bluuebunny/crossref_metadata_2025 huggingface dataset:
Late‐onset warfarin necrosis
Authors: Scarff Catherine E , Baker Chris , Hill Prue , Foley Peter
Published: March 2003

A 43‐year‐old woman developed tenderness and induration of her thighs and lower abdomen, 56 days after commencing warfarin for aortic and mitral valve replacements. Investigations showed elevated inflammatory markers, mild renal impairment, normal echocardiogram and low protein C and S levels consistent with warfarin therapy. Three weeks later, purpuric areas evolved into large tender haemoserous bullae, which broke down to form ulcers. Histology confirmed the clinical impression of warfarin‐induced skin necrosis with dermal and subcutaneous venular thrombi. Despite cessation of warfarin and commencement of heparin, the lesions progressed. When the patient became febrile, blood cultures grew Pseudomonas aeruginosa, which was treated with intravenous imipenem and vancomycin. Wound swabs grew methycillin‐resistant Staphylococcus aureus and the antibiotics were changed. The patient developed septic shock and, despite intensive care management, her condition deteriorated and she died 9 weeks after the onset of the skin symptoms.
Allergic contact dermatitis following exposure to essential oils
Authors: Bleasel Narelle , Tate Bruce , Rademaker Marius
Published: March 2003

Allergic contact dermatitis from the topical use of essential oils is not widely recognized as an occupational hazard. Four cases of allergic contact dermatitis to essential oils occurring in three aromatherapists and one chemist with a particular interest in aromatherapy are described. All presented with predominantly hand dermatitis and demonstrated sensitization to multiple essential oils. One patient developed a recurrence of cutaneous symptoms following ingestion of lemongrass tea. Workers within this industry should be aware of the sensitization potential of these products and the risk of limiting their ability to continue employment.
Short‐term resolution of psoriasis after total thyroidectomy for euthyroid multinodular goitre
Authors: Kuchel Johanna , Barakate Michael , Delbridge Leigh , Agarwal Gaurav , Beattie John , Barnetson Ross
Published: March 2003

A 36‐year‐old Chinese female with an 8‐year history of chronic, generalized plaque psoriasis demonstrated a marked improvement of the disease after removal of an intercurrent euthyroid multinodular goitre. Thyroxine was commenced immediately postoperatively. No thyroid antibodies were detected and thyroid function and calcium levels remained within normal limits both pre‐ and postoperatively. Four weeks following surgery, narrow‐band ultraviolet B (nbUVB) therapy was recommenced for recurrent psoriasis. The manifestations of psoriasis at this stage were less severe than before thyroidectomy and responded well to treatment, whereas before surgery the response to therapy had been poor. One year following total thyroidectomy, the patient received very effective psoriasis control with nbUVB therapy. The possible role of surgery and thyroid hormones in altering the pathogenesis of psoriasis in the acute setting is clearly of interest and warrants further research consideration.
Thalidomide in dermatology
Authors: Wines Nina Y , Cooper Alan J , Wines Michael P
Published: March 2003

Thalidomide is an effective agent to treat over 25 seemingly unrelated dermatological conditions that have an inflammatory or autoimmune basis. The main side‐effects of teratogenesis and peripheral neuropathy limit its use. Currently, in Australia no assurance is given as to the quality, safety and efficacy of thalidomide. The use of thalidomide for toxic epidermal necrolysis can lead to an increase in mortality, and its use as a prophylactic agent for the prevention of chronic graft‐versus‐host disease following bone marrow transplantation has raised more speculations as to the safety of this notorious drug. A review of the therapeutic indications for thalidomide in dermatology as well as the mechanisms of action and side‐effects of this drug are presented. The current suggested guidelines for its use in clinical practice in Australia are discussed.
Atopic dermatitis: Review of immunopathogenesis and advances in immunosuppressive therapy
Authors: Meagher Linton J , Wines Nina Y , Cooper Alan J
Published: March 2003

This paper reviews the theories of the pathogenesis of atopic dermatitis (AD), with a particular emphasis on its immunopathogenesis. The contribution of predisposing factors, immunopathogenic factors and provoking factors in the pathogenesis of AD are considered. Predisposing factors explored in this article include genetics and the disturbance of skin function. Immunopathogenic factors reviewed include T cell dysfunction, biphasic cytokine expression and the role of immunoglobulin E. Provoking factors considered include microbial factors, psychosomatic interactions, contact allergens and irritants, inhalant allergens, food and climate. Immunosuppressive treatments reviewed include cyclosporin, azathioprine, methotrexate, tacrolimus, interferon‐γ, phosphodiesterase inhibitors and pimecrolimus (SDZ ASM 981).
Cost of psoriasis: A study on the morbidity and financial effects of having psoriasis in Australia
Authors: Jenner Nicole , Campbell Jan , Plunkett Anne , Marks Robin
Published: March 2003

Eighty‐three participants with psoriasis were followed over a 2‐year period assessing the severity, morbidity and cost of their disease over time. At recruitment, they were examined by a dermatologist who classified them on a global basis as mild (47%), moderate (35%) or severe (18%). A Psoriasis Area and Severity Index (PASI) score was also recorded at the initial interview. Participants completed questionnaires on the morbidity related to having psoriasis using the Psoriasis Disability Index (PDI) and a self‐administered PASI (SAPASI) score at the initial interview and at 3‐monthly intervals over the 2‐year period. During the 3‐monthly follow ups, patients also collected information on the cost of treatment. Using the PDI data, two‐thirds of the respondents said that, as a result of their psoriasis, they altered the way they carried out their normal daily activities; more than 50% wore different types or colours of clothing; more than 50% said their home was made more messy or untidy; and over a third had problems at the hairdresser or difficulties playing sport. The annual out‐of‐pocket expense for medical products was around AUD$250 per person, with costs ranging from zero to more than AUD$2000 per individual over the 2‐year period. Costs were highest for over‐the‐counter products purchased without a medical prescription. There were similar variations in the out‐of‐pocket expenses of medical consultations depending on the level of medical care required. The study revealed that the standard methods used for classification of severity of psoriasis, such as the PASI or SAPASI scores, do not take into account the treatment being used at the time the score is recorded and therefore may not accurately reflect the true severity.
Porphyria cutanea tarda in south‐east New South Wales
Authors: McCrossin Ian
Published: March 2003

Thirteen patients with porphyria cutanea tarda diagnosed between 1994 and 2000 were reviewed to evaluate the precipitating factors and associations of porphyria cutanea tarda in a regional area of coastal and rural NSW. The majority had more than one precipitating factor, with excess alcohol intake, mutations in the haemochromatosis gene, chronic hepatitis C infection and oestrogen therapy being the most common. Antibodies to the hepatitis C virus were detected in 25% and these patients presented at a younger age. Of the patients tested for the two known haemochromatosis gene mutations, six (46%) had at least one copy of the C282Y mutation. Two (15%) patients were homozygous for the C282Y mutation and two (15%) were compound heterozygous for the C282Y and H63D mutations. All patients responded to venesection, which is the treatment of choice for the majority of patients with porphyria cutanea tarda.
Birt–Hogg–Dubé syndrome and multinodular goitre
Authors: Drummond Catherine , Grigoris Irene , Dutta Bish
Published: March 2003

A 50‐year‐old woman presented with multiple skin‐coloured facial papules. There was a family history of similar lesions. Histology of one of these papules was consistent with fibrofolliculoma. Multiple fibrofolliculomas together with flexural acrochordons suggested the diagnosis of Birt–Hogg–Dubé syndrome. Investigations to exclude associated disease revealed changes consistent with multinodular goitre on thyroid ultrasound. The literature regarding the association of Birt–Hogg–Dubé syndrome with internal disease is reviewed.
Factors supporting sustainability of a community‐based scabies control program
Authors: Wong Li‐Chuen , Amega Beth , Barker Ruth , Connors Christine , Dulla Mary Elizabeth , Ninnal Angela , Cumaiyi Margaret Mary , Kolumboort Loyola , Currie Bart J
Published: March 2003

Scabies remains a major problem in Aboriginal communities within the Northern Territory of Australia. Secondary skin infection with Group A streptococcus (GAS) is very common and post‐streptococcal disease rates remain high. Treating families in isolation will have only limited success, as reinfection frequently occurs as a result of the high levels of movement between households and communities. We describe the results of a successful community intervention to reduce scabies and GAS skin infection in one of the largest Aboriginal communities in the Northern Territory, 15 months post‐intervention, and we discuss factors that have led to the success and sustainability of the program.
Benign familial pemphigus: Little benefit from superficial radiotherapy
Authors: Roos Daniel E , Reid Catherine M
Published: March 2003

Benign familial pemphigus (Hailey–Hailey disease) is a rare relapsing–remitting epidermal blistering disease palliated by a multitude of medical and surgical treatments. There are limited reports of benefit from low‐penetration X‐rays. We describe two resistant cases that appeared to respond initially to superficial radiotherapy, a 66‐year‐old man who had multiple courses to the groins (4 × 2.00 Gy/5 × 3.00 Gy) and to the axillae and low back (10 × 2.00 Gy) and a 53‐year‐old man treated twice to the groins and perineum (5 × 3.00 Gy/10 × 2.00 Gy). However, on longer follow up, benefit was found to be questionable. We conclude that while superficial radiotherapy may offer temporary relief, there is little evidence that it alters the natural history of this disease.
Solar keratoses: Analysis in a dermatological practice in Australia
Authors: Rosen Robert H , Studniberg Howard
Published: March 2003

Two hundred consecutive patients with solar keratoses (SK) seen in a private dermatology practice had on average 61.9 SK compared with eight reported in the general population. Non‐melanoma skin cancer was present in 41% of patients and 17% had squamous cell carcinoma (SCC). The ratio of basal cell carcinoma to SCC in the cohort was 1.7:1. The commonest site of SK was the upper limbs but the greatest density of lesions was on the face, particularly the nose. Squamous cell carcinomas were most commonly found on the upper and lower limbs. Basal cell carcinomas were most common on the head and neck.
Onychomycosis of toenails: Orthopaedic and podiatric considerations
Authors: Murray Stuart C , Dawber Rodney PR
Published: March 2003

Onychomycosis is common, affecting approximately 5% of the population, and is the most resistant form of superficial fungal infection. Dermatologists often view the nail apparatus in static terms and unfortunately give little consideration to the functional aspects of the digit. In the case of toenails, it is important to consider the toes and foot as a closely integrated functional unit. It is essential that in any case of onychomycosis or onychodystrophy that, as clinicians, we have an understanding of foot dynamics, of structure/function relationships and of the implications of orthopaedic/ podiatric factors when evaluating cases of nail dystrophy. When confronted with cases of possible onychomycosis, we must adopt a systematic and sometimes multidisciplinary approach in the evaluation and management of these patients to improve patient outcomes.
Methods of evaluating hair growth
Authors: Chamberlain Alexander J , Dawber Rodney PR
Published: March 2003

For decades, scientists and clinicians have examined methods of measuring scalp hair growth. With the development of drugs that stem or even reverse the miniaturization of androgenetic alopecia, there has been a greater need for reliable, economical and minimally invasive means of measuring hair growth and, specifically, response to therapy. We review the various methods of measurement described to date, their limitations and value to the clinician. In our opinion, the potential of computer‐assisted technology in this field is yet to be maximized and the currently available tools are less than ideal. The most valuable means of measurement at the present time are global photography and phototrichogram‐based techniques (with digital image analysis) such as the ‘TrichoScan’. Subjective scoring systems are also of value in the overall assessment of response to therapy and these are under‐utilized and merit further refinement.
Anogenital and buttock ulceration in infancy
Authors: Halbert Anne R , Chan Jonathan J
Published: March 2003

Rashes in the anogenital and buttock region are some of the commonest dermatological problems occurring in infancy. The most frequent causes seen in clinical practice are ulcerating haemangiomas, bullous impetigo and severe irritant contact dermatitis. Other causes include nutritional deficiencies, bullous diseases, trauma, Langerhans cell histiocytoses and inflammatory disorders such as pyoderma gangrenosum and Crohn’s disease. This review presents a brief overview of these causes and outlines the recommended management strategies.
Eosinophilic pustular folliculitis (Ofuji's disease) in Singapore: A review of 23 adult cases
Authors: Tang Mark BY , Tan Eileen , Chua Sze Hon
Published: March 2003

The case records of 23 patients with classic eosinophilic pustular folliculitis (EPF), or Ofuji's disease, seen at the National Skin Centre in Singapore, from 1990 to 2001 were reviewed. All patients had clinical and histopathological findings consistent with EPF. There were eight men and 15 women (ratio 1:1.6). The mean age at presentation was 35 years. There was a marked predilection for Chinese patients (87%), with a racial distribution of 20:2:1 of Chinese, Malay and Indian patients, respectively. The most frequent site of occurrence was the face, particularly over both cheeks. The majority of patients (90%) treated with oral indomethacin had a good response within 2–4 weeks. Relapses were frequent in 82.6% of patients and maintenance with indomethacin or ketoprofen was beneficial. Eosinophilic pustular folliculitis is a rare but important disease entity presenting with recurrent indurated erythematous papulopustules and plaques on the face. Increased awareness of this condition is important as it can mimic many other conditions presenting as red plaques on the face.
Birt–Hogg–Dubé syndrome
Authors: Godbolt Amanda M , Robertson Ivan M , Weedon David
Published: March 2003

We present three members of a Queensland family with clinical and histopathological features consistent with Birt–Hogg–Dubé syndrome. Two of the three family members were able to be screened for associated disorders. The mother of the family was found to have a solitary colonic polyp, a large ovarian cyst and two chorioretinal scars. No associated disorders were found on investigation of one of the two affected sons.
Androgenetic alopecia in a postmenopausal woman as a result of ovarian hyperthecosis
Authors: Kim Youngjin , Marjoniemi Veli‐Matti , Diamond Terry , Lim Adrian , Davis Greg , Murrell Dedee
Published: March 2003

A 65‐year‐old woman presented with an 8‐year history of progressive frontotemporal alopecia and hirsutism. She had elevated serum levels of testosterone, androstenedione and estradiol. Ultrasound and computed tomography imaging suggested a right ovarian mass, while bilateral ovarian venous sampling demonstrated increased testosterone levels originating from both ovarian veins. Histology obtained following bilateral oophorectomy demonstrated bilateral ovarian hyperthecosis. Six months after surgery, the patient remains well with no progression of the alopecia. Ovarian hyperthecosis is a rare cause of androgenetic alopecia in postmenopausal women. The role of hyperthecosis and its relationship to androgenetic alopecia is reviewed.
O'Brien's actinic granuloma in association with prolonged doxycycline phototoxicity
Authors: Lim Davin S , Triscott Joe
Published: March 2003

O'Brien's actinic granuloma is clinically characterized by annular papules and plaques on sun‐exposed areas of skin. These lesions often occur insidiously on a background of severe solar elastosis; however, an acute variant following sunburn has been reported in the literature. We present two cases of acute actinic granuloma precipitated by episodes of sunburn occurring on a background of prolonged doxycycline phototoxicity. Biopsies from both patients showed a histiocytic infiltrate with multinucleate giant cells engulfing elastotic material, with a reduction of elastin towards the centre of the papule. Marked resolution of the lesions was noted after 8 weeks of treatment with betamethasone dipropionate 0.05% ointment in optimized vehicle together with adequate photoprotection in the form of broad‐spectrum sunscreens.
Ulcerated juvenile xanthogranuloma of the scalp
Authors: Behne Karen , Casey Terrence
Published: March 2003

A 7‐month‐old girl presented with a single rapidly enlarging thickly crusted lesion on her frontal scalp. Histology was consistent with a juvenile xanthogranuloma (JXG) with ulceration and surface crust formation. Reports of ulcerating, crusted lesions of JXG are rare and the few reports have been confined to giant forms or those involving mucosal sites. This unusual presentation delayed diagnosis. Our report highlights the great variabilty in clinical presentation of JXG and is a reminder to consider this diagnosis in the differential of any lesion developing in an infant, particularly on the head, neck and upper trunk.
Epidemiology and pathogenesis of scleroderma
Authors: Chen Keng , See Adrian , Shumack Stephen
Published: March 2003

Scleroderma is a heterogenous connective tissue disorder characterized by fibrosis of the skin, with or without internal organ involvement. The aetiology of scleroderma may involve both environmental and genetic factors. Abnormalities involving the immune system, vascular tissue and extracellular matrix have been demonstrated. Recent research has focused on microchimerism as a risk factor for the development of scleroderma. This article reviews the epidemiology and pathogenesis of this disorder.
ROLE OF ABDOMINAL DRAINS IN PERFORATED DUODENAL ULCER PATIENTS: A PROSPECTIVE CONTROLLED STUDY
Authors: Pai D. , Sharma A. , Kanungo R. , Jagdish S. , Gupta A.
Published: March 2003

Background: Duodenal ulcer perforation is a common emergency in south India, with about 100–120 cases being treated at Jawaharalal Institute of Post Graduate Medical Education and Research each year. The routine to date has been to leave two tube drains: one in the Morrison’s pouch and one in the pelvis after omental patch closure. This study was conducted to test the efficacy and safety of drain usage routinely after duodenal ulcer perforation closure with Roscoe Graham omental patch technique.

Methods: In this prospective controlled study, 44 patients formed the test group (without drains) and 75 patients formed the control group (with abdominal drainage). Only patients of perforated duodenal ulcer closed with Roscoe Graham omental patch technique were included in the study. The incidence of postoperative fever, wound infection, time for return of bowel function and duration of hospital stay were noted. Details of drainage noted were the mean amount of daily drainage, mean time of drain removal and occurrence of drain‐related complications. Peritoneal fluid, wound discharges, drain tips and drain wounds were cultured. Abdominal ultrasound was performed in all patients in the second postoperative week or if earlier indicated to detect intra‐abdominal collections.

Results: It was found that there was no difference in incidence or duration of postoperative pyrexia, return of bowel function or postoperative hospital stay between the two groups. Routine use of drains was not effective in preventing postoperative fluid collection nor in decreasing the incidence of intra‐abdominal abscesses. The migration of bacteria from the exterior to the peritoneal cavity via the drain was also demonstrated. Drains were found to cause morbidity including intestinal obstruction.

Conclusion: The routine use of drains was found to be neither safe nor effective in patients of perforated duodenal ulcer treated by omental patch closure.
Consultative Committee on Road Traffic Fatalities: Trauma Audit Methodology
Authors: McDermott Francis T. , Cordner Stephen M. , Tremayne Ann B. ,   The Consultative Committee on Road Traffic Fatalities in Victoria
Published: March 2003

Background: Since 1992 the Consultative Committee on Road Traffic Fatalities in Victoria has identified deficiencies and errors in the management of 559 road traffic fatalities in which the patients were alive on arrival of ambulance services. The Committee also assessed the preventability of deaths. Reproducibility of results using its methodology has been shown to be statistically significant. The Committee’s findings and recommendations, the latter made in association with the learned Colleges and specialist Societies, led to the establishment of a Ministerial Taskforce on Trauma and Emergency Services. As a consequence, in 2000, a new trauma care system will be implemented in Victoria. This paper presents a case example demonstrating the Committee’s methodology.

Methods: The Committee has two 12 member multidisciplinary evaluative panels. A retrospective evaluation was made of the complete ambulance, hospital and autopsy records of eligible fatalities. The clinical and pathological findings were analysed using a comprehensive data proforma, a narrative summary and the complete records. Resulting multidisciplinary discussion problems were identified and the potential preventability of death was assessed.

Results: In the present case example the Committee identified 16 management deficiencies of which 11 were assessed as having contributed to the patient’s death; the death, however, was judged to be non‐preventable.

Conclusion: The presentation of this example demonstrating the Committee’s methodology may be of assistance to hospital medical staff undertaking their own major trauma audit.
Modern radiotherapy for modern surgeons: An update on radiation oncology
Authors: Kenny Lizbeth , Peters Lester , Rodger Alan , Barton Michael , Turner Sandra
Published: March 2003

Changes in the practice of radiation oncology have been significant over the last decade and continue to develop at an exciting rate. These advances range from our understanding of the increasingly important role of radiotherapy in the adjuvant and definitive settings to huge technological progress in the areas of tumour delineation, treatment planning, delivery and verification. In many cases, benefits have resulted from the ability of modern radiotherapy to deliver high doses with great accuracy and increasing safety in a highly individualized manner. This has impacted favourably on the management of all major malignancies as discussed in this paper. A good understanding of what can be achieved with modern radiotherapy has never been more important in ensuring an effective multidisciplinary approach to cancer management.
Residual pituitary enlargement in primary hypothyroidism despite 1 1/2 years of L‐thyroxine therapy
Authors: Goswami Ravinder , Tandon Nikhil , Sharma Raju , Kochupillai Narayana
Published: March 2003

Pituitary hyperplasia consequent to untreated primary hypothyroidism undergoes impressive regression following thyroxine therapy. We describe a young man with primary hypothyroidism and pituitary hyperplasia, who showed significant but incomplete regression of pituitary enlargement despite 18 months of L‐thyroxine therapy (1 year in replacement dose (150 μg/day) and an additional 6 months in suppressive dose (300 μg/day)).
Establishment and growth of seedlings of Eucalyptus obliqua: Interactive effects of litter, water, and pathogens
Authors: Facelli José M. , Williams Richard , Fricker Stephen , Ladd Brenton
Published: March 2003

We studied how leaf litter, water and fungal pathogens affect the establishment, survivorship, and growth of Eucalyptus obliqua using glasshouse and field experiments. In a glasshouse experiment, the presence of leaf litter of E. obliqua increased the establishment of seedlings when the seeds were placed beneath the litter, but dense litter layers reduced seedling emergence when seeds were placed on top. Results from a complementary experiment suggest that the effect of litter may be mediated by the high humidity microenvironment it creates, which may enhance imbibition of unburied seeds. In another glasshouse experiment, litter in combination with excessive water applications reduced seedling emergence and increased seedling mortality, but the addition of fungicide reverted these effects. Litter with lower water application or fungicide added increased seedling emergence. In all cases higher biomass in seedlings growing in litter treatments was associated with earlier emergence. In two recently burnt sites, the density of seedlings of E. obliqua was positively correlated to the presence of litter. Experimental addition of litter in the field reduced soil temperature during the summer, and together with watering, increased soil water content, and the water potential of established seedlings. However, neither treatment had any positive effect on their growth or survivorship. On the contrary, litter addition reduced the height and number of leaves, probably as a result of increased herbivory. We conclude that in Mediterranean‐type systems litter may produce various effects on seedling establishment depending on their developmental stage, and the season.
Associations between lycaenid butterflies and ants in Australia
Authors: Eastwood Rod , Fraser Ann M.
Published: March 2003

A comprehensive and critical review of all available literature on associations between Australian lycaenid butterflies and ants was undertaken to establish an accurate database of the partners involved. Collections and observations of lycaenids and ants were used to augment this review, resulting in a significant number of newly documented association (and non‐association) records. Twenty published records considered to be erroneous or doubtful are noted, with justifications given for their deletion from the association database. In total, 265 different associations between lycaenids and ants, plus 65 non‐attendance records are documented for Australia. Nearly 80% of the lycaenid species in Australia, for which the early stages are known, are recorded associating with ants and half of these are obligately ant‐associated. Patterns of association are examined from the perspective of both lycaenids and ants, with a focus on ant systematics and ecology. Lycaenids are recorded with five ant subfamilies, including the first record of an association with the Pseudomyrmecinae. The Dolichoderinae, and to some extent the Formicinae, have a disproportionately high percentage of genera that associate with lycaenid butterflies. All ant species that tend lycaenids spend at least some portion of their time foraging on vegetation to collect plant and insect nectar. There is a robust relationship between the competitive status of ants within a community, and their frequency and degree of association with lycaenids. Obligate ant‐association is accompanied by a high degree of specificity for ant partner, but two notable exceptions,Ogyris aenoneandO. amaryllisare discussed. Facultative myrmecophiles tend to associate with a broad range of ants, although interactions with ecologically dominant ants are less frequent than might be expected based on the abundance of dominant ant species in Australian communities.
Novel foods across the lifespan: From infant formula to impacton ageing
Authors: Ahmed Faruk
Published: March 2003

The purpose of the present paper was to examine the scopeof novel foods in improving and/or preventing the nutritionaldisorders in different stages of lifespan. First, attempts weremade to review the current trend and magnitude of the nutritionalproblems in each of the stages starting from fetal development toold age. The paper then describes the possible potential role ofnovel foods in alleviating and/or preventing these nutritional/health problems.The conclusion made is that the novel foods have a great potentialfor improving the overall nutritional status throughout the lifespan,thereby reducing the risk of early death or disability due to chronic diseases.However, to achieve a noticeable impact of novel foods on publichealth, efforts are needed to ensure that these foods are availableand affordable to the population most at risk.
Effect of dietary cholesterol, trans and saturated fatty acids on serum lipoproteins in non‐human primates
Authors: Idris Che Anishas Che , Sundram Kalyana
Published: March 2003

Nine cynomolgus monkeys were rotated randomly through four dietary treatments with each treatment lasting 6 weeks. A wash‐out period of 4 weeks was maintained between each dietary rotation. The animals were fed diets containing 32% energy fat derived from palm olein (POL), lauric‐myristic‐rich oil blend (LM), American Heart Association (AHA) rich oil blend and hydrogenated soybean oil blend (trans). Diets were fed with (phase 1) or without (phase 2) the addition of dietary cholesterol (0.1%). In phase 1, when animals were fed without dietary cholesterol, plasma total cholesterol (TC) and low‐density lipoprotein cholesterol (LDL‐C) was significantly raised and high‐density lipoprotein cholesterol (HDL‐C) was significantly depressed by the trans diets relative to all other dietary treatments. The resulting LDL‐C/HDL‐C ratio was also significantly increased. The LM diet increased TC significantly relative to the AHA diet while LDL‐C was significantly increased compared to both POL and AHA. Apolipoprotein (apo) B was not affected significantly by these dietary treatments. Apo A1 was significantly increased by POL relative to all other dietary treatments. The trans diet reduced apo A1 and the resulting apo B/A1 ratio was increased significantly by trans relative to all other dietary treatments. Addition of 0.1% dietary cholesterol to these diets almost doubled the plasma TC and LDL‐C in all dietary treatments. However, HDL‐C was only marginally higher with the addition of dietary cholesterol. The LM + C (cholesterol added) diet resulted in the highest TC and LDL‐C that was significant compared to all other dietary treatments. Trans + C increased TC compared to POL + C and AHA + C diets while increases in the LDL‐C did not attain significance. The addition of dietary cholesterol did not affect HDL‐C between treatments whereas plasma triglycerides were significantly increased by the trans + C diet relative to all other treatments. Both the trans + C and LM + C diets increased apo B and decreased apo A1 relative to the POL + C and AHA + C diets. The resulting apo B/A1 ratio was similarly altered. These results affirm that the lauric + myristic acid combination, along with trans fatty acids, increased lipoprotein‐associated coronary heart disease risk factors compared to either POL or AHA.
17β‐Estradiol epoxidation as the molecular basis for breast cancer initiation and prevention
Authors: Yu Fu‐Li
Published: March 2003

Epidemiological and animal studies have indicated that 17β‐estradiol (E2) is involved in breast cancer; however, the mechanism is unclear. We found that E2 could be activated by epoxidation, resulting in its ability to inhibit nuclear DNA‐dependent RNA synthesis, and to bind DNA, forming DNA adducts both in vitro and in vivo. Because epoxidation is required for the activation of many chemical carcinogens, including benzo(a)pyrene, 7,12‐dimethylbenz(a)anthracene and aflatoxins, we proposed previously that E2 epoxidation is the underlying mechanism for the initiation of breast cancer. The first part of this review is to present the experimental evidence obtained from this laboratory in support of this hypothesis. Based on these newly discovered insights on E2 epoxidation and its initiation role in breast cancer carcinogenesis, a method to screen chemopreventive agents against breast cancer has been developed. This constitutes the second part of the review. Two examples will be used to illustrate the utility of this screening technique. The effect of fat on breast cancer has been a longstanding but unresolved issue. Epidemiological studies provide conflicting results regarding the association of dietary fat and breast cancer. Because vegetable oils contain various amount of mono‐ and polyunsaturated fatty acids, they are potential antioxidants. Data are presented to show that commercial vegetable oils, independent of their mono‐ or polyunsaturated fatty acid content, are all able to prevent the formation of E2 epoxide, as measured by the loss of the ability of E2 to inhibit nuclear RNA synthesis in vitro. Tamoxifen (TAM), an anti‐estrogen used for breast cancer treatment, has recently been found to have a strong breast cancer preventive effect. The mechanism for this is unknown. Using the same screening technique, we found that when incubated together with E2 for epoxidation, TAM was able to prevent the formation of E2 epoxide, as evidenced by both the loss of the ability of E2 to inhibit nuclear RNA synthesis and the reduced binding of [3H]‐labelled E2 to nuclear DNA in a dose‐dependent manner. These experimental results suggest that the breast cancer preventive effect of TAM is to prevent the formation of E2 epoxide through a competitive epoxidation mechanism with E2.
Sociocultural aspects of the aged: A case study in Indonesia
Authors: Abikusno Nugroho
Published: March 2003

In the year 2020, the life expectancy in Indonesia will be 71.7 years and the proportion of older people will be between 10 and 11% or 30 million persons. Presently, older men are mostly married, while older women are mostly divorced. Older men are the heads of the household, while older women are spouses or parents in the household. Older women mostly do not have any formal education, while older men have primary and intermediate education. Older men are mostly literate, while older women are illiterate. Monthly income of older women is mostly below US$5, while that of older men is above US$10. The objective of the present study was to illustrate intracultural perception of older people in five ethnic groups in Indonesia: Batak, Java, Pendalungan (mixed Java and Madurese), Bali, and Buginese. The sociocultural and operation research technique was used in the study. A total of 300 informants participated in the study. They were divided into groups that consisted of 10 informants. The groups were differentiated based on family status, gender, and socioeconomic status. Semi‐structure group discussions (SSGD) were limited to 1−1.5 h of discussion using two study instruments: ethnography flow chart and theme guide matrix. Themes discussed in the SSGD were (i) cultural ideas of ageing; (2) the needs of older people; and (iii) intracultural perception of themes such as older person health, communication, and socioeconomics. Perspectives of cultural perception given by informants showed that their conceptualized opinions were based mainly on their sociocultural, socioeconomic and sociogeographical backgrounds.
Malnutrition and poverty alleviation in Vietnam during the last period 1985−2000
Authors: Hop Le Thi , Khan Nguyen Cong
Published: March 2003

During the 1980s and early 1990s, Vietnam was classified among the group of poor countries in the world, having a relatively high rate of poverty households. Compared to other developing countries, undernutrition among Vietnamese children is still a serious public health problem. On 16 September 1995 the Government of Vietnam ratified the National Plan of Action for Nutrition (NPAN) for the period 1995−2000. Poverty reduction is one of the basic social policies given special attention. In this regard, the Hunger Eradication and Poverty Reduction programme (HEPR) has been executed by Ministry of Labour, Invalid and Social Affairs since 1992 with special emphasis on supports for poor communes and poor households. The present paper will begin by looking at the trends of undernutrition and the achievements of poverty reduction in Vietnam over the past decades. For the past few years the HEPR has achieved great outcomes. Vietnam is evaluated by the international community as one of the countries with the best performance in poverty reduction. The gross domestic product per head in 2000 was 1.8‐fold against that in 1990. The percentage of hunger and poor households declined rapidly, from approximately 40% in 1985 to nearly 30% in the early 1990s, to 20% in 1995 and 11% in the year 2000. It has been shown that after 5 years of implementation of the NPAN1 (1995−2000), the nutritional status of people in Vietnam has considerably improved and important nutrition goals (including micronutrient deficiencies, food supply etc.) were achieved by the year 2000. It could be concluded that the HEPR and the NPAN in Vietnam during the last decade have been successfully implemented.
Micronutrient deficiency and its alleviation: The Philippine experience
Authors: Barba Corazon VC , Feliciano Emerita A
Published: March 2003

Results of the 1998 Fifth National Nutrition Survey (NNS) of the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI‐DOST) revealed that the country has persisting micronutrient deficiencies of vitamin A, iron and iodine along with protein−energy malnutrition (PEM) and an increasing number of cases of android obesity. An interplay of various physiological, socioeconomic and political factors performs a role in the nutrition situation of the country. The Medium‐Term Philippine Plan of Action for Nutrition (MTPPAN) is a product of multisectoral and multidisciplinary efforts for nutrition adequacy for all Filipinos. It gives priority attention to persisting and emerging nutritional problems through timely and focused strategies. Long‐term programmes to address food insecurity through food‐based interventions for alleviating PEM and micronutrient deficiencies will be strengthened. Thus, the successor MTPPAN 1999−2004 still implements similar programmes and strategies proven to be effective but they must be fully implemented with more vigor and aggressiveness. The FNRI, as the principal arm of the government as regards food and nutrition, not only conducts national nutrition surveys but also efforts in food fortification research and development as an integral component of the food fortification programme of the MTPPAN. This food‐based strategy aims to develop technologies for fortification of commonly consumed food items to increase nutrient availability and consequently increase nutrient intake of the Filipinos.
Genetic variation and dietary response: Nutrigenetics/nutrigenomics
Authors: Simopoulos Artemis P
Published: March 2003

Advances in molecular and recombinant DNA technology have led to exquisite studies in the field of genetics and the recognition in a much more specific way, through DNA sequencing, of how unique each one of us is, and the extent to which genetic variation occurs. The importance of the effects of genetic variation has been extensively studied and applied by pharmacologists in drug development and evaluation of drug metabolism and adverse reactions to drugs. In the past two decades, physicians, geneticists, and nutritionists have begun to study the effects of genetic variation and gene−nutrient interactions in the management of chronic diseases, such as coronary heart disease, hypertension, cancer, diabetes and obesity; and the role of nutrients in gene expression. A new era is being ushered in that may be called ‘nutrigenetics/nutrigenomics’. The new genetics has enormous implications for nutrition research both in the prevention and management of chronic diseases. Because families share both genes and environment (in this case, diet), similarity may result from either. Much research has been carried out to define the contribution of each and their interaction in the development of the individual. Knowledge of genetic susceptibility to disease will help identify those at higher risk for disease, as well as their response to diet. The prospect of targeting specific dietary treatment to those predicted to gain the most therapeutic benefit clearly has important clinical and economic consequences, particularly in diseases of high prevalence such as coronary artery disease, hypertension, osteoporosis, and possibly cancer. With the unfolding genomic and technological revolution, continuing investments in research offers unprecedented opportunities to understand disease processes, prevent intrinsic and environmental risks to health and develop new approaches to improve the quality of life worldwide. Furthermore, knowledge of genetic susceptibility to disease will help identify those at higher risk for disease, as well as their response to diet. As a result, there will be a need for the development of novel foods targeted to individuals, families and subgroups within populations. Although the emphasis of new genetics has been on pharmacogenetics, it is the responsibility of the nutrition scientists to expand in parallel the relationship of genetics and nutrition and establish nutrigenetics/nutrigenomics as a major discipline in nutrition in the 21st century.
Macronutrient innovations and their educational implications: Proteins, peptides and amino acids
Authors: Read Richard SD
Published: March 2003

Recent estimates of human requirement for indispensable amino acids have shown that the requirement for key amino acids such as lysine is twofold−threefold higher than previously thought. As a consequence recommended intakes for protein, particularly for vulnerable groups such as the elderly, need to be revised. Indispensable amino acids can also be used directly to improve amino acid supply in diets. A range of nitrogen compounds such as creatine and branched chain amino acids are currently used by groups such as athletes, although their efficacy is open to question. Peptides are natural components of the diet and some of these have been shown to have beneficial effects. The emergence of methods for genetic modification of food proteins raises possibilities of the development of novel foods for a variety of benefits including improved supply of indispensable amino acids, reduced allergenicity, or preformed antibodies to reduce risk of disease.
Micronutrient restoration and fortification: Communicating change, benefits and risks
Authors: Darnton‐Hill Ian , Bloem Martin W , De Benoist Bruno , Brown Lynn R
Published: March 2003

Food fortification has played a significant role in the current nutritional health and well‐being of populations in industrialized countries for over 70 years. A relative lack of a concentrated food processing chain, less developed commercial markets, and relatively low consumer awareness and demand have hindered the same application of the intervention in the transitional, and even more, in the least developed countries until quite recently. The present paper reviews fortification of foods with micronutrients in advantaged (industrialized), transitional (developing) and least developed countries briefly, including reference to bio‐fortification, examining some of the public health issues involved. There are different needs and challenges in getting this technology accepted and making it sustainable. Primary constraints in reaching poor target populations are adequate availability, accessibility, and quality assurance/quality control. The paper then examines some issues of risk and benefit and the communication of these, and finally looks towards the future and draws some conclusions. Despite these issues there has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Along with dietary diversification, supplementation and related public health and private sector interventions, this has resulted in considerable progress in reducing the prevalence of vitamin A and iodine deficiencies, but much less so with iron, even as zinc and folic acid deficiencies have emerged as significant public health problems. Food fortification based on sound principles and supported by clear policies and regulations will play an increasingly large role in the progress towards the prevention and control of micronutrient malnutrition. Success and sustainability require clear communication of the small risks involved and the substantial benefits, particularly to populations with significant levels of micronutrient malnutrition, as a complementary approach with other public health measures, in reducing the prevalence of deficiencies and their health consequences.
Nutrition communication: Do we need a new outlook?
Authors: Worsley Anthony
Published: March 2003

The present paper will discuss the nature of nutrition communication and knowledge in relation to novel foods. The paper starts with an introduction to trends in present‐day society, then focuses on the concepts of knowledge and information in relation to human needs and motivation. Next, the relevance of food and nutrition communication to consumer lifestyles is discussed. This is followed by consideration of consumer issues related to novel foods. The key conclusions are that nutrition communication is a minor part of most consumers’ lifestyles and that the promotion of novel foods must be based on the dissemination of sound nutrition principles throughout the various values and lifestyles segments of the population.
Consequences of childhood and adolescent obesity
Authors: Loke Kah Yin
Published: March 2003

Obesity, increasingly recognized as a chronic disease, is associated with physical, psychosocial and economic consequences to society. With the burgeoning global epidemic, health care workers must rally together to understand, treat and prevent obesity and its complications.
Behavioural determinants of the obesity epidemic
Authors: Crawford David , Ball Kylie
Published: March 2003

Obesity is a serious and growing public health problem affecting developed and developing countries. It is generally agreed that the causes of the current obesity epidemic are not genetic in origin, but are the result of changes in the environments in which we live. While acknowledging the importance of environmental factors, the central role of behaviour in the obesity epidemic cannot be ignored. It is our eating, physical activity and sedentary behaviours that form the interface between our biology and the environments to which we are exposed. However, a lack of understanding of the specific behaviours that are important in the aetiology of obesity poses a major constraint to preventing obesity. A better understanding of the behaviours that contribute to weight gain and obesity is critical in order to plan and implement effective obesity prevention initiatives. Theory‐driven investigations of eating, physical activity and sedentary behaviours, their determinants, and their role in weight gain and obesity among different population groups are urgent research priorities. Without an understanding of the key behaviours that contribute to weight gain, and the influences on these behaviours, it will remain difficult to identify where to intervene in the environment and be confident that action will prevent obesity.