bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in Aneurysm and Patient Characteristics Between Cohorts of Finnish and Dutch Patients With Subarachnoid Hemorrhage
Authors: van Munster Caspar E.P. , von und zu Fraunberg Mikael , Rinkel Gabriel J.E. , Rinne Jaako , Koivisto Timo , Ronkainen Antti
Published: October 2008

Background and Purpose—

The high incidence of aneurysmal subarachnoid hemorrhage (aSAH) in Finland may be related to genetic or environmental factors, which may also influence patient and aneurysm characteristics. We compared these characteristics in 2 cohorts in Finland (Kuopio) and the Netherlands (Utrecht).

Methods—

For aSAH patients in Kuopio (n=1786) and Utrecht (n=1788), we compared sex, age at onset, and the sites and number of aneurysms from 1986 to 2005. Five-year time trends were assessed with χ
2
tests (sex distribution and the sites and number of aneurysms) and with 1-way ANOVA (age).

Results—

The proportion of men in Kuopio (46.1%; 95% CI, 43.8% to 48.4%) was higher than in Utrecht (33.6%, 95% CI, 31.4% to 35.8%) and declined in Kuopio from 50.9% (95% CI, 46.3% to 55.5%) in 1986–1990 to 42.8% (95% CI, 38.0% to 47.6%) in 2001–2005. Mean±SD age at onset was 52.4±13.3 years in Kuopio and 53.3±14.3 years in Utrecht. Both increased similarly over time. The most common aneurysm site in the Kuopio cohort was the middle cerebral artery (33.1%; 95% CI, 30.9% to 35.3%) and in the Utrecht cohort was the anterior communicating artery (38.0%; 95% CI, 35.5% to 40.5%). Multiple aneurysms were more frequent in Kuopio (27.8%; 95% CI, 25.1% to 29.2%) than in Utrecht (14.8%; 95% CI, 13.0% to 16.6%). Sites and proportions of multiple aneurysms did not change during 1986–2005.

Conclusions—

The cohorts of aSAH patients differed with respect to age at onset and the number and sites of aneurysms. The decline in the proportion of men in Kuopio coincided with increased smoking and alcohol use in women and decreased smoking in men. The differences in aneurysm characteristics remained stable, which suggests that these factors are less influenced by environmental factors.
Do Female and Male Employees in Iran Experience Similar Work–Family Interference, Job, and Life Satisfaction?
Authors: Karimi Leila
Published: October 2008

This study aims at examining gender differences in the experience of work–family interference and perceived job–life satisfaction in a group of Iranian employees. The participants in the study consist of 387 Iranian male and female employees from a variety of organizations. The results of t tests and multiple regression analysis using EQS 6.1 support the hypothesis that Iranian male and female employees experience similar interference in their work–family domains although they spend different numbers of hours in the workplace. The findings also show that whereas work-to-family interference has significant and negative effects on job–life satisfaction among male employees, for female employees, working hours and family-to-work interference had even more significant and negative effects on their job–ife satisfaction. Implications are discussed and recommendations made regarding future research and interventions in this area.
Professionals delivering palliative care to people with COPD: qualitative study
Authors: Spence A , Hasson F , Waldron M , Kernohan WG , McLaughlin D , Watson B , Cochrane B , Marley AM
Published: October 2008

This article describes health and social care professionals’ perceptions of palliative care and facilitators and barriers to the delivery of such care for patients with advanced chronic obstructive pulmonary disease. Health professionals participated in semi structured interviews and focus groups which were analysed using content analysis. According to participants, care of patients with chronic obstructive pulmonary disease is focused upon the management of symptoms, with emphasis focused predominately on an acute model of care. Key barriers towards the delivery of palliative care included the reluctance to negotiatie end-of-life decisions and a perceived lack of understanding among patients and carers regarding the illness trajectory. Consequently the delivery of palliative care was viewed as a specialist role rather than an integral component of care. There is a need for education and training for health and social care professions to plan and provide high quality end-of-life care.
Intercultural Communication and New Forms of Citizenship
Authors: Elhajji Mohammed
Published: October 2008

This paper presents some thoughts focusing on the problems of ethnico-cultural communalism, its meaning in the current global socio-political context and its implications with regard to principles of democracy, citizenship and the nation-state. It gives particular attention to the issues of interculturality and intercultural communication (IC) as central markers in the contemporary socio-political landscape. The author claims that IC (particularly in its communal and ethnic forms) may prevent or resolve the communal separation that threatens many groups throughout the world. Apart from the essential role it has in production, reproduction and circulation of meaning within, as well as outside, the group, the discourse developed by communal communication media is an ideological, reflexive construction whose aim it is to create an impact on the social cognition of its receivers. This is why ethnicocultural groups scattered around the world generally have effective communal media that reinforce their social, cultural and political cohesion at local, national and global levels. Because, as well as expressing their positions and views on the issues facing a nation's society, this formal discourse provides group members with a legitimate and coherent framework for action and argument.
African Cultural Diversity in the Media
Authors: Bidima Jean-Godefroy
Published: October 2008

With the disenchantment with independence in Africa, economic failure, the crimes of the elites from the independence years, the paralysis of symbolism, and finally the states' loss of dynamism, the 1990s ushered in a so-called phase of democratization. This was about rethinking citizenship and the relationship to politics. This democratization was a response to the notion of diversity. This paper claims that the answer to this diversity issue fell far short of expectations and proceeds different examples taken from social, cultural and political life, including the struggle for recognition and the appearance of terrorist violence in sub-Saharan Africa. Multiparty systems designed to respond to the diversity question produced only many versions of the same by ignoring that true diversity is the encroachment on the same of the strange, the different and the unexpected.
Democracy and Recognition: Building Research Partnerships
Authors: Therrien Michèle
Published: October 2008

This paper illustrates the demand for recognition by peoples through an analysis of the partnerships between researchers and Inuit communities in Canada and Alaska. One of the great questions concerns work in the field, namely to identify the most appropriate forms of interaction between researcher and informant, to recognize the multiplicity of indigenous voices, to avoid inappropriate generalizations, and to approach generational disparity.
Factor Structure of the DIAL-3
Authors: Assel Mike A. , Anthony Jason L.
Published: October 2008

Using data from the standardization sample of the Developmental Indicators for the Assessment of Learning—Third Edition (DIAL-3), this study compared the usefulness of an empirically derived factor structure introduced by Anthony, Assel, and Williams with the author's theoretical conceptualization. Confirmatory factor analyses (CFAs) were conducted on three age groups of children (i.e., 831 3- and 4-year-olds, 729 5- and 6-year-olds, and 1,560 3- to 6-year-olds). Both models explained the younger group of children's performances reasonably well (e.g., Comparative Fit Indices [CFIs] = .93) and yielded equivalent standardized fits. The two models explained the older children's performances reasonably well (e.g., CFIs = .93), and their fits were also equivalent. Finally, the two models characterized performances of the standardization sample quite well (e.g., CFIs = .96), and their fits were also equivalent. Results are discussed in terms of how assessments are standardized and validated and how this is relevant for clinicians and consumers.
Amphiphilic Scorpion-like Macromolecules as Micellar Nanocarriers
Authors: Djordjevic Jelena , Del Rosario Leilani S. , Jinzhong Wang  , Uhrich Kathryn E.
Published: October 2008

Amphiphilic scorpion-like macromolecules (AScMs), that self-assemble as nanocarriers, were evaluated for intracellular delivery. To qualitatively examine the intracellular fate of AScMs in human umbilical vein endothelial cells (HUVECs), representative polymers (M12P5) were labeled with a fluorescent dye, fluorescein isothiocyanate (FITC). The FITC-labeled M12P5 micelles were prepared by mixing a low concentration of FITC-labeled M12P5 polymer (10wt%) with unlabeled M12P5 polymer (90wt%). Optical sectioning by confocal laser scanning microscopy of HUVECs incubated with FITC-labeled polymer micelles revealed that the polymers were localized in subcellular components within 60 min. Transmission electron microscopy was used to highlight the rapid accumulation of a polymer-encapsulated agent in the nucleus by 60 min. This study demonstrated that the M12P5 polymers were internalized into HUVECs. Based on these data, the polymeric nanocarriers are potential candidates for intracytoplasmic and nuclear delivery of drugs, proteins and/or genes.
Ecological Citizenship and the Corporation
Authors: Crane Andrew , Matten Dirk , Moon Jeremy
Published: October 2008

This article introduces the concept of ecological citizenship to management theory and in particular to ways of understanding the roles and responsibilities of the corporation. It begins by establishing the case for incorporating citizenship thinking into the literature on organizations and the environment and specifically for developing a greater political orientation to new corporate environmentalism. It goes on to identify the nature of the ecological citizenship concept and the three different understandings that are prevalent in the literature. Applying these perspectives to corporations, it then establishes how ecological citizenship can help us to examine corporate responsibilities for exporting liberal citizenship, rethink the stakeholder set, and reconfigure the community of the corporation.
Structural prerequisites for principals' and teachers' communication about teaching and learning issues
Authors: Ärlestig Helene
Published: October 2008

The common view of a successful school includes a visible principal who communicates frequently about the school's pedagogical tasks, teaching and learning. In this article, a study about principals' communication with their teachers is presented. Twenty-four Swedish secondary schools are divided into four groups depending on how they meet academic and social objectives. Questionnaires about teachers' and principals' views on the structural aspects of the communication process and regarding teaching and learning issues were analysed. Principals in the successful schools used communication in a more multidimensional way and communicated more often about issues related to pedagogical tasks. However, principals in all schools conducted few classroom visits and rarely gave teachers feedback. Even though all principals attended many meetings, the organizational structures did not support communication about teaching and learning issues and student outcomes, which indicates a widespread weakness in pedagogical leadership.
Community connection and change: a different conceptualization of school leadership
Authors: Lewis Marian
Published: October 2008

Many of our schools are situated in communities characterized by high levels of disadvantage, presenting a range of challenges. One possible response is to acknowledge this disadvantage and to try to address some of the problems it raises for students. Another is for the school to be proactive, recognizing the challenges faced by the community and taking a lead in bringing about change. Part of a larger research project, this article explores the extraordinary leadership role of Prospect Road State School (a pseudonym) in bringing change to a multiply disadvantaged community though collaborative action with other agencies and creative approaches to bringing people together. This school's experiences and achievement illustrate what may be possible when school leadership proactively sets out to improve a community described by the principal as being `in crisis'. The experiences explored indicate ways of rethinking the relationship between school and disadvantaged community — of working synergistically with others to make a significant difference.
Social capital in wonderland
Authors: Fine Ben
Published: October 2008

Whilst, from their internally privileged position, the World Bank's social capitalists have defended their use and heavy promotion of social capital within the Bank as a strategy for civilizing the Bank's economists, this is shown to have been both a flawed strategy and one that misreads both the internal dynamic of the Bank and its external influence.
Transformational Leadership, Team Goal Fulfillment, and Follower Work Satisfaction
Authors: Wolfram Hans-Joachim , Mohr Gisela
Published: October 2008

The impact of deep-level similarity between managers ( N1 = 117) and followers ( N2 = 403) on the interrelations between transformational leadership and outcomes was analyzed. The authors accounted for similarity in subjective meaning of work, occupational self-efficacy, and emotional irritation. Unexpectedly, the authors found a negative interrelation between transformational leadership and team goal fulfillment when followers scored higher than their managers on subjective meaning of work and when followers were more emotionally irritated than their managers. Thus, to increase transformational leadership's positive effects, managers should show appreciation of work values, and their followers' level of exhaustion should be kept to a minimum.
News Coverage of 9/11 and the Demise of the Media Flows, Globalization and Localization Hypotheses
Authors: Archetti Cristina
Published: October 2008

An international comparative study of the elite press framing of 9/11 in the US, Italy, France and Pakistan reveals that there is little empirical backing for the claims of three core strands of research about news exchanges within the field of international communications. The findings of the empirical investigation neither support the existence of international news flows, nor the idea that news is becoming homogenized on a global scale. The analysis does not suggest a localization of news at a national level either. News coverage, instead, appears to be markedly different at the level of the single newspaper and this can be explained through different variables than the international macro-processes addressed by news studies within the field. The analysis fundamentally suggests that, if research within international communications wants to explain news in the information age, it needs to broaden its horizons and to adopt a multidisciplinary perspective that includes both the analysis of national political processes and a deeper understanding of the dynamics of news production in each single media organization.
A Comparison of the Use of Distal Radius Vascularised Bone Graft and Non-Vascularised Iliac Crest Bone Graft in the Treatment of Non-Union of Scaphoid Fractures
Authors: BRAGA-SILVA J. , PERUCHI F. M. , MOSCHEN G. M. , GEHLEN D. , PADOIN A. V.
Published: October 2008

We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1–5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.
Extra-Osseous Ewing’s Sarcoma of the Thumb
Authors: BISWAS G. , PARASHAR A. , GHOSH S. , KAKKAR N.
Published: October 2008

The hand is an uncommon location for Ewing’s tumour of the bone. This paper details the presentation, pathology and management of an extra-osseous Ewing’s sarcoma of the thumb in an adult woman. The management entailed a combination of neo-adjuvant chemotherapy and surgical excision, followed by reconstruction with an interposition bone graft from the subcutaneous surface of the ulna.
Preliminary Soft Tissue Distraction Using External Fixator in Radial Club Hand
Authors: KANOJIA R. K. , SHARMA N. , KAPOOR S. K.
Published: October 2008

Preliminary soft tissue distraction using an external fixator before centralisation and tendon transfer of the flexor and extensor carpi ulnaris to the little finger metacarpal was used to treat Bayne’s type III and IV deformities in 18 hands of 14 patients with radial club hands. Treatment with external fixator was started at a mean age of 8 (range 3–30) months. In 16 of 18 hands, the surgical treatment was completed before 10 months of age. Adequate soft tissue stretching was achieved before centralisation using fractional distraction with the external fixator in the majority of hands. After an average follow-up period of 31 months, there were seven good, eight satisfactory and one unsatisfactory result.
Effect of silver on precipitation response of Al–Li–Cu–Mg alloys
Authors: Khan A. K. , Robinson J. S.
Published: October 2008

The precipitation response of silver bearing and silver free Al–Li–Cu–Mg alloys has been monitored using hardness and electrical conductivity measurements. The silver bearing alloy displayed enhanced age hardening with an anomalous decrease in conductivity. Transmission electron microscopy was used to investigate the evolution of microstructure in these alloys. The presence of small amounts of silver promoted the formation of GP zones and Al2Cu ( θ′) precipitates, and greatly enhanced the precipitation of T1. The anomalous decrease in conductivity was associated with the precipitation of T1 phase. The initial age hardening in silver bearing alloy was due to δ′, GP zones and θ′. Precipitation of T1, δ′ and small amounts of θ′ and S′ were responsible during the later stages of aging. Precipitation of θ′ was not observed in the silver free alloy. In the overaged condition, dissolution of δ′ was more prominent in the silver free alloy.
Pulmonary hypertension in COPD
Authors: Chaouat A. , Naeije R. , Weitzenblum E.
Published: October 2008

Mild-to-moderate pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD); such a complication is associated with increased risks of exacerbation and decreased survival. Pulmonary hypertension usually worsens during exercise, sleep and exacerbation. Pulmonary vascular remodelling in COPD is the main cause of increase in pulmonary artery pressure and is thought to result from the combined effects of hypoxia, inflammation and loss of capillaries in severe emphysema.

A small proportion of COPD patients may present with “out-of-proportion” pulmonary hypertension, defined by a mean pulmonary artery pressure >35–40 mmHg (normal is no more than 20 mmHg) and a relatively preserved lung function (with low to normal arterial carbon dioxide tension) that cannot explain prominent dyspnoea and fatigue. The prevalence of out-of-proportion pulmonary hypertension in COPD is estimated to be very close to the prevalence of idiopathic pulmonary arterial hypertension.

Cor pulmonale, defined as right ventricular hypertrophy and dilatation secondary to pulmonary hypertension caused by respiratory disorders, is common. More studies are needed to define the contribution of cor pulmonale to decreased exercise capacity in COPD. These studies should include improved imaging techniques and biomarkers, such as the B-type natriuretic peptide and exercise testing protocols with gas exchange measurements.

The effects of drugs used in pulmonary arterial hypertension should be tested in chronic obstructive pulmonary disease patients with severe pulmonary hypertension. In the meantime, the treatment of cor pulmonale in chronic obstructive pulmonary disease continues to rest on supplemental oxygen and a variety of measures aimed at the relief of airway obstruction.
Carotid body oxygen sensing
Authors: López-Barneo J. , Ortega-Sáenz P. , Pardal R. , Pascual A. , Piruat J. I.
Published: October 2008

The carotid body (CB) is a neural crest-derived organ whose major function is to sense changes in arterial oxygen tension to elicit hyperventilation in hypoxia. The CB is composed of clusters of neuron-like glomus, or type-I, cells enveloped by glia-like sustentacular, or type-II, cells. Responsiveness of CB to acute hypoxia relies on the inhibition of O2-sensitive K+channels in glomus cells, which leads to cell depolarisation, Ca2+entry and release of transmitters that activate afferent nerve fibres. Although this model of O2sensing is generally accepted, the molecular mechanisms underlying K+channel modulation by O2tension are unknown. Among the putative hypoxia-sensing mechanisms there are: the production of oxygen radicals, either in mitochondria or reduced nicotinamide adenine dinucleotide phosphate oxidases; metabolic mitochondrial inhibition and decrease of intracellular ATP; disruption of the prolylhydroxylase/hypoxia inducible factor pathway; or decrease of carbon monoxide production by haemoxygenase-2. In chronic hypoxia, the CB grows with increasing glomus cell number. The current authors have identified, in the CB, neural stem cells, which can differentiate into glomus cells. Cell fate experiments suggest that the CB progenitors are the glia-like sustentacular cells. The CB appears to be involved in the pathophysiology of several prevalent human diseases.
Desmosine as a biomarker of elastin degradation in COPD: current status and future directions
Authors: Luisetti M. , Ma S. , Iadarola P. , Stone P. J. , Viglio S. , Casado B. , Lin Y. Y. , Snider G. L. , Turino G. M.
Published: October 2008

Desmosine (DES) and isodesmosine (IDES) are two unusual, tetrafunctional, pyridinium ring-containing amino acids involved in elastin cross-linking. Being amino acids unique to mature, cross-linked elastin, they are useful for discriminating peptides derived from elastin breakdown from precursor elastin peptides. According to these features, DES and IDES have been extensively discussed as potentially attractive indicators of elevated lung elastic fibre turnover and markers of the effectiveness of agents with the potential to reduce elastin breakdown. In the present manuscript, immunology-based and separation methods for the evaluation of DES and IDES are discussed, along with studies reporting increased levels of urine excretion in chronic obstructive pulmonary disease (COPD) patients with and without α1-antitrypsin deficiency. The results of the application of DES and IDES as surrogate end-points in early clinical trials in COPD are also reported. Finally, recent advances in detection techniques, including liquid chromatography tandem mass spectrometry and high-performance capillary electrophoresis with laser-induced fluorescence, are discussed. These techniques allow detection of DES and IDES at very low concentration in body fluids other than urine, such as plasma or sputum, and will help the understanding of whether DES and IDES are potentially useful in monitoring therapeutic intervention in COPD.
Pediatric campylobacteriosis in northern Taiwan from 2003 to 2005
Authors: Yang Ji-Rong , Wu Ho-Sheng , Chiang Chuen-Sheue , Mu Jung-Jung
Published: October 2008

Background

There has been a marked increase in the incidence of, and concern regarding, humanCampylobacter jejuniandC. coliinfections worldwide during the last decade. As the highest infectious disease control apparatus in Taiwan, we aimed to describe the character ofCampylobacterisolates from infected children, as well as basic information about the patients, from December 2003 to February 2005.

Methods

A total of 894 fecal specimens were collected by several clinics and hospitals from children who had diarrhea, followed by plating onto selective media. Drug susceptibility test of the isolates from these specimens were conducted by disc diffusion method and their serotypes were also studied using commercial antisera made in Japan.

Results

The isolation rate ofCampylobacterduring these 15 months was 6.8% and was higher in winter (11.1%) than in other seasons.C. jejuniwas the most prevalent (95.1%) species in northern Taiwan, comparable to other developed countries. Among the 61Campylobacterisolates, most were resistant to tetracycline (93.4%), nalidixic acid (91.8%), ciprofloxacin (90.2%), and ampicillin (85.5%). Erythromycin-resistant isolates represented 3.3% of all isolates, suggesting that this drug may be the first choice for treatment. The serotypes of the 61 isolates were demonstrated and only 41.4% were typable.

Conclusion

In this study, the Taiwan CDC provided an epidemiological analysis ofCampylobacterinfection, including the isolation rate, age, seasonal distribution, antimicrobial drug susceptibility patterns, and serotypes of the isolates from pediatric patients in northern Taiwan from 2003 to 2005.
The effect of a single blood meal on the phenotypic expression of insecticide resistance in the major malaria vector Anopheles funestus
Authors: Spillings Belinda L , Coetzee Maureen , Koekemoer Lizette L , Brooke Basil D
Published: October 2008

Background

Anopheles funestus is a major malaria vector in southern Africa. Vector control relies on the use of insecticide chemicals to significantly reduce the number of malaria vectors by targeting that portion of the female population that takes blood meals and subsequently rests indoors. It has been suggested that the intake of a blood meal may assist female mosquitoes to tolerate higher doses of insecticide through vigour tolerance. It is hypothesized that during the process of blood digestion, detoxification mechanisms required for the neutralizing of harmful components in the blood meal may also confer an increased ability to tolerate insecticide intoxication through increased enzyme regulation.

Methods

Bottle bioassays using a range of concentrations of the pyrethroid insecticide permethrin were performed on pyrethroid susceptible and resistant laboratory strains of An. funestus in order to detect differences in insecticide susceptibility following a single blood meal. Based on these results, a discriminating dosage was identified (double the lowest dosage that resulted in 100% mortality of the susceptible strain). Blood-fed and unfed females drawn from the resistant strain of An. funestus were then assayed against this discriminating dose, and the percentage mortality for each sample was scored and compared.

Results

In the insecticide dose response assays neither the fully susceptible nor the resistant strain of An. funestus showed any significant difference in insecticide susceptibility following a blood meal, regardless of the stage of blood meal digestion. A significant increase in the level of resistance was however detected in the resistant An. funestus strain following a single blood meal, based on exposure to a discriminating dose of permethrin.

Conclusion

The fully susceptible An. funestus strain did not show any significant alteration in susceptibility to insecticide following a blood meal suggesting that vigour tolerance through increased body mass (and increased dilution of internalized insecticide) does not play a significant role in tolerance to insecticide intoxication. The increase in insecticide tolerance in the pyrethroid resistant strain of An. funestus following a blood meal suggests that insecticide detoxification mechanisms involved in insecticide resistance are stimulated by the presence of a blood meal prior to insecticide exposure, leading to enhanced expression of the resistance phenotype. This finding may be significant in terms of the methods used to control indoor resting populations of An. funestus if the mass killing effect of insecticide application proves increasingly inadequate against blood-feeding females already carrying the insecticide resistance phenotype.
Cannabis use by people with severe mental illness – is it important?
Authors: Atakan Zerrin
Published: October 2008

Cannabis use is more common among people with severe mental illness than in the general population. It has detrimental effects on the course of the illness, physical health and social life of users, as well as being a financial burden on health services. It is important to understand why some people with severe mental illness continue to use cannabis, despite experiencing its effects on their condition. This article reviews research on the scale of cannabis use by such patients, the effects on the course of their illness, possible reasons to explain why they use it, and how they can be assessed in clinical settings, as well as providing some assessment tools to measure various characteristics related to cannabis use.
Brief alcohol interventions – everybody's business
Authors: Boland Billy , Drummond Colin , Kaner Eileen
Published: October 2008

Heavy drinking poses a significant risk to public health in the UK. Opportunistic screening and brief interventions offer a cost-effective method of reducing the harm related to excessive alcohol consumption at both an individual and a public health level. Given the high prevalence of alcohol misuse among patients attending mental health services and its impact on behaviour and health, professionals need to be skilled in identifying and treating these problems in all areas of mental health. There is also a need for effective joint working between mental health and specialist addiction services. This article describes the principles and evidence base for brief alcohol interventions, and methods of implementation in health settings.
Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study
Authors: Bowers Len , Whittington Richard , Nolan Peter , Parkin David , Curtis Sarah , Bhui Kamaldeep , Hackney Diane , Allan Teresa , Simpson Alan
Published: October 2008

Background

Special observation (the allocation of nurses to watch over nominated patients) is one means by which psychiatric services endeavour to keep in-patients safe from harm. The practice is both contentious and of unknown efficacy.

Aims

To assess the relationship between special observation and self-harm rates, by ward, while controlling for potential confounding variables.

Method

A multivariate cross-sectional study collecting data on self-harm, special observation, other conflict and containment, physical environment, patient and staff factors for a 6-month period on 136 acute-admission psychiatric wards.

Results

Constant special observation was not associated with self-harm rates, but intermittent observation was associated with reduced self-harm, as were levels of qualified nursing staff and more intense programmes of patient activities.

Conclusions

Certain features of nursing deployment and activity may serve to protect patients. The efficacy of constant special observation remains open to question.
Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder
Authors: Montgomery Stuart , Chatamra Krai , Pauer Lynne , Whalen Ed , Baldinetti Francesca
Published: October 2008

Background

Pregabalin is a novel compound that has been shown to have efficacy in the treatment of generalised anxiety disorder and is licensed for the treatment of the disorder in the European Union.

Aims

The current study was designed to evaluate the safety and efficacy of pregabalin, an α2δ-ligand, in the treatment of generalised anxiety disorder in people 65 years and older.

Method

This was a double-blind, randomised (2:1), placebo-controlled, 8-week trial of pregabalin, in flexible doses of 150–600 mg/day, in the treatment of DSM–IV generalised anxiety disorder with a baseline Hamilton Rating Scale for Anxiety (HRSA) total score ⩾20. The primary outcome was end-point (week 8 or last visit, with last observation carried forward (LOCF)) change in HRSA total score.

Results

A total of 273 patients (women, 78%; mean age, 72 years (s.d.=6); mean baseline HRSA total score, 26 (s.d.=4.6)) were randomised and received study treatment. On the primary intent-to-treat LOCF analysis, pregabalin was associated with a 2-point greater reduction in HRSA total score than placebo (12.87 v. 10.7; P<0.05). In a post hoc repeated measures mixed-effect model analysis, pregabalin was associated with significantly greater improvement than placebo in the HRSA total score from week 2 (–9.8 (s.d.=0.6) v. −7.2 (s.d.=0.8); P=0.0052) through week 8 (–14.4 (s.d.=0.6) v. −11.6 (s.d.=0.8); P=0.0070). Significant improvement was observed in the pregabalin group on both the HRSA psychic and somatic anxiety factors. There was a significantly greater decrease from baseline in mean Hamilton Rating Scale for Depression (HRSD) score with pregabalin compared with placebo (–5.48 (s.d.=0.46) v. −4.02 (s.d.=0.59); P=0.041). Pregabalin was well-tolerated, with almost all adverse events in the mild-to-moderate range, and self-limiting (median duration of 4–16 days). Discontinuations due to adverse events were similar for pregabalin (10.7%) and placebo (9.4%).

Conclusions

Pregabalin, in doses of 150–600 mg/day, was a safe and effective treatment of generalised anxiety disorder in patients 65 years and older. The anxiolytic efficacy of pregabalin had an early onset (by 2 weeks) and significantly improved both psychic and somatic symptoms of anxiety.
Time course of regional brain activation associated with onset of auditory/verbal hallucinations
Authors: Hoffman Ralph E. , Anderson Adam W. , Varanko Maxine , Gore John C. , Hampson Michelle
Published: October 2008

The time course of brain activation prior to onset of auditory/ verbal hallucinations was characterised using functional magnetic resonance imaging in six dextral patients with schizophrenia. Composite maps of pre-hallucination periods revealed activation in the left anterior insula and in the right middle temporal gyrus, partially replicating two previous case reports, as well as deactivation in the anterior cingulate and parahippocampal gyri. These findings may reflect brain events that trigger or increase vulnerability to auditory/verbal hallucinations.
Longitudinal MRI study in schizophrenia patients and their healthy siblings
Authors: Brans Rachel G. H. , van Haren Neeltje E. M. , van Baal G. Caroline M. , Staal Wouter G. , Schnack Hugo G. , Kahn René S. , Pol Hilleke E. Hulshoff
Published: October 2008

To investigate whether genetic and/or disease-related factors are involved in progressive structural brain changes in schizophrenia, magnetic resonance imaging scans with a 5-year scan interval were acquired in patients, their same-gender siblings and matched healthy controls. Structural equation modelling was applied to assess disease and familial effects. Whole brain and cerebral grey matter volumes decreased excessively in patients compared with their siblings and the controls, suggesting that the progressive brain loss in schizophrenia may be related to the disease process.
Suicide rates in people of South Asian origin in England and Wales: 1993–2003
Authors: McKenzie Kwame , Bhui Kamaldeep , Nanchahal Kiran , Blizard Bob
Published: October 2008

Background

Low rates of suicide in older men and high rates in young women have been reported in the South Asian diaspora worldwide. Calculating such suicide rates in the UK is difficult because ethnicity is not recorded on death certificates.

Aims

To calculate the South Asian origin population suicide rates and to assess changes over time using new technology.

Method

Suicide rates in England and Wales were calculated using the South Asian Name and Group Recognition Algorithm (SANGRA) computer software.

Results

The age-standardised suicide rate for men of South Asian origin was lower than other men in England and Wales, and the rate for women of South Asian origin was marginally raised. In aggregated data for 1999–2003 the age-specific suicide rate in young women of South Asian origin was lower than that for women in England and Wales. The suicide rate in those over 65 years was double that of England and Wales.

Conclusions

Older, rather than younger, women of South Asian origin seem to be an at-risk group. Further research should investigate the reasons for these changes and whether these patterns are true for all South Asian origin groups.
Effects of cannabis use on outcomes of psychotic disorders: systematic review
Authors: Zammit Stanley , Moore Theresa H. M. , Lingford-Hughes Anne , Barnes Thomas R. E. , Jones Peter B. , Burke Margaret , Lewis Glyn
Published: October 2008

Background

It is unclear if research findings support clinical opinion that cannabis use leads to worse outcomes in people with psychosis, or whether this impression is confounded by other factors.

Aims

To systematically review the evidence pertaining to whether cannabis affects outcome of psychotic disorders.

Method

We searched 10 relevant databases (to November 2006), reference lists of included studies and contacted experts. We included 13 longitudinal studies from 15 303 references. Data extraction and quality assessment were conducted independently and in duplicate.

Results

Cannabis use was consistently associated with increased relapse and non-adherence. Associations with other outcome measures were more disparate. Few studies adjusted for baseline illness severity, and most made no adjustment for alcohol, or other potentially important confounders. Adjusting for even a few confounders often resulted in substantial attenuation of results.

Conclusions

Confidence that most associations reported were specifically due to cannabis is low. Despite clinical opinion, it remains important to establish whether cannabis is harmful, what outcomes are particularly susceptible, and how such effects are mediated. Studies to examine this further are eminently feasible.
Involving patients in decisions during psychiatric consultations
Authors: Goss Claudia , Moretti Francesca , Mazzi Maria Angela , Del Piccolo Lidia , Rimondini Michela , Zimmermann Christa
Published: October 2008

Background

Patient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry.

Aims

To assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement.

Method

Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested usingt-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients.

Results

Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level.

Conclusions

The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
Digit symbol coding and general cognitive ability in schizophrenia: worth another look?
Authors: Dickinson Dwight
Published: October 2008

For decades, schizophrenia researchers have sought to map specific aspects of cognitive performance onto specific neurobiological systems in hopes of dividing broad cognition and neurobiology into more tractable components. Recent findings from studies using neuropsychological test batteries, in combination with emerging neurobiological evidence, argue for a complementary focus on more generalised cognitive and biological dimensions.
Early intervention in psychosis service and psychiatric admissions
Authors: Dodgson Guy , Crebbin Kathleen , Pickering Caroline , Mitford Emma , Brabban Alison , Paxton Roger
Published: October 2008

Aims and Method

To investigate the effects of a standard National Health Service early intervention in psychosis service on bed days and engagement with services. We conducted a naturalistic before-and-after study comparing outcomes of individuals who received treatment from the service (n=75) with outcomes of individuals who presented to mental health services before the early intervention service was established and received treatment as usual (n=114).

Results

People treated by the early intervention in psychosis service had significantly fewer admissions (P < 0.001), readmissions (P < 0.001), total bed days (P < 0.01) and better engagement with services (P < 0.05).

Clinical Implications

An early intervention in psychosis service compliant with current British mental health policy led to reduced use of psychiatric bed days confirming recent findings elsewhere. This leads to major financial savings, easily justifying the initial cost of investment in the service.
Treatment adherence and the care programme approach in individuals with eating disorders
Authors: Schmidt Martin , Morgan John F. , Yousaf Farida
Published: October 2008

Aims and Method

To examine service-level variables predicting treatment adherence in a specialist eating disorder unit. We analysed a sample of 157 individuals consecutively referred to the unit over an 18-month period. Associations were determined using odds ratios.

Results

Individuals with a formal care programme at the point of referral were more likely to stay in treatment. Treatment adherence was not predicted by illness severity or waiting time. Follow-up by a dietician and acceptance of referral to a support group predicted better treatment outcomes.

Clinical Implications

Although the standard care programme approach may be relinquished in the UK, we recommend that this approach or its equivalent be used in specialist eating disorder services to improve treatment adherence.
Taking the path less trodden: UK psychiatrists working in low- and middle-income countries
Authors: McColl Helen , Sheriff Rebecca Syed , Hanlon Charlotte
Published: October 2008

UK-based psychiatrists have the opportunity to work in low- and middle-income countries. the political climate is supportive, as evidenced by the recent Crisp report on ‘Global Health Partnerships: the UK Contribution to Health in Developing Countries’, and the Royal College of Psychiatrists volunteer scheme. However, many psychiatrists are unaware of ways in which they might contribute. In this article, we give examples of the diverse ways in which UK-based psychiatrists are already engaged in collaborative work overseas. We discuss some of the mutual benefits that such partnerships can bring and highlight the under-recognised benefits to the UK, both to the individual and to the National Health Service.
Prescribing safely in elderly psychiatric wards: survey of possible drug interactions
Authors: Vasudev Akshya , Harrison Richard
Published: October 2008

Aims and Method

A cross-sectional survey of patient drug prescriptions on two elderly psychiatric wards was carried out to estimate the potential of drug–drug interactions. Two standardised databases, British National Formulary (BNF; British Medical Association & Royal Pharmaceutical Society of Great Britain, 2007) and Upto Date (www.uptodate.com/), were employed.

Results

A majority (96%) of drug prescriptions in our study could potentially cause drug–drug interactions. Most patients were on multiple drugs (on average eight drugs per patient). There was poor concordance between the two databases: BNF picked up fewer cases of potential drug–drug interactions than Upto Date (43 v. 152 instances) and they also estimated the potential for hazardousness differently.

Clinical Implications

Polypharmacy is common in elderly psychiatric patients and this increases the possibility of a drug–drug interaction. Estimating the risk of interactions depends on a sound knowledge in therapeutics and/or referring to a standardised source of information. the results of this study question the concordance of two well-referenced databases.
Invited commentary on … Patient information on schizophrenia on the internet
Authors: Shiers David , French Paul
Published: October 2008

‘An honest tale speeds best, being plainly told.’

William Shakespeare, King Richard III

William Shakespeare and a few well chosen words … 400 years on, the vellum may have been replaced by a computer screen but Kalk & Pothier remind us that simple messages plainly told still work best.
Epigenetic Regulation of E-Cadherin Controls Endometrial Receptivity
Authors: Rahnama Fahimeh , Thompson Bridget , Steiner Michael , Shafiei Farhad , Lobie Peter E. , Mitchell Murray D.
Published: October 2008

Key to the success of human reproduction is the capacity of an embryo to attach and implant into the endometrial wall after which a nutrient supply is established through placentation. Herein, we have examined the potential epigenetic regulation of uterine receptivity by use of the receptive RL95-2 and nonreceptive AN3-CA endometrial epithelial carcinoma cell lines. Using an in vitro model of embryo implantation, we demonstrate that inhibition of DNA methylation by 5′-aza-2′-deoxycytidine (AZA), resulted in the nonreceptive AN3-CA cell line becoming receptive to BeWo cell spheroid attachment. Examination of components of the adherens junction complex revealed that AZA specifically increased the expression of E-cadherin and plakoglobin at the mRNA and protein levels in AN3-CA cells, and E-cadherin protein expression was found to localize to sites of intercellular contact. Forced expression of E-cadherin in AN3-CA cells significantly enhanced receptivity. Small interfering RNA (siRNA)-mediated depletion of the individual DNA methyltransferase (DNMT) molecules did not induce E-cadherin expression in AN3-CA cells; however, concomitant siRNA-mediated depletion of both DNMT3A and DNMT3B induced the expression of E-cadherin. Furthermore, E-cadherin expression was significantly increased after the concomitant siRNA-mediated depletion of DNMT-1, -3A, and -3B in AN3-CA cells. Therefore, we have provided evidence that E-cadherin plays an important role in uterine receptivity and that E-cadherin expression is epigenetically regulated in AN3-CA cells, suppressed by the combined actions of DNMT-1, -3A, and -3B.

Inhibition of DNA methylation increases both E-cadherin expression and receptivity in an endometrial cell line, suggesting that endometrial receptivity in human pregnancy is epigenetically regulated.