bluuebunny/crossref_metadata_2025 huggingface dataset:
Proliferative kidney disease and renal myxosporidiosis in juvenile salmonids from rivers in England and Wales
Authors: Feist S W , Peeler E J , Gardiner R , Smith E , Longshaw M
Published: March 2003

The results from a survey for proliferative kidney disease (PKD) and renal myxosporidiosis in wild salmonids from rivers in England and Wales are presented. One hundred and eighty‐five salmon, Salmo salar, 235 brown trout, Salmo trutta, 16 charr, Salvelinus alpinus, and five grayling, Thymallus thymallus, were obtained from 23 locations on 16 rivers between July and October 1997. They were examined for the presence of clinical PKD and for histological evidence of infections with Tetracapsula bryosalmonae and other renal myxozoans. Prevalence of infection with T. bryosalmonae detected histologically in brown trout varied from 11 to 43% in enzootic rivers and was only found in salmon in two rivers at low prevalence. Nephromegaly was positively associated with PKD in brown trout but in salmon mild nephromegaly was only associated with infection with an unidentified Chloromyxum sp.
Naturally occurring lesions and micro‐organisms in two species of free‐living sharks: the spiny dogfish, Squalus acanthias L., and the smooth dogfish, Mustelus canis (Mitchill), from the north‐western Atlantic
Authors: Borucinska J D , Frasca S
Published: March 2003

Twenty‐three smooth dogfish, Mustelus canis L., and 20 spiny dogfish, Squalus acanthias (Mitchill), were examined for the presence of diseases. Sharks were collected from the north‐western Atlantic between April and September 2000. Major organs were sampled for histopathology and bacterial cultures were taken from kidneys. Macroscopic lesions were infrequent and included intestinal cestodiasis and gastric and dermal erosions. Microscopic lesions were common in both shark species. Mustelus canis had numerous degenerative lesions involving the pancreatic ducts, seminiferous tubules and coronary vessels. The most frequent lesions in S. acanthias were parasitic and included pancreatic nematodiasis and biliary myxosporeosis. Additionally, both species had focal meningitis, encephalitis, dermatitis, gastritis, enteritis and glomerulomesangial thickening. Microscopic parasites included intestinal coccidiosis, unclassified gastric and testicular protozoa, skeletal muscle and renal tubular myxosporeans, a branchial trichodinid ciliate, olfactory and branchial trematodes, gastrointestinal cestodes and larval nematodes. Shewanella putrefaciens, Photobacterium sp., Vibrio sp., Pseudomonas sp. and Alteromonas sp. were isolated from kidneys of nine sharks. The role of the above lesions in the natural mortality and morbidity of the two shark species is unknown. The finding that apparently healthy sharks can harbour potentially debilitating lesions warrants the inclusion of histopathological studies in the management and conservation of sharks.
Establishment of cell lines from a tropical grouper, Epinephelus awoara (Temminck & Schlegel), and their susceptibility to grouper irido‐ and nodaviruses
Authors: Lai Y‐S , John J A C , Lin C‐H , Guo I‐C , Chen S‐C , Fang K , Lin C‐H , Chang C‐Y
Published: March 2003

Four tropical marine fish cell lines have been established from the eye, fin, heart and swim bladder of grouper, Epinephelus awoara (Temminck & Schlegel). Optimum media and temperature conditions for maximum growth were standardized. The eye and swim bladder cells were mostly epithelial, but the fin and heart cells were mostly fibroblastic. The viability of cells was 95% after 1 year of storage in liquid nitrogen (−196 °C). Besides these four cell lines, previously established grouper brain, kidney and liver cell lines were also used for a viral susceptibility study which showed that all the cell lines were sensitive to grouper iridovirus, whereas only brain, fin and liver cell lines were susceptible to the yellow grouper nervous necrosis virus (a nodavirus). Electron microscopy studies of the grouper irido‐ and nodaviruses in ultrathin sections of infected cells showed an abundance of viral particles in the cytoplasm of the virus‐infected cells indicating the effective replication of these two viruses. It is suggested that these cell lines can be used for the isolation of putative fish specific viruses and provide a valuable tool to study the mechanisms of host–pathogen interactions. Furthermore, these cell lines upon transfection, using pEGFP‐C1 and pEGFP‐aMT2.5 (ayu metallothionein promoter), produced significant fluorescent signals indicating their utility for exogenous studies.
Vibrio species isolated from diseased farmed sole, Solea senegalensis (Kaup), and evaluation of the potential virulence role of their extracellular products
Authors: Zorrilla I , Arijo S , Chabrillon M , Diaz P , Martinez‐Manzanares E , Balebona M C , Moriñigo M A
Published: March 2003

Bacteria isolated from an outbreak with moderate mortalities in farmed sole, Solea senegalensis (Kaup), in the south of Spain were identified as Vibrio harveyi and V. parahaemolyticus. Only bacterial strains showing swarming were virulent in sole and caused mortalities in experimentally inoculated fish. However, the signs of the disease were only reproduced with V. harveyi. The intramuscular inoculation of the extracellular products (ECPs) of both species produced mortalities in inoculated fish and the appearance of surface ulcers in the case ofV. harveyi. However, the inoculation of sublethal doses of ECPs to fish showed a protective effect against V. harveyi.
Antagonistic activity of Aeromonas media strain A199 against Saprolegnia sp., an opportunistic pathogen of the eel, Anguilla australis Richardson
Authors: Lategan M J , Gibson L F
Published: March 2003

A bacteriocin‐like inhibitory substance (BLIS) produced by Aeromonas media strain A199 inhibited the growth of Saprolegnia sp. in vitro, an opportunistic pathogen isolated from affected eels, Anguilla australis (Richardson). The presence of BLIS in solid media inhibited the growth of the vegetative state of the aquatic mould as well as the germination of cysts. Uninhibited growth was, however, observed in the presence of inactive BLIS, suggesting that the in vitro antagonism derived from the BLIS of A199. In four independent in vivo tank observations of fish affected with saprolegniosis, the daily addition of A199 to tank water contributed to the subsequent swift recovery of affected hosts from invasion by this opportunistic pathogen.
A survey of feeding practices in infants with phenylketonuria
Authors: Portnoi P. , MacDonald A. , Watling R. , Clarke B. J. , Barnes J. , Robertson L. , White F. , Jarvis C. , Laing S. , Weetch E. , Holliday K. , Francis D. , Netting M. , Wall C.
Published: March 2003

Background: Although the management of phenylketonuria (PKU) in infancy and early childhood is a critical part of the overall care of the disorder, there are few guidelines on infant feeding in this condition. This survey was undertaken to establish the practices of dietitians from major PKU centres in Australia and the UK.

Methods: A postal questionnaire examining infant feeding practices was sent to dietitians at nine major PKU centres in the UK and four in Australia, with each dietitian describing the infant feeding process in their last five infants. A total of 63 infants were investigated.

Results: A lower than expected incidence of infants with PKU were breast fed at the time of diagnosis: 28% of infants in the UK and 41% from Australia. Amino acid intake varied between 2.0 g kg−1 day−1 to 3.5 g kg−1 day−1 with 86% of dietitians calculating total amino acid intake derived from both protein substitute intake and normal infant formula. Amino acid intake was not calculated in breast‐fed infants. In breast‐fed infants, phenylalanine‐free protein substitute was always given before breast feeds. In bottle‐fed infants, normal infant formula was given before phenylalanine‐free protein substitute in 75% of infants. Solids were usually introduced between 3 and 6 months and phenylalanine‐free solids were given initially to the majority of infants. Most problems were seen when introducing a more concentrated phenylalanine‐free protein substitute to maintain the required amino acid intake in older infants. Age of introduction varied between 4 and 12 months and type of approach included concentrating infant protein substitutes, use of L‐amino acid protein substitutes only, or L‐amino acid protein substitutes with added carbohydrate, vitamins and minerals.

Conclusions: There appeared to be no uniform policy of infant feeding in PKU and more work is needed correlating practices to develop national and even international protocols for management.
A10. Dietary intake and anthropometric indices of hip fracture patients: a case control study
Authors: Upton W. J.
Published: March 2003

Background There is concern regarding the increasing rates of fractures that are being attributed to osteoporosis. It is estimated that around 60 000 hip fractures occur annually in the U.K. The majority being in the elderly, resulting in considerable morbidity and mortality (
DoH, 1998). Investigations into the causes, prevention and treatment of fractures are therefore of both clinical and economic importance.

Aim The aim of this study was to compare a group of elderly, fractured neck of femur patients (female, 60–102 years, n 64) with a group of healthy age‐matched controls (female, 63–90, n 45). Differences in their current dietary intake, intake in the recent and distant past, anthropometric indices lifestyle factors and food choice were all investigated.

Methods Interviewer administered questionnaires were used to obtain the information necessary and three consecutive 24 h recalls determined current dietary intake (analysed using ’Dietplan’). Anthropometric indices examined included; weight, height, demispan, mindex, demiquet, body mass index (BMI), triceps skinfold thickness (TSF), mid upper arm circumference (MUAC), mid upper arm muscle circumference (MUAMC) and maximum calf circumference.

Independent t‐tests and chi‐square were used to assess statistical significance.

Results Current dietary intake data revealed that the control group consumed almost all nutrients in greater amounts. Energy, carbohydrate, protein, thiamine, pyridoxine, calcium, phosphate, magnesium, potassium, iron, selenium, iodine and fibre were all significantly greater in the control group (P = < 0.01). Although, neither the cases nor controls achieved 100% of the RNI for energy (mean values).

There was also found to be a significant difference between the majority of the anthropometric indices measured. The controls were significantly heavier than the cases (P = 0.001) and had a greater mean mindex value (P = 0.001). Also, significantly lower TSF and MUAC values were seen in the cases (P = 0.005 and 0.001, respectively). All these results suggest that the fractured neck of femur patients were nutritionally compromised and would benefit from supplementation to aid recovery.

Analysis of past calcium intake produced surprising results, in that a greater percentage of the cases than controls stated consuming a ’high’ calcium intake in both childhood and early adulthood. The effect of recall bias needs to be considered here. But, although these results contradict the majority of findings in this field, similar results have previously been found ( New et al., 1998
).

Conclusions Various potential risk factors for hip fractures have been highlighted in this study (including; low body weight, low muscle mass and low activity level). Therefore, in conclusion, improved nutrition could help to prevent hip fracture occurrence and supplementation of the diet is an important part of the treatment for fractured neck of femur.
A12. The effect of nutrition intervention, using the Balance of Good Health Model, on the composition of the packed lunches of 10–11‐year‐old schoolchildren
Authors: Barton R.
Published: March 2003

Background The decline in the nutritional standard of school meals equates closely with an overall decline in the quality of the diets of British children. Numerous studies have found children’s diets to be high in fat and sugar, and low in fibre, calcium and iron (
Department of Health, 1989,
Adamson et al., 1991
). A balanced diet is important in schoolchildren to promote good growth and development, to protect against short‐term illnesses and diseases such as dental caries and obesity, and to avoid manifestations of diseases in adult life such as coronary heart disease (CHD) and diabetes.

Lunches eaten at school make an important contribution to a child’s daily energy and nutrient intake ( Ruxton et al., 1996
), and in recognition of this the government has proposed a set of new nutritional standards for school meals. However, an increasing number of children are consuming packed lunches, which are not addressed in the new proposals.

Aim This study investigated whether an intervention based on a teaching session using the ’Balance of Good Health’ model would have an effect on the content of packed lunches eaten by 10–11‐year‐old schoolchildren. The study also looked at parents’ views on healthy eating for their children.

Methods Twenty‐five children from a Primary school in Lincolnshire took part in the study. The contents of their lunch boxes were nutritionally analysed and scored against the Balance of Good Health model for three days in the preintervention week and for three days in the third week postintervention. Differences between weeks were statistically analysed using a paired t‐test. A questionnaire was administered to parents in order to discover their views on healthy eating and on the intervention.

Results A significant difference (P = 0.05) in the carbohydrate content of the lunch boxes was observed postintervention. There was also a greater compliance with guidelines on fat, protein and riboflavin, although the change was not statistically significant. Consistent with results from previous studies; iron and calcium were found to be lower than the recommended amount. No significant difference was found when lunch boxes were scored against the Balance of Good Health.

Conclusions All parents recognized the importance of healthy eating for their children but felt the largest barrier to changing children’s eating habits were the child’s likes and dislikes.

The study highlights the need for more nutrition education both inside and outside the school.
A13. The ’Balance of Good Health’– a Chinese version
Authors: Chan S.
Published: March 2003

Background Although attempts had been made to consider foods consumed by ethnic minority groups to ensure transcultural application when developing the National Food Guide –’The Balance of Good Health’, an Afro‐Caribbean version has now been prepared and it was felt that both the format of the display and the context of the food guide were not applicable to the Chinese community in UK. To ensure everyone benefits from the National Health Care Service, health professionals and health education agencies must be sensitive to linguistic, socio‐economic and lifestyle diversity within the ethnic minorities.

Aims The aim of the project was to develop a food guide using Chinese foods and with appropriate written Chinese form to address the members of the Chinese community with consistent messages of healthy eating, and translate the nutrient recommendations into food guidance to them.

Methods The research involved 54 Chinese members and they were recruited from various areas in London. Different shapes (in the form of a bowl, a triangle or a tilted plate) of the guide were developed and were used to assess subjects’ performance (how well the information was understood and recalled) in a meal ranking and a food sorting task. Subjects’ preferences for a particular shape of the guide were asked after undertaking the tasks. Comp‐eat was used in designing the meals and statistical tests such as Mann–Whitney, Kruskal–Wallis and Chi‐square were used to assess the significance of the results.

Results The key findings were that exposure to a guide could have a significant effect on consumer’s understanding and recall of guide concepts (P < 0.01). Secondly. guides that were in the shape of a triangle were better at conveying messages of nutritional equivalence and proportionality than those in the shape of a bowl or tilted place (P < 0.05). However, the preference studies showed that the Chinese consumers preferred a tilted plate to a triangle or a bowl because of some Chinese traditional beliefs.

Conclusions It was concluded that a guide in the form of a tilted plate should be used since consumers’ preferences should be respected, and alternative ways to reinforce nutritional messages through a tilted plate model should be sought.
The food consumption patterns and perceptions of dietary advice of older people
Authors: McKie L. , MacInnes A. , Hendry J. , Donald S. , Peace H.
Published: March 2003

Background Prevention policies do not have an upper age limit, and as the overwhelming majority of older people continue to reside in the community there is a growing role for community dietetics and primary care team members in the promotion of healthy eating.

Method The multi‐method project ascertained the dietary beliefs and practices of older people residing in high‐income, low‐income and rural localities of Scotland. One hundred and fifty‐two people aged 75 years and over were interviewed using a semistructured interview schedule and 24‐h food recall questionnaire.

Results An analysis of the food recall questionnaire demonstrated that the diets of the elderly appear to differ little from the Scottish population as a whole. In all groups there was an under consumption of fruits and vegetables reported. Findings from the interviews demonstrated that dietary beliefs were found to be firmly rooted in childhood and lifetime experiences. Participants defined healthy eating as ‘proper meals’, ‘proper foods’, and a variety of foods eaten in moderation. These definitions were based upon the consumption of fresh foods which would be considered healthy. Changing and conflicting advice on health and nutrition was contrasted with personal experiences. Few knew of the role of the dietitian or community dietitian.

Conclusions This study demonstrates a contrast between stated beliefs and actual consumption patterns. Access to food, and the cost and quality of foods impacted upon food practices. The role of the community dietitian should be promoted. Advice on healthy eating must work with contemporary practices and beliefs building upon positive aspects of diet and eating and involving the food industry, retail sector and health services.
Dietary intakes and nutrient status of vegetarian preschool children from a British national survey
Authors: Thane C.W. , Bates C.J.
Published: March 2003

Background Dietary intakes and nutrient status were compared in meat‐eaters and non‐meat‐eaters from the National Diet and Nutrition Survey of children aged 1.5–4.5 years.

Methods Children (n = 1351) were categorized as ‘omnivores’ or ‘vegetarians’, according to whether they consumed meat or meat products during a 4‐day dietary record. Blood samples were also obtained for analysis of haematological and biochemical nutrient status.

Results Three per cent of children were ‘vegetarian’. They consumed higher proportions of milk and milk products, although this was significant only in older children (P = 0.007), owing to high consumption by the high proportion of Asian children. In vegetarians, energy intakes tended to be lower in both age groups. Percentage energy from protein and fat were lower, while that from carbohydrate was higher compared with omnivores. Cholesterol intakes were lower, significantly so for younger children (P < 0.001). Intakes of micronutrients were either higher (vitamins C and E, potassium) or lower (niacin and sodium) in younger vegetarians compared with omnivores. Energy‐adjusted intakes of iron and zinc did not differ significantly from those of omnivores, although both intakes were low in many children (6–20% < LRNI), particularly in the younger group. Haematological and biochemical nutrient status indices showed few differences. Serum ferritin was lower in vegetarians, significantly so in younger children (P = 0.002). Antioxidant vitamin (A, C and E) status tended to be higher in vegetarians, while vitamin B12 intakes and status were more than adequate. Apart from poorer vitamin D intake and status in older Asian vegetarians, very few ethnic differences were observed.

Conclusions Nutrient intakes and status were generally adequate in preschool children who did not eat meat. Although serum ferritin levels were inferior (particularly in vegetarians under 3 years old), the lower intakes of fat, cholesterol and sodium, and higher antioxidant vitamin intakes and status indices were potentially beneficial. Given a balanced diet, adequate nutrient intakes and status can be maintained without consuming meat.
Clinical audit of the effects of low‐fibre diet on irritable bowel syndrome
Authors: Woolner J. T. , Kirby G. A.
Published: March 2003

Introduction High‐fibre diets are frequently advocated for the treatment of irritable bowel syndrome (IBS) although there is little scientific evidence to support this. Experience of patients on low‐fibre diets suggests that this may be an effective treatment for IBS, warranting investigation.

Methods Symptoms were recorded for 204 IBS patients presenting in the gastroenterology clinic. They were then advised on a low‐fibre diet with bulking agents as appropriate. Symptoms were reassessed by postal questionnaire 4 weeks later. Patients who had improved on the diet were advised on the gradual reintroduction of different types of fibre to determine the quantity and type of fibre tolerated by the individual.

Results Seventy‐four per cent of questionnaires were returned. A significant improvement (60–100% improvement in overall well‐being) was recorded by 49% of patients.

Conclusion This preliminary study suggests that low‐fibre diets may be an effective treatment for some IBS patients and justifies further investigation as a full clinical trial.
Dietitians and the internet: are dietitians embracing the new technology?
Authors: Kirk S. F. L. , Cade J. E. , Greenhalgh A.
Published: March 2003

Background

Internet use is increasing and in the future it will become a valuable tool for health professionals seeking and communicating health, diet and nutritional information. This study aimed to explore the use of the Internet by dietitians in the UK.

Methods

A cross‐sectional study was carried out on a random sample of 200 dietitians selected from the British Dietetic Association database. A self‐completion questionnaire was distributed to determine access to the Internet and the views of dietitians on the use of the Internet for the provision of health and nutrition information.

Results

Of the 156 respondents to the questionnaire, 96% were female and 4% were male. The results revealed that 66% of respondents had access to the Internet at work, with 39% using the Internet once a week or more. The main reported uses of the Internet were searching for health information, research and communication. Thirteen per cent of respondents reported seeing information obtained from the Internet by patients. Concerns about the use of the Internet for the provision of health information centred on creating unrealistic patient expectations.

Conclusion

The research revealed that the Internet does have a role in augmenting current services. A substantial proportion of the dietitians studied were already using the Internet routinely in their work, with the real potential for its use beginning to be realized.
Selective serotonin re‐uptake inhibitors for the treatment of perseverative and maladaptive behaviours of people with intellectual disability
Authors: Branford D. , Bhaumik S. , Naik B.
Published: March 2003

A retrospective case‐note analysis was undertaken of 37 adults with intellectual disability who lived in Leicestershire, England. The subjects were prescribed one of two selective serotonin re‐uptake inhibitor (SSRI) antidepressants, i.e. fluoxetine or paroxetine, for perseverative and maladaptive behaviours. The SSRIs proved to be of no benefit for 15 subjects (40%) and led to a deterioration in a further nine cases (25%). However, some reduction of perseverative and maladaptive behaviours was achieved in 13 cases (35%). There was no difference in the responses to fluoxetine or paroxetine.
Environmental characteristics of nursing homes and community‐based settings, and the well‐being of adults with intellectual disability
Authors: Heller T. , Miller A. B. , Factor A.
Published: March 2003

The present study examined whether characteristics of the environment of nursing homes and community‐based residential settings are associated with the adaptive behaviour, health and community integration of adults with intellectual disability living in those settings. The specific characteristics of the environment were type of facility, size, level of residential involvement in policy‐making, and the degree of variety and stimulation of the physical environment. The study assessed 249 residents with intellectual disability over a 3‐year period who lived in nursing homes at baseline. At follow‐up, 50 of the residents had moved to community‐based facilities while 199 of the residents remained in nursing homes. The results indicated that type, size and characteristics of the environment were related to the level of adaptive behaviour and community integration at follow‐up. Residents living in community‐based settings had better health and greater levels of community integration than residents living in nursing homes. Residents living in smaller facilities had greater adaptive behaviour at follow‐up than residents living in larger facilities. More variety and stimulation in the residential physical environment was associated with greater adaptive behaviour among residents at follow‐up. Residential facilities that permitted greater resident involvement in policy‐making, and had greater variety and stimulation in their physical environment were associated with greater levels of community integration among their residents at follow‐up.
Identification of early self‐injurious behaviour in young children with intellectual disability
Authors: Murphy G. , Hall S. , Oliver C. , Kissi‐Debra R.
Published: March 2003

Very little is known about the early stages of self‐injurious behaviour (SIB) in young children with developmental disabilities, even though there has been a great deal of research into the prevalence, assessment and treatment of well‐established SIB in older individuals. In the present initial study, teachers in special schools for children under 11 years of age with severe intellectual disability and/or autism were asked to identify children who were beginning to show early self‐injury (the index group). These children were then matched to classroom controls (of the same ability level and mobility), and teachers were interviewed about the children’s behaviours and skills. The index children showed significantly more potential SIB than the control group children, but there was overlap between the groups in terms of percentage duration of potential SIB, suggesting that teachers do not find it easy to identify children with ‘early’ SIB. The index children’s skills and problem behaviours, their sensory impairments and degree of autism did not differ significantly from those of the control group. When all the children showing any potential SIB were pooled together, it transpired that developmental age and degree of mobility were significantly correlated with percentage duration of SIB, suggesting that these characteristics may be important risk markers. The index children were also observed at 3‐month intervals at school over the following 18 months and self‐injury clearly escalated for some of the index children, while it did not do so for others. Using regression analysis, increases in SIB were shown to be associated only with the degree of concern expressed about the child’s behaviour at time 1 by the teacher, no other variables predicting increases in SIB.
Family factors influencing out‐of‐home placement decisions
Authors: Llewellyn G. , Dunn P. , Fante M. , Turnbull L. , Grace R.
Published: March 2003

Flying in the face of national community care policies, families of young children with severe disabilities continue to seek out‐of‐home placement. The present paper explores the factors which influence families to care for their children at home or to place them out‐of‐home. Data for the present study were derived from a qualitative in‐depth study of the everyday family life experiences of 167 families of young children with a disability and high support needs. One hundred and twenty‐five (75%) of these families definitely did not want to place their child, 32 (19%) were undecided, and 10 (6%) were actively seeking or had already sought placement. Coded interview data were subjected to exploratory factor analysis to reveal eight factors influencing everyday family life. An analysis of variance (ANOVA) revealed significant differences between the three groups of families on three out of the eight factors. The families’ views about placing their child were compared across the three groups using text analysis techniques. Without exception, the primary desire of all families was to care for their child at home. However, when placement was considered a possibility, even if remote, the most frequently reported reasons were family ‘survival’ and mitigating circumstances. The finding that one‐quarter of the families had already sought or were considering placement for children in this young age range is provocative. The implications of the findings for policy and practice are discussed.
Alcohol problems and intellectual disability
Authors: Clarke J. J. , Wilson D. N.
Published: March 2003

The present paper discusses some of the difficulties in working with people with an intellectual disability and an alcohol problem, and draws on the sparse literature about alcohol problems in people with intellectual disability. Four individuals drawn from the current clinical case loads of medical practitioners in UK community intellectual disability services are described. Some suggestions for staff training, patient education and health promotion, and therapeutic approaches are made.
Determinants of aggression, and adaptive and maladaptive behaviour in older people with Down’s syndrome with and without dementia
Authors: Cosgrave M. P. , Tyrrell J. , McCarron M. , Gill M. , Lawlor B. A.
Published: March 2003

In a cross‐sectional study of aggression, and adaptive and maladaptive behaviour in 128 subjects with Down’s syndrome (DS), 29 of whom had dementia, the current authors found that the presence of dementia was not predictive of aggression or maladaptive behaviour. However, the level of adaptive behaviour was shown to be lower in subjects with dementia, and in those with lower levels of cognitive functioning, as measured on a rating instrument, the Test for Severe Impairment. Although the presence of aggressive behaviours is not higher in subjects with dementia and DS on cross‐sectional review, it remains to be seen whether aggression will increase in individual cases with the onset or progression of dementia. The decline in adaptive behaviour shown in the present study confirms the findings of previous studies and indicates a direction for service development for persons with the dual diagnosis of dementia and DS.
The use of ECT in intellectual disability
Authors: Cutajar P. , Wilson D.
Published: March 2003

The present survey examines the use of electroconvulsive therapy (ECT) by consultant psychiatrists working with people with intellectual disability in Trent Region, UK, which has a population of 4.7 million people. In the first phase of the study, all consultants in the area were sent a questionnaire to find out how many patients had been given ECT during the previous 5 years. Some 92% of the consultant psychiatrists returned the questionnaires. Eight patients were given a total of 122 ECTs, which is low when compared with the use of ECT by general adult psychiatrists. The second phase of the research involved a study of the individual medical case notes to obtain information about individual indications for ECT, outcome and consent issues. The commonest indication for ECT was depression, and the best response was obtained when the clinical picture was dominated by biological and/or psychotic symptoms.
Breast cancer screening for older women with intellectual disability living in community group homes
Authors: Davies N. , Duff M.
Published: March 2003

Breast cancer is one of the commonest cancers to affect women. Present health service guidelines call for screening and mammography for all women aged between 50 and 65 years in an effort to increase early detection and improve survival rates. Nulliparity is one of the associated risk factors for breast cancer. Women with intellectual disability (ID) are increasing in longevity and are frequently nulliparous, and therefore, they are at increased risk of developing breast cancer. The aim of the present study was to review the uptake and knowledge of women with ID living in the community of breast screening programmes. A postal survey of women aged ≥ 50 years with ID living in community group homes was used to gather data. Only one‐third of the women carried out regular breast examination and a similar proportion had received invitations to mammography. General practitioners and practice nurses were currently playing very minor roles in breast screening these women. Primary health care professionals may be missing opportunistic health promotion opportunities and the support services for women with ID living in the community could be provided with better training and resources to improve breast cancer screening in this vulnerable group.
Factors associated with intended staff turnover and job search behaviour in services for people with intellectual disability
Authors: Hatton C. , Emerson E. , Rivers M. , Mason H. , Swarbrick R. , Mason L. , Kiernan C. , Reeves D. , Alborz A.
Published: March 2003

Staff turnover is a major problem in services for people with intellectual disability (ID). Therefore, understanding the reasons for staff turnover is vital for organizations seeking to improve their performance. The present study investigates the factors directly and indirectly associated with an intention to leave an organization and actual job search behaviour amongst staff in services for people with ID. As part of a large‐scale survey of staff in services for people with ID, information was collected from 450 staff concerning intended turnover, job search behaviour and a wide range of factors potentially associated with these outcomes. Path analyses revealed that work satisfaction, job strain, younger staff age and easier subjective labour conditions were directly associated with intended turnover. The same factors, with the exception of younger staff age, were also directly associated with job search behaviour. Factors indirectly associated with these outcomes included wishful thinking, alienative commitment to the organization, lack of staff support, role ambiguity, working longer contracted hours, having a low‐status job, a lack of influence over decisions at work and less orientation to working in community settings with people with ID. The models of staff turnover empirically derived in the present study confirm and extend previous research in this area. The implications for organizations are discussed.
Adjunctive gabapentin in patients with intellectual disability and bipolar spectrum disorders
Authors: Carta M. G. , Hardoy M. C. , Dessì I. , Hardoy M. J. , Carpiniello B.
Published: March 2003

The aim of the present study was to assess the efficacy of adjunctive gabapentin (GBP) in the treatment of patients with intellectual disability (ID) and bipolar spectrum disorders. Ten affected subjects with demonstrable increases in symptomatology during ‘significant’ life events which had interfered with or induced the interruption of their rehabilitation programmes were chosen for this study. The meaning of ‘significant’ was defined for each patient as a frequently repeated life event which had elicited a marked increase in symptoms on at least two occasions. Gabapentin (300–900 mg day−1) was added to the standard therapy. The subjects’ psychopathological conditions during the significant life event were assessed by means of standardized tools both before and after adjunctive therapy with GBP. A positive response to therapy was observed, with subsequent improvement of psychopathological conditions, particularly for anxiety and depressive symptoms. The promising results obtained with GBP suggest the need for further trials. Adjunctive GBP may become an alternative treatment approach for patients with ID in whom traditional mood‐stabilizing agents have frequent contraindications.
Psychopathology and young people with Down's syndrome: childhood predictors and adult outcome of disorder
Authors: McCarthy J. , Boyd J.
Published: March 2003

There is a scarcity of follow‐up studies into adult life of psychiatric disorder in young people with intellectual disability. The key aims of the present study were: (1) to determine the outcome of psychopathology present in childhood in individuals with Down's syndrome (DS); and (2) to look at childhood predictors of adult psychiatric disorder. Fifty‐two young people with DS were identified from a sample of 193 subjects examined in childhood and adolescence for psychiatric and behaviour disorder. These young adults were interviewed for the presence of psychiatric disorder. No significant relationship was found between childhood mental disorder and psychiatric disorder in adult life for those individuals with DS. Early childhood factors of psychiatric disorder, challenging behaviour and family environment, except social background, did not predict adult psychopathology in young people with DS. Childhood disorder in individuals with DS has a good early prognosis with little evidence of continuity of the disorder into adult life.
Hyponatremia during carbamazepine therapy in patients with intellectual disability
Authors: Kelly B. D. , Hillery J.
Published: March 2003

Carbamazepine is an anticonvulsant and psychotropic medication commonly used in the treatment of people with intellectual disability (ID). The incidence of hyponatremia during treatment in this population is unclear. The present study aimed to determine the prevalence of hyponatremia during carbamazepine treatment in patients with ID, and to investigate the risk factors and clinical features of this condition. The prevalence of hyponatremia was retrospectively assessed in 53 people receiving carbamazepine (subject group) and 64 people not receiving carbamazepine (control group) who lived in a residential centre for people with ID. The relationship between serum sodium level, sex, age, daily carbamazepine dose and serum carbamazepine levels was examined. The prevalence of the clinical features of hyponatremia was assessed in this population using a checklist. The prevalence of hyponatremia was 41.5% and 9.4% in the subject and control groups, respectively. The mean serum sodium level in the subject group was significantly lower than that in the control group. Hyponatremia correlates significantly with a high daily carbamazepine dose and a high serum carbamazepine level. The checklist of clinical features was not useful in detecting hyponatremia clinically. Hyponatremia is a common occurrence in this population. In the light of the uncertain significance of mild, chronic hyponatremia, the value of routine monitoring of serum electrolytes has yet to be established.
Patterns of offending among people with intellectual disability: a systematic review. Part I: methodology and prevalence data
Authors: Simpson M. K. , Hogg J.
Published: March 2003

A systematic review of research on offenders with intellectual disability (ID) was conducted. In the present study, the first of a two‐part presentation of the findings, the authors outline the methodology of the review and present data on the prevalence of offending by adults with ID. The review highlights the methodological problems of the research and the low level of rigour in many of the studies. The organization of the penal and ‘care’ systems are seen to have a huge impact on research findings. In addition, studies which adopt an IQ‐based concept of ID show low rates of offending, whilst those which use wider definitions (e.g. attendance at special school) show higher ones. There is also preliminary evidence for believing that the prevalence of arson and sexual offences may be higher relative to other kinds of crimes for people with ID than for other offenders.
Dermatoglyphics and abnormal palmar flexion creases as markers of early prenatal stress in children with idiopathic intellectual disability
Authors: Rosa A. , Gutiérrez B. , Guerra A. , Arias B. , Fañanás L.
Published: March 2003

A number of studies have shown the importance of dermatoglyphics as markers of prenatal disturbance in developmental disorders of unknown origin. Genetic and non‐genetic factors are involved in the aetiology of intellectual disability (ID), although the cause remains unknown in up to 50% of cases. The aim of the present study was to analyse dermatoglyphic traits and abnormal palmar flexion creases as markers of environmental prenatal stress in children with idiopathic ID (IID) using a case‐control study design. Three dermatoglyphic variables, which have been reported as altered in other congenital disorders, were considered were studied in a sample of 62 children with IID (IQ < 70) and 75 healthy controls (IQ > 70): (1) fingerprint patterns; (2) total a–b ridge count (TABRC); and (3) abnormal palmar flexion creases (APFCs). More arches, the simplest fingerprint pattern, and more radial loops, an unusual pattern, were found in IID cases in comparison to controls (χ23= 9.26;P= 0.02), with especially marked differences in boys (χ23= 6.5;P= 0.0008). A significant increase of APFCs was also found in the affected children (χ24= 28.52;P< 0.00; odds ration = 3.86, 95% confidence interval = 1.77–8.47). For TABRC, the differences between IID cases and controls failed to reach the conventional level of significance. These findings suggest that environmental factors acting early in development, or mechanisms involving an interaction of genotype and environment could be involved in the aetiology of some cases of ID.
Prevalence of ‘criminal offending’ by men and women with intellectual disability and the characteristics of ‘offenders’: implications for research and service development
Authors: Holland T. , Clare I. C. H. , Mukhopadhyay T.
Published: March 2003

The investigation of the relationship between criminal offending and the presence of an intellectual disability (ID) is problematic for two main reasons. First, because of problems associated with the definition of ‘ID’, and secondly, because much criminal offending goes undetected or unreported, and studies can only investigate those already involved with the criminal justice process. Studies using IQ as a continuous variable indicate that significantly below‐average intellectual ability is an independent predictor of future offending. Whilst people with ID may be over‐represented in parts of the criminal justice system, given the intellectual and other psychosocial disadvantages which they experience, the level of offending behaviour in this particularly vulnerable group is strikingly low. The present authors propose that two broad groups of people can be identified. The first, broader, group is one of people for whom social disadvantage and mental ill health (particularly substance abuse), coupled with a significant intellectual impairment, are the main characteristics. Secondly, there is a smaller group of people, usually already known to ID services as service users, but for whom the process whereby what might have been conceptualized as ‘challenging behaviour’ becomes ‘offending’ is far from clear. The distinction the present authors make between challenging behaviour and offending is important for understanding how ‘difficult’ behaviour becomes identified as ‘antisocial/criminal behaviour’. They argue that research needs to move from prevalence and descriptive studies to investigating the processes which determine movement in and out the criminal justice system. The present political emphasis on public protection and proposals for significantly broader mental health legislation raise the danger of a re‐expansion of institutional models of care, rather than the development of multi‐agency support networks. The present paper underscores a note of caution, particularly where choices have to be made between expanding institutional models on the one hand and providing more integrated services on the other. Over and above policy decisions, these are social and political choices.
The Edinburgh Principles with accompanying guidelines and recommendations
Authors: Wilkinson H. , Janicki M. P.
Published: March 2003

A panel of experts attending a 3‐day meeting held in Edinburgh, UK, in February 2001 was charged with producing a set of principles outlining the rights and needs of people with intellectual disability (ID) and dementia, and defining service practices which would enhance the supports available to them. The Edinburgh Principles, seven statements identifying a foundation for the design and support of services to people with ID affected by dementia, and their carers, were the outcome of this meeting. The accompanying guidelines and recommendations document provides an elaboration of the key points associated with the Principles and is structured toward a four‐point approach: (1) adopting a workable philosophy of care; (2) adapting practices at the point of service delivery; (3) working out the coordination of diverse systems; and (4) promoting relevant research. It is expected that the Principles will be adopted by service organizations world‐wide, and that the accompanying document will provide a useful and detailed baseline from which further discussions, research efforts and practice development can progress.
Bone mineral density in patients with Crohn's disease during long‐term treatment with azathioprine
Authors: Florén  , Ahrén  , Bengtsson  , Bartosik  , Obrant
Published: March 2003

Florén C‐H, Ahrén B, Bengtsson M, Bartosik J, Obrant K (Lund University, Malmö, Sweden). Bone mineral density in patients with Crohn's disease during long‐term treatment with azathioprine. J Intern Med 1998; 243: 123–26.

Objectives

To ascertain whether patients with Crohn's disease treated with azathioprine maintained bone mineral mass better than patients treated with steroids alone.

Design

Retrospective study.

Setting

University Hospital of Malmö, Sweden.

Subjects

A total of 59 patients with ileocolonic, ileocaecal or colonic Crohn's disease.

Methods

Bone mass was assessed by dual photon X‐ray absorptiometry at the level of L2 – L4.

Results

Patients treated with a high lifetime dose of steroids (> 5 g prednisolone) had significantly (P= 0.011) lower Z‐score of L2–L4 (−0.87 ± 1.11; 11 SD) than steroid‐treated patients, who had received a low dose of prednisolone (< 5 g) (0.08 ± 1.16 SD). Azathioprine did not negatively influence the steroid effect on bone mineral density.

Conclusions

Azathioprine does not seem to affect bone mineral density by itself. However, by being steroid‐saving, it seems to conserve bone mineral mass in patients with Crohn's disease.