bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple birth and cerebral palsy in Europe: a multicenter study
Authors: Topp Monica , Huusom Lene Drasbek , Langhoff‐Roos Jens , Delhumeau Cecile , Hutton Jane L. , Dolk Helen
Published: May 2004

Background. A European multicenter study (Surveillance of Cerebral Palsy in Europe, SCPE) was used to describe changes over time in multiple birth rates and cerebral palsy (CP) rates among multiple born infants, to compare CP rates and clinical types between multiples and singletons, and to analyse the influence of birth order in twins.

Methods. Data were collected from 12 European population‐based CP registers on 6613 children born in 1975–90, as well as demographic data.

Results. The rate of multiple birth in the populations increased from 1.9% in 1980 to 2.4% in 1990, and the proportion of multiples among CP infants increased from 4.6% in 1976 to 10% in 1990. Multiples have a four times higher rate of CP than singletons [7.6 vs. 1.8 per 1000 live births, relative risk (RR) 4.36; 95% confidence interval (CI) 3.76–4.97] overall. The risk is marginally higher in multiples with birthweight > 2500 g (RR 1.60; 95% CI 0.95–2.28) and born at term (RR 1.65; 95% CI 0.91–2.40), and there is no difference in the risk for the low‐birthweight and preterm groups. Correcting for differences in gestational age and birthweight, the clinical type of CP was the same in multiples and singletons. Twin CP infants are more often second than first born (56% vs. 44%,p < 0.05).

Conclusions. Multiple born infants have a four times higher risk of developing cerebral palsy than singletons, mainly related to the higher risk of preterm birth in multiples. As the rate of multiples doubled through the 1980s, cerebral palsy cases in multiples increased in the same period.
A longitudinal study on different models of postabortion care in Tanzania
Authors: Rasch Vibeke , Massawe Siriel , Mchomvu Yasinta , Mkamba Mashombo , Bergström Staffan
Published: May 2004

Objective.  To identify women having unsafe abortions and elucidate whether an acceptable follow‐up rate among these women can be retrieved.

Study population.  One thousand three hundred and fifty‐seven women attended Temeke Municipal Hospital, Dar es Salaam with an abortion‐related diagnosis.

Methods.  Women having unsafe abortions were identified by an empathetic dialogue, offered a contraceptive service and asked to return for follow‐up. Three different ways of achieving follow‐up information were tested. In phase 1, a combination of hospital‐based and home‐based interviews was utilized, in phase 2, an additional 1‐month control visit was added to the protocol, and in phase 3, the contraceptive counseling and service was provided by technically well‐skilled counselors.

Results.  Seven hundred and eighty‐eight women were identified as having had unsafe abortions and 491 women as spontaneous abortions. Women having unsafe abortions were younger, more often single and of higher parity than women having spontaneous abortions. The follow‐up rate achieved varied from 47%−72%, being lowest in phase 1 and highest in phase 3. The two most common reasons for loss to follow‐up were the interviewer's inability to locate the respondent's house either because of an unspecific or a remote address (58%) and migration (29%).

Conclusion.  If hospital‐based and confidential home‐based interviews are used combined and if the women having unsafe abortions are counseled by technically well‐skilled counselors, it is possible to achieve a reasonable follow‐up rate among women having unsafe abortions.
Pulmonary embolism associated with combined oral contraceptives: reporting incidences and potential risk factors for a fatal outcome
Authors: Hedenmalm Karin , Samuelsson Eva , Spigset Olav
Published: May 2004

Background.  It is established that combined oral contraceptive (COC) treatment increases the risk of a pulmonary embolism (PE), but specific risk factors for a fatal outcome from a PE remain to be determined. This study aimed to identify such risk factors, and to calculate the reporting rates of fatal and non‐fatal PE.

Methods.  Cases of suspected PE during treatment with COCs reported to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) between 1965 and 2001 were included. Medical records were scrutinized for potential risk factors for a venous thromboembolism (VTE). Annual sales data were obtained from the National Corporation of Pharmacies.

Results.  A total of 248 cases of a suspected PE were reported; 207 non‐fatal and 41 fatal. A VTE was verified in all fatal, and in 83.5% of non‐fatal cases. The presence of nausea or abdominal pain, an age >35 years, concomitant treatment with other drugs which may increase the VTE risk, vein or lymph vessel malformation, and a deep vein thrombosis above the knee level were positively associated with a fatal outcome. Chest pain and previous COC use were negatively associated with a fatal outcome. The reporting rate of a PE with a verified VTE was 1.72 (95% confidence interval 1.47–2.00) cases per 100 000 treatment years, and of a fatal PE 0.25 (95% confidence interval 0.16–0.37) cases per 100 000 treatment years.

Conclusion.  Several specific potential risk factors for a fatal outcome from a COC‐induced PE were identified. Recognition of these in combination with a high suspicion of VTE in COC users may reduce the risk of a fatal outcome.
Introduction to Improving Arab‐Jewish Relations in Israel: Theory and Practice in Coexistence Educational Programs
Authors: Stephan Cookie White , Hertz‐Lazarowitz Rachel , Zelniker Tamar , Stephan Walter G.
Published: May 2004

Israeli Jewish and Arab experts within Israel have developed innovative intergroup relations programs, educational efforts designed to improve relations between Israeli Jews and Israeli Arabs. Social scientists, educators, and practitioners on both sides of the Arab‐Jewish conflict have dedicated themselves to lessening the hostility between these two groups within Israel through coexistence educational training. This issue presents theory, methods, and data from these coexistence educational programs. The introductory article presents a brief history of this conflict; the groups' differing perceptions regarding the dispute; some information about the role of culture, socioeconomic status, and ethnicity in the discord; and some of the social psychological processes that perpetuate and recreate the hostilities. Last, it provides a brief preface of this issue's articles.
Nature, Rationale, and Effectiveness of Education for Coexistence
Authors: Bar‐Tal Daniel
Published: May 2004

Coexistence is a state of mind shared by society members who recognize the rights of another group to exist peacefully as a legitimate, equal partner with whom disagreements have to be resolved in nonviolent ways. Achieving coexistence is a great challenge because of the negative relations between the two groups. These negative relations, the result of ethnocentric beliefs or intractable conflict, are widely shared and their abolition requires deep societal change. Education for coexistence plays an important function in this change. The article suggests that when negative relations are based on ethnocentrism, education for coexistence plays a major role in changing the nature of the relations. But when negative relations derive from intergroup conflict, education for coexistence has less influence.
Coping With the Jewish‐Arab Conflict: A Comparison Among Three Models
Authors: Ben‐Ari Rachel
Published: May 2004

Three models are surveyed and compared with regard to their efficacy in promoting change in intergroup attitudes and relations, particularly in Israel's Jewish‐Arab relationships: the contact model, the information model, and the metacognitive model. The first two models have been widely applied to intergroup conflict, including the Jewish‐Arab situation, but both have faced some serious problems. Proposed as an alternative, the metacognitive model could address problems faced by the contact and information models. The article discusses the theoretical aspects and practical applications of the model, and proposes how it can be combined with the contact and information models in order to increase the efficacy of coping with intractable cases of intergroup relations such as the Jewish‐Arab conflict.
Planned Encounters Between Jewish and Palestinian Israelis: A Social‐Psychological Perspective
Authors: Suleiman Ramzi
Published: May 2004

Several ideas derived from Social Identity Theory are used to analyze intergroup processes taking place in planned encounters between Jews and Palestinians in Israel. In addition to the interpersonal dimension of such encounters, the article focuses on the importance of intergroup variables (e.g., power and status differences) in understanding psychological and behavioral reactions of majority and minority group members. The theoretical analysis brought here is used to suggest ways that can improve the management of structured Jewish‐Palestinian meetings.
Culturally Sensitive Education: Adapting Self‐Oriented Assertiveness Training to Collective Minorities
Authors: Dwairy Marwan
Published: May 2004

Palestinian Arab citizens of Israel have suffered from neglect and discrimination. They face a policy of “Israelization” and rejection of their national and cultural identity. The self‐oriented education that is advocated by the Israeli ministry of education is perceived as a threat to Arabic family unity and to their cultural and national identity; therefore, it is resisted. Adopting culturally sensitive education would be an important step toward trust and coexistence. This article suggests a culturally sensitive adaptation of assertiveness training programs. Respecting Arab values and norms, as well as the joining of parents, teachers, and community leaders is central to accomplishing success for this program. Implications for coexistence meetings of Palestinian Israelis and Jews are discussed.
Existence and Coexistence in Acre: The Power of Educational Activism
Authors: Hertz‐Lazarowitz Rachel
Published: May 2004

This article presents a five‐year action‐research project of systemic change toward coexistence in Acre, a mixed Arab‐Jewish city in Israel. Educational activism was the basis for this project. Because education in Acre was closely interwoven with discriminative politics, this project used a citywide systemic approach consisting of three layers: (a) work in schools that used cooperative learning to increase achievement, (b) work with parents in school‐family literacy partnerships, and (c) work with the city's educational and political leadership for citywide change. Data presented for each layer show the potential of this long‐term holistic approach to bring coexistence to the community even though regional and political factors worked against community coexistence.
The Jewish‐Palestinian Encounter in a Time of Crisis
Authors: Halabi Rabah , Sonnenschein Nava
Published: May 2004

For over two decades the School for Peace at Neve Shalom/Wahat al‐Salam has been bringing together Jews and Arabs for dialogue workshops. This article examines the unique approach that the School for Peace has developed over the years in the light of existing theory in the field and of existing research in the field of social identity construction and majority‐minority relations. The article then shows how processes that take place in our encounter workshops may even shed light on the Jewish‐Palestinian conflict from 1948 until today. Understanding these processes is essential to any attempt at building a more humane society based on equality and justice between the two peoples.
A Narrative‐Based View of Coexistence Education
Authors: Salomon Gavriel
Published: May 2004

Collective narratives of groups in conflict—their perceived histories, beliefs, self‐image, and those of their adversaries—play a central role in interpreting and fueling the conflict—and, thus, can play an equally central role in facilitating coexistence. One of their main correlates is their implied delegitimization of the “other's” collective narrative, its pains, its sufferings, its history, and its aspirations. It is this deligitimization that ought to be the main target for change if coexistence is to be promoted, including the acknowledgement of one's own contribution to the conflict. Four dilemmas are discussed: coexistence programs for the dominant versus the subordinate groups; possible counterproductive outcomes; resistance against antagonistic, dominant narratives; and the problem of short‐term intervention programs.
Coexistence Is in the Eye of the Beholder: Evaluating Intergroup Encounter Interventions Between Jews and Arabs in Israel
Authors: Maoz Ifat
Published: May 2004

This article presents a paradigm of process evaluation of intergroup contact interventions that has two objectives: (a) to classify intergroup encounters by their ideology and (b) to define and apply criteria that evaluate the quality of intergroup interaction, focusing on symmetry between members of both groups in active participation in the encounter. This paradigm was applied to evaluate 47 encounters programs between Israeli Jews and Israeli Arabs that were classified into two major approaches—those that emphasize coexistence and similarities between the sides and those that emphasize conflict and confrontation. Equality in participation of Jewish and Arab participants was found in the vast majority (89%) of programs. However, symmetry between Jewish and Arab facilitators varied and was higher in programs including confrontational elements.
Arab‐Jewish Bilingual Coeducation in Israel: A Long‐Term Approach to Intergroup Conflict Resolution
Authors: Bekerman Zvi , Horenczyk Gabriel
Published: May 2004

This article offers insights into a new educational adventure in Israel that attempts to overcome interethnic conflict through bilingual coeducation. These insights were gathered during a two‐year research project in which the authors followed the activities of two recently established Arab‐Jewish bilingual schools. Their analysis is based primarily on qualitative data of educational and sociocultural processes involved in the functioning and development of the schools as they relate to four major areas: language, cultural and religious identity, national identity, and social interactions. The study showed the potential benefits of one type of intergroup contact, namely, bilingual long‐term coeducation, but also shed light on the complexity and the difficulties facing all of the parties involved in such an adventurous enterprise.
Education for Coexistence and Arab‐Jewish Encounters in Israel: Potential and Challenges
Authors: Abu‐Nimer Mohammed
Published: May 2004

The killing of thirteen Arabs by Israeli police forces in October 2000 points to the mounting tension and hostility between Arabs and Jews in Israel. Encounter and coexistence programs constitute one of the few channels for the development of communication, trust, and genuine understanding of the complex Arab‐Jewish reality in Israel. Thus, it is essential that these encounters be examined and professionally developed to respond to the needs of the two communities. This article examines certain shortcomings of these encounter programs and provides suggestions to improve their efficacy. The conclusions are based on an earlier empirical study conducted between 1992 and 1998, which investigated six encounter programs, and on a series of interviews with Arab‐Jewish facilitators conducted in 2001.
WHAT'S IN A (N EMPTY) NAME?
Authors: ADAMS FRED , DIETRICH LAURA A.
Published: May 2004

Abstract:  This paper defends a direct reference view of names including empty names. The theory says that empty names literally have no meaning and cannot be used to express truths. Names, including empty names, are associated with accompanying descriptions that are implicated in pragmati‐cally imparted truths when empty names are used. This view is defended against several important objections having to do with differences in names, descriptions associated with the names, and considerations of modality. The view is shown to be superior to an alternative theory treating empty names as the “descriptive names” of Kripke and Evans.
A multi‐site comparison of psychosocial approaches for the treatment of methamphetamine dependence
Authors: Rawson Richard A. , Marinelli‐Casey Patricia , Anglin M. Douglas , Dickow Alice , Frazier Yvonne , Gallagher Cheryl , Galloway Gantt P. , Herrell James , Huber Alice , McCann Michael J. , Obert Jeanne , Pennell Susan , Reiber Chris , Vandersloot Denna , Zweben Joan ,   the Methamphetamine Treatment Project Corporate Authors
Published: May 2004

Aims  The Center for Substance Abuse Treatment (CSAT) Methamphetamine Treatment Project (MTP) is the largest randomized clinical trial of treatments for methamphetamine (MA) dependence to date. The objective of the study was to compare the Matrix Model, a manualized treatment method, with treatment‐as‐usual (TAU) in eight community out‐patient settings in the Western United States.

Design  Over an 18‐month period between 1999 and 2001, 978 treatment‐seeking, MA‐dependent people were randomly assigned to receive either TAU at each site or a manualized 16‐week treatment (Matrix Model).

Setting  The study was conducted as an eight‐site out‐patient trial, with six sites located in California and one each in Montana and Hawaii.

Findings  In the overall sample, and in the majority of sites, those who were assigned to Matrix treatment attended more clinical sessions, stayed in treatment longer, provided more MA‐free urine samples during the treatment period and had longer periods of MA abstinence than those assigned to receive TAU. Measures of drug use and functioning collected at treatment discharge and 6 months post‐admission indicate significant improvement by participants in all sites and conditions when compared to baseline levels, but the superiority of the Matrix approach did not persist at these two timepoints.

Conclusions  Study results demonstrate a significant initial step in documenting the efficacy of the Matrix approach. Although the superiority of the Matrix approach over TAU was not maintained at the post‐treatment timepoints, the in‐treatment benefit is an important demonstration of empirical support for this psychosocial treatment approach.
Mortality in England and Wales attributable to any drinking, drinking above sensible limits and drinking above lowest‐risk level
Authors: White Ian R. , Altmann Dan R. , Nanchahal Kiran
Published: May 2004

Aims  To quantify mortality attributable to any alcohol consumption, and mortality attributable to consumption above different levels.

Design  We related all‐cause mortality to alcohol consumption using cause‐specific mortality models from a systematic review and using the distribution of alcohol consumption and causes of death by age and sex in England and Wales in 1997. We estimated the deaths and person‐years of life lost to age 65 that were attributable: to any drinking; to drinking above the nadir (the level of alcohol consumption carrying the lowest risk); and to drinking more than the British Royal Colleges’ recommended limits of 21 units/week in men and 14 units/week in women.

Findings  Ischaemic heart disease deaths prevented by alcohol consumption (11 276 in men, 4050 in women) roughly balanced other deaths attributable to alcohol consumption (9246 in men, 4216 in women). Overall, 0.8% of all deaths in men were prevented by alcohol consumption (95% confidence interval, 0.2% to 1.3%), while 0.1% of all deaths in women were attributable to alcohol consumption (95% confidence interval, – 0.3% to 0.4%); 2.1% (1.9–2.3%) of all deaths in men and 0.8% (0.6–1.0%) of all deaths in women were attributable to drinking more than the recommended limits, while 2.8% and 1.2% of deaths, respectively, were attributable to drinking above the nadir. Of all person‐years of life lost to age 65, 10.3% in men and 5.6% in women were attributable to any drinking; 8.5% and 4.0% were attributable to drinking above the recommended limits; and 12.6% and 6.0% were attributable to drinking above the nadir.

Conclusions  Although overall mortality risks and benefits of alcohol consumption appear roughly equal, drinking above recommended limits remains responsible for many deaths and a large loss of person‐years of life.
Intensity of drug injection as a determinant of sustained injection cessation among chronic drug users: the interface with social factors and service utilization
Authors: Bruneau Julie , Brogly Susan B. , Tyndall Mark W. , Lamothe François , Franco Eduardo L.
Published: May 2004

Aims  The objective of this study was to identify factors associated with sustained injection cessation and to examine further the relationship between the occurrence of sustained injection cessation of injection drug users (IDUs) and prior injection frequency.

Design and setting  IDUs in the Montreal St Luc Cohort who had at least three consecutive interviews between 1995 and 1999 were included. Sustained injection cessation was defined as a period of at least 7 consecutive months without injection. All IDUs completed interview‐administered questionnaires on socio‐demographic characteristics, drug and sexual behaviours and health‐related issues. Logistic regression was used for analyses.

Findings  A total of 186/1004 (18.5%) IDUs reported a period of sustained injection cessation during the study period. In multivariate analysis, HIV‐positive status, ‘booting’ and cumulative time spent in prison were negatively associated with injection cessation, while injection initiation after 35 years of age and frequent crack use were positively associated with injection cessation. We found a negative association between the occurrence of injection cessation and the frequency of injection; the odds ratios (OR) for cessation were 0.49 [95% confidence interval (CI): 0.03, 0.78] for IDUs who injected 30–100 times and 0.21 (95% CI: 0.10, 0.46) for IDUs who injected more than 100 times in the previous month. Attending needle exchange programmes (NEPs) or pharmacies appeared to be a modifier of the relation between cessation and prior injection frequency. The OR was 0.68 (95% CI: 0.42, 1.12) for IDUs who injected 30–100 times prior to injection and attended NEPs or pharmacies and was 0.07 (0.01, 0.30) for IDUs who did not use these services.

Conclusions  Overall, a fifth of IDUs experienced at least one episode of injection cessation of 7 months or more during a period of 4.5 years. Our data suggest that NEPs and pharmacies may have played a role in inducing injection cessation episodes in a subgroup of IDUs. Research is needed to better identify the characteristics of IDUs who could benefit from an injection cessation intervention strategy. This information is important for social and health policy planning.
Cost and cost‐effectiveness of standard methadone maintenance treatment compared to enriched 180‐day methadone detoxification
Authors: Masson Carmen L. , Barnett Paul G. , Sees Karen L. , Delucchi Kevin L. , Rosen Amy , Wong Wynnie , Hall Sharon M.
Published: May 2004

Aims To compare the cost and cost‐effectiveness of methadone maintenance treatment and 180‐day methadone detoxification enriched with psychosocial services.

Design Randomized controlled study conducted from May 1995 to April 1999.

Setting Research clinic in an established drug treatment program.

Participants One hundred and seventy‐nine adults with diagnosed opioid dependence.

Intervention Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180‐day detoxification (n = 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months.

Measurements Total health‐care costs and self‐reported injection drug use. A two‐state Markov model was used to estimate quality‐adjusted years of survival.

Findings Methadone maintenance produced significantly greater reductions in illicit opioid use than 180‐day detoxification during the last 6 months of treatment. Total health‐care costs were greater for maintenance than detoxification treatment ($7564 versus $6687;P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855,P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life‐year gained is $16 967. Sensitivity analysis revealed a cost‐effectiveness ratio of less than $20 000 per quality‐adjusted life‐year over a wide range of modeling assumptions.

Conclusions Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost‐effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction.
The Society for the Study of Addiction (SSA)
Authors: Tober Gillian
Published: May 2004

The Society for the Study of Addiction (SSA) is a learned society which is a company limited by guarantee with charitable status, an independent organization promoting the cause of research, public policy and treatment of addiction. Founded in London in 1884 with the aim of promoting a research‐based understanding of inebriety, it is the oldest society of its kind. The pursuit and enhancement of evidence‐based policy and treatment informed its work in the early days and has remained its organizing principle throughout its history. Led initially by medical political interests, the Society has grown to encompass a broader disciplinary base, reflecting the expansion of interest in addiction from biological, psychological and social science into nursing, social work, probation, other arms of criminal justice work and voluntary sector professionals. Today its membership is made up of researchers, practitioners and policy makers from all these disciplines, the majority of whom reside and work in the United Kingdom; its international membership makes up nearly one‐third of the total membership and there are current endeavours to expand collaboration with other national societies in the field. Its activities are focused upon the Society journals,AddictionandAddiction Biology, other publishing activities, the annual symposium and a number of policy initiatives.
Comparison of acute lethal toxicity of commonly abused psychoactive substances
Authors: Gable Robert S.
Published: May 2004

Aims  To determine the acute lethal toxicity of a range of psychoactive substances in terms of the dose customarily used as a single substance for non‐medical purposes.

Design and method  A structured English‐language literature search was conducted to identify experimental studies and clinical reports that documented human and non‐human lethal doses of 20 abused substances that are distributed widely in Europe and North America. Four inclusion criteria were specified for the reports, and approximately 3000 relevant records were retrieved from search engines at Biosis, Science Citation Index, Google and the National Library of Medicine's Gateway. In order to account for different drug potencies, a ‘safety ratio’ was computed for each substance by comparing its reported acute lethal dose with the dose most commonly used for non‐medical purposes.

Findings  The majority of published reports of acute lethal toxicity indicate that the decedent used a co‐intoxicant (most often alcohol). The calculated safety ratios varied between substances by more than a factor of 100. Intravenous heroin appeared to have the greatest direct physiological toxicity; several hallucinogens appeared to have the least direct physiological toxicity.

Conclusions  Despite residual uncertainties, the substantial difference in safety ratios suggests that abused substances can be rank‐ordered on the basis of their potential acute lethality.
Economic analysis of costs and consequences of the treatment of drug misuse: 2‐year outcome data from the National Treatment Outcome Research Study (NTORS)
Authors: Godfrey Christine , Stewart Duncan , Gossop Michael
Published: May 2004

Aims  Some economic costs and consequences of drug misuse and treatment were investigated among clients recruited to the National Treatment Outcome Research Study (NTORS).

Design  This was a longitudinal prospective cohort design comprising

549 clients recruited from 54 residential and community treatment programmes: data were collected from interviews conducted at treatment intake, at 1 year and at 2‐year follow‐ups.

Measurements  Treatment costs included index and other drug treatments. Costs were estimated for use of health and social care services, criminal activity and the use of criminal justice resources. Costs were based upon self‐reported data collected by structured face‐to‐face interviews combined with unit cost estimates taken from a variety of sources.

Findings  Addiction treatment was costed at £2.9 million in the 2 years prior to index treatment, and a further £4.4 million in the subsequent 2 years. Economic benefits were largely accounted for by reduced crime and victim costs of crime. Crime costs fell by £16.1 million during the first year, and by £11.3 million during the second year. Health‐care costs were relatively small but approximately doubled during the course of the study. The ratio of consequences to net treatment investment varied from 18 : 1 to 9.5 : 1, depending on assumptions. This is likely to be a conservative estimate of the benefit–cost ratio because many potential benefits were not estimated.

Conclusions  The data showed clear economic benefits to treating drug misusers in England.
The Gambling Related Cognitions Scale (GRCS): development, confirmatory factor validation and psychometric properties
Authors: Raylu Namrata , Oei Tian P. S.
Published: May 2004

Aims  The aims of this study are to develop and validate a measure to screen for a range of gambling‐related cognitions (GRC) in gamblers.

Design and participants  A total of 968 volunteers were recruited from a community‐based population. They were divided randomly into two groups. Principal axis factoring with varimax rotation was performed on group one and confirmatory factor analysis (CFA) was used on group two to confirm the best‐fitted solution.

Measurements  The Gambling Related Cognition Scale (GRCS) was developed for this study and the South Oaks Gambling Screen (SOGS), the Motivation Towards Gambling Scale (MTGS) and the Depression Anxiety Stress Scale (DASS‐21) were used for validation.

Findings  Exploratory factor analysis performed using half the sample indicated five factors, which included interpretative control/bias (GRCS‐IB), illusion of control (GRCS‐IC), predictive control (GRCS‐PC), gambling‐related expectancies (GRCS‐GE) and a perceived inability to stop gambling (GRCS‐IS). These accounted for 70% of the total variance. Using the other half of the sample, CFA confirmed that the five‐factor solution fitted the data most effectively. Cronbach's alpha coefficients for the factors ranged from 0.77 to 0.91, and 0.93 for the overall scale.

Conclusions  This paper demonstrated that the 23‐item GRCS has good psychometric properties and thus is a useful instrument for identifying GRC among non‐clinical gamblers. It provides the first step towards devising/adapting similar tools for problem gamblers as well as developing more specialized instruments to assess particular domains of GRC.
Abstinence rates and predictors of outcome for smoking cessation: do Brazilian smokers need special strategies?
Authors: Chatkin José Miguel , Mariante de Abreu Carolina , Haggsträm Fábio Maraschin , Wagner Mário Bernardes , Fritscher Carlos Cezar
Published: May 2004

Aims  To study tobacco abstinence and risk factors for failure in smoking cessation program and to evaluate the need for special strategies in a Brazilian cohort of smokers.

Design  A non‐randomized, prospective, open clinical trial.

Patients and methods  We studied smokers who attended the Smoking Cessation Clinics of Hospital Sao Lucas da PUCRS, in Porto Alegre, Brazil between July, 1999 and June, 2003. All participated in the same behavioral therapy program and, according to the Fagerstrom test, also received nicotine patches and/or bupropion. Sustained abstinence was confirmed by exhaled CO measurements ≤ 10 parts per million (p.p.m.). Quit rates were evaluated at 12 months. The study included 381 patients (62% women, mean age ± SD 47.4 ± 11.5 years).

Findings  Smokers treated with only counseling, counseling + NRT, counseling + bupropion, and counseling + bupropion + NRT had an abstinence rates at the end of 12 months of 14.5%, 25.4%, 22.8% and 38.5%, respectively (P < 0.001). The estimated success rate was 23.2% at 12 months. The likelihood of failure in smoking cessation at the end of 12 months increased with higher nicotine dependence (HR: 1.63; 95% CI: 1.13–2.35; P = 0.009). Failure occurred significantly less in those patients treated with counseling + NRT + bupropion (HR: 0.39; 95% CI: 0.24–0.63 P < 0.001).

Conclusions  The higher percentage of smoking cessation was achieved using multiple therapies (counseling + NRT + bupropion). The only significant predictor of failure detected was severe nicotine dependence.
Socio‐demographic predictors of quitting smoking: how important are household factors?
Authors: Chandola Tarani , Head Jenny , Bartley Mel
Published: May 2004

Aims  To compare different socio‐demographic predictors of quitting smoking in a cohort representative of adult smokers in the British population using appropriate models that take into account the clustering of smoking behaviours at the household and area levels.

Design  A longitudinal, population representative survey of British adults (the British Household Panel Survey, BHPS) from 1991 to 2000.

Setting and participants  At wave 1 of the BHPS, 10264 adults living in 5511 households were interviewed. Around 30% of the wave 1 respondents reported smoking cigarettes. Of these, 21% had quit smoking over a 10‐year period.

Measurements  ‘Quitters’ (quitting smoking) were defined as smokers who had subsequently described themselves as non‐smokers for at least 2 consecutive waves (years) of the BHPS. Degree of dependence was indexed using the number of cigarettes currently smoked per day.

Findings  Degree of dependence was the strongest predictor of quitting smoking, followed by occupational social class, social support, marital status and the proportion of smokers in the household. There was some evidence of clustering of quitting smoking behaviour within households—members of the same household had similar quitting smoking behaviours. This clustering at the household level appeared to be explained by mechanisms related to the household level. However, there was little evidence for clustering of smoking behaviour within areas.

Conclusions  In addition to reducing addiction to cigarettes, policies designed to encourage smokers to quit may need to take into account factors related to household support and employment relations, in order to encourage smokers from all socio‐demographic groups to quit
Gender convergence in alcohol consumption and related problems: issues and outcomes from comparisons of New Zealand survey data
Authors: McPherson Mervyl , Casswell Sally , Pledger Megan
Published: May 2004

Aims  This paper aims to compare women's and men's alcohol consumption patterns and alcohol‐related problems in New Zealand in 1995 and 2000, by age groups. Secondary aims are to consider the findings in relation to debates on the gender convergence hypothesis regarding the link between gender convergence in alcohol consumption and possible explanations, such as social role convergence and policy changes.

Design  Data were collected in two general population surveys conducted in New Zealand in 1995 (n = 4232) and 2000 (n = 5113) using the same questionnaire.

Measurements  Quantity consumed on a typical drinking occasion, volume of absolute alcohol consumed per annum, proportions drinking 20+ litres per annum, proportion of total consumption consumed in heavy drinking occasions, frequency of consumption, proportion who drink enough to feel drunk at least once a week, proportions reporting three or more alcohol‐related problems and attitudes to intoxication.

Findings  Evidence for gender convergence was found across a range of measures of alcohol consumption and alcohol‐related problems. In the 20–39‐year age group quantities of alcohol consumed on a typical occasion and the related measures of volume, drunkenness and problems all showed convergence. In the groups over 40 years of age convergence occurred in relation to frequency of drinking. In the groups below 20 years, which consumed relatively high quantities and where the differences in consumption between gender groups were relatively small, further convergence did not occur.

Conclusions  Gender convergence took place in New Zealand from 1995 to 2000.
Prevention of non‐steroidal anti‐inflammatory drug gastrointestinal complications – review and recommendations based on risk assessment
Authors: Chan F. K. L. , Graham D. Y.
Published: May 2004

The incidence of non‐steroidal anti‐inflammatory drug‐related ulcer complications remains high despite the availability of potent anti‐ulcer drugs and selective cyclo‐oxygenase‐2 inhibitors. Non‐steroidal anti‐inflammatory drug‐related ulcer complications can be minimized by prospective assessment of patients’ baseline risk, rational choice and use of non‐steroidal anti‐inflammatory drugs, and selective use of co‐therapy strategies with gastroprotectives. Current recommendations regarding strategies using anti‐ulcer drugs and cyclo‐oxygenase‐2 inhibitors for prevention of clinical non‐steroidal anti‐inflammatory drug upper gastrointestinal events are largely derived from studies using surrogates such as endoscopic ulcers, erosions, and symptoms in low‐ to average‐risk patients. Conclusions based on surrogate and potentially manipulatable end‐points are increasingly suspect with regard to applicability to clinical situations. This article reviews the risks associated with non‐steroidal anti‐inflammatory drugs including aspirin and includes the effect of the patients’ baseline risk, and the confounding effects of Helicobacter pylori infection. In addition, uncertainties regarding the clinical efficacy of anti‐ulcer drugs and cyclo‐oxygenase‐2 inhibitors against non‐steroidal anti‐inflammatory drug‐related ulcer complications are put into perspective. We propose management strategies based on the risk category: low risk (absence of risk factors) (least ulcerogenic non‐steroidal anti‐inflammatory drug at lowest effective dose), moderate risk (one to two risk factors) (as above, plus an antisecretory agent or misoprostol or a cyclo‐oxygenase‐2 inhibitor), high risk (multiple risk factors or patients using concomitant low‐dose aspirin, steroids, or anticoagulants) (cyclo‐oxygenase‐2 inhibitor alone with steroids, plus misoprostol with warfarin, or plus a proton pump inhibitors or misoprostol with aspirin), and very high risk (history of ulcer complications) (avoid all non‐steroidal anti‐inflammatory drugs, if possible or a cyclo‐oxygenase‐2 plus a proton pump inhibitors and/or misoprostol). The presence of H. pylori infection increases the risk of upper gastrointestinal complications in non‐steroidal anti‐inflammatory drug users by two‐ to fourfold suggesting that all patients requiring regular non‐steroidal anti‐inflammatory drug therapy be tested for H. pylori.
Health‐related quality of life in patients with cardiovascular disease – the effect of upper gastrointestinal symptom treatment
Authors: van Rossum L. G. M. , Laheij R. J. F. , Vlemmix F. , Jansen J. B. M. J. , Verheugt F. W. A.
Published: May 2004

Background : Upper gastrointestinal discomfort decreases the already impaired health status of patients with cardiovascular disease.

Aim : To evaluate whether acid suppressive therapy improves health‐related quality of life in patients who developed upper gastrointestinal symptoms after starting low‐dose acetylsalicylic acid.

Methods : In a double‐blind, placebo‐controlled randomized trail, cardiac patients using low‐dose (80 mg) acetylsalicylic acid with (n = 142) and without (n = 90) upper gastrointestinal symptoms were included. Patients with symptoms were treated with rabeprazole or placebo for 4 weeks. At baseline and 4 weeks information about gastrointestinal symptoms and health‐related quality of life was assessed.

Results : The 73 patients assigned to rabeprazole when compared with 69 patients given placebo reported the same quality of life scores 4 weeks after randomization. The differences in quality of life scores between patients with and without symptoms at baseline remained after 4 weeks. Patients in whom treatment led to complete symptom relief or those who remained symptom‐free reported significantly higher scores for Physical Component Summary (P < 0.01) and Mental Component Summary (P < 0.01), when compared to those with persistent symptoms or new onset symptoms.

Conclusion : Proton‐pump inhibitor therapy did not improve quality of life. Upper gastrointestinal symptom relief in itself considerably increased quality of life.
The effect of an empirical trial of high‐dose lansoprazole on symptom response of patients with non‐cardiac chest pain – a randomized, double‐blind, placebo‐controlled, crossover trial
Authors: Bautista J. , Fullerton H. , Briseno M. , Cui H. , Fass R.
Published: May 2004

Background : Empirical trial with high‐dose omeprazole has been shown to be a sensitive tool for diagnosing patients with gastro‐oesophageal reflux disease‐related non‐cardiac chest pain.

Aim : To determine the clinical value of an empirical trial of high‐dose lansoprazole in detecting patients with gastro‐oesophageal reflux disease‐related non‐cardiac chest pain.

Methods : Patients who were referred by a cardiologist after a comprehensive evaluation, with at least three episodes per week of unexplained chest pain as the predominant symptom, were enrolled into the study. Oesophageal mucosal disease was determined by upper endoscopy followed by 24‐h oesophageal pH monitoring to assess acid exposure. Patients were then randomized to either placebo or lansoprazole 60 mg am and 30 mg pm for 7 days. After a washout period of 1 week, patients crossed over to the other arm of the study for an additional 7 days. Patients completed a daily diary assessing severity and frequency of chest pain as the predominant symptom throughout the baseline treatment and washout periods. The lansoprazole empirical trial was considered diagnostic if chest pain score improved ≥50% than baseline.

Results : Of the 40 patients with non‐cardiac chest pain that were enrolled, 18 (45%) had erosive oesophagitis and/or abnormal pH test (gastro‐oesophageal reflux disease‐positive) and 22 (55%) had both tests negative (gastro‐oesophageal reflux disease‐negative). Of the gastro‐oesophageal reflux disease‐positive patients, 14 (78%) had significantly higher symptom improvement on lansoprazole than on placebo (22%) (P = 0.0143). Of the gastro‐oesophageal reflux disease‐negative group, two (9.1%) markedly improved on the medication and eight (36.3%) on placebo (P = 0.75). The sensitivity and specificity of the lansoprazole empirical trial was 78 and 80%, respectively. By day 2, 12 (85.7%) of the gastro‐oesophageal reflux disease‐related non‐cardiac chest pain responders had either complete or almost complete symptom resolution.

Conclusions : The lansoprazole empirical trial is highly sensitive and specific for diagnosing gastro‐oesophageal reflux disease‐related non‐cardiac chest pain patients. The trial enables diagnosing most of the responders within the first 2 days and thus a shorter duration of therapy may be considered in a subset of non‐cardiac chest pain patients.
Evaluation of the pharmacokinetics and pharmacodynamics of intravenous lansoprazole
Authors: Freston J. W. , Pilmer B. L. , Chiu Y.‐L. , Wang Q. , Stolle J. C. , Griffin J. S. , Lee C. Q.
Published: May 2004

Aim : To compare the pharmacokinetics and pharmacodynamics of lansoprazole 30 mg administered intravenously in 0.9% NaCl or in polyethylene glycol, or orally.

Methods : Twenty‐nine subjects received lansoprazole orally on days 1–7 and intravenous lansoprazole in NaCl on days 8–14. Blood samples were collected on days 1, 7, 8 and 14. Fasting basal acid output and pentagastrin‐stimulated maximal acid output were determined on days −1, 8, 9 and 15. Thirty‐six different subjects received one of four regimen sequences: intravenous lansoprazole in NaCl, intravenous in polyethylene glycol, per orally, or intravenous placebo, each for 5 days. Twenty‐four hour intragastric pH was recorded on days 1 and 5.

Results : Intravenous and per oral lansoprazole for 7 days produced equivalent basal acid output and maximal acid output suppression. Pharmacokinetics and mean pH values with intravenous lansoprazole in NaCl or polyethylene glycol were equivalent. Both produced mean pH and percentages of time pH above 3, 4, 5 and 6 that were significantly greater than did per orally.

Conclusions : Intravenous lansoprazole inhibits acid secretion as effectively in NaCl as in polyethylene glycol, and its onset of action is faster than per oral lansoprazole.
Laboratory markers predict bone loss in Crohn's disease: relationship to blood mononuclear cell function and nutritional status
Authors: Trebble T. M. , Wootton S. A. , Stroud M. A. , Mullee M. A. , Calder P. C. , Fine D. R. , Moniz C. , Arden N. K.
Published: May 2004

Background : Crohn's disease is associated with reduced bone density. The power of simple markers of systemic inflammation to identify higher rates of bone loss, in Crohn's disease, is uncertain. This relationship and the role of circulating (peripheral blood) mononuclear cells were investigated in a case–control study.

Methods : Urinary deoxypyridinoline/creatinine and serum osteocalcin concentrations were compared in male and premenopausal females with ‘active’ Crohn's disease (C‐reactive protein ≥ 10 and/or erythrocyte sedimentation rate ≥ 20) (n = 22) and controls with ‘quiescent’ Crohn's disease (C‐reactive protein < 10 and erythrocyte sedimentation rate < 20) (n = 21). No patients were receiving corticosteroid therapy. Production of tumour necrosis factor‐α, interferon‐γ and prostaglandin E2 by peripheral blood mononuclear cells were measured.

Results : Active Crohn's disease was associated with a higher deoxypyridinoline/creatinine (P = 0.02) and deoxypyridinoline/creatinine:osteocalcin ratio (P =0.01) compared with quiescent Crohn's disease, but similar osteocalcin (P = 0.24). These were not explained by vitamin D status, dietary intake or nutritional status. However, production of interferon‐γ by concanavalin A‐stimulated peripheral blood mononuclear cells was lower in active Crohn's disease (P = 0.02) and correlated negatively with the deoxypyridinoline/creatinine:osteocalcin ratio (r = −0.40, P = 0.004).

Conclusion : In Crohn's disease, raised C‐reactive protein and erythrocyte sedimentation rate may indicate higher rates of bone loss and, if persistent, the need to assess bone mass even where disease symptoms are mild. This may be partly explained by altered production of interferon‐γ by peripheral blood mononuclear cells.