bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐starch polysaccharide intake in vegans and the relationship with energy distribution and mineral intakes
Authors: Lightowler H. J. , Davies G. J.
Published: March 2003

Background There is little information available about non‐starch polysaccharide (NSP) intake in vegans. This study aimed to estimate the intake of NSP in the habitual vegan diet and to assess the relationship between NSP intake and energy distribution, and intakes of selected minerals.

Method NSP intake, energy distribution and intakes of calcium, magnesium, iron and zinc were estimated, using a 4‐day weighed record, in 26 adult vegans (male n = 11, female n = 15) consuming their habitual diet.

Results Mean BMI values in males (22.0) and females (21.1) were significantly lower than the average for the UK population. Mean daily NSP intakes in males (27 g) and females (23 g) were higher than the dietary reference value (DRV) population average of 18 g day–1, although six subjects had intakes below this and two male subjects had intakes below the DRV individual minimum of 12 g day–1. Cereals were the major contributor to total NSP intakes. Mean contributions to total energy intake in males and females were in‐line with the DRV. Mean calcium intakes were below the reference nutrient intake (RNI) while mean intakes of magnesium, iron and zinc were above the RNIs. There were significant positive correlations between NSP intake and calcium, magnesium, iron and zinc.

Conclusion Occasional low NSP intakes and, conversely, high intakes of NSP combined with marginal calcium intakes in some vegans are of concern. Further work is needed to assess food sources and NSP intakes in the current vegan diet.
Vocational aspirations of sheltered workshop workers with intellectual disability in Hong Kong
Authors: Li E. P.‐Y.
Published: March 2003

In Hong Kong, the understanding of the vocational experience of sheltered workshop workers with intellectual disability is still relatively meagre. Twenty‐three participants with intellectual disability and four professionals from their sheltered workshops were interviewed using mainly open‐ended questions. Content analysis and constant comparative method were adopted to categorize the descriptive data into themes that were salient to the participants' vocational aspirations to try open employment. The insider perspective showed that all participants were motivated to have employment. Thirteen participants with intellectual disability preferred to try open employment and they had individual vocational preferences which mainly belonged to unskilled and manual work. The professionals pointed out that sheltered workshop workers with intellectual disability needed professionals' assistance and parents' consent in moving on to open employment, and parents were the key people in this decision‐making process. These findings indicate that sheltered workshop workers with intellectual disability have limited self‐determination in the work arena. The need to empower people with intellectual disability, improve the quality of sheltered employment services and increase the involvement of their family members are discussed.
Maladaptive behaviours and symptoms of dementia in adults with Down's syndrome compared with adults with intellectual disability of other aetiologies
Authors: Cooper S.‐A. , Prasher V. P.
Published: March 2003

Dementia commonly occurs in elderly people with intellectual disability, especially those with Down's syndrome. The non‐cognitive symptoms of dementia can be of greater significance to individuals and carers than the cognitive changes caused by this condition. It is not known whether there are differences between people with Down's syndrome and those with intellectual disability of other causes with regard to the prevalence of such symptoms. The present study was undertaken to draw a comparison between a group with Down's syndrome and dementia (n= 19), and a group with intellectual disability of other causes and dementia (n= 26). Maladaptive behaviours and psychiatric symptomatology were assessed in both groups. The group with Down's syndrome had a higher prevalence of low mood, restlessness/excessive overactivity, disturbed sleep, being excessively uncooperative and auditory hallucinations. Aggression occurred with greater frequency in those subjects with intellectual disability of other causes. These findings are of epidemiological importance in terms of service planning and understanding psychiatric presentation.
Dysthymic disorder in adolescents with intellectual disability
Authors: Masi G. , Mucci M. , Favilla L. , Poli P.
Published: March 2003

The present report examines the clinical features of dysthymic disorder in a sample of adolescents with mild intellectual disability (ID). Frequency of symptoms, comorbidity, agreement between reports of subjects and parents, comparison between the frequency of depressive symptoms in subjects with ID and in two different groups of normal IQ dysthymic subjects (aged 7–11, 11 and 12–18 years) are described. The sample consisted of 12 subjects (age range = 12–25.6 years; mean age = 16.3 years) screened from unselected consecutively referred patients with mild ID. All the subjects were comprehensively diagnosed with a structured diagnostic interview, the Kiddie‐Schedule for Affective Disorder and Schizophrenia (K‐SADS), according to DSM‐IV criteria. A symptomatic profile in the group with ID showed that intrapsychic and cognitive symptoms, such as depressed mood, irritability, pathological guilt and low self‐image, were frequently reported in people with ID. Parents were less aware of depressed mood, but they reported high rates of low self‐esteem; the agreement between the depressive reports of ID subjects and their parents was higher than in previous findings in normal IQ children. The symptomatic profile of subjects with ID was more comparable to that of prepubertal dysthymic children than that of dysthymic adolescents, but more significant are the analogies between dysthymic disorder in ID and normal IQ subjects. High rates of comorbidity with generalized anxiety disorder were evident in the group with ID. According to the present data, dysthymic disorder can be diagnosed in adolescents with mild ID. The K‐SADS clinical interview seems to be a reliable instrument for the diagnosis and clinical definition of depressive symptomatology in this special population.
A descriptive survey of long‐term residents with epilepsy and intellectual disability at the Chalfont Centre: is there a relationship between maladaptive behaviour and magnetic resonance imaging findings?
Authors: Andrews T. M. , Everitt A. D. , Sander J. W. A. S.
Published: March 2003

The advent of high‐resolution magnetic resonance imaging (MRI) has facilitated the identification of subtle, aetiologically relevant structural brain abnormalities in a significant proportion of patients with epilepsy and negative standard neuro‐imaging. In the present study of people with intellectual disability (ID), the authors show that a high frequency of cerebral structural abnormalities (72.4%) can be demonstrated by high‐resolution MRI in patients with epilepsy and ID. Malformations of cortical development (MCD) were found in 8.7% of people without profound ID. An earlier age of onset of habitual seizures was associated with more severe ID and more severe seizures in adulthood. There was no obvious association between this finding and maladaptive behaviour, but a past history of febrile convulsions was associated with increased irritability and agitation. Since there was no obvious association between a history of febrile convulsions and MRI abnormalities, the reason for the above finding remains unclear. Inevitably, any residential epilepsy centre population is subject to selection biases. The population studied was highly skewed, with only one‐third of the sample being female and 80% having mild ID. Thus, the findings of the present study cannot necessarily be generalized to all people with ID.
Sleep problems and daytime challenging behaviour in a community‐based sample of adults with intellectual disability
Authors: Brylewski Jane , Wiggs Luci
Published: March 2003

The present study aimed to explore associations between sleep problems and daytime challenging behaviour in a community sample of adults with intellectual disability. Sleep and behaviour questionnaires were completed for 205 people aged 18 years or over living in health‐ or social‐services‐managed community housing. This sample represented an 86% return rate. The informants were carers and the individuals themselves where possible. Seventy‐nine people with sleep problems were compared with 121 individuals without this difficulty; five people were excluded from the analysis. Individuals with sleep problems displayed significantly more daytime irritability, stereotypy and hyperactivity than those without sleep problems. Individuals displaying clinically significant aggression/temper, self‐injury and screaming were significantly more likely to have a concurrent sleep problem, and these forms of challenging behaviour were significantly more severe in the sleep problem group. Associations between sleep problems and daytime challenging behaviour exist in this population, although the nature of any links remains unclear and should be the attention of future research.
An Italian–Australian comparison of quality of life among people with intellectual disability living in the community
Authors: Verri A. , Cummins R. A. , Petito F. , Vallero E. , Monteath S. , Gerosa E. , Nappi G.
Published: March 2003

This paper reports the measurement of both objective and subjective quality of life in samples of people either with intellectual disability or from the general adult population, drawn from Australia and Italy. Measures were made using the Comprehensive Quality of Life Scale. Generally, it was found that the scores for all groups were comparable. This finding is consistent with the provision of generally decent objective living conditions in both countries and subjective well‐being homeostasis, wherein subjective quality of life is held within a predictable range. These results are discussed in the context of measurement difficulties imposed by the need for simple Likert scales and subjective data which are strongly negatively skewed.
Strategic planning and progress under the All Wales Strategy: reflecting the perceptions of stakeholders
Authors: Todd S. , Felce D. , Beyer S. , Shearn J. , Perry J. , Kilsby M.
Published: March 2003

Nominated representatives from the various stakeholder interests, i.e. social services, health, education, voluntary organizations, parent groups and self‐advocacy groups, involved in the implementation of the All Wales Strategy for the development of services for people with intellectual disability were interviewed 2 years after the end of the initial 10‐year phase. Interviewees were asked to reflect on the strengths and weaknesses of policy implementation, including: changing priorities, planning arrangements, agency roles, central guidance and financial mechanisms, consumer participation, and the impact of more recent policy or structural developments. Despite recognition of the leadership of the Welsh Office, the shift in thinking achieved, the developments made in joint agency collaboration and in consumer participation in planning, and an increasing competence to plan effectively over time, the overriding perception was that more could have been made of the opportunity afforded by the clearest and best resourced central government policy within the UK in this area. At the heart of this judgement lay concerns about pragmatic rather than strategic planning, a failure to link annual service developments to a final comprehensive end point and a related failure to integrate planning to meet community needs with hospital resettlement. Factors which may have contributed to these weaknesses are discussed, as are lessons for subsequent community care policy.
Behavioural and emotional difficulties in students attending schools for children and adolescents with severe intellectual disability
Authors: Cormack K. F. M. , Brown A. C. , Hastings R. P.
Published: March 2003

Background For several decades, researchers and clinicians have been aware of an increased prevalence of psychiatric disorder in children with intellectual disability. However, there are few research studies exploring this issue.

Methods The parents of 123 children attending schools for children with ‘severe learning difficulties’ completed the Developmental Behaviour Checklist (DBC) in order to identify those children with clinically significant behavioural and emotional problems. Comparisons were made with norms for the DBC and a range of child variables were investigated as possible correlates of disorder.

Results Some 50.4% of the children scored above the cut‐off on the DBC for psychiatric disorder. The child's severity of physical disability was related most strongly to parental ratings of behavioural and emotional problems. There were also effects for the child's age and the absence of Down's syndrome.

Conclusions The present study confirms previous research findings of a high prevalence of behavioural and emotional difficulties amongst children with intellectual disability, and identifies a number of correlates of disorder which require further investigation.
Continuity and change in the use of residential services by adults with intellectual disability: the Aberdeen cohort at mid‐life
Authors: May D. , Hogg J.
Published: March 2003

The present paper reports a follow‐up study of a representative cohort of people with intellectual disability, now in middle age, who entered adult services on leaving school in the late 1960s, and whose adult years have coincided with a period of radical policy change and considerable service expansion. The present authors focus on the changes which have taken place in their use of residential services over this period. Firstly, the situation in early adulthood when they were last studied is examined. At this time, 60% of the cohort were still living at home, almost all with both parents. The remaining 40% were in institutions, mainly long‐stay mental handicap hospitals. Out‐of‐home placement is associated with gender (maleness), challenging behaviour, and the absence of one or both parents. The present authors compare this with the situation 20 years later. The most significant change in this time is the expansion of the community sector, accounting for about half of the surviving cohort, with numbers still at home or in hospital correspondingly reduced. Almost half of the cohort had experienced little or no change in residential situation. On average, they were less intellectually and socially able than those who had moved into community provision.
General practitioners’ perception of their role in care for people with intellectual disability
Authors: Dovey S. , Webb O. J.
Published: March 2003

The present study set out to determine general practitioners’ (GPs’) view of their role in the care of people with intellectual disability who live in the community, and to explore the special issues which providing this care raises for them. A postal questionnaire was sent to a random sample of 250 out of the 698 GPs in the southern region. Twenty statements were presented and participants indicated the extent of their agreement with each statement on a seven‐point Likert‐type scale. After each scaled response, an open‐ended question obtained a written expansion of the numerical response. These qualitative responses were analysed thematically, and combined with descriptive and cluster analyses of quantitative responses to provide a robust assessment of the characteristics of respondents providing contrasting replies. The role of GPs as part of the group of carers for people with intellectual disability was well recognized. Their normal practice routines may not always be adequate because of the small number of patients an individual GP might care of and their lack of explicit training in the special medical needs of such people.
Hidden psychiatric morbidity in a vocational programme for people with intellectual disability
Authors: Salvador‐Carulla L. , Rodríguez‐Blázquez C. , De Molina M. Rodríguez , Pérez‐Marín J. , Velázquez R.
Published: March 2003

The aim of the present study was to assess the point‐prevalence of psychiatric disorders according to DSM‐III‐R criteria and the hidden morbidity in individuals with intellectual disability working in a vocational setting. The present study was carried out in a vocational centre in Southern Spain which is considered to be a model for social integration. One hundred and thirty workers with intellectual disability were interviewed by two experienced clinicians using the Assessment and Information Rating Profile, DSM‐III‐R criteria, and the General Assessment of Functioning and Clinical Global Impression scales. The point‐prevalence of psychiatric morbidity, hidden morbidity and treatment adequacy were estimated. Morbidity was hidden (i.e. not previously diagnosed) in 50% of psychiatric cases. Forty‐two (32.3%) subjects had a psychiatric diagnosis with the following distribution: schizophrenia (17.7%), other psychotic disorders (9.23%), mood disorders (4.61%), adaptive disorders (2.31%), anxiety disorders (1.54%) and other psychiatric disorders (6.15%). Treatment was judged inadequate in 30% of subjects. The point‐prevalence of psychiatric problems in a vocational setting in Spain was similar to that found in other environments. Hidden morbidity was similar to that found in primary care. The present study highlights the need for standardized instruments for psychiatric assessment in non‐clinical settings as well as specific training in this area.
Working in the public and private domains: staff management of community activities for and the identities of people with intellectual disability
Authors: Todd S.
Published: March 2003

In addition to describing how the concept of stigma continues to be a pervasive influence in encounters between people with intellectual disability and others, the present study suggests that the management of this situation has passed into the control of care staff. An ethnographic study of young adults and community relationships suggests that the activities of staff are crucial in shaping the social profile of people with intellectual disability. The views of care staff about the taken‐for‐granted rights which characterize presence and participation in the community domain encourage them to adopt a semi‐insulation approach to their work. Staff extend this approach by adopting information control strategies to conceal important information from students. The present author argues that there is a need for on‐going research into staff activity in the community domain.
Helicobacter pylori: Has the killer escaped from the institution? A possible cause of increased stomach cancer in a population with intellectual disability
Authors: Duff M. , Scheepers M. , Cooper M. , Hoghton M. , Baddeley P.
Published: March 2003

Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointestinal tract malignancy, and previous research showing higher‐than‐expected gastrointestinal tract malignancy in institutionalized adults with intellectual disability (ID) prompted a review of all deaths as a result of cancer in the Stoke Park group of hospitals for people with ID between 1946 and 1996. A 50‐year, retrospective case note analysis of all deaths from cancer in an institution for people with ID was undertaken. Death from stomach cancer accounted for up to 48% of all cancer deaths. A further 25 residents had died of perforated stomach ulcers. The higher proportion of deaths specifically caused by stomach cancer in a population with ID has not been noted previously. It is postulated that the high levels of H. pylori infection found in institutionalized populations may be instrumental in this higher mortality rate and that the closure of the institutions without evaluation of H. pylori status transfers the problem unresolved to the community. Existing guidelines for the screening and eradication of H. pylori developed for the general population are inadequate when applied to people with ID, and therefore, the value of population screening and mass eradication programmes is explored.
Abilities underlying decoding differences in children with intellectual disability
Authors: Conners F. A. , Atwell J. A. , Rosenquist C. J. , Sligh A. C.
Published: March 2003

Researchers in recent years have made much progress towards understanding why some children struggle to learn to read. However, little of this research has involved children with intellectual disability associated with an IQ < 70 (ID, also called mental retardation). In the present analysis, the authors examined cognitive similarities and differences between stronger and weaker decoders, all of whom have ID. The 65 children with ID in the present analysis were initially referred by their teachers for a study that involved training basic phonological reading skills. The present analysis compares 21 children who were excluded from the training study because their decoding skills were already too high with 44 children whose decoding skills were low enough for the training study. The groups were compared on general intelligence, language ability, phonemic awareness and phonological memory. Initial analyses showed that the stronger decoders were significantly better than weaker decoders in language ability, phonemic awareness and rehearsal in phonological memory, but not in intelligence. They were also significantly older than weaker decoders. When age was covaried out, the groups differed significantly only in rehearsal in phonological memory, although the difference for phonemic awareness was marginally significant when the poorest performers were excluded. When intelligence is substantially limited, the ability to rehearse or refresh phonological codes in working memory plays a major role in determining children's success in learning to read. This ability appears to be more important than intelligence, language ability and phonemic awareness. It is possible that the reason the phonemic awareness measure was not as good at distinguishing the groups as the phonological rehearsal measure was because the former did not involve assembling phonological output. It is suggested that it is the combination of poor phonological representation and poor phonological output assembly that makes decoding difficult for some children with ID.
Cancer incidence among people with intellectual disability
Authors: Patja K. , Eero P. , Iivanainen M.
Published: March 2003

The aim of the present study was to address the unresolved question of the risk of neoplasms among people with intellectual disability (ID). A total of 2173 individuals with ID from a large, representative, nation‐wide population study conducted in Finland in 1962 were followed‐up for cancer incidence between 1967 and 1997. Standardized incidence ratios (SIRs) were defined as ratios of observed to expected numbers of cancer cases. Expected rates were based on national incidence rates. The observed number of cancers in the cohort (173) was close to what was expected [SIR = 0.9, 95% confidence interval (95% CI) = 0.8–1.0]. There was a significantly reduced risk of cancers of the prostate (SIR = 0.2, 95% CI = 0.0–0.5), urinary tract (SIR = 0.3, 95% CI = 0.1–0.7) and lung (SIR = 0.6, 95% CI = 0.4–1.0). The risk was increased in cancers of the gallbladder (SIR = 2.8, 95% CI = 1.1–5.8) and thyroid gland (SIR = 2.1, 95% CI = 1.0–4.8). The risks of lung and gallbladder cancer were lowest and highest, respectively, in those subjects with profound and severe ID, a group who also had significantly elevated SIRs for brain cancer (SIR = 3.46, 95% CI = 1.5–14.4) and testicular cancer (SIR = 9.9, 95% CI = 1.2–35.6). The incidence of cancer among people with ID was comparable with the general population, despite their low prevalence of smoking and apparently decreased diagnostic screening activity. Nevertheless, a few types of cancer carry a higher risk in the population with ID, possibly because of conditions typical among this group, such as gallstones or oesophageal reflux.
Behavioural and emotional problems in children with intellectual disability attending special schools in Cape Town, South Africa
Authors: Molteno, G. , Molteno, C. D. , Finchilescu G. , Dawes A. R. L.
Published: March 2003

A sample of 355 children with intellectual disability (ID) attending special schools in Cape Town, South Africa, were assessed on the Developmental Behavioural Checklist – Teacher Version (DBC‐T). A prevalence rate of 31% for psychopathology was found. Boys manifested more behaviour problems than girls, especially in relation to disruptive, self‐absorbed and antisocial behaviours. Children with severe and profound levels of ID showed more behavioural difficulties than those in the mild and moderate categories. Specific behaviour problems were self‐absorbed and autistic behaviours in children with profound ID, communication problems and anxiety in those with severe ID and antisocial behaviour in children with mild ID. Epilepsy, but not cerebral palsy was associated with higher total behaviour scores. Ambulant children were more disruptive and antisocial, while non‐ambulant children were more anxious. Non‐verbal children had higher scores on all of the subscales except for disruptive behaviour.
Subjective judgements of quality of life: a comparison study between people with intellectual disability and those without disability
Authors: Hensel E. , Rose J. , Kroese B. Stenfert , Banks‐Smith J.
Published: March 2003

Background The present study investigated the relationship between objective and subjective measures of quality of life (QoL), and in particular, health status and primary care services.

Methods Thirty‐one people with intellectual disability (ID) were interviewed using a QoL questionnaire. Thirty‐one matched controls from the general population filled in a parallel questionnaire.

Results The results in both groups support the findings of many researchers which indicate that satisfaction with aspects of life is generally high (i.e. ≈ 75% of maximum possible satisfaction). The present study also confirms previous findings which indicate that satisfaction with aspects of life does not generally correlate with objective circumstances in either group. The importance that people attach to aspects of their lives did not generally correlate with their objective circumstances or their satisfaction with life. However, people with ID attached greater importance to all aspects of their lives than those without disability. This may be linked to their aspirations, preferences and opportunities for choice, and therefore, these factors may be a more meaningful way of considering their QoL.

Conclusions The present findings call into question the use of satisfaction as a general measure of QoL, and also indicate that the use of importance as a mediating variable in understanding satisfaction may not be a solution. The participants with ID had poorer health than the controls, and were significantly less satisfied with their health. Contrary to other findings, the present participants with ID reported that they had received more health checks than the controls over the previous year. Half of these checks had been carried out by ‘special’ services rather than primary care services.
Contraception of women with intellectual disability: prevalence and determinants
Authors: Servais L. , Jacques D. , Leach R. , Conod L. , Hoyois P. , Dan B. , Roussaux J. P.
Published: March 2003

Background The contraception of women with intellectual disability (ID) is a major concern for caregivers. However, the prevalence of contraception and the frequency of use of different methods (e.g. sterilization) remain generally unknown. Moreover, indications specific to women with ID are controversial.

Methods The present authors conducted a population‐based study among 97% of the women with ID aged between 18 and 46 years attending government‐funded facilities in Brussels and the nearby province of Walloon Brabant in Belgium.

Results Out of 397 subjects, 40.8% did not use any contraceptive method, 22.2% were sterilized, 18.4% used an oral contraceptive agent, 17.6% used depotmedroxyprogesterone acetate and 1% used an intrauterine device. These figures differ widely from those of the general Belgian population. Binary logistic regression for ‘contraceptive utilization’ showed the strong influence of institutional factors such as sleeping environment (i.e. institutional or parental), sexual relationship policy and contraception policy. Having or having had a boyfriend is also correlated with a stronger probability of contraceptive use. Other factors have a smaller influence (e.g. a milder level of ID). Very few factors, none of which are medical, are correlated with an increased use of a specific method. The present results are discussed in the light of the general medical application of contraception and the commonly assumed specific indications for women with ID.
Changes in explicit memory associated with early dementia in adults with Down’s syndrome
Authors: Krinsky‐McHale S. J. , Devenny D. A. , Silverman W. P.
Published: March 2003

Background

A modified version of the Selective Reminding Test (SRT) (Buschke 1973) was used to examine the changes in memory that occur with early‐stage dementia of the Alzheimer’s type (DAT) in adults with intellectual disability (ID) and Down’s syndrome (DS), and to compare these changes to those occurring with ‘normal’ ageing.

Method

Hierarchical linear modelling analyses showed steep declines in the performance of participants who had met the criteria for the onset of DAT. Non‐demented participants also showed declines in performance which were related to their age. However, the absolute magnitude of these declines was consistent with a ‘normal’ ageing pattern and not with undetected dementia.

Results

In analysing the specific memory components that are compromised, the present authors found that participants with early‐stage DAT showed severely diminished long‐term storage and retrieval processing abilities compared to their non‐demented peers. Notably, these declines preceded other symptoms of dementia, in most cases by more than a full year and sometimes by as much as 3 years.

Conclusions

Thus, the present results clearly confirm that memory processes are affected during early dementia in adults with DS, and that the SRT has promise as a clinical tool.
Feasibility, reliability and validity of the Spanish version of Psychiatric Assessment Schedule for Adults with Developmental Disability: a structured psychiatric interview for intellectual disability
Authors: Gonzalez‐Gordon R. G. , Salvador‐Carulla L. , Romero C. , Gonzalez‐Saiz F. , Romero D.
Published: March 2003

Background Over 30% of people with intellectual disability (ID) have a comorbid psychiatric disorder. However, there are few assessment instruments available for international use and cross‐cultural validation studies of these instruments are rare. The aim of the present study was to standardize the Spanish version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS‐ADD‐10), a semi‐structured interview for people with ID.

Methods After a conceptual translation, feasibility (i.e. applicability, acceptability and practicality) and reliability analyses were carried out. The predictive validity of the PAS‐ADD‐10 CATEGO‐5 codings was also examined (i.e. positive and negative predictive values). Four independent raters with wide‐ranging experience in quantitative evaluation and psychiatric assessment of ID evaluated a sample of 80 subjects with ID and borderline intellectual functioning at the AFANAS occupational centre in Jerez, Southern Spain. The ICD‐10 codes were used for psychiatric diagnosis.

Results The practicality of the PAS‐ADD‐10 is limited because of the need for previous standardization of SCAN interviews. Nevertheless, its overall feasibility was judged adequate by raters and the PAS‐ADD‐10 was considered extremely useful for training. Test–retest and inter‐rater reliability kappa values were moderate to high. The CATEGO coding showed limited validity because of overdiagnosis of anxiety disorders and underdiagnosis of mood and psychotic disorders (positive predictive value = 74%, negative predictive value = 76%).

Conclusions The PAS‐ADD‐10 is a useful tool for standard psychiatric assessment of people with ID; however, CATEGO codings show low validity and a series of modifications should be considered before this instrument is used extensively in Spain. In this regard, a study on the clinical usefulness of the PAS‐ADD‐10 in patients with ID and severe mental disorders has been undertaken.
Motion analysis of stereotyped hand movements in Rett syndrome
Authors: Wright M. , Van Der Linden M. L. , Kerr A. M. , Burford B. , Arrowsmith G. , Middleton R. L.
Published: March 2003

BackgroundRett syndrome is a genetic developmental disorder, and stereotyped hand movements are a striking feature of this condition. The aim of the present study was to subject these movements to objective analysis and compare the results in one girl at different ages.

MethodThe hand movements of a 10‐year‐old girl with Rett syndrome were subjected to accurate, three‐dimensional (3D) computerized motion analysis and compared to two‐dimensional (2D) video analysis of the same girl at 3 years of age.

ResultsThree‐dimensional computerized analysis revealed regular patterns with strong coupling between the hands. Frequency analysis showed a dominant frequency at 1.2 Hz, with a higher component at 2.4 Hz that may relate to the activity of basic rhythm generators. The same coupling characteristics were extracted from standard, 2D video recordings made at the same time as the 3D capture.

ConclusionAn informal video of the same girl taken when she was 3 years of age was analysed in the same way as the 2D video and showed the same characteristics, indicating the possible future use of automated video analysis for early screening and intervention evaluation.
Determinants of negative emotional reactions and causal beliefs about self‐injurious behaviour: an experimental study
Authors: Hastings R. P. , Tombs A. K. H. , Monzani L. C. , Boulton H. V. N.
Published: March 2003

Background  Caregivers’ emotional and cognitive reactions to challenging behaviours have been identified as potential determinants of their reinforcing responses towards such behaviours. However, few studies have explored factors affecting caregivers’ emotional and cognitive responses to challenging behaviours.

Methods  Sixty students inexperienced in work with people with challenging behaviours and 60 experienced staff watched one of two carefully matched, acted videotapes depicting self‐injury maintained by attention or escape‐from‐task demands. The participants were also told whether the self‐injury depicted typically led to mild or severe consequences for the person filmed. The subjects completed measures of their negative emotional reactions to the self‐injury and their behavioural causal beliefs about the behaviour depicted.

Results  Analyses of variance revealed that students reported more negative emotional reactions and were less likely to endorse behavioural causal hypotheses. Those who watched the severe self‐injury videotape also reported more negative emotional reactions. Two effects of the behavioural function of the depicted self‐injury were also found: (1) attention‐maintained self‐injury was associated with higher levels of endorsement of behavioural causal hypotheses; and (2) severe attention‐maintained self‐injury led to the strongest negative emotional reactions, but only from students.

Conclusions  The effects of experience and behavioural function on emotional reactions and behavioural causal beliefs need to be explored in more detail in future research. If replicated, the present results have significant implications for theory and practice in the remediation of challenging behaviours and the support of care staff.
Has hospital mortality from acute myocardial infarction been markedly reduced since the introduction of thrombolytics and aspirin?
Authors: Reikvam  , Abdelnoor  , Sivertssen
Published: March 2003

Reikvam Å, Abdelnoor M , Sivertssen E for the European Secondary Prevention Study Group (Ullevål University Hospital, Oslo, Norway). Has hospital mortality from acute myocardial infarction been markedly reduced since the introduction of thrombolytics and aspirin?J Intern Med 1998; 243: 259–63.

Objectives

There are conflicting views on how hospital mortality with respect to acute myocardial infarction (AMI) has changed since the introduction of thrombolytics and aspirin. Our purpose therefore was to explain this by studying hospital mortality in a nonselected AMI population, and then assess how patients allocated to different treatment groups contribute to overall mortality.

Design

Extensive data were collected on all AMI patients admitted to the 10 hospitals in health region 1 (population 850 000) in Norway during a 2 month period. A protocol approved by the European Secondary Prevention Study Group was used.

Results

Of the 487 patients, 32% received thrombolytics, 72% aspirin and 22% none of the treatments. Average in‐hospital mortality was 18%. Mortality within the different groups was as follows: no thrombolytics nor aspirin group 35.0% (39/111), aspirin group 13.7% (30/218), thrombolytics group 17.3% (4/23), and thrombolytics plus aspirin group 11.0% (15/135). The characteristics of the non‐treated group compared to the aspirin and aspirin plus thrombolytics groups were more females, older, increased frequency of previous AMI, left ventricular failure, cardiopulmonary resuscitation, history of stroke and peptic ulcer, and electrocardiogram (ECG) findings other than ST elevation.

Conclusion

In a nonselected AMI population, a patient group receiving neither thrombolytics nor aspirin contributed most significantly to an overall high mortality. This indicates a modest reduction in total AMI mortality after the new therapies were introduced, as the mortality for this group, with a high risk profile, has presumably remained unchanged.
Associations between aldosterone synthase gene polymorphism and the adrenocortical function in males
Authors: HAUTANEN A. , HAUTANEN A. , LANKINEN L. , KUPARI M. , JÄNNE O. A. , ADLERCREUTZ H. , NIKKILÄ H. , WHITE P. C.
Published: March 2003

. Hautanen A, Lankinen L, Kupari M, Jänne OA, Adlercreutz H, Nikkilä H, White PC (Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland. University of Texas Southwestern Medical Center, Dallas, TX, USA). Associations between aldosterone synthase gene polymorphism and the adrenocortical function in males. J Intern Med 1998; 244: 11–18.

Objectives

Two diallelic polymorphisms, one in the transcriptional regulatory region (promoter) and the other in the second intron, have been identified in the aldosterone synthase (CYP11B2) gene encoding aldosterone synthase, the enzyme catalysing the last steps of aldosterone biosynthesis. We have examined the associations between these genetic variations and adrenocortical function in a cohort of Finnish males.

Design

A cross‐sectional study.

Setting

Helsinki University Central Hospital, Finland.

Subjects

Ninety‐two males aged 30–55 years.

Main outcome measures

Basal adrenocortical function was assessed by measuring urinary excretion of aldosterone and cortisol. Functional activity was determined by responses of several adrenal steroids to dexamethasone suppression followed by ACTH stimulation. Polymerase chain reactions were used to identify the polymorphisms in the CYP11B2 gene.

Results

The –344TT genotype group in the CYP11B2 promoter had lower systolic blood pressures (P= 0.039), but higher urinary aldosterone excretion (P= 0.016), and 11‐deoxycortisol responses to ACTH stimulation (P= 0.021) than the –344CC genotype group. Urinary aldosterone excretion (P= 0.033), 11‐deoxycortisol (P= 0.026), and aldosterone (P= 0.013) responses to ACTH were higher in the intron 2 conversion than the nonconversion genotype groups.

Conclusions

Polymorphisms in or near the aldosterone synthase gene are associated with variations in aldosterone and 11‐deoxycortisol production in males. This may modulate the activity of the renin–angiotensin system and thereby contribute to blood pressure regulation.
Seasonal changes in symptomatic duodenal ulcer activity in Taiwan: a comparison between subjects with and without haemorrhage
Authors: Tsai  , Lin
Published: March 2003

Abstract. Tsai C‐J, Lin C‐Y (Chi Mei Foundation Hospital, Tainan, Taiwan). Seasonal changes in symptomatic duodenal ulcer activity in Taiwan: a comparison between subjects with and without haemorrhage. J Intern Med 1998; 244: 405–10.

Objectives

To examine if climatic changes may influence the presentation of pain and haemorrhage in patients with duodenal ulcers.

Design

Cross‐sectional study.

Setting

Tertiary referral centre.

Subjects

A total of 10 331 symptomatic duodenal ulcer diseases were diagnosed from 1989 to 1996. The patients who had any extrinsic factors that might influence the exacerbation of duodenal ulcer were not included. Patients were divided into those whose ulcer bled once or repeatedly as distinct from those whose ulcers caused pain without haemorrhagic complications. Patients with acute cholangitis diagnosed in the same period were studied as controls.

Results

During the 7‐year period, 10 331 symptomatic duodenal ulcer diseases were diagnosed. Amongst these, 5328 showed active duodenal ulcer without haemorrhage, 2088 showed acute duodenal ulcer with stigmata of recent haemorrhage, and 2915 showed a deformed bulb. The incidence of total duodenal ulcers showed significant monthly variation and was found to be more common from November to March (P < 0.001). The monthly incidence of total episodes of upper gastrointestinal tract bleeding peaked from November to March (P < 0.001) with significant variation. The monthly incidence of bleeding episodes from duodenal ulcer only was the same (P < 0.001). In patients whose duodenal ulcers repeatedly caused pain without haemorrhage, there were significant monthly fluctuations, with peak months from December to March (P < 0.001). In the control diagnosis, there were no significant calendar variations (P = 0.85).

Conclusions

Our study has shown that both groups of patients demonstrated similar monthly fluctuations. The incidence is significantly higher during the cold seasons. These data suggest that climatic changes may influence the presentation of pain and haemorrhage in duodenal ulcer patients.
A nurse‐managed weight reduction programme for obstructive sleep apnoea syndrome
Authors: Lojander  , Mustajoki  , Rönkä  , Mecklin  , Maasilta
Published: March 2003

Lojander J, Mustajoki P, Rönkä S, Mecklin P, Maasilta P (Helsinki University Central Hospital, Helsinki, Finland). A nurse‐managed weight reduction programme for obstructive sleep apnoea syndrome. J Intern Med 1998; 244: 251–55.

Objectives

This longitudinal, clinical intervention study was designed to investigate whether pulmonary departments can set up a cost‐effective weight and lifestyle programme as primary treatment of obstructive sleep apnoea syndrome (OSAS).

Setting

A weight reduction programme (1 year) in a pulmonary department for outpatients in Helsinki University Central Hospital.

Subjects

A total of 24 (23 men) moderately obese (body mass index [BMI], 30–40 kg m−2) patients with newly diagnosed OSAS.

Interventions

The first 6 weeks consisted of a very low‐calorie diet (VLCD, 500 kcal day−1) and thereafter normal food low in calories. There were altogether 12 group meetings for behavioural management.

Main outcome measures

Daytime somnolence, BMI and oxygen desaturation index of 4% (ODI4) were measured prior to the programme, at the end of the VLCD phase and at 1 year.

Results

The programme was easy to administer without any serious side‐effects. At 1 year, patients had lost a mean of 33% of their overweight (mean weight at baseline 110 kg, after 99 kg) and their ODI4 indexes improved significantly (P < 0.005). There was no correlation between the amount of weight loss and improvement in ODI4 indexes. The cost per patient was about half the cost of treatment with nCPAP (nasal continuous positive airway pressure) for 1 year at our hospital.

Conclusions

A nurse‐managed programme with VLCD and behavioural management is safe and effective on an outpatient basis. Weight loss should be encouraged in OSAS in patients with moderate overweight. The amount of weight loss needed for improvement of OSAS is unique to each individual.
Short stature and prognosis of coronary heart disease in women
Authors: Wamala S. P. , Mittleman M. A. , Horsten M. , Schenck‐Gustafsson K. , Orth‐Gomér K.
Published: March 2003

Objectives.  To investigate the effect of short stature on prognosis following an acute event of coronary heart disease (CHD) in women.

Setting.  All women who were hospitalized for an acute event of CHD in any of the 10 cardiology clinics in greater Stockholm were investigated for the first time in the Stockholm Female Coronary Risk Study between 1991 and 1994, and were followed until August 1997 for recurrent coronary events.

Design.  A follow‐up study of women with either acute myocardial infarction (AMI) or unstable angina pectoris. Median follow‐up period was 4.8 years.

Subjects.  A total of 292 Swedish women, aged 65 years or younger.

Main outcome measures.  Recurrent AMI, death from CHD or revascularization procedure (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting).

Results.  Independent of the confounding effects of other risk factors of clinical importance for CHD (age, socioeconomic status, menopausal status, index event, congestive heart failure, angina severity, diabetes, hypertension, smoking, triglycerides and HDL cholesterol), the shortest 25% of women (< 160 cm) had a 2.1‐fold (95% CI = 1.0–4.4) increased rate of developing adverse cardiac events (cardiovascular death, recurrent AMI or revascularization procedure) compared with the tallest 25% (> 165 cm). In addition, an increased rate was observed for each 10 cm difference in height (hazard ratio = 1.7, 95% CI = 1.4–2.7). Similar results were observed when analysing each outcome separately.

Conclusions.  These data indicate that short stature is a strong predictor of poor prognosis after an acute coronary event in women, independent of socioeconomic status and other risk factors for CHD.
Oral anticoagulation in peripheral vascular surgery: how intense, for how long, or at all?
Authors: Kretschmer G. , Hölzenbein T. J.
Published: March 2003

To evaluate the influence of postoperative pharmacotherapy (antiplatelet therapy with acetylsalicylic acid (ASA) or oral anticoagulation) following various peripheral vascular surgical interventions (femoro‐popliteal reconstruction, femoro‐popliteo‐tibial venous bypass;) two clinical series of patients were analysed (A1–2) and we made the hypothesis that adjuvant therapy may be beneficial. Thereafter two clinical trials were carried out (B1–2), to assess the value of postoperative antiaggregant and anticoagulant treatment. It was not possible to demonstrate any influence of ASA on improving patency at the iliaco‐popliteal level or on patient survival. It was concluded that the ASA dosage of 1500 mg daily was too high, and produced severe side‐effects, probably leading to insufficient patient compliance to therapy. In the B2 trial 130 patients received a femoro‐popliteal above‐ or below‐knee vein bypass, and were assigned to the therapy group (n = 66) and treated with anticoagulants or to the control group (n = 64) which received no therapy. During the follow‐up, for a maximum of 10 years, the probability of bypass function, limb salvage and patient survival were significantly in favour of the treatment. The described single centre clinical trial B‐2 produced in accordance with other trials a level II evidence in favour of postoperative pharmacotherapy. Level 1 trials assessing the direct comparison of antiaggregant versus anticoagulant therapy are underway, but results are unavailable yet, similarly the results of the Antithrombotic Trialist’s Collaboration (ATT) are currently unknown.