bluuebunny/crossref_metadata_2025 huggingface dataset:
Infectious Source Factors Affecting the Severity of Sexually Transmitted Acute Hepatitis due to Hepatitis B Virus Genotype C
Authors: Michitaka Kojiro , Horiike Norio , Chen Yan , Yatsuhashi Hiroshi , Yano Michitami , Kojima Naohiko , Ohkubo Keiji , Tanaka Yosikazu , Yamamoto Kazuhisa , Ohno Naofumi , Onji Morikazu
Published: April 2005

Objective: The aim of this study was to identify clinical features and virological aspects of infectious sources that are related to the severity of sexually transmitted acute hepatitis B virus (HBV) infection in patients, especially in cases of genotype C. Methods: Nineteen patients with acute HBV infection, 10 classified with severe acute hepatitis (SH) (prothrombin time; PT <40%) and 9 with typical acute hepatitis (AH) (PT >40%), and their infectious sources (all were sexual partners) were studied. Infectious source factors were analyzed in relation to the severity of hepatitis in the patients’ partners. Results: The nucleotide homology of HBV-DNA between each pair was ≧98.9%. Sixteen were infected with HBV genotype C. Among the 16 infectious sources, age, numbers with elevated alanine aminotransferase (ALT, 7/9 vs. 1/7), anti-HBe positivity (8/9 vs. 1/7) and core promoter mutations at nt 1762 (7/9 vs. 1/7), nt 1764 (8/9 vs. 1/7) and precore mutation at nt 1896 (8/9 vs. 1/7) were significantly higher in the sources of SH than in those of AH. Conclusion: Higher age, elevated ALT, anti-HBe positivity and core promoter/precore mutations were possible risk factors for an infectious source of the severe form of sexually transmitted acute hepatitis due to HBV genotype C.
Hepatitis B Virus Genotypes in Korea: An Endemic Area of Hepatitis B Virus Infection
Authors: Song Byung-Cheol , Cui Xiu Ji , Kim Heung
Published: April 2005

Objectives: It has been reported that distribution of hepatitis B virus (HBV) genotypes shows geographic difference and are associated with clinical outcomes of HBV infection, including response to antiviral therapy and progression of chronic liver diseases. In this study, we analyzed the distribution of HBV genotypes according to the various clinical outcomes of chronic HBV infection in Korea, which is one of the most endemic areas of HBV infection. Methods: A total of 200 patients with chronic HBV infection were enrolled. Clinical diagnoses of the 200 patients with chronic liver diseases were as follows: hepatitis B e antigen (HBeAg)-positive healthy carrier (defined as HBeAg+, anti-HBe–, HBV DNA+ by hybridization, normal transaminase; n = 40); inactive HBsAg carrier (n = 40); chronic hepatitis B (n = 40); liver cirrhosis (n = 40); hepatocellular carcinoma (n = 40). HBV genotypes were determined by nested polymerase chain reaction using genotype-specific primers. Results: All patients except 2 (inactive HBsAg carriers) were positive for nested PCR and they have genotype C regardless of clinical outcomes. Conclusions: HBV genotype was genotype C regardless of various clinical outcomes of chronic HBV infection in Korea. Considering that HBV genotypes have clinical relevance, distribution of HBV genotype in each area should be monitored when management for chronic HBV infection is planned.
Virological and Biochemical Relapse after Discontinuation of Lamivudine Monotherapy for Chronic Hepatitis B in Japan: Comparison with Breakthrough Hepatitis during Long-Term Treatment
Authors: Akuta Norio , Suzuki Fumitaka , Kobayashi Mariko , Matsuda Marie , Sato Junko , Suzuki Yoshiyuki , Sezaki Hitomi , Hosaka Tetsuya , Someya Takashi , Kobayashi Masahiro , Saitoh Satoshi , Arase Yasuji , Ikeda Kenji , Kumada Hiromitsu
Published: April 2005

Objective: Comparison of virological and biochemical relapse in patients with chronic hepatitis B, based on continuation or discontinuation of lamivudine monotherapy. Methods: In Japanese genotype C-dominant hepatitis B patients, 25 patients who stopped treatment at normal levels of alanine transferase (ALT) were retrospectively compared with 75 patients who continued treatment. Both groups were matched for age, sex, and observation period after start of treatment. We investigated the relapse rates, and evaluated predictive factors for relapse and efficacy of retreatment of the discontinuous group. Results: Virological and biochemical relapse occurred significantly earlier in the discontinuous than continuous group, and the peak levels and ratios of peak to pretreatment levels of serum bilirubin and ALT after relapse were not significantly different between the two groups. Multivariate analysis identified three independent factors at discontinuation of treatment associated with early biochemical relapse: HBeAg positivity, presence of liver cirrhosis, detection of basic core promoter mutant. Normalization of ALT levels with retreatment occurred in 62.5% of patients, but 2 HBeAg-positive patients retreated after the emergence of YMDD motif mutant developed severe relapse with hyperbilirubinemia. Conclusion: Our results in Japanese patients with genotype C-dominant hepatitis B suggest that discontinuation of lamivudine monotherapy, and retreatment after the emergence of YMDD mutant should be given attention.
Replication-Competent Chimeric Hepatitis C Virus Subgenomic Replicons
Authors: Lemm Julie A. , Liu Mengping , Rose Ronald E. , Fridell Robert , O’Boyle II Donald R. , Colonno Richard , Gao Min
Published: April 2005

Objective: To utilize chimeric hepatitis C virus (HCV) replicons to select adaptive mutation(s) that allow replication of a genotype 1a replicon. Methods: We used a genetic approach to gradually apply selective pressure by generating chimeric replicons through sequential replacement of nonstructural genes of a 1b replicon with genotype 1a sequences. Results: A chimeric replicon containing a genotype 1a NS5A protein did not replicate in a transient assay, but could be used to establish stable cell lines using G418 selection. The cell lines contained a K1846T mutation in NS4B which functioned as an adaptive mutation that now allowed the chimera to replicate at levels similar to wild-type replicons. Similarly, replication of a 1a NS5A5B chimera was only observed after establishment of stable cell lines, even in the presence of the K1846T mutation. Sequence analysis of this cell line revealed an additional adaptive mutation of M1496L in NS3. Lastly, by including the K1846T mutation in a replicon that was entirely genotype 1a sequence, stable 1a cell lines could be established. Conclusion: These studies identify an NS4B adaptive mutation, K1846T, which allows establishment of a replication-competent 1a replicon and demonstrate the utility of this chimeric approach for establishing replicons for various HCV genotypes.
Detection of HIV RNA Levels in Intraocular and Cerebrospinal Fluids in Patients with AIDS-Related Cryptococcosis
Authors: Peng Chi-Hsien , Chen Shih-Jen , Ho Chi-Kung , Ku Hung-Hai , Lin Hon-Wun , Chen Steve S.-L. , Wu Chih-Chiau , Chi Chin-Wen , Hsu Wen-Ming , Chiou Shih-Hwa
Published: April 2005

The objective of the present study was to evaluate human immunodeficiency virus (HIV) levels in the aqueous humor and vitreous fluid in patients with and those without ocular involvement due to AIDS-related cryptococcosis. We also assessed whether cryptococcosis infection in the central nervous system (CNS) was associated with elevated HIV levels in the cerebrospinal fluid (CSF). From 1993 to 2003, we obtained 16 CSF samples from 9 AIDS patients with cryptococcal meningitis and 7 AIDS patients without CNS opportunistic infection. Samples of intraocular fluids were obtained from all 9 patients with cryptococcal meningitis. Five cases presented with ocular involvement in patients with meningitis. By using the method of reverse transcriptase-polymerase chain reaction, we detected higher HIV loads in aqueous humor (27,244 ± 4,123 copies/ml) and vitreous fluid (84,930 ± 5,071 copies/ml) in patients with concomitant CNS and ocular involvement due to AIDS-related cryptococcosis (p<0.05). HIV levels in the vitreous fluid were correlated with levels in CSF (r = 0.77). Mean HIV level in the CSF (209,761 ± 18,787 copies/ml) was significantly elevated in AIDS patients with cryptococcoal meningitis (p<0.05). To our knowledge, this is the first report to study the level of HIV loads in the CSF and intraocular fluid simultaneously in AIDS patients with cryptococcosis. Our results revealed the intrathecal and intraocular HIV replication in patients with cryptococcosis.
The Incidence of Myelofibrosis in Essential Thrombocythaemia, Polycythaemia vera and Chronic Idiopathic Myelofibrosis: A Retrospective Evaluation of Sequential Bone Marrow Biopsies
Authors: Kreft Andreas , Büsche Guntram , Ghalibafian Maryam , Buhr Thomas , Fischer Thomas , Kirkpatrick Charles James
Published: April 2005

The incidence of myelofibrosis (MF) among the three major Philadelphia chromosome-negative chronic myeloproliferative disorders, i.e. essential thrombocythaemia (ET), polycythaemia vera (PV) and chronic idiopathic myelofibrosis (CIMF), is not well documented since the diagnostic criteria have recently been redefined by the WHO. Therefore we performed a retrospective analysis of follow-up biopsies of 275 patients with ET, PV and CIMF according to the WHO classification of chronic myeloproliferative disorders. In the diagnostic bone marrow biopsies, MF was observed in 57 of the 136 CIMF patients (42%), 4 of the 73 PV patients (5%) and none of the 66 patients with ET. Within a median observation time of 2.9 years, 34 of the 79 patients with CIMF (43%), 13 of the 69 patients with PV (19%) and 1 of the 66 patients with ET (1.5%) – each initially without MF – developed MF regardless of myelosuppressive therapy.
Chemoprevention of Gastric Cancer: Role of COX-2 Inhibitors and Other Agents
Authors: Nardone Gerardo , Rocco Alba
Published: April 2005

Despite the decrease in incidence, gastric cancer remains the second leading cause of cancer-related death worldwide. Prevention is likely to be the most effective means of not only reducing the incidence but also mortality from this disease. The term ‘chemoprevention’ has been referred to the prevention of cancer using specific agents to suppress or reverse the carcinogenic process. In recent years, attention has been focused on the anticancer properties of non-steroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori eradication therapy and diet life-style. In vitro and in vivo studies show that widespread and long-term use of NSAIDs may be adopted in the healthy population for gastric chemoprevention. Albeit, enthusiasm has been thwarted by the potential toxic effects, i.e., risk of peptic ulcer disease. The new NSAIDs, selective cyclooxygenase-2 inhibitors, causing less injury to the mucosa of the upper gastrointestinal tract may be a valid alternative. However, fundamental questions such as safety, efficacy, mechanisms of actions, and optimal treatment regimens need to be defined. H. pylori triggers gastric carcinogenesis, however, cost-effect analyses suggest that only a subgroup of H. pylori-infected subjects present beneficial changes following eradication therapy. Diet plays an important role in the pathogenesis of gastric cancer either increasing the risks of or protecting against, cancer development. Thus, a reasonable suggestion for the general population is a natural chemoprevention based on life-style ‘eat to live, not live to eat’.
Endoscopic Palliation and Nutritional Support in Advanced Gastric Cancer
Authors: Dormann A.J.
Published: April 2005

Most of the patients with advanced gastric cancer have incurable disease at presentation and require palliative treatment to reduce symptoms as vomiting, nausea and inability to eat. Treatment options are palliative surgery and endoscopic techniques. Insertion of self-expanding metal stents is nowadays a well-established method of treating biliary and esophageal strictures and is also effective in gastric tumors. The indication and application technique are described in this review. In addition, enteral nutrition is indicated if the gastrointestinal tract functions but swallowing or mastication is compromised by disease or if it is needed to pass an obstructed area, especially in gastric tumor patients. This article reviews the enteral nutrition techniques and their clinical value for patients with advanced gastric cancer.
Recent Developments in Chemotherapy of Advanced Gastric Cancer
Authors: Götze Tobias , Schütte Kerstin , Röcken Christoph , Malfertheiner Peter , Ebert Matthias P.A.
Published: April 2005

Approximately 1 million individuals develop gastric cancer every year and the mortality of gastric cancer is only second to lung cancer. The poor prognosis is caused by late diagnosis of most cancers in advanced stages and the limited therapeutic options in these stages. Apart from the elucidation of underlying molecular and genetic changes in the development and progression of gastric cancers, the development of new treatment strategies is critical for the improvement of the treatment and prognosis of these patients. In this review we have summarized and critically assessed recent studies dealing with the chemotherapy of advanced gastric cancer. While the efficacy of most treatment regimens is only limited, new developments may indicate that treatment with chemotherapy may confer some benefit in the future.
Modification of Collagen Matrices for Enhancing Angiogenesis
Authors: Yao Chang , Prével Pascale , Koch Sabine , Schenck Peter , Noah Ernst Magnus , Pallua Norbert , Steffens Guy
Published: April 2005

The vascularization of engineered tissues in many cases does not keep up with the ingrowth of cells. Nutrient and oxygen supply are not sufficient, which ultimately leads to the death of the invading cells. The enhancement of the angiogenic capabilities of engineered tissues therefore represents a major challenge in the field of tissue engineering. The immobilization of angiogenic growth factors may be useful for enhancing angiogenesis. The most potent angiogenic growth factor specific to endothelial cells, vascular endothelial growth factor (VEGF), occurs in several splice variants. The variant with 165 amino acids both has a high angiogenic activity and a high affinity for heparin. We therefore incorporated heparin molecules into collagen matrices by covalently cross-linking them to amino functions on the collagen. Physical binding of VEGF to the heparin may then prevent a rapid clearance from the implant, while the release rate may become coupled to the degradation of the collagen matrix. The modified matrices were characterized by determination of the extent of the heparin immobilization, the in vitro degradation rate by collagenase. For testing the angiogenic properties, non-modified and heparinized collagen specimens were – either loaded with VEGF or non-loaded – subcutaneously implanted on the back of rats. Specimens were explanted after varying periods of implantation, the dry weights and the hemoglobin contents, as well as immunostained histological sections were evaluated: heparinized collagen matrices loaded with VEGF are vascularized to a substantially higher extent as compared to non-modified matrices.
The Slit Ventricle Syndrome: Advances Based on Technology and Understanding
Authors: Rekate Harold L.
Published: April 2005

Despite many articles on slit ventricle syndrome (SVS) over the last 25 years, accepted terminology regarding the definition of this condition is lacking. Any shunted individual with a severe headache disorder in the context of ventricles that are normal or smaller than normal can be said to suffer from SVS, even though there are at least five forms of the condition. Logical management of SVS requires an understanding of the specific pathogenesis of the problem in individual patients, whether based on monitoring of intracranial pressure (ICP) or observation at the time of shunt failure or symptoms. Overdrainage syndromes, whether intermittent proximal obstruction or low pressure states, are best managed with valve upgrades and the addition of devices that retard siphoning. Increased ICP without ventriculomegaly at the time of shunt failure is best managed by shunting devices that access the cortical subarachnoid space such as lumboperitoneal shunts or shunts involving the cisterna magna. Cranial expansion operations and subtemporal decompression should be limited to patients with craniofacial syndromes.
Spinal Neurenteric Cyst
Authors: Shenoy S.N. , Raja A.
Published: April 2005

Neurenteric cysts are rare congenital lesions of the spine that are lined with entodermal epithelium. We describe 4 unusual cases of neurenteric cysts in patients aged between 3 and 16 years. The cyst was situated anteriorly in 3 patients and posteriorly in 1. All the patients had varied clinical and radiological features. The child with dorsal neurenteric cyst had stigmata of spinal dysraphism along with other vertebral anomalies. Another child had an associated syringomyelia along with evidence of severe arachnoiditis. All 4 patients underwent laminectomy and total microsurgical excision of the cysts through a posterior approach. The patient with diastematomyelia developed early recurrence of the cyst and underwent reoperation. Three patients showed an excellent recovery after surgery. The child with arachnoiditis failed to recover neurologically.
Spinal Rhabdomyosarcoma in a Child with Lipomyelomeningocele
Authors: Wagner Wolfgang , Koch Dorothee
Published: April 2005

Malignant tumors arising within dysrhaphic malformations are very rare and are mostly teratomas; so far, only one rhabdomyosarcoma has been reported in this context. We report another case of a girl with lipomyelomeningocele who developed a lumbar rhabdomyosarcoma 2 years after birth and primary closure of the neural tube defect. We present clinical, radiological and pathological findings, discuss possible mechanisms of malignant transformation and review the literature.
Germinoma of the Basal Ganglia
Authors: Takeda Naoya , Fujita Katsuzo , Katayama Shigenori , Uchihashi Yoshito , Okamura Yusuke , Nigami Hiroyuki , Hashimoto Kimio , Kohmura Eiji
Published: April 2005

We describe a case of germinoma of the left basal ganglia. An 11-year-old boy, who demonstrated calcification of the left basal ganglia on CT scan following a head injury at the age of 3 years, presented with a weakness of the right upper extremity for 2 months. MRI demonstrated high intensity in the left basal ganglia on a T1-weighted image without enhancement as well as high intensity on a T2-weighted image. Ipsilateral hemiatrophy of the hemisphere and midbrain was also noted. In addition, high intensity in the left internal capsule and cerebral peduncle was demonstrated on T2-weighted image. Surgical specimens obtained by stereotactic biopsy showed germinoma with a two-cell pattern. The patient had remained asymptomatic for 8 years after abnormal calcification was initially detected on CT scan. Ipsilateral hemiatrophy of the hemisphere and midbrain was demonstrated before the onset of weakness.
Mood and Cognitive Function in Elderly Diabetic Patients Living in Care Facilities
Authors: Hagemann Rachel , Sartory Gudrun , Hader Claus , Köbberling Johannes
Published: April 2005

Community studies found deficits of cognitive function in elderly persons with diabetes. The aim of the present study was to compare diabetes and other age-related diseases among residents of senior citizens’ care facilities. Participants were 130 residents with and 130 without a diagnosis of diabetes aged between 65 and 98 years. Measures were neuropsychological tests designed for this age group, questionnaires of mood, quality of life and daily activities and level of glycosylated hemoglobin (HbA1c) as an index of metabolic control. Only verbal memory was significantly more impaired in residents with than without diabetes. Otherwise, both groups showed overall impairment of cognitive function and mood. Unexpectedly, a slightly elevated HbA1c level (6–8%) was associated with an increased level of cognitive and everyday functioning. In old age, diabetic patients might benefit from a slightly higher level of blood glucose than has hitherto been assumed.
A Note on Linkage Analysis with Affected Sib Triplets
Authors: Knapp Michael
Published: April 2005

Previously, it has been shown for affected sib pairs that the mean test is the uniformly (in Θ) most powerful test in case of a multiplicative mode of inheritance and that the mean test is equivalent to parametric linkage analysis calculated under an assumed multiplicative mode of inheritance. Here, these two results are extended to samples consisting of affected sib triplets. For affected sib quadruplets, however, it is shown that these results are no longer valid.
Common Genetic and Environmental Effects on Lipid Phenotypes: The HERITAGE Family Study
Authors: Feitosa Mary F. , Rice Treva , Rankinen Tuomo , Almasy Laura , Leon Arthur S. , Skinner James S. , Wilmore Jack H. , Bouchard Claude , Rao D.C.
Published: April 2005

Objective: Despite the well known genetic component influencing plasma lipid-lipoprotein levels and the observed correlations among these traits, little is known about pleiotropic heritable determinants among them. Our aim is to investigate pair-wise polygenic and environmental correlations among lipid-lipoprotein levels at baseline and in response to regular exercise in Whites and Blacks. Methods: Common pair-wise genetic and environmental correlations among levels of total cholesterol (TC), LDL-C, ApoB, HDL-C (also HDL2-C and HDL3-C), triglycerides (TG, HDL-TG and LDL-TG) and ApoA-1 were investigated at baseline and again after a 20-week endurance exercise program using a variance-components-decomposition. Results: With a few exceptions, all lipid phenotypes were heritable at baseline and for training responses in Blacks and Whites. Strong to high genetic and environmental correlations (0.4 < ρg < 0.7) were observed for the majority of the baseline pair-wise traits. For training responses, many of the same patterns were noted, although fewer genetic correlations were significant as compared to the baseline results. Conclusions: Results suggest that the observed phenotypic correlations among many of these traits may be due to in part to pleiotropic genes, in particular between LDL-C and ApoB and between TG and HDL-C. This shared genetic architecture should be considered in follow-up gene finding studies.
Attachment and Borderline Personality Disorder: Implications for Psychotherapy
Authors: Levy Kenneth N. , Meehan Kevin B. , Weber Michal , Reynoso Joseph , Clarkin John F.
Published: April 2005

Background: Psychopathology researchers and theorists have begun to understand fundamental aspects of borderline personality disorder (BPD) such as unstable and intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment, intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. In the present study, we will examine self-reported attachment in a study group of well-characterized patients reliably diagnosed with BPD. Sampling and Methods: Ninety-nine outpatients reliably diagnosed with BPD using the International Personality Disorders Examination, completed a number of attachment measures including the Relationship Questionnaire, Relationship Style Questionnaire, and Experiences in Close Relationships inventory. Results: Factor analysis revealed six factors that clustered into three groups corresponding to an avoidant attachment pattern, a preoccupied attachment pattern, and a fearfully preoccupied pattern. The preoccupied pattern showed more concern and behavioral reaction to real or imagined abandonments, whereas the avoidant group had higher ratings of inappropriate anger. The fearfully preoccupied group had higher ratings on identity disturbance, although only at the trend level. Conclusions: The psychometric properties and response characteristics of the ECR items suggest that the scales, keying, and domains are appropriate for assessment of attachment in BPD samples. The scales generally retain their factor structure and show a similar pattern of correlations and inter-relationships. Nevertheless, consistent with a developmental psychopathology model, there are some important differences in factor structure, indicating the need to look at both typical and atypical samples when constructing models of attachment. Further research is needed to delineate the prognostic and prescriptive significance of attachment patterns for treating patients with BPD.
Carnitine Therapy Is Associated with Decreased Hospital Utilization among Hemodialysis Patients
Authors: Kazmi Waqar H. , Obrador Gregorio T. , Sternberg Maya , Lindberg Jill , Schreiber Brian , Lewis Vyoone , Pereira Brian J.G.
Published: April 2005

Background/Aims: Hospitalizations account for 41% of the total cost of end-stage renal disease (ESRD) care. Carnitine deficiency is common among dialysis patients, and some studies have shown improvements in anemia, and cardiac and skeletal muscle function upon administration of L-carnitine. We hypothesized that L-carnitine may be associated with decreased hospital utilization in these patients. Methods: The Fresenius Medical Care North America dialysis database was used for this retrospective analysis. Adult patients who received carnitine for at least 3 months, and had at least 3 months of pre-carnitine follow-up were included in the study. Hospitalization and hospital day rates were compared before and during carnitine therapy, and with a matched population. Results: Carnitine therapy at a mean dose of 1.5 ± 0.7 g per administration for an average of 9.7 ± 5.4 months was associated with a significant reduction in hospital utilization. Patients with cardiovascular disease, defined as hospitalizations for angina, myocardial infarction, arrhythmia, congestive heart failure, cerebral vascular disease or peripheral vascular disease prior to receiving carnitine, and those with anemia and hypoalbuminemia derived the greatest benefit from carnitine therapy. In a multivariate analysis, compared to 3 months prior to the initiation of carnitine, the adjusted relative risk for hospitalization was 11, 11, and 15% lower at 3, 6, and 9 months, respectively. Among patients with cardiovascular disease, the reduction in risk was even more significant (24, 31, and 34% lower at 3, 6, and 9 months, respectively). Similar results were observed with adjusted relative risk for hospital days. Conclusion: Administration of L-carnitine to chronic hemodialysis patients is associated with lower hospital utilization.
Body Fat Distribution and Long-Term Risk of Stroke Mortality
Authors: Tanne David , Medalie Jack H. , Goldbourt Uri
Published: April 2005

Background and Purpose—

Excess weight is an important determinant of cardiovascular disease, but the relationship between excess weight, its distribution, and stroke is yet unclear. We examined in a large prospective cohort study the association between body fat distribution and stroke mortality among middle-aged men.

Methods—

A cohort of male civil servants and municipal employees free of cardiovascular disease in Israel (n=9151) were followed up for mortality over 23 years. The subscapular skinfold (SSF) was used as a measure of trunk and overall obesity and the ratio of subscapular to triceps skinfold thickness (SFR) as an indicator of trunk versus peripheral distribution of body fat.

Results—

During the follow-up period, 316 died of stroke, and 865 died of coronary heart disease. The estimated age-adjusted hazard ratios (HRs) for stroke mortality, associated with 1 SD increment of SSF, was 1.12 (95% CI, 1.01 to 1.25) and for body mass index, 1.17 (1.06 to 1.30), but these associations were markedly weakened when adjusting for blood pressure. SFR was associated with an age-adjusted HR for stroke mortality of 1.14 (1.03 to 1.26). Further adjusting for systolic blood pressure, diabetes mellitus, cigarette smoking, and socioeconomic status (HR, 1.11; 1.01 to 1.23) as well as body mass index (HR, 1.11; 1.00 to 1.23) only mildly attenuated this association. Subjects with SFR in the upper quartile exhibited a ≈1.5-fold higher adjusted HR (1.53; 1.10 to 2.12) compared with the lowest quartile.

Conclusion—

Indices of body fat and body fat distribution predict long-term stroke and coronary heart disease mortality among middle-aged men. SFR, an indicator of trunk versus peripheral distribution of body fat, is associated with stroke mortality, independent of main mediators of the effect of obesity on health and of body mass index.
Phosphodiesterase 4D
Gene, Ischemic Stroke, and Asymptomatic Carotid Atherosclerosis
Authors: Bevan S. , Porteous L. , Sitzer M. , Markus H.S.
Published: April 2005

Background and Purpose—

Phosphodiesterase 4D
(
PDE4D
) was identified recently as the first novel stroke gene to predispose to ischemic stroke independently of conventional risk factors. An association was only found with large vessel and cardioembolic stroke, suggesting a mechanism of accelerated atherosclerosis. We sought to replicate this association in ischemic stroke as a whole, and individual stroke subtypes, in a non-Icelandic European population. To assess a role in early atherosclerosis, we also sought associations with underlying asymptomatic atherosclerosis itself, assessed by carotid ultrasound in a community population.

Methods—

A total of 737 consecutive white patients with stroke and 933 white community controls free of symptomatic cerebrovascular disease were examined using a case control methodology. For association with atherosclerosis, intima-media thickness (IMT) in a community population (n=1000) was assessed using carotid ultrasound. Nineteen single nucleotide polymorphisms (SNPs) and 1 minisatellite in the
PDE4D
gene were determined, with haplotyping undertaken using Phase 2.0.

Results—

No association with ischemic stroke overall was identified. Six of the 19 SNPs were associated with cardioembolic stroke and 2 different SNPs with large vessel disease. There was no association with carotid artery IMT or carotid plaque in the asymptomatic community subjects.

Conclusions—

The
PDE4D
gene is not a major risk factor for ischemic stroke, or early atherosclerosis, within the 2 European population samples studied. On analysis of individual stroke subtypes, there is a possible association with cardioembolic stroke, but the lack of association with carotid IMT and plaque would suggest that this is via a mechanism other than accelerated atherosclerosis.
Natriuretic Peptides and Mortality After Stroke
Authors: Mäkikallio A.M. , Mäkikallio T.H. , Korpelainen J.T. , Vuolteenaho O. , Tapanainen J.M. , Ylitalo K. , Sotaniemi K.A. , Huikuri H.V. , Myllylä V.V.
Published: April 2005

Background and Purpose—

Measurement of natriuretic peptides provides prognostic information in various patient populations. The prognostic value of natriuretic peptides among patients with acute stroke is not known, although elevated peptide levels have been observed.

Methods—

A series of 51 patients (mean age, 68±11years) with first-ever ischemic stroke underwent a comprehensive clinical examination and measurements of plasma atrial natriuretic peptides (N-ANP) and brain natriuretic peptides (N-BNP) in the acute phase of stroke. The patients were followed-up for 44±21 months. Risk factors for all-cause mortality were assessed. Control populations, matched for gender and age, consisted of 51 patients with acute myocardial infarction (AMI) and 25 healthy subjects.

Results—

Plasma concentrations of N-ANP (mean±SD, 988±993 pmol/L) and N-BNP (751±1608 pmol/L) in the stroke patients were at the same level as those in the AMI patients (NS for both), but significantly higher than those of the healthy subjects (358±103 pmol/L,
P
<0.001 and 54±26 pmol/L,
P
<0.01, respectively). Elevated levels of N-ANP and N-BNP predicted mortality after stroke (risk ratio [RR] 4.3,
P
<0.01 and RR 3.9,
P
<0.01, respectively) and after AMI (
P
<0.05), and remained independent predictors of death after stroke even after adjustment for age, diabetes, coronary artery disease, and medication (RR 3.9,
P
<0.05 and RR 3.7,
P
<0.05, respectively).

Conclusion—

Plasma levels of natriuretic peptides are elevated in the acute phase of stroke and predict poststroke mortality.
The Ins and Outs of Homeschooling
Authors: Collom Ed
Published: April 2005

This research investigates two major aspects of homeschooling. Factors determining parental motivations to homeschool and the determinants of the student achievement of home-educated children are identified. Original survey data from an organized group of homeschoolers is analyzed. Regression models are employed to predict parents’ motivations and their students’ standardized test achievement. Four sets of homeschooling motivations are identified. Academic and pedagogical concerns are most important, and it appears that the religious base of the movement is subsiding. Several major demographic variables have no impact upon parental motivations, indicating that this is a diverse group. Parents’ educational attainment and political identification are consistent predictors of their students’ achievement. Race and class—the two major divides in public education—are not significant determinants of standardized test achievement, suggesting that homeschooling is efficacious. It is concluded that homeschoolers are a heterogeneous population with varying and overlapping motivations.
School Engagement Among Latino Youth in an Urban Middle School Context
Authors: Garcia-Reid Pauline , Reid Robert J. , Peterson N. Andrew
Published: April 2005

The education of many Latino youth residing in urban communities is often hindered by fear of crime and violence occurring in places where they live and attend school. Addressing these concerns, this study tested a path model predicting school engagement that included neighborhood and school environment variables (e.g., neighborhood youth behavior, neighborhood safety, and school safety) and social support variables (e.g., teacher support, friend support, parent support, and neighbor support). A total of 226 Latino youth from an urban middle school in the northeastern United States participated in the study. The hypothesized model was found to fit data from the sample and showed direct effects of teacher support, friend support, and parent support on school engagement. In addition, neighborhood youth behavior and neighborhood safety influenced school engagement indirectly through its effect on social support variables. Implications for school-based interventions are discussed.
Toward the Theoretical Measurement of Ethnic Identity
Authors: Pegg Phillip O. , Plybon Laura E.
Published: April 2005

The purpose of this study was to examine the psychometric qualities of two theoretical subscales of the Multigroup Ethnic Identity Measure (MEIM), Ethnic Identity Exploration and Ethnic Identity Commitment, that have been supported in research with early adolescent samples. The study was conducted to further validate the MEIM as a two-factor measure of the theoretical constructs of ethnic identity exploration and ethnic identity commitment. This study was conducted with 134 African American girls residing in a southeastern city. Psychometric support was found for the use of a subset of items derived from the MEIM that assesses the constructs of ethnic identity exploration and ethnic identity commitment. Discussion regarding the psychometric quality of the two-factor model is presented.
Early Puberty, Peer Victimization, and Internalizing Symptoms in Ethnic Minority Adolescents
Authors: Nadeem Erum , Graham Sandra
Published: April 2005

One thousand twenty-four African American and Latino sixth graders participated in a study examining the moderating role of pubertal development on the relation between peer victimization and adolescent self-worth, depressed mood, and physical symptoms using peer and self-reported victimization. It was hypothesized that early-maturing girls who were victimized would experience heightened internalized distress. Among boys, two competing hypotheses were tested: (a) the imbalance of power hypothesis predicted that late-maturing boys who were victimized would experience more psychological distress and (b) the social misfit hypothesis predicted that early-maturing victims would experience more distress. Results indicated that African American and Latino early-maturing boys and girls who were viewed as victims by their peers reported elevated depressed mood and physical symptoms and lower self-worth. The moderating role of early puberty was documented with reputational (peer report) measures of victimization rather than self-report measures, which highlights the social consequences of early maturation.
New Directions in Staff Consultation and Communication in the British Civil Service and Prison Service
Authors: Farnham David , Horton Sylvia , White Geoff
Published: April 2005

This article considers the changing nature of partnership, staff consultation, and communication practices in the British civil service and prison service. These changes began in the 1980s with the development of new public management and have continued under the Labour government’s rubric of public sector modernization. The article examines and reviews current attempts to create new forms of partnership at work, between public employers, trade unions, and individual employees, and other staff consultation and communication processes in response to modernization. The research is based on telephone interviews conducted in 2001 with senior managers and trade union officials in the civil service and prison service and supplementary documentary sources provided by the respondents.
Workplace Learning and Public Service Needs
Authors: Kessler Ian , Gibney Jane
Published: April 2005

This article evaluates a partnership scheme between the public sector union UNISON and the London Borough of Tower Hamlet designed to address the learning needs of teaching assistants. Highlighting local and national pressures affecting the role of teaching assistants, it explores how this scheme sought to develop new skills and capabilities among this group of employees with limited experience of formal learning. The article assesses the outcomes of the scheme from the perspective of the three key stakeholders, the assistants, the borough, and the union, arguing that many but not all of the respective objectives were met.
Predictors of African American Representation in Municipal Government
Authors: Goode Shelton J. , Baldwin J. Norman
Published: April 2005

This article presents the results of a path analysis that investigates the explanatory power of five new predictors of African American representation in city government against eight traditional predictors of representation in municipal government. The findings generally indicate that the percentage of African Americans in the city population and African American personnel directors are the most consistent predictors of African American representation in municipal civil service. African American actors in the internal environment of the personnel game—personnel directors, administrators, mayors, and council members—are also generally more predictive of African American representation in city government than variables in the external environments of municipalities.
Travels in Stroke Country
Authors: Kelley Heidi , Betsalel Ken
Published: April 2005

This ethnographic photo essay raises questions concerning the best way to represent the disabled. Drawing on one author’s experience of stroke and subsequent fieldwork in “stroke country,” this essay argues for a new kind of disability studies ethnography, an ethnography that critically understands disability as social construct while at the same time remains faithful to the stories disabled people tell.
Art in Nursing Research
Authors: Malinski Violet M.
Published: April 2005

The purpose of this column is to present the plan of a research project involving researchers, artists, and research participants. The planned research project will explore with the Parse method eight universal lived experiences important to persons in community. It is anticipated that art works will complement story and text in order to enhance understanding. The authors here present the first attempt of including an embedded artist with Parse method involving one participant who spoke about her experience of feeling respected-not respected. Researcher text and artist works are shown to enhance meaning and understanding.
The Language of Loss When a Baby Dies Prior to Birth: Cocreating Human Experience
Authors: Jonas-Simpson Christine , McMahon Eileen
Published: April 2005

When a baby dies prior to birth, a woman and her family begin a life long journey of living and transforming with loss. The language used with families during times of devastating loss is important to reflect upon since, language has the potential to either intensify suffering or enhance the family’s experience of grieving. Words that affirm the meaning the baby holds for the family can provide comfort as families engage with the reality of lost hopes and dreams. Recognizing that healthcare professionals do not intend to harm families whose babies die prior to birth, the current authors offer this column as a vehicle for reflecting on the meanings of words used during this particular time of loss and grief. The authors further explore the role that the arts have to play in expressing loss and in helping others to understand.
Customer Heterogeneity in Service Management
Authors: Danaher Peter J.
Published: April 2005

Possible customer heterogeneity is ignored in most customer satisfaction survey analyses, which is surprising given the prominence that customer segmentation has in many other marketing disciplines. In this article, the author examines some segmentation methods that are appropriate for the analysis of customer satisfaction survey data. This helps determine whether segmentation of customers in service environments is worthwhile. If segmentation is worthwhile, the author shows how to deliver targeted delivery to appropriate segments for examples from the airline and telecommunications industries.
Cultural Influences on Service Quality Expectations
Authors: Donthu Naveen , Yoo Boonghee
Published: April 2005

Service quality has been conceptualized as the difference between perceived service performance and expected service level. The authors study the effect of consumers' cultural orientation on their service quality expectations. Using the Hofstede dimensions of culture operationalized at the individual level and the dimensions of service quality from the SERVQUAL scale, they develop and test hypotheses relating dimensions of culture with overall service expectations and dimensions of those expectations. Results show that consumers low on power distance have high overall service quality expectations and expect responsive and reliable service. Individualistic consumers have high overall service quality expectations and expect empathy and assurance from the service provider Consumers high on uncertainty avoidance and short-termoriented consumers have high overall service quality expectations.
The Future of Health Promotion: Talkin™ Technology Blues
Authors: Wang Caroline C.
Published: April 2005

Talking about the future often means talking about technology. Does the future of health promotion lie in technology? This article offers a user’s perspective on this issue. By returning to core values in which health education practice is rooted, it raises basic questions we ought to ask as we apply technology to meet the challenges we face.
Who Knows the Streets as Well as the Homeless? Promoting Personal and Community Action through Photovoice
Authors: Wang Caroline C. , Cash Jennifer L. , Powers Lisa S.
Published: April 2005

Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. The purpose of the Language of Light Photovoice project was to enable men and women living at a shelter in Ann Arbor, Michigan to photograph their everyday health, work, and life conditions as a way to document their struggles and strengths; to promote critical dialogue through group discussion about their photographs; and to reach policy makers and the broader public about issues of concern to homeless people. The authors’ approach used photovoice, an innovative participatory action research method based on health promotion principles and the theoretical literature on education for critical consciousness, feminist theory, and a community-based approach to documentary photography. Photovoice involves community members’ taking pictures, telling stories, and informing policy makers about issues of concern at the grassroots level. The authors describe and analyze the project, offer recommendations to health promotion practitioners carrying out photovoice projects with society’s most vulnerable groups, and discuss implications for practice.
Recruitment, Retention, and Activity of Volunteers Promoting Mammography Use in Rural Communitites
Authors: Andersen M. Robyn , Hagher Micheelle , Meischke Hendrike , Shaw Carole , Yasui Yataka , Urban Nicole
Published: April 2005

As of a community mammography promotion, the authors recruited volunteers in rural communities to conduct intervention activities. Volunteers were trained to promote mammography use among the women in their community using a variety of community activities and/or barrier-specific telephone counseling (BSTC). As prior research on BSTC has suggested that it is a particularly effective means of screening promotion, the authors were interested in determining whether volunteers could be recruited and trained to be effective counselors. The results of this analysis suggest that recruiting volunteers for BSTC is not more difficult than recruitment of volunteers for more traditional community activities, but that special efforts may be required to retain volunteers doing BSTC and to encourage their activity. Overall, the use of community volunteers for mammography promotion in rural areas is possible, and volunteers using either intervention strategy may be able to increase screening use.
Family Matters: A Family-Directed Program Designed to Prevent Adolescent Tobacco and Alcohol Use
Authors: Bauman Karl E. , Foshee Vangie A. , Ennett Susan T. , Hicks Katherine , Pemberton Michael
Published: April 2005

This article describes a program for families that is intended to reduce adolescent tobacco and alcohol use. The program, featuring mailed booklets and follow-up telephone contacts by health educators, is directed toward general populations and is being evaluated with a randomized experiment involving families throughout the contiguous states of the United States. Considerations include description of the principles that influenced program features, the conceptual model for the program, the formative research conducted to design the program, the attributes of the final program as implemented nationally for 658 families, parent assessments of the program, program costs, and the evaluation design.
Concept Analysis of Pregnancy Planning Drawn from Women of Childbearing Age
Authors: Morin Pascale , St-Cyr-Tribble Denise , de Wals Philippe , Payette Hélène
Published: April 2005

Pregnancy planning is becoming an important issue in preconception health promotion. Unfortunately, its definition and measurement remain imprecise. This article will develop an operational definition and identify essential components of the concept of pregnancy planning. Six steps from Walker and Avant’s concept analysis procedure were used. Data were collected through a literature review, interviews with key informants, and three focus groups. The concept analysis yielded a conceptual framework comprising three essential components: attitude, timing, and sexual behavior. Pregnancy planning is defined as the adoption of an attitude centered on conception, including sexual behaviors (proceptive or contraceptive) and timing. Moreover, pregnancy planning is not a clear-cut phenomenon with questions that can be answered simply with “yes” or “no”. Rather, it is a dynamic process that evolves according to contextual factors. From these results, an instrument evaluating the intensity of pregnancy planning can be developed for epidemiological research and promotional purposes.