bluuebunny/crossref_metadata_2025 huggingface dataset:
Looking at the future and seeing the past: the challenge of the middle years of parenting a child with intellectual disabilities
Authors: Todd S. , Jones S.
Published: May 2005

Background  This paper seeks to understand and conceptualize the experience of mothers of adolescents with intellectual disabilities (IDs) at a time in their lives which others have characterized as ‘mid‐life’ or the ‘middle years of parenting’. The concerns of the paper are the lifecourse concerns in mothers’ own lives and with biographical elements of becoming and being such a parent.

Methods  Qualitative interviews were conducted with mothers of adolescents with IDs. The average age of mothers was 48 years. Typically parents were interviewed on two to three occasions.

Results  The data suggest that despite the difficulties they faced, these parents had constructed a ‘life‐as‐ordinary’ in the early phase of their parental careers. They saw themselves as ‘ordinary mothers’. However, the social content and events of the middle years of parenting prompt a realization that their lives and, for some, their sense of ‘self’, are undergoing considerable change. Mothers are forced to look over their lives to find the meaning and significance of these events. For some, there is biographical reinforcement. For others, there is only disruption.

Discussion  The overall picture of these years is one of considerable changes and challenges, and underlines the need for a focus on the lifecourse concerns of parents as well as their children. The implications of the data for further research and service development are discussed in the context of identity theory.
Endometrial adenocarcinoma presenting in a premenopausal patient with tuberous sclerosis
Authors: Jaffe J. S. , Chambers J. T.
Published: May 2005

Background  Endometrial adenocarcinoma is very uncommon in women under 40 years of age.

Case  A 39‐year‐old woman with tuberous sclerosis and severe intellectual disability presented with irregular bleeding unresponsive to oral contraceptive therapy. She was subsequently found to have a deeply invasive endometrial adenocarcinoma.

Conclusion  Caregivers must pay particular attention to signs and symptoms in non‐verbal patients. Persistent irregular bleeding on oral contraceptive therapy warrants additional evaluation.
ADHD symptoms and insistence on sameness in Prader‐Willi syndrome
Authors: Wigren M. , Hansen S.
Published: May 2005

Background  Apart from a pervasive eating disorder, the Prader‐Willi (PWS) syndrome is characterized by a distinct behavioural profile comprising maladaptive behaviours, obsessive‐compulsive traits and skin picking, all included in the PWS behavioural phenotype. In this study, we present a further delineation of this characteristic behavioural profile by screening for indices of executive dysfunctions related to attention‐deficit/hyperactivity disorder (ADHD), immature compulsive‐like adherence to sameness and skin picking, and how these features aggregate into symptom constellations in children and adolescents with PWS.

Method  Parents of 58 individuals with PWS (aged 5–18 years) participated by completing Childhood Routines Inventory (CRI) and Conners’ Parent Rating Scale (CPRS‐48).

Results  Results showed that indices of ADHD and excessive insistence on sameness were common, comorbid and of early onset. They were both associated with conduct problems. Skin picking, appearing as a single and comorbid symptom, was less associated with childlike compulsions and ADHD‐related problems.

Conclusions  Findings are discussed in terms of further research in executive dysfunctions in PWS.
Risk factors for low bone mineral density in individuals residing in a facility for the people with intellectual disability
Authors: Jaffe J. S. , Timell A. M. , Elolia R. , Thatcher S. S.
Published: May 2005

Background  Individuals with intellectual disability (ID) are known to have a high prevalence of both low bone mineral density (BMD) and fractures with significant attendant morbidity. Effective strategies aimed at reducing fractures will be facilitated by the identification of predisposing risk factors.

Methods  Bone mineral density was measured by quantitative ultrasound of the calcaneus performed on 79 women and 132 men residing in a facility for adults with ID. Multiple variable logistic regression analysis was performed to determine the significance of risk factors for low BMD.

Results  Mobility impairment consistently appeared to be a significant risk factor for low BMD regardless of age or sex and especially for middle‐aged men with profound ID. Further risk was identified for postmenopausal women taking enzyme inducing anticonvulsant medications and middle‐aged men who were either smokers or tended to be short. Hispanic followed by Caucasian origin also put middle‐aged males at a greater risk than their African‐American counterparts.

Conclusions  Specific risk factors for low BMD, some of which have potential for modification, were identified in the study population. Targeted strategies for risk factor reduction may result in a decrease in the high rate of fractures among these individuals.
Schistosoma japonicum reveals distinct reactivity with antisera directed to proteases mediating host infection and invasion by cercariae of S. mansoni or S. haematobium
Authors: Chlichlia K. , Schauwienold B. , Kirsten C. , Doenhoff M. J. , Fishelson Z. , Ruppel A.
Published: May 2005

Serine proteases released from the acetabular glands of cercariae, also known as cercarial elastases, are key enzymes in the penetration process of schistosomes through the skin of the final host. Antisera against these enzymes secreted from Schistosoma mansoni or S. haematobium reveal differences in the patterns of elastase expression among schistosome species and among different developmental stages of the larvae. Immunolocalization studies showed that antisera raised against the enzyme s28 protease react with S. mansoni, S. haematobium and also S. japonicum, in developing as well as mature cercariae and in both pre‐ and post‐acetabular glands. Antisera against the enzyme SmCE detect the respective antigen solely in the pre‐acetabular glands. Remarkably, the SmCE‐1a isoform is detectable with DNA‐vaccinated mouse sera in S. mansoni and S. haematobium only, but is apparently absent from the acetabular glands of S. japonicum. These differences in immunoreactivity of cercarial enzymes may be related to the distinct infection process of S. japonicum.
Longitudinal study on the relationship between cat allergen and endotoxin exposure, sensitization, cat‐specific IgG and development of asthma in childhood – report of the German Multicentre Allergy Study (MAS 90)
Authors: Lau S. , Illi S. , Platts‐Mills T. A. E. , Riposo D. , Nickel R. , Grüber C. , Niggemann B. , Wahn U. ,   The Multicentre Allergy Study Group
Published: May 2005

Background:  Controversial data have emerged regarding the question whether cat exposure in childhood favours or decreases the risk of sensitization and allergic airway disease. In a prospective birth‐cohort study, we assessed the association between longitudinal cat allergen exposure, sensitization (immunoglobulin E, IgE), IgG antibody (ab) levels to cat and the development of asthma in children up to the age of 10 years.

Methods:  Of 1314 newborn infants enrolled in five German cities in 1990, follow‐up data at age 10 years were available for 750 children. Assessments included yearly measurements of specific serum IgE to cat and at age 6 and 18 months, 3, 4 and 10 years measurement of cat allergen Fel d 1 in house dust samples. Additionally, Fel d 1‐specific IgG ab were determined in 378 serum samples of 207 children. Endotoxin exposure in mattress dust was measured in a subgroup of 153 children at age 10 years. From age 4 years on, International Study of Asthma and Allergy in Childhood (ISAAC) questionnaires were completed yearly in order to assess the prevalence of wheeze and asthma.

Results:  Serum IgG‐levels to cat showed a large variation, however, intraindividually values showed rather constant concentration over a longer time period. The IgG levels at school‐age correlated with cat allergen exposure during the first 2 years of life. Specific IgE to cat was clearly associated with wheeze ever, current wheeze and bronchial hyperresponsiveness (BHR), this was also observed for children with specific IgE ab to cat (>0.35 kU/l) plus IgG levels above 125 U/ml. A large percentage of very highly exposed children showed high IgG but no IgE responses to cat, however, not all highly exposed children were found to be protected from sensitization. Children with IgG but without IgE ab to cat showed the lowest prevalence of wheeze ever and current wheeze despite high cat allergen exposure, however, this trend did not achieve significance. While homes of cat owners showed higher Fel d 1 concentrations than homes without cats, homes of cat owners were not found to have higher endotoxin levels in carpet dust samples than homes without cats.

Conclusions:  We could confirm that high cat allergen exposure in a cohort with lower community prevalence of cats is associated with higher serum IgG and IgE levels to cat in schoolchildren. Sensitization to cat allergen (IgE) is a risk factor for childhood asthma. While exposure to cat allergen during infancy is associated with sensitization (IgE), only in the very highly exposed children the likelihood of sensitization (IgE) is decreased and high IgG levels to cat without IgE were associated with low risk of wheeze. However, cat‐specific IgG ab levels did not protect children with IgE‐mediated sensitization from wheeze.
Effects of allergen inhalation and oral glucocorticoid on serum soluble CTLA‐4 in allergic asthmatics
Authors: Qin X.‐J. , Shi H.‐Z. , Qin S.‐M. , Kang L.‐F. , Huang C.‐P. , Zhong X.‐N.
Published: May 2005

Background:  The serum soluble cytotoxic T lymphocyte associated antigen‐4 (sCTLA‐4) concentration is significantly elevated in patients with asthma, and sCTLA‐4 concentration correlate with the severity of asthma. The aim of the present study was to investigate effects of allergen inhalation and oral glucocorticoid on concentration of serum sCTLA‐4 in patients with allergic asthma.

Methods:  Allergen inhalation challenge was conducted in allergic asthmatics with isolated early asthma response and those with dual asthma response. In a randomized, double‐blind, placebo‐controlled, parallel group fashion, prednisolone or placebo was give orally once a day for 2 weeks. Venous blood samples were collected before and after allergen inhalation or prednisolone administration for obtaining sera. The serum sCTLA‐4 concentrations were determined using enzyme‐linked immunosorbent assay.

Results:  The serum sCTLA‐4 concentrations in the dual responder group increased from 29.0 (14.5–43.7) μg/l [median (25–75 percentiles)] before allergen inhalation to 44.0 (24.3–61.3) μg/l 24 h after allergen inhalation. In the isolated early responders, there were no significant increase in serum sCTLA‐4 concentrations after allergen inhalation compared with baseline levels. There was a significant decrease in serum sCTLA‐4 concentrations after 2 weeks of glucocorticoid therapy [22.0 (15.5–31.0) μg/l] compared with baseline values [37.0 (19.5–53.0) μg/l], whereas there was no significant difference in the placebo group.

Conclusion:  This study has demonstrated that serum sCTLA‐4 concentrations increased after allergen inhalation in sensitized asthmatic subjects, and that serum sCTLA‐4 concentrations were downregulated by prednisolone therapy.
Evaluation of an intranasal house dust mite provocation model as a tool in clinical research
Authors: Oldenbeuving N. B. , KleinJan A. , Mulder P. G. , Lumley P. , de Groot E. J. J. , van Drunen C. M. , Fokkens W. J.
Published: May 2005

Background:  As a result of the all‐year‐round exposure to house dust mite (HDM), perennial rhinitis patients never have a clear symptom‐free period. In this study, we investigated whether, despite these symptoms, we can still use nasal HDM provocations to study perennial allergic rhinitis and the effects of treatment.

Methods:  In a parallel‐group study, after 1 week treatment with either fluticasone propionate aqueous nasal spray (FPANS) or placebo, 20 patients, allergic to HDM, registered symptoms (nasal obstruction, rhinorrhoea, sneezing, pruritus and eye symptoms) using three different scoring methods [Lebel, categorical and visual analogue scale (VAS)] and peak nasal inspiratory flow (PNIF) after HDM provocations. Provocations were performed with 1000 biological units/ml and 24 h later with 10 000 biological units/ml of HDM. Before and after the provocations, nasal mucosa biopsies were taken for immunohistochemical staining to determine the number of eosinophils.

Results:  House dust mite provocations resulted in an increase in symptoms and a decrease in PNIF. Even at high‐dose provocation, the FPANS group registered significantly lower symptoms than the placebo group for nasal blockage, sneezing, eye symptoms, and PNIF in both early and late phases. FPANS also suppressed rhinorrhoea during the late phase and the influx of eosinophils in the lamina propria.

Conclusion:  Despite the high background of symptoms, allergic responses can be induced in this perennial rhinitis model. The VAS score seems most suited to detect these changes and the suppression of symptoms by 7 days of FPANS treatment. Epithelial eosinophilia at baseline was correlated positively with the severity of the reaction after the first provocation.
Polarization of Th1/Th2 in human CD4+ T cells separated by CD62L: analysis by transcription factors
Authors: Matsuzaki S. , Shinozaki K. , Kobayashi N. , Agematsu K.
Published: May 2005

Background:  T‐cell surface antigens that differentiate clearly between Th1 and Th2 have not been identified. Discrimination of Th1/Th2 subpopulations by CD62L expression has been reported. We investigated the expression of transcription factors that regulate Th1/Th2 cytokine synthesis in human CD4+ T‐cell subpopulations separated by CD45RO and CD62L, and compared the ratio of CD62L+ to CD62L− cells between healthy individuals and patients with allergic diseases.

Methods:  Human peripheral blood samples were obtained from healthy volunteers and patients. CD4+ T cells were isolated by negative selection. Three CD4+ T‐cell subpopulations separated by CD45RO and CD62L were isolated using three‐color fluorescence. Sorted cells were stimulated with anti‐CD3 monoclonal antibody, and the cytokine levels were measured using a Cytometric Bead Array Kit. Transcription factor expression was examined by reverse transcriptase polymerase chain reaction (RT‐PCR) and real‐time RT‐PCR.

Results:  Interleukin (IL)‐4 and IL‐5 production levels by CD45RO+CD62L+CD4+ T cells were higher than those of CD45RO+CD62L−CD4+ T cells (P < 0.05), whereas interferon‐γ and tumor necrosis factor‐α production were lower levels (P < 0.05). T‐cell immunoglobulin mucin‐3 and T‐bet expression were detected in CD45RO−CD62L+ and CD45RO+CD62L− cells following stimulation, but not in CD45RO+CD62L+ cells. However, the ratio of CD62L+ to CD62L− cells was the same in both healthy individuals and patients (P = 0.54). There was no difference in Th1/Th2 cytokine synthesis by CD4+ T cells.

Conclusion:  Analyses of cytokine syntheses and transcription factor expression demonstrated that CD62‐negative and ‐positive subpopulations of human CD45RO+CD4+ T cells represent characteristics of Th1 and Th2, respectively.
Identification of IgE‐binding epitopes on gliadins for patients with food allergy to wheat
Authors: Battais F. , Mothes T. , Moneret‐Vautrin D. A. , Pineau F. , Kanny G. , Popineau Y. , Bodinier M. , Denery‐Papini S.
Published: May 2005

Background:  Food allergy to wheat induces different symptoms as atopic eczema/dermatitis syndrome (AEDS), urticaria and more severe reactions as wheat‐dependent exercise‐induced anaphylaxis (WDEIA). Different gliadin classes are involved in this allergy but IgE‐binding epitopes are known only on ω5‐gliadins and for WDEIA cases.

Objectives:  The aim of the study was to identify IgE‐binding epitopes on several gliadin classes and for several patients with different symptoms and ages.

Methods:  Eleven sera were analysed by pepscan with overlapping synthetic peptides.

Results:  Sera from five patients with anaphylaxis, urticaria or WDEIA, displayed strong IgE‐binding to sequential epitopes of the repetitive domains of αβ, γ, ω2 or ω5‐gliadins with two immunodominant epitopes on ω5‐gliadin and a consensus motif of the type QQX1PX2QQ (X1 being L, F, S or I and X2 Q, E or G). One patient allergic to deamidated wheat proteins also had IgE to a repetitive peptide of γ and ω2‐gliadins of the type QPQQPFP. Sera from four patients with AEDS detected no linear epitopes on gliadins, despite the fact that they contained specific IgE to α, β, γ or ω‐gliadins. One child with AEDS recognized cysteine‐containing sequences in the nonrepetitive domains of αβ and γ‐gliadins.

Conclusion:  B epitopes in wheat allergy were different from B epitopes of coeliac disease. Differences exist in IgE‐binding epitopes between patients with food allergy to wheat. IgE from those suffering from WDEIA, anaphylaxis and urticaria detected sequential epitopes in the repetitive domain of gliadins whereas IgE from AEDS patients probably recognized conformational epitopes.
The use of low dose octreotide prophylaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial
Authors: Hesse Uwe J , Meester Daan , Troisi Roberto , Cathenis Koen , Lameire Norbert , de Hemptinne Bernard
Published: May 2005

Abstract:  Aim:  The aim of this study was to investigate the effect of octreotide in the perioperative course of pancreas transplants drained into the bowel in terms of fistula formation, pancreatitis, hemorrhage and thrombosis, and to compare the results to patients not receiving octreotide in a prospectively, randomized single center trial.

Patients and methods:  Forty pancreas transplant recipients were prospectively randomized to either receive or not to receive octreotide 0.1 mg subcutaneously at the time of operation and 3×/d there after until post‐operative day 7. The incidence of pancreatic leakage from the anastomosis and the content of peritoneal fluid drainage regarding amylase and lipase concentrations collected by abdominal drains were registered on day 0–10. Both groups were comparable for age, sex, onset of diabetes, surgical procedure and immunosuppressive regimen.

Results:  There were 35 simultaneous pancreas‐kidney transplants and five solitary pancreas transplants, two in the octreotide and three in the control group two pancreas after kidney, one pancreas after liver pancreas, one pancreas after simultaneous pancreas kidney transplantation, one pancreas transplant alone. All had enteric drainage. Twenty patients received octreotide and 20 did not. In one patient, receiving octreotide the pancreas had to be removed for septic complications because of an enteric fistula arising from the anastomosis (1/20 = 5%). The incidence in patients on octreotide vs. non‐octreotide was 1 vs. 0 for pancreatitis, 2 vs. 3 for hemorrhage, 2 vs. 1 for thrombosis and 2 vs. 0 for pancreatic fistulae resulting in an actual overall 12 months patient survival of 100% in both groups and a pancreas survival of 85% vs. 95%. For primary simulaneous pancreas kidney the pancreas graft survival was 93%. The amylase and lipase concentrations of fluid collections drained into the peritoneum on day 0 to 10 post‐operatively indicating pancreatic fistulization was comparable in both groups.

Conclusion:  The use of octreotide following pancreas transplantation did not prevent pancreatic fistula formation from the anastomosis neither from the pancreatic capsule in pancreas transplantation with enteric drainage. Further studies are required to finally evaluate the benefit of this prophylactic treatment.
A calcineurin antagonist‐free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: long‐term results from a prospective single centre trial*
Authors: Arbogast Helmut , Hückelheim Henning , Schneeberger Helmut , Illner Wolf‐D , Tarabichi Anwar , Fertmann Jan , Wimmer Cosmas D , Hillebrand Günter F , Mistry‐Burchardi Nouhad , Thomae Robert , Acikgöz Ali , Land Walter
Published: May 2005

Abstract:  Background:  With the aim to improve the inferior outcomes in elderly recipients of kidneys from elderly cadaver donors, we applied and investigated a therapeutic regimen consisting of calcineurin inhibitor (CNI)‐free, mycophenolate mofetil (MMF)‐based immunosuppressive (i.s.) induction/maintenance protocol. In this article, we report the long‐term results of this clinical trial.

Methods:  A total of 89 recipients (mean age: 63.8 yr) of kidneys from cadaver donors (mean age: 66.8 yr) were consecutively recruited for this 5‐yr, prospective, open, single centre, pilot trial. Induction therapy consisted of MMF and steroids in conjunction with a short course (4–10 d) of rabbit antithymocyte globulin (ATG). Maintenance treatment was performed with MMF/steroids or MMF alone under strict therapeutic drug monitoring by aiming target mycophenolic acid (MPA)‐trough levels between 2 and 6 mg/mL.

Results:  Cumulative 5‐year patient and renal allograft survival was 87.69% and 69.81%, respectively. Acute rejection episodes occurred in 23.6% (21 patients). Long‐term function of the old renal allografts proved to be satisfactory as reflected by serum creatinine‐values of 1.53 mg/dL and urea‐values of 57.9 mg/dL at 5 yr.

Conclusion:  Application of a nephrotoxicity‐ and atherogenicity‐free, MMF‐based i.s. induction/maintenance protocol in elderly recipient of kidneys from elderly cadaver donors leads to improved long‐term outcomes which are comparable with data from young recipients who have received allografts from young cadaver donors.
Outcome of renal transplants from pediatric donors <5 yr of age
Authors: El‐Sabrout Rafik , Buch Kerri
Published: May 2005

Abstract: Aim: Outcomes of single renal transplants from donors <5 yr old have traditionally been inferior to those from older donors. We retrospectively studied our experience with patients who received renal transplants, either individually or en bloc, from young donors (<5 yr of age) to determine the utility of these organs. We also compared the outcomes of these transplant patients maintained on either cyclosporine‐ (CyA) or tacrolimus‐based (TRL) immunosuppression regimens.

Patients: Ninety‐eight patients received transplants at our center from donors <5 yr of age between August 1993 and August 2003. They were followed‐up from 12 months to 11 yr. Patients were divided into four groups based on whether they received single or en bloc transplants, and whether CyA or TRL was the base immunosuppressive agent. Patients in group I (n = 13) received single pediatric kidneys and were treated with CyA regimens; group II patients (n = 26) also received single pediatric kidneys, but were treated with TRL regimens; group III patients (n = 31) were transplanted en bloc and were treated with CyA; and group IV patients (n = 28) received en bloc transplants and were treated with TRL.

Results: One‐year patient and death‐censored graft survival was not significantly different between recipients of en bloc vs. single grafts (i.e. 88 and 85% vs. 90 and 87%, respectively), or between the four treatment groups (group I: 85 and 85%, group II: 92 and 88%, group III: 87 and 84%, and group IV: 89 and 86%, respectively). The overall 1‐yr rejection rate was 30% (29 of 98), which was significantly higher in the CyA‐treated patients 19 of 44; i.e. 43%, than in TRL‐treated patients 10 of 54, i.e. 19%, p = 0.03). In the en bloc recipients, seven grafts (12%) were lost as a result of vascular thrombosis. Notably, none of the single kidneys were lost because of vascular thrombosis. At the end of follow‐up the creatinine levels of both groups were comparable.

Conclusions: Pediatric donor kidneys transplanted individually provide for equal patient and graft survival when compared with en bloc transplants. TRL can be used reduce the detrimental effect of acute rejection on graft growth and function when compared with CyA. Single use of such kidneys can safely and efficaciously be transplanted into adult recipients, greatly expanding the donor pool.
Early onset post‐transplant lymphoproliferative disease is associated with allograft localization
Authors: Bakker Nicolaas A , Van Imhoff Gustaaf W , Verschuuren Erik AM , Van Son Willem J , Homan van der Heide Jaap J , Veeger Nic JGM , Kluin Philip M , Kluin‐Nelemans Hanneke C
Published: May 2005

Abstract:  Post‐transplant lymphoproliferative disease (PTLD) is a major complication after solid organ transplantation. We analyzed incidence, patient characteristics, clinical presentation, and prognostic factors for treatment outcome and survival of PTLD patients transplanted at our center. Records from adult kidney and lung transplant recipients, transplanted between January 1985 and December 2002 with a histologically confirmed diagnosis of PTLD, were retrieved. Histology was reviewed and prognostic factors for treatment outcome were evaluated by multivariable analysis. Of 1354 kidney and 206 lung transplants, PTLD was diagnosed in 40 transplant recipients (2.6%). Lung transplant recipients had a significantly higher incidence of PTLD (8.3%) than kidney transplant recipients (1.7%). Sites of presentation were highly heterogeneous. Notably, PTLD localized in the allograft occurred significantly earlier after transplantation than PTLD localized outside the allograft (p = 0.001). This was true for lung (p = 0.006) as well as for kidney transplant recipients (p = 0.03). In multivariable Cox regression, performance status (p = 0.01) and advanced stage (p = 0.04) were factors negatively predictive for response to first‐line treatment. Only performance status remained as negative predictive factor for survival (p = 0.002) and freedom from tumor progression (p = 0.01). In conclusion, the allograft is significantly more often involved as primary site of PTLD presentation during the first post‐transplant year. This may have clinical consequences and give new insights in pathogenesis of PTLD. Performance status and stage are important risk factors for outcome of PTLD.
Medicare‐approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?
Authors: Chisholm Marie A , Marshall Josh , Smith Kimberly E , Garrett Charlene J , Turner Jeanie C
Published: May 2005

Abstract:  Background:  Post‐transplant prescription medications are expensive, often costing over $12 000 annually. Many solid‐organ transplant patients have Medicare coverage and patients enrolled in Medicare‐approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs. The purpose of this study was to determine whether enrolling renal transplant patients (RTPs) into a MADDC produces significant savings in prescription costs.

Methods:  Two Medicare RTPs, with prescription medication profiles representative of an RTP within 3 months post‐transplant and an RTP greater than 5 yr post‐transplant, were randomly selected from the Medication Access Program's database. Cost benefit analyses were from the patients’ perspective and were performed using the: (i) prescription cost from the Medicare website of MADDCs that listed the greatest and least prescription costs compared with the retail cash price of the same prescription without using the MADDCs; and (ii) MADDCs’ annual enrollment fee. The potential cost difference of using MADDCs and not using MADDCs to purchase the prescription medications were calculated.

Results:  RTPs’ monthly out‐of‐pocket cost for prescription medications ranged from $162 to $340, and MADDCs offered discounts of 20–37% from retail prices; thus outweighing the MADDC enrollment cost.

Conclusion:  MADDCs, when selected and used appropriately, can reduce prescription medication cost for RTPs. Card selection is of great importance as discount rates vary greatly among cards, and only under restricted circumstances is a patient allowed to switch to another card. It is imperative that practitioners are aware of these programs and utilize cost‐effective prescribing practices.
Expanding the donor pool: use of renal transplants from non‐heart‐beating donors supported with extracorporeal membrane oxygenation
Authors: Lee Chih‐Yuan , Tsai Meng‐Kun , Ko Wen‐Je , Chang Chee‐Jen , Hu Rey‐Heng , Chueh Shih‐Chieh , Lai Ming‐Kuen , Lee Po‐Huang
Published: May 2005

Abstract:  In response to organ shortage, we used the renal grafts from non‐heart‐beating donors (NHBDs). Extracorporeal membrane oxygenation (ECMO) was used to maintain NHBDs before organ procurement. We compared the results of renal transplantation from different donors, including heart‐beating donors (HBDs), living‐related donors (LDs), and NHBDs supported with ECMO. From February 1998 to June 2003, we recruited 219 patients receiving renal transplantation at National Taiwan University Hospital. Among them, 31 received kidneys from NHBDs supported with ECMO, 120 from HBDs, and 68 from LDs. Multiple organ transplant recipients were not included in this study. We compared the graft survival, serum creatinine levels, and estimated glomerular filtration rates of the three groups. The rate of delayed graft function was higher in NHBD recipients (41.9%) than in HBD recipients (27.0%) and LD recipients (10.9%) (p = 0.003). In the NHBD group, the recipients of grafts with delayed function had significantly longer ECMO runs (63.1 ± 3.0 min) than those without delayed function (53.7 ± 2.5 min) (p = 0.024). Estimated glomerular filtration rate (p = 0.472) and mean serum creatinine level (p = 0.286) were not significantly different between the three groups using a longitudinal approach. The 5‐yr graft survival rates for NHBD (88.4%, 95% CI: 0.680–0.962), HBD (83.2%, 95% CI: 0.728–0.899), and LD transplant recipients (89.3%, 95% CI: 0.619–0.974) were not significantly different (p = 0.239). The 5‐yr patient survival rates for NHBD, HBD, and LD transplant recipients were 100, 93.0 (95% CI: 0.859–0.966) and 100% respectively. The long‐term allograft survival and function of kidneys from NHBDs supported by ECMO, HBD, and LD did not differ significantly. Long ECMO running time tended to delay graft function.
Outcome of hepatic artery reconstruction in liver transplantation with an iliac arterial interposition graft
Authors: Gaudio Massimo Del , Grazi Gian Luca , Ercolani Giorgio , Ravaioli Matteo , Varotti Giovanni , Cescon Matteo , Vetrone Gaetano , Ramacciato Giovanni , Pinna Antonio Daniele
Published: May 2005

Abstract:  Background: In case of anomal hepatic arterial inflow, it can be necessary to perform revascularization of the liver allograft by iliac arterial interposition graft.

Methods:  We analyzed retrospectively 613 liver transplants in a 16‐yr period. The hepatic artery (HA) graft group (n = 101) consisted of patients with arterial inflow based on recipient infrarenal aorta using donor iliac artery graft tunneled through the transverse mesocolon. The control group (n = 512) consisted of patients who underwent liver transplantation with routine HA reconstruction.

Results:  Both groups are homogeneous and comparable. In case of retransplantation, arterial conduit with iliac graft was adopted more frequently instead of conventional arterial anastomosis (24.8% vs. 9%, p < 0.0001). The 1‐, 3‐ and 5‐yr overall survival was 85.41, 79.42, 76.57% in the control group and 76.21, 73.43, 73.43% in the HA graft group, respectively (p = ns). The 1‐, 3‐ and 5‐yr graft survival was better in the control group (81.51, 73.66, 69.22% vs. 71.17, 62.50, 53.42%) (p = 0.01). In case of retransplantation, the 1‐, 3‐ and 5‐yr overall (57.81, 53.95, 41.96% vs. 60, 51.95, 49.85%) and graft survival (57.52, 53.68, 41.75% vs. 56, 50.4, 40.3%) was similar in control and HA graft group, respectively (p = ns). Hepatic artery thrombosis (HAT) rate is 21.8% vs. 8.6% (p < 0.0001) in HA graft group and control group, respectively. The only factor independently predictive of early HAT resulted arterial conduit (p = 0.001, OR = 3.13, 95% CI: 1.57–6.21). Retransplant procedure, donor age and arterial iliac conduit were found to be a significant risk factors for late HAT, at univariate analysis. At multivariate analysis, donor age >50 yr old resulted the only factor independently associated with late HAT (p < 0.0001, OR = 1.05, 95% CI: 1.02–1.07).

Conclusion:  Iliac arterial interpositional graft is an alternative solution for arterial revascularization of liver allograft in case of retransplantation when the use of HA is not possible. In case of primary transplantation, is better not to perform arterial conduit if it is possible, for poor graft survival and high incidence of early HAT, especially in case of liver donor aged over 50 yr.
Chronic allograft nephropathy and nephrotic range proteinuria
Authors: Ramanathan Venkataraman , Suki Wadi N. , Rosen Daniel , Truong Luan D.
Published: May 2005

Abstract:  While the association between post‐transplant nephrotic range proteinuria (PTx‐NP) and chronic allograft nephropathy (CAN) has been described, the factors that determine graft survival in such patients are unclear. We retrospectively identified 30 patients with biopsy‐proven CAN who presented with PTX‐NP between 1988 and 2002. Patients were stratified into two groups according to PTX‐NP onset: <1 yr vs. >1 yr post‐transplantation. Both groups were comparable with respect to the degree of renal dysfunction (serum creatinine 4.3 ± 2.5 mg/dL vs. 3.4 ± 1.5 mg/dL) and proteinuria (4.7 ± 1.6 gm/d vs. 5.8 ± 3 gm/d). After a mean follow‐up of 14 months post‐biopsy, 87% of patients had lost their grafts in both groups (89% vs. 83%, p = NS). Overall, patients with serum creatinine ≤2 mg/dL had better graft survival during follow‐up than patients with serum creatinine >2 mg/dL (75% vs. 4%, Fisher Exact Probability p = 0.0038). Using Kaplan–Meier estimate, the 5‐yr graft survival rate was 100% for patients with serum creatinine ≤2 mg/dL and 40% in those with >2 mg/dL (p = 0.06). The magnitude of proteinuria beyond 3 gm/d did not influence graft survival. One‐half of the patients (n = 15) received therapy with angiotensin converting enzyme inhibitors (ACEI). Graft survival, however, was not different between the patients who received ACEI compared with the patients who did not receive ACEI (13% vs. 13%).

PTx‐NP related to CAN was associated with poor allograft survival, irrespective of the time of onset of presentation, especially when renal function was reduced at the time of biopsy.
p53 Expression in Canine Lymphoma
Authors: Sokołowska J. , Cywińska A. , Malicka E.
Published: May 2005

The tumour suppressor p53 plays a key role in DNA damage and repair. It is the most frequently altered gene in human cancers and these mutations may implicate the genesis and/or progression of tumours. Mutations of thep53gene were also found in a number of canine cancers, although it is poorly estimated in canine lymphomas. Thus, the aim of this study was to investigate the p53 status in these types of tumours. We have shown that the expression of p53 in canine lymphomas is rare, however significantly differs between lymphomas of T‐ and B‐cell origin.
High Prevalence of Ulcerative Posthitis in Rasa Aragonesa Rams Associated with a Legume‐rich Diet
Authors: Loste A. , Ramos J. J. , García L. , Ferrer L. M. , Verde M. T.
Published: May 2005

This study describes an outbreak of ulcerative posthitis that eventually affected 76 of 80 of rams in a flock of Rasa Aragonesa sheep on a legume‐rich diet. Lesions were confined to the prepuce and varied from mild hyperaemia to ulcerations.Corynebacterium renalewas isolated from the lesions. Treatment of an initial group of 17 was based on a change of diet and topical treatment with Veterin Banedif®with prednisolone once a day for 15 days and was successful. Lesions in this group were completely resolved after 15 days. The relationship between a legume‐rich diet, ruminal alkalosis, elevated urine pH and posthitis is discussed.
Home health nursing care agenda based on health policy in Korea
Authors: Ryu Hosihn , An Jiyoung , Koabyashi Mia
Published: May 2005

Abstract Home health nursing care (HHNC) in Korea has taken on an important role under the mandate of the national health care system since 2000. This program was developed to verify the possibility of early discharge of hospitalized patients and cost containment through a research and development project that was conducted with the government from 1994 to 1999. The process of development of HHNC provided an opportunity to realize the advancement and changes in the system into a consumer‐focused structure. This is an important turning point for the Korean health care system that suggests certain possibilities for building a foundation for further changes in the service delivery structure. The structure, which had been limited to a supplier‐oriented model, is moving to a consumer‐oriented structure. Accordingly, the major function and role of nursing policy makers in Korea is to develop an agenda and alternatives for policy‐making in a systematic manner and to present implementation strategies clearly.
Hepatitis C prevention with nurses
Authors: Keller Sarah , Daley Karen , Hyde James , Greif Richard S. , Church Daniel R.
Published: May 2005

Abstract A state campaign to educate nurses about hepatitis C and encourage nurses to fight the epidemic provided an opportunity to assess the relationship between information and safety practices. Baseline and follow‐up surveys were sent to random, representative samples (n = 6000) of licensed nurses in Massachusetts, USA. Responses received by 42% (n = 2443) at baseline and 37% (n = 2167) at follow‐up were compared to explore the relationship between receiving information and propensity to counsel patients or use safety equipment. Only data from nurses in direct patient care were analyzed. Although few changes were observed, the assessment provided further evidence that more than a single intervention is needed to achieve health behavior change. The number of nurses who never used safety equipment did decrease slightly, from 13.3% (191) to 8.2% (132), and nurses who received information were more likely to talk to patients about the virus: 49% (414) compared to 21% (120). Hepatitis information aimed at nurses may help control this emerging epidemic.
Childhood obesity in Taiwan: Review of the Taiwanese literature
Authors: Hsieh Pei‐Lin , FitzGerald Mary
Published: May 2005

Abstract In a number of countries, including Taiwan, the prevalence of childhood obesity has been steadily increasing. A study to assess school nurses’ perspective on their role in supporting children and preventing childhood obesity in Taiwan is currently being undertaken. A search of the literature reveals that most research publications come from the West and these studies have been useful. However, it is important to isolate the research and policy materials that take into account the contextually and culturally relevant factors in Taiwan and neighboring countries. Findings from a review of the Taiwanese literature are presented in this paper. The literature reveals the factors associated with the prevalence of childhood obesity and prevention strategies. A significant proportion of the research is medical and focuses on cardiovascular disease rather than health promotion and education. However, there are findings in this review that generally support health promotion activities and programs that are school based. There appears to be an urgent need for investment in research that assesses the long‐term effectiveness of interventions designed to promote the maintenance of healthy weight during childhood in the Taiwanese society. Western literature is referred to occasionally in this paper in order to introduce an issue or to compare with a Taiwanese paper.
Developing an audit tool to assess genetic services
Authors: Skirton Heather
Published: May 2005

The aim of this study was to use clients’ accounts and factor analysis to develop a robust assessment and audit tool for clinical genetic services.

Qualitative data abstracted from published studies were used to generate a number of statements (n = 57) related to outcomes of genetic services. The resulting questionnaire was mailed to clients of the Wales genetic service, who were asked to rank each statement on a 7‐point Likert type scale. Ninety‐seven anonymised responses were received (73% response rate) and subjected to factor analysis. Six main factors were found to contribute to the outcome of the service and were labeled (i) enhanced understanding; (ii) positive psychological change; (iii) respect for autonomy; (iv) adaptation; (v) disequilibrium; and (vi) value of contact. The tool will be validated for use in clinical and research contexts.
Supportive‐expressive group therapy for women with brca1/2mutations: Results of a phase II trial
Authors: Esplen Mj , Hunter J , Leszcz M , Warner E , Narod S , Butler K , Glendon G , Liedem A , Metcalfe K , DiProspero L , Kieffer S , Young Ma , Irwin E , Wong J
Published: May 2005

The purpose of the study was to develop, standardize and test a model of supportive‐expressive group therapy for women with BRCA1/2 mutations. Method: A pre/post design was used. Results: 38/70 participants (54.3%) had a previous diagnosis of cancer and 32 (45.7%) had no cancer. There were statistically significant reductions in the levels of intrusion or cancer worries (t [64] = 2.9, p = 0.004), depression (t [69] = 2.5, p = 0.015), anxiety (t [68] = 2.2, p = 0.033) and global psychosocial functioning (t [60] = 2.75, p = 0.008). A significant number of women made decisions concerning prophylactic surgery (oophorectomy/mastectomy). Conclusions: These findings are encouraging and suggest the effectiveness of a group intervention for both affected and unaffected carriers and have implications for a future randomized trial.
Genetics education needs of healthcare practitioners in maternity care
Authors: Metcalfe Alison , Haydon Jo , Bennett Catherine , Farndon Peter
Published: May 2005

In the UK, midwives rather than obstetricians provide most of the care for women throughout their pregnancy and childbirth. A questionnaire survey using bipolar scale asked midwives to rate the importance of particular skills against their personal level of confidence in performing in the clinical situations described in a series of vignettes, where a basic knowledge of genetics was required. 416 midwives responded (51% response rate). The midwives rated the skills in genetics as very important but rated their personal competence in carrying them out as low. This study identified that the clinical components of genetics with the bio‐molecular and psychosocial aspects integrated into this clinical focus, was the most likely to encourage midwives to attend further training.
Parents of children with neurofibromatosis 1: Comparison of maternal and paternal responses
Authors: Dylis AM
Published: May 2005

Neurofibromatosis 1 (NF) is the most common single gene nervous system disorder. Prior adaptation research to a child's chronic illness has focused on maternal responses. Paternal/maternal comparison studies demonstrated contradictory and inconclusive findings (Katz, 2002), although Ablon (1996; 2000) documented NF gender differences.

This study's purpose is to compare paternal/maternal responses from an international sample (N = 337) of parents of children with NF. Parental gender had significant indirect effects on family functioning (r = 0.27, P = 0.000) (Dylis, 2003). Independent T‐tests in this ongoing secondary analyses revealed significant gender differences (P = 0.000) in all coping subscales and uncertainty stress (P = 0.009). These findings might assist in future development of individualized, gender specific parental adaptation interventions.
Sodium ascorbyl phosphate shows in vitro and in vivo efficacy in the prevention and treatment of acne vulgaris
Authors: Klock J. , Ikeno H. , Ohmori K. , Nishikawa T. , Vollhardt J. , Schehlmann V.
Published: May 2005

Synopsis

Acne vulgaris is the most common inflammatory skin disorder and jeopardizes seriously the facial impression of a person. Development of acne involves a complex relation among several causes. Treatment and prevention success can be archived by affecting the main contributors positively like Proprionibacterium acnes or lipid oxidation leading to inflammatory reactions and follicular keratinization. Vitamin C tends to break down in cosmetic formulations resulting in a brownish discoloration. Sodium ascorbyl phosphate (SAP) represents a stable precursor of vitamin C that ensures a constant delivery of vitamin C into the skin. We were able to show that 1% SAP has a strong antimicrobial effect with a log reduction of 5 after 8 h on P. acnes in a time‐kill study. Further on in a human in vivo study with 20 subjects an SAP O/W formulation significantly prevents the UVA‐induced sebum oxidation up to 40%. Finally, we performed an open in vivo study with 60 subjects with a 5% SAP lotion over 12 weeks. The efficacy ranked as excellent and good of SAP was 76.9%, which was superior compared with a widely prescribed acne treatment. In conclusion, these data show that SAP is efficient in the prevention and treatment of acne vulgaris. SAP can be used in a non‐antibiotic and effective treatment or co‐treatment of acne with no side effects, which makes it particularly attractive for cosmetic purposes.
Sampling distributions associated with the multivariate t distribution
Authors: Nadarajah Saralees , Kotz Samuel
Published: May 2005

The known sampling distributions and simulation methods associated with multivariate t distributions are reviewed. We believe that this review will serve as an important reference and encourage further research activities in the area.
Effective literacy teaching behaviours
Authors: Topping Keith , Ferguson Nancy
Published: May 2005

There is much current interest in the identification of effective programmes for raising literacy standards. However, the effectiveness of such programmes might vary greatly according to implementation integrity and the preferred teaching styles or behaviours of teachers. This research explored whether highly effective teachers of literacy used teaching behaviours that were independent of any specific programme, whether these were consistent between teachers and different literacy teaching contexts, and whether teacher perceptions corresponded with observations of their behaviour. Five teachers were selected on the basis of high pupil literacy attainment and expert nomination, and observed during shared reading and general literacy teaching contexts. These highly effective literacy teachers tended to utilise similar teaching behaviours, but they did not utilise all behaviours thought to be associated with pupil achievement. Additionally, they utilised effective behaviours more in shared reading sessions than in general literacy sessions. Thus even these highly effective literacy teachers had room for improvement. To some extent the teachers were actually using more complex behaviours than they reported perceiving. They did not appear to perceive their behavioural variation between contexts, nor any under‐use of other effective teaching behaviours. The implications for professional practice, professional development and future research are explored.