bluuebunny/crossref_metadata_2025 huggingface dataset:
A case–control study of preterm delivery risk factors according to clinical subtypes and severity
Authors: Ip Marisa , Peyman Elmera , Lohsoonthorn Vitool , Williams Michelle A.
Published: January 2010

Aims:  To examine risk factors of preterm delivery (PTD) among Thai women.

Methods:  Our case–control study included 467 term controls and 467 PTD cases. PTD was studied in aggregate and in subgroups (i.e. spontaneous preterm labor and delivery [SPTD], preterm premature rupture of membrane [PPROM], medically indicated preterm delivery [MIPTD], moderate preterm delivery [32–36 weeks], and very preterm delivery [<32 weeks]). We used multivariable logistic regression procedures to estimate odds ratio (OR) and 95% confidence intervals (CI) of potential PTD risk factors.

Results:  Advanced maternal age (≥35 years) was associated with a 2.27‐fold increased PTD risk overall (95%CI: 1.40, 3.68); and with a 3.79‐fold increased risk of MIPTD (95%CI: 1.89, 7.59). Young maternal age (<20 years) was associated with a 2.07‐fold increased risk of SPTD (95%CI: 1.19, 3.61). Prior history of PTD was associated with a 3.64‐fold increased PTD risk overall (95%CI: 1.87, 7.09), and with a 5.69‐fold increased risk of MIPTD (95%CI: 2.44, 13.24). No prenatal care was associated with all PTD subtypes. Lean women (body mass index < 18.5 kg/m2), compared with normal weight women (18.5–24.9 kg/m2), had a 1.70‐fold increased risk of PTD (95%CI: 1.21, 2.39). Risk of SPTD (OR = 2.16, 95%CI: 1.44, 3.24) and very PTD (OR = 2.45, 95%CI: 1.35, 4.45) were also elevated in lean women.

Conclusions:  Maternal age, pre‐pregnancy body mass index, prior history of PTD and no utilization of prenatal care were covariates identified in this study as risk factors for PTD. Our findings also suggest heterogeneity in risk factors for clinical subtypes of PTD.
Translocation of a cerclage band into the endocervical canal after preconception transabdominal cervico‐isthmic cerclage
Authors: Park Moon‐Il , Hoh Jeong‐Kyu
Published: January 2010

A 34‐year‐old woman, who had a history of five spontaneous losses and failures of two McDonald purse‐string cerclages, underwent a transabdominal cervico‐isthmic cerclage (TCC). She became pregnant 17 months after TCC. At 35 weeks of gestation, she was admitted to our hospital due to preterm labor and delivered a healthy female baby (2270 g) by cesarean section. After delivery of the newborn infant, we found a migration of about one third of the cerclage band into the endocervical canal. Two years later, she had one further pregnancy, reached 33 weeks of gestation, and delivered a 1450 g male baby by cesarean section due to a preterm labor without any signs of infection. Although it could have been a case of pure coincidence, we take a chance to speculate that the migration of the cerclage band into the endocervical canal might have been the reason for the preterm labor, and it must have been removed at her first cesarean section and replaced by a new cerclage band for her next pregnancy.
Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia
Authors: Chongsuvivatwong Virasakdi , Bachtiar Hafni , Chowdhury Mahbub Elahi , Fernando Sunil , Suwanrath Chitkasaem , Kor‐anantakul Ounjai , Tuan Le Anh , Lim Apiradee , Lumbiganon Pisake , Manandhar Bekha , Muchtar Masrul , Nahar Lutfan , Hieu Nguyen Trong , Fang Pan Xiao , Prasertcharoensuk Witoon , Radnaabarzar Erdenetungalag , Sibuea Daulat , Than Kyu Kyu , Tharnpaisan Piangjit , Thach Tran Son , Rowe Patrick
Published: January 2010

Aim:  To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals

Methods:  Hospital based prospective study at 12 centers of 9 countries.

Results:  12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non‐significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P < 0.001). Vaginal delivery also had higher rates of severe asphyxia and palsy than elective cesarean section.

Conclusion:  Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.
Coevolution of antibiotic production and counter‐resistance in soil bacteria
Authors: Laskaris Paris , Tolba Sahar , Calvo‐Bado Leo , Wellington Liz
Published: January 2010

We present evidence for the coexistence and coevolution of antibiotic resistance and biosynthesis genes in soil bacteria. The distribution of the streptomycin (strA) and viomycin (vph) resistance genes was examined in Streptomyces isolates. strA and vph were found either within a biosynthetic gene cluster or independently. Streptomyces griseus strains possessing the streptomycin cluster formed part of a clonal complex. All S. griseus strains possessing solely strA belonged to two clades; both were closely related to the streptomycin producers. Other more distantly related S. griseus strains did not contain strA. S. griseus strains with only vph also formed two clades, but they were more distantly related to the producers and to one another. The expression of the strA gene was constitutive in a resistance‐only strain whereas streptomycin producers showed peak strA expression in late log phase that correlates with the switch on of streptomycin biosynthesis. While there is evidence that antibiotics have diverse roles in nature, our data clearly support the coevolution of resistance in the presence of antibiotic biosynthetic capability within closely related soil dwelling bacteria. This reinforces the view that, for some antibiotics at least, the primary role is one of antibiosis during competition in soil for resources.
Impact of concurrent macrovascular co‐morbidities on healthcare utilization in patients with type 2 diabetes in Europe: a matched study
Authors: Fu A. Z. , Qiu Y. , Radican L. , Yin D. D. , Mavros P.
Published: January 2010

Aim: To examine and to quantify the impact of concurrent macrovascular co‐morbidities (MVC) on healthcare resource utilization among patients with type 2 diabetes mellitus (T2DM) in Europe.

Methods: This is a matched cohort study based on the Real‐Life Effectiveness and Care Patterns of Diabetes Management study, a multicentre, observational study with retrospective medical chart reviews of T2DM patients in Spain, France, UK, Norway, Finland, Germany and Poland. Included patients were aged ≥30 years at time of diagnosis of T2DM who added a sulfonylurea or a PPARγ agonist to failing metformin monotherapy (index date) and had concurrent MVC (cases). A control cohort with T2DM but without concurrent MVC was identified using 1:1 propensity score matching. Logit models were used to identify the relationship between concurrent MVC and the likelihood of emergency room admission, receiving medical/surgical procedures, and hospitalization during the study period after controlling for baseline demographics, clinical information and baseline treatment. Negative binomial models were used to predict the number of office visits and length of hospital stay per year attributable to the concurrent MVC.

Results: Relative to controls, patients with MVC were significantly more likely to have emergency department admissions [odds ratio (OR) 2.69; 95% CI: 1.56–4.65], receiving medical/surgical procedures (OR 2.57; 95% CI: 1.56–4.21) and hospitalizations (OR 2.58; 95% CI: 1.64–4.07) after controlling for other predictors. Similarly, MVC were associated with 1.49 additional office visits per year (p = 0.036) and 0.32 days of hospital stay per year (p = 0.023).

Conclusions: Within a seven‐country European sample, this study showed that T2DM patients with MVC were more likely to use healthcare resources compared with T2DM patients without MVC.
Screening for metabolic syndrome and testosterone deficiency in patients with erectile dysfunction: results from the first UK prospective study
Authors: Somani Bhaskar , Khan Shahid , Donat Roland
Published: January 2010

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b

OBJECTIVE

To screen patients with erectile dysfunction (ED) for the presence of metabolic syndrome (MetS), testosterone deficiency and cardiovascular (CV) risk factors, in a secondary referral centre in the UK, as men with ED have a high incidence of CV risk factors that might amount to MetS, with obesity, increased risk of coronary heart disease and type II diabetes; testosterone deficiency has also been associated with both ED and MetS.

PATIENTS AND METHODS

We assessed 124 men presenting with ED between March 2007 and August 2008. Data were collected prospectively for patient demographics, risk factors associated with MetS, and hypogonadism. MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III Criteria 2005 (based on three or more of five criteria: waist circumference, high triglycerides, low levels of high‐density lipoprotein cholesterol, hypertension and impaired glucose tolerance).

RESULTS

The mean (range) age of the men was 50 (16–76) years; 50 of 124 (40%) patients had MetS and 27% had hypogonadism. The latter was also associated with a low testicular volume and decreased libido. Ninety‐seven patients (82%) were either overweight or obese, and 64 (52%) were current or ex‐smokers.

CONCLUSIONS

Our audit confirms a high incidence of MetS and hypogonadism in patients with ED in the UK. We recommend routine screening for CV risk factors, MetS and testosterone deficiency in all patients in the UK with ED.
The increasing incidence of mumps orchitis: a comprehensive review
Authors: Davis Niall F. , McGuire Barry B. , Mahon Jackie A. , Smyth Anna E. , O’Malley Kiaran J. , Fitzpatrick John M.
Published: January 2010

There has been a recent increase in mumps orchitis among pubertal and postpubertal males. These outbreaks can be attributed to a reduction in the uptake of measles‐mumps‐rubella (MMR) vaccine during the early to mid‐1990s in children who have now matured. The mumps virus is commonly associated with extra‐salivary complications. Unvaccinated postpubertal males diagnosed with mumps virus frequently develop complications such as mumps orchitis. Therefore, it is important that urologists are familiar with the diagnosis, treatment and complications of this condition. Here we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility.
VIRTUE, EMOTION, AND ATTENTION
Authors: BRADY MICHAEL S.
Published: January 2010

Abstract: The perceptual model of emotions maintains that emotions involve, or are at least analogous to, perceptions of value. On this account, emotions purport to tell us about the evaluative realm, in much the same way that sensory perceptions inform us about the sensible world. An important development of this position, prominent in recent work by Peter Goldie amongst others, concerns the essential role that virtuous habits of attention play in enabling us to gain perceptual and evaluative knowledge. I think that there are good reasons to be sceptical about this picture of virtue. In this essay I set out these reasons, and explain the consequences this scepticism has for our understanding of the relation between virtue, emotion, and attention. In particular, I argue that our primary capacity for recognizing value is in fact a non‐emotional capacity.
VIRTUE ETHICS AND VIRTUE EPISTEMOLOGY
Authors: CRISP ROGER
Published: January 2010

Abstract:The aim of this essay is to test the claim that epistemologists—virtue epistemologists in particular—have much to learn from virtue ethics. The essay begins with an outline of virtue ethics itself. This section concludes that a pure form of virtue ethics is likely to be unattractive, so the virtue epistemologist should examine the “impure” views of real philosophers. Aristotle is usually held up as the paradigm virtue ethicist. His doctrine of the mean is described, and it is explained how that doctrine can provide a framework for an account of epistemic virtue. The conclusion of the essay is that a virtue epistemology based on analogies with virtue ethics, though well worth developing and considering, will face several challenges in fulfilling the significant promises that have been made on its behalf.
EPISTEMIC MALEVOLENCE
Authors: BAEHR JASON
Published: January 2010

Abstract: Against the background of a great deal of structural symmetry between intellectual and moral virtue and vice, it is a surprising fact that what is arguably the central or paradigm moral vice—that is, moral malevolence or malevolence proper—has no obvious or well‐known counterpart among the intellectual vices. The notion of “epistemic malevolence” makes no appearance on any standard list of intellectual vices; nor is it central to our ordinary ways of thinking about intellectual vice. In this essay, I argue that there is such a thing as epistemic malevolence and offer an account of its basic character and structure. Doing so requires a good deal of attention to malevolence simpliciter. In the final section of the essay, I offer an explanation of our relative unfamiliarity with this trait.
RIGHT ACT, VIRTUOUS MOTIVE
Authors: HURKA THOMAS
Published: January 2010

Abstract: The concepts of virtue and right action are closely connected, in that we expect people with virtuous motives to at least often act rightly. Two well‐known views explain this connection by defining one of the concepts in terms of the other. Instrumentalists about virtue identify virtuous motives as those that lead to right acts; virtue‐ethicists identify right acts as those that are or would be done from virtuous motives. This essay outlines a rival explanation, based on the “higher‐level” account of virtue defended in the author's Virtue, Vice, and Value. On this account rightness and virtue go together because each is defined by a (different) relation to some other, more basic moral concept. Their frequent coincidence is therefore like a correlation between A and B based not on either's causing the other but on their being joint effects of a single common cause.
VIRTUES, SOCIAL ROLES, AND CONTEXTUALISM
Authors: WRIGHT SARAH
Published: January 2010

Abstract: Contextualism in epistemology has been proposed both as a way to avoid skepticism and as an explanation for the variability found in our use of “knows.” When we turn to contextualism to perform these two functions, we should ensure that the version we endorse is well suited for these tasks. I compare two versions of epistemic contextualism: attributor contextualism (from Keith DeRose) and methodological contextualism (from Michael Williams). I argue that methodological contextualism is superior both in its response to skepticism and in its mechanism for changing contexts. However, methodological contextualism still faces two challenges: explaining why we are solidly committed to some contexts, and explaining why knowledge within a context is valuable. I propose virtue contextualism as a useful extension of methodological contextualism, focusing on the way that our virtues depend on our social roles. My proposed virtue contextualism retains the benefits of methodological contextualism while explaining both our commitment to particular contexts and the value of knowledge held within those contexts.
Women's Occupational Trends in the Irish Economy: Moving towards High‐skilled Occupations or Evidence of Deskilling?
Authors: Turner Thomas , McMahon Juliette
Published: January 2010

In recent years the increased participation of women in the Irish labour market and in tertiary education would appear to have placed them in an advantageous position to make use of the expanded opportunities in knowledge‐based occupations. Using occupational data from the 1996 and 2006 census this article examines the experience of women in high‐ and low‐skilled occupations. The data indicate that women are over‐represented in high‐skilled occupations relative to their overall participation rate in the labour force but there is also an increase in the proportion of women in low‐skilled occupations. The employment of women in high‐skilled occupations is substantially weaker in the private sector than the public sector. Public sector employment, we argue, is a crucial factor in the increased participation of women in high‐skilled occupations.
Sumatriptan is Effective in the Treatment of Menstrual Migraine: A Review of Prospective Studies and Retrospective Analyses
Authors: Salonen R , Saiers J
Published: January 2010

Menstrual migraine may be debilitating, long-lasting, and refractory to treatment. Because the efficacy and tolerability of abortive and prophylactic treatment options for menstrual migraine have generally not been evaluated in controlled clinical trials, treatment choices are often made on the basis of personal experience and anecdotal reports. This article reviews evidence from retrospective analyses and prospective studies showing that sumatriptan injection and tablets are effective and well tolerated in menstrual migraine. (1) Sumatriptan injection 6 mg was as effective in the treatment of menstrual migraine attacks as it was for nonmenstrual attacks in a retrospective analysis of data from two randomized, double-blind, placebo-controlled, parallel-group trials ( n = 1104). In the menstrual migraine group, 80% of women treated with sumatriptan injection 6 mg compared with 19% of placebo-treated patients reported headache relief 1 h postdose ( p< 0.001). (2) Sumatriptan injection 6 mg was effective in the acute treatment of menstrual migraine attacks in a prospective, double-blind, placebo-controlled, parallel-group, two-attack study ( n=226). Across the two attacks, 70-71% of patients treating menstrual migraine attacks with sumatriptan injection 6 mg compared with 22-24% of placebo-treated patients reported headache relief 1 h postdose ( p< 0.001). (3) Sumatriptan tablets 100 mg were effective in the acute treatment of menstrual migraine attacks in a prospective, double-blind, placebo-controlled, crossover study in women diagnosed with menstrual migraine ( n = 115). For menstrual migraine attacks, headache relief 4 h postdose was reported by 67% of sumatriptan-treated patients compared with 33% of placebo-treated patients. Sumatriptan injection and tablets were generally well tolerated in these studies, in which adverse events were characteristic of those typically observed in sumatriptan acute migraine clinical trials. These data demonstrate that sumatriptan injection and tablets are effective and well tolerated in the treatment of menstrual migraine.
Does the Antimigraine Action of Flunarizine Involve the Dopaminergic System? A Clinical-Neuroendocrinological Study
Authors: Cupini LM , Troisi E , Placidi F , Diomedi M , Silvestrini M , Argiro G , Bernardi G
Published: January 2010

We have investigated the prolactin response to bromocriptine (BRC), a D2 dopamine receptor agonist in migrainous women before and after treatment with flunarizine. We evaluated whether this test was predictive of therapeutic efficacy of flunarizine treatment and whether the therapeutic response to flunarizine treatment was related to its effect on dopaminergic system at tuberoinfundibular level. Ten migrainous women underwent a BRC test in the late follicular phase before and after 1 and 3 months of treatment with flunarizine 10 mg at bedtime. Blood samples of prolactin (PRL), growth hormone, follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were taken at basal condition. PRL was also evaluated 1 and 2 h after BRC (2.5 mg) administration. Each patient kept a daily headache diary for 1 month prior to the test and throughout the study. The level of PRL inhibition after BRC administration, observed before flunarizine treatment, was not predictive of the therapeutic response observed after 1 and 3 months of treatment. The effect of flunarizine on PRL level was not related to the therapeutic efficacy of the drug. These data suggest that flunarizine does not attenuate the activity of dopaminergic neurons in migrainous patients, and that the antimigraine effect of flunarizine does not seem related to its action on dopaminergic system at least at tuberoinfundibular level.
Psychosocial Factors in Children and Adolescents with Migraine and Tension-Type Headache: A Controlled Study and Review of the Literature
Authors: Karwautz A , Wöber C , Lang T , Böck A , Wagner-Ennsgraber C , Vesely C , Kienbacher C , Wöber-Bingöl ç
Published: January 2010

We investigated 341 children and adolescents to evaluate the relevance of psychosocial factors in idiopathic headache. According to the criteria of the International Headache Society, 151 subjects had migraine and 94 had tension-type headache (TTH). Ninety-six subjects were headache-free controls. Psychosocial factors covered family and housing conditions, school problems, relations in the peer group, and several other items. We found that migraine patients did not differ from headache-free controls. Patients with TTH more often had divorced parents than the headache-free controls, and they had fewer peer relations than migraineurs and controls. In addition, migraine patients were significantly more often absent from school due to headache. All other psychosocial factors failed to discriminate between the three study groups. In conclusion, this controlled study in children and adolescents suggests that migraine is not related to family and housing conditions, school situation, or peer relations, whereas TTH is associated with a higher rate of divorced parents and fewer peer relations.
Drug-Induced Headache: Long-Term Results of Stationary Versus Ambulatory Withdrawal Therapy
Authors: Suhr B , Evers S , Bauer B , Gralow I , Grotemeyer KH , Husstedt IW
Published: January 2010

Drug-induced headache is a well-known complication of the treatment of primary headache disorders, and its successful management is only possible by withdrawal therapy. However, it is unknown whether ambulatory or stationary withdrawal is the therapy preferred. We conducted a prospective study on the outcome of stationary versus ambulatory withdrawal therapy in patients with drug-induced headache according to the International Headache Society criteria. Out of 257 patients with the diagnosis of drug-induced headache during the study period, 101 patients (41 after ambulatory and 60 after stationary withdrawal therapy) could be followed up for 5.9 ± 4.0 years. The total relapse rate after successful withdrawal therapy was 20.8% (14.6% after ambulatory and 25.0% after stationary withdrawal therapy, p <0.2). The main risk factors for a relapse were male sex (OR=3.9, CI=1.3-11.6), intake of combined analgesic drugs (OR=3.8, CI=1.4-10.3), administration of naturopathy (OR=6.0, CI=1.2-29.3), and a trend to tension-type headache as the primary headache disorder (OR=1.9, CI=0.6-53.0). Our data suggest that neither the method of withdrawal therapy nor the kind of analgesic and other antimigraine drugs has a major impact on the long-term result after successful withdrawal therapy. Patients with risk factors according to our findings should be informed and monitored regularly, and combined drugs should be avoided. Furthermore, our data suggest that there is a need for research on individual psychological and behavioral risk factors for relapse after successful withdrawal therapy in drug-induced headache.
Indirect Costs of Migraine in A Managed Care Population
Authors: Fishman P , Black L
Published: January 2010

Migraine is a highly prevalent condition that commonly affects individuals during their most productive years. The aggregate cost of providing healthcare for persons with migraine is substantial, but the economic consequences of lost and reduced productivity among this population are greater. This paper presents estimates of the annual indirect costs associated with migraine in a managed-care population. Our estimates include workplace and domestic productivity losses for persons employed outside the home as well as those persons engaged exclusively in domestic production or who are unable to work. We find that migraine is associated with annual indirect costs for men and women, respectively, of $4,548 and $4,897 in 1990 dollars, and that indirect costs increase with headache severity. Further research should continue to emphasize headache's effect on domestic production in order to avoid bias in measuring the economic effect of headache on women.
Effectiveness of Lamotrigine in the Prophylaxis of Migraine with Aura: an Open Pilot Study
Authors: D'Andrea G , Granella F , Cadaldini M , Manzoni GC
Published: January 2010

We report a small open pilot study to evaluate the efficacy of lamotrigine (100 mg/day) in the prevention of migraine with aura attacks. We studied 24 patients affected by migraine with aura with a high frequency of attacks. Following a 1-month run-in period, the patients took lamotrigine for 3 months. Mean attack number per month was reduced from 6.1 ± 4.1 during the run-in period to 0.7 ± 1.3 at the 3rd month of treatment ( p< 0.0001). In 13 out of 21 patients who completed the study, the attacks were completely abolished at the 3rd month of treatment, while only one patient was completely unresponsive to the drug. Lamotrigine seems worthy of a controlled trial as prophylaxis of a migraine with aura.
Migrainous disorder and headache of the tension-type not fulfilling the criteria: a follow-up study in children and adolescents
Authors: Zebenholzer K , Wöber C , Kienbacher C , Wöber-Bingöl Ç
Published: January 2010

In this follow-up study in children and adolescents with recurrent headaches classified as migrainous disorder (IHS 1.7) and headache of the tension-type not fulfilling the criteria (IHS 2.3), 28.6% were headache-free and 71.4% still had headaches 2-5 years after the first examination. The majority remained in the same one-digit IHS diagnosis, whereas 20% changed from migraine to tension-type headache or vice versa. The number of IHS criteria fulfilled increased significantly from the first to the second examination. The reason for diagnosing IHS 1.7 and IHS 2.3 most often was a short headache duration or headache characteristics not meeting the criteria. By reducing the minimum headache duration to 1 h, 11 of 58 patients could be diagnosed as migraine without aura. There was a remarkable overlap in the diagnostic criteria for migraine without aura and tension-type headache. In IHS 1.7 and IHS 2.3 this overlap exceeded 80%, with a trend to decrease at the second examination.
Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial
Authors: White AR , Resch K-L , Chan JCK , Norris CD , Modi SK , Patel JN , Ernst E
Published: January 2010

A multicentre, randomized clinical trial was undertaken to test the hypothesis that acupuncture is more efficacious than sham control procedure in the prevention of episodic tension-type headache. Fifty subjects were randomized to receive a course of treatment with either brief acupuncture or a sham procedure. Subjects were followed up for 3 months. Changes in headache were assessed by daily diary, the primary outcome measure being the number of days with headache. No significant differences were found between the changes in the two groups for any measure at any time point. Results also show that patient blinding was successful. In conclusion, this study does not provide evidence that this form of acupuncture is effective in the prevention of episodic tension-type headache.
Withdrawal Therapy Improves Chronic Daily Headache Associated with Long-Term Misuse of Headache Medication: A Retrospective Study
Authors: Linton-Dahlöf P , Linde M , Dahlöf C
Published: January 2010

Chronic daily headache (CDH) associated with long-term misuse of headache medication is a common clinical problem which is refractory to most treatments. The present study is a retrospective analysis of the effect of drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients (74 women and 27 men, aged between 16 and 72 years, mean age 43 years) were evaluated 1–3 months after drug withdrawal therapy had been initiated. The mean headache frequency at baseline was 26.9 ± 4.0 days per month. Fifty-seven (56%) patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: group I, those who had between 0 and 10 headache days per month ( n = 41), group II, those who had 11–20 days ( n = 37), and group III, those who had 21–30 days ( n = 23). The mean headache frequencies in groups I, II and III were 5.6 ± 2.8 days, 15.7 ± 2.5 days and 28.7 ± 2.4 days, respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Ten of those 22 patients (36%) experienced a significant (≥ 50%) reduction of headache days. It is concluded that out-patient drug withdrawal therapy is the treatment of choice in patients with CDH and frequent long-term use of headache symptomatic medication, and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only.
Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria
Authors: Cano A , Palomeras E , Alfonso S , Ortega D , Sanz P , Fossas P
Published: January 2010

The widely used criteria of the IHS to define migraine without aura in children are highly specific but show poor sensitivity, with a large percentage of headaches being classified as migrainous disorder (MD). The objective of this study was to assess how many headache patients in a series of children met the diagnostic criteria of the IHS for migraine without aura or MD and to determine the changes required to convert the greatest number of MD into migraine without aura, without affecting classification of the remaining headache types. A prospective study was undertaken of 131 patients under 15 years old referred to our centre for headache. Patients were classified according to the IHS criteria and according to a modification of these criteria consisting of: (1) reduction of minimum time required for classification into migraine without aura from 2 h to 1 h; (2) acceptance of bifrontal location in addition to hemicranial; (3) acceptance of either phonophobia or photophobia as valid criteria instead of requiring presence of both. Using the IHS criteria, 51 (39%) children were diagnosed as having migraine without aura and 26 (20%) as having MD. According to our revised IHS criteria, 68 (52%) were diagnosed as migraine without aura and nine (7%) as MD. When the three modified criteria were applied, three tension headaches and one unclassifiable headache changed category. When only reduced duration and bifrontal location were applied, none of the headaches other than MD changed category. Application of two modifications to the IHS criteria—reduction in duration of headache to 1 h and acceptance of bifrontal location—increased sensitivity without reducing specificity in classifying migraine without aura in children.
Exteroceptive Suppression Periods and Pericranial Muscle Tenderness in Chronic Tension-Type Headache: Effects of Psychopathology, Chronicity and Disability
Authors: Lipchik GL , Holroyd KA , O'donnell FJ , Cordingley GE , Waller S , Labus J , Davis MK , French DJ
Published: January 2010

We examined pericranial muscle tenderness and abnormalities in the second exteroceptive suppression period (ES2) of the temporalis muscle in chronic tension-type headache (CTTH; n = 245) utilizing a blind design and methods to standardize the elicitation and scoring of these variables. No ES2 variable differed significantly between CTTH sufferers and controls (all tests, P > 0.05). We found no evidence that CTTH sufferers with daily or near daily headaches, a mood or an anxiety disorder, or high levels of disability exhibit abnormal ES2 responses (all tests, P > 0.05). CTTH sufferers were significantly more likely than controls to exhibit pervasive tenderness in pericranial muscles examined with standardized (500 g force) manual palpation ( P < 0.005). Female CTTH sufferers exhibited higher levels of pericranial muscle tenderness than male CTTH sufferers at the same level of headache activity ( P < 0.0001). Elevated pericranial muscle tenderness was associated with a comorbid anxiety disorder. These findings provide further evidence of pericranial hyperalgesia in CTTH and suggest this phenomenon deserves further study. Basic research that better elucidates the biological significance of the ES2 response and the factors that influence ES2 assessments appears necessary before this measure can be of use in clinical research.
High Altitude Headache. A Prospective Study of its Clinical Characteristics
Authors: Serrano-Dueñas M
Published: January 2010

Altitude headache (AH) is the most common symptom of high altitude exposure. This prospective cross-sectional and analytical study, conducted in the Ecuadorian Andes, aimed to explore AH symptomatology, taking into account subjects' views. Thirty mountain climbers took part in the Questionnaire Elaboration. The symptoms were grouped into three categories: (A) pain dimension (PD) — intensity, location, quality, outset form, evolution, exacerbating and relieving elements; (B) concurrent symptom dimension (CSD); and (C) feeling/mood dimension (FMD). Ninety-eight mountain climbers comprised the sample for Field Research. Three evaluations were carried out: 4700-5000 m, n = 1, and 5700-5800 m, n = 2. Pearson's correlation coefficient was used to assess internal consistency. Scores between 0.7 and 1 were considered as significant to assess the strength of association between the PD and its different items and CSD and FMD. The following clinical features were found: holocranial 65.6%; pulsatile-burst type quality 75.3%; oscillating evolution 36.7%; increasing with exercise 49.5%; relieved by rest 41.8%; concurrent symptoms referred to, anorexia 26.8%, irritability 26.5%, and finally pessimism and anxiety feelings 33.2 and 29.5%, respectively. We believe that elements provided by us must lead to a new official AH diagnosis criterion.
Cervical Spine ROM Measurements: Optimizing the Testing Protocol by Using a 3D Ultrasound-Based Motion Analysis System
Authors: Strimpakos N , Sakellari V , Gioftsos G , Papathanasiou M , Brountzos E , Kelekis D , Kapreli E , Oldham J
Published: January 2010

The aim of this study was to evaluate the intra- and inter-examiner reliability and validity of neck range of motion (ROM) measurements. Thirty-five healthy subjects were assessed in all neck movements from two initial positions, sitting and standing, actively (open and closed eyes) and passively by using a 3D ultrasound-based motion analysis device (Zebris). Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. X-rays in neck flexion and extension were used to validate the Zebris system. The standing position yielded higher intraclass correlation coefficient (ICC) values (>0.86) with less error [smallest detectable difference (SDD) < 13.8%] than sitting (ICC > 0.79, SDD < 14%). Passive assessment of neck ROM presented better reproducibility than active assessment with open or closed eyes in both positions. The inter-examiner reliability was moderate (ICC = 0.43-0.68). The correlation between the Zebris system and X-rays was high in both flexion and extension movements. The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position. The measurements were well validiated against X-rays and the experience of the investigators must be considered before any comparison among studies is employed.
Migraine in the Andes and Headache at Sea Level
Authors: Appenzeller O , Minko T , Qualls C , Pozharov V , Gamboa J , Gamboa A , Wang Y
Published: January 2010

In Cerro de Pasco (CP), Peru (altitude 4338 m) 24% of men have migraine with aura. We studied 30 men. Twenty CP natives, examined in CP, were rated using a chronic mountain sickness (CMS) score to separate controls (10) from those with CMS (10), a maladaptation syndrome in natives to altitude which includes severe, recurring headache. We collected white cells in CP and, from the same men, within 1 h of arrival in Lima (150 m above sea level). Ten normal US men volunteered white cells for comparison. After RNA extraction we assessed gene expression by reverse transcription-polymerase chain reaction. Low ATP1A1 subunit of the ATPase gene mRNA expression in CP was correlated with headache ( P = 0.002), acral paraesthesias ( P = 0.004) and CMS score ( P < 0.001). ATP1A1 subunit expression was increased in all Andeans in Lima ( P < 0.001). There were no differences between Andean controls in Lima and US controls. Manipulation of Na+/K+ATPase could offer relief for migraineurs at sea level.
Migraine and Probable Migraine — Results of FRAMIG 3, a French Nationwide Survey Carried out According to the 2004 IHS Classification
Authors: Lantéri-Minet M , Valade D , Géraud G , Chautard MH , Lucas C
Published: January 2010

The 2004 International Headache Society (IHS) classification of headache disorders introduced the new category of probable migraine defined by the existence of all but one of typical migraine criteria. FRAMIG 3, the first nationwide population-based survey performed in France using the 2004 IHS classification, assessed the prevalence of probable migraine and compared its features and management with those of strict migraine. Of a representative sample of 10 532 adult subjects interviewed, 1179 subjects (11.2%) were diagnosed as having strict migraine and 1066 (10.1%) as having probable migraine. The criterion most frequently missing was typical headache duration (4-72 h) and most subjects with probable headache had shorter average headache duration. Migraine severity and disability, although lower than those noted in subjects with strict migraine, were significant in subjects with probable migraine and quality of life impairment was identical among the two groups of migraine sufferers. Strict and probable migraine, which have similar prevalence and impact on migraine subjects, deserve similar medical and therapeutic management.
Efficacy of Multidisciplinary Treatment in a Tertiary Referral Headache Centre
Authors: Zeeberg P , Olesen J , Jensen R
Published: January 2010

Despite the high prevalence of headaches, multidisciplinary headache clinics are few and their efficacy still needs validation. We set out to describe the procedures, characterize the patients and evaluate the treatment results in Danish Headache Centre. All clinical records for patients discharged in 2002 were systematically reviewed. Diagnoses were classified in accordance with ICHD-II. Outcome results were analysed with respect to headache diagnoses, frequency, intensity, absence from work and medication use. Five hundred and five patients were included and 336 were eligible for the study. Mean age was 46 years and male/female ratio 1 : 2.4. For patients without medication overuse headache (MOH) a reduction in headache frequency (P < 0.01) and intensity ( P < 0.05) was seen for frequent episodic and chronic tension-type headache (TTH), migraine, cluster and other headaches. No reduction was seen in post-traumatic headache. Absence from work decreased significantly for migraine ( P < 0.001) and frequent episodic TTH (P < 0.05). For patients with MOH a reduction in headache frequency was seen for TTH and migraine ( P < 0.001). A specialized headache centre is valuable in treatment of patients with complex headache disorders.
Evolutionary consequences of autopolyploidy
Authors: Parisod Christian , Holderegger Rolf , Brochmann Christian
Published: January 2010

Autopolyploidy is more common in plants than traditionally assumed, but has received little attention compared with allopolyploidy. Hence, the advantages and disadvantages of genome doublingper secompared with genome doubling coupled with hybridizations in allopolyploids remain unclear. Autopolyploids are characterized by genomic redundancy and polysomic inheritance, increasing effective population size. To shed light on the evolutionary consequences of autopolyploidy, we review a broad range of studies focusing on both synthetic and natural autopolyploids encompassing levels of biological organization from genes to evolutionary lineages. The limited evidence currently available suggests that autopolyploids neither experience strong genome restructuring nor wide reorganization of gene expression during the first generations following genome doubling, but that these processes may become more important in the longer term. Biogeographic and ecological surveys point to an association between the formation of autopolyploid lineages and environmental change. We thus hypothesize that polysomic inheritance may provide a short‐term evolutionary advantage for autopolyploids compared to diploid relatives when environmental change enforces range shifts. In addition, autopolyploids should possess increased genome flexibility, allowing them to adapt and persist across heterogeneous landscapes in the long run.
Effects of an Exotic Plant Invasion on Native Understory Plants in a Tropical Dry Forest
Authors: PRASAD AYESHA E.
Published: January 2010

Abstract:  The dry forests of southern India, which are endangered tropical ecosystems and among the world's most important tiger (Panthera tigris) habitats, are extensively invaded by exotic plants. Yet, experimental studies exploring the impacts of these invasions on native plants in these forests are scarce. Consequently, little is known about associated implications for the long‐term conservation of tigers and other biodiversity in these habitats. I studied the impacts of the exotic plant Lantana camara on understory vegetation in a dry‐forest tiger habitat in southern India. I compared the richness, composition, and abundance of tree seedlings, herbs, and shrubs and the abundance of grass among plots in which Lantana was cleared or left standing. These plots were distributed across two blocks—livestock free and livestock grazed. Removal of Lantana had an immediate positive effect on herb–shrub richness in the livestock‐free block, but had no effect on that of tree seedlings in either livestock block. Tree‐seedling and herb–shrub composition differed significantly between Lantana treatment and livestock block, and Lantana removal significantly decreased survival of tree seedlings. Nevertheless, the absence of trees, in any stage between seedling and adult, indicates that Lantana may stall tree regeneration. Lantana removal decreased the abundance of all understory strata, probably because forage plants beneath Lantana are less accessible to herbivores, and plants in Lantana‐free open plots experienced greater herbivory. Reduced access to forage in invaded habitats could negatively affect ungulate populations and ultimately compromise the ability of these forests to sustain prey‐dependent large carnivores. Additional research focused on understanding and mitigating threats posed by exotic plants may be crucial to the long‐term protection of these forests as viable tiger habitats.
Multispecies and Multiscale Conservation Planning: Setting Quantitative Targets for Red‐Listed Lichens on Ancient Oaks
Authors: PALTTO HEIDI , THOMASSON INGRID , NORDÉN BJÖRN
Published: January 2010

Abstract:  Species occurrence in a habitat patch depends on local habitat and the amount of that habitat in the wider landscape. We used predictions from empirical landscape studies to set quantitative conservation criteria and targets in a multispecies and multiscale conservation planning effort. We used regression analyses to compare species richness and occurrence of five red‐listed lichens on 50 ancient oaks (Quercus robur; 120–140 cm in diameter) with the density of ancient oaks in circles of varying radius from each individual oak. Species richness and the occurrence of three of the five species were best explained by increasing density of oaks within 0.5 km; one species was best explained by the density of oaks within 2 km, and another was best predicted by the density of oaks within 5 km. The minimum numbers of ancient oaks required for “successful conservation” was defined as the number of oaks required to obtain a predicted local occurrence of 50% for all species included or a predicted local occurrence of 80% for all species included. These numbers of oaks were calculated for two relevant landscape scales (1 km2 and 13 km2) that corresponded to various species responses, in such a way that calculations also accounted for local number of oaks. Ten and seven of the 50 ancient oaks surveyed were situated in landscapes that already fulfilled criteria for successful conservation when the 50% and 80% criteria, respectively, were used to define the level of successful conservation. For cost‐efficient conservation, oak stands in the landscapes most suitable for successful conservation should be prioritized for conservation and management (e.g., grazing and planting of new oaks) at the expense of oak stands situated elsewhere.
Hindrance of Conservation Biology by Delays in the Submission of Manuscripts
Authors: O’DONNELL RYAN P. , SUPP SARAH R. , COBBOLD STEPHANIE M.
Published: January 2010

Abstract:  Timely dissemination of scientific findings depends not only on rapid publication of submitted manuscripts, a topic which has received much discussion, but also on rapid submission of research after the research is completed. We measured submission delay (time from the last date of data collection to the submission of a manuscript) for every paper from 14 journals in 2007 and compared these submission delays among four fields of biology (conservation, taxonomy, behavior, and evolution). Manuscripts published in leading journals in the field of conservation biology have the longest delays in publication of accepted manuscripts and the longest intervals between completion of research and submission of the manuscript. Delay in manuscript submission accounts for more than half of the total time from last date of data collection to publication. Across fields, the number of authors was significantly negatively correlated with submission delay, but conservation journals had the second highest number of authors and the greatest submission delay, so submission of conservation manuscripts was not hindered by a shortage of collaboration relative to other fields. Rejection rates were greater in conservation journals than in behavior and evolution, but rejection times were faster; thus, there were no obvious net differences among fields in the time papers spent waiting to be rejected. Publication delay has been reduced significantly in the last 7 years, but was still greater in conservation journals than in any of the other three fields we studied. Thus, the urgent field of conservation biology is hindered in both preparation and publication of manuscripts.