bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months
Authors: Northstone K. , Emmett P. , Nethersole F. ,   the ALSPAC Study Team
Published: March 2003

Aim

The study aimed to document the dietary patterns of infants and determine the development of feeding difficulties as perceived by the mother according to the age at which lumpy solids were introduced into the diet.

Study design

Information was collected from a geographically representative population of 9360 mothers of infants born in 1991/92, part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Self‐completion questionnaires enquiring about the foods and drinks consumed by the infant and any difficulties experienced by the mothers in feeding her child at both 6 months and 15 months of age were collected.

Methods

Infants were divided into three groups based on the age at which they were first introduced to ‘lumpy’ solids: 10.7% were introduced before 6 months of age, 71.7% were introduced between 6 and 9 months and 17.6% were introduced after 10 months of age. The foods eaten by those introduced before 6 months and after 10 months were compared to those introduced between 6 and 9 months. Behaviours and problems as reported by the mother were also assessed.

Results

Those infants who were introduced to lumpy solids at the earliest ages consumed a greater variety of family foods at the age of 6 months, while those introduced at 10 months or later had been given fewer solids of all types by 6 months of age and at 15 months were significantly less likely to be having family foods when compared to those introduced between 6 and 9 months. At each age, those introduced late (10 months or older) to lumps were more difficult to feed and had more definite likes and dislikes.

Conclusions

A significant difference was observed in the variety of foods given to infants at both 6 and 15 months according to the age at which they began to have lumps in their food, and feeding difficulties were more likely to occur when lumps were introduced at or after 10 months of age.
The incidence of dieting amongst adolescent girls: a question of interpretation?
Authors: Roberts S. J. , Maxwell S. M. , Bagnall G. , Bilton R.
Published: March 2003

Aim

It is the intention of this study establish the extent of dieting practices amongst adolescent girls and identify their perceptions with regard to ‘dieting’ and ‘healthy eating’.

Methods

A total of 140 girls, aged 12–13 years, were recruited from two schools. A self‐reported questionnaire, which determined the incidence of dieting and sought to identify the girls’ perceptions of ‘dieting’ and ‘healthy eating’, was used to collect data.

Results

Out of the total group, 33.6% reported that they had dieted at some time and 15.8% were presently dieting. The most popular definition of dieting amongst the dieters was ‘eating less/cutting down’; however, the second most popular answer was ‘eating healthy food’ which was the most popular answer amongst the non‐dieters. The most popular definition of healthy eating was ‘increasing fruit/veg/salads’, which is similar to how many girls perceived dieting, i.e. eating healthy food (fruit/veg/salads).

Conclusion

Establishing the actual incidence of dieting amongst adolescent girls is not a clear‐cut issue as it can be interpreted in many different ways, depending on the perceptions of the individual. The results of this study showed that in many cases ‘dieting’ and ‘healthy eating’ were perceived in a similar light, concluding that the dietary intake of dieters may be similar to that of non‐dieters with both groups being at risk from any related health problems.
Dietary trends among Scottish schoolchildren in the 1990s
Authors: Inchley J. , Todd J. , Bryce C. , Currie C.
Published: March 2003

Background

In recent years, healthy eating messages have sought to highlight the advantages of a healthy balanced diet, but there is little evidence that the recommendations have been translated into sustained behavioural change. In Scotland, the national diet has become a major focus in key policy documents, and the diet of children and young people has been consistently highlighted as an area of particular concern. This paper reports on dietary trends among Scottish schoolchildren during the 1990s.

Methods

Data were collected from a representative sample of Scottish schoolchildren as part of the WHO Cross‐national Health Behaviour of School‐aged Children (HBSC) study. Three consecutive national surveys were undertaken in Scotland, in 1990, 1994 and 1998, using self‐completion food frequency questionnaires with 11‐, 13‐and 15‐year‐old school pupils.

Results

Between 1990 and 1998, fruit and vegetable consumption increased among Scottish schoolchildren, especially among girls, but levels of consumption fell below current dietary recommendations. There has been a concomitant increase in consumption of high‐fat and high‐sugar foods, and consumption of these foods is higher among boys and children from lower socio‐economic groups.

Conclusion

The findings emphasize the need for continued health promotion efforts to improve the diet of schoolchildren in Scotland especially among lower socio‐economic groups.
Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate
Authors: Giskes K. , Turrell G. , Patterson C. , Newman B.
Published: March 2003

Objective  To determine whether socioeconomic groups differ in their food intakes for fruit and vegetables, their consumption of fruit and vegetables dense in vitamin A, folate and vitamin C, and their nutrient intakes of vitamin C, folate and vitamin A.

Methods  The 1995 Australian National Nutrition Survey collected food intake data from 8883 adults aged 18–64 years using a 24‐h dietary recall. Fruit and vegetables were measured as amount (g) consumed. Intakes of nutrients were estimated from the 24‐h dietary recall data. Participants were categorized by whether or not they consumed fruit or vegetables high in vitamin A, folate and vitamin C. Gross annual household income was used to measure socioeconomic position.

Results  Participants from low‐income households consumed a smaller quantity of fruit and vegetables. They were also less likely to consume fruit and vegetables high in vitamin C, folate and vitamin A. Consistent with these findings, men and women from disadvantaged socioeconomic groups had lower intakes of vitamin C and folate compared with their more affluent counterparts. These differences were small to moderate in magnitude. Vitamin A intakes were not significantly related to income.

Conclusion  As well as promoting healthy dietary practices, nutrition‐promotion strategies should target the nutrient intakes of lower socioeconomic groups. These programmes should focus on improving the quantity and choice of fruit and vegetables consumed by people from low‐income households.
Tube feeding controversial patients: what do dietitians think?
Authors: Healy S. , McNamara E.
Published: March 2003

The use of tube feeding in some patients can be controversial, however, few studies have investigated dietitians' opinions on this subject. A cross‐sectional survey of 345 members the Irish Nutrition and Dietetic Institute was conducted using a self‐administered, anonymous, postal questionnaire. A 44% response rate was achieved. Mean number of years qualified was 9.3 (8.4). Eighty‐one per cent of responders were involved in initiating tube feeding in stroke patients, and 8.5% in discontinuing tube feeding in a patient in a persistent vegetative state (PVS). Nine per cent felt that their input had no influence on the care plan of the patient with dementia and 67% felt that the information given to families (or other decision makers) concerning tube feeding was inadequate. The majority of respondents favoured tube feeding fictitious stroke and cancer patients, but less than half favoured tube feeding a fictitious patient in a PVS or a patient with dementia. When given similar scenarios involving themselves, fewer dietitians wanted to be tube fed.
Increased life expectancy in people with untreated phenylketonuria
Authors: Jancar J.
Published: March 2003

The records of 17 people with intellectual disability and untreated phenylketonuria (12 females and five males), who were resident in the Stoke Park Group of Hospitals, Bristol, England, 25 years ago, were reexamined for life expectancy. Six subjects had died (five females and one male). The oldest deceased female was 69 years of age. The average age at death was 55.8 years. Eleven subjects were still alive (seven females and four males). The oldest living male was 79 years of age. The average age of the survivors was 55.7 years.
Service support to people in Wales with severe intellectual disability and the most severe challenging behaviours: processes, outcomes and costs
Authors: Felce D. , Lowe K. , Perry J. , Baxter H. , Jonesna E. , Hallam A. , Beecham J.
Published: March 2003

A survey of people with severe intellectual disability and the most severe challenging behaviour in Wales identified five adults living in family homes, 17 in new specialist community housing and 19 in traditional services. With the omission of two people from the latter group and with a restricted collection of data for people living in the family home, the present study explored service input, outcome and costs across the three setting types. Process and outcome indicators for the family home group, who received little service input, were better than those for the traditional service group, although less good than those for the community house group. The specialist community home model produced significant gains over the traditional services in virtually all areas. Across the residential data set as a whole, there was no association between staff:resident ratios and severity of disability or between costs and severity of disability. This was largely true of the service types separately. There was a relationship between costs and service quality. However, this association was underpinned by gross differences between community houses and traditional settings. Costs, processes and outcomes ceased to be related when the two residential types were considered separately. Although higher costs of new community services compared to traditional services may be set against improved outcomes, high costs within the former could not be related to benefit. Outcome indicators were generally related to each other, suggesting that high quality in one sense was matched by high quality in other senses. Outcome was significantly associated with the ability of residents. Outcome indicators also tended to be related to observed staff performance, which was independent of resident ability. Therefore, outcome may be considered as dually determined by differences in resident ability and in what staff did.
Executive function and theory of mind performance of boys with fragile‐X syndrome
Authors: Garner C. , Callias M. , Turk J.
Published: March 2003

Fragile‐X syndrome is the most common genetically inherited cause of intellectual disability. People with this syndrome typically show a behavioural profile of abnormal social interactions which are similar in some ways to those seen in people with autism. The present study investigated whether cognitive processes which have been hypothesized to underlie social abnormalities associated with autism are also impaired in boys with fragile‐X syndrome without autistic spectrum disorders. Eight boys with fragile‐X syndrome and eight with intellectual disability of unknown aetiology, matched on receptive verbal ability, age and with no diagnosis of autism, were tested on a battery of theory of mind and executive function tasks. Significantly more boys with fragile‐X syndrome failed the simplest theory of mind task. However, this could be attributed to overall level of ability rather than group membership. No differences were found between the groups on any other measures used. A proportion of both groups failed first‐ and second‐order false belief tasks. The performance of both groups on the executive function measure was at the floor of the test. At low levels of overall ability, the performance of boys with fragile‐X syndrome and boys with intellectual disability of unknown aetiology may be more similar than they are different. The implication of this result for clinical interventions is discussed.
Comparison of rating scales for the diagnosis of dementia in adults with Down’s syndrome
Authors: Deb S. , Braganza J.
Published: March 2003

Making a diagnosis of dementia, particularly in its early stages, in a person with intellectual disability can be difficult. Some neuropsychological tests which were originally devised for the diagnosis of dementia in the non‐intellectually disabled population have been modified for use in people with intellectual disability. Observer‐rated scales have also been used for making a diagnosis of dementia in people with intellectual disability. Within the context of a genetic study, the rates of diagnosis of dementia according to different criteria, namely the clinician’s diagnosis (ICD‐10), the Dementia Questionnaire for Persons with Mental Retardation (DMR), the Dementia Scale for Down Syndrome (DSDS) and the Mini Mental State Examination (MMSE), were compared among 62 adults with Down’s syndrome (26 demented and 36 non‐demented adults according to the clinician’s diagnosis). A comparison between the clinician’s diagnosis and the diagnosis according to DMR criteria showed specificity and sensitivity at the 0.92 level for both categories. Similarly, a comparison between the clinician’s diagnosis and the diagnosis according to the DSDS criteria showed a specificity of 0.89 and a sensitivity of 0.85. A good positive correlation was also shown between the scores of the DSDS and the DMR (Pearson’s r = + 0.868, P 0.001). A similar positive correlation was found between the overall DSDS score and the scores in the main subcategories of the DMR. An MMSE could be performed in only 34 (55%) out of the 62 subjects with Down’s syndrome. Out of the 30 subjects who had an MMSE score of less than 24 (the usual cut‐off for the diagnosis of possible dementia), 23 (77%) did not have a diagnosis of dementia according to any criteria. It seems that the observer‐rated scales, rather than the direct neuropsychological tests, are more useful for the diagnosis of dementia in people with an intellectual disability.
Quantitative comparison of radial cell columns in children with Down's syndrome and controls
Authors: Buxhoeveden D , Fobbs A , Roy E , Casanova M
Published: March 2003

No one has examined the configuration of the minicolumns in Down's syndrome (DS) brains even though these are a basic functional unit of the cortex. In the present study, the authors used computerized imaging to examine minicolumns in the posterior superior temporal gyrus in both the brains of patients with DS and normal controls. They compared the brains of children aged 4 and 6 years with those of adults for both people with DS and the normal population. Columns in the brains of two DS children aged 4 and 6 years were almost the same size as those of the adults with DS. The neuropil space in the periphery of the columns was also considerably wider. In contrast, minicolumns in aged‐matched control children were smaller, both relatively and absolutely, when compared to the mean size of adult columns. The size of the minicolumns in the normal children apparently corresponded to the overall brain size, whereas the large columns in children with DS appeared to be independent of brain size, at least in area Tpt. This seems to reflect a rapid ageing process that is striking when compared to normal controls. Columns in adults with DS were large and less cell dense, while brain volumes were significantly smaller than in controls. This combination suggests reduced neuronal complexity based on a decrease in processing units, which supports previous findings of decreased cell numbers and synaptic diminution in DS brains.
Residential care in the community for adults with intellectual disability: needs, characteristics and services
Authors: Mansell J. , Ashman B. , Macdonald S. , Beadle‐Brown J.
Published: March 2003

Background The pattern of residential services for people with intellectual disability in England has changed dramatically since 1971, with many more places being made available in residential homes in the community. The aim of the present study was to assess the needs and characteristics of residents and features of all the residential homes provided by a national charity.

Method Assessments of adaptive behaviour, problem behaviour and social impairment were completed by staff who knew residents well; information about costs and staffing was provided from central records.

Results A significant proportion of residents have important care needs relating to their skills, their behaviour and their social abilities. Residents with these needs are dispersed throughout services, so that a large majority of services include one or more residents with relatively complex needs.

Conclusions Compared with services in the late 1980s, these services care for a much more disabled client group. Since individuals with high levels of particular needs are typically distributed throughout services, a very high proportion of services require staff who have relatively advanced skills. Current national plans do not adequately address this need and case management arrangements may encourage the re‐creation of more institutional services.

Declaration of interest The first author is a Trustee of the charity.
Healthcare needs of people with intellectual disability in institutions in Taiwan: outpatient care utilization and implications
Authors: Lin J.‐D. , Wu J.‐L. , Lee P.‐N.
Published: March 2003

Background  The present study assessed the outpatient care use of people with intellectual disability (ID) in order to identify patterns of healthcare needs and the factors affecting this utilization.

Methods  The primary method used in this study was a cross‐sectional survey of 1390 subjects with ID in Taiwan. Data were obtained from questionnaires completed at 30 registered institutions caring for people with ID.

Results  The findings show that people with ID in Taiwan are likely to make more outpatient visits per year than members of the general population. The prevalence of illness in people with ID was 41%, with epilepsy being the most frequently reported disease. A total of 39.5% of individuals with ID took medicine regularly, and 38.9% had used alternative forms of medication besides Western medicine. In terms of the use of outpatient facilities by people with ID, paediatric clinics were the most frequently utilized. The average monthly number of outpatient visits per person with ID was 2.18 (around 26 visits per year). This study found that the need for outpatient care is determined by a variety of factors relating to: the age of people with ID, the type of handicap, the place of medical treatment, having a family physician, the accessibility of medical care, the time‐consuming nature of the medical visits, having an illness, ID accompanied with other disabilities, and finally, a need for rehabilitative care.

Conclusions  From the examination of the expressed needs of people with ID, it was found that these individuals have a heightened need for healthcare and the treatment of special diseases/disorders in comparison to members of the general population in Taiwan. Within the context of ordinary services, it is particularly important to have a precise view of the ways in which the health needs of people with ID are different from the general population as a whole. This will enable healthcare services to respond to these needs, either through support systems within generic care or, in some cases, through the delivery of specific healthcare through specialized services which are kept separate from generic care.
The activated immune system and the renin–angiotensin–aldosterone system in congestive heart failure
Authors: Samsonov  , Lopatin  , Tilz  , Artner‐Dworzak  , Nassonov  , Mareev  , Belenkov  , Wachter  , Fuchs
Published: March 2003

Samsonov M, Lopatin J, Tilz G, Artner‐Dworzak E, Nassonov E, Mareev V, Belenkov J, Wachter H, Fuchs D, (Cardiology Research Centre, Moscow, Russia; University of Graz, and the University of Innsbruck, Austria). Activated immune system and the renin–angiotensin–aldosterone system in congestive heart failure. J Intern Med 1998; 243: 93–98.

Objects

The aim of the study was to investigate a possible relationship between plasma renin activity, angiotensin II, serum levels of angiotensin‐converting enzyme, aldosterone and markers of immune activation in congestive heart failure (CHF).

Patients and Methods

Fifty‐three patients (50 male, three female, mean age 46 ± 16 years) with congestive heart failure were studied. Twenty‐eight patients had I or II NYHA class of CHF and 25 patients had III or IV NYHA class (NYHA class, mean ± SD : 2.3 ± 0.9). Serum neopterin concentration and hormones were measured by commercial radioimmunoassays. Serum soluble receptors of tumour necrosis factor and interleukin‐2 were determined by ELISA.

Results

All analytes significantly correlated with NYHA classes (P < 0.05). There existed correlations between neopterin and angiotensin‐converting enzyme or aldosterone (rs= 0.35 and rs= 0.36, P < 0.05). The soluble tumour necrosis factor receptor concentrations correlated with plasma renin activity (rs= 0.38, P < 0.05).

Conclusion

The result of our study suggest that there exists some relationship between the renin–angiotensin–aldosterone system and immune activation in severe congestive heart failure, however, the associations found are rather weak.
Metabolic features of inflammatory bowel disease in a remission phase of the disease activity
Authors: Capristo  , Mingrone  , Addolorato  , Greco  , Gasbarrini
Published: March 2003

Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G (Sacred Heart Catholic University, Rome, Italy). Metabolic features of inflammatory bowel disease in a remission phase of the disease activity. J Intern Med 1998; 243: 339–47.

Objectives

To evaluate the anthropometric and metabolic characteristics of patients with Crohn's disease (CD) and ulcerative colitis (UC), comparing both groups with healthy volunteers.

Design

A cross‐sectional study.

Setting

The Department of Internal Medicine, Catholic University Hospital, Rome, Italy.

Subjects

Thirty‐four patients with biopsy‐proven inflammatory bowel disease (18 CD; 16 UC) in clinical remission (SCDAI <3 and Powell–Tuck index <4) not receiving steroid therapy.

Interventions

All patients had a clinical examination.

Main outcome measures

Blood indicators of inflammation and nutritional status. Body composition was assessed by both anthropometry and bioimpedance and metabolic variables were measured by indirect calorimetry over a 60–90 min period.

Results

CD had a lower body weight than both controls (58.1 kg, range 41.5–71.0 vs. 66.4 kg, range 57.0–76.0; P < 0.001) and UC) 58.1 kg, range 41.5–71.0 vs. 69.6 kg, range 50.5–94.0; P < 0.001). Fat‐free mass (FFM) did not differ between the groups, whilst fat mass was significantly lower in CD than in UC (P < 0.05) and controls (P < 0.001). Normalizing the basal metabolic rate by FFM, a higher value was found in CD compared with UC (143 kJ kg−1 d–−1, range 97.5–179 vs. 133 kJ kg−1 d−1, range 123–148; P < 0.05) and control subject 143 kJ kg−1 d−1, range 97.5–179 vs. 134 kJ kg−1 d−1, range 122–162; P < 0.05). The nonprotein respiratory quotient was significantly lower in CD compared to UC 0.80, range 0.73–0.84 vs. 0.84, range 0.79–0.91; P < 0.01) and controls (0.80, range 0.73–0.84 vs. 0.83, range 0.81–0.87; P < 0.001), with a consequently higher lipid oxidation rate in CD.

Conclusions

CD subjects showed a decreased fat mass and enhanced utilization of lipids compared with UC and controls. These data could be explained by the larger intestinal involvement and considered as a contribution to lipid tissue wasting in CD.
Imported rickettsioses: think of murine typhus
Authors: Van Der Kleij  , Gansevoort  , Kreeftenberg  , Reitsma
Published: March 2003

van der Kleij FGH, Gansevoort RT, Kreeftenberg HG, Reitsma WD (University Hospital Groningen, the Netherlands). Imported Rickettsioses: think of murine typhus (case report). J Intern Med 1998; 243:177–79.

Murine typhus is a disease still prevalent in many parts of the world. Because the incidence in the US and Europe has declined rapidly, physicians in these continents have become unfamiliar with the clinical picture. Murine typhus is associated with significant morbidity and fatalities do occur, especially in the elderly and when late recognized. We present a patient with murine typhus that illustrates the wide variety of symptoms in this disease, which makes diagnosis difficult. However, if one keeps the possibility of murine typhus in mind, it is easily diagnosed and treated.
Sleep and cardiac symptoms amongst women aged 40–64 years
Authors: Asplund  , Åberg
Published: March 2003

. Asplund R, Åberg H (County Hospital, Strömsund; and Karolinska Institute, Huddinge; Sweden). Sleep and cardiac symptoms amongst women aged 40–64 years.J Intern Med1998;243: 209–13.

Objectives.

To determine whether the occurrence of cardiac symptoms is related to sleep disturbances.

Design

An epidemiological survey by means of a questionnaire.

Setting

The county of Jämtland in northern Sweden.

Subjects

Randomly selected women (6000) aged 40–64 years, with a similar number of women in each 5‐year age group. A total of 3669 responded.

Main outcome measures

Sleep disturbances and cardiac symptoms.

Results

In total, 81.9% of the women reported a good night's sleep. Amongst them, 0.4% stated that they were troubled by both spasmodic chest pain and a sensation of irregular heart beat, 0.8% spasmodic chest pain alone, 5.8% irregular heart beat and 93.0% neither of these conditions. The corresponding frequencies amongst the women who slept poorly were 1.5, 1.8, 15.0 and 81.7%, respectively (P< 0.0001).

Amongst the subjects with reported sleep complaints, there was an increase in heart symptoms, both in those with trouble falling asleep, frequent awakenings and difficulty in getting to sleep again, and in those who awoke too early in the morning. Spasmodic chest pain was 8.8 (1.9–40.3) times and irregular heart beat 7.7 (3.3–18.1) times more common in women with nightmares almost every night than in those who never experienced nightmares. Daytime sleepiness was also associated with increased heart symptoms.

Conclusion

Poor sleep was associated with an increase in spasmodic chest pain and irregular heart beat.
Effects of Simvastatin and omega‐3 fatty acids on plasma lipoproteins and lipid peroxidation in patients with combined hyperlipidaemia
Authors: Nordøy  , Bønaa  , Nilsen  , Berge  , Hansen  , Ingebretsen
Published: March 2003

Nordøy A, Bønaa KH, Nilsen H, Berge R, Hansen JB, Ingebretsen OC (University of Tromsø, Tromsø, Norway). Effects of Simvastatin and omega‐3 fatty acids on plasma lipoproteins and lipid peroxidation in patients with combined hyperlipidemia. J Intern Med 1998; 243: 163–70.

Objectives

.Patients with combined hyperlipidemia are at increased risk for development of coronary heart disease. The purpose of this study was to evaluate the efficiency and the safety of treatment with Simvastatin and omega‐3 fatty acids in patients with this lipid disorder.

Design

.A double‐blind placebo controlled, randomized study evaluating the effects of Simvastatin separately and in combination with omega‐3 fatty acids in 41 healthy patients with defined hyperlipidemia. After a 16 weeks dietary run‐in period the patients were treated in periods of 5 weeks.

Results

.As expected Simvastatin (20 mg day−1) reduced serum total cholesterol, triacylglycerols, apolipoproteins B and E and increased HDL‐cholesterol and apolipoprotein A1. Addition of omega‐3 fatty acids (4 g day−1) further decreased serum triacylglycerols (P= 0.007), total cholesterol (P= 0.052) and apolipoprotein E (P= 0.035). No significant changes attributable to supplementation of polyunsaturated fatty acids on the content of lipid peroxides in plasma and in the various lipoprotein fractions were observed.

Conclusions

.The combined treatment of Simvastatin and omega‐3 fatty acids seems to be an efficient and safe alternative for patients with combined hyperlipidemia.
Use of dobutamine echocardiography for cardiac risk stratification of patients with chronic renal failure
Authors: Marwick  , Lauer  , Lobo  , Nally  , Braun
Published: March 2003

Marwick TH, Lauer MS, Lobo A, Nally J, Braun W (Cleveland Clinic Foundation, Cleveland, USA). Use of dobutamine echocardiography for cardiac risk stratification of patients with chronic renal failure. J Intern Med 1998; 244: 155–61.

Objectives

This study sought to define the value of dobutamine echocardiography (DbE) for cardiac risk stratification in patients with chronic renal failure (CRF).

Design

Outcome study correlating results of DbE with late cardiac events in patients with CRF.

Setting

Academic medical centre.

Subjects

All patients with CRF (serum creatinine > 2.5 mg dL−1) undergoing DbE were studied; we analysed 193 consecutive patients (aged 63 ± 13 years, 73 men).

Interventions

A standard dobutamine–atropine stress was administered until attainment of peak dose, or the development of severe ischaemia or side‐effects. The electrocardiogram (ECG) and echocardiogram were obtained before, during and after stress. Ischaemia was identified by new or worsening wall‐motion abnormalities with stress.

Outcome measures

Patients were followed up after 38 ± 14 months for cardiac death, myocardial infarction or coronary disease progression requiring revascularization.

Results

DbE demonstrated ischaemia in 36 patients (19%), scar in 36 (19%) and a normal study in 121 patients. The heart‐rate response to dobutamine was submaximal (< 85% age‐predicted heart rate) in the absence of wall‐motion abnormalities in 69 patients (36%), 54 of whom completed the protocol. Follow‐up data were complete in 191 patients (99%); cardiac events occurred in 33 patients (17%), including 17 with cardiac death, 7 with infarction, and 9 requiring late revascularization. Spontaneous events occurred in 7 patients with ischaemia, 3 with scar (8%), 11 with a nondiagnostic study (16%) and 3 patients with a normal study (6%). Over the entire follow‐up, the event‐free survival in patients with ischaemia (66%) was markedly lower than those without ischaemia (84%, P= 0.006). However, the event rate in patients with nonischaemic responses increased from 8% to 16% between 24 and 40 months, and whilst ischaemia was an independent predictor of outcome at 24 months, it was not at 40 months.

Conclusions

In patients with CRF, the identification of ischaemia at DbE is associated with a significant risk of adverse cardiac events. Patients with nonischaemic scans have a low frequency of events over short‐term follow‐up, but this increases at later follow‐up. These later events may reflect progressive coronary disease, attributable to the atherogenic milieu of these patients, and imply that repeated testing may be required to maintain cardiac risk stratification in patients with CRF.
Clinical management of the multiple endocrine neoplasia syndromes: results of a computerized opinion poll at the Sixth International Workshop on Multiple Endocrine Neoplasia and von Hippel–Lindau disease
Authors: Lips
Published: March 2003

Lips CJM (University Hospital, Utrecht, The Netherlands). Clinical management of the multiple endocrine neoplasia syndromes: results of a computerized opinion poll at the Sixth International Workshop on Multiple Endocrine Neoplasia and von Hippel–Lindau disease (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 589–94.

Objectives and design

In order to provide all participants of the Sixth International Workshop on Multiple Endocrine Neoplasia and von Hippel–Lindau Disease with the opportunity to express their opinion on medical, ethical and social issues on clinical management of these hereditary cancer syndromes, a meeting employing an interactive voting system was organized.

Results

In many aspects, the majority of the participants shared the same opinion. The following percentages of participants felt that, if a specific germline mutation is present in a definitely affected family member, DNA diagnosis should be performed in the offspring of this patient before the age of 10: 78% for MEN‐1, 93% for MEN‐2, and 71% for VHL. About 71% felt the clinical specialist should provide information about the consequences of DNA analysis and be responsible for disclosing the DNA test results and performing genetic counselling. If possible, selective surgery is preferred to maintain organ function. To make a complete diagnosis in a patient with an apparently sporadic tumour, 89% believed that mutation analysis of germline DNA is mandatory in order to investigate the possibility of inherited disease. In several areas, controversial opinions exist, depending on diversity in discipline, specific research area, experience in the field, and cultural and religious backgrounds. In particular, in vitro fertilization combined with pre‐implantation genetic diagnosis is an area which attracts considerable emotion.

Conclusions

In order to avoid confusion in the families, explicit and common guidelines are needed for the identification, treatment and follow‐up of individuals who have predisposing MEN or VHL mutations. Close collaboration between endocrinologists, oncologists, surgeons, pathologists, psychologists and geneticists is required in order to establish and verify such guidelines.
The hypothalamus–pituitary–gonad axis and testicular function in male patients after treatment for haematological malignancies
Authors: Kauppila  , Viikari  , Irjala  , Koskinen  , Remes
Published: March 2003

Abstract. Kauppila M, Viikari J, Irjala K, Koskinen P, Remes K (Turku University Central Hospital, Turku, Finland). The hypothalamus–pituitary–gonad axis and testicular function in male patients after treatment for haematological malignancies. J Intern Med 1998; 244: 411–6.

Objective

The effect of aggressive chemotherapy on the hypothalamus–pituitary–gonad axis and on testicular function was assessed in nine male patients who had received chemotherapy only (CT, group I) and in 10 males after allogeneic bone marrow transplantation (BMT, group II). The mean time from CT or BMT to the assessment was 3.7 (range, 1.0–11.7) years.

Design

The responses of follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) were assessed by the gonadotropin‐releasing hormone (GnRH) test and, in addition, serum basal values for testosterone and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. In 13/19 patients the human chorionic gonadotropin (hCG) test was performed.

Results

In group I, only one patient had an abnormal basal FSH value, but all (100%) had pathologically poor responses to the GnRH test. In contrast, all baseline FSH values were raised in group II (mean, 18; range, 11–30 U L−1), indicating toxic injury to the seminiferous tubules. Also in group II the responses to GnRH were low throughout the test (90%) and there were no clear peak values. In group II, the basal FSH and its maximum response to GnRH were significantly more affected than in group I (P < 0.001). The difference may be due to the effect of the conditioning regimen. Serum basal LH was raised in three of the patients in group I and they also had abnormal releasing test responses. In group II, baseline LH was abnormal in four patients, but the responses to GnRH were normal. However, the maximum response to the releasing test was significantly more affected in group II (P = 0.024). Serum testosterone levels were normal in all test subjects in both study groups. However, in two patients in both groups, the serum free androgen index was below the low reference limit, and an impaired response of serum testosterone to hCG stimulation was common (60%).

Conclusions

A toxic injury in the testis is common in haematological patients, especially after high‐dose chemoradiotherapy. Serum basal testosterone usually remains normal, but even then subnormal serum free androgen index, impaired testosterone response to hCG injection and abnormal response in LH may indicate a deficient androgen status. It may well be that testosterone replacement therapy should be considered in these cases.
Factors predicting clinical remission in adult patients with type 1 diabetes
Authors: Schölin A. , Berne C. , Schvarcz E. , Karlsson F. A. , Björk E.
Published: March 2003

Objectives. To describe the course of clinical remission in adult patients (16–50 years of age) with type 1 diabetes and to identify factors predictive of the occurrence and length of remission.

Design. A retrospective cohort study.

Subjects. Sixty‐two consecutive patients (43 men and 19 women) with new onset IDDM, 27 ± 8 years at diagnosis and treated with multiple insulin injections from the beginning.

Setting. Department of Medicine, Uppsala University Hospital and Örebro Medical Centre, Sweden.

Main outcome measures. Length and occurrence of remission (defined as maintenance of HbA1C <6.5% and an insulin dosage of <0.4 U kg−1 day−1 for a minimum of 1 month) in relation to nine biochemical and clinical factors at diagnosis.

Results. Sixty‐one per cent of the patients entered remission. The duration of remission was longer in males than females (10 ± 12 vs. 2 ± 3 months; P < 0.01). Male gender, normal serum bicarbonate at onset and a short time of classic symptoms before onset were predictive markers (P < 0.01; P < 0.05 and P < 0.01, respectively) for longer duration of remission. Low serum bicarbonate levels at onset were associated with lower occurrence of remission. Blood glucose, body mass index (BMI), and age at diagnosis did not influence the occurrence or the duration of remission.

Conclusions. In most adult patients with new onset of type 1 diabetes remission is induced when using multiple insulin injection therapy. Male patients seem particularly prone to remission, and the length and extent of β‐cell strain prior to diagnosis strongly influences its course.
Long‐term effects of LDL apheresis on carotid arterial atherosclerosis in familial hypercholesterolaemic patients
Authors: Koga N. , Watanabe K. , Kurashige Y. , Sato T. , Hiroki T.
Published: March 2003

Objectives. To assess the long‐term effect of LDL apheresis on carotid arterial atherosclerosis in severe familial hypercholesterolaemic (FH) patients.

Design. Changes in existing plaque, new plaque formation and annual progression rate of carotid early plaque were evaluated by B‐mode ultrasonography.

Subjects. LDL apheresis group: two homozygous FH and nine heterozygous FH patients received a combination of LDL apheresis and cholesterol‐lowering drug therapy for a mean of 7.8 years. Control group: 10 heterozygous FH patients were maintained by medication only for a mean of 5.5 years.

Results. As a result of LDL apheresis treatment, LDL cholesterol levels reduced from 16.0 ± 3.60 to 6.43 ± 0.07 mmol L–1 in homozygous FH patients and from 11.5 ± 2.46 to 4.32 ± 1.2 mmol L–1 in heterozygous FH patients. During the long‐term treatment period, the existing plaque tended to progress and new plaque formation in carotid arteries was also observed in both groups. The annual progression rate of mean maximum intima–media thickness in the common carotid artery was a mean of –0.0023 ± 0.0246 mm year–1 in heterozygous FH patients in the LDL apheresis group, suggesting regression. This was significantly lower when compared with the control group, which had a mean of 0.0251 ± 0.0265 mm year–1.

Conclusion. The results suggest that the long‐term treatment with combined LDL apheresis and drugs may delay the progression of the atherosclerotic process and prompt the stabilization of atheromatous plaque in severe FH patients.
The role of TNFα and TNF receptors in obesity and insulin resistance
Authors: Hotamisligil G. S.
Published: March 2003

Abstract. Hotamisligil GS (Harvard University, Boston, Massachusetts, USA). The role of TNFα and TNF receptors in obesity and insulin resistance. (Minisymposium: Genes & Obesity). J Intern Med 1999; 245: 621–625.

Insulin resistance, a smaller than expected response to a given dose of insulin, is associated with many common diseases including, ageing, polycystic ovarian disease, syndrome X, cancer, infections, trauma and, most significantly, obesity and type 2 diabetes mellitus. The biochemical basis of insulin resistance in type 2 diabetes has been the subject of many studies. Earlier studies have indicated that quantitative regulation of the insulin sensitive glucose transporters (Glut‐4) and insulin receptors themselves may contribute to this disorder, however, these two factors are probably inadequate to explain the extent of insulin resistance. This point also became apparent by the development of only mild hyperinsulinaemia in mice with a targeted mutation in the Glut‐4 gene. Studies on postreceptor defects in type 2 diabetes has recently focused on the intrinsic catalytic activity of the insulin receptor and downstream signalling events. A reduction in tyrosine phosphorylation of both the insulin receptor (IR) and the insulin receptor substrate‐1 (IRS‐1) has been noted in both animal and human type 2 diabetes. Importantly, this appears to occur in all of the major insulin‐sensitive tissues, namely the muscle, fat and liver. It is now clear that decreased signalling capacity of the insulin receptor is an important component of this disease. I will review some of the potential mechanisms underlying this deficiency.
Heparin‐induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases
Authors: Kadidal V. V. , Mayo D. J. , Horne M. K.
Published: March 2003

Abstract. Kadidal VV, Mayo DJ, Horne MK (National Institutes of Health, Bethesda, MD 20892, USA) Heparin‐induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases (Case Report). J Intern Med 1999; 246: 325–329.

Three cases of heparin‐induced thrombocytopenia (HIT) are reported that were provoked by daily heparin flushes of central venous access devices. Each case had confounding features that delayed recognition of the problem. A review of the literature revealed only 29 previously reported cases of HIT secondary to heparin flushes. However, the true incidence of this problem is unknown. A high index of suspicion and confirmatory laboratory tests are necessary to make the diagnosis.
Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus
Authors: Landstedt‐Hallin L. , Englund A. , Adamson U. , Lins P.‐E.
Published: March 2003

Abstract. Landstedt‐Hallin L, Englund A, Adamson U, Lins P‐E (Karolinska Institute, Danderyd Hospital, Danderyd; and Uppsala University Hospital, Uppsala, Sweden). Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus. J Intern Med 1999; 246: 299–307.

Objectives. To study effects of insulin‐induced hypoglycaemia on the cardiac repolarization, using QT interval measurements, in patients with type 2 diabetes.

Design. Hypoglycaemia was induced by an i.v.

insulin‐infusion and blood glucose was clamped at 2.7 mmol L–1 for 60 min (T = 90–150 min) in two experiments, with (+GLIB) and without (–GLIB) glibenclamide. In a third experiment, with similar hyperinsulinaemia, glucose was clamped at a euglycaemic level (

5 mmol L–1). ECG was continuously recorded for arrhythmia‐monitoring, and 12‐lead ECGs were recorded at T = 0 and 150 min. QT intervals were measured, and we determined QT dispersion (difference between the maximum and the minimum QT interval) reflecting interlead variability of repolarization.

Subjects. Thirteen patients with type 2 diabetes, on combined insulin and glibenclamide treatment, were studied during hypoglycaemia, and eight of them participated in the euglycaemic experiment.

Results. No significant arrhythmias were seen during hypoglycaemia but the mean QT intervals and QT dispersion increased significantly (P < 0.001), with no differences between –GLIB and +GLIB. During the euglycaemic clamp all QT measurements remained unchanged. Serum potassium decreased significantly (P < 0.001) during all three clamps, but the decrease was more pronounced during hypoglycaemia. The change in potassium was not correlated to the degree of QT prolongation or QT dispersion.

Conclusions. Significant changes in the repolarization of the heart can be seen during hypoglycaemia in patients with type 2 diabetes, indicating an increased risk of arrhythmia at low blood glucose levels.
Effects of hypocaloric dietary treatment enriched in oleic acid on LDL and HDL subclass distribution in mildly obese women
Authors: Zambon A. , Sartore G. , Passera D. , Francini‐Pesenti F. , Bassi A. , Basso C. , Zambon S. , Manzato E. , Crepaldi G.
Published: March 2003

Zambon A, Sartore G, Passera D, Francini‐Pesenti F, Bassi A, Basso C, Zambon S, Manzato E, Crepaldi G (University of Padova , Padova, Italy). Effects of hypocaloric dietary treatment enriched in oleic acid on LDL and HDL subclass distribution in mildly obese women. J Intern Med 1999; 246: 191–201.

Objective. To study the effects of a carbohydrate‐enriched (HiCarbo) or olive‐oil‐enriched (HiMUFA) hypocaloric diet on plasma lipoprotein levels and physical properties.

Design. A six‐month follow‐up dietary intervention study with a HiCarbo diet providing 60% of total calories as complex carbohydrates, 15% as proteins and 25% as fats [10% saturated (SFA); 7% monounsaturated (MUFA); 8% polyunsaturated fatty acids (PUFA)]; or a HiMUFA diet with 40% complex carbohydrates, 15% proteins and 45% fats (10% SFA; 27% MUFA; 8% PUFA).

Subjects. Twenty consecutive, mildly obese, normolipidemic premenopausal women (11 on HiCarbo and nine on HiMUFA diets) and 14 age‐ and sex‐matched, lean controls.

Measurements. Body mass index (BMI), waist/hip ratio, plasma lipoproteins, apolipoprotein (apo) AI and B, LDL and HDL density distribution, and phospholipid fatty acid composition at baseline, and after 3 and 6 months on dietary treatment.

Results. Body weight progressively decreased during the first 3 months and then it stabilized during the following 3 months (–11% vs. baseline in both groups; P < 0.01). LDL‐Cholesterol decreased significantly in both groups. HDL‐Cholesterol increased significantly in the HiMUFA group, whereas a decreased level was observed in the HiCarbo group. At baseline the obese women had higher very low density lipoprotein (VLDL)
and dense LDL‐Cholesterol, and lower HDL2 cholesterol levels than the controls;
these abnormalities persisted in the HiCarbo diet, whilst a significant decrease in the dense LDL associated with an increase in the HDL2 cholesterol was seen in the HiMUFA diet. HDL3 was not affected by either diet. The LDL/HDL‐Cholesterol ratio was not affected by the HiCarbo diet, whilst it was significantly reduced after 6 months of HiMUFA diet as compared with baseline. Apo AI increased in the HiMUFA group, and decreased in the HiCarbo group.

Conclusions. Both diets were effective in decreasing body weight. At steady weight conditions, only the HiMUFA diet improved LDL and HDL subclass distribution abnormalities present in mildly obese normolipidemic women.