bluuebunny/crossref_metadata_2025 huggingface dataset:
Drink consumption in British preschool children: relation to vitamin C, iron and calcium intakes
Authors: Watt R. G. , Dykes J. , Sheiham A.
Published: March 2003

Objective To examine the impact of soft drinks, fruit juices, milk and tea consumption on vitamin C, iron and calcium intakes in a large, representative sample of preschool children in the UK.

Design Secondary analysis of 4‐day weighed dietary diaries.

Sample 1675 children aged 1.5–4.5 years living in the UK in 1992/993.

Results Fruit juice consumers, but not soft drink consumers, had higher vitamin C intakes and higher plasma ascorbate levels than nonconsumers (P < 0.001). However, overall intakes tended to exceed the RNI and 45% of children still had adequate intakes without the contribution of soft drinks and 56% without the contribution of fruit juice. Children who did not consume fruit juice or soft drinks were no more likely to have depleted levels of vitamin C than consumers. Tea drinkers had diets which were lower in iron and vitamin C than nonconsumers (P < 0.005). They had lower levels of haemoglobin (P < 0.05) but not ferritin. Children under 4 years old were less likely to meet the RNI for iron if they were tea drinkers (P < 0.005) but no more likely to be anaemic. Calcium intakes were significantly higher for whole milk consumers than for nonconsumers (P < 0.005) and 73% of overall calcium intake was predicted by quantity of all milks consumed. Whole milk consumers both under and over 4 years of age were significantly more likely to reach the RNI for calcium (P < 0.00005 and P < 0.05).

Conclusions Preschool children’s drinking has an impact on their intakes of vitamin C, iron and calcium. In particular, intakes of calcium are closely linked to the amount of milk consumed in this age group.
What British children are eating and drinking at age 12–18 months
Authors: De La Hunty A. , Lader D. , Clarke P. C.
Published: March 2003

Background Health and growth during the first 2 years of life demand adequate nutrition. Proportionate to the toddler’s size, the nutrient requirements exceed those of adults by up to six‐fold.

Objective This study reports the first national survey to assess the diets of British children at 14 months.

Methods The data were gathered by postal questionnaire sent to the mothers who had participated in the 1995 National Survey of Infant Feeding. The results were evaluated in respect of the recommendations from COMA for the UK.

Results A total of 5069 children of average age 14 months were included. Bread and cereal were consumed frequently. Fifty per cent of the children ate raw fruit, 51% ate cooked vegetables, 34% ate meat and 76% drank cow’s milk daily. Consumption of sweetened drinks (such as squashes and carbonated drinks) was common. This study confirmed the influence of social, economic and educational inequalities on dietary practices.
Safety, acceptability and efficacy of a high‐energy, fibre‐containing oral nutritional supplement in malnourished patients: an observational study
Authors: Mayr P. , Kalde S. , Vogt M. , Kuhn K. S.
Published: March 2003

We describe an open, uncontrolled, observational study to evaluate the safety, acceptability and efficacy of a high‐energy, fibre‐containing oral nutritional supplement in patients who were either malnourished or who had experienced recent, acute weight loss and therefore needed a high‐energy and/or fibre supplement.

Assessments For assessment of safety and tolerance, occurrence of adverse events and oedema were to be documented during the 2‐week trial and routine blood biochemistry was measured. The acceptability of the oral nutritional supplement was rated by the patients. In order to assess efficacy, patients’ body mass index (BMI) was calculated at baseline and following 2 weeks of nutritional intervention.

Results A daily intake of 400–600 mL of a high‐energy, fibre‐containing liquid nutritional supplement was well accepted and no adverse events or problems with compliance were recorded. The high acceptability was underlined by favourable ratings of taste, smell, texture and overall acceptability. The patients’ median (interquartile range) BMI increased from 18 kg m–2 (18–19 kg m–2) to 20 kg m–2 (19–20 kg m–2); this increase was highly significant (P < 0.001).

Conclusion We conclude that a high‐energy, fibre‐containing nutritional supplement is safe, well tolerated and associated with improved nutritional status in malnourished patients.
A prospective study of the workload of a newly formed PEG advice team
Authors: Matthewson K. , White S. , Torrance A. , Clark S. , Bottrill P.
Published: March 2003

Background

A multidisciplinary advice team may be the optimal way of providing the long‐term nutritional and percutaneous endoscopic gastrostomy (PEG)‐related care for patients dependent on PEG feeding but the workload involved is unknown.

Aim

To study prospectively the workload of a proactive, multidisciplinary PEG advice team over a 2‐year period.

Methods

Separate documentation from main case notes of each episode of the team’s contact with PEG or potential PEG patients, including assessment, advice and therapy given, from the time of its establishment, for four consecutive 6‐monthly periods.

Results

During the audit, 89 patients were referred to the team for consideration of PEG insertion and PEGs were placed in 74. Eighty‐nine additional patients were referred for follow up having had a PEG placed elsewhere. During the four audit periods the rate of new PEG insertions increased by 53%, the rate of PEG replacements by 315%, and the number of patients under the team increased from 16 to 70, an increase of 337%. Numbers of inpatient and outpatient consultations, and visits to other institutions by members of the team increased commensurately.

Conclusions

The rapidly increasing workload of the team suggests it is playing a valued role but there are significant resource implications.
A reassessment of the fat intake of children from meat and meat products and an estimate of haem iron intakes
Authors: Burgess L. , Hackett A. F. , Kirby S. , Maxwell S. , Nathan I.
Published: March 2003

Background

It is possible that fat intake from red meat has declined as a consequence of changes in animal husbandry and butchery practices. In particular, a study of the intake of vegetarian and meat‐eating children concluded that their fat intakes were similar, but the most recent information on the fat content of meat was not available. In addition, iron availability is probably as important as the total amount of iron consumed but estimates of haem iron intake are rarely made.

Methods

The dietary intake of 50 omnivorous children was reanalysed to produce new estimates of fat and haem iron intakes. Fat intake from meat and meat products only was recalculated using supplements to the food tables not available to the initial survey. Haem iron intake was calculated by discriminating between the different types of meat consumed and estimates of the proportion of iron which is in the haem form.

Results

The recalculated diets had significantly lower energy (8.03–7.50 MJ), fat (79–73 g) and carbohydrate (257–237 g) levels. The proportions of energy from fat (36%) and carbohydrate (51%) were unaffected. Meat supplied 3.2 mg (33%) of the iron intake (9.6 mg) of which 1.3–1.5 mg (13–16% of the total) was estimated to be in the haem form. Children may be relatively unaffected by the changes in the composition of meat as such, if they consume highly processed foods which include, for example, rusk, pastry, breadcrumbs and batter.

Conclusions

The original estimates of the intake of fat of these omnivorous children from meat and meat products do appear to have been overestimates, but only as the weight of fat consumed not as a percentage of energy. Haem iron was found to supply a substantial proportion of the iron intake of these children and may account for their higher haemoglobin values.
Intolerance to an extensively hydrolysed formula mistaken for postoperative diarrhoea in a child with neuroblastoma
Authors: Ward E. , Picton S.
Published: March 2003

Background

Persistent diarrhoea has recently been reported as a common problem following surgical resection for advanced abdominal neuroblastoma.

Case study

A 10‐month‐old child, who had previously had no nutritional problems whilst undergoing chemotherapy treatment for a stage IV neuroblastoma, developed severe diarrhoea following tumour resection. He required nutritional support and was commenced on a continuous overnight nasogastric feed of a non‐milk protein hydrolysate feed (MCT Pepdite 0‐2, S.H.S. International Ltd, UK) His diarrhoea persisted and it was assumed that this was a postoperative problem which in time would regress. Two months later the child was admitted with a rectal prolapse, and a colonoscopy and biopsy suggested allergic protocolitis. The diarrhoea resolved rapidly on stopping the feed.

Conclusion

Although he was never re‐challenged with the non‐milk protein hydrolysate, it appears that he had a rare intolerance to an extensively hydrolysed protein formula which was masked by the assumption that his diarrhoea was a postoperative problem.
Rights‐based food and nutrition perspective: 21st century challenge for dietetics
Authors: Florencio C. A.
Published: March 2003

Progress in addressing the problems of hunger and malnutrition has been slow and uneven across regions and countries of the world. A rights‐based perspective, not merely a utilitarian argument, must serve as the rationale for humans to be properly nourished. Rights impose corresponding binding obligations on others and the concept of rights holders and duty bearers goes beyond the human development paradigm. The right to adequate food is realized when every man, woman and child, alone or in community with others, has physical and economic access at all times to adequate food or means for its procurement. As duty bearers, governments are obligated to assure the realization of that right and accountable if the right is violated. The use of the human rights approach to adequate food necessarily implies a re‐examination and fundamental changes in the way we think about hunger and malnutrition and their causes; the manner of shaping and reshaping policies; the context and processes of planning, monitoring and evaluating programmes; and the substance and method of research and education in food and nutrition. Dietitians and dietetic associations can be instrumental in making the human right to adequate food a reality.
Application of Hazard Analysis Critical Control Points system to enteral tube feeding in hospital
Authors: Oliveira M. R. , Batista C. R. V. , Aidoo K. E.
Published: March 2003

An HACCP system was implemented for the quality assurance of preparation, storage and delivery of enteral feeds to patients in hospital. Routine methods of feed preparation, storage and delivery to patients were studied and a flow chart was initially made. After identifying hazards, an HACCP team was assembled, a flow chart was modified and critical control points were defined using a decision tree. Control measures for each step of the process and its monitoring and corrective measures to be applied were also defined. In addition, feed samples were analysed for microbiological quality and feed storage temperatures were also recorded, before and after the implementation of the HACCP system. When the control measures were applied and monitored, the hazard was reduced. Bacterial counts in feed were reduced from 105 cfu mL–1 to < 101 cfu mL–1. The results show that contamination of enteral feed may be reduced or eliminated if a systematic approach such as HACCP is applied effectively.
A case of monosomy 21 found to be an unbalanced de novo t(5p;21q) by fluorescence in situ hybridization
Authors: Flaherty L. , Moloney J. , Watson N. , Robson L. , Bousfield L. , Smith A.
Published: March 2003

A case is presented in which monosomy 21 was detected by routine cytogenetics and fluorescence in situ hybridization (FISH) studies demonstrated an unbalanced translocation t(5;21). The patient was partially monosomic for both 5p and 21q. The phenotype of the infant showed some features of the 5p‐ (cri‐du‐chat) syndrome, but there were also features present which were uncharacteristic of this syndrome. The present findings, combined with similar cases reported in the literature, provide further support for a proximal monosomy 21q syndrome.
Factors associated with staff stress and work satisfaction in services for people with intellectual disability
Authors: Hatton C. , Emerson E. , Rivers M. , Mason H. , Mason L. , Swarbrick R. , Kiernan C. , Reeves D. , Alborz A.
Published: March 2003

Staff stress and morale have been identified as major issues affecting the quality of services for people with intellectual disability. The present study investigates factors directly and indirectly associated with staff general distress, job strain and work satisfaction amongst staff in services for people with intellectual disability. As part of a large‐scale survey of staff in services for people with intellectual disability, information was collected from 450 staff concerning general distress, job strain and work satisfaction, and a wide range of factors potentially associated with these outcomes. Path analyses revealed that three factors accounted for 28% of the variance in general distress scores: (1) wishful thinking, (2) stress linked to work–home conflict and (3) role ambiguity. Six factors accounted for 50% of the variance in job strain scores: (1) wishful thinking, (2) stress linked to a lack of staff support, (3) alienative commitment, (4) role ambiguity, (5) stressors linked to a low status job and (6) working longer contracted hours. Six factors accounted for 66% of the variance in work satisfaction scores: (1) stress linked to a low status job, (2) support from supervisors, (3) influence over work decisions, (4) alienative commitment, (5) support from colleagues and (6) older staff age. A range of factors indirectly associated with the three outcome measures was also identified. The models of general distress, job strain and work satisfaction empirically derived in the present study confirm and extend previous research in this area. The implications for organizations and future research are discussed.
Fragile‐X syndrome, Down’s syndrome and autism: awareness and knowledge amongst special educators
Authors: York A. , Von Fraunhofer N. , Turk J. , Sedgwick P.
Published: March 2003

Fragile‐X syndrome is the commonest cause of inherited intellectual disability. There is good evidence for a behavioural phenotype. This has implications for school staff using standard educational techniques. Similarly, autism is known to create particular educational requirements. The present study examined the awareness and knowledge of fragile‐X syndrome, Down’s syndrome and autism amongst staff in special and mainstream education. One hundred and two special school staff and 40 mainstream school staff completed questionnaires. Most staff offered a variety of features ‘typical’ of Down’s syndrome and autism. In contrast, staff knew less about fragile‐X syndrome. Specific knowledge about the learning styles of these children was very poor, but was associated with having taught an affected child. Mainstream and special school staff offered similar levels of knowledge for all three conditions. Staff did not demonstrate a sufficiently specialized knowledge of fragile‐X syndrome to ensure that the special educational needs of these children were being met fully.
Incompetence in practice in health care in the Netherlands: report of a study
Authors: Biesaart M. C. I. H. , Hubben J. H.
Published: March 2003

Recent health legislation in the Netherlands makes specific provisions for patients who are not (fully) capable of acting reasonably in their own interests. If this legislation is actually to improve the legal position of incompetent people, it must be clear to whom these provisions apply. The description in modern legislation is that the person ‘is regarded as not being able to make a reasonable assessment of his interests in the issue in question’. The law does not provide criteria according to which competence can be assessed in practice. In the present study, data on the competence assessment of 133 clients were collected by means of a poll held among those people who decide on competence in practice and a total of 485 assessors were polled. Client files were also examined with the intention of gaining insight into the carers’ motivation to involve or exclude clients from the decision‐making process. Finally, interviews were conducted with clients who have a mild or moderate intellectual disability. Large differences appeared to exist between the various assessors in the assessment of the general competence of clients. A general assessment of a client’s competence is not sufficient in daily practice; therefore, partial competence was also assessed. Opinions about the partial competence of clients varied considerably among assessors. A ranking was compiled of discriminating characteristics in the qualification of competence or incompetence.
Parental scaffolding of the discourse of children and adolescents with intellectual disability: the case of, referential expressions
Authors: Abbeduto L. , Weissman M.D. , Short‐Meyerson K.
Published: March 2003

Individuals with intellectual disability find the process of establishing referents to be an especially challenging component of discourse. The present study was designed to examine whether these problems partly result from a failure of parents to appropriately scaffold the discourse participation of individuals with intellectual disability. Children and adolescents with intellectual disability and their parents participated in two dyadic non‐face‐to‐face referential tasks which afforded parents an opportunity to scaffold their children’s behaviour as speaker and as listener. Comparisons were made with parents and their typically developing children who completed the same tasks. It was found that the parents of individuals with intellectual disability scaffolded their children’s discourse participation to the same extent, as effectively and in the same manner as the parents of the typically developing children. The former were also found to adjust their scaffolding according to their children’s level of behavioural competence. In summary, there is no evidence that parents contribute to the referential problems of individuals with intellectual disability.
Self‐injurious behaviour before and after deinstitutionalization
Authors: Nøttestad J. A. , Linaker O. M.
Published: March 2003

The deinstitutionalization movement is presently spreading in Europe. Studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) have been inconclusive. The present paper focuses on people without self‐injurious behaviour (SIB) who developed SIB after deinstitutionalization. The present authors studied individual and environmental characteristics before and after deinstitutionalization to look for factors associated with the development of SIB which could also be possible intervention points for preventive action. All those individuals in an institution for people with ID who did not have SIB before deinstitutionalization were included in the present study. The individuals who developed SIB after deinstitutionalization (n = 15) formed the study group (group A) and those who did not (n = 53) comprised the control group (group B). The population was examined both before and after deinstitutionalization. As far as possible, the same methods were used at both occasions. The covariates were both individual (e.g. mental health, behaviour disturbances and behaviour deficits) and environmental (e.g. caretaker education, caretaker:patient ratio, housing and leisure activities). Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults, which was filled in by the caretakers. In 1987, the people in group A who acquired SIB had lower developmental quotients, used wheelchairs more often and had trouble with moving around without help. They also had a greater frequency of epileptic seizures, and hearing and communication impairment. In 1995, there were only minor environmental differences between groups A and B. There were significantly more individuals involved in the rotation period and more unskilled caretakers working with the people in group A than group B. The present authors found no differences between the two groups on variables such as global mental health and behaviour disturbances, or in the use of neuroleptics before or after deinstitutionalization. Groups A and B did not show differences in behaviour disturbances or psychiatric disorders in 1987. In both 1987 and 1995, there were no differences between groups A and B on variables such as accommodation, caretaker:patient ratio, the number of caretakers involved in direct care, the caretakers' education, or the time spent in structured activities before and after deinstitutionalization. The individual characteristics indicating that a person may acquire SIB are behaviour deficits which are suggestive of central nervous system dysfunction or damage, even if the results are inconclusive. The development of SIB may also be facilitated by communication deficits or by reinforcement of a incidentally occurring SIB if the staff includes many unskilled caretakers in the rotation period.
Psychiatric adjustment to leaving school in adolescents with intellectual disability: a pilot study
Authors: Hepper F. , Garralda M. E.
Published: March 2003

The negotiation of stressful life cycle transitions may contribute to the higher prevalence of psychiatric disorders amongst people with intellectual disability (ID). It is possible that leaving school at the age of 16 years might place particular psychological demands on adolescents, increasing the risk of psychiatric morbidity at a time when they are vulnerable as a result of losing the links with health services sustained through school attendance. The present pilot study was designed as a prospective cohort study to investigate whether there is an increase of psychiatric morbidity [rated with the Strengths and Difficulties Questionnaire (SDQ), and through semi‐structured interviews with parents] in adolescents with ID at the time of their transition from school to adult education and services. Although there was a high frequency (eight out of 10 subjects) of reported emotional and behavioural problems prior to transition, there was no increase or decrease in psychiatric morbidity for the group as a whole during the 6 months after leaving school. However, there were marked individual differences in scores on the SDQ, which may be worth investigating in a larger study.
Psychometric evaluation of a Swedish version of the Reiss Screen for Maladaptive Behavior
Authors: Gustafsson C. , Sonnander K.
Published: March 2003

Background People with intellectual disability (ID) are afflicted by mental health problems to a greater extent than other individuals, and the coexistence of ID and mental health problems involves diagnostic as well as treatment difficulties.

Methods A Swedish version of the Reiss Screen for Maladaptive Behavior (RSMB), an instrument used for identification of mental health problems in people with intellectual disability (ID) was evaluated in terms of inter‐rater agreement, internal consistency, item grouping and criterion validity based on a random sample and a clinical group of adults with ID.

Results The Swedish version of the RSMB had moderate‐to‐low inter‐rater agreement on specific items and good internal consistency. The total score was considered to be a fairly reliable measure of a positive or negative result on the RSMB. A principal component analysis yielded seven interpretable components. A close resemblance in sets of items between the Swedish version and the original version of RSMB was found for three subscales: Aggressive Behaviour, Avoidance Disorder and Depression (Behavioural Signs). The outcome of the criterion validity analysis indicated a higher rate of false negatives than false positives.

Conclusions The potential influence of concurrent psychopharmacological treatment is discussed. It is concluded that the Swedish version of the RSMB can be used as intended by staff as a primary screening device for the identification of mental health problems among people with ID in a Swedish setting.
Obsessional slowness in Down's syndrome
Authors: Charlot L. , Fox S. , Friedlander R.
Published: March 2003

Background

Obsessional slowness was originally described by S. Rachman in 1974. His patients had obsessive–compulsive disorder (OCD) and spent hours performing daily routines such as bathing, dressing and eating. Although some ritualistic behaviours were seen, slowness was the most prominent problem for these patients. Subsequently, a number of similar case reports emerged. In 1994, R. J. Pary described a small number of patients who had both obsessional slowness and Down's syndrome (DS). Apart from this, only one other report of slowness symptoms in people with developmental disabilities has been found in the literature, and this individual also had DS.

Methods

In the present exploratory case series report, 11 individuals with DS and slowness are described based on a retrospective chart review. Descriptive data and four case vignettes are presented.

Results

The 11 individuals with DS were described as spending hours engaged in usual daily routines. Several individuals had tics, hypothyroidism and periods of freezing. Although some ritualistic behaviours were described, slowness was seen to occur in the absence of these, and often without manifest anxiety.

Discussion

Obsessional slowness may be a severe variant of OCD. Although it appears to occur infrequently, there may be an elevated rate in people with DS. The current report is severely limited in scope since the case descriptions were based on a retrospective review. However, because of the paucity of published information about this clinical phenomena, it was felt that the case series might serve to establish the need for further, more systematic, prospective evaluation of individuals with DS and clinically significant slowness.
Specialist health services for people with intellectual disability in Scotland
Authors: Smiley E. , Cooper S.‐A. , Miller S. M. , Robertson P. , Simpson N.
Published: March 2003

Background People with intellectual disability (ID) are known to have a high prevalence of health needs, and to require access to specialist health services in addition to primary care and generic secondary care health services. However, there is no national database of each locality's specialist health service provision. Such a record would highlight variation in provision and enable benchmarking.

Method A 15‐item questionnaire was developed which included questions on ID health services and staffing levels. This was sent to the chief executive of each of the 15 identified National Health Service primary care trusts/health boards which provide ID services in Scotland. The same questionnaire was also sent to the lead clinician/clinical director of each service. The results were converted to per 100 000 population per trust and presented in cumulative frequency tables to allow benchmarking.

Results A response rate of 100% was achieved. The results show a wide range in the type of services provided by each locality in Scotland. Only three services (21%) have completed the process of resettlement. There was a wide‐ranging variability in the number of beds/day places and professionals employed per 100 000 population per trust.

Conclusions There is widespread diversity in the service provision between different parts of Scotland. Geographical distances and responsibilities for service provision to remote and rural communities did not appear to account for these differences.
From research and development to practice‐based evidence: clinical governance initiatives in a service for adults with mild intellectual disability and mental health needs
Authors: Newman D. W. , Kellett S. , Beail N.
Published: March 2003

Background  Practice‐based evidence represents the contribution of practitioners who utilize research methodologies to examine the quality of their clinical practice and service provision.

Methods  The present paper describes the evolution of a routine practice‐based evidence system (PBES) via four phases of research and development. The four phases are described, as is their relevance to assessment and intervention with regard to the mental health problems of people with mild intellectual disability. Phase four describes the development of a routine PBES.

Results  The PBES is capable of profiling the individual mental health needs of service users and examining service effectiveness and quality at an organizational level.

Conclusions  The PBES is discussed according to its current utility and possible directions for future development. The system is presented as an example of clinical governance that could be utilized by multidisciplinary teams to develop and maintain an organizational culture of quality.
Increased sensitivity of factor IX to phenprocoumon as a cause of bleeding in a patient with antiphospholipid antibody associated thrombosis
Authors: Harbrecht  , Oldenburg  , Klein  , Weber  , Rockstroh  , Hanfland
Published: March 2003

Harbrecht U, Oldenburg J, Klein P, Weber D, Rockstroh J, Hanfland P (University of Bonn, Bonn; University of Würzburg, Würzburg; and Evangelische Diakonissen Anstalt Bremen, Bremen, Germany). Increased sensitivity of factor IX to phenprocoumon as a cause of bleeding in a patient with antiphospholipid antibody associated thrombosis. J Intern Med 1998; 243: 73–77.

We report one patient who presented with a spontaneous bleeding complication under phenprocoumon therapy. Oral anticoagulation was initiated due to deep‐vein thrombosis which was attributed to an antiphospholipid antibody syndrome. Coagulation analysis revealed a strong and selective reduction of factor IX (F IX) activity to 1%, whereas the other vitamin K‐dependent factors (II, VII, X), the prothrombin time and International Normalized Ratio (INR) were within the therapeutic range. After withdrawal of phenprocoumon, all vitamin K‐dependent factors including F IX normalized. Because the patient suffered from a recurrence of thrombotic events, he was re‐exposed to phenprocoumon and the disproportionate decline of F IX was observed again. These findings indicate an increased sensitivitiy of F IX to vitamin K antagonists, representing an uncommon mechanism associated with bleeding complications under oral anticoagulant treatment.
Erythrocytic protein kinase C activity in primary hypertension
Authors: Ek  , Toomik  , Eriksson  , Frithz  , Ronquist  , Engström
Published: March 2003

Ek P, Toomik R, Eriksson S, Frithz G, Ronquist G, Engström L (University of Uppsala and University Hospital, Uppsala; and Central Hospital, Eskilstuna, Sweden). Erythrocytic protein kinase C activity in primary hypertension. J Intern Med 1998; 243: 299–305.

Objectives

Increased protein kinase C activity has been reported in erythrocytes from patients with primary hypertension and also from hypertensive rats. In this phenomenological study, we investigated whether a possible increased activity was the result of an augmented amount of enzyme molecules or a more active enzyme.

Design

Collect blood samples, separate erythrocytes from other blood cells. After partial purification of protein kinase C in the erythrocyte lysate, assay the enzyme activity under optimal conditions using a specific peptide substrate.

Setting

Central Hospital in Eskilstuna and University Hospital in Uppsala, Sweden.

Subjects

Healthy individuals: 47 persons (20 women and 27 men). Ten patients with untreated primary hypertension.

Main outcome measures

Erythrocytes were separated from leucocytes and platelets by passing through a cellulose column followed by repeated washings. Some proteins in the erythrocyte lysate interfering with protein kinase C assay were removed by chromatography on DEAE‐cellulose.

Results

The mean protein kinase C activity in erythrocytes from healthy individuals was 0.18 ± 0.02 pmol [32P]phosphate min−1× 106 cells, regardless of sex and age. The corresponding value for patients with primary hypertension was 0.16 ± 0.04 pmol [32P]phosphate min−1× 106 cells.

Conclusions

The amount of protein kinase C, measured as the activity at optimal assay conditions, in erythrocytes from patients with primary hypertension is not critical for the development of moderate hypertension.
Dynamic assessment of parathyroid function in acute malaria
Authors: Davis  , Singh  , Choo  , Ibrahim  , Sulaiman  , Kadir  , Ismail
Published: March 2003

Davis TME, Singh B, Choo KE, Ibrahim J, Sulaiman SA, Kadir ZA, Ismail R (University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. Universiti Sains Malaysia, Kubang Kerian, Kota Bharu; General Hospital, Kota Bharu, Kuala Krai Hospital, Kuala Krai; Kelantan, Malaysia) Dynamic assessment of parathyroid function in acute malaria. J Intern Med 1998; 243: 349–54.

Objectives

To investigate the dynamic parathyroid response to rapidly induced, sustained hypocalcaemia in patients with acute malaria and in healthy volunteers.

Design

Serum intact parathormone (PTH) concentrations were measured on samples taken before and during a variable‐rate tri‐sodium citrate infusion designed to ‘clamp’ the whole blood ionised calcium concentration 0.20 mmol L−1 below baseline for 120 min.

Subjects

Six Malaysian patients aged 17–42 years with acute malaria, four of whom were restudied in convalescence, and 12 healthy controls aged 19–36 years.

Main outcome measures

Whole‐blood ionised calcium and serum intact PTH concentrations.

Results

The mean (SD baseline ionised calcium was lower in the malaria patients than in controls (1.09 ± 0.06 vs. 1.18 ± 0.03 mmol L−1, respectively; P= 0.01) but PTH concentrations were similar (3.0 ± 1.8 vs. 3.3 ± 1.3 pmol L−1; P= 0.33). Target whole‐blood ionised calcium concentrations were achieved more rapidly in the controls than the patients (within 15 vs. 30 min) despite significantly more citrate being required in the patients (area under the citrate infusion‐time curve 0.95 (0.25 vs. 0.57 ± 0.09 mmol kg−1; P < 0.01). The ratio of the change in serum PTH to that in ionised calcium (δPTH/δCa2+), calculated to adjust for differences in initial rate of fall of ionised calcium, was similar during the first 5 min of the clamp (132 ± 75 × 10−6 vs. 131 ± 43 × 10−6 in patients and controls, respectively, P > 0.05), as were steady‐state serum PTH levels during the second hour (7.0 ± 2.2 pmol L−1 in each case). Convalescent patients had normal basal ionised calcium levels but the lowest serum intact PTH levels before and during the clamp, consistent with an increase in skeletal PTH sensitivity after treatment.

Conclusions

There is a decreased ionised calcium ‘set point’ for basal PTH secretion but a normal PTH response to acute hypocalcaemia in malaria. Skeletal resistance may attenuate the effects of the PTH response but patients with malaria appear relatively resistant to the calcium chelating effects of citrated blood products.
Do genetic determinates of ischaemic heart disease imply that prevention may become more difficult?
Authors: Tonstad
Published: March 2003

Tonstad S. (Ullevål Hospital, Oslo, Norway). Do genetic determinants of ischaemic heart disease imply that prevention may become more dificult? (Review) J Intern Med 1998; 243: 333–37.

Favourable changes in environment and lifestyle in the community may lead to a situation in which genetic determinants of ischaemic heart disease assume greater importance. Does this imply that ischaemic heart disease becomes more difficult to prevent? Much of the role of the family history as a risk factor within populations may be explained by new genetic mutations. However, differences between populations are generally attributable to environmental differences. A model of gene‐environment interaction implies that individuals or populations with genetic risk markers are both more susceptible and more responsive to environmental changes, including lifestyle and drugs, and thus, may be eminently treatable.
Germline and somatic mutation of the gene for multiple endocrine neoplasia type 1 (MEN1)
Authors: Marx  , Agarwal  , Kester  , Heppner  , Kim  , Emmert‐Buck  , Debelenko  , Lubensky  , Zhuang  , Guru  , Manickam  , Olufemi  , Skarulis  , Doppman  , Alexander  , Liotta  , Collins  , Chandrasekharappa  , Spiegel  , Burns
Published: March 2003

Marx SJ, Agarwal SK, Kester MB, Heppner C, Kim YS, Emmert‐Buck MR, Debelenko LV, Lubensky IA, Zhuang Z, Guru SC, Manickam P, Olufemi SE, Skarulis MC, Doppman JL, Alexander RH, Liotta LA, Collins FS, Chandrasekharappa SC, Spiegel AM, Burns AL (National Institutes of Health, Bethesda, USA). Germline and somatic mutation of the gene for multiple endocrine neoplasia type 1 (MEN1) (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 447–53.

Dideoxyfingerprinting was used to screen for germline and somatic MEN1 mutations. This method, applied to a panel of germline DNA from 15 probands with multiple endocrine neoplasia type 1 (MEN‐1), allowed confident discovery of the MEN1 gene. Germline MEN1 mutation has been found in 47 out of 50 probands with familial MEN‐1, in 7 out of 8 cases with sporadic MEN‐1, and in 1 out of 3 cases with atypical sporadic MEN‐1. Germline MEN1 mutation was not found in any of five probands with familial hyperparathyroidism. Somatic MEN1 mutations were found in 7 out of 33 parathyroid tumours not associated with MEN‐1. Allowing for repeating mutations, a total of 47 different germline or somatic MEN1 mutations have been identified. Most predict inactivation of the encoded ‘menin’ protein, supporting expectations that MEN1 is a tumour suppressor gene. The 16 observed missense mutations were distributed across the gene, suggesting that many domains are important to its as yet unknown functions.
Comparison between subcutaneous and intravenous interleukin‐2 treatment in HIV disease
Authors: Witzke  , Winterhagen  , Reinhardt  , Heemann  , Grosse‐Wilde  , Kreuzfelder  , Roggendorf  , Philipp
Published: March 2003

Witzke O, Winterhagen T, Reinhardt W, Heemann U, Grosse‐Wilde H, Kreuzfelder E, Roggendorf M, Philipp T (Departments of Medicine, Immunology and Virology, University of Essen, Germany). Comparison between subcutaneous and intravenous interleukin‐2 treatment in HIV disease. J Intern Med 1998; 244: 235–40.

Objectives

Therapy of HIV‐infection using intravenous interleukin‐2 (IL‐2) is known to be effective in terms of increasing CD4‐counts but is associated with significant side‐effects and hospitalization. However, the combination with protease‐inhibitor therapy has not been tested yet. The aim of the present study was to investigate the safety and efficacy of intravenous vs. subcutaneous IL‐2 regimes using 9 Mio I.U. of IL‐2, in combination with protease‐inhibitor therapy.

Design

All patients were treated with a combination of two reverse transcriptase inhibitors and a protease‐inhibitor prior to IL‐2 administration for at least 6 weeks. Ten patients were assigned to the intravenous IL‐2 group (group A), 10 to the subcutaneous group (group B).

Results

In both treatment groups, CD4 count significantly increased shortly after the end of therapy (group A: 223% over baseline [day 7]; group B: 264% over baseline [day 7]). During the follow‐up CD4 counts slowly decreased thereafter but remained above baseline 3 months following IL‐2 treatment. The CD8 lymphocytes showed a similar but less pronounced pattern with a maximum at day 7 (group A: 116% over baseline, group B: 158% over baseline) and reached baseline earlier in the follow‐up‐period. Altogether the CD4/CD8‐ratio was elevated through long periods on follow‐up. Throughout follow‐up, there were no apparent changes in viral load during IL‐2 therapy in either groups. IL‐2 therapy was administered for a mean time of 4.2 ± 0.1 days in the intra‐venous group and of 4.8 ± 0.1 days in the subcutaneous group until therapy was terminated at day 5 or due to side‐effects. Only 1/10 patients completed the 5‐day course of intravenous therapy in contrast to 6/10 in the subcutaneous group.

Conclusions

Subcutaneous interleukin‐2 using 9 Mio IU day−1 in combination with protease‐inhibitors showed equal efficacy as intravenous therapy and was associated with less side‐effects.
Lipid disorders in NIDDM: implications for treatment
Authors: Taskinen  , Smith
Published: March 2003

Taskinen M‐R, Smith U (University of Helsinki, Helsinki, and Sahlgrenska University Hospital, Gothenburg, Sweden). Lipid disorders in NIDDM: implications for treatment. J Intern Med 1998; 244: 361–70.

Diabetes conveys high risk lipid status for cardiovascular disease (CVD). To target the management of diabetic dyslipidaemia requests the understanding of metabolic basis of diabetic dyslipidaemia and its components. Recent progress has opened new information to direct future lipid lowering intervention trials in type 2 diabetic patients. To reduce substantially the risk for CVD aggressive modification of all known risk factors is warranted on the basis of existing data.
Insulin‐like growth factor‐I lowers fasting and postprandial triglyceride levels without affecting chylomicron clearance in healthy men
Authors: Bianda T. , Zapf J. , Froesch E. R. , Schmid C.
Published: March 2003

Abstract. Bianda T, Zapf J, Froesch ER, Schmid C (University Hospital, Zürich, Switzerland). Insulin‐like growth factor‐I lowers fasting and postprandial triglyceride levels without affecting chylomicron clearance in healthy men. J Intern Med 1999; 245: 455–462.

Objectives. To study whether IGF‐I treatment alters the postprandial lipid and lipoprotein metabolism.

Design. Randomized, crossover study.

Setting. University Hospital, Zürich, Switzerland.

Subjects. Seven young healthy male subjects (aged 27 ± 4 years, body mass index (BMI) 21.8 ± 1.7 kg m–2).

Interventions. Each subject was studied two times at 2‐week intervals, treated with saline 0.9% (S) and IGF‐I (8 µg kg–1 h–1) by a continuous subcutaneous infusion. 60 h after the start of treatment a vitamin A loading test was performed after an overnight 12‐h fast.

Main outcome measures. Glucose, insulin, total and free IGF‐I, FFA, triglycerides and retinyl palmitate, total cholesterol, HDL and LDL cholesterol, lipoprotein (a) and apolipoprotein B were measured in serum before and after the fatty meal.

Results. Total IGF‐I levels rose from 29.0 ± 3.3 nmol L–1 to 113.3 ± 9.0 nmol L–1 (P < 0.02) and free IGF‐I from 0.24 ± 0.05 to 1.08 ± 0.28 nmol L–1 (P < 0.02) during IGF‐I treatment. IGF‐I administration reduced insulin concentrations by 50% (P < 0.02), as assessed by the area under the curve. Serum triglyceride levels were significantly lower at baseline and after the fat load during IGF‐I treatment (P < 0.02), whereas the retinyl palmitate concentrations in chylomicron and nonchylomicron lipoprotein fractions were similar during both treatment periods.

Conclusions. IGF‐I treatment reduces the triglyceride levels most probably by decreasing insulin secretion and the production of VLDL particles, and possibly by increasing their turnover. IGF‐I treatment has no significant effect on the metabolism of intestine‐derived triglyceride‐rich lipoproteins after a high fat meal in healthy young men.
The measurement of venous haematocrit in patients with polycythaemia vera
Authors: Andréasson B. , Wahlström E. , Jacobsson S. , Björkholm M. , Samuelsson J. , Birgegård G. , Wadenvik H. , Kutti J.
Published: March 2003

Abstract. Andréasson B, Wahlström E, Jacobsson S, Björkholm M, Samuelsson J, Birgegård G, Wadenvik H, Kutti J (Medical Clinic, Kärnsjukhuset, Skövde; Sahlgrenska University Hospital, Göteborg; Karolinska Hospital, Stockholm; Huddinge University Hospital, Huddinge; and Akademiska Hospital, Uppsala, Sweden). The measurement of venous haematocrit in patients with polycythaemia vera. J Intern Med 1999; 246: 293–297.

Objective. In clinical practice, patients with polycythaemia vera (PV) are monitored by measurement of venous packed cell volume (PCV). However, whereas treatment recommendations are still based upon studies in which the results were obtained with the centrifuged microhaematocrit, currently in most instances automated blood cell counters are used to calculate PCV. In a group of patients with polycythaemia we therefore compared the results obtained by the microhaematocrit method with PCV calculated by haematology analysers.

Design. The study was carried out on a prospective basis. Duplicate venous blood samples were collected. The centrifuged microhaemotocrit was obtained by using an IEC Micro‐MB Centrifuge. Depending on different routine methods used in the participating hospitals, the blood cell counter PCV was calculated using Coulter STKS, Bayer Technicon H2 or H3.

Setting. Patients were included from four Swedish university hospitals: Akademiska (Uppsala), Huddinge and Karolinska (Stockholm) and Sahlgrenska (Göteborg).

Subjects. Seventy‐four patients with PV and 10 patients with secondary polycythaemia were included and a total of 150 duplicate blood samples were analysed from these subjects.

Results. In the 150 measurements the mean blood cell counter calculated PCV was 0.448 ± 0.037; the mean for centrifuged microhaematocrit was 0.467 ± 0.037 and the difference between means was highly significant (P = 6.8 × 10–25). The means for centrifuged haematocrit and calculated PCV differed significantly in the groups of PV patients treated with phlebotomy only, hydroxyurea or radiophosphorous (P < 0.0001, respectively). In PV patients treated with α‐interferon and in patients with secondary polycythaemia the difference in means did not reach statistical significance (P = 0.07 and P = 0.13, respectively). The groups of patients with MCV <80 fL and ≥80 fL both presented significant differences between means for calculated PCV and centrifuged haematocrit.

Conclusions. If PV patients are monitored with blood cell counter calculated PCV it appears that the therapeutic goal should be to maintain the calculated PCV below 0.43, provided the local differences in calculated PCV and centrifuged haematocrit are of the same magnitude as in this study.
Printed medical journals – will they survive?
Authors: Böttiger L. E.
Published: March 2003

Abstract.   Böttiger LE (Saltsjö‐Boo, Sweden). Printed medical journals – will they survive? (Editorial). J Intern Med 1999; 246: 127–131.