 10(-5) M hydrocortisone. Conditioned medium from HIE-exposed HBEC lead to significant increase in neutrophil chemotaxis and adhesion to endothelial cells in vitro. These results suggest that HIE may affect epithelial cell function and influence inflammation of the airway mucosa via induction of proinflammatory mediators.
Effects of dexamethasone on cytokine and phorbol ester stimulated c-Fos and c-Jun DNA binding and gene expression in human lung
Authors: Adcock IM , Brown CR , Shirasaki H , Barnes PJ
Published: October 2003

Glucocorticosteroids have a wide variety of effects which result in the long-term dampening of inflammatory responses. An important site of steroid action may be on the control of the activator protein-1 (AP-1) binding to deoxyribonucleic acid (DNA). AP-1 is a proinflammatory transcription factor composed of a heterodimer of Fos and Jun proto-oncogenes, which can be induced by phorbol esters and various cytokines. We have examined the hypothesis that dexamethasone may inhibit inflammation via an effect on AP-1 activation in human lung tissue. The effect of dexamethasone on the phorbol ester and cytokine activation of AP-1 and its monomers was examined in human lung tissue obtained from transplantation donors. AP-1 activation was measured by its ability to bind DNA, its localization in the nucleus by Western blotting, and the levels of fos and jun messenger ribonucleic acids (mRNAs) using Northern blotting. The phorbol ester, phorbol myristate acetate (PMA), caused a significant 2-3 fold increase in AP-1 DNA binding, which was sustained for 24 h and completely attenuated by co-incubation with dexamethasone. Dexamethasone alone caused a 40% decrease in AP-1 DNA binding. Dexamethasone modulated the expression of both c-jun and c-fos mRNA and produced long-term (24 h) 40% reduction in both mRNAs when compared to control tissues. PMA induced a rapid and prolonged increase in c-Fos and c-Jun nuclear localization, which was not attenuated by co-incubation with dexamethasone.(ABSTRACT TRUNCATED AT 250 WORDS)
Suppression of T-cell activation by pulmonary alveolar macrophages: dissociation of effects on TcR, IL-2R expression, and proliferation
Authors: Strickland DH , Kees UR , Holt PG
Published: October 2003

Suppression of local T-cell activation in the lower respiratory tract by resident pulmonary alveolar macrophages (PAMs) is believed to play an important role in the maintenance of local immunological homeostasis. However, the mechanism(s) by which pulmonary alveolar macrophages regulate T-cell responses are poorly characterized. The present study examines early events during the activation process in mitogen-stimulated T-cell cultures, in which proliferation was completely blocked by the presence of pulmonary alveolar macrophages. Despite inhibition of proliferation, the T-cells demonstrated normal Ca++ flux, normal modulation of surface expression of CD3 and T-cell receptor alpha/beta (TCR alpha/beta), upregulation of interleukin-2 receptors alpha and beta (IL-2R alpha and IL-2R beta), and secretion of high levels of interleukin-2 (IL-2). Thus, pulmonary alveolar macrophage regulation of T-cell activation appears to permit initial expression of effector function, but selectively inhibits further amplification of the overall T-cell response by limiting clonal expansion of the activated effector T-cell.
Thy1 (+) and (-) lung fibrosis subpopulations in LEW and F344 rats
Authors: McIntosh JC , Hagood JS , Richardson TL , Simecka JW
Published: October 2003

Appreciation of the potential of fibroblasts as effector cells in inflammation has led to the recognition of fibroblast subpopulations, the most stable of which are the Thy1 (+) and Thy1 (-) subpopulations in mouse lung fibroblasts. We investigated the presence of Thy1 (+) and (-) fibroblasts in rats, comparing the percentage in primary cultures from rats with different susceptibility to fibrosis, and whether the characteristics were similar in mice and rats, and between normal and fibrotic rats lungs. Using primary cultures of rat fibroblasts obtained both from normal and fibrotic lungs, we analysed the percentage of Thy1 (+) and (-) fibroblasts by fluorescence-activated cell sorter (FACS) analysis. We sorted the fibroblasts to evaluate immune region associated antigen (Ia) expression, which tends to be raised in tissues involved in inflammation, and other characteristics. We found that Thy1 (+) and (-) fibroblasts: 1) are distinct subpopulations in rat lungs; 2) are found in different proportions in rat strains with different propensity towards lung fibrosis; and 3) have similar but not identical characteristics in mice and rats. We also found that bleomycin-induced fibrosis increases the percentage of Ia expression in Thy1 (-), but not Thy1 (+) fibroblasts. The presence of these stable fibroblast supopulations in multiple species, and the fact that these fibroblasts differ in their response to a fibrosing agent, suggests the importance of considering fibroblast subpopulations in development and disease.
Nonresponse bias in EC Respiratory Health Survey in Italy
Authors: de Marco R , Verlato G , Zanolin E , Bugiani M , Drane JW
Published: October 2003

In the three Italian centres involved in the European Community Respiratory Health Survey (ECRHS), prevalence of asthma-like symptoms was assessed through a mailback questionnaire. Since the nonresponse rate was not negligible, ranging 10-18%, we investigated whether nonresponse bias affected the results and, if so, whether the bias could be eliminated from the final estimates of prevalence. A screening questionnaire was sent by mail to 7,000 randomly selected subjects 20-44 yrs of age, and nonresponders were contacted again by phone. Additional information was collected on a subsample of the respondents through a clinical interview. A logistic regression analysis showed that, except for one symptom (awakening for coughing), symptom prevalence significantly decreased from the first to the subsequent contact, when controlling for age, sex, centre and season of interview. The decrease in symptom prevalence was largely independent of smoking habits and socioeconomic status, and was seemingly caused by a symptom-related self-selection. When correcting results according to a linear regression model, observed estimates appeared to be slightly overestimated, by 4-10%. A simulation with the Italian data showed that the bias increased steeply at nonresponse rate higher than 30%, a situation quite common in asthma surveys. In conclusion, nonresponse bias affects the results of ECRHS in Italy, slightly inflating prevalence estimates. To make reliable comparisons on international data in the presence of different nonresponse rates, a correction of the observed prevalence seems necessary.
Symptoms related to asthma and chronic bronchitis in three areas of Sweden
Authors: Bjornsson E , Plaschke P , Norrman E , Janson C , Lundback B , Rosenhall A , Lindholm N , Rosenhall L , Berglund E , Boman G
Published: October 2003

Does the prevalence of respiratory symptoms differ between regions? As a part of the European Community Respiratory Health Survey, we present data from an international questionnaire on asthma symptoms occurring during a 12 month period, smoking and symptoms of chronic bronchitis. The questionnaire was mailed to 10,800 persons aged 20-44 yrs living in three regions of Sweden (Vasterbotten, Uppsala and Goteborg) with different environmental characteristics. The total response rate was 86%. Wheezing was reported by 20.5%, and the combination of wheezing without a cold and wheezing with breathlessness by 7.4%. The use of asthma medication was reported by 5.3%. Long-term cough and/or morning cough together with problems with phlegm was reported by 12.8%; the prevalence being highest in the most polluted area (Goteborg). When using multivariate analysis, no significant difference in asthma-related symptoms was found between the centres. Women reported cough more frequently, but otherwise gender did not influence symptom prevalence. Our results indicate that bronchitis symptoms occur more frequently in Goteborg, the most polluted of the Swedish centres, but that the prevalence rates of asthma-related symptoms do not differ between these three regions.
Tidal breathing analysis and response to salbutamol in awake young children with and without asthma
Authors: Carlsen KH , Lodrup Carlsen KC
Published: October 2003

The purpose of the present study was to investigate: 1) whether tidal flow patterns can be used to discriminate between children with asthma and those without respiratory illness; and 2) whether reversibility to salbutamol in young children can be detected by tidal breathing analysis? Lung function was measured by tidal flow-volume loops (SensorMedics 2600) in 26 awake young children (13 males) with asthma (aged 7-85 months; mean age 33 months), and 26 (13 males) (aged 3-72 months; mean age 34 months) without respiratory illness, before and 15 min after inhalation of nebulized salbutamol, 0.05 mg.kg-1. The ratios of the time and volume until peak expiratory flow to the total expiratory time and volume, respectively, (TPEF/TE and VPEF/VE), and the ratio of tidal expiratory flow at 25% remaining expiration to peak expiratory flow, TEF25/PEF, were significantly lower in asthmatic children than in controls, and increased significantly after salbutamol inhalation in the former. Conversely, TPEF/TE and VPEF/VE, but not TEF25/PEF decreased significantly in the controls after salbutamol inhalation. Respiratory rate and expiratory volume.kg-1 body weight did not differ significantly between the two groups before and after salbutamol inhalation. We conclude that tidal breathing analysis can discriminate young children with asthma from children without respiratory illness, both regarding baseline lung function and reversibility to salbutamol.
Incidence of acute decreases in peak expiratory flow following the use of metered-dose inhalers in asthmatic patients
Authors: Shaheen MZ , Ayres JG , Benincasa C
Published: October 2003

This study aimed to investigate and compare the incidence of metered-dose inhaler (MDI)-associated bronchoconstriction in an asthmatic population, following the use of three different MDIs. Two different placebo metered-dose inhaler preparations containing the same chlorofluorocarbons but differing in dispersant chemicals, one containing oleic acid (MDI-OA) and the other lecithin NF (MDI-L), were compared with a MDI containing salmeterol xinafoate (25 micrograms) and lecithin NF (MDI-S). The study population comprised 11,850 asthmatic patients, who were assigned to receive two puffs from one of the three inhalers: MDI-S (n = 3,948); MDI-L (n = 3,942); or MDI-OA (n = 3,960). Peak expiratory flow (PEF) was measured before and 5 min after inhalation. A 20% fall in PEF was defined as a clinically significant bronchoconstriction. Overall 180 (1.5%) patients demonstrated bronchoconstriction, 43 (1.1%) in the MDI-S group, 67 (1.7%) in the MDI-L group and 70 (1.8%) in the MDI-OA. A significantly lower incidence of bronchoconstriction was seen with the salmeterol xinafoate MDI compared to either of the other two preparations. The risk of acute bronchoconstriction was also shown to increase with age and with decreasing pretreatment PEF. The study has shown that acute bronchoconstriction is an uncommon adverse reaction following the use of metered-dose inhalers. In addition, the study suggests that one of the inert constituents currently within metered-dose inhalers is the likely source of the irritant leading to bronchoconstriction.
Acute exacerbations of asthma in adults: role of Chlamydia pneumoniae infection
Authors: Allegra L , Blasi F , Centanni S , Cosentini R , Denti F , Raccanelli R , Tarsia P , Valenti V
Published: October 2003

Respiratory infections precipitate wheezing in many asthmatic patients and may be involved in the aetiopathogenesis of asthma. Several studies have demonstrated that viral infections may provoke asthma. Bacterial infections seem to play a minor role. However, Chlamydia pneumoniae has been recently reported as a possible cause of asthma. The aim of the present study was to evaluate the role of C. pneumoniae infection in acute exacerbations of asthma in adults. Seventy four adult out-patients with a diagnosis of acute exacerbation of asthma were studied. Acute and convalescent (> or = 3 weeks) serological determination of antibodies to cytomegalovirus, respiratory syncytial virus, adenovirus, influenza A and B, parainfluenza 1 and 3, Mycoplasma pneumoniae and Legionella pneumophila were performed by means of immunofluorescence tests. C. pneumoniae specific antibodies were detected by two microimmunofluorescence tests using a specific antigen (TW-183) and a kit with three chlamydial antigens. Pharyngeal swab specimens were also obtained for C. pneumoniae identification. Samples for bacterial culture were obtained in patients with productive cough (15 out of 74 patients). Fifteen patients (20%) presented seroconversion to at least one of the studied pathogens. Seven were found to be infected by virus, six by C. pneumoniae alone, and one by M. pneumoniae. One more patient showed seroconversion to C. pneumoniae and cytomegalovirus.(ABSTRACT TRUNCATED AT 250 WORDS)
Low plasma concentrations of VIP and elevated levels of other neuropeptides during exacerbations of asthma
Authors: Cardell LO , Uddman R , Edvinsson L
Published: October 2003

Neuropeptides in the lung occur in neurons, neuroendocrine and inflammatory cells. Their widespread distribution and physiological effects suggest that they may play important roles in asthma. We investigated whether, during an exacerbation of asthma, patients displayed changes in plasma levels of the neuropeptides vasoactive intestinal peptide (VIP), calcitonin gene-related peptide (CGRP), substance P (SP), and neuropeptide Y (NPY). Venous blood from 25 adult patients attending the emergency ward with an exacerbation of asthma was sampled before and after treatment. Plasma levels of VIP-, SP-, CGRP- and NPY-like immunoreactivity (-LI) were determined by immunoassay, and the results obtained were compared with findings in 21 healthy controls. The mean plasma levels of VIP-LI were lower in patients (3.4 +/- 0.4 pmol.l-1) than in controls (10.4 +/- 0.7 pmol.l-1), whereas the levels of CGRP-LI (43.7 +/- 3.4 pmol.l-1), SP-LI (4.6 +/- 0.4 pmol.l-1) and NPY-LI levels (159 +/- 6 pmol.l-1) were higher in patients than in controls (21.1 +/- 3.4; 2.2 +/- 0.2 and 105 +/- 8 pmol.l-1, respectively). A relationship was seen between the reversibility of obstruction, expressed as improvement of peak expiratory flow upon treatment, and the neuropeptide levels, such that lower VIP-LI levels and higher CGRP-LI levels correlated with less reversibility. Plasma levels of neuropeptides, VIP-LI and CGRP-LI in particular, may therefore be employed as predictors of responsiveness to bronchodilatory therapy.
The effects of indomethacin on refractoriness following exercise both with and without a bronchoconstrictor response
Authors: Wilson BA , Bar-Or O , O'Byrne PM
Published: October 2003

Repeated exercise tests demonstrate refractoriness to the development of exercise-induced asthma (EIA). It is unclear whether it is the initial exercise per se or the resulting bronchoconstriction that causes the attenuated response to the second exercise challenge. This study was designed to determine whether the reported blocking of the refractory period by indomethacin requires a significant bronchoconstriction following the primary exercise challenge. Thirteen asthmatic teenagers (aged 12-16 yrs) were tested on four visits. Each visit included two 7 min treadmill exercise challenges at 80% maximum heart rate, separated by a 30 min rest. Conditions for the second exercise challenge (Ch2) were always thermoneutral (20-22 degrees C and 25-35% relative humidity (RH); whilst challenge one (Ch1) was completed twice in thermoneutral and twice in warm-humid breathing conditions (33-35 degrees C and 90-95% RH). A pretreatment for 3 days in a double-blind design with either placebo or indomethacin was completed. Forced expiratory volume in one second (FEV1) was measured before and repeatedly following each challenge. The % fall in FEV1 following Ch1 of the placebo thermoneutral trial was taken as reference. "Percent protection" at each visit was expressed as the decrease in EIA following Ch2, compared to reference. Warm-humid breathing reduced the EIA post Ch1 by 75%, whilst providing similar protection to thermoneutral conditions. Indomethacin had no significant effect on EIA after Ch1, but reduced "percent protection" for both warm-humid (from 67 to 16%) and thermoneutral (from 70 to 26%) conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
High-dose inhaled steroids in asthmatics: moderate efficacy gain and suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Research Council of the Norwegian Thoracic Society
Authors: Boe J , Bakke P , Rodolen T , Skovlund E , Gulsvik A
Published: October 2003

We wanted to evaluate the improvement in efficacy when increasing the daily dose of inhaled steroids and to compare the efficacy, safety, and tolerance of 1.6 mg beclomethasone dipropionate (BDP) with that of 2.0 mg fluticasone propionate (FP). The study was a randomized, double-blind, 3 month, multicentre study. One hundred and thirty four asthmatics currently using inhaled steroids (0.4-1.6 mg BDP or budesonide (BUD)) were stratified according to pretrial daily steroid use. Within each stratum they were randomized to either 1.6 mg BDP or 2.0 mg FP. A significant increase in the primary efficacy variables, i.e. mean morning and evening peak expiratory flow (PEF) (approximately 20 l.min-1) during the treatment period, was found for both treatments. No significant differences between the drugs were revealed for these primary or any other secondary efficacy variables (use of beta 2-agonists, symptom scores, and PEF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) recorded at the clinical visits). However, significant differences between treatments occurred regarding decrease of serum cortisol and adrenocorticotropic hormone. We conclude that, although both treatments gave statistically significant increases in efficacy parameters when compared with baseline, the increases were so small that they can be regarded as being clinically unimportant. Daily doses of BDP, 1.6 mg, and FP, 2.0 mg, had comparable effects on lung function. A suppression of the hypothalamic pituitary adrenal (HPA) axis was only found with a daily dose of 2 mg FP.
The influence of age on aerosol deposition in children with cystic fibrosis
Authors: Chua HL , Collis GG , Newbury AM , Chan K , Bower GD , Sly PD , Le Souef PN
Published: October 2003

Nebulized aerosols are commonly used to deliver drugs for the treatment of respiratory disease in children, but there are inadequate data on the dose of drug depositing in the lungs in this age group, and the effect of age on this dose. We therefore aimed to quantify total and regional deposition of nebulized aerosol in children of widely differing age. Twelve infants (median age 0.8 yrs, range 0.3-1.4 yrs) who were asleep, and eight older children (median age 10.8 yrs, range 6.3-18.0 yrs) with cystic fibrosis were studied. Radiolabelled normal saline aerosol was generated by a Turret nebulizer, with a driving flow of 9 l.min-1. All subjects inhaled aerosol via the nasal route, whilst the older children undertook a second study with inhalation via the oral route. Following aerosol inhalation, planar and single-photon emission computed tomography (SPECT) scans were obtained. For the nasal route, total lung deposition was lower in infants (median 1.3%, range 0.3-1.6%) than in older children (median 2.7%, range 1.6-4.4%). For the older children inhaling via the nasal or oral route, there was no influence of age on lung, upper respiratory tract, or the sum of upper respiratory tract and lung deposition. We conclude that the dose of a nasally inspired aerosol reaching the lungs of infants who are asleep is approximately half that for older children, when the nebulizer is operating at 9 l.min-1. Age does not affect deposition of nasally or orally inspired aerosols in older children.