bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of stressors on the dynamics of Bonamia exitiosus Hine, Cochennec‐Laureau & Berthe, infections in flat oysters Ostrea chilensis (Philippi)
Authors: Hine P M , Diggles B K , Parsons M J D , Pringle A , Bull B
Published: March 2003

Oysters, Ostrea chilensis, infected with Bonamia exitiosus were held under stressful conditions for 14 days, and then under normal conditions for 3.5 months, to determine the affects of stress on B.exitiosus infection levels.

The stressors used were (1) air exposure for 8 h daily; (2) hot water (25–26 °C), or (3) cold water (7 °C) for 1 h daily; (4) hyposaline (15‰), or (5) hypersaline (39–40‰) water; (6) starvation in filtered sea water; and (7) vigorous stirring four times a day. A control tank held oysters in static sea water, which was changed daily. Oysters were also (8) kept in a trough among heavily infected oysters (trough exposure), or (9) in a trough without other oysters (control), for 4 months. Oysters in hyposaline conditions all died within 3 weeks, but this was apparently unrelated to Bonamia infection. Otherwise, cumulative mortalities were highest in trough exposure, cold, hypersaline and hot treatments. There was a significant difference in prevalence between treatments, and the stir, hot, cold, hypersalinity and trough exposure treatments had significantly higher intensities of infection than controls. The mean intensity of Bonamia infection was significantly higher among female and spent oysters than in male and hermaphrodite oysters.
Characterization of serum and mucosal antibody responses and relative per cent survival in rainbow trout, Oncorhynchus mykiss (Walbaum), following immunization and challenge with Flavobacterium psychrophilum
Authors: LaFrentz B R , LaPatra S E , Jones G R , Congleton J L , Sun B , Cain K D
Published: March 2003

Serum and mucosal antibody responses of juvenile rainbow trout, Oncorhynchus mykiss, were characterized by enzyme‐linked immunosorbent assay (ELISA) following immunization with various preparations of formalin‐killed Flavobacterium psychrophilum cells. The protective nature of these preparations was then determined by immunizing rainbow trout fry and challenging with the bacterium. Juvenile rainbow trout immunized intraperitoneally (i.p.) with formalin‐killed F. psychrophilum emulsified with Freund's complete adjuvant (FCA), and i.p. with formalin‐killed F. psychrophilum either with or without culture supernatant generated significant serum antibody responses by 6 and 9 weeks, respectively. Significant mucosal antibody responses were detected by 9 weeks only in fish immunized i.p. with killed F. psychrophilum/FCA. Following immunization and bacterial challenge of rainbow trout fry, protective immunity was conferred in F. psychrophilum/FCA and saline/FCA groups with relative per cent survival values of up to 83 and 51, respectively. Significant protection was not observed in treatment groups immunized by immersion or i.p. without adjuvant at the challenge doses tested. Results suggest that stimulation of non‐specific immune factors enhances the ability of fish to mount a protective immune response, but specific antibody appears necessary to provide near complete protection. In this study, an ELISA was developed to monitor anti‐F. psychrophilum antibody production in trout. The relationship of such responses to protective immunity suggests that future vaccination strategies against coldwater disease may require stimulation of both the innate and adaptive arms of the immune response.
Detection of Flexibacter maritimus in fish tissue using nested PCR amplification
Authors: Cepeda C , García‐Márquez S , Santos Y
Published: March 2003

A nested polymerase chain reaction (PCR) system was developed for the detection of Flexibacter maritimus from fish tissue. The total procedure for the diagnosis of marine flexibacteriosis, from the point of DNA extraction to the electrophoretic analysis, can be performed in <4 h. This was achieved by the combination of a short thermal cycling programme with a rapid DNA extraction procedure. The assay was extremely sensitive, capable of detecting as few as 75 cfu mg−1 fish tissue. The accuracy of the nested PCR was confirmed under field conditions using tissue samples recovered during 1993–2002 from fish suffering marine flexibacteriosis. The nested PCR method proved to be efficient for the rapid and sensitive detection of F. maritimus from fish tissues and can be used for routine diagnosis of the disease caused by this pathogen.
The development and evaluation of a diet for maintaining remission in Crohn's disease
Authors: Woolner J. , Parker T. , Kirby G. , Hunter J.
Published: March 2003

Background: Elimination diets have been used in Crohn's disease to help maintain remission following enteral feeding. However, patients often find the strict regimen difficult to follow resulting in poor compliance. This paper describes the development and evaluation of an alternative method of food(r)re‐introduction, a low‐fibre, fat‐limited exclusion diet or ‘LOFFLEX’ diet.Methods: Patients achieving remission on an elemental or peptide feed or total parenteral nutrition (TPN) chose to follow either an elimination or LOFFLEX diet. Their progress was assessed regularly and life‐analysis tables used to calculate remission rates for the two groups at the end of a 2‐year period.Results: In a series of 76 treatment episodes (74 patients having achieved remission on an enteral feed, two on TPN), 28 patients (37%) chose the elimination diet and 48 (63%) the LOFFLEX diet. Fourteen per cent failed to comply with the elimination diet and 8% failed to comply with the LOFFLEX diet. Eleven per cent of the elimination group and 12.5% of the LOFFLEX group relapsed immediately and were all found to have tight strictures. At 24 months, the proportion of compliant, non‐strictured patients still in remission was 59% for the elimination diet and 56% for the LOFFLEX diet.Conclusion: This study suggests that the LOFFLEX diet has a similar efficacy to the elimination diet whilst being more acceptable to the patient. A randomized, prospective controlled study is now underway to further investigate these findings.
Monitoring of dietary quality in outpatients by qualitative meal classification method
Authors: Wissing  , Lennernäs*  , Ek  , Unosson
Published: March 2003

Background: The aim of this study was to evaluate whether qualitative meal‐classification used as a dietary evaluation tool reflects eating frequency and key nutrients in the diet, and whether it could be used to monitor the dietary quality in elderly outpatients. The qualitative meal‐classification tool used was based on eight food categories combined into four types of meals: Complete, Incomplete, Less Balanced and Vegetarian Meals, and three types of snacks: High‐, Mixed‐ and Low‐Quality Snacks.
Methods: Dietary intake was assessed during 7 consecutive days by use of an estimated food record in nine elderly women with leg ulcers. Mean 7‐day dietary intakes of energy, macronutrients, beta‐carotene, retinol, vitamin E, ascorbic acid, calcium, iron, zinc and dietary fibre were calculated. Each eating event was classified in accordance with the food‐based classification method. The frequency of the four types of meals and three types of snacks, their energy content and nutrients, and their contribution to total intake were subsequently analysed.
Results: Meals were associated with a higher energy, vitamin and mineral content than were snacks. Complete Meals were the major source for beta‐carotene and ascorbic acid. Intakes from Low‐Quality Snacks were relatively high in energy, fat and sucrose.
Conclusion: The qualitative meal‐classification tool was found to be simple to use and useful for reflecting meal order and the nutritional roles of different types of meals and snacks in the diet. This method is recommended for dietary monitoring.
Validation of a food frequency questionnaire for use in a Scottish population: correlation of antioxidant vitamin intakes with biochemical measures
Authors: Bodner C. H. , Soutar A. , New S. A. , Scaife A. R. , Byres M. , Henderson G. D. , Brown K. , Godden D. J.
Published: March 2003

Background: The food frequency questionnaire (FFQ) has become established as the primary method for assessing dietary intake in epidemiological studies of diet and disease; attention must now be given to developing and evaluating FFQs that extend the range of populations studied.
Aim: To assess the validity of antioxidant vitamin intake estimates derived from a self‐administered food frequency questionnaire which was developed for use in Scottish populations.
Method: Intake estimates of vitamins A, C, E and β‐carotene were compared with corresponding biochemical measurements in 273 Scottish men and women aged 39–45 years.
Results: The mean ratios of energy intake to calculated basal metabolic rate were 1.40 for men and 1.46 for women suggesting that the intake values derived from the FFQ were not biased towards under‐reporting. Significant positive correlation coefficients ranging from 0.14 (for vitamin A) to 0.42 (for vitamin C) were observed between total intake (including diet and supplements) and plasma values. Adjustment for other known determinants of diet and plasma values (i.e. energy intake, body mass index, gender, smoking and plasma lipid levels) improved the correlations for vitamin E and β‐carotene. Excluding supplement users generally reduced the correlations suggesting that failure to include supplemental sources may result in misclassification of antioxidant vitamin intake. The food frequency questionnaire assigned 68–89% of subjects correctly into the upper or lower plus adjacent tertiles of plasma vitamin concentration. Conclusions: These results demonstrate that the food frequency questionnaire is a valid measure of antioxidant vitamin intake.
Why is there an association between eating fruit and vegetables and a lower risk of stroke?
Authors: Bradley S. , Shinton R.
Published: March 2003

Background: For some years now health professionals have been advising the general public to increase their intake of fruit and vegetables to reduce the risk of specific cancers and cardiovascular disease. This review specifically looks at the effect on reducing risk of stroke.
Method: In January 1996 MEDLINE was used to identify study papers using the key words: fruit and vegetables, folic acid, homocysteine and cerebrovascular disease. All papers that could be obtained via the inter‐library loan within the area were reviewed. More recent, relevant articles, up to and including March 1998, which came to the attention of the authors, were also included.
Results and conclusions: Recent research has shown that beta‐carotene supplements, with or without vitamin A, are not an effective means of reducing the risk of stroke. Vitamin C supplementation has not been shown to be effective but may have an effect on blood pressure. Deficiency of folic acid and its effect on homocysteine concentrations is a more recent hypothesis. Consistent data link elevated levels of homocysteine with increased risk of cardiovascular disease. Certain fruits and vegetables are a good source of folic acid and those who eat more may benefit from a low plasma homocysteine and resultant lower risk of stroke. A higher consumption of fruit and vegetables may simply affect intake of total fat, potassium or sodium. However, as with any dietary association, confounding variables must not be ruled out and there are many that cannot easily be excluded: smoking, hypertension, lack of exercise and social class variations to name a few. The studies reviewed support the recommendation to eat five portions of fruits and vegetables a day.
The effect of different types of dietary advice on body composition in a group of Scottish men
Authors: Drummond S. , Kirk T.
Published: March 2003

Aims: This study aimed to compare the effect of advice to reduce both dietary fat and sugar, with the effect of advice to reduce dietary fat only, on dietary intake, body weight and body composition in normal to moderately overweight Scottish men.
Methods: Subjects were randomly assigned to a control Group 0 (no advice), Group 1 (advice to reduce fat and sugar) or Group 2 (advice to reduce fat only). Dietary intakes, body weight, BMI, % body fat and waist:hip ratio were measured throughout the 6‐month study period.
Results: Both groups 1 and 2 significantly decreased percentage energy from fat after 6 months. Group 1 decreased percentage energy from added sugar and non‐milk extrinsic sugar (NMES) from baseline to 6 weeks but there was no difference from baseline at 6 months. A small decrease in percentage body fat was observed in Group 1 (0.8%) without weight loss, whereas a larger decrease in percentage body fat was observed in Group 2 (1.4%) with a weight loss of 1.2 kg at 6 months.
Conclusion: There may be no advantage in advising individuals to reduce sugar intakes in terms of promoting a ‘healthy diet’ or with respect to maintaining a healthy body weight status.
Development of an interview‐administered food‐frequency questionnaire for use amongst women of South Asian ethnic origin in Britain
Authors: Kassam‐Khamis T. , Nanchahal K. , Mangtani P. , dos Santos Silva I. , McMichael A. , Anderson A.
Published: March 2003

Objectives: To develop an interview‐administered food‐frequency questionnaire (FFQ) to assess usual long‐term intake of foods and nutrients amongst women from the largest South Asian communities residing in Britain.

Methods: A list of foods and dishes consumed by these South Asian communities was compiled from data collected in previous studies. Foods which contributed to interindividual variation in the intake of the various macronutrients or were rich in fat or fibre were included in the FFQ. Portion size for traditional foods were estimated using sets of eight colour photographs. A nutrient database was modified to make it appropriate for South Asian diets. The reliability of the FFQ was assessed in a group of volunteer South Asian women (n=14) of differing regional and religious backgrounds. A preliminary validation exercise was conducted in a group of Punjabi Muslim women (n=11) who had kept 7‐day weighed records 2 years previously.

Results: The reliability of this FFQ was high, with most women being classified in the same tertile for energy and macronutrient intake in the two interviews. The main sources of energy and macronutrients identified by the FFQ were similar to those identified by the weighed records but the average nutrient intakes estimated by the FFQ were slightly higher. The level of agreement between the two dietary methods, measured by the ability of the FFQ to classify women in the same tertile of intake as the weighed records, was high for percentage energy intake from fat, protein and carbohydrates, but less so for absolute nutrient intakes. These results were, however, limited because of the small sample size.

Conclusions: This is the first FFQ specifically designed for South Asian communities in Britain. Despite the diversity of diets, these preliminary findings suggest it will be a useful and easy to administer tool in chronic disease epidemiology to obtain standardized information on long‐term usual dietary intake from these communities. A more comprehensive validation of this FFQ is now underway.
A1. The public perception of the role of dietitians compared with physiotherapists and radiographers
Authors: Crocker J.
Published: March 2003

Background There is increasing awareness of the importance of nutrition among health professionals and the public. This has led to a growing demand for dietetic and nutritional advice. However, dietitians may not be widely recognized by the public as experts in this field. Little research has been done on the public perception of dietitians and other health professionals.

Aim To assess public perception in Aberdeen of the role of dietitians by means of a questionnaire. It was decided to compare dietetics with physiotherapy, a well known health profession and radiography, which is probably on the same level of public perception as dietitians. The questionnaire was also used to determine who the public would go to first for nutrition information.

Method A random sample of 165 individuals was recruited from two local supermarkets.

Results Results show that the public had a good perception of the role of physiotherapists but a poorer perception of the dietitians’ and the radiographers’ roles. Doctors were frequently seen as nutrition decision makers. It was found that 26% of the sample population thought dietitians distributed and collected hospital menus and 21% thought dietitians prepared meals in hospital. Doctors were the preferred choice for nutrition information, however, respondents made wide use of the media for their information. Dietitians were the second choice for the majority of respondents, however, health food shops were a more popular first choice for younger people. Access to a dietitian was mentioned as a problem, and, for this reason, was often put after doctor, practice nurse and health food shop as a source for nutrition information.

Conclusions It is recommended that dietitians make themselves more accessible to the public. Dietetics could make more use of the media to promote what the provision does and to provide sound nutritional information for the public.
The move from a long‐stay learning disabilities hospital to community homes: a comparison of clients’ nutritional status
Authors: Bryan F. , Allan T. , Russell L.
Published: March 2003

Background  Adults with learning disabilities have a greater incidence of health problems than the general population. It is now well established that they are a nutritionally vulnerable group with polarized weight distributions.

Aim This study was undertaken to investigate the nutritional consequences of the closure of a large learning disabilities hospital and the resettlement of clients in small community homes.

Methods  The nutritional changes were measured using a locally devised nutrition screening form. This had previously been tested for reliability and validity.

Clients were screened in the month prior to their discharge from Stallington Hall and at 1 year post‐discharge. The two screening forms for each client were then compared.

The screening form assessed risk in three areas: nutritional adequacy, weight and nutrition‐related problems.

Results  A number of significant increases in risk between the two screens were seen. In particular, there was an increase in overall risk relating to food groups, unintentional weight gain and loss and overall risk relating to weight.

At the first screen, 70% of the women and 55% of the men were outside the normal weight ranges and by the second screen these percentages had increased to 82% and 60%, respectively. It was not possible to weigh 15% of the study participants at the second screen because suitable scales were not available.

Conclusions  The study confirms the nutritional vulnerability of the participants and highlights a number of adverse nutritional changes. It supports the need for regular screening and dietetic input.
Weight change after myocardial infarction: statistical perspectives for future study
Authors: Hankey C. R. , Leslie W. S. , Currall J. E. P. , Matthews D. , Lean M. E. J.
Published: March 2003

Objectives  Survivors of acute myocardial infarction (MI) often experience weight changes and weight management is often appropriate. Estimates of the sample size required in intervention weight loss studies are essential to the success of future evaluations. The aims of this study were therefore two‐fold: (1) to describe pilot data on the effectiveness of advice for weight loss; (2) to provide information on the sample size required for future research to assess weight management in similar patients.

Methods  Further analysis of data from a randomized controlled study carried out in 84 post‐MI patients attending cardiac rehabilitation. Forty‐three intervention patients received dietary advice in line with current UK guidelines. Additionally, overweight intervention subjects were given individualized weight management advice. Forty‐two control patients were recruited and received usual care. Anthropometric measurements were made at baseline and followed up at 52 weeks post‐rehabilitation. Power calculations were performed using these data to determine the required sample size to adequately power a study examining the effectiveness of weight management.

Results  Seventy patients completed the study. At 52 weeks anthropometric measurements were unchanged in the 25 overweight patients provided with weight management advice, and also for all those (n = 20) with body mass index <25 kg m−2. In contrast, anthropometric measurements increased significantly (body weight +2.4 kg, P = 0.02; waist circumference +2.6 cm, P = 0.008) in overweight control patients. A minimum sample size of 71 patients is required for a future study of weight change in overweight subjects, and 58 for a study of healthy weight subjects.

Conclusions  Pilot data suggested that significant weight changes occur in patients not given nutritional or weight management advice after MI. Power calculations carried out on these data indicate that a sample size at least three times as large as the present study is required to accurately evaluate weight management in this group.
The nature of leisure in the lives of older adults with intellectual disability
Authors: Rogers N. B. , Hawkins B. A. , Eklund S. J.
Published: March 2003

The purpose of this study was to examine the nature of leisure in a sample of older adults with intellectual disability. Twenty‐nine older adults participated in in‐depth interviews. An interview guide was utilized which included topics relating to leisure participation and social interaction in a variety of environments. Data were analysed according to the constant comparative method. The most pronounced theme that emerged from the data was lack of self‐determination in leisure. Participants had few opportunities to freely choose leisure in any aspect of their lives. In many cases, opportunities for self‐determined leisure were further constricted by age‐related changes in the participants' lives.
Time demands and experienced stress in Greek mothers of children with Down's syndrome
Authors: Padeliadu S.
Published: March 2003

The purpose of the present study was to asses the time demands placed on mothers of children with Down's syndrome, and the possible relationship between those demands and the stress which the mothers experience. The study sample consisted of 41 mothers of children with Down's syndrome living in Northern Greece and a comparison group of 41 mothers of non‐disabled children. Three instruments were used for the data collection: (1) a questionnaire for biographic information; (2) a self‐report form assessing the time demands placed on the mothers; and (3) an adaptation of the Clark Questionnaire on Resources and Stress (QRS) for the evaluation of the stress experienced. The results of the present study revealed increased time demands on the mothers of children with Down's syndrome in comparison to the mothers of non‐disabled children in terms of recreational/educational activities and total time demands. Furthermore, the mothers of children with Down's syndrome perceived the time they spend with their children less positively than the mothers of the comparison group. In regard to the stress experienced, it appeared that mothers of children with Down's syndrome differ significantly from‐mothers of non‐disabled children, not only on the level of the stress which they experience, but on the activities related to this stress as well.
Effectiveness of antipsychotic medication in people with intellectual disability and schizophrenia: a systematic review
Authors: Duggan L. , Brylewski J.
Published: March 2003

The aim of the present study was to determine the efficacy of any antipsychotic medication for treating people with a dual diagnosis of intellectual disability and schizophrenia. The authors performed an electronic search of Biological Abstracts, the Cochrane Schizophrenia Group’s Register of trials, the Cochrane Library, EMBASE, PsycLIT and MEDLINE. Unpublished data were sought from pharmaceutical companies. Both authors independently selected the relevant studies from the reports identified in this way. Only one relevant randomized trial was found by the searches (Foote 1958). This study included four people with a dual diagnosis of schizophrenia and intellectual disability, but results were only available for two subjects. The groups to which the other two people were allocated were unclear. Using the methods described, the reviewers found no trial evidence to guide the use of antipsychotic medication for those with both intellectual disability and schizophrenia. Until the urgent need for randomized controlled trials is met, clinical practice will continue to be guided by evidence from trials involving people with schizophrenia but without intellectual disability.
Seizure disorders in people with intellectual disability: an analysis of differences in social functioning, adaptive functioning and maladaptive behaviours
Authors: Matson J. L. , Bamburg J. W. , Mayville E. A. , Khan I.
Published: March 2003

The present study is an investigation into the effects of seizure disorders/epilepsy on psychopathology, social functioning, adaptive functioning and maladaptive behaviours using a sample of 353 people diagnosed with a seizure disorder, and either severe or profound intellectual disability. People with a diagnosis of seizure disorder were found to have significantly less social and adaptive skills when compared to developmentally disabled controls with no seizure disorder diagnosis. Additionally, patterns of maladaptive behaviours were identified for individuals with seizure disorders and found to be similar to those found in people without seizure activity. The implications of the present findings are discussed.
Review: Rapid cycling bipolar affective disorder in people with intellectual disability: a systematic review
Authors: Vanstraelen M. , Tyrer S. P.
Published: March 2003

Rapid cycling bipolar affective disorder has attracted renewed interest in the general adult psychiatric literature, particularly as the response to lithium prophylaxis is poor in this subgroup of patients. The present paper describes a systematic Medline/Psyclit review of case studies and small series of patients with rapid cycling bipolar affective disorder in people with intellectual disability (ID). Rapid cycling bipolar affective disorder in people with ID may differ from its occurrence in the non‐ID population in terms of a relative preponderance of males, an increased likelihood of rapid cycling onset in those with an early (prepubertal) onset of affective disorder and a different response to prophylactic drugs. The efficacy of treatment and prophylaxis of rapid cycling illnesses needs further investigation in the population with ID.
Early intervention for children with cerebral visual impairment: preliminary results
Authors: Lanners J. , Piccioni A. , Fea F. , Goergen E.
Published: March 2003

According to the ophthalmological literature, cerebral visual impairment (CVI) is defined as a temporary or permanent visual loss caused by a disturbance of the posterior visual pathways and/or occipital lobes. The study of CVI is still a new field, and diagnosis is frequently difficult and sometimes may not even be considered. Different studies have taken into account various aetiologies of CVI. Neurological problems are common findings in children with CVI and this population may also show ocular abnormalities. The present study reviews the clinical history of 76 patients who have been examined at the Robert Hollman Foundation, Cannero, Italy, over the past 3 years. Infants and children were studied from birth to 4 years of age from both a neurological and an ophthalmological point of view. Taking the development of the children into account, responses to visual stimulation were analysed in order to compare the behaviours exhibited by the sample with those described in literature.
Correlations between clinical and historical variables, and cerebral structural variables in people with mild intellectual disability and schizophrenia
Authors: Sanderson T. L. , Doody G. A. , Best J. , Owens D. G. C. , Johnstone E. C.
Published: March 2003

The increased prevalence of schizophrenia in the population with mildly intellectual disability (ID) remains unexplained. The present study explores several possibilities by examining historical/clinical findings in relation to structural neuroimaging findings in three groups: (1) comorbid mild ID and schizophrenia; (2) schizophrenia alone; and (3) mild ID alone. Information about clinical and historical variables was obtained from 101 subjects (39 with comorbidity, 34 with schizophrenia and 28 with mild ID), out of whom 68 (23, 25 and 20, respectively) had had a cerebral magnetic resonance imaging (MRI) scan. Although a number of significant correlations exist between clinical variables and structural MRI abnormalities in all three groups, no clearly predictive inter‐ or between‐group differences emerged. More striking was the finding that showed small amygdalo‐hippocampal size to be associated with a history of central nervous system injury, especially meningitis. These findings provide support for the view that cognitive impairment and comorbid psychosis can result from a common cause, such as meningitis or obstetric complications, possibly interacting with other factors, such as family history.
Depression in mothers and fathers of children with intellectual disability
Authors: Olsson M. B. , Hwang C. P.
Published: March 2003

Parental depression was assessed using the Beck Depression Inventory (BDI) in 216 families with children with autism and/or intellectual disability (ID), and in 214 control families. Mothers with children with autism had higher depression scores (mean = 11.8) than mothers of children with ID without autism (mean = 9.2), who in turn, had higher depression scores than fathers of children with autism (mean = 6.2), fathers of children with ID without autism (mean = 5.0), and control mothers (mean = 5.0) and fathers (mean = 4.1). Forty‐five per cent of mothers with children with ID without autism and 50% of mothers with children with autism had elevated depression scores (BDI > 9), compared to 15–21% in the other groups. Single mothers of children with disabilities were found to be more vulnerable to severe depression than mothers living with a partner.
Risk assessment in offenders with intellectual disability: the evidence base
Authors: Johnston S. J.
Published: March 2003

A review of the current literature on risk assessment and management in offenders with intellectual disability (ID) revealed little direct evidence for the specific population. Theoretical models and non‐ID populations have been abstracted and adapted, but not validated, for those with ID. The varying conceptual frameworks of risk, and its assessment and management, must be considered in context. Difficulties remain with the consideration of offences versus offence‐like behaviour, offender versus those with similar needs, and indeed, what is regarded as ‘intellectual disability’. Mainstream forensic assessment has moved towards a more dynamic appreciation of risk and risk management, as opposed to risk elimination. This development is more in line with the normalization principles of ‘risk‐taking’ in ID. Consideration is given to future research and development priorities.
Prevalence of Helicobacter pylori in people with intellectual disability in a residential care centre in Israel
Authors: Morad M. , Merrick J. , Nasri Y.
Published: March 2003

Background In 1982, Helicobacter pylori (formerly Campylobacter pylori) was
identified as a pathogenic factor in peptic ulcer disease by researchers from Australia.
Because only a small number of studies of H. pylori infection have been conducted in people with intellectual disability (ID), and none of these were done in Israel, the present authors decided to conduct a pilot study on its prevalence in this population.

Methods The Israeli Division for Mental Retardation provides services to over 6000 people in 54 residential care centres (or institutions), and one centre in the south of the country with kibbutz‐style living arrangements was selected for this pilot study. The study was performed as part of the yearly routine medical examination of all residents, and blood specimens were drawn for IgG antibodies to H. pylori (ELISA).

Results Out of the 47 individuals screened, 75% (n = 36) were seropositive.

Conclusion In addition to the reported high rates of H. pylori infection in residents with ID living in large facilities, the present pilot study suggests that people with ID living in smaller, kibbutz‐style arrangements are also at high risk.
Costs of village community, residential campus and dispersed housing provision for people with intellectual disability
Authors: Hallam A. , Knapp M. , Järbrink K. , Netten A. , Emerson E. , Robertson J. , Gregory N. , Hatton C. , Kessissoglou S. , Durkan J.
Published: March 2003

Background

In recent years, a growing volume of research evidence has been generated about the relative cost‐effectiveness of various types of community‐based residential supports for people with intellectual disability (ID) in the UK. However, few reliable data are available to inform planners, commissioners or service providers about the quality and costs of providing support within residential or village communities.

Methods

The evaluation described in the present paper aimed to fill some of the gaps in knowledge by examining the comparative costs of supporting people in village community settings, in National Health Service (NHS) residential campuses and in dispersed, community‐based housing schemes. The complete service package received by each study participant was described and costed, and a series of statistical analyses was undertaken to identify factors associated with variations in the cost of support. The analyses reported in the present paper were based on comparisons of 86 people living in village communities, 133 in residential campuses and 281 in dispersed housing schemes.

Results

Wide variations in cost were found, not only between models of accommodation, but between individual organizations, settings and service users. Multivariate analysis revealed that higher costs were associated with supports for people with higher levels of ID and more severe challenging behaviour. The cost of support was affected by the size of the residential setting, with smaller facilities likely to be more expensive. Associations were also found between increased costs, and services for younger users, male users and people who had not moved from a NHS hospital. Generally, more sophisticated service processes within the setting were associated with higher costs; although systematic arrangements for supervision and training of staff had a negative effect on cost.

Conclusions

The cost findings should be considered alongside evidence on outcomes. A comparison of village communities and dispersed housing schemes suggests that both models of provision appear be associated with particular benefits, although different types of setting are appropriate for different individuals and therefore, the continued development of a range of residential models is important.
Preliminary evaluation of a scale to assess cognitive function in adults with Down's syndrome: the Prudhoe Cognitive Function Test
Authors: Kay D. W. K. , Tyrer S. P. , Margallo‐Lana M. L. , Moore P. B. , Fletcher R. , Berney T. P. , Vithayathil E.
Published: March 2003

Background  In the clinical diagnosis of dementia in Down's syndrome (DS), it may be difficult to distinguish between cognitive deterioration and the various degrees of pre‐existing intellectual disability (ID). Serial measurements of both cognitive function and behaviour are required. The aim of the present study was to evaluate the performance of non‐demented adults with DS on a subject‐directed instrument, the Prudhoe Cognitive Function Test (PCFT), preliminary to its serial use in a prospective study.

Methods  From 1985 to 1986, 85 non‐demented hospitalized adults with DS were interviewed using the PCFT. The Adaptive Behavior Scale (ABS) was administered to the carers. The subjects’ levels of ID (graded from mild through moderate, severe and profound to untestable) were based on their scores on the Stanford–Binet Intelligence Scale, as reported in the medical records, and the relationship between level of disability and performance on the PCFT and ABS, and their respective domains, was examined.

Results  Both scales produced a wide range of scores and the correlation between them was highly significant. Both scales correlated highly significantly with the degree of ID, but more subjects with high levels (i.e. profound to untestable) of disability obtained very low or zero scores on the PCFT and its domains than on the ABS.

Conclusions  The PCFT provides a reliable quantitative measure of cognitive function in subjects with DS, and could be a useful adjunct to the diagnosis of dementia in prospective studies. However, the almost uniformly low scores obtained by those with high levels of ID suggests that its power to detect cognitive decline will be limited to those who are less disabled, while the ABS may be more useful than the PCFT in detecting deterioration in people with profound ID.
Mastery motivation in young children with Down's syndrome: relations with cognitive and adaptive competence
Authors: Niccols A. , Atkinson L. , Pepler D.
Published: March 2003

Background  Prior research on relations between motivation and competence have focused on cognitive competence, despite theoretical predictions that mastery motivation spurs behaviour that is effective in meeting the demands of one's environment, i.e. adaptive competence. Issues of adaptive competence are especially relevant for children with developmental delay since functional independence is an important long‐term goal for these children.

Methods  In the present study, mastery motivation was examined in relation to both cognitive and adaptive competence in 5‐year‐old children with Down's syndrome (n = 41).

Results  Scores on mastery task and parent‐report measures of mastery motivation were generally low, but positively related to scores on standardized measures of cognitive competence and adaptive competence.

Conclusions  This is the first study of motivation–competence relations in pre‐school‐age children. The findings have implications for both developmental theory and early intervention efforts, and the authors hope that they will serve as a stimulus for future research on cross‐domain relationships in atypical populations.
Assessment of change with the Developmental Behaviour Checklist
Authors: Clarke A. R. , Tonge B. J. , Einfeld S. L. , Mackinnon A.
Published: March 2003

Background  The Developmental Behaviour Checklist (DBC) is a 96‐item instrument designed for assessing behavioural and emotional problems among young people with intellectual disability.

Methods  The present study investigated the validity of the DBC as a measure of change. Changes in individual's DBC scores were correlated with changes in expert clinicians’ ratings of the same subjects.

Results  A high correlation was found between expert clinician ratings of change in behaviour and change in the total behaviour problem score of the DBC.

Conclusions  The DBC is able to measure changes in behaviour and emotions which are recognized by an experienced clinician who is following the progress of a child with ID.
Radiocontrast‐induced natriuresis associated with increased urinary urodilatin excretion
Authors: Haller  , Meyer  , Scheele  , Koch  , Forssmann  , KÜbler
Published: March 2003

Haller C, Meyer M, Scheele T, Koch A, Forssmann W‐G and Kübler W (University of Heidelberg; and Lower Saxony Institute for Peptide Research, Hanover; Germany). Radiocontrast‐induced natriuresis associated with increased urinary urodilatin excretion (original article). J Intern Med 1998; 243: 155–62.

Objective

Intravascular radiocontrast agents induce a pronounced diuresis. The aim of the present study was to investigate the (patho‐)physiological mechanisms of the radiocontrast‐induced diuresis.

Design

The fractional excretion of sodium, the urinary excretion of the renal natriuretic peptide urodilatin and the plasma concentration of atrial natriuretic peptide were measured in 42 unselected patients immediately before and after intravascular radiocontrast administration during coronary angiography.

Setting

Cardiac catheterization laboratory of a university hospital.

Results

After angiography both the plasma concentration of atrial natriuretic peptide (median post‐pre difference: 3.9 pmol L−1, quartiles −1.2; 7.0) and the urinary excretion of urodilatin (median post‐pre difference: 67.0 nmol urodilatin/mol creatinine, quartiles 39.7; 152.1) were increased. The urinary urodilatin excretion was correlated with an increase in the fractional excretion of sodium (median post‐pre difference: 1.7%, quartiles 0.6; 3.1). There was no correlation between the serum concentration of atrial natriuretic peptide and urinary sodium excretion. For the radiocontrast‐induced increase in both urodilatin and sodium excretion there was no indication for differences between patients without (31) and with (11) intravenous saline infusion.

Conclusion

The radiocontrast‐induced diuresis is a natriuresis which is associated with an increased urinary excretion of urodilatin. The association between natriuresis and urinary urodilatin excretion irrespective of baseline volume status corroborates the hypothesis that urodilatin contributes to the sodium excretion after radiocontrast administration in a paracrine manner. This finding has pathophysiological and potentially therapeutic implications in radiocontrast‐induced nephropathy.
Pathology of MEN‐1: morphology, clinicopathologic correlations and tumour development
Authors: Komminoth  , Heitz  , Klöppel
Published: March 2003

Komminoth P, Heitz PU, Klöppel G (University of Zürich, Switzerland; and University of Kiel, Germany). Pathology of MEN‐1: morphology, clinicopathologic correlations and tumour development (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 455–64.

Multiple endocrine neoplasia type 1 (MEN‐1) is an inherited syndrome which is characterized by the occurrence of neoplastic lesions in the parathyroids, the pancreas, duodenum, anterior pituitary and, less commonly, also in the stomach, thymus and lung. Its genetic defect has recently been identified and appears to involve a new type of tumour suppressor gene called mu on chromosome 11q13. In this overview, we will summarize the morphological features of the MEN‐1 phenotype, discuss its clinicopathologic profile and prognosis and outline the recent findings on the molecular pathology of this syndrome.
Expression of the MEN‐1 gene in a large kindred with multiple endocrine neoplasia type 1
Authors: Burgess  , Greenaway  , Shepherd
Published: March 2003

Burgess JR, Greenaway TM, Shepherd JJ (Royal Hobart Hospital, and University of Tasmania, Hobart, Tasmania, Australia). Expression of the MEN‐1 gene in a large kindred with multiple endocrine neoplasia type 1 (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 465–70.

In 1983 a large family with MEN‐1 (designated Tasman 1) was identified in Tasmania. Kindred screening and case follow‐up over the subsequent 15 years has yielded data on over 160 MEN‐1‐affected patients. Hyperparathyroidism is present in over 60% of gene carriers by age 20 years and 95% by age 30 years. Hyperplasia is the characteristic pathological finding. Kaplan–Meier analysis indicates hyperparathyroidism recurs in the majority of patients despite near‐total parathyroidectomy. Gastrinoma, ‘nonfunctioning’ pancreatic adenoma and insulinoma occur in up to 60, 50 and 10% of patients, respectively. Metastatic gastroenteropancreatic (GEP) tumours develop in up to 35% of family members, being frequent in some branches of Tasman 1, whilst rare in others. Pituitary disease developed in 19% of patients. Prolactinoma and ‘nonfunctioning’ adenoma account for 76 and 24%, respectively, of pituitary abnormalities. Prolactinomas exhibit clustering within branches of the Tasman 1 kindred. Adrenal adenomas occur in 36% of patients. The majority of adrenal lesions are benign and nonsecretory and develop in association with pancreatic neoplasia. Carcinoid tumours are uncommon but important malignancies. Malignant thymic carcinoid occurs in male patients, whereas bronchial carcinoid occurs predominantly in women. Prior to recognition of MEN‐1 in Tasman 1, complications of hyperparathyroidism and malignancy accounted for the majority of patient mortality. Since commencement of prospective screening, malignant GEP tumours and cardiovascular disease have become the most prevalent causes of death amongst MEN‐1‐affected patients.
Abnormal metabolism of free fatty acids in hypertriglyceridaemic men: apparent insulin resistance of adipose tissue
Authors: Mostaza  , Vega  , Snell  , Grundy
Published: March 2003

Mostaza JM, Vega GL, Snell P, Grundy SM (The Center for Human Nutrition, and the Departments of Clinical Nutrition and Internal Medicine, University of Texas South Western Medical Center, and the Veterans Affairs Medical Center at Dallas, Texas, USA). Abnormal metabolism of free fatty acids in hypertriglyceridaemic men: apparent insulin resistance of adipose tissue. J Intern Med 1998; 243: 265–74.

Objective

.There is growing evidence that endogenous hypertriglyceridaemia is frequently accompanied by a state of insulin resistance. The present study was performed to determine whether patients with primary endogenous hypertriglyceridaemia commonly have abnormalities in plasma concentrations and turnover rates of free fatty acids (FFA), which could reflect a state of insulin resistance in adipose tissue and could account for raised plasma triglycerides.

Design

.Hypertriglyceridaemic and normotriglyceridemic control patients underwent measurements of plasma concentrations and turnover rates of FFA. Fat weights in both groups were determined by hydrodensitometry, and fat distribution was assessed by skin‐folds and measurement of waist and hip circumferences. Other measurements included plasma glucose, insulin, lipids, and lipoproteins.

Subjects

.Fifteen men with normal plasma triglycerides and 21 men with primary endogenous hypertriglyceridaemia were studied. Men in both groups varied in body weights and total fat weights, but total fat weights were entirely overlapping for the two groups. Waist‐to‐hip ratios and waist circumferences also were similar for the two groups.

Results

.For any total body fat content or waist circumference, most hypertriglyceridaemia patients had higher mean plasma concentrations of FFA and higher turnover rates (flux) for FFA than did normotriglyceridemic patients. Hypertriglyceridaemic patients also had higher fasting insulin concentrations for a given body fat content. In general, both FFA flux and plasma insulin levels were positively correlated with plasma concentrations of triglyceride and inversely with high density lipoprotein (HDL) cholesterol.

Conclusions

.These studies indicate that many patients with primary endogenous hypertriglyceridaemia have increased flux of FFA and hyperinsulinemia that cannot be explained either by increased total body fat content or by greater waist circumferences than observed in normotriglyceridemic patients.