bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of the Use of Central Venous Access Devices Within and Outside of the Intensive Care Unit: Results of a Survey Among Hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention
Authors: Climo Michael , Diekema Dan , Warren David K. , Herwaldt Loreen A. , Perl Trish M. , Peterson Lance , Plaskett Theresa , Price Connie , Sepkowitz Kent , Solomon Steve , Tokars Jerry , Fraser Victoria J. , Wong Edward
Published: March 2006

Objective:

To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.

Design:

A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.

Setting:

Inpatient wards and ICUs of six large urban teaching hospitals.

Results:

At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.

Conclusions:

Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.
Administrative Databases Provide Inaccurate Data for Surveillance of Long-Term Central Venous Catheter-Associated Infections
Authors: Wright Sharon B. , Huskins W. Charles , Dokholyan Rachel S. , Goldmann Donald A. , Platt Richard
Published: March 2006

Background:

Efficient methods are needed to monitor infections associated with long-term central venous catheters (CVCs) in both inpatient and outpatient settings. Automated medical records and claims data have been used for surveillance of these infections without evaluation of their accuracy or validity.

Objective:

To determine the feasibility of using electronic records to identify CVC placement and design a system for identifying CVC-associated infections.

Design and Setting:

Retrospective cohort study at an HMO and two teaching hospitals in Boston, one adult (hospital A) and one pediatric (hospital B), between January 1991 and December 1997. Tunneled catheters, totally implanted catheters, and hemodialysis catheters were examined. Claims databases of both the HMO and the hospitals were searched for 10 CPT codes, 2 ICD-9 codes, and internal charge codes indicating CVC insertion. Lists were compared with each other and with medical records for correlation and accuracy.

Patients:

All members of the HMO who had a CVC inserted at one of the two hospitals during the study period.

Results:

There was wide variation in the CVC insertions identified in each database. Although ICD-9 codes at each hospital and CPT/ICD-9 combinations at the HMO found similar total numbers of CVCs, there was little overlap between the individuals identified (62% for hospital A with HMO and 4% for hospital B).

Conclusion:

Claims data from different sources do not identify the same CVC insertion procedures. Current administrative databases are not ready to be used for electronic surveillance of CVC-associated complications without extensive modification and validation.
Electronic Interpretation of Chest Radiograph Reports to Detect Central Venous Catheters
Authors: Trick William E. , Chapman Wendy W. , Wisniewski Mary F. , Peterson Brian J. , Solomon Steven L. , Weinstein Robert A.
Published: March 2006

Objective:

To evaluate whether a natural language processing system, SymText, was comparable to human interpretation of chest radiograph reports for identifying the mention of a central venous catheter (CVC), and whether use of SymText could detect patients who had a CVC.

Design:

To identify patients who had a CVC, we performed two surveys of hospitalized patients. Then, we obtained available reports from 104 patients who had a CVC during one of two cross-sectional surveys (ie, case-patients) and 104 randomly selected patients who did not have a CVC (ie, control-patients).

Setting:

A 600-bed public teaching hospital.

Results:

Chest radiograph reports were available from 124 of the 208 participants. Compared with human interpretation, SymText had a sensitivity of 95.8% and a specificity of 98.7%. The use of SymText to identify case- and control-patients resulted in a sensitivity of 43% and a specificity of 98%. Successful application of SymText varied significantly by venous insertion site (eg, a sensitivity of 78% for subclavian and a sensitivity of 3.7% for femoral). Twenty-six percent of the case-patients had a femoral CVC.

Conclusions:

Compared with human interpretation, SymText performed well in interpreting whether a report mentioned a CVC. In patient populations with less frequent CVC placement in femoral veins, the sensitivity for CVC detection likely would be higher. Applying a natural language processing system to chest radiograph reports may be a useful adjunct to other data sources to automate detection of patients who had a CVC.
Helicobacter pylori and Infantile Hypertrophic Pyloric Stenosis
Authors: Dahshan Ahmed , Donovan Kevin G. , Halabi Issam M. , Ranne Richard , Li Mary , Illig William P.
Published: March 2006

Background:

Recently, it has been suggested that Helicobacter pylori might be a cause of some cases of infantile hypertrophic pyloric stenosis (IHPS) in infancy on the basis of its epidemiologic and clinical features. We performed this study to evaluate the possible relationship between IHPS and H. pylori.

Design:

In consecutive infants with IHPS, we performed upper gastrointestinal endoscopy with biopsy before pyloromyotomy. The endoscopic appearance of the pylorus was noted to validate endoscopic features of IHPS.

Results:

Sixteen infants, 15 male, 14 white, mean age 42 days, range 21 to 104 days, were studied. The index case had chronic active gastritis on biopsy with organisms suspicious for H. pylori. Four others had chronic active gastritis, six more had focal or mild chronic gastritis, five were normal, and none had H. pylori on histology or immune histochemical staining in selected cases. All patients had negative rapid urease test. Most common endoscopic findings of IHPS were thickened prominent asymmetric pyloric folds and pin‐hole pylorus that could not be intubated by the pediatric endoscope.

Conclusion:

H. pylori was not specifically identified in our patients with IHPS. The presence of H. pylori‐like organisms in the gastric mucosa in our index case and finding of chronic active gastritis in several others may indicate the possibility of an acquired infectious etiology for IHPS.
Decreased Peroxisome Proliferator Activated Receptor α Is Associated with Bile Duct Injury in Cystic Fibrosis Transmembrane Conductance Regulator−/− Mice
Authors: Pall Harpreet , Zaman Munir M. , Andersson Charlotte , Freedman Steven D.
Published: March 2006

Background:

Primary sclerosing cholangitis (PSC) is associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. As proof of concept that CFTR dysfunction plays a role in PSC, induction of colitis in cftr−/− mice results in bile duct injury that can be prevented by pretreatment with docosahexaenoic acid (DHA).

Objectives:

Determine whether 1) CFTR dysfunction in cftr−/− mice through a reduction in peroxisome proliferator activated receptor (PPAR)α or γ leads to bile duct injury and 2) whether DHA prevents bile duct injury through an increase in PPAR.

Methods:

Cftr−/− and wild‐type (WT) mice were treated with dextran sodium sulfate (DSS) to induce colitis with or without pretreatment with oral DHA. PPARα and γ as well as tumor necrosis factor (TNF)α were analyzed in liver tissue. PPARα−/− mice were also treated with DSS and histology examined.

Results:

PPARγ mRNA levels were low, with DSS suppressing mRNA levels equally in WT and cftr−/− mice. PPARα levels were no different between cftr−/− and WT litter mates by reverse‐transcription polymerase chain reaction. After DSS, WT mice showed a 9.3‐fold increase in PPARα mRNA levels and increased nuclear localization compared with no DSS (P < 0.05), with no increase seen in cftr−/− mice. This was not caused by changes in TNFα. DHA treatment led to 7.0‐fold increase in PPARα mRNA levels in cftr−/− mice (P < 0.01). PPARα−/− mice treated with DSS did not develop bile duct injury, indicating that PPARα alone is not sufficient to cause bile duct inflammation.

Conclusion:

DSS induced bile duct injury in cftr−/− mice is associated with a defect in PPARα expression, which is reversed by DHA.
Functional Gastrointestinal Disorders in African American Children in Primary Care
Authors: Uc Aliye , Hyman Paul E. , Walker Lynn S.
Published: March 2006

Objective:

To determine the prevalence of functional gastrointestinal disorders (FGIDs) in a primary care setting and to assess the usefulness of pediatric Rome criteria.

Methods:

The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) assessing the pediatric Rome criteria was administered to 243 school‐age children visiting a general pediatric clinic for annual school physicals. Pearson χ2 statistics were used to determine the association of various demographic factors with FGIDs.

Results:

All children were African American, 47.7% were girls, and the mean ± standard deviation age of the group was 10.7 ± 3.9 years. QPGS detected 52 children (21.4%) with FGID. Diagnoses included aerophagia (6), abdominal migraine (1), cyclic vomiting syndrome (2), functional dyspepsia (2), functional abdominal pain syndrome (1), functional constipation (39) and functional fecal retention (1). Thorough clinical evaluation identified 47 (19.3%) children with FGIDs. Five of the children (2.1%) identified as having FGID on QPGS were felt not to have FGID by the examining physician. Children with FGIDs were not different from healthy children in age, insurance, parent's education, employment or number of children in the family. FGIDs were more common in girls (29/47 girls, P = 0.028). Children with FGIDs tended to live in single‐parent households and miss school more often than children without FGIDs (P = 0.08).

Conclusions:

Functional gastrointestinal disorders are common among African American children and adolescents in a primary care setting and predominantly affect girls. Symptom‐based criteria are useful in the diagnosis of pediatric FGIDs.
The Stereospecific Triacylglycerol Structures and Fatty Acid Profiles of Human Milk and Infant Formulas
Authors: Straarup Ellen Marie , Lauritzen Lotte , Faerk Jan , Høy (Deceased) Carl‐Erik , Michaelsen Kim F.
Published: March 2006

Background:

The stereospecific structures of the triacylglycerol molecules in human milk differ from that of cow's milk and vegetable oils, which are the fat sources used in infant formula. In human milk, palmitic acid (16:0) is predominantly esterified in the sn2 position, whereas vegetable oils or cow's milk fat contain most of their 16:0 in the outer positions of the triacylglycerol molecules. Furthermore, human milk contains long‐chain polyunsaturated fatty acids, which are not present in either cow's milk or vegetable oils.

Methods:

By standard lipid analysis procedures, we examined the triacylglycerol structures and fatty acid profiles of fats from 28 infant formulas or formulas for special indications available in the Danish market from 1999 to 2003.

Results:

The total fatty acid compositions of the formulas showed a 16:0 content almost similar to human milk, whereas the content in the sn2 position was considerably lower. The content of oleic acid was found to be equal to or higher than in human milk in 21 of 28 formulas, whereas the content in the sn2 position was higher in all but one formula. Most formulas had linoleic acid levels considerably above that of human milk. Long‐chain polyunsaturated fatty acids (arachidonic acid and docosahexaenoic acid) were present in all preterm formulas, but only in 3 of the term formulas.

Conclusion:

We found that most of the examined infant formulas, both preterm and term as well as special formulas, had stereospecific structures and fatty acid profiles that differed considerably from that of human milk.
Usefulness of an Assessment Score to Predict Early Stopping of Exclusive Breast‐feeding
Authors: Giannì M. L. , Vegni C. , Ferraris G. , Mosca F.
Published: March 2006

Exclusive breast‐feeding is recommended during the first 6 months of life. Use of simple indicators to predict early stopping of exclusive breast‐feeding may be desirable in clinical practice. A breast‐feeding assessment evaluated at discharge and including maternal age, previous breast‐feeding experience, latching difficulty, and breast‐feeding interval could be useful.
Trade Liberalization in Agriculture in Developed Nations and Incidence of Child Labour in a Developing Economy
Authors: Chaudhuri Sarbajit , Dwibedi Jayanta Kumar
Published: March 2006

This paper is an attempt to analyse the consequence of trade liberalization in agriculture in the developed countries on the incidence of child labour in a developing economy in terms of a three‐sector general equilibrium model with informal sectors. Adult labour and child labour are substitutes for each other in the two informal sectors of the economy and are used together apart from capital in producing two exportable commodities. The interesting result that appears from the analysis is that agricultural trade liberalization in the developed countries may be effective in bringing down the incidence of child labour in the system. The paper substantiates the desirability of trade liberalization in agriculture in the developed nations from the perspective of the developing economies for reasons other than welfare improvement.
Money Demand in an EU Accession Country: A VECM Study of Croatia
Authors: Cziráky Dario , Gillman Max
Published: March 2006

The paper estimates the money demand in Croatia using monthly data from 1994 to 2002. A failure of the Fisher equation is found, and adjustment to the standard money‐demand function is made to include the inflation rate as well as the nominal interest rate. In a two‐equation cointegrated system, a stable money demand shows rapid convergence back to equilibrium after shocks. This function performs better than an alternative using the exchange rate instead of the inflation rate as in the ‘pass‐through’ literature on exchange rates. The results provide a basis for inflation rate forecasting and suggest the ability to use inflation targeting goals in transition countries during the EU accession process. Finding a stable money demand also limits the scope for central bank ‘inflation bias’.
‘I Just Don't Want to Get Picked on by Anybody’: Dynamics of Inclusion and Exclusion in a Newly Multi‐Ethnic Irish Primary School
Authors: Devine Dympna , Kelly Mary
Published: March 2006

Given the changing patterns of immigration in the Republic of Ireland in the past 10 years, this article considers how factors related to ethnic and gender identity mediate children's interaction with one another in a newly multi‐ethnic Irish primary school. Central to the analysis is the exercise of power between children and how the experience of inclusion and exclusion in peer relations is underpinned by concepts of sameness/difference that draw upon wider discourses of ethnic and gender identity. Recommendations in relation to classroom and school practice are made with reference to the need for teachers to take account of the complexity of children's social worlds and the dynamics of power and control that operate within it. Copyright © 2006 The Author(s).
Beyond the Gender Differential: Very Young Children Coping with HIV/AIDS
Authors: Hayden Jacqueline
Published: March 2006

This article reports on a recent study of HIV/AIDS which investigated the role of gender in the experiences of young children in one region of Namibia. The findings reveal that while gender is reported to shape school‐age girls and boys’ experiences of being infected or affected by HIV/AIDS in many African nations, gender was not an influential variable in the experiences of very young children coping with HIV/AIDS. Conditions of poor health, deprivation and stigma were equally distributed amongst young girl and boy participants. Connectivity with families and communities was shown to be influenced by living conditions but not differentiated by gender. No gender differences were identified regarding young childrens’ sense of hope and vision for the future. The article implies that there may be a particular juncture when gender begins to make a difference in the life of girls and boys—and that this could be an important focus for research. Copyright © 2006 The Author(s).
Monitor‐induced tachycardia in a patient with a rate‐responsive pacemaker
Authors: Houtman S. , Rinia M. , Kalkman C.
Published: March 2006

A patient with a ventricle‐paced, ventricle‐sensed and inhibited, respiratory rate‐responsive pacemaker presented for orthopaedic surgery. She had been operated upon recently without any adverse effects. In the recovery unit her electrocardiograph showed a paced ventricular tachycardia of about 140 beats.min−1 without any other adverse sign or symptom. Although this tachycardia initially decreased to 70 beats.min−1 after about 30 min, it later rose again to 140 beats.min−1. A pacemaker technician was consulted, who suggested that there may be interference between the bioelectric impedance signals of the patient monitoring system that was being used to measure respiratory rate and the pacemaker's own measurement systems.
Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia
Authors: Sharma S. , Smith A. F. , Rooksby J. , Gerry B.
Published: March 2006

In this qualitative study using observation and interviews, 10 anaesthetists from five Departments of Anaesthesia in the North‐West region of England were enlisted to participate in the design of an online system to allow the sharing of critical incidents. Respondents perceived that existing schemes had differing and sometimes conflicting aims. Reporting was used for reasons other than simply logging incidents in the interests of promoting patient safety. No existing scheme allowed the lessons learned from incidents to be shared between members of the professional group from which they arose. Using participants' suggestions, we designed a simple, secure, anonymous system favouring free‐text description, intended to enable the on‐line sharing and discussion of selected incidents. Seven incidents were posted during the 6‐month pilot period. The practitioners in our study valued the opportunity to share and discuss educational incidents ‘horizontally’ within their community of practice. We suggest that large‐scale reporting systems either incorporate such a function or allow other systems that permit such sharing to co‐exist.
Orthogonal search‐based rule extraction for modelling the decision to transfuse
Authors: Etchells T. A. , Harrison M. J.
Published: March 2006

Data from an audit relating to transfusion decisions during intermediate or major surgery were analysed to determine the strengths of certain factors in the decision making process. The analysis, using orthogonal search‐based rule extraction (OSRE) from a trained neural network, demonstrated that the risk of tissue hypoxia (ROTH) assessed using a 100‐mm visual analogue scale, the haemoglobin value (Hb) and the presence or absence of on‐going haemorrhage (OGH) were able to reproduce the transfusion decisions with a joint specificity of 0.96 and sensitivity of 0.93 and a positive predictive value of 0.9. The rules indicating transfusion were: 1. ROTH > 32 mm and Hb < 94 g.l−1; 2. ROTH > 13 mm and Hb < 87 g.l−1; 3. ROTH > 38 mm, Hb < 102 g.l−1 and OGH; 4. Hb < 78 g.l−1.
Haemodynamic and catecholamine stress responses to the Laryngeal Tube‐Suction Airway and the Proseal Laryngeal Mask Airway
Authors: Dahaba A. A. , Prax N. , Gaube W. , Gries M. , Rehak P. H. , Metzler H.
Published: March 2006

Supraglottic airway devices such as the ProSeal Laryngeal Mask AirwayTM (PLMA) and Laryngeal Tube‐SuctionTM Airway (LTS) that provoke the least stress responses could be beneficial in many situations, especially in patients with cardiovascular disease. We compared the haemodynamic and catecholamine stress response of the LTS and PLMA in a randomised study of 36 patients. Mean arterial pressure, heart rate, epinephrine and norepinephrine levels were all reduced following induction of anaesthesia with no significant differences between the two groups. Following insertion of LTS, mean arterial pressure, heart rate, epinephrine and norepinephrine levels increased to pre‐induction levels. However, following the insertion of the PLMA, mean arterial pressure, heart rate, epinephrine and norepinephrine levels remained significantly lower than pre‐induction values. Mean arterial pressure, heart rate and epinephrine were significantly greater in the LTS group than in the PLMA group. We conclude that the LTS produces a greater and more sustained haemodynamic and catecholamine stress response than does the PLMA.
The changing practice of thoracic epidural analgesia in the United Kingdom: 1997–2004
Authors: Pennefather S. H. , Gilby S. , Danecki A. , Russell G. N.
Published: March 2006

The clinical governance framework and medico‐legal climate in the United Kingdom has changed significantly in the past 7 years. We used a postal questionnaire to survey thoracic epidural practice in the United Kingdom in 1997 and repeated this survey in 2004. The response rate to both surveys was 59–60%. There has been considerable change in respect of taking specific consent for thoracic epidural analgesia (24% in 1997, 74% in 2004), awake epidural cannulation (40% in 1997, 84% in 2004), availability of an acute pain service (47% in 1997, 95% in 2004) and HDU‐only nursing of patients (63% in 1997, 30% in 2004). Of the 2004 respondents, < 1% used the newer, less toxic local anaesthetics, 49% would consider inserting a thoracic epidural in patients receiving clopidogrel, and 34% would consider inserting a thoracic epidural in patients receiving both aspirin and clopidogrel. A central register of thoracic epidural complications would assist in further developing practice.
Keeping close: mothering with serious mental illness
Authors: Montgomery Phyllis , Tompkins Catherine , Forchuk Cheryl , French Susan
Published: March 2006

Aim.  The aim of this paper is to describe the experiences of mothers with serious mental illness from their perspectives and how they attempted to manage their mothering circumstances.

Background.  The desire to mother in women with serious mental illness is increasingly acknowledged by healthcare professionals. For these women, mothering is often framed as a pathological problem needing professional intervention. Yet little is known about mothering and illness from the perspectives of the mothers themselves.

Method.  Using Glaser's grounded theory approach and both purposive and theoretical sampling, interviews were conducted with 20 mothers who were receiving treatment for mental health problems. The data were collected in 2002.

Findings.  We found the core category of Keeping close described mothers’ efforts to have meaningful relationships with their children in the context of illness and suffering. To this end, mothers chose strategies that would hide illness for the sake of protecting their roles and their children. These strategies – masking, censoring speech, doing motherwork and seeking help – served to imitate ideal perceptions of mothering while making illness invisible to their children. Mothering in illness, however, became a vortex of contradictions, resulting in mothers ‘hitting bottom’, a point in time when they realized they could not keep close via pretences. To return to the valued place of mother, they sought treatment, hoping to learn how to be with their children authentically.

Conclusion.  To assist mothers with serious mental illness, healthcare professionals must be sensitive to the social and cultural context in which they mother in order to create healthier possibilities for nurturing their children.
Communication enhancement: nurse and patient satisfaction outcomes in a complex continuing care facility
Authors: McGilton Katherine , Robinson Heather Irwin , Boscart Veronique , Spanjevic Lily
Published: March 2006

Aims.  This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility.

Background.  The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long‐term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention.

Methods.  Twenty‐one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses’ job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care.

Results.  Nursing staff felt closer to their patients (F(2,40) = 3·0, P = 0·045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4·1, P = 0·02). No changes were found in the level of patient satisfaction with care.

Conclusions.  Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands‐on caregiving, requires further exploration.
Dimensions of hospital nurses’ quality of working life
Authors: Hsu Ming‐Yi , Kernohan George
Published: March 2006

Aim.  This paper is a report of a study describing the quality of working life of nurses in Taiwan. The purpose of the study was to gather data on which to base a questionnaire to be used in further research.

Background.  Nurses often complain of overwork and underpay. Problems persist with nurses’ job satisfaction, stress, organizational commitment and intent to leave. ‘Quality of working life’ is a system of analysing how people experience work: it relates to job satisfaction, intent to leave, turnover rate, personality and work stress. However, reliable information on hospital nurses’ quality of working life is limited.

Method.  A descriptive study was carried out with a convenience sample. A total of 16 focus groups in one medical centre and five regional hospitals informed a quality of working life framework. Each group had three to five participants who were Registered Nurses in medical or surgical wards with at least 2 years’ nursing experience, and who held a position below assistant nurse manager. The data were collected in 2000.

Findings.  A total of 56 nurses’ quality of working life categories were identified and fitted into six dimensions: socio‐economic relevance, demography, organizational aspects, work aspects, human relation aspects and self‐actualization. In this paper, we focus on issues emphasized by focus group participants. These were managing shift work within the demands of family life; accommodation; support resources; and nurses’ clinical ladder system and salary system.

Conclusions.  Further research is needed with other groups of nurses in a wider variety of settings in order to examine strengths and weaknesses in the total healthcare work environment and to develop appropriate strategies for nurses’ quality of working life.
Evolution of cognitive impairment in bipolar disorder: a systematic review of cross‐sectional evidence
Authors: Robinson Lucy J , Nicol Ferrier I
Published: March 2006

Objectives:  The notion that sufferers of bipolar disorder achieve complete syndromal and functional recovery between illness episodes has been brought into question by evidence that a large proportion of patients fail to regain premorbid levels of functioning after the resolution of major affective symptoms. A growing body of evidence suggests that bipolar patients exhibit neuropsychological impairment that persists even during the euthymic state, which may be a contributory factor to poor psychosocial outcome. However, the aetiology of such impairment and its relation to progression of illness are not well understood. This review aims to consider evidence from studies investigating both the relationship between cognitive impairment and clinical outcome and studies of neurocognitive function in unaffected first‐degree relatives (FDRs) of bipolar sufferers to address issues of the temporal evolution of cognitive impairment in bipolar disorder.

Methods:  Systematic literature review.

Results:  The weight of evidence suggests that greater neuropsychological dysfunction in bipolar disorder is associated with a worse prior course of illness, particularly the number of manic episodes, hospitalizations and length of illness. The most consistent finding was a negative relationship between the number of manic episodes and verbal declarative memory performance. Impairment in unaffected FDRs was reported in verbal declarative memory and some facets of executive function.

Conclusions:  Cognitive impairment may be a trait vulnerability factor for bipolar disorder that is present before illness onset and worsens as the illness progresses. Further investigation into the causal relationship between cognitive impairment and illness course is essential.
The catechol O‐methyltransferase Val158Met polymorphism and herpes simplex virus type 1 infection are risk factors for cognitive impairment in bipolar disorder: additive gene‐environmental effects in a complex human psychiatric disorder
Authors: Dickerson Faith B , Boronow John J , Stallings Cassie , Origoni Andrea E , Cole Sara , Leister Flora , Krivogorsky Bogdana , Yolken Robert H
Published: March 2006

Background:  Bipolar disorder is associated with deficits in cognitive functioning. The etiology of cognitive impairment in bipolar disorder may relate to both genetic and environmental factors. A valine/methionine polymorphism of the catechol O‐methyltransferase gene at amino acid 158 (COMT Val158Met polymorphism) has been identified as a risk factor for cognitive impairment in schizophrenia. Serological evidence of infection with herpes simplex virus type 1 (HSV‐1) has also been identified as a risk factor for cognitive impairment in bipolar disorder.

Methods:  We used Taqman technology to measure COMT Val158Met alleles in 107 individuals with bipolar disorder and in 95 controls. We also measured antibodies to HSV‐1 in sera obtained from the same individuals. Cognitive functioning was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and the Letter‐Number Sequencing Test. The effects of the COMT Val158Met polymorphism and antibodies to HSV‐1 on cognitive functioning were analyzed with multinomial logistic regressions.

Results:  The COMT Val158Val genotype and serological evidence of infection with HSV‐1 are independent risk factors for cognitive impairment in individuals with bipolar disorder, particularly in the domains of immediate and delayed memory. Individuals with bipolar disorder with the COMT158 Val/Val genotype and serological evidence of HSV‐1 infection were more than 85 times more likely to be in the lowest quintile of cognitive functioning when compared with the highest quintile when controlling for potential confounding variables such as symptom severity and education. Control individuals did not display this association.

Conclusion:  Both the COMT Val158Met polymorphism and serological evidence of HSV‐1 infection affect cognitive functioning in individuals with bipolar disorder.
Temporal relation between sleep and mood in patients with bipolar disorder
Authors: Bauer Michael , Grof Paul , Rasgon Natalie , Bschor Tom , Glenn Tasha , Whybrow Peter C
Published: March 2006

Background:  Early recognition of the prodromal symptoms of bipolar disorder, combined with a patient action plan, may help to prevent relapses. Sleep disturbances are frequent warning signs of both mania and depression. This study used cross correlation analysis to characterize the relationship between mood, sleep and bedrest in longitudinal data.

Methods:  Self‐reported mood, sleep and bedrest (mean 169 ± 59 days of data per patient) from 59 outpatients with bipolar disorder receiving standard treatment were analyzed. The cross correlation function was used to determine the latency between the changes in sleep and/or bedrest and mood for time shifts of between –7 and 7 days.

Results:  For sleep and/or bedrest, a significant inverse correlation was found with the change in mood, most commonly with a time latency of one day. Sleep plus bedrest had the strongest relationship with a change in mood, with a significant correlation in 24 of 59 patients (41%) for the night before or night of a mood change. The patients with a significant cross‐correlation between mood and sleep plus bedrest reported about two thirds of all large sleep changes of >3 h and three fourths of all large mood changes (>20 on 100‐unit scale). Patients with a significant cross correlation were more likely to take benzodiazepines.

Conclusion:  In most patients with a significant cross correlation between sleep and/or bedrest and mood, the mood change occurred on the day following the change in sleep and/or bedrest. Sleep changes from a previous pattern, especially those of more than 3 h, may indicate that a large mood change is imminent.
Increased levels of SNAP‐25 and synaptophysin in the dorsolateral prefrontal cortex in bipolar I disorder
Authors: Scarr E , Gray L , Keriakous D , Robinson PJ , Dean B
Published: March 2006

Objective:  In order to identify whether the mechanisms associated with neurotransmitter release are involved in the pathologies of bipolar disorder and schizophrenia, levels of presynaptic [synaptosomal‐associated protein‐25 (SNAP‐25), syntaxin, synaptophysin, vesicle‐associated membrane protein, dynamin I] and structural (neuronal cell adhesion molecule and alpha‐synuclein) neuronal markers were measured in Brodmann's area 9 obtained postmortem from eight subjects with bipolar I disorder (BPDI), 20 with schizophrenia and 20 controls.

Methods:  Determinations of protein levels were carried out using Western blot techniques with specific antibodies. Levels of mRNA were measured using real‐time polymerase chain reaction.

Results:  In BPDI, levels of SNAP‐25 (p < 0.01) and synaptophysin (p < 0.05) increased. There were no changes in schizophrenia or any other changes in BPDI. Levels of mRNA for SNAP‐25 were decreased in BPDI (p < 0.05).

Conclusion:  Changes in SNAP‐25 and synaptophysin in BPDI suggest that changes in specific neuronal functions could be linked to the pathology of the disorder.
Galantamine treatment of cognitive impairment in bipolar disorder: four cases
Authors: Schrauwen Eric , Nassir Ghaemi S
Published: March 2006

Objective: To determine if galantamine is effective in the treatment of chronic cognitive impairment in bipolar disorder.

Methods: All charts of patients meeting DSM‐IV criteria for bipolar disorder treated with galantamine in an academic bipolar disorder specialty clinic psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impression scale for Improvement.

Results: Galantamine was effective in two of four patients, both of whom took at least 24 mg/day. It was ineffective in two patients who only took 8 mg/day. Sedation limited higher dosing in one patient, and a second patient experienced sedation and tremor. Improvement in cognition was not associated with improvement in mood. Galantamine appeared neutral in its effect on mood.

Conclusions: This pilot case series suggests that galantamine may have some utility in improving chronic cognitive impairment in bipolar disorder. Larger studies are required to clarify these initial pilot data.
Boar Contact does not Induce Oxytocin Release During the Period of Embryo Migration in Sows
Authors: Langendijk P , Schams D , Soede N , Kemp B
Published: March 2006

Contents

Nine multiparous cyclic sows with permanent jugular catheters were introduced to a boar at day 10 (n = 9) or 11 (n = 5) after ovulation to study the effect on oxytocin (OT) release. If it occurs, the release of OT might play a role in embryo migration which occurs around this time, by stimulating uterine contractions. Blood samples were taken before introduction of the boar and at 2‐min intervals up to 10 min after boar introduction. On average, OT levels after boar introduction were not higher than before. In only three out of the 14 occasions of boar introduction, a rise in OT level was observed that was higher than two times the standard deviation above base level. However, even on these occasions OT levels were far below the range normally observed during other events where exogenous stimuli cause OT release, such as boar introduction during estrus and suckling during lactation. We conclude that boar contact around day 10 of the estrous cycle does not induce a biologically significant OT release in sows.
The Endometrium of the Anoestrous Female Pig: Studies on Infiltration by Cells of the Immune System
Authors: Jiwakanon J , Persson E , Dalin A‐M
Published: March 2006

Contents

The aim of this study was to investigate the distribution of immune cells in the endometrium of anoestrous female pigs, five sows in anoestrus by lactation and five pre‐pubertal gilts (Swedish Landrace × Swedish Yorkshire). Uterine samples, taken immediately after slaughter, were fixed, embedded in plastic resin and stained with toluidine blue or cryo fixed and stored in a freezer at −70°C until analysed by immunohistochemistry with an avidin–biotin peroxidase method. Immune cells in the surface (luminal) and the glandular epithelium as well as the subepithelial and the glandular connective tissue layers were counted using light microscopy. In the surface (luminal) and the glandular epithelia of gilts and sows, lymphocytes were the predominant immune cells found. There were no significant differences between gilts and sows. Macrophages were detected in the glandular epithelium of sows but not in gilts. In the subepithelial and the glandular connective tissue layers of both gilts and sows, lymphocytes were also the most common immune cells found. The numbers of lymphocytes and macrophages were significantly higher in the sows than in the gilts (p ≤ 0.05) in both the layers of connective tissue. Numbers of plasma cells, mast cells, eosinophils and neutrophils in the connective tissue were low and not significantly different between sows and gilts. In both the surface (luminal) epithelium and the subepithelial connective tissue, higher numbers of CD2 than CD3 positive cells were found (p ≤ 0.01). The numbers of CD2 positive cells in both epithelium and connective tissue and the number of CD3 positive cells in the epithelium were significantly higher in the sows than the gilts (p ≤ 0.05). A few CD79 positive cells were found in the subepithelial connective tissue and none in the epithelia. A few CD14 and SWC3 positive cells were found in the epithelia. The numbers of CD14, SWC3 and MHC class II positive cells were significantly higher in the sows than in the gilts (p ≤ 0.05) in the subepithelial connective tissue. In conclusion, the distribution of immune cells in the endometrium of anoestrous female pigs was affected by experienced pregnancy and parturition. In sows with lactation‐induced anoestrus, there was a markedly higher cell infiltration (lymphocytes and macrophages) than in the pre‐pubertal gilts. In pre‐pubertal gilts, lymphocytes dominated, which indicates a role in the maturation of the endometrium.
Clinical features and treatment outcome in Japanese patients with social anxiety disorder: Chart review study
Authors: SHINDO MASANOBU , SHIOIRI TOSHIKI , KUWABARA HIDKI , MARUYAMA MAKI. , TAMURA RYU , SOMEYA TOSHIYUKI
Published: March 2006

Abstract  The lifetime prevalence of social anxiety disorder (SAD) is high at 3–13%, but there have been only limited reports investigating the clinical features of this disorder in a large number of Japanese patients. The authors have conducted a retrospective, chart review study of 52 patients with SAD and obtained the following results. (i) The proportion of SAD in first visit outpatients at the Department of Psychiatry, Niigata University Medical and Dental Hospital, Niigata, Japan, was 1.04%. The male : female ratio was 1:0.73, so male patients appeared to be more common in the sample. (ii) With regard to subtype, generalized type (73% of the patients) was more common than non‐generalized type (27%). (iii) The mean age of onset was 18.6 ± 7.8 years, and there was a trend towards onset of disease at a younger age in the generalized type compared to the non‐generalized type. (iv) The most common chief complaint was anxiety and tension in front of others (40.4%). (v) Pharmacotherapy resulted in improvement in 63.5% of the patients. Treatment by fluvoxamine and alprazolam resulted in high response rates of more than 70%.
Psychological burdens are associated with young male transsexuals in Korea
Authors: KIM TAE‐SUK , CHEON YOUNG‐HOON , PAE CHI‐UN , KIM JUNG‐JIN , LEE CHANG‐UK , LEE SU‐JUNG , PAIK IN‐HO , LEE CHUL
Published: March 2006

Abstract  The purpose of this study was to compare differences of the psychological burdens between young male transsexuals and age–gender matched non‐transsexuals with standardized psychiatric rating scales in Korea. A total of 43 biologically unrelated young male transsexuals and 49 age–gender matched non‐transsexuals participated in the study. All subjects completed Beck’s Depression Inventory (BDI), Social Avoidance and Distress Scale (SADS), Self‐Esteem Scale (SES) and Family Adaptability and Cohesion Evaluation Scale (FACES‐III). The transsexuals showed significantly higher scores on the BDI (P < 0.0001) and SADS (P = 0.002) and lower scores on the SES (P < 0.0001) and Adaptability and Cohesion subscales (P = 0.016 and P < 0.0001, respectively) of the FACES‐III than those of the non‐transsexuals. The present study found young male transsexuals may be potentially vulnerable to develop psychiatric and familial problems in comparison with non‐transsexuals, at least in Korea, although methodological limitations exist. Further well‐designed researches should be launched to confirm this preliminary study.
Effect of age and education on the Trail Making Test and determination of normative data for Japanese elderly people: The Tajiri Project
Authors: HASHIMOTO RYUSAKU , MEGURO KENICHI , LEE EUNJOO , KASAI MARI , ISHII HIROSHI , YAMAGUCHI SATOSHI
Published: March 2006

Abstract  The Trail Making Test (TMT) is a common two‐part neuropsychological test, in which visuospatial ability (TMT‐A) and executive function (TMT‐B) are evaluated. Normative data for this test have not been reported for Japanese subjects; therefore, the purpose of the present paper was to investigate the effect of age and education on the TMT in 155 healthy elderly adults with clinical dementia rating 0 (healthy). The participants were classified into three groups based on age (70–74 years, 75–84 years and ≥85 years), and also into three groups based on educational level (6 years, 8 years and ≥10 years). The time to complete TMT‐A and TMT‐B were measured, and the difference in score between TMT‐A and TMT‐B (B–A) and the ratio of the score (B/A) were calculated as indices of executive function. The time for completion of both parts of the TMT increased markedly in the ≥85‐years group. For TMT‐A, there was a significant difference between the 6‐years and 8‐years groups, and between the 6‐years and ≥10‐years groups, and for TMT‐B, there was a significant difference between the 6‐years and ≥10‐years groups, and between the 8‐years and ≥10‐years groups. The difference and ratio scores increased in the ≥85‐years group, but the educational level did not significantly influence these scores. Our data suggest that cognitive functions evaluated by TMT‐A and TMT‐B are not affected by aging until the subjects are ≥85 years old. For TMT‐A, an educational effect becomes apparent when the population includes poorly educated subjects, but this part of the test is not affected by educational level provided that the subjects have some education (>6 years). The time to complete TMT‐B is affected by educational level, consistent with previous reports. However, when adjusted using the results for TMT‐A [(B‐A) or (B/A)], the educational effect on executive function disappeared. Thus, the effect of educational level on executive function was unclear in normal elderly subjects.
Attention‐deficit/hyperactivity disorder and dissociative disorder among abused children
Authors: ENDO TARO , SUGIYAMA TOSHIRO , SOMEYA TOSHIYUKI
Published: March 2006

Abstract  The aim of this study was to investigate the psychiatric problems and characteristics among children of child abuse (CA). Specifically, the authors investigated whether attention‐deficit/hyperactivity disorder (ADHD) symptoms were exhibited before or after CA. A total of 39 abused child inpatients who were treated at Aichi Children’s Health and Medical Center, Aichi, Japan, (mean age, 10.7 ± 2.6; mean IQ scores, 84.1 ± 19.3) were included in the study. The most frequent diagnosis was dissociative disorder in 59% of abused subjects. ADHD was diagnosed in 18% of abused subjects, and 71% of ADHD children had comorbid dissociative disorder. A total of 67% of all CA subjects fulfilled the ADHD criteria A according to DSM‐IV‐TR, however, only 27% of those fulfilled the criteria before CA. The subjects of dissociative disorder fulfilled ADHD criteria A more frequently than those of non‐dissociative disorder (P = 0.013), and this result led to an increase in the frequency of the apparent ADHD. The rate of ADHD‐suspected parents in the subjects who fulfilled ADHD criteria A after CA was significantly lower than those who fulfilled it before CA (P = 0.005). While it is difficult to distinguish ADHD from dissociative disorder, abused children may have increased apparent ADHD due to dissociative disorder. Further studies should be conducted in order to explore the distinct biological differences between ADHD before CA and the subjects who fulfilled ADHD criteria A after CA.