bluuebunny/crossref_metadata_2025 huggingface dataset:
Research for Health: Background and Immediate Implications
Authors: Twelvetree Timothy
Published: September 2007

This article examines the history surrounding the development of research activity within the English National Health Service, leading to the most recently published Research for Health strategy in 1993. It specifically focuses on the 2 most dominant professional groups; the medical and nursing professions and subsequently examines the impact of the strategy upon them.
Passive Smoking in Childhood
Authors: Di Benedetto G.
Published: September 2007

There is increasing interest in the effects of adult smoking on the health of infants and children. Although passive smoking is important in many childhood disorders, most attention has been paid to its effects on the respira tory tract and on infant mortality. Several studies have reported an increased risk of sudden infant death syndrome and respiratory illness in infants of mothers who had smoked during pregnancy. Post-natal exposure to passive smoking has been found responsible for an increased risk of acute respiratory illness morbidity and an increased occurrence of chronic respiratory symptoms. Maternal cigarette smoking aggravates asthma symptoms and bronchial responsive ness in children with an established diagnosis of the disease, and the possibility that passive smoking has a causal role in the aetiology of asthma is currently a matter of growing interest. In addition, several studies have shown small but significant reductions in lung function values of children exposed to passive smoking.
A code of practice on dealing with infectious diseases on aircraft
Authors: Grainger C.R. , Young M J F , John H.H.
Published: September 2007

Increasing numbers of people are travelling to and from more distant destina tions with the possibility of exposure to common as well as exotic disease.

At the present time there are no readily accessible rules or guidance for dealing with possible cases of infectious disease occurring during international flights. A 'Code of Prac tice on dealing with infectious disease on aircraft' is proposed as a ready means of dealing with the problem without excessive action or expense.
The physiological threat of compulsive syndromes
Authors: Cohn Leslie G.
Published: September 2007

Compulsive syndromes, especially obsessive-compulsive disorder, are much more common than previously believed. The behaviours that are a part of these syndromes can lead to physiologically threatening conditions whose medical consequences range from minor to fatal. It is crucial that not only mental health professionals, but all health profes sionals better understand the nature and consequences of compulsive disorders and their importance to general health.
Identifying problems in community health promotion
Authors: MacLachlan M.
Published: September 2007

Recognition of the extent and consequences of HIV/AIDS in Africa has resulted in many large scale health promotion programmes. These programmes usually provide information about how to avoid contracting HIV as well as information to dispel false beliefs about the virus. However there also exist anti-health promotion ideas about HIV/AIDS which often challenge the very premises on which health promotion messages are based. Such anti-health promotion ideas may represent reassuring benefits and these are likely to vary not only across cultures but also between different communities and 'at risk' groups within the same culture. The Nominal Group Technique (NGT) is a participative exercise which can be used with small groups to achieve a consensus concerning which anti-health promotion ideas are most influential in terms of encouraging people to ignore health promoting messages. The application of the NGT is illustrated with a group of Malawian students.
Nomenclature of health care organisations: The extent of public understanding
Authors: Cresswell Patricia A. , Tait Elaine J. , Donaldson Liam J.
Published: September 2007

S u m m a ry Health care systems in many parts of the world are undergoing organisational change. In Britain, the establishment of new organisations following the National health Service (NHS) reforms of 1990 has led to a change and a greater diversity in the nomenclature of health bodies. An important but often overlooked consequence of such change is the extent to which the public, as consumers of services, can recognise health organisations by their names. We investigated this in a study in the North east of England in early 1994. Eleven hundred respondents were asked to identify their local health authority, acute hospital and community health service provider. Mean scores for correct identification were: health authorities (or consortia of health authorities) 32%; acute hospitals 36% ; community units 19%. Worst performing organisations scored very high 'don't know' responses: worst performing health authority 52%; acute hospitals 59%; community unit 48%. This survey demonstrates that the names chosen for themselves by health care organisations can convey little meaning to the public. This is an area which needs attention if health care systems are to create a culture in which they regard their patients as informed consumers.
Social marketing
Authors: Montazeri Ali
Published: September 2007

There is a longstanding debate on the contribution of social marketing to public health in general, and to health education and health promotion in particular. This paper presents further discussion from a public health point of view and concludes that priority should be given to health-oriented approaches rather than market-oriented strategies.

It is argued that, at best, social marketing is a tool not a solution for health education's and health promotion's problems. To communicate health education messages effectively and efficiently, health needs assessment is recommended as a way forward. It is a public health approach and contains a range of flexible methods in the implementation of health education/promotion programmes.
"An awful visitation of Providence": The Irish Famine of 1845-49
Authors: Jordan T.E.
Published: September 2007

This essay examines the condition of Ireland before, during and after the famine which began in 1845 when the potato crop began to fail. A series of topics is presented: the quality of life, families, government aid, philanthropy, population changes, literacy, emigration, and public policy.

The essay draws on the author's research quantifying the quality of life in Ireland, and on reasearch analysing the heights of a sample of Irish army recruits in the famine era.
Daily practices, study performance and health during the Ramadan fast
Authors: Afifi Z.E.M.
Published: September 2007

A cross-sectional study was carried out to explore the effect of the Ramadan fast on daily practices (life events, diet and smoking), health and performance of 265 university students. Analysis showed that more people got involved in stress reducing (watching TV, listening to the radio and visiting) and spiritual activities (prayers and reading Koran) during this month. They drank less caffeine-containing beverages and smoked less.

Food intake appeared to improve during Ramadan with higher proportions eating foods from all food groups. The amount of foods did not differ significantly except in the case of foods from the cereal, meat and vegetable groups. Even though less, cereal consumption was still in the adequate range.

Change in weight was variable. Weight loss was significantly more among the sick. A large proportion of the latter improved during the month especially those with irritable bowel syndrome and constipation. Reduced activity, study desire and concentration ability were reported by more than 50% of subjects.
Overdose among youth in Bahrain: psycho-social characteristics, contact with helping agencies and problems
Authors: Al-Ansari A.M.S. , Hamadeh R.R. , Matar A.M. , Buzaboon B. , Marhoon H. , Raees A.G.
Published: September 2007

A one year cohort of 67 overdose attempts among youth (15-24 years) was examined as part of a case control study. The prevalence rate of 105 per 100,000 population is lower than reported rates in the West but higher than those for the region. The majority of attempters were females and nationals who used paracetamol, and their suicide intent was low. Thirteen percent visited a helping agency in the previous week and 18% in the previous month. The most common difficulties preceding the overdoses were problems with parents, school or work, social isolation and problems with boyfriends, or girlfriends respectively. Adjustment disorder was the most common diagnosis followed by depression. A seasonal variation was noted with 46% of the cases occurring in the summer months. The implications of these findings with respect to future policy making and prevention were discussed.
Lessons to be learned: a case study approach
Authors: Olukoga A.
Published: September 2007

The case is presented of a 65 year old lady with recent onset of neuromuscular manifestations, comprising paraparesis, areflexia and unsteady gait, along with episodes of slurring of speech and diplopia, later confirmed to be due to severe hypercalcaemia - which itself was caused by primary hyperparathyroidism. Restoration of normocalcaemia, by means of rehydration and bisphosphonate therapy, resulted in clinical improvement - whilst subsequent parathyroidectomy was followed by complete resolution of all symptoms. In order to make prompt differentiation between the neurological sequelae of hyperparathyroidism and a primary neurological disorder, a high index of suspicion is required. An urgent serum calcium assay, as part of a bone profile, is mandatory in patients who present with neurological symptoms - especially the elderly, amongst whom hyperparathyroidism is especially common.
Cigarette smoking and erectile dysfunction
Authors: Jeremy J.Y. , Mikhailidis Dimitri P.
Published: September 2007

Erectile dysfunction (ED, formerly referred to as impotence, is a common (especially in dia betic and older men) and distressing condition. Several risk factors have been identified; among these are smoking,hyperlipidaemia, hypertension and diabetes mellitus. These risk factors are shared with atherosclerotic vascular disease (e.g. ischaemic heart disease). This observation underlies a common vascular pathology. Smoking may cause ED by several mechanisms, including adversely affecting intrapenile blood flow. It is important to be aware of the link between smoking and ED since this information may motivate some male smokers to quit. In this context, it is important to be aware of the link between smoking and ED since this information may motivate smokers to quit. In this context, it is relevant that there is evidence that quitting may restore/improve erectile function.
Lessons to be learned: a case study approach
Authors: Sankar Nagamanickam Sai , Donaldson David
Published: September 2007

The case is described of a hitherto well, alert and intelligent lady of 85 years of age, who commenced medication with diuretics - prescribed for mild congestive cardiac failure; she developed constipation consequent upon the diuresis and dehydration thereby provoked. As a result she began to take, unknown to her general practitioner, regular and increasing amounts of laxatives. At about this time she was noted by her son to become "rapidly senile" - with the result that she fell on account of losing her normally good concentration and attention; she sustained fractures of the right tibia and fibula. Shortly after admission to hospital she was premedicated, anaesthetised and operated upon, following which there was a postoperative regimen comprising several litres of low sodium isotonic infusions, all given intravenously. She was found at this point to be severely hyponatraemic with a low serum osmolality, but following the institution of water restriction rapidly improved as her serum sodium rose again; there was an accompanying massive diuresis as the previously retained water was voided. Concomitant with the serum sodium rise her mental concentration and attention regained their former levels. The biochemical and cellular mechanisms underlying this patient's symptoms are discussed.
Incidence of reported cerebral concussion in adult taekwondo athletes
Authors: Pieter Willy , Zemper Eric D
Published: September 2007

The purpose of the present study was to assess the exact conditions under which cerebral concussions occur in full-contact taekwondo competition. Injury data were collected by project staff and tournament medical personnel with simple check-off forms that describe the athlete and nature, site, circumstances and severity of the injury. The Mann-Whitney U test was used to determine the difference in injury rate between men and women. The men (7.04/1,000 athlete-exposures) sustained more cerebral concussions than the women (2.42/1,000 athlete-exposures) (p<0.001). The dominant injury mechanism in both the males and females was receiving a blow (6.46/1,000 athlete-exposures and 2.42/ 1,000 ath lete-exposures for the men and women, respectively).
Lessons to be learned: a case study approach
Authors: Olukoga Adebayo , Horsman Graham , Stewart Felicity
Published: September 2007

The case is presented of a 74 year-old woman who was admitted with severe hypo-osmolar hyponatraemia associated with inappropriately raised urinary osmolality, and who was subsequently discovered to have primary hypothyroidism. A normal serum sodium concentration was restored by means of judicious fluid restriction and thyroid hormone replacement. Low dose thyroxine therapy led to rapid but modest increases in the serum activities of alanine aminotransferase (ALT) and alkaline phosphatase (ALP); both returned to normal over a period of three weeks. These sub- clinical enzyme changes may indicate tissue 'hyperthyroidism'; and in this case, the fact that they occurred acutely at only low doses of thyroxine possibly suggests an increased hepatic sensitivity to the hormone.
Genital thrush in women: the attitudes and practice patterns of General Practitioners in Teesside and North Yorkshire
Authors: Opaneye A.A.
Published: September 2007

This study was performed in order to determine the attitudes and practice patterns of some of the GPs on Teesside and North Yorkshire in the management of their female patients complaining of genital thrush, a term often used to mean vulvo-vaginal candidosis an extremely common condition (Tobin, 1995; Elliott, 1998; Lopez-Martinez et al, 1984). Postal questionnaires were sent to 65 GPs on Teesside and the bordering areas of North Yorkshire. There were 45(69%) completed replies. Nearly all the GP's believed that antibiotic usage was associated with the development of this disorder; less than half (44%) of the patients seen had a confirmatory microbiological test in the form of examination of a high vaginal swab (HVS). The most frequently prescribed antifungal compound was found to be clotrimazole.
The relationship between building design and escapes from secure units
Authors: Enser J. , MacInnes D.
Published: September 2007

The research presented is a survey of all of the identified forensic psychiatry Medium Secure Units (MSUs) within Great Britain. The study examined the numbers and nature of all escapes from these units over a 42-month period. The research focused on the relationship between the building design of the units and the nature of patient escapes. The results showed that overall numbers of patient escapes from the units was low. The average number of escapes was 3.14 per unit over the three-and-a- half-year time-span of the survey. However, the recent increases in bed numbers in medium secure units had been paralleled by a larger percentage rise in escapes. Most escapes from the units occurred from three main areas. These were the perimeter fence, the roof, and internal and external windows. The implications of the methods of escape and their relationship to the building design of MSUs were discussed and recommendations made for future building designs.
Nutrition: a necessary adjunct to hospital care?
Authors: Holmes S.
Published: September 2007

Good nutrition is undoubtedly central to optimum health and to the recovery from illness yet research and clinical surveys repeatedly demonstrate an unacceptably high incidence of malnutrition in hospital patients in whom it delays recovery, increases the incidence of complications and significantly increases the cost of treatment; the human cost is inestimable.
A quality roadmap of a restructured hospital
Authors: Chow-Chua C .F. P. , Goh M.
Published: September 2007

This paper presents a quality roadmap of a restructured hospital. Specifically, a case study is showcased to reveal how a FOCUS-PDCA model is applied to the Central Portering Services (CPS) within a restructured hospital, to provide better service to other departments within the hospital who can then in turn value add to the patient care delivery chain. The preliminary results suggest that implementers of quality and service improvement programmes using the FOCUS-PDCA approach should note some of the key implementation difficulties. These difficulties occur at all levels and include issues relevant to change management, process improvement programmes, accessibility to data, communication and judicious execution of the change process.
Lessons to be learned: a case study approach: Pseudohyperkalaemia due to thrombocytosis in a case of tubo-ovarian abscess
Authors: Mazarelo F. , Donaldson D.
Published: September 2007

The case described here is that of a 48-year-old lady who presented with abdominal pain and fever; at a later stage she was found to have hyperkalaemia of uncertain origin. Blood examination revealed there to be marked elevation of the platelets (thrombocytosis) on some occasions. It was then realised that there was correlation between the platelet levels and serum potassium values. During the clotting process the release of potassium from the increased number of platelets caused the serum potassium to be elevated on account of an in vitro effect. The important point is that the raised serum potassium levels were not due to an in vivo phenomenon and, therefore, the patient did not need treatment for this; however, the presence of thrombocytosis was itself a clue to the diagnosis- which was eventually recognised as being due to an infection. At operation a tubo-ovarian abscess was discovered to be the cause of the problem.
Rickets and deprivation: a Nigerian study
Authors: Akpede G.O. , Omotara B.A. , Ambe J.P.
Published: September 2007

Under-fives in 461 households were assessed clinically to determine the prevalence of rickets in sub-urban and rural communities in the Sahel savanna. Overt rickets was found in 11 (2.4%) of households and abnormalities suggestive of rickets in 69 (14.9%). There were significant variations (p<0.05) in the prevalence of rickets in association with ethnic grouping (higher in southerners and non-Kanuri, non-Hausa-Fulani northerners), religion (more prevalent among Christians), and mother's occupation and educational status (higher with working class mothers and mothers with at least a primary education). A significantly higher prevalence was also associated with late introduction (at more than seven months of age) of cereals to the infant's diet, more than one under-five in a household and presence of under-fives aged 13-48 months. In contrast, no significant variations in prevalence were observed in association with duration of breast feeding, use of multivitamins or cod liver oil, history of convulsions in under-fives, sex, nutritional status, or history of diarrhoea within a recall period of six months.

Thus, rickets is common in under-fives in rural and sub-urban communities in the Sahel savanna and may be related more to enviromental and dietary factors than to culture and religion. Further studies are required to determine the relative roles of vitamin D or calcium deficiency to facilitate the planning and execution of a community-based intervendon programme in the area.
Obesity among Kuwait University students: an explorative study
Authors: AI-Isa A.N.
Published: September 2007

University students' dietary habits have been criticised for their nutritional inadequacy and faddism. Kuwait University students may face the risk of obesity because of affluence and modernisation and the dynamic changes in their level of physical activity and caloric intake. This promted a study of a random sample of 842 Kuwait University students for dietary and socioeconomic factors associated with obesity. Weight and height were measured to calculate the body mass index (BMI), which is the weight in kilograms divided by the height in meters squared (kg/m2). Obesity was classified into grade 1 and 2 (BMI >25 and >30 kg/m2). The associated factors studied and obtained through questionnaires included gender, age, marital status, parental obesity, education and occupation, dieting, last dental and health check-up, year of study, number of siblings (total, brothers and sisters), eating in between meals, high school and college GPA and major, exercising, number of regular meals eaten, obese relatives, those living at home, and servants, highest desired degree, birth order, having a chronic disease, countries prefer visiting, family income, governorate, and socioeconomic status (SES). Grade 1 and 2 obesity were found to be 32.0 and 8.9%, respectively. Factors that were found to be significantly associated with obesity included gender, age, marital status, obesity among parents, dieting, last physical check-up, year of study, number of brothers, sisters and regular meals eaten and high school GPA. Logistic regression analysis revealed that the same factors significantly contributed to the development of obesity except the last four. The level of obesity among Kuwait University students is high. Obesity is a risk factor for a variety of chronic diseases. There is a need to address the challenge of instituting measures that would reduce the future ill-effects of obesity on young adults. It is widely believed that during the young adult years many important health habits are formed and set. It is at this stage (or earlier) that wellness and self-care programming for college students is essential and worthy of being explored and its efficacy assessed.
Reversion mutations in patients with leukocyte adhesion deficiency type-1 (LAD-1)
Authors: Uzel Gulbu , Tng Emilia , Rosenzweig Sergio D. , Hsu Amy P. , Shaw Jacqueline M. , Horwitz Mitchell E. , Linton Gilda F. , Anderson Stacie M. , Kirby Martha R. , Oliveira Jaõ B. , Brown Margaret R. , Fleisher Thomas A. , Law S. K. Alex , Holland Steven M.
Published: September 2007

Leukocyte adhesion deficiency type-1 (LAD-1) is an autosomal recessive immunodeficiency caused by mutations in the β2 integrin, CD18, that impair CD11/CD18 heterodimer surface expression and/or function. Absence of functional CD11/CD18 integrins on leukocytes, particularly neutrophils, leads to their incapacity to adhere to the endothelium and migrate to sites of infection. We studied 3 LAD-1 patients with markedly diminished neutrophil CD18 expression, each of whom had a small population of lymphocytes with normal CD18 expression (CD18+). These CD18+ lymphocytes were predominantly cytotoxic T cells, with a memory/effector phenotype. Microsatellite analyses proved patient origin of these cells. Sequencing of T-cell subsets showed that in each patient one CD18 allele had undergone further mutation. Interestingly, all 3 patients were young adults with inflammatory bowel disease. Somatic reversions of inherited mutations in primary T-cell immunodeficiencies are typically associated with milder clinical phenotypes. We hypothesize that these somatic revertant CD18+ cytotoxic T lymphocytes (CTLs) may have altered immune regulation. The discovery of 3 cases of reversion mutations in LAD-1 at one center suggests that this may be a relatively common event in this rare disease.
Loss of spermatogonia and wide-spread DNA methylation defects in newborn male mice deficient in DNMT3L
Authors: La Salle Sophie , Oakes Christopher C , Neaga Oana R , Bourc'his Déborah , Bestor Timothy H , Trasler Jacquetta M
Published: September 2007

Background

Formation of haploid spermatozoa capable of fertilization requires proper programming of epigenetic information. Exactly how DNMT3L (DNA methyltransferase 3-Like), a postulated regulator of DNA methyltransferase activity, contributes to DNA methylation pattern acquisition during gametogenesis remains unclear. Here we report on the role of DNMT3L in male germ cell development.

Results

A developmental study covering the first 12 days following birth was conducted on a Dnmt3L mutant mouse model; lower germ cell numbers and delayed entry into meiosis were observed in Dnmt3L
-/- males, pointing to a mitotic defect. A temporal expression study showed that expression of Dnmt3L is highest in prenatal gonocytes but is also detected and developmentally regulated during spermatogenesis. Using a restriction enzyme qPCR assay (qAMP), DNA methylation analyses were conducted on postnatal primitive type A spermatogonia lacking DNMT3L. Methylation levels along 61 sites across chromosomes 4 and X decreased significantly by approximately 50% compared to the levels observed in Dnmt3L
+/+ germ cells, suggesting that many loci throughout the genome are marked for methylation by DNMT3L. More so, hypomethylation was more pronounced in regions of lower GC content than in regions of higher GC content.

Conclusion

Taken together, these data suggest that DNMT3L plays a more global role in genomic methylation patterning than previously believed.
Calcium-sensitive regulation of monoamine oxidase-A contributes to the production of peroxyradicals in hippocampal cultures: implications for Alzheimer disease-related pathology
Authors: Cao Xia , Wei Zelan , Gabriel Geraldine G , Li XinMin , Mousseau Darrell D
Published: September 2007

Background

Calcium (Ca2+) has recently been shown to selectively increase the activity of monoamine oxidase-A (MAO-A), a mitochondria-bound enzyme that generates peroxyradicals as a natural by-product of the deamination of neurotransmitters such as serotonin. It has also been suggested that increased intracellular free Ca2+ levels as well as MAO-A may be contributing to the oxidative stress associated with Alzheimer disease (AD).

Results

Incubation with Ca2+ selectively increases MAO-A enzymatic activity in protein extracts from mouse hippocampal HT-22 cell cultures. Treatment of HT-22 cultures with the Ca2+ ionophore A23187 also increases MAO-A activity, whereas overexpression of calbindin-D28K (CB-28K), a Ca2+-binding protein in brain that is greatly reduced in AD, decreases MAO-A activity. The effects of A23187 and CB-28K are both independent of any change in MAO-A protein or gene expression. The toxicity (via production of peroxyradicals and/or chromatin condensation) associated with either A23187 or the AD-related β-amyloid peptide, which also increases free intracellular Ca2+, is attenuated by MAO-A inhibition in HT-22 cells as well as in primary hippocampal cultures.

Conclusion

These data suggest that increases in intracellular Ca2+ availability could contribute to a MAO-A-mediated mechanism with a role in AD-related oxidative stress.
Genetic variants of Complement factor H gene are not associated with premature coronary heart disease: a family-based study in the Irish population
Authors: Meng Weihua , Hughes Anne , Patterson Chris C , Belton Christine , Kamaruddin Muhammad S , Horan Paul G , Kee Frank , McKeown Pascal P
Published: September 2007

Background

The complement factor H (CFH) gene has been recently confirmed to play an essential role in the development of age-related macular degeneration (AMD). There are conflicting reports of its role in coronary heart disease. This study was designed to investigate if, using a family-based approach, there was an association between genetic variants of the CFH gene and risk of early-onset coronary heart disease.

Methods

We evaluated 6 SNPs and 5 common haplotypes in the CFH gene amongst 1494 individuals in 580 Irish families with at least one member prematurely affected with coronary heart disease. Genotypes were determined by multiplex SNaPshot technology.

Results

Using the TDT/S-TDT test, we did not find an association between any of the individual SNPs or any of the 5 haplotypes and early-onset coronary heart disease.

Conclusion

In this family-based study, we found no association between the CFH gene and early-onset coronary heart disease.
Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers
Authors: Buckby Joe A , Yung Alison R , Cosgrave Elizabeth M , Killackey Eoin J
Published: September 2007

Background

The overlap between Depression and Anxiety has led some researchers to conclude that they are manifestations of a broad, non-specific neurotic disorder. However, others believe that they can be distinguished despite sharing symptoms of general distress. The Tripartite Model of Affect proposes an anxiety-specific, a depression-specific and a shared symptoms factor. Watson and Clark developed the Mood and Anxiety Symptom Questionnaire (MASQ) to specifically measure these Tripartite constructs. Early research showed that the MASQ distinguished between dimensions of Depression and Anxiety in non-clinical samples. However, two recent studies have cautioned that the MASQ may show limited validity in clinical populations. The present study investigated the clinical utility of the MASQ in a clinical sample of adolescents and young adults.

Methods

A total of 204 Young people consecutively referred to a specialist public mental health service in Melbourne, Australia were approached and 150 consented to participate. From this, 136 participants completed both a diagnostic interview and the MASQ.

Results

The majority of the sample rated for an Axis-I disorder, with Mood and Anxiety disorders most prevalent. The disorder-specific scales of the MASQ significantly discriminated Anxiety (61.0%) and Mood Disorders (72.8%), however, the predictive accuracy for presence of Anxiety Disorders was very low (29.8%). From ROC analyses, a proposed cut-off of 76 was proposed for the depression scale to indicate 'caseness' for Mood Disorders. The resulting sensitivity/specificity was superior to that of the CES-D.

Conclusion

It was concluded that the depression-specific scale of the MASQ showed good clinical utility, but that the anxiety-specific scale showed poor discriminant validity.
Functional analysis of cancer-associated EGFR mutants using a cellular assay with YFP-tagged EGFR intracellular domain
Authors: de Gunst Matheus M , Gallegos-Ruiz Marielle I , Giaccone Giuseppe , Rodriguez Jose Antonio
Published: September 2007

Background

The presence of EGFR kinase domain mutations in a subset of NSCLC patients correlates with the response to treatment with the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. Although most EGFR mutations detected are short deletions in exon 19 or the L858R point mutation in exon 21, more than 75 different EGFR kinase domain residues have been reported to be altered in NSCLC patients. The phenotypical consequences of different EGFR mutations may vary dramatically, but the majority of uncommon EGFR mutations have never been functionally evaluated.

Results

We demonstrate that the relative kinase activity and erlotinib sensitivity of different EGFR mutants can be readily evaluated using transfection of an YFP-tagged fragment of the EGFR intracellular domain (YFP-EGFR-ICD), followed by immunofluorescence microscopy analysis. Using this assay, we show that the exon 20 insertions Ins770SVD and Ins774HV confer increased kinase activity, but no erlotinib sensitivity. We also show that, in contrast to the common L858R mutation, the uncommon exon 21 point mutations P848L and A859T appear to behave like functionally silent polymorphisms.

Conclusion

The ability to rapidly obtain functional information on EGFR variants of unknown relevance using the YFP-EGFR-ICD assay might prove important in the future for the management of NSCLC patients bearing uncommon EGFR mutations. In addition, our assay may be used to determine the response of resistant EGFR mutants to novel second-generation TKIs.
Extensive psoriasis induced by pegylated interferon: a case report
Authors: Citro Vincenzo , Fristachi Raffaele , Tarantino Giovanni
Published: September 2007

This paper describes the clinical course of a patient with chronic hepatitis C, genotype 2a/2c, previously treated with Interferon α2b and subsequently with Lymphoblastoid Interferon without any response, and also without any cutaneous side effects. The patient, a 50 year-old woman, was re-treated with Pegylated α2b Interferon plus Ribavirin for 24 weeks, at standard doses; during the third month of therapy she developed a mild form of psoriasis. However, encouraged by the progressive improvement of her transaminase levels and viral load decrease, the patient asked to continue the treatment; she normalized the transaminase levels during the fourth month and showed HCV-RNA negativity during the fifth month of therapy. Nevertheless, the psoriasis become worse, extending to over 75% of her body. Therapy was completed after sixth months. A month after the therapy was ceased, the patient's psoriasis receded spontaneously and completely. During the subsequent four years the patient did not experience any recurrence of either the hepatic disease or the psoriasis.
Electroconvulsive therapy machines
Authors: Robertson Carol , Fergusson Grace
Published: September 2007

Electroconvulsive therapy (ECT) is a long established form of treatment for specific, serious mental disorders, but one which is still surrounded by much misunderstanding and fear. The use of electrical current administered to the brain to ‘treat’ illness remains a barbaric concept to many people. Much research has been conducted to establish the efficacy of ECT, which is now widely accepted. However, the working principles of the ECT machine itself are little understood, and more research remains to be done to establish, more scientifically, which is the ‘best’ way to administer the electrical stimulus. With the recent introduction of the concept of “stimulus dosing” (for a review see Lock, 1994), the need to be aware of the ECT machines available and their abilities and limitations is important.
Are we providing a good service for people with chronic schizophrenia?
Authors: Wing John
Published: September 2007

The first target of the government's mental Health of the Nation strategy is to improve the health and social functioning of mentally ill people. Most health service professionals would agree with the implication that there is substantial room for improvement. It is as important to be aware of the extent to which a service is failing as it is to know that needs are being met.
Consultants and clinical team management
Authors: Oldham John
Published: September 2007

Over the past 10 years or so, management has gained greater significance as a career choice for doctors. They see enormous opportunities to improve clinical care by having a greater say in setting the agenda of their organisation and directing the deployment of the local healthcare budget. While doctors have always enjoyed a position of major influence over the direction of the health service, real opportunities to operate as managers only became available in the mid 1980s with the implementation of the Griffiths Report (Department of Health and Social Security, 1983). Although mental illness hospitals had Medical Superintendents until the 1970s, professional hierarchies and consensus decision making, combined with incremental planning and an administrative culture, resulted in few opportunities for meaningful involvement of doctors in management.
The management of somatisation
Authors: Smith Graeme C.
Published: September 2007

Somatisation remains a matter of bewilderment in medicine. Medical students have trouble defining it, psychiatry trainees wilt in its presence, and all doctors are prone to become entangled in it. The current spate of reviews on the topic is appropriate (Mayouet al, 1995a; Barsky, 1996; Gill & Bass, 1996). There is a great need for those required to manage patients with ‘medically unexplained symptoms’ to be informed sufficiently to take a stance on the theoretical issues involved and develop appropriate management plans.
Services for younger sufferers with dementia
Authors: Wilson K. C. M. , Ferran José
Published: September 2007

Prevalence and incidence rates of dementia in people under the age of 65 are difficult to determine. Surveys differ in design, examine different population samples and include varying levels of disease in estimating rates. Most of the surveys are small and are conducted through case note review.
Prevention of burn-out
Authors: Roberts Glenn A.
Published: September 2007

There is a widespread concern that the medical profession is itself sick. This is represented in professional disillusionment and demoralisation, an increasing inclination to consider leaving the profession, and the ill-health of its practitioners in terms of their mental health, marriages and use of drugs and alcohol (British Medical Association, 1992). These trends have been attributed, at least in part, to protracted job stress and dissatisfaction, which may in turn be a major determinant in the quality of health care (Caplan, 1994). Although these issues have been cautiously acknowledged for some time, the concept of ‘burn-out’ has provided an opportunity for more open acceptance and creative debate.
Learning disabilities and old age
Authors: Cooper Sally-Ann
Published: September 2007

People with learning disabilities form only a small part of the general population, but because of their many special needs, they require the provision of specialist health services. National statistics on the prevalence of learning disabilities are poor, but it has been estimated that 160 000 people in England and Wales have severe or profound learning disabilities (Audit Commission, 1987).
Assessing children for the courts
Authors: Lindsey Caroline
Published: September 2007

In recent years, there has been growing recognition of the significant incidence of child abuse and neglect in the population, and of its adverse effect on the development of children and their mental and physical health. This awareness has led, especially following the implementation of the Children Act 1989, to an increased demand for psychiatric assessments of children for the courts by social services, solicitors, guardians adlitem and the courts themselves. There has been some reluctance to take up this work, for two main reasons. First, there has been concern that these time-consuming assessments will result in a shift of resources away from treatment, thus having an adverse impact on the balance of child mental health services. In some areas, the need has been recognised within the commissioning and contracting processes. Provision has been increased accordingly, acknowledging that it is part of the responsibility of the health authorities to assist the local authorities in this way.
Assessment and management of rapid-cycling bipolar affective disorder
Authors: Ahmed Mukhtar , Morriss Richard
Published: September 2007

Rapid-cycling bipolar affective disorder presents a unique spectrum of therapeutic difficulties. This article outlines some practical guidelines on the assessment and management of the disorder in the light of current research and clinical practice.
Conflicts in the investigation and treatment of sexually abused children
Authors: Glaser Danya
Published: September 2007

This paper examines the complex relationship between the process of investigation and the provision of treatment in cases of child sexual abuse. Child sexual abuse is now a well-recognised and documented phenomenon, the deleterious sequelae of which have been studied, initially in survivors presenting in adulthood (Wyatt & Powell, 1989) and (more recently) during childhood (Briere, 1992; Kendall-Tackett et al, 1993). Following the recognition of sexual abuse from the accounts of adult survivors, and in order to reduce the harm caused to sexually abused children by providing earlier protection and treatment, attention began to be directed to the earlier recognition of child sexual abuse, during childhood.
Learning from adverse events
Authors: Zigmond A. S.
Published: September 2007

“Experience is of no ethical value. It is merely the name men give to their mistakes” Oscar Wilde (The Picture of Dorian Grey).

Whenever colleagues meet it seems there is discussion about the latest inquiry into suicides or homicides. One cannot turn on the television without the news or a documentary referring to the latest tragedy. Risk assessment and defensible documentation are commonly the subjects of lectures and symposia. Lessons are learned, or not, from published inquiries and associated media attention. The attribution of blame is always high on the agenda. Yet when visiting psychiatric services and talking to staff I am usually impressed by their professionalism and staggered by their workload.
False memories: finding a balance
Authors: Mollon Phil
Published: September 2007

There can be few more agonising experiences than being falsely accused of having sexually abused one's child – except perhaps to be told that one's long-standing memories of childhood abuse are an example of false memory syndrome. People have been profoundly hurt both by false accusations of abuse and by false denials and dismissals of memories of abuse. Both of these can happen.
Commentary
Authors: Brandon Sydney
Published: September 2007

In my view Dr Mollon fails to achieve the balance he is seeking and at times appears to take a partisan position.
Commentary
Authors: James A. , Javaloyes A.
Published: September 2007

We would like to comment on some issues raised by the very helpful paper by Cotgrove & Gowers.
Should consultant psychiatrists be trained in psychotherapy?
Authors: Temple Nick
Published: September 2007

Psychosocial aspects of treatment have become increasingly important with the changes in psychiatric practice away from the hospital to the community. Effective psychosocial interventions and high staff morale are likely to be the key to the success of a community-based mental health service. There is a growing expectation that all psychiatrists should have a basic knowledge of therapeutic approaches in order to take a leading role in the multi-disciplinary team. They should be able to assess patients for a range of psychological and psychotherapeutic treatments. This role is vital as the matching of the patient's needs with the appropriate treatment is the key to a successful outcome.
Learning objectives for teaching and training
Authors: Hughes Patricia
Published: September 2007

“Everywhere increased complexity and mind-burdening terminology. What is the teacher to do? And more important, what can the poor student do, confronted with so much new knowledge and a Rabelaisian onomatomania?” (Osier, 1913).

The publication of Tomorrow's Doctors(General Medical Council, 1993) opened our minds to the need for a more thoughtful and evaluated approach to education in medicine. The expansion of medical knowledge has shown no sign of slowing, which makes it imperative that we find ways to prioritise and organise what we teach so that students are given a clear structure. Learning objectives are one of the building blocks that give order to what we do with and for our students.
Use of investigations in the diagnosis and management of alcohol use disorders
Authors: Drummond Colin , Ghodse Hamid
Published: September 2007

The purpose of this review is to familiarise the reader with the clinical utility of investigations in the diagnosis and management of alcohol use disorders (AUDs). Many biochemical and haematological tests are widely available, and can improve significantly the quality of diagnosis and management. However, there is no single test that can detect AUDs with complete accuracy. Further, the validity of a test will vary depending on the clinical application. Such tests should never be relied on in isolation. Adequate clinical evaluation also needs to include a combination of interview and examination of the patient, and interview of other informants (Cantwell & Chick, 1994; Edwardset al, 1997). In the research setting, self-report is generally a valid and reliable method of assessing alcohol consumption (Baboret al, 1987), particularly when it is elicited by a standardised method (e.g. Sobellet al, 1980) and the information is provided in confidence. In the clinical setting, however, the patient may report his or her version of past drinking subject to the demand characteristics of the situation, particularly if adverse consequences are likely to ensue (e.g. discharge from a treatment programme).
Biologic and Clinical Characteristics of Breast Cancer With Single Hormone Receptor–Positive Phenotype
Authors: Rakha Emad A. , El-Sayed Maysa E. , Green Andrew R. , Paish E. Claire , Powe Desmond G. , Gee Julia , Nicholson Robert I. , Lee Andrew H.S. , Robertson John F.R. , Ellis Ian O.
Published: September 2007

Purpose

Response to endocrine therapy in breast cancer correlates with estrogen receptor (ER) and progesterone receptor (PgR) status. It is usually easier to decide treatment strategies in cases of double-positive/-negative phenotypes than in single-positive tumors.

Patients and Methods

We have examined a large and well-characterized series of primary invasive breast carcinoma (1,944 cases) with long-term clinical follow-up and hormone therapy data. Patients were stratified according to ER and PgR expression and the study was focused on the single-positive groups (ER–/PgR+ and ER+/PgR–), to assess their main features and evaluate any prognostic and predictive difference between them and compare them with the double-positive/-negative tumors.

Results

ER+/PgR–tumors were found more frequently in elderly, postmenopausal women. The majority were grade 2 ductal/no specific type carcinomas. There was no difference between the two groups with regard to lymph node stage. Survival analyses showed no difference between the two groups in terms of disease-free interval and overall survival. However, when compared with the double-negative phenotype, ER+/PgR–showed an association with better outcome but no such survival advantage was detected in case of ER–/PgR+ tumors. In the group of patients with ER+ tumors who received adjuvant hormonal therapy, absence of PgR (ER+/PgR–) was an independent predictor of development of recurrence and shorter survival and, hence, poorer response to hormonal therapy.

Conclusion

ER+/PgR–and ER–/PgR+ tumors are biologically and clinically distinct groups of breast cancer that may require different treatment strategies with ER–/PgR+ exhibiting more aggressive behavioral characteristics.