bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician knowledge, attitudes and practices regarding a widely implemented guideline
Authors: Ward Marcia M. , Vaughn Thomas E. , Uden‐Holman Tanya , Doebbeling Bradley N. , Clarke William R. , Woolson Robert F.
Published: March 2003

Rationale, aims and objectives Although clinical practice guidelines
have been promoted widely, there is considerable concern that physicians have not
incorporated them into their practice. Models suggest that a ‘knowledge–attitude–behaviour’
sequence is important in modifying physician practice patterns. To address this,
we examined physicians’ knowledge of, attitudes towards and compliance with
a widely implemented guideline – the Agency for Health Care Policy and Research
(AHCPR) smoking cessation guideline. Methods A survey was mailed to a random
sample of physicians at 128 veterans health administration facilities, which had
implemented the guideline 2 years previously. Results Completed surveys
were received from 879 physicians (50.3% response rate). Only 26%
of physicians reported receiving a copy or summary of the guideline, 44%
reported little or no familiarity with it, 42% did not know if they agreed
with it, 40% did not know if they complied with it and 46% did not
know if it was effective. However, a high percentage of physicians reported that
they always or usually explain the health risks of smoking (86%) and that
they always or usually suggest that their smoking patients stop (94%). Conclusions In spite of little familiarity with the guideline, the responding physicians reported practice patterns consistent with adherence to it. Knowledge is only one of a spectrum of barriers that affects physician adherence to guidelines. There are numerous opportunities for health care organizations to overcome the barriers to physician adoption of clinical practice guidelines in their day‐to‐day practice.
Risk factors for spinal deformities in Atlantic salmon, Salmo salar L.
Authors: Vågsholm  , Djupvik
Published: March 2003

Risk factors for spinal deformities or short tails in Atlantic salmon, Salmo salar L., were examined in a cohort study in Hordaland County of Norway, in which 177 slaughter groups consisting of 5000 salmon were followed from sea water introduction in April 1994 until slaughter in February 1996. If the smolt weight increased from 0.05 to 0.1 kg, the risk of spinal deformities decreased (relative risk, RR = 0.2). An increased period from smolt vaccination to seawater introduction of from 2 to 5 months was associated with an increased risk (RR = 1.6). Salmon reared in fjord sites were at higher risk for spinal deformities (RR = 1.9) than those reared in oceanic sites, possibly due to the larger variation in salinity and temperatures in the fjord sites. Rapidly growing salmon were at lower risk of spinal deformities at slaughter (RR = 0.2), and they were likely to be slaughtered earlier, which could explain the observed lower risk for salmon slaughtered in June (RR = 0.4). Moreover, the findings concerning egg suppliers could indicate a possible role of genetic factors in the aetiology of spinal deformities.
An amoeba associated with gill disease in turbot, Scophthalmus maximus (L.)
Authors: Leiro  , Paniagua  , Ortega  , Paramá  , Fernández  , Sanmartín
Published: March 2003

An amoeba associated with a severe gill disease affecting farmed turbot, characterized by pronounced hyperplasia of the branchial epithelia and accumulation of mucus between the secondary lamellae, is described for the first time. The amoeba was isolated, cloned and cultured on Bactoagar. Light microscopy showed that trophozoites had a mean length of 12 μm (range 8–20 μm), with a nucleus 3–5 μm in diameter containing a large central nucleolus 1–3 μm in diameter. Transmission electron microscopy showed that the mitochondria, Golgi bodies, rough endoplasmic reticulum, microfilaments, cytoplasmic microtubules and glycocalyx were similar to those previously reported for the genus Platyamoeba. These and other findings strongly suggest that the amoeba isolated is of the genus Platyamoeba, while its morphometric characteristics suggest that it may represent a new species. This is the first report of a species of the genus Platyamoeba in association with gill disease in turbot.
Branchiomyces infection in farm‐reared channel catfish, Ictalurus punctatus (Rafinesque)
Authors: Khoo L. , Leard A. T. , Waterstrat P. R. , Jack S. W. , Camp K. L.
Published: March 2003

Four cases (representing outbreaks in four different ponds on three farms) of branchial mycosis caused by Branchiomyces spp. were identified in channel catfish fry during the summer of 1996. Mortalities ranged from a few hundred to several thousand fish per pond. Significant gross and histopathological findings from these four cases were limited to the gills. All fry examined had fungal mycelia that were mainly but not entirely confined to the base of the primary lamellae and the gill arches. These fungal hyphae were intravascular and occluded vessels in the gill tissues. The present paper describes the fungal characteristics and pathology of branchial mycosis caused by Branchiomyces spp. in channel catfish.
Influence of water quality and temperature on adhesion of high and low virulence Flavobacterium columnare strains to isolated gill arches
Authors: Decostere A. , Haesebrouck F. , Turnbull J. F. , Charlier G.
Published: March 2003

The ability of Flavobacterium columnare (Flexibacter columnaris) to attach to the gills of common carp, Cyprinus carpio L., was evaluated using a gill perfusion model. A comparison between a high and a low virulence strain of F. columnare was made and evaluated in comparison to results obtained previously with an in vivo model. The ion composition of the water of the organ bath in which the gills were suspended was varied and the influence on adhesion processes assessed. Experiments were carried out to examine the influence of water quality (i.e. nitrite and organic matter) and temperature on the capacity of the bacteria to adhere. It was found that the high virulence strain adhered more readily than the low virulence strain, as was found during the in vivo experiments. Moreover, it was observed that adhesion of the high virulence strain was enhanced by a number of factors. These were immersion of the gill in bivalent, ion‐rich water, the presence of nitrite or organic matter, and high temperatures.
Effects of thermal stress on skin defence lysins of European eel, Anguilla anguilla L.
Authors: Aranichi F. , Mano N. , Nakane M. , Hirose H.
Published: March 2003

Fish skin contains a variety of humoral defence lysins which have an integral role in fish immunity because of the ability of these proteins to destroy invading substances ( Alexander & Ingram 1992). These lysins generally comprise bacteriolysins, proteolysins and haemolysins. The lysins seem to be either individually or cooperatively stimulated to respond to pathogenic infection and environmental stress, such as ionic, osmotic, thermal and pollution stress (
Shephard 1994;
Rice, Kergosien & Adams 1996;
Bly, Quiniou & Clem 1997). There have only been a few reports on these lysins (
Al‐Hassan, Thomson, Ali & Criddle 1987;
Aranishi, Mano, Nakane & Hirose 1998). The present paper describes thermal effects on defence lysis, such as proteolysis, bacteriolysis and haemolysis, in the skin of the European eel, Anguilla anguilla L.
Distended, water‐filled stomach in seawater farmed rainbow trout, Oncorhynchus mykiss (Walbaum), provoked experimentally by osmoregulatory stress
Authors: Rørvik K‐A. , Skjervold P O. , Fjæra S O. , Steien S H.
Published: March 2003

The present study evaluates if abdominal dis‐tension caused by a water‐filled stomach in seawater farmed rainbow trout, Oncorhynchus mykiss (Walbaum), and Atlantic salmon, Salmo salar L., could be provoked experimentally by live chilling in sea water (0.5 °C). Fifty rainbow trout and 50 salmon were visually classified, either as normal or suffering from the condition. Prior to chilling, no rainbow trout or salmon suffered from a water‐filled stomach. During chilling, 25% of the rainbow trout and 2.5% of the salmon developed water‐filled stomach. Affected rainbow trout had significantly higher blood plasma osmolality and significantly lower body weight than normal trout. The frequency of trout with a water‐filled stomach increased significantly with increasing chilling time and increasing plasma osmolality. The regression coefficients revealed that the proportion of affected rainbow trout in‐creased by 0.82% h−1 of chilling and by 0.46% per unit increase in mosmol L−1. The present study revealed that abdominal distension in seawater farmed rainbow trout was far more severe than in Atlantic salmon and could be provoked experimentally by osmoregulatory stress. This is consistent with the observation that water‐filled stomach appear only occasionally in seawater farmed Atlantic salmon.
Muscle infections in imported neon tetra, Paracheirodon innesi Myers: limited occurrence of microsporidia and predominance of severe forms of columnaris disease caused by an Asian genomovar of Flavobacterium columnare
Authors: Michel C , Messiaen S , Bernardet J‐F
Published: March 2003

Serious and repeated mortality recently experienced in imported neon tetra, Paracheirodon innesi Myers, by French ornamental fish traders and empirically ascribed to the microsporidian Pleistophora hyphessobryconis on the basis of clinical signs, was investigated. Although Pleistophora sp. spores were observed in a few cases, laboratory results demonstrated that similar clinical signs were generally caused by the pathogenic bacterium Flavobacterium columnare. In all cases, muscle was the main target tissue, and the most noticeable external signs were limited to fading of skin colouration and the development of white areas of necrosis. Three isolates were studied and typed by bacteriological tests and molecular techniques. Although their phenotypic characteristics were in accordance with F. columnare descriptions, except for higher optimal growth temperatures (18–30 °C), they all appeared to differ genetically from common European and American isolates and to be similar to Asian isolates recently assigned to a new genomovar by Japanese workers. Experimental infections suggested the isolates were highly virulent for ornamental species. The use of polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) for identification and detection of the agent in tissue samples, and the implications of this finding for health control management of imported fish and domestic species are discussed.
Characterization of β‐haemolytic Group B Streptococcus agalactiae in cultured seabream, Sparus auratus L., and wild mullet, Liza klunzingeri (Day), in Kuwait
Authors: Evans J J , Klesius P H , Gilbert P M , Shoemaker C A , Al Sarawi M A , Landsberg J , Duremdez R , Al Marzouk A , Al Zenki S
Published: March 2003

Streptococcus agalactiae was isolated from cultured gilthead seabream, Sparus auratus L., and diseased wild Klunzinger's mullet, Liza klunzingeri (Day), in Kuwait Bay, Arabian Gulf. Isolates were catalase negative, β‐haemolytic, Gram‐positive cocci and serogroup B. Experimental infectivity trials with mullet and seabream brain isolates in Nile tilapia, Oreochromis niloticus L., caused 100 and 90% mortality, respectively, within 7 days post‐inoculation indicating virulent S. agalactiae as the bacterial pathogen responsible for the epizootic in Kuwait Bay.
An intranuclear bacilliform virus associated with near extirpation of Austropotamobius pallipes Lereboullet from the Nant watershed in Ardéche, France
Authors: Edgerton B F , Watt H , Becheras J‐M , Bonami J‐R
Published: March 2003

White‐clawed crayfish, Austropotamobius pallipes, were endemic to the Nant watershed, Ardéche, France, until they were extirpated by epizootic mortality at the beginning of the twentieth century. A. pallipes were successfully reintroduced to the Nant watershed in the middle of the twentieth century. However, epizootic mortality was observed in the Nant watershed in the summer of 2000 during which time A. pallipes was extirpated from downstream regions. Dead and moribund crayfish were again detected in several episodes in summer 2001 and by October the range of A. pallipes was reduced to the headwaters of just one of the three streams in the watershed. Water quality for the watershed in summer 2001 was appropriate for crayfish habitation. Bacteriology and mycology on A. pallipes collected during several of the mortality episodes in 2001 failed to reveal a cause. However, histopathology revealed a high occurrence of intranuclear eosinophilic inclusions in hepatopancreatocytes of A. pallipes. The nuclei were hypertrophic and contained bacilliform virions consisting of a cylindrical nucleocapsid surrounded by a trilaminar envelope. Virions in section were approximately 63 × 258 nm and nucleocapsids were approximately 52 × 225 nm. It is unclear whether the intranuclear bacilliform virus was the cause of the mortality episodes or was a contributor to a disease complex involving one or several other undetected pathogens.
A review of the nutritional management of chyle leakage in adults
Authors: Bonner  , Warren
Published: March 2003

Background: Dietitians at the Oxford Radcliffe Hospital encountering the problem of chyle leakage found a lack of information regarding its dietetic management. This study was undertaken to review the literature and to survey current dietetic practice and medical opinion in the UK.
Methods: A postal survey of dietitians and clinicians in relevant specialities at hospitals involved in the clinical training of dietetic students (
n=110) was undertaken. The dietitians’ questionnaire examined knowledge and experience of chyle leakage, types of patients treated, dietary therapies employed, responsibilities for prescriptions and outcomes. A different questionnaire was used to assess clinician's opinions on appropriate management.
Results: A link between the origin of chyle leakage and the effectiveness of conservative management became apparent from the literature review. Conservative management appears to be most effective in chyle leakage associated with head and neck surgery, and least effective when chyle leakage is associated with malignancy.
Completed questionnaires were received from 336 dietitians in 90 training departments and 132 clinicians. Dietitians reported the use of a number of dietary therapies, including low‐fat diets. These ranged from minimal long chain triglycerides (LCT) to ‘standard‘ low‐fat diets. These were sometimes used in conjunction with medium chain triglycerides (MCT). The use of total parenteral nutrition (TPN) was also reported, either alone or in combination with a ‘low‐fat diet‘. No clear pattern emerged as to when a particular therapy was indicated or should be revised.
More than 70% of respondents to the medical survey considered there to be a role for conservative management in the treatment of chyle leakage. TPN appeared to be slightly favoured over minimal‐fat (LCT) diet.
Dietitians are hampered by the lack of consensus about the optimum nutritional therapy for this condition. This was reflected in the wide variation in the composition of reported dietary regimens. The majority of dietitians who had treated such patients reported the use of ‘low‐fat‘ diets, but only 5 (13%) respondents specified a level of fat restriction.
Conclusions: The literature suggests that TPN may be the most effective treatment for reducing chyle flow. However, given the risks of TPN an initial trial of minimal‐fat (LCT) diet plus MCT is warranted. The need for readily accessible practice guidelines for dietitians is apparent.
How drug therapy can affect, threaten and compromise nutritional status
Authors: White R. , Ashworth A.
Published: March 2003

Background and aims This article reviews the published literature on the mechanisms by which drugs alter nutrient intake and the interactions between drugs and nutrients. We aimed to examine evidence of nutrient deficiencies caused by drug therapy, to indicate groups of ‘at‐risk’ patients and suggestions made for practical methods of detection and intervention.

Methods Information was retrieved from a MEDLINE search of English language literature from 1963 to January 1999. Search terms included nutrient, deficiencies and interactions. Additional references were obtained from cross‐referencing related review articles and from pharmacology textbooks relating to interactions and side‐effects of drugs. All drugs are referred to by their generic names.

Results Drugs can reduce nutrient intake in several ways and can be broadly classified as: (i) drugs that reduce oral intake; (ii) drugs that alter nutrient absorption and (iii) drugs that affect nutrient metabolism. In this review the mechanisms by which drugs can alter nutritional status are discussed, with specific examples of drug therapy and associated symptoms of deficiencies.

Conclusions Patients at high risk of experiencing the effects of drug‐induced nutrient deficiencies are the elderly and chronically ill. Recommendations made for methods of intervention include counselling and annotations on drug prescriptions.
Children's perceptions of who controls their food
Authors: Robinson S.
Published: March 2003

Background The purpose of this study was to explore children's perceptions of who controlled the quality and quantity of their food during the week.

Methods Semi structured interviews were carried out with 98 9‐year‐old children. The children were asked to describe who chose what they ate during a typical week day. They were also asked about who decided how much they ate.

Results The children thought that adults had a high degree of control over their food. They frequently reported that either they were allowed to choose from a selection provided by an adult, or that an adult chose their food without consultation. Many children reported that adults were very influential in determining how much food they ate.

Conclusions Although the children thought that adults imposed control upon their food choices, it is argued that children have more choice about their food than at any time in history. The children's perceptions highlight the need for planned dietary change to acknowledge the various influences which can affect choices of children's food.
A comparison of household food availability in 11 countries
Authors: Byrd‐Bredbenner C. , Lagiou P. , Trichopoulou A.
Published: March 2003

Objective To identify intercountry food intake patterns, we compared the household food availability data collected by the Nationwide Food Consumption Survey (NFCS) in the United States and the Household Budget Surveys (HBS) from 10 European countries that participated in the DAta Food NEtworking (DAFNE) project, namely Belgium, Germany, Greece, Hungary, Ireland, Luxembourg, Norway, Poland, Spain and the United Kingdom.

Methodology The DAFNE project harmonized European household food availability data by clarifying which food items were included in each country's HBS, and then defining comparable food categories among countries. NFCS household data were harmonized with the HBS data by applying the same procedures used in the DAFNE project.

Results The results presented in this paper reveal a number of similarities and differences in household food availability among 11 nations. In nearly all countries studied, red meat was available in greater quantities than poultry and seafood combined. Most countries favoured bread and rolls over other types of grain products, had a low to moderate availability of seafood and legumes, had a moderate amount of sugar available, and consumed approximately two‐thirds or more of fruits and vegetables in a fresh form. Milk availability tended to be inversely correlated with cheese availability. Only in Mediterranean households was vegetable oil, namely olive oil, the primary type of added lipid available. While the data presented in this paper can do much to improve our understanding of food availability in US and European households, it is important to remember that these data do not include foods purchased and consumed away from home.

Applications Despite the limitations of household food availability data, the results presented in this paper can help health professionals develop a more international perspective.
Do dietitians feel that they have had adequate training in behaviour change methods?
Authors: Rapoport L. , Perry K. Nicholson
Published: March 2003

Aim To investigate dietitians’ perceived adequacy of pre‐ and postregistration training in a range of behaviour change techniques, current main approach to dietary treatment and perceived usefulness of future training in five core behaviour change modalities.

Method A questionnaire was designed and distributed to all dietitians registered in the BDA membership base (n = 4202).

Results Three hundred and ninety‐four questionnaires were returned. The majority of these respondents had obtained their degree since 1982 (77%), since when courses were more likely to have contained a psychological component. Despite the fact that facilitating dietary behaviour change is a key dietetic role, respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. Training was perceived to be most satisfactory in active listening skills, but this was perceived as barely adequate. Training was perceived as particularly poor in: applying theories of cognitive and behavioural therapy (CBT); motivational techniques; group work skills; and in both theory and skills of relapse prevention. Although 40% of respondents reported receiving explicitly psychologically based training, skills‐based training (mainly counselling) was reported by only 25% and was limited by being mainly short 1‐ or 2‐day courses. Overall, where further training was obtained it was perceived to be more adequate than that reported within preregistration dietetic training.

Conclusion Respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. The application of CBT, motivational techniques and relapse prevention was perceived as particularly deficient in training and the majority of respondents felt that future training would be useful or very useful. In the current health service climate, where evidence‐based practice is crucial for all practitioners with the emphasis on improved quality of care with measurable outcomes, research must be funded and undertaken to support attempts to improve dietitians’ effectiveness as behaviour change agents.
Women’s readiness to follow milk product consumption recommendations: design and evaluation of a ‘stage of change’ algorithm
Authors: Gulliver P. , Horwath C.
Published: March 2003

Objective

To investigate readiness to follow milk product consumption recommendations in two random samples of New Zealand women, using an algorithm designed and evaluated to assess the stage of change construct of the Transtheoretical Model.

Protocol

Women were classified according to stage of readiness to perform two goal behaviours: consumption of two or four servings of milk products per day. Stage classification, as determined by the algorithm, was evaluated by estimating mean calcium intake in each stage using a validated food frequency questionnaire. This was undertaken in two independent samples of women randomly selected from the electoral rolls of two cities in New Zealand’s South Island.

Results

Over 60% of women were classified as maintaining an intake of two servings of milk products per day. Of those women not meeting the goal of two servings per day, 73% had no intention of increasing their consumption. Over 80% of women were in the precontemplation stage for consuming four servings of milk products per day. Mean calcium intakes were significantly higher in women classified in action and maintenance stages than in preaction stages of change for both goal behaviours.

Conclusion

Of those women not currently meeting the recommendation for two servings of milk products per day, most are in precontemplation, a stage characterized by resistance to change. Use of the staging algorithm developed in this study makes possible the classification of women according to their readiness to change, and thus the provision of appropriate stage‐tailored advice.
The involvement, understanding and attitudes of dietitians towards research and audit
Authors: Harrison J. A. , Brady A. M. , Kulinskaya E.
Published: March 2003

Aim

To investigate the involvement of dietitians in research and audit and to assess their understanding of and attitudes towards these activities.

Methods

A postal questionnaire was used to investigate the knowledge, attitude towards and involvement in research and audit of State Registered Dietitians practising in the National Health Service (NHS) in the UK.

Results

A response rate of 64% was achieved. Few respondents (15%) were currently involved in research, although more (65%) were currently involved in audit. Involvement in audit rose significantly with increasing grade and managerial responsibility. Dietitians qualifying more recently were more likely to believe that their college training prepared them to undertake research, but felt less confident about undertaking audit. Experience of audit made respondents more confident about auditing their work and improved their belief that they understood audit terminology. Higher grade dietitians were more likely to see audit as an important part of their role than were their more junior colleagues. Understanding of the terms ‘research’ and ‘audit’ was poor, although 48% of respondents identified the link between the two activities. Perceived constraints to involvement in research and audit were identified.

Conclusion

The present level of involvement of dietitians in research and audit activities falls below that recommended in the BDA’s (1997a) National Professional Standards for Dietitians Practising in Healthcare. This study identifies factors that influence dietitians’ involvement in, understanding of and attitudes towards research and audit and recommends ways of increasing their involvement in these activities.
Is there a relationship between the food intakes of Scottish 5½−8½‐year‐olds and those of their mothers?
Authors: Longbottom P. J. , Wrieden W. L. , Pine C. M.
Published: March 2003

Background  Recent reports have highlighted certain aspects of the diets of children and adults in Scotland today that are a cause for concern. If there are significant associations between family members in food choice and thus in nutrient intakes, this may be important in the aetiology and prevention of diseases relating to dietary risk factors.

Aim  To compare the food intake of Scottish children aged 5½−8½ years with that of their mothers.

Methods  As part of a larger study, data on food intakes were obtained from 4‐day weighed food records for 36 Scottish children (12 boys and 24 girls), aged 5½−8½ years, who had participated in the 1992/1993 National Diet and Nutrition Survey (NDNS), and their mothers.

Results  Compared with their mothers, children had higher median densities [weight (g) of foods per 4.2 MJ (1000 kcal)] of snack foods including fruit, bread and confectionery and lower median densities of meat and meat products, fish, potatoes and vegetables. Positive, significant correlations between children and mothers were found for median densities of bread (r = 0.360, P < 0.05), fruit (r = 0.735, P < 0.001) and potatoes (r = 0.572, P < 0.001) and also for chips (r = 0.651, P < 0.001) and chocolate confectionery (r = 0.368, P < 0.05), the latter two being foods that should be reduced in the average Scottish diet.

Conclusions  Children's intakes of snack foods were correlated with that of their mothers emphasizing the need for change at a family level if current guidelines on diet are to be implemented.
Face recognition and emotion perception in boys with fragile‐X syndrome
Authors: Bouras N. , Turk J. , Cornish K.
Published: March 2003

Two independent and complementary studies were conducted to assess the ability of boys with fragile‐X syndrome to recognize facial and emotional expressions. Both studies failed to find any specific deficits associated with fragile‐X syndrome. The performance of the test group was comparable to the level of subjects with intellectual disability and subjects of average cognitive development matched for intellectual ability. This suggests that chronological age and intellectual level are unlikely to explain the findings. The results are discussed in the context of the controversy surrounding the relationship between autism and fragile‐X syndrome. The findings are consistent with fragile‐X individuals having a profile of social, communicatory and ritualistic disturbances, which in some ways may differ from those found in individuals who have more typical autistic spectrum disorders.
conference report: Mental health and intellectual disability: an international perspective
Authors: Bouras N. , Holland A. J. , Koot H. M.
Published: March 2003

The present paper reports on the inaugural meeting of the Mental Health Special Interest Research Group (SIRG) of the International Association for the Scientific study of Intellectual disability which was held at Fitzwilliam College, Cambridge, UK, in March 1998. The meeting was organized in conjunction with the Ninth Annual SIRG on ageing and intellectual disability. Representatives from North America, several European and Scandinavian countries, Australia, and Israel attended. Two broad themes had been determined prior to the meeting: ‘Improving the detection of mental health problems’ and ‘Research strategies for identifying risk factors for mental health problems’. In the presentations and subsequent discussions, it was apparent that there were extrenely diverse perspectives both across and within the different countries represented. Not only were individuals' experiences very different, but most strikingly, the theoretical frameworks were very diverse. This was partly a function of there being understandable differences in perspectives across disciplines, but at its most marked, there were fundamental differences in the way both intellectual disability and mental health were conceptualized.
An inpatient treatment model for adults with mild intellectual disability and challenging behaviour
Authors: Xenitidis K. I. , Henry J. , Russell A. J. , Ward A. , Murphy D. G. M.
Published: March 2003

Following the closure of the large mental handicap hospitals in the UK, the majority of people with intellectual disability (ID) are currently living in the community. However, people with ID who also exhibit challenging behaviour (CB) have been the most difficult‐to‐place group and use a large amount of service resources. A variety of service options have been proposed for the assessment and treatment of CBs, but there is little information on the effectiveness of these alternatives. The Mental Impairment Evaluation and Treatment Service (MIETS) is one of these service options and the aim of the present study is to describe and evaluate this service. The present authors studied the first 64 patients admitted to MIETS following its opening. A within‐subject comparison research design was used. Demographic and clinical data were obtained from case records and the effectiveness of MIETS interventions was evaluated by comparing the number of incidents of challenging behaviour, the use of seclusion, and the place of residence before and after the MIETS intervention. Only 10 (17.5%) of the patients had been admitted from community facilities, but 48 (84.2%) of the patients were discharged to community placements (P 0.0001). The MIETS also significantly reduced the frequency and severity of challenging behaviours (P 0.0001). It is concluded that the MIETS is an effective treatment model for people with ID and CB, and that there is no place for therapeutic nihilism in this difficult‐to‐place group of patients.
Age at onset of dementia and age of menopause in women with Down’s syndrome
Authors: Cosgrave M. P. , Tyrrell J. , McCarron M. , Gill M. , Lawlor B. A.
Published: March 2003

Menstrual status and the age of menopause were investigated in 143 Irish females with Down’s syndrome (DS). The average age of menopause in 42 subjects (44.7 years) was younger than in the general population. The age at onset of dementia correlated with the age of menopause. This finding may be a manifestation of accelerated ageing in DS or point to oestrogen deficiency being an independent risk factor for the development of Alzheimer’s dementia in DS. The implications of this finding for possible treatments are discussed.
Is megalencephaly specific to autism?
Authors: Ghaziuddin M. , Zaccagnini J. , Tsai L. , Elardo S.
Published: March 2003

Several recent reports have described the presence of increased head circumference (megalencephaly) in patients with autism. Although some studies have described reports of megalencephaly in other disorders such as schizophrenia in adults, few such studies have been performed in children and adolescents. In the present study, the authors compared 20 subjects with autism/pervasive developmental disorder (DSM‐IV; all males; mean age =  10.9 years) with 20 controls with attention deficit hyperactivity disorder (DSM‐IV; all males; mean age =  11.1 years). Four subjects and five controls had evidence of megalencephaly. In addition to their core symptoms, the autistic subjects with megalencephaly were hyperactive and impulsive. These findings suggest that megalencephaly may not be specific to autism, and when present, it may index the presence of additional symptoms such as hyperactivity and impulsivity.
An investigation into diet treatment for adults with previously untreated phenylketonuria and severe intellectual disability
Authors: Fitzgerald B. , Morgan J. , Keene N. , Rollinson R. , Hodgson A. , Dalrymple‐Smith J.
Published: March 2003

There is evidence in the literature which suggests that adults with previously untreated phenylketonuria (PKU) benefit from a low phenylalanine diet. A prospective study providing a phenylalanine‐restricted diet to five subjects with severe intellectual disability arising from untreated PKU is reported. Physical, social and behavioural measures were used to monitor the effects of the diet. Four out of the five subjects derived considerable benefit. It is concluded that the restricted diet is worth trying in most individuals with previously untreated PKU, and that possible benefits are in the areas of concentration, alertness, mood, irritability and adaptive behaviour.
Assessment of the convergent validity of the Questions About Behavioral Function scale with analogue functional analysis and the Motivation Assessment Scale
Authors: Paclawskyj, T. R. , Matson, J. L. , Rush, K. S. , Smalls Y. , Vollmer T. R.
Published: March 2003

The present study examined the convergent validity of the Questions About Behavioral Function (QABF) scale, a behavioural checklist for assessing variables maintaining aberrant behaviour, with analogue functional analyses and the Motivation Assessment Scale (MAS). The two checklists were more highly correlated with each other than either checklist with results from the analogue sessions, and the QABF was more highly correlated with analogue sessions than the MAS. Using analogue sessions, the experimenters failed to ascertain behavioural function for a number of subjects because the behaviour problems in question were low frequency/high intensity and failed to appear during the course of the analysis, pointing out a limitation of this technology. These findings, taken together with recent research outlining the psychometric properties of the QABF, seem to support the use of the QABF in a hierarchical model of functional analysis. The implications of the findings are discussed.
Mental health of primary family caregivers with children with intellectual disability who receive a home care programme
Authors: Shu B.‐C. , Lung F.‐W. , Huang C.
Published: March 2003

Background The aims of the present study were to describe the change in mental health over time in a group of family caregivers with a child with intellectual disability (ID) and to explore the effect of a home care service on the psychological well‐being of the caregiver.

Methods The authors identified children with ID who received home care services in the southern part of Taiwan. A total of 46 primary family caregivers (age range = 21–65 years) were recruited for the present study. The study design was a quasi‐experimental follow‐up analysis. The children with ID and their families regularly received home‐based care. The 12‐item version of the Chinese Health Questionnaire (CHQ) was used to evaluate the subjects’ mental health at three time points: (1) baseline, (2) 3 months and (3) 9 months. The validity and reliability of the CHQ have been tested in Taiwan. The Generalized Estimating Equation was used to conduct longitudinal data analyses.

Results The authors found that the family caregivers showed a significant improvement in their mental health by month 9.

Conclusions The preliminary findings of this study accredit the effect of home care services and suggest that home care services are necessary for family caregivers.
Measuring staff support in services for people with intellectual disability: the Staff Support and Satisfaction Questionnaire, Version 2
Authors: Harris P. , Rose J.
Published: March 2003

Background Social support is an important determinant of well‐being, including the stress experienced within the work setting.

Methods The present paper reports on the development of the Staff Support and Satisfaction Questionnaire (3SQ), from a previously published measure: the Staff Support Questionnaire. The 3SQ was piloted with 21 health professionals and examined for evidence of test–retest reliability with 24 staff. Data on internal reliability were collected on three occasions from a total sample of 177 staff. The validity of the 3SQ was examined in four studies with a total of 238 staff by testing it against validated measures of psychological well‐being.

Results The data showed that the total scale had a high level of test–retest reliability
(rs = 0.82, P < 0.001) and consistently high internal reliability. Three out of the four validity studies showed statistically significant inverse relationships between the total scale and measures of psychological well‐being. The weakest link was the ‘Supportive People’ subscale.

Conclusions The reliability and validity studies suggest that the psychometric properties of the 3SQ are generally robust, except for the ‘Supportive People’ subscale, which should be interpreted with caution.
Medical needs of people with intellectual disability require regular reassessment, and the provision of client‐ and carer‐held reports
Authors: Kerr A. M. , McCulloch D. , Oliver K. , McLean B. , Coleman E. , Law T. , Beaton P. , Wallace S. , Newell E. , Eccles T. , Prescott R. J.
Published: March 2003

Background  Previous work has indicated a wide range of unmet medical health needs in people with intellectual disability (ID).

Methods  A profile of recorded medical needs was produced for 589 people with ID through a detailed search of individual medical and nursing case records. Specialist optometric and audiological assessments were offered, and reports were provided in technical and plain English terms. A Health Watch project delivered folders with copies of the plain English reports to 60 individuals and carers.

Results  The case record review indicated a wide range of medical disorders; however, exact diagnoses and counselling regarding underlying neurological conditions were seldom recorded. Assessed levels of hearing and vision loss were much greater than had been previously recognized. The Health Watch reports were welcomed by the clients and carers.

Conclusions  If satisfactory healthcare is to be achieved for people with ID, medical needs must be monitored, regular specialist reassessments offered, access to specialist services facilitated and reports clearly explained to carers.
Predictors and mode of death over 5 years amongst patients admitted to the emergency department with acute chest pain or other symptoms raising suspicion of acute myocardial infarction
Authors: Herlitz  , Karlson  , Lindqvist  , SJölin
Published: March 2003

Herlitz J, Karlson BW, Lindqvist J, Sjölin M (Sahlgrenska University Hospital, Göteborg, Sweden). Predictors and mode of death over 5 years amongst patients admitted to the emergency department with acute chest pain or other symptoms raising suspicion of acute myocardial infarction. J Intern Med 1998; 243: 41–48.

Aim

To describe the mortality and mode of death over 5 years, and factors associated with death amongst patients with acute chest pain.

Patients

All patients who came to the emergency department at Sahlgrenska Hospital in Göteborg with acute chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI) during a 21‐month period.

Results

In all, 5241 patients were evaluated, of whom 1345 (26%) died during the 5 years of follow‐up. The following factors were independent predictors of an increased risk of death: age (P < 0.001); male sex (P < 0.001); symptoms of acute congestive heart failure (P < 0.001) or unspecific symptoms on admission (P < 0.05); smoking (P < 0.001); a history of either congestive heart failure (P < 0.001), diabetes mellitus (P < 0.001), previous myocardial infarction (P < 0.001) or hypertension (P < 0.05); initial degree of suspicion of AMI (P < 0.001) and presence of pathological electrocardiogram (P < 0.001) on admission to hospital. Amongst patients who died, 66% died a cardiac death and 35% died in association with a myocardial infarction.

Conclusion

Amongst patients admitted to the emergency department due to chest pain or other symptoms raising suspicion of AMI, several predictors based on clinical history and clinical presentation can be defined, which are strongly related to the long‐term prognosis.
HFE mutations in patients with hereditary haemochromatosis in Sweden
Authors: Cardoso  , Stål  , Hagen  , Cabeda  , Cabeda  , Esin  , De Sousa  , Hultcrantz
Published: March 2003

Cardoso EMP, Stål P, Hagen K, Cabeda JM, Esin S, De Sousa M, Hultcrantz R (Karolinska Hospital, Stockholm; Huddinge University Hospital, Huddinge; and Karolinska Institute, Stockholm, Sweden; Santo António Hospital; Abel Salazar Institute for Biomedical Sciences, Porto, Portugal). HFE mutations in patients with hereditary haemochromatosis in Sweden. J Intern Med 1998; 243: 203–8.

Objective

To determine the frequency of mutations (C282Y and H63D) in a newly identified gene HFE in patients with hereditary haemochromatosis (HH) in Sweden.

Design

Molecular genetic analyses of the HFE gene (polymerase chain reaction (PCR) followed by enzyme restriction) were performed in genomic DNA from unrelated patients with a clinical diagnosis of HH and in healthy subjects.

Settings

Patients with HH treated with phlebotomies at Karolinska Hospital and Huddinge Hospital were analyzed.

Subjects

Eighty‐seven unrelated patients with HH and 117 healthy controls.

Results

It was found that the HFE C282Y mutation occurs in 94.2% of chromosomes from patients with HH. Eighty patients (92.0%) were homo‐ zygous for the C282Y mutation and one was heterozygous. Three patients were heterozygous for both C282Y and H63D mutations. One patient was homozygous and one was heterozygous for the H63D mutation. One patient carried normal alleles. In healthy controls, the C282Y mutation occurred in nine subjects (7.7%), all of which were heterozygous. The H63D mutation was found in 28 control subjects, one of which was homozygous.

Conclusions

We found that the majority of patients with HH have the C282Y mutation in the HFE gene. The frequency of the H63D mu‐ tation was higher in controls than in patients with HH, although in chromosomes at risk the frequency of the H63D mutation was higher in patients.
The genetic analysis of cancer
Authors: Pearson  , Van der Luijt
Published: March 2003

Pearson PL, Van der Luijt RB (Utrecht University, Utrecht, the Netherlands). The genetic analysis of cancer (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 413–17.

During the past two decades an overwhelming amount of knowledge has been acquired on the molecular genetics of human cancer. It is now evident that cancer is essentially a genetic disease, arising from inherited and/or somatically acquired mutations at different genetic loci, and that tumourigenesis is a multistep process. Gene mapping studies of inherited cancer syndromes have resulted in the identification of many genes implicated in the initiation of tumours. Importantly, alterations of the same genes were also found to play a role in the development of common, non‐familial tumours. The genes involved belong to distinct functional classes, and include proto‐oncogenes and tumour suppressor genes, which are regulators of cellular growth and proliferation, cell adhesion and programmed cell death. Another class of cancer susceptibility genes consists of DNA repair genes, which are involved in maintaining genomic stability. In unravelling the genetic basis of cancer, the localization and identification of genes involved in tumourigenesis can be considered as the ‘easy’ part; determination of the normal physiological function of these genes and their precise role in tumourigenesis has proved to be much more difficult. In this review, we highlight some of the major breakthroughs in the field of cancer genetics, and discuss recent insights in the putative role of proto‐oncogenes, tumour suppressor genes and DNA repair genes in the initiation and progression of cancer. Also, we point to some of the challenges to be faced in the coming years.
Influence of chronic alcohol abuse on body weight and energy metabolism: is excess ethanol consumption a risk factor for obesity or malnutrition?
Authors: Addolorato  , Addolorato  , Capristo  , Greco  , Stefanini  , Stefanini  , Gasbarrini
Published: March 2003

Abstract. Addolorato G, Capristo E, Greco AV, Stefanini GF, Gasbarrini G (Catholic University, Rome; ‘G. Fontana’ University Center for the Study and Treatment of the Alcohol Addiction, Bologna; and Civic Hospital, Faenza, Italy). Influence of chronic alcohol abuse on body weight and energy metabolism: is excess ethanol consumption a risk factor for obesity or malnutrition?J Intern Med 1998; 244: 387–95.

Objectives

To evaluate the influence of chronic alcohol abuse on body composition and energy metabolism in patients affected by chronic alcoholism (group A) compared with a group of healthy social drinkers (group B).

Setting

A university hospital clinic in Italy.

Subjects

A total of 32 alcoholics without clinical or laboratory signs of liver cirrhosis and malabsorption.

Measurements

Body composition was assessed by anthropometric measurements. Resting energy expenditure (REE) and substrate oxidation rate was measured by indirect calorimetry. Daily caloric intake was computed on the basis of a food diary compiled over 7 days.

Results

Alcoholics showed a significantly lower body weight (P < 0.05) and a significant lower fat mass (P < 0.05) compared with controls. A higher waist‐to‐hip ratio was found in group A than in group B, both as a whole group (P < 0.01) or separated by gender (females, P < 0.01; and males, P < 0.001), indicating a prevalence of fat distribution in the abdominal region in alcoholics. REE was significantly higher in group A than in group B (P < 0.05). The non‐protein respiratory quotient was significantly lower in group A than in group B (P < 0.001) with a consequent higher utilization of lipids (P < 0.01) and a lower carbohydrate oxidation (P < 0.05) in group A. The energy intake provided only by food ingestion was found to be significantly higher in group B (P < 0.01), whilst the total caloric intake, computed as food intake plus alcohol intake, was higher in group A (P < 0.01).

Conclusions

Alcoholics, as compared with social drinkers, showed a lower body weight due essentially to a fat mass reduction, a higher REE value normalized by fat‐free mass, and a preferential utilization of lipids as energy substrate. These findings might suggest that chronic ethanol abuse is able to determine an impairment of nutritional status due, at least in part, to an alteration of the substrate oxidation.