bluuebunny/crossref_metadata_2025 huggingface dataset:
The development of plumage polymorphism in male Madagascar paradise flycatcher Terpsiphone mutata
Authors: Mizuta Taku
Published: June 2003

The development of plumage polymorphism in male Madagascar paradise flycatcher Terpsiphone mutata (Linnaeus, 1766) was investigated in north‐western Madagascar. Four distinct morphs were observed, namely, white‐coloured with long tails (WL), rufous‐coloured with long tails (RL), rufous‐coloured with tails of middle length (RM), and rufous‐coloured with short tails (RS). Females were rufous and had short tails. Indivudual males were marked and re‐observed during 1994–98. RS males changed to RM in the following seasons. Among RM males, some individuals retained RM, others changed to RL or WL. RM males which changed to WL in the next season had possessed white patches on their belly, whereas RM males which changed to RL had not had such patches. Neither WL nor RL males changed their morphs. Nestlings were rufous regardless of their father's morph. One nestling changed to RS in the next season. From these results and the difference of body size among four morphs, it is deduced that RS males are one year old, and change to RM males in the next season. RM males change to RL or WL males after one or two years. RL and WL are two stable terminal plumages, and they may be genetically determined morphs.
The home range of the Sonso community of chimpanzees from the Budongo Forest, Uganda
Authors: Newton‐Fisher Nicholas E.
Published: June 2003

Early studies of chimpanzees in the Budongo Forest, Uganda, reported only rough estimates for home range size. This study aimed to quantify home range size and habitat composition for chimpanzees of the Sonso community in this forest. Home range is the habitually used portion of the total area over which an animal travels, and for chimpanzees the home range is shared by the community. From data collected in 1994 and 1995, the home range for this community was estimated to cover an area of 6.78 km2using the minimum convex polygon analysis technique and 6.89 km2using fixed kernel analysis. Habitat was highly heterogeneous. The small home range and consequent high local population density (approximately 6.8 individuals km−1) suggests that the Sonso region is highly productive in chimpanzee foods, possibly in contrast to other parts of the forest. This estimate of home range size is among the smallest reported for habituated chimpanzees, but comparisons with other sites are confounded by methodological and analytical differences. Future studies of chimpanzee ranging patterns should endeavour to use precise locations and the latest analytical techniques to ensure accurate estimation of range size and structure, and intersite comparability.
Tree fruiting phenology in Kalinzu Forest, Uganda
Authors: Muhanguzi Hosea D. R. , Obua Joseph , Oryem‐Origa Hannington , Vetaas Ole R.
Published: June 2003

The spatial and temporal variations in species composition and abundance of trees that fruited in mechanically logged, intensively pit‐sawn and essentially undisturbed forest areas in Kalinzu Forest (0°17′S, 0°30′S and 30°00′, 30°07′E) were assessed. The duration and frequency of fruiting episodes of selected pioneer, understorey and canopy tree species were also determined. These phenology aspects were monitored for 18 months (between February 1997 and July 1998) in 99 plots, each 20 m × 20 m in size. Eighty species consisting of 1489 trees fruited during the study. Most of the species were recorded in the undisturbed forest area and least in the mechanically logged areas. Monthly number of individuals and species that fruited in each forest condition were significantly related to monthly rainfall. Two pioneer species (Musanga leo‐errerae and Trema orientalis), one sub‐canopy (Funtumia africana) and canopy (Parinari excelsa) species had extended fruiting phases (>5 months). Two understorey species (Oxyancius speciosus and Tabernaemontana spp.) had an extended phase while the third (Teclea nobilis) had a short (≤5 months) fruiting phase. Of the selected species, only Strombosia scheffleri (a sub‐canopy species) and P. excelsa had more than one fruiting episode.
A validated symptoms questionnaire (Chinese GERDQ) for the diagnosis of gastro‐oesophageal reflux disease in the Chinese population
Authors: Wong W. M. , Lam K. F. , Lai K. C. , Hui W. M. , Hu W. H. C. , Lam C. L. K. , Wong N. Y. H. , Xia H. H. X. , Huang J. Q. , Chan A. O. O. , Lam S. K. , Wong B. C. Y.
Published: June 2003

Background and aims: To develop a validated gastro‐oesophageal disease (GERD) symptom questionnaire for the Chinese population.

Methods: One hundred Chinese patients with GERD and 101 healthy Chinese controls were presented with a 20‐item GERD questionnaire in the Chinese language (Chinese GERDQ). Quality of life in GERD patients was assessed by SF‐36. A standard dose of proton pump inhibitors for 4 weeks was prescribed to 35 patients with newly diagnosed GERD. The Chinese GERDQ was performed before, 4 weeks and 8 weeks after treatment. Concept, content, construct, discriminant validity and reliability of the questionnaire were assessed.

Results: Seven items were selected by logistic regression to account for most of the differences between controls and GERD patients with a good reproducibility and internal consistency. A cut‐off score of equal or greater than 12 was determined to discriminate between controls and GERD patients with a sensitivity of 82% and a specificity of 84%. The Chinese GERDQ correlated negatively with five domains of the SF‐36 and discriminated between GERD patients who reported symptomatic improvement during proton pump inhibitor treatment and symptoms deterioration upon withdrawal of proton pump inhibitor treatment.

Conclusions: The Chinese GERDQ could be used in epidemiological studies to assess the frequency and severity of GERD in patient populations and in interventional studies of GERD.
Review article: clinic‐based testing for Helicobacter pylori infection by enzyme immunoassay of faeces, urine and saliva
Authors: Kabir S.
Published: June 2003

Enzyme immunoassays have been used to detect Helicobacter pylori infection in human body materials such as faeces, urine and saliva. The stool antigen assay (HpSA), which uses polyclonal anti‐H. pylori antibody as a capture reagent, has been widely used in the pre‐treatment diagnosis of the infection in adults and children. Although the assay has the potential for monitoring eradication therapy, there are controversies over its use, especially at an early stage after treatment. The efficacy of the stool antigen assay can be modified by using monoclonal antibodies towards well characterized H. pylori faecal antigens. Two types of enzyme immunoassays (enzyme‐linked immunosorbent assay [ELISA] and immunochromatography) have been used to detect antibodies to H. pylori in urine. Immunochromatography of urine is a rapid assay well suited for epidemiological studies. The salivary ELISA, used in a number of studies, has shown inconsistent results with less than optimum sensitivity and specificity. Urinary and salivary immunoassays may not distinguish between past and present infections, thus limiting their potential to monitor eradication therapy.
Mycophenolate mofetil in refractory inflammatory bowel disease
Authors: Ford A. C. , Towler R. J. , Moayyedi P , Chalmers D. M. , Axon A. T. R.
Published: June 2003

Background:  Mycophenolate mofetil has been claimed to be effective and well tolerated in refractory inflammatory bowel disease although there is little information regarding its use in clinical practice.

Aim:  To review our experience in achieving and maintaining remission in refractory inflammatory bowel disease and to document tolerability, major toxicity and efficacy.

Methods:  A retrospective audit was performed of the records of all patients with inflammatory bowel disease treated with mycophenolate mofetil (1–2 g/day) over a 3‐year period.

Results:  Thirty‐nine patients were identified. Almost all had been intolerant of, or had not responded to azathioprine, and 38 were steroid‐dependent. mycophenolate mofetil was discontinued in 22 patients, 11 due to intolerance and 10 because of lack of efficacy. Of the 17 on treatment at the end of the study period 16 were in remission and off all steroid therapy, but one needed infliximab to maintain remission. No major toxicity was noted and there was no major sepsis.

Conclusions:  Approximately 40% of patients with severe refractory inflammatory bowel disease achieved remission and complete steroid withdrawal on mycophenolate mofetil therapy, almost 30% could not tolerate the drug, and a further 30% did not respond. Mycophenolate mofetil therapy may have a role for steroid‐dependent patients refractory to azathioprine.
Repifermin (keratinocyte growth factor‐2) for the treatment of active ulcerative colitis: a randomized, double‐blind, placebo‐controlled, dose‐escalation trial
Authors: Sandborn W. J. , Sands B. E. , Wolf D. C. , Valentine J. F. , Safdi M. , Katz S. , Isaacs K. L. , Wruble L. D. , Katz J. , Present D. H. , Loftus E. V. , Graeme‐Cook F. , Odenheimer D. J. , Hanauer S. B.
Published: June 2003

Background: Repifermin (keratinocyte growth factor‐2) has been shown to reduce inflammation in animal models of colitis.

Aim: To evaluate repifermin for the treatment of active ulcerative colitis.

Methods: Eighty‐eight patients with active ulcerative colitis were enrolled in a 6‐week, double‐blind trial. Patients were randomized to receive treatment for five consecutive days with intravenous repifermin at a dose of 1, 5, 10, 25 or 50 μg/kg, or placebo. The primary objective of the study was to evaluate the safety of repifermin. The primary efficacy outcome was clinical remission at week 4, defined as a score of zero on the endoscopic appearance and stool blood components of the Mayo score and a score of zero or unity on the stool frequency and physician's global assessment components.

Results: At week 4, the rates of clinical remission in the 1, 5, 10, 25 and 50 μg/kg repifermin groups were 19%, 9%, 0%, 0% and 0%, respectively, and 11% for the placebo group (P = 0.32 for repifermin vs. placebo). The frequencies of commonly occurring adverse events and severe adverse events were similar in both groups.

Conclusions: Intravenous repifermin at a dose of 1–50 μg/kg was very well tolerated, but there was no evidence that repifermin was effective for the treatment of active ulcerative colitis at these doses. An additional study to determine the efficacy of repifermin at doses of > 50 μg/kg or for a longer treatment duration may be warranted, as the maximally tolerated dose was not reached in the present study.
Is irritable bowel syndrome more likely to be persistent in those with relatives who suffer from gastrointestinal symptoms? A population‐based study at three time points
Authors: Kalantar J. S. , Locke G. R. , Talley N. J. , Zinsmeister A. R. , Fett S. L. , Melton L. J.
Published: June 2003

Background: We tested the hypothesis that subjects with relatives who suffered from abdominal pain or bowel dysfunction would be at an increased risk of more persistent irritable bowel syndrome.

Methods: A valid, self‐report questionnaire was mailed to an age‐ and gender‐stratified random sample of residents, aged 30–64 years, in Olmsted County, MN, USA, on three occasions over a 4‐year period. Persistent irritable bowel syndrome was defined as the presence of irritable bowel syndrome on at least two of the three surveys, and fluctuating irritable bowel syndrome was defined as the presence of irritable bowel syndrome on only one of the surveys.

Results: Subjects were less likely to have persistent irritable bowel syndrome over the age of 50 years [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.09, 0.47]. A positive family history was reported by 23%. A family history of gastrointestinal symptoms was independently associated with persistent irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.5; 95% CI, 1.3, 4.9) and fluctuating irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.4; 95% CI, 1.3, 4.4). However, subjects reporting a positive family history were not more likely to report persistent vs. fluctuating irritable bowel syndrome (OR, 1.2; 95% CI, 0.5, 2.9). The use of non‐steroidal anti‐inflammatory drugs (OR, 2.3; 95% CI, 1.2, 4.3) and a history of food sensitivity (OR, 3.6; 95% CI, 1.9, 6.9) were the only other predictors of persistent irritable bowel syndrome.

Conclusions: A history of abdominal pain or bowel troubles in first‐degree relatives appears to be independently associated with both persistent and fluctuating irritable bowel syndrome.
Antibodies to human recombinant tissue transglutaminase may detect coeliac disease patients undiagnosed by endomysial antibodies
Authors: Tesei N. , Sugai E. , Vázquez H. , Smecuol E. , Niveloni S. , Mazure R. , Moreno M. L. , Gomez J. C. , Mauriño E. , Bai J. C.
Published: June 2003

Background:The screening and diagnosis of coeliac disease have been simplified by the advent of new serological tools.

Aim:To assess the clinical utility of a newly developed kit for antibodies to human recombinant tissue transglutaminase (hu‐anti‐tTG) in a large population of patients undergoing intestinal biopsy for suspected intestinal disorders.

Methods:We evaluated 426 serum samples from consecutive adult patients (250 from untreated coeliac disease patients and 176 from individuals in whom a diagnosis of coeliac disease had been excluded), obtained at the time of intestinal biopsy. Samples were tested for immunoglobulin A (IgA) hu‐anti‐tTG by enzyme‐linked immunoabsorbent assay, IgA endomysial antibodies (EmA) by indirect immunofluorescence and IgA and IgG antigliadin antibodies by enzyme‐linked immunoabsorbent assay. A sub‐group of samples was also assessed for a guinea‐pig‐based anti‐tissue transglutaminase.

Results:According to the cut‐off for hu‐anti‐tTG, the sensitivity, specificity and positive and negative predictive values were 91%, 96%, 97% and 87%, respectively. Simultaneous determination of EmA showed values of 86%, 100%, 100% and 83% for the same parameters. Although 19 coeliac disease patients (7.6%) were negative for EmA and hu‐anti‐tTG, both tests rendered superior statistical values to antigliadin antibody tests. At diagnosis, IgA deficiency was detected in 11 patients, but both assays were able to detect samples with mild to moderate deficiency. The comparison of hu‐anti‐tTG with EmA showed excellent concordance between the tests (κstatistic, 0.85). Discordance was observed in 20 samples from coeliac disease patients (8%) and in nine samples from controls (5%). Fifteen samples had an EmA‐negative but hu‐anti‐tTG‐positive serology, and five showed the converse pattern. Comparison of human recombinant and guinea‐pig tests showed concordant results in 96% of cases.

Conclusions:The quantitative determination of hu‐anti‐tTG type IgA using a commercial enzyme‐linked immunoabsorbent assay kit was highly sensitive and specific for the detection of coeliac disease. Our results in a large population of patients with a clinical condition suggestive of the disorder demonstrated that the test can be used to detect a substantial number of patients otherwise unrecognized by IgA EmA.
A practical method for the detection of macroprolactinaemia using ultrafiltration
Authors: Prazeres Susana , Santos M. Amparo , Ferreira H. Gil , Sobrinho Luís G.
Published: June 2003

objective The aim of this study was to evaluate a method for the estimation of the percentage of big‐big prolactin (bb‐PRL) in serum, based on centrifugal ultrafiltration (UF) and to be used for the detection of macroprolactinaemia.

design Serum samples were submitted to gel filtration chromatography (GFC), UF and precipitation with polyethylene glycol (PEG).

patients Serum samples obtained from 13 patients with macroprolactinaemia (Group 1) and from 15 hyperprolactinaemic patients without macroprolactinaemia (Group 2) were studied by the three methods.

measurements PRL was measured in serum, fractions from GFC, filtrate and retentate obtained after UF (this last measurement was used only to study the ‘recovery’ of PRL after UF and was not necessary for clinical purposes), and supernatant obtained after PEG precipitation.

 The calculation of the percentage of bb‐PRL, by UF, was made using a simple algorithm.

results In Group 1 the percentages (mean and SD) of bb‐PRL as determined by GFC, UF and PEG were, respectively, 73 ± 16, 83 ± 5·3 and 78 ± 7·0. In Group 2, the percentages of bb‐PRL were, in the same order as above, 4·3 ± 8·2, 16 ± 19 and 3·7 ± 11. The difference of the means between Groups 1 and 2 was highly significant (P << 0·001) for all the three methods. In Group 1 the percentages of bb‐PRL were widely scattered when measured by GFC but closely clustered when measured by either UF or PEG. The opposite occurred in Group 2.

conclusions The centrifugal ultrafiltration method for the detection of macroprolactinaemia is simple, inexpensive, requires only two prolactin assays and yields the same results as the polyethylene glycol precipitation method.
The correlation between the response to progestogen treatment and the expression of progesterone receptor B and 17β‐hydroxysteroid dehydrogenase type 2 in human endometrial carcinoma
Authors: Utsunomiya Hiroki , Suzuki Takashi , Ito Kiyoshi , Moriya Takuya , Konno Ryo , Sato Shinji , Yaegashi Nobuo , Okamura Kunihiro , Sasano Hironobu
Published: June 2003

objective  In situ metabolism and synthesis of oestrogens are considered to play important roles in the pathogenesis and development of human endometrial endometrioid adenocarcinoma. Approximately 3–5% of patients with these neoplasms are under age 40, some of whom have been treated with progestogen alone as a primary therapy for both atypical endometrial hyperplasia and adenocarcinoma in order to preserve their fertility. Medroxyprogesterone acetate (MPA) has been used extensively in the treatment of both breast and endometrial disorders as an endocrine therapy. However, details of the alterations of in situ oestrogen metabolism following progestogen treatment have yet to be fully elucidated.

design, patients and measurements  In this study we examined the immunolocalization of 17β‐hydroxysteroid dehydrogenase (17β‐HSD) types 1 and 2, oestrogen receptor (ER), progesterone receptor (PR)A + PRB, PRB, and Ki67 in progestogen‐treated endometrial endometrioid adenocarcinoma (16 cases). We compared our findings both prior to and following treatment. These findings were then correlated with the treatment outcome of individual patients in order to elucidate factors associated with the response to treatment.

results  17β‐HSD type 2 immunoreactivity was detected in 8/16 cases examined, whereas 17β‐HSD type 1 immunoreactivity was undetected in all cases examined. 17β‐HSD type 2 positive immunostaining, PRA + PRB labelling index (LI), and PRB/PRA + PRB ratio were all significantly higher in cases responding to the treatment than in those not responding. There were no significant correlations between responsive and nonresponsive cases for positive 17β‐HSD type 1 immunostaining, Ki67 LI, ER LI and age. There were no significant differences in the positive immunostaining for 17β‐HSD types 1 and 2, Ki67 LI, ER LI, PRA + PRB LI, age and PRB/PRA + PRB ratio between specimens taken prior to and following progestogen treatment.

conclusion  These results suggest that in situ abundance of 17β‐HSD type 2 and PR, especially PRB, can predict the possible response of patients with endometrial carcinoma to progestogen treatment.
The effects of soy protein containing isoflavones on lipids and indices of bone resorption in postmenopausal women
Authors: Dalais Fabien S. , Ebeling Peter R. , Kotsopoulos Dimitra , McGrath Barry P. , Teede Helena J.
Published: June 2003

objective To assess the effect of a dietary soy protein supplement containing isoflavones on lipids and indices of bone resorption in postmenopausal women.

design Placebo‐controlled, double‐blind, randomized study.

patients One hundred and six postmenopausal women were randomized to dietary soy supplementation (n = 51) or placebo (n = 55) for 3 months, of which 78 were included in the final analysis.

measurements Lipid profiles including total, low‐density lipoprotein (LDL) and HDL cholesterol as well as triacylglycerol were measured. Pyridinoline and deoxypyridinoline were used as markers of bone resorption. Urinary isoflavone excretion was measured to assess compliance.

results There was a significantly greater increase in urinary isoflavone excretion detected in the soy group compared to placebo. Lipid profiles improved with significant decreases in LDL cholesterol (−0·60 ± 0·10 vs.–0·29 ± 0·09 mmol/l, P < 0·05), triacylglycerol (−0·22 ± 0·07 vs. +0·01 ± 0·05 mmol/l, P < 0·005) and the LDL : HDL ratio (−0·32 ± 0·10 vs. +0·20 ± 0·10, P < 0·005) in the soy group compared to placebo. There were no significant differences between the soy and placebo groups for urinary excretion of pyridinoline (−3·8 ± 3·1 vs.−0·8 ± 3·1 nmol/mmolCr, P = 0·4) or deoxypyridinoline (−0·8 ± 0·9 vs.–0·3 ± 0·7 nmol/mmolCr, P = 0·4).

conclusions In postmenopausal women, dietary supplementation with soy protein containing isoflavones does not appear to have oestrogenic effects on markers of bone resorption. Soy protein favourably affected lipids; however, these effects (fall in triacylglycerol and no change in HDL) differ from those observed with oral oestrogen. These findings suggest that soy may not have biologically significant oestrogenic effects on bone resorption and we hypothesize that the lipid effects may be mediated, at least in part, through nonoestrogenic mechanisms.
CTLA4 gene and Graves’ disease: association of Graves’ disease with the CTLA4 exon 1 and intron 1 polymorphisms, but not with the promoter polymorphism
Authors: Vaidya B. , Oakes E. J. C. , Imrie H. , Dickinson A. J. , Perros P. , Kendall‐Taylor P. , Pearce S. H. S.
Published: June 2003

objective Recent studies have shown that Graves’ disease (GD) is linked to and associated with alleles of the cytotoxic T lymphocyte antigen‐4 (CTLA4) locus. However, the true pathogenic polymorphism(s) at this locus remains uncertain. Moreover, the association studies of the promoter CTLA4(−318)C/T polymorphism in white GD populations have produced conflicting results. Therefore, we have analysed three CTLA4 single nucleotide polymorphisms, including promoter CTLA4(−318)C/T, exon 1 CTLA4(49)A/G and intron 1 CTLA4(1822)C/T in our GD cohort from the UK.

patients and methods We studied 301 white patients with GD and 349 healthy ethnically matched local controls. Amongst GD probands, 129 had significant thyroid‐associated orbitopathy (TAO; NOSPECS class III or worse). The CTLA4(−318)C/T, CTLA4(49)A/G and CTLA4(1822)C/T polymorphisms were genotyped by using the restriction enzymes MseI, Bst71I and HaeIII, respectively.

results We found no association between GD and alleles of CTLA4(−318)C/T. GD was found to be associated with the G allele of CTLA4(49)A/G[P = 5·9 × 10−6, odds ratio (OR) 1·65] and the T allele of CTLA4(1822)C/T (P = 7·7 × 10−6, OR 1·64). The frequencies of these alleles were significantly higher in GD probands with significant TAO than in those without TAO (G allele: P = 0·001, OR 1·68; T allele: P = 0·001, OR 1·70).

conclusions The promoter CTLA4(−318)C/T polymorphism is not in linkage disequilibrium with the pathogenic polymorphism(s) at the CTLA4 locus. The alleles of both the exon 1 CTLA4(49)A/G and the intron 1 CTLA4(1822)C/T polymorphisms are associated with GD, which is stronger in patients with TAO.
Combined pituitary hormone deficiency in Australian children: clinical and genetic correlates
Authors: McLennan Kim , Jeske Yvette , Cotterill Andrew , Cowley David , Penfold James , Jones Tim , Howard Neville , Thomsett Michael , Choong Catherine
Published: June 2003

objective Mutations in the gene for the POU domain transcription factor POU1F1 (human Pit‐1) have been reported in patients with GH, TSH and PRL deficiencies. PROP1 (Prophet of Pit‐1) gene mutations also cause gonadotrophin deficiencies and in some cases partial ACTH deficiency. This study analyses the POU1F1 and PROP1 genes in a cohort of Australian children with combined pituitary hormone deficiency (CPHD) and correlates results with patient phenotype.

patients and design Genomic analysis was carried out on 33 patients with CPHD referred from centres around Australia. Clinical data were collected from medical records and referring physicans.

results POU1F1 mutations were identified in two of four patients with a suggestive phenotype. In a female patient, novel compound heterozygous POU1F1 mutations were identified: Arg143Leu in exon 3 and Leu194Gln in exon 4. This patient presented with failure to thrive at 6 weeks of age and has deficiencies of TSH and GH. A previously described heterozygous Arg271Trp mutation in exon 6 of the POU1F1 gene was identified in a female infant who presented with growth failure and was diagnosed with TSH then GH deficiencies. No PROP1 mutations were identified; however, we describe a number of previously unreported PROP1 polymorphisms. No patients presenting with deficiencies of all anterior pituitary hormones early in life had POU1F1 or PROP1 gene mutations.

conclusions In 33 Australian children with CPHD we have identified POU1F1 mutations in two patients and no PROP1 mutations. We speculate that in the majority of children other genes must be responsible for the CPHD phenotype.
Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth
Authors: Greenman Y. , Ouaknine G. , Veshchev I. , Reider‐Groswasser I. I. , Segev Y. , Stern N.
Published: June 2003

background Postoperative management of clinically nonfunctioning pituitary adenomas (NFPA) presents difficult challenges. There are no good serum markers for presence or growth of the tumour, medical treatment is not effective and radiotherapy carries the risk of significant side‐effects.

objective The purpose of this study was to investigate the natural history and biological behaviour of surgically treated NFPA, with a special effort to identify characteristics indicative of a more aggressive course that could assist in the clinical decision‐making process.

study design Patients operated on at our institution for NFPA undergo uniform routine clinical follow‐up at the endocrine clinic. Magnetic resonance imaging (MRI) studies are performed 3, 6 and 12 months after transsphenoidal surgery and yearly thereafter for the first 5 years. Subsequently, imaging is performed once every 2 years or as clinically indicated. From 1992 onwards, no patient received immediate postoperative radiation therapy.

patients One hundred and twenty‐two patients (78M/45F) operated on at our institution since 1989 and with a minimal follow‐up of 1 year comprised the study group.

measurements Tumour size and characteristics were determined by MRI using a modification of Hardy's and Wilson's classifications. Maximal tumour height was also recorded and the information was routinely stored in a computerized database.

results Mean (± SD) follow‐up was 51 ± 31 months. Fourteen patients received postoperative radiation therapy. Subsequent tumour growth was observed in five of them, reduction in tumour size in four and no size changes in five. One hundred and eight patients did not receive postoperative radiation. Tumour enlargement occurred in 41 of 78 and in six of 30 patients with and without residual tumour after operation (P = 0·0024). The presence of cavernous sinus invasion before surgery [P = 0·02, odds ratio (OR) 2·72; confidence interval (CI) 1·1–6·43] and the extent of suprasellar extension in the postoperative tumour remnant (P = 0·0054 for presence of stage A, OR 4·4; 95% CI 1·5–12·5; and P = 0·012 for presence of stages B or C, OR 16·2; CI 1·8–144) were strong independent predictors of tumour enlargement.

conclusion Our data may ease the selection of patients in whom radiation therapy is likely to be necessary for tumour control, and confirms that close postoperative follow‐up is an adequate primary approach in low‐risk patients.
Hypothalamic growth hormone‐releasing hormone (GHRH) cell number is increased in human illness, but is not reduced in Prader–Willi syndrome or obesity
Authors: Goldstone Anthony P. , Unmehopa Unga A. , Swaab Dick F.
Published: June 2003

backgroundAcute illness leads to increased GH, but reduced IGF‐I secretion, while both are reduced in chronic illness. Prader–Willi syndrome (PWS) is a genetic obesity syndrome, with GH deficiency a feature independent of obesity. Reduced GH secretion may result from decreased hypothalamic release of GH‐releasing hormone (GHRH).

objectiveTo quantify hypothalamic GHRH neurone cell number in control subjects with various lengths of premorbid illness duration, PWS and non‐PWS obese subjects.

designWe examined GHRH neurones in the infundibular nucleus/median eminence complex of control subjects (n = 26, including four children), PWS (n = 6) and non‐PWS (n = 4) obese adults and PWS children (n = 2), by quantitative immunocytochemistry, using postmortem material.

resultsWe found: (i) higher GHRH cell number during prolonged illness prior to death in both control adults (r = +0·62,P = 0·002, cell numbervs.premorbid illness duration) and PWS adults (r = +0·90,P = 0·02); (ii) higher GHRH cell number in female than male adults [by 53% (95% confidence interval 28–83%) in controls,P = 0·005, correcting for premorbid illness duration]; (iii) no difference in GHRH cell number between PWS adults and control or non‐PWS obese adults (P = 0·7 andP = 0·4, adjusting for sex and illness duration); and (iv) low GHRH cell number in only one PWS child (who had been receiving exogenous GH therapy).

conclusionsThese findings suggest continued activation of GHRH neurones during prolonged illness. There is no evidence that the GH deficiency in PWS results from reduced GHRH cell number, and GHRH neuronal reponses to illness and exogenous GH treatment appear normal in PWS.
The circulating IGF system and its relationship with 24‐h glucose regulation and insulin sensitivity in healthy subjects
Authors: Frystyk Jan , Nyholm Birgit , Skjærbæk Christian , Baxter Robert C. , Schmitz Ole , Ørskov Hans
Published: June 2003

objective and design It has been suggested that circulating free IGF‐I participates in glucose homeostasis and that IGFBP‐1 reflects changes in insulin sensitivity. To study this further, we examined 10 healthy, nonobese subjects under standardized conditions for 24 h with and without an intravenous infusion of glucose, the latter in order to augment insulin sensitivity. Serum was collected every 2 h for analysis of free and total IGFs, IGFBP‐1, − 2 and − 3 and the acid labile subunit (ALS). Insulin sensitivity was estimated at the end of each 24‐h study period by use of the hyperinsulinaemic euglycaemic clamp technique.

results Glucose infusion resulted in mild hyperglycaemia (P < 0·0001), a reduction in IGFBP‐1 by approximately 40% (P < 0·0003), and increased insulin and C‐peptide levels (P < 0·0001). Glucose infusion also increased insulin sensitivity (P < 0·003). However, despite the reduction in IGFBP‐1, glucose infusion did not increase free IGF‐I over the control level, and free IGF‐II was slightly reduced (P < 0·02). Irrespective of glucose infusion, free IGF‐I and ‐II remained stable during daytime (i.e. they were unresponsive to meal‐related changes in plasma glucose), but both free fractions decreased during the night, reaching nadir at 04·00 h. None of the other members of the IGF system showed any relationship with plasma glucose levels. Finally, we failed to observe any relationship between changes in insulin sensitivity and the circulating IGF system.

conclusion We found no evidence that the circulating IGF system is involved in meal‐related blood glucose regulation or that it reflects short‐term changes in insulin sensitivity in healthy, nonobese subjects. However, we cannot preclude that the observed changes in circulating IGFBP‐1 may affect the glucose‐lowering effect of IGF‐I and ‐II at the local tissue level.
Constructions of spirituality in contemporary nursing theory
Authors: Henery Neil
Published: June 2003

Background. The nursing literature on spirituality tends to agree that modern science is relatively powerless to address the loss of personal meaning experienced by people facing death, suffering and loss. As a remedy, the literature recommends addressing patients' spirituality. The typical analytical move is to distinguish spirituality from religion and consider it a part, dimension or property of the patient.

Aim and method. This paper uses discourse analysis to identify the formal properties of scientific and religious discourses and their social and political implications. The nursing literature is then investigated to detect the use of such discourses in constructing the object spirituality and to consider any implications for nursing as a social practice.

Findings. Far from escaping science and religion, the literature constructs spirituality by means of scientific and religious discourses. These discourses have characteristic strengths and weaknesses that the nursing literature seems to miss. Accordingly, its use of religious discourse lacks coherence and depth, and risks merging human with transcendent authority. Its use of scientific discourse lacks precision and clarity and risks intensifying those features of modernity which contribute to a loss of personal meaning in the face of death, suffering and loss.

Conclusion. Nursing literature on spirituality raises important questions but is limited in its capacity to address them. This paper provides an alternative perspective. First, it draws on an analysis of the modern institutional environment and its existential dimension. Secondly, it applies discourse analysis to the task of helping people experiencing illness and injury. This approach respects the strengths and limitations of both scientific and religious discourses.
Psychometric evaluation of the Spiritual Coping Strategies scale in English, Maltese, back‐translation and bilingual versions
Authors: Baldacchino Donia R. , Buhagiar Anton
Published: June 2003

Background. The little research that has been done on the topic considers spiritual coping as consisting mainly of religious coping strategies. This limits spiritual coping solely to believers. However, it is argued that spiritual coping should address both believers and non‐believers. The development of the new Spiritual Coping Strategies (SCS) scale, which consists of both religious and non‐religious coping strategies attempts to fill this research gap.

Aim. The aim of this article is to discuss the psychometric assessment of the SCS scale designed in four versions, namely English, Maltese, back‐translation and bilingual.

Methods. The Likert‐type SCS scale comprises 20 items, each represented by the frequency and helpfulness of both religious and non‐religious coping strategies. Test–retest of the four versions was conducted between October 1999 and January 2000, with 55 final year nursing students, mean age of 24·5 years, recruited from the same class to facilitate supervision and prevent contamination of results. Test–retest reliability of the scale was investigated by cross‐tabulations, Kappa (κ) measures and Spearman's correlation coefficient. Internal consistency was tested by Cronbach's α. The correlation structure was examined by the multivariate techniques of R‐type cluster analysis and direct oblimin factor analysis.

Results. Cross‐tabulations between tests and retests gave highly significant values of chi‐squared (P ≤ 0·0001) for most items in all versions of the scale. These cross‐tabulations also yielded reasonably good values for κ. Additionally, satisfactory values for Spearman's coefficient of correlation resulted between tests and retests. Twelve frequency variables and 13 helpfulness variables had test–retest correlations in the range 0·5 ≤ rs ≤ 0·79 in at least three of the versions. Optimum values of Cronbach's α were observed for the helpfulness variable in retests namely, 0·81 for the English version, 0·73 for the Maltese version, 0·79 for the back‐translation, and 0·82 for the bilingual version. These values were all above the acceptable minimum value of 0·7. The correlation structure identified two factors, namely religious and non‐religious coping strategies. Although the two factors together explained only between 33% and 40% of the variance in the different versions, the religious factor had good reliability, with 0·77 ≤ α ≤ 0·82 for the four versions, whilst thenon‐religious factor also had α ≥ 0·71 for all versions except the Maltese one, for which α = 0·59.

Conclusion. Therefore, psychometric assessment suggests that the SCS scale, in any of the four versions, is a reliable tool which can be used in future studies on SCS in Maltese patients.
Symptom status and health‐related quality of life: clinical relevance
Authors: Sousa Karen H. , Williamson Ann
Published: June 2003

Background. Nursing continues to struggle to identify outcomes that measure quality of care. Health‐related quality of life (HRQOL) has been identified as an outcome indicator that is sensitive to health‐care interventions. However, clinicians remain skeptical about its relevance.

Aim. This article discusses the conceptual issues surrounding HRQOL research and provides an example that demonstrates how symptom status can serve as a clinically relevant and measurable dimension of HRQOL.

Methods. The study sample (n = 99) were patients presenting to the emergency department of an academic medical centre in the United States of America (USA) between July 1997 and March 1999 with the diagnosis of gastrointestinal bleeding. The mean age was 57·86 (17·52) years and 62·6% of the sample was male. The Short Form‐12 (SF‐12) (measurement used for HRQOL) and a 15‐item symptom checklist were administered within the first 24 hours following the emergency department visit and by phone 1 month after discharge.

Results. Regression analysis controlling for age, gender, haematocrit and comorbidities was used to examine the relationships between symptom status and HRQOL. The analysis suggests that symptom status is a key predictor of HRQOL.

Study limitations. The sample was a relatively small convenience sample from one emergency department in the USA.

Conclusions. Nurses are concerned with improving patients' HRQOL. Certainly, symptoms are amenable to nursing interventions. We provide one example that demonstrates the relationship between symptom status and HRQOL. By tracking and studying trends in the number of symptoms over time we can begin to track HRQOL as an outcome of care. Thus, we conclude that by helping patients manage their symptoms their overall HRQOL would improve.
Pain management in nursing procedures on premature babies
Authors: Halimaa Sirkka‐Liisa
Published: June 2003

Background. Pain can be caused to premature babies when nursing and other procedures are carried out. Procedural pain management for these babies raises challenging questions for health care professionals. Optimal pain management for premature babies can be reached by using and further developing existing pharmacological and non‐pharmacological pain alleviation methods for procedural pain before, during, and after procedures.

Aims. The aims of this study were to describe the environment of pain management in nursing procedures and examinations with premature babies; to describe preparation of the baby for the procedure; to describe non‐pharmacological pain alleviation methods during and after the procedures; and to develop a process describing procedural pain management in premature babies.

Method. The material for this study consisted of journal articles on non‐pharmacological procedural pain alleviation in infants published between 1994 and 2002. During this period knowledge of pain management in premature babies has improved considerably. The study was based on the method of content analysis.

Findings. Procedural pain management in premature babies was described by researchers as a process comprising: (1) an environment that is favourable to effective pain management, (2) safe preparation of the baby for the procedure, (3) pain alleviation during the procedure, and (4) restoring the baby's sense of security after the procedure. Pain management is recommended to be used alone or together with pharmacological interventions. Additionally, systematic pain management requires documentation of the whole pain management process.

Conclusion. Pain management can be described as a process. It is important to test and assess this process and individual non‐pharmacological pain management methods in practical nursing situations. The findings of this review can be used to improve pain management methods in premature babies.
Life with a rare chronic disease: the scleroderma experience
Authors: Joachim Gloria , Acorn Sonia
Published: June 2003

Background. Little is known about the experience of living with a rare disease and how people with rare diseases cope with not only the disease but also the reactions of others. Scleroderma is a rare chronic connective tissue disease that results in fibrotic changes involving all or some organs of the body. The two types of scleroderma are systemic scleroderma, which involves the skin and internal organs and is the more serious type, and local scleroderma, which attacks the skin and surrounding tissues. Some people with scleroderma have signs that are visible to outsiders, while others have invisible signs. Having this chronic condition and being different from the general population may subject people with scleroderma to stigmatization by others.

Aim. The aim of this study was to understand, from the individual's perspective, the experience of living with scleroderma.

Method. Focus group interviews were conducted with two groups of individuals with scleroderma. Because of the rarity of the disease and the illness of the participants, only two groups were held. The same questions were asked of both groups. A moderator and assistant guided the groups.

Findings. Data analysis revealed five themes: physical manifestations, disclosure/non‐disclosure to others, living, being normal and facing the future. The data are discussed in light of participants' having visible signs, invisible signs and the rarity of their condition. For those with visible signs, disclosure was automatic. They were conscious of being different from others without scleroderma. Those with invisible signs managed their disease information in such a way as to minimize the stigma of being different. The rarity of the disease added the problem of others not understanding their difficulties. Those who disclosed their disease not only had to deal with the reactions of others, but faced the additional burden of having to explain their condition.

Conclusion. Nurses may have little knowledge about scleroderma. It is possible that they, through their ignorance of such rare conditions, may stigmatize individuals. Through understanding about rare diseases will they be able to teach patients the skills necessary to help them cope with their symptoms, as well as the reactions of others to their diagnosis and appearance.
The impact of incontinence on older spousal caregivers
Authors: Cassells Colin , Watt Elizabeth
Published: June 2003

Background. The role of informal spousal caregivers has increased as the population ages, levels of disability in society increase, and governments seek to restrain expenditure on the provision of institutional health care. Care giving has attracted a vast body of research, largely directed at caregiver burden. Incontinence, however, has been relatively unexplored, despite being a common problem faced by caregivers, and being recognised as a major caregiver burden and predictor of institutional placement.

Aims. This study began to explore the impact of care recipient incontinence on major care providers, that is, their spouses.

Approach. A qualitative approach based on the grounded theory method was used. Eight home‐based caregivers of spouses with incontinence were interviewed.

Findings. Data analysis revealed a number of categories, grouped under three major themes: underpinnings, processes and consequences. The underpinnings were lifelong love and friendship, and acceptance; the processes were problem‐solving and constant watchfulness. The consequences were role change, financial cost, decreased intimacy, emotional responses, sleeping issues and social isolation.

Discussion. The research highlighted the interconnectedness of factors in the experiences of carers, reinforcing the need for holistic assessment beyond a focus on the ‘continence issue’ alone. Nevertheless, simple interventions could make substantial differences. A framework is proposed which may guide nursing assessment.
Spring hunting changes the regional movements of migrating greater snow geese
Authors: Béchet Arnaud , Giroux Jean‐Francois , Gauthier Gilles , Nichols James D. , Hines James E.
Published: June 2003

Human‐induced disturbance such as hunting may influence the migratory behaviour of long‐distance migrants. In 1999 and 2000 a spring hunt of greater snow geese Anser caerulescens atlanticus occurred for the first time in North America since 1916, aimed at stopping population growth to protect natural habitats.

We evaluated the impact of this hunt on the staging movements of geese along a 600‐km stretch of the St Lawrence River in southern Quebec, Canada.

We tracked radio‐tagged female geese in three contiguous regions of the staging area from the south‐west to the north‐east: Lake St Pierre, Upper Estuary and Lower Estuary, in spring 1997 (n = 37) and 1998 (n = 70) before the establishment of hunting, and in 1999 (n = 60) and 2000 (n = 59) during hunting.

We used multi‐state capture–recapture models to estimate the movement probabilities of radio‐tagged females among these regions. To assess disturbance level, we tracked geese during their feeding trips and estimated the probability of completing a foraging bout without being disturbed.

In the 2 years without hunting, migration was strongly unidirectional from the south‐west to the north‐east, with very low westward movement probabilities. Geese gradually moved from Lake St Pierre to Upper Estuary and then from Upper Estuary to Lower Estuary.

In contrast, during the 2 years with hunting westward movement was more than four times more likely than in preceding years. Most of these backward movements occurred shortly after the beginning of the hunt, indicating that geese moved back to regions where they had not previously experienced hunting.

Overall disturbance level increased in all regions in years with hunting relative to years without hunting.

Synthesis and applications. We conclude that spring hunting changed the stopover scheduling of this long‐distance migrant and might further impact population dynamics by reducing prenuptial fattening. The spring hunt may also have increased crop damage. We propose that staggered hunt opening dates could attenuate secondary effects of such management actions.