bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence that channel catfish, Ictalurus punctatus (Rafinesque), mortality is not linked to ingestion of the hepatotoxin microcystin‐LR
Authors: Snyder G S , Goodwin A E , Freeman D W
Published: March 2003

Catfish farms located in the south‐eastern USA using brackish (3–5 g NaCl L−1) well water experience sporadic fish kills sometimes with high mortality. An investigation of three catastrophic losses occurring in this region identified no involvement of infectious diseases or traditional water quality problems, including oxygen, ammonia or nitrite. The high mortality and time course of the problem was indicative of exposure to a toxin. Attempts by other workers to explain the cause of this unique syndrome (high chloride associated toxicosis of catfish, HCTC), suggested that the losses might be because of microcystin‐producing blooms of Microcystis aeruginosa, but our investigations failed to support this conclusion. We found that (1) the liver histology of catfish experimentally exposed to pure microcystin‐LR is very different from that of catfish sampled during outbreaks of HCTC; (2) measurements of microcystin‐LR concentrations in the three cases were far lower than the concentration required to kill catfish by experimental immersion; (3) the HCTC toxin appears to have a short half‐life, whereas microcystin‐LR does not; (4) experimental gavage of catfish with massive amounts of microcystin‐LR does not cause the acute mortality typical of HCTC; (5) outbreaks of HCTC appear to be associated with heavy blooms of Anacystis marina, a halophytic cyanobacteria, not with blooms of M. aeruginosa.
Influence of water quality on the outbreak of proliferative kidney disease – field studies and exposure experiments
Authors: El‐Matbouli M , Hoffmann R W
Published: March 2003

This paper presents data from field studies and exposure experiments and the possible association of limno‐ and physicochemical parameters with outbreaks of proliferative kidney disease (PKD) in rainbow and brown trout. The investigations were carried out at Singold Brook in southern Germany. Exposure experiments and sampling of wild fish were performed in Singold at least twice a year in 1992, 1994, 1996 and 2000. Both wild fish collected from the specific sites and experimentally exposed rainbow trout were investigated histologically for the occurrence of PKD. At the time of sampling, various water parameters at the respective river sites were measured. The results indicate strongly the existence of a correlation between organic pollution of water, the presence of Bryozoa and the outbreak of PKD.
Nutritional support for children with epidermolysis bullosa
Authors: Haynes
Published: March 2003

The term epidermolysis bullosa (EB) describes a number of rare, genetically determined blistering disorders characterized by excessive fragility of the skin and mucous membranes. Complications in the mouth, oesophagus and anus, combined with chronic skin infections and blood loss can severely compromise nutritional intake , leading to prolonged malnutrition and extreme growth failure. However, with early nutritional assessment and intervention, it is possible to achieve substantial improvements in nutritional status and growth, benefiting a variety of aspects of quality of life and reducing morbidity and mortality. In severe cases, attempts to enhance oral intake alone fail to promote satisfactory growth, and placement of a button gastrostomy device is the treatment of choice. In a multisystem condition such as EB, the success of dietary manipulations invariably depends on satisfactory management of a number of related factors—notably chronic constipation, gastro‐oesophageal reflux and skin care. To promote appropriate strategies of intervention, it is highly advantageous for the dietitian to understand the aetiology and prognosis of the different types of EB, and to operate as an integral and pro‐active member of the large multidisciplinary team required to manage these children.
Oral nutritional supplements promote significant weight gain in cystic fibrosis patients
Authors: Skypala  , Ashworth  , Hodson  , Leonard  , Knox  , Hiller  , Wolfe  , Littlewood  , Morton  , Conway  , Patchell  , Weller  , McCarthy  , Redmond  , Dodge
Published: March 2003

Background: Malnutrition and poor growth are major problems for many patients with cystic fibrosis (CF), and nutritional supplements can enhance the success of dietary strategies. The purpose of this study was to assess Scandishake (Scandipharm Ltd, U.K.), an energy dense (2.0 kcal/ml) oral supplement.
Methods: The study design included a 4‐week monitoring period, followed by 8 weeks of supplementation with Scandishake. The subjects had anthropometry assessed at weeks 0, 4 and 12, and their dietary intake assessed at weeks 0 and 12.

Results: Data from 26 patients (16 male, 10 female; age range 9–34 years) showed a significant mean weight increase of 1.9 kg (range 1.6–4 kg) and a mean increase of 0.5 cm (range 1.1–2.7 cm) in mid‐arm muscle circumference. There was also an increase in energy intakes, rising from a mean of 11.15 MJ (2665 kcals) to a mean of 13.42 MJ (3208 kcals) (
P < 0.01), and the mean of individual percentages of estimated average requirement (EAR) for energy increased from 120% (73–182%) to 143% (67–221%).

Conclusion: The energy dense formulation of Scandishake makes it a useful adjunct in the treatment of malnutrition and the promotion of normal growth in patients with CF.
The dietary intake of people with non‐insulin‐dependent diabetes (NIDDM): how valid is self‐reported intake?
Authors: Adams
Published: March 2003

Background: In diabetes care, an accurate assessment of dietary intake is essential for clinical management. This study assessed the validity of dietary records from people with NIDDM by comparing reported energy and protein intakes with estimated total energy expenditure (TEE) and urinary nitrogen excretion.

Method: To assess energy and nutrient intake 185 patients kept dietary records for two 3‐day periods. Basal metabolic rate (BMRest) was estimated to calculate reported energy intake/BMRest. Appropriate age and sex‐specific physical activity levels (PAL=TEE/BMR) from published doubly‐labelled water studies of TEE, were used to calculate a cut‐off PAL for energy intake/BMRest, below which intakes were statistically unlikely to be valid. A subgroup (46 patients) collected a complete 24‐h urine sample to compare nitrogen excretion with protein intake.

Results: The mean value of energy intake/BMRest (1.14±0.3) was markedly below the calculated cut‐off point (1.58±0.06) suggesting widespread underreporting. Protein intake (82.5±21.3) was also lower than estimated protein losses (92.5±19.4). Obese and female NIDDS were more likely to underreport and their intakes were closer to the diabetes dietary recommendations.
Conclusion: This study found that people with NIDDM were likely to underreport their food intake.
Parenteral nutrition. Do dietitians have a role? Results of the Parenteral and Enteral Nutrition Group survey
Authors: Gilmour  , Glencorse
Published: March 2003

Aim: To examine the role of the nutrition support dietitian in parenteral nutrition (PN).

Methods: Two postal surveys were sent to members of the Parenteral and Enteral Nutrition Group (PENG) in 1993 and 1995. The questionnaires were designed to examine four key areas of dietetic practice in PN.

Results: Response rates of 73% in 1993 and 75% in 1995 were achieved. In 1993, a minority of dietitians, only 5%, assumed total responsibility for the formulation of parenteral nutrition regimens. In 1995 this figure had risen to 14%. However, 83% of nutrition support dietitians wanted to increase their involvement in PN. Results from the 1995 survey showed that 42% of dietitians felt that education at undergraduate level was inadequate, whilst 58% felt education at postgraduate level could be improved.

Conclusion: Both surveys raised a number of issues concerning present prescribing practices of PN in the UK. There appears to be little practical clinical nutrition education concerning PN either in the medical, dietetic or pharmaceutical curriculum. This may indicate that present prescribing practices are suboptimal. Because dietitians are involved in nutritional assessment and calculation of nutritional requirements it would seem sensible that dietitians should have a greater prescribing role in PN. In order to become competent advisors in this area, more must be done to improve education for dietitians at the undergraduate and postgraduate levels, otherwise the opportunity to be actively involved in this area may be lost.
Diabetes Exercise Project
Authors: Murphy  , Simkins  , Helowicz
Published: March 2003

Background: Exercise can play a major role in improving diabetic control and prevention of complications. In order to encourage overweight people with poorly controlled diabetes to take more exercise a group exercise programme was set up.

Objectives: To evaluate the effectiveness of the diabetes exercise project 20 months after professional contact and funding had ceased. The project ran from October 1994 to March 1996 and the evaluation was carried out in November 1997.

Method: Evaluation was carried out through a postal questionnaire, focus group discussions and clinical data collection on a sample of those referred on to the project.

The project set out to find: (1) the number of the original group who took up the exercise programme and were still exercising on a regular basis; (2)the clinical outcomes in terms of changes in body mass index (BMI), glycosylated haemoglobin (HbA1) and diabetes medication from the start of the exercise project to the evaluation; (3) the self‐reported benefits to those with diabetes on the exercise programme, including any self‐reported effect regular exercise has had on their diabetes control at the time of the evaluation; (4) the factors associated with their ability to carry on exercising.

Results: Clinical outcomes showed no significant changes in those who continued to exercise and those who stopped. However, there was a statistically significant increase (P = 0.01) in the proportion of those with non‐insulin dependent diabetes (NIDDM) who were treated with insulin, from 30% to 53%. Of the 42 who had replied to the questionnaire, 71% continued to exercise for more than 6 months and, of these, 52% continued to exercise for over 20 months. Self‐reported benefits of exercise included ‘increased energy levels’, a greater ability to concentrate and enjoy exercise, increased motivation and more positive mood and feelings. Improvement in diabetic control was reported by 25 (60%). Further benefits reported included a stabilizing of their diabetes, loss of weight and a more positive attitude towards their health.

Conclusions: It is possible to motivate overweight, poorly controlled people with diabetes to exercise on a regular basis. To do so successfully, consideration needs to be given to having the right personnel involved in the exercise programmes, support from the health professionals and suitable facilities and instruction. Injury and lack of time were given as the main barriers to exercise.
Nutritional status of a brain‐injured population in a long‐stay rehabilitation unit: a pilot study
Authors: French A. M. , Merriman S. H.
Published: March 2003

Background: Studies elsewhere have shown a high incidence of malnutrition in brain‐injured people and in in‐patient populations.

Objectives: To investigate the incidence of malnutrition in long‐term rehabilitation at the National Centre for Brain Injury Rehabilitation and to evaluate the usefulness of a range of measures of nutritional status.

Methods: All (n=33) patients were invited to participate. Anthropometric, dietary, haematological and biochemical measurements were made.

Result: The incidence of malnutrition was nil. The incidence of obesity was comparable to the ‘normal’ population. Subjects consumed a nutritionally adequate diet, except for NSP (fibre).

Conclusion: The result was not only better than that of other therapeutic communities, it was better than the ‘normal’ population. Useful tools for assessment of nutritional status were found to be BMI, arm anthropometry, biochemistry, haematology and food diaries. Further study of the nutritional status of all admissions will identify the changes which can occur during long‐term rehabilitation.
Dietary habits of patients with renal stone disease in Greece
Authors: Hassapidou M. N. , Paraskevopoulos S. TH. , Karakoltsidis P. A. , Petridis D. , Fotiadou E.
Published: March 2003

Objective: To assess the dietary habits of 62 renal stone patients and to relate their diet to the likelihood of nephrolithiasis.

Subjects and methods: All subjects completed a dietary questionnaire including questions regarding anthropometric characteristics, dietary habits and food consumption frequencies. Subjects were grouped according to sex.

Results: Sixty per cent of the subjects were male and 40% female. Seventy‐nine per cent of the patients were obese (BMI > 25). The percentage of obese individuals was higher for men (84%) than for women (72%). Furthermore, BMI increased with age with a peak at the age of 50 years. All subjects had a high meat intake indicating a high animal protein consumption. Forty‐two per cent of the subjects consume meat 5–8 times per week and 24% consume meat 9–12 times per week. All subjects had a low milk and dairy products intake as well as low vegetable and fruit intake, indicating a strong possibility of low calcium and fibre intake.

Conclusion: The results of the dietary survey recorded a diet which is associated with an increased risk of nephrolithiasis. The majority of the subjects were obese, had a high intake of animal protein from meat, a low intake of foods rich in calcium and a low number of meals per day.
A11. The influence of the media on eating disorders
Authors: Almond S.
Published: March 2003

Background The cause of eating disorders is multifactorial. One of these is sociocultural factors which include family, peers and the media. It has been suggested that constant media pressures can lead to body dissatisfaction, which may result in distorted eating patterns.

Aims To review the role of the media in relation to eating disorders

Results There has been a shift in the media portrayal of the ’ideal’ body size for women, from the voluptuous curved figure of Marilyn Monroe in the 1950s to a thinner ’waif‐like’ look of Kate Moss in the 1980s.

In the mass media shape and weight define perfection. Women perceive themselves as being bigger than they actually are. Their figure deviates from the ideal thus resulting in self body dissatisfaction.

’All I see is these pretty models, I wish I could look like one of them.’ ( Wertheim et al. 1997
)

The ’ideal’ body image is far from the physiologic norm. Supermodels are born with a specific body type and what the public doesn’t understand is that they cannot diet to achieve it.

’Women don’t set out to be anorexic, they begin by thinking they’re too fat because everywhere they go the media is telling them that they are right’ ( Barrett, 1997)

Products are often advertised displaying the ideal body shape in the hope that it will enhance the product and create body dissatisfaction. Purchasing the product is perceived as a positive step towards reaching the ’perfect’ body image. Concern surrounds the appearance of such advertisements in magazines aimed at adolescent girls, as at this age they are particularly vulnerable to the influences of the media.

Stice and Shaw (1994) stated that exposure to the thin ’idea’ may have a negative effect on emotions leading to body dissatisfaction. Such emotions include depression, stress, guilt, shame, insecurity, unhappiness, and lower self‐confidence.

A study by Schotte et al. (1990)
indicated that negative emotions can disrupt eating behaviour. Dieters watching a frightening film increased their food intake, whereas nondieters did not.

Conclusion The media are not solely responsible for eating disorders but they do contribute by promoting the ’ideal’ physique. There is some resistance to media messages, as the majority of people do not develop distorted eating patterns.
A2. The carer’s perception of dietitians’ advice and its impact on the management of patients receiving haemodialysis
Authors: Rezaie M. A.
Published: March 2003

Background Patients with end stage renal disease and their carers suffer many changes in their daily life style as a result of haemodialysis (HD) treatment. Information and education concerning the management of dietary requirements and restrictions for renal patients should be aimed at both patients and their carers.

Aim This study investigated the impact of dietitians’ involvement and advice on the carers’ ability to manage patients’ dietary/fluid requirements.

Method A total of 36 carers of renal patients receiving unit haemodialysis treatment were randomly recruited into this study from a hospital in Cardiff, Wales. All the carers completed the Haemodialysis carers questionnaire (HCQ), specifically designed for this study, delivered to them in the outpatient clinic by the dietitian.

Results Of the 36 carers, 22 (61%) were female, six (16.7%) were male and eight (22%) did not report their gender. Thirteen (36%) of the carers were between the ages of 20–54 years and 23 (64%) were 55 years of age and older. Twenty‐six (72%) of the carers involved in this study were spouses and 34 (94.4%) of the carers lived with the patient. The mean duration of haemodialysis treatment for the patient was found to be 20 months. The results indicated that although the majority of the carers were informed about patients’ dietary and fluid restrictions, 45% had not received any dietary information. Dietitians’ one‐to–one interactions with the carer was the most effective way of providing information in enabling them to better manage the patient compared to other methods such as leaflet and information packs (P = 0.01). The majority of the carers knew how to contact the renal dietitian, however, many did not (P = 0.001). Almost all the carers considered receiving information about the purpose of HD, feed back on the patients’ condition, fluid/dietary restriction and details of available community resources as very important. Those carers who had the benefit of a dietitian’s involvement believed that their advice was very helpful and enabled them to cope better with the management and complications of patient fluid and dietary requirements (P < 0.02). Strong correlations were found (rs = 0.67; P < 0.01) between the amount of information received by the carers and the level of the carers satisfaction with this information. In contrast, there were no significant correlations between the amount of information received by the carers and different aspects of managing the patients’ diet, because 45% of the carers received none or little information.

Conclusions Dietitians should involve the carers in the management of HD patient’s dietary/fluid requirements and restrictions in order to provide better quality of care and quality of life for both the patient and the carer.
A comparison of the amount of food served and consumed according to meal service system
Authors: Wilson A. , Evans S. , Frost G.
Published: March 2003

Background Malnutrition affects between 25 and 40% of all hospitalized patients, the majority of whom receive their main nutritional intake from the food provided by the hospital catering system. There is currently very little published information concerning the nutritional impact on patients of different methods of catering service.

Objective In the current study the effects of two catering service systems, plated and bulk service, on food and nutrient intake of hospital patients were compared.

Methods One‐hundred and eight patient meals were surveyed, 51 on the plated meal and 57 on the bulk meal services. Patients were either on a general medical or an orthopaedic ward. Weighed food intake data were collected by weighing food served and comparing it to the weight of food left on the plate. Equal numbers of lunch and supper dishes were weighed. Also, a number of weekend surveys were carried out to take into account variation in service at weekends.

Results Food wastage was greater with the plated system. Comparing the amount of energy and nutrients consumed by patients according to meal system: energy intakes were significantly lower with the plated system (414 ± 23 kcal vs. 319 ± 22 kcal, P < 0.004). Protein, fat and carbohydrate intakes were also significantly lower. The main reason for the observed differences was the higher total food intake of the main course of the bulk service meals. Energy intake from the main course was significantly higher among patients receiving bulk service meals (227 ± 10 kcal vs. 165 ± 14 kcal, P < 0.006).

Conclusion Catering service systems can have a major impact on the nutritional intake of hospitalized patients.
Percutaneous endoscopic gastrostomy feeding in haemodialysis out‐patients
Authors: Sayce H. A. , Rowe P. A. , McGonigle R. J. S.
Published: March 2003

Introduction Malnutrition is highly prevalent in haemodialysis (HD) patients and plays a major role in influencing outcome. Although use of home enteral feeding is expanding rapidly in the UK, it is a method of nutritional support which remains under‐utilized in HD out‐patients. We report our experience and outcomes in a series of eight cases.

Methods Home gastrostomy feeding was initiated in eight malnourished HD out‐patients, administered either continuously overnight or as daily bolus feeds. Nutritional parameters were monitored weekly by the renal dietitian and included dry weight, upper‐arm anthropometry and serum albumin. The number and duration of hospitalizations during the period of feeding were recorded.

Results After 3 months of feeding, median dry weight increased from 43.0 to 48.3 kg (P = 0.012), mid‐upper arm circumference increased from 20.2 to 24.8 cm (P = 0.018), triceps skinfold thickness increased from 7.3 to 11.3 mm (P = 0.046), mid‐upper arm muscle circumference increased from 17.7 to 19.8 cm (P = 0.027) and serum albumin increased from 29.5 to 36.5 g L−1 (P = 0.011). Few complications were encountered and hospital admission rates were low.

Conclusion Home gastrostomy feeding, with appropriate monitoring and support, is an effective method of improving and maintaining nutritional status in this vulnerable group.
The challenges of innovation in the organization of home enteral tube feeding
Authors: Howard P. , Bowen N.
Published: March 2003

The number of patients discharged from hospital who need home enteral tube feeding has been increasing steadily in the UK. Arrangements for support of these patients is extremely variable. The unsatisfactory arrangements for home enteral tube feeding which existed in Avon in 1996 prompted an innovative reorganization. On the basis of that experience, this review examines the key issues involved and the questions to be considered, which may be of benefit to other trusts faced with similar challenges.
The validation of a nursing nutritional assessment tool for use on acute elderly wards
Authors: McCall R. , Cotton E.
Published: March 2003

Background

Elderly people are at great risk of poor nutritional status. Identifying those at nutritional risk is complex owing to its multifactorial nature and highlights the need for an easily administered nutritional screening tool.

Aim

To test the robustness of a tool used to identify those patients who require further dietetic assessment.

Method

The tool was tested on an ‘acute elderly’ ward to assess its statistical robustness, i.e. test–retest reliability, inter‐rater reliability, internal consistency and factor structure, concurrent and construct validity. The research was carried out by a dietitian and two nurses on an overall sample of 185 consecutive admissions.

Results

Test–retest results reflect that the tool is capable of yielding consistent assessments over time. Inter‐rater reliability results revealed that when comparisons of agreement between nurses and dietitians were examined there was consistent disagreement. Internal consistency was found to be low but the rotated factor analysis suggested a relationship between the items in the tool. Concurrent validity was exhibited with body mass index, albumin and American Nutrition Risk Index only. Construct validity was not sufficiently exhibited with any of the measures used.

Conclusion

The tool has not demonstrated reliability as determined by the statistical measures and hence validity at this stage. Issues which need to be addressed to allow this tool to be used appropriately are discussed.
Dietary restraint in relation to nutrient intake, physical activity and iron status in adolescent females
Authors: Mulvihill C. B. , Davies G. J. , Rogers P. J.
Published: March 2003

Aim

To investigate the prevalence of dietary restraint in a female adolescent population, and to examine the nutritional consequences of dietary restraint and its implications for iron status.

Methods

A total of 64 adolescent females, aged 14–15 years, were recruited from two all‐girl schools in central London. Nutrient intake, body weight, physical activity and iron status were measured. Findings were compared between three groups of subjects classified by dietary restraint.

Results

Adolescents with a higher BMI percentile were more likely to be highly restrained. Scores on the dietary restraint psychometric measures were comparable with other UK studies in this age group. Energy intake was inversely related to dietary restraint (mean energy intake (SE) for each restraint group were: low 8.99 MJ (0.48), medium 7.98 MJ (0.22) and high 7.35 MJ (0.39) P < 0.05); however, a corresponding relationship between dietary restraint and reduced micronutrient intakes was not found. Highly restrained eaters obtained more of their energy intake from bread, fruit and cheese and less from meat, meat products and confectionery. Levels of physical activity were not significantly different between the dietary restraint groups. There was a poor relationship between reported energy intake and estimated energy expenditure. Haematological parameters of iron status were similar across the restraint groups.

Conclusions

Dietary restraint was exercised by the consumption of a `healthy eating diet'. Dieting was not related to a lower iron status; however, the low dietary iron intake and poor iron status of the whole sample is of concern.
Estimation of total body water from bioelectrical impedance analysis in patients with pancreatic cancer – agreement between three methods of prediction
Authors: Bauer J. , Capra S. , Davies P. S. W. , Ash S. , Davidson W.
Published: March 2003

Introduction

Bioelectrical impedance analysis (BIA) is a useful field measure to estimate total body water (TBW). No prediction formulae have been developed or validated against a reference method in patients with pancreatic cancer. The aim of this study was to assess the agreement between three prediction equations for the estimation of TBW in cachectic patients with pancreatic cancer.

Methods

Resistance was measured at frequencies of 50 and 200 kHz in 18 outpatients (10 males and eight females, age 70.2 ± 11.8 years) with pancreatic cancer from two tertiary Australian hospitals. Three published prediction formulae were used to calculate TBW – TBWs developed in surgical patients, TBWca‐uw and TBWca‐nw developed in underweight and normal weight patients with end‐stage cancer.

Results

There was no significant difference in the TBW estimated by the three prediction equations – TBWs 32.9 ± 8.3 L, TBWca‐nw 36.3 ± 7.4 L, TBWca‐uw 34.6 ± 7.6 L. At a population level, there is agreement between prediction of TBW in patients with pancreatic cancer estimated from the three equations. The best combination of low bias and narrow limits of agreement was observed when TBW was estimated from the equation developed in the underweight cancer patients relative to the normal weight cancer patients. When no established BIA prediction equation exists, practitioners should utilize an equation developed in a population with similar critical characteristics such as diagnosis, weight loss, body mass index and/or age.

Conclusions

Further research is required to determine the accuracy of the BIA prediction technique against a reference method in patients with pancreatic cancer.
Community care for adults with Williams syndrome: how families cope and the availability of support networks
Authors: Udwin O. , Howlin P. , Davies M. , Mannion E.
Published: March 2003

A study of the adjustment difficulties and needs of 70 adults with Williams syndrome found that the majority continued to live at home and remained heavily dependent on their families for their self‐care. Twenty‐nine families (41.4%) had had no contact with a social worker in the preceding 2 years, and 34 out of the 48 families whose children still lived at home (70.8%) had no access to respite care. Advice regarding benefits, and appropriate living and occupational arrangements for the adults was also patchy. Despite progressive medical problems, and high rates of behavioural and emotional difficulties, only 20 adults (29%) were receiving regular health checks, while 21 (30%) had had some contact with a mental health service in the preceding 2 years. In the majority of cases, families continued to shoulder the main burden of care for their sons and daughters with Williams syndrome well into adulthood, with little support from statutory and voluntary agencies. The implications of these findings are considered with regard to the principles of community care.
Facing stress and conflict: a comparison of the predicted responses and self‐concepts of aggressive and non‐aggressive people with intellectual disability
Authors: Jahoda A. , Pert C. , Squire J. , Trower P.
Published: March 2003

The present research consisted of two studies. A total of 44 participants were involved in the first study: 22 individuals with problems of aggression (Ag) and 22 non‐aggressive (NAg) individuals. A sentence completion test was used to explore whether there were differences between the two groups' predicted coping responses in stressful situations. While the Ag group provided most aggressive responses, the NAg participants were more assertive. However, gender differences also emerged, with women proving to be less aggressive. A high number of passive answers were given across all the groups, suggesting that background experience could have influenced the participants' sense of efficacy in stressful situations. In the second study, a subsample of the participants were interviewed. The aim was to explore whether particular background experience coloured their perceptions of self and others, in situations of conflict. While nine out of the 10 Ag participants described incidents where they felt treated in a derogatory manner which could be linked to their disability, only two out of the nine NAg participants felt slighted in this fashion. Hence, a vulnerable sense of self could contribute to greater sensitivity in interpersonal situations, increasing the likelihood of an aggressive response. The clinical relevance of this work is discussed, alongside the possibilities for future research in this area.
Affective psychosis and Prader–Willi syndrome
Authors: Bouras N. , Beardsmore A. , Dorman T. , Cooper S.‐A. , Webb T.
Published: March 2003

Previous studies have demonstrated that maladaptive behaviours are common amongst adults with Prader–Willi syndrome (PWS). Case reports have also previously demonstrated that psychosis can occur amongst adults with PWS. The present study was undertaken in order to gain a better understanding of the psychopathology of the psychosis of PWS. Twentythree out of 25 adults identified with PWS living in Northamptonshire, UK, agreed to participate. Comprehensive psychiatric assessments (using the PPSLD), and measures of adaptive and maladaptive behaviours (using the AAMR‐ABS) were completed. Comparisons were made for the prevalence of psychiatric disorders against those from a previous epidemiological study of adults with intellectual disability of other aetiologies from a neighbouring county. The PWS group was found to have higher rates of affective disorders (a point prevalence of 17.4%), in which psychotic symptoms were common, but similar rates of schizophrenia/delusional disorders (4.3%) compared with the comparison group. Behaviour disorders were also common. Surprisingly, none of the PWS group was found to have generalized anxiety or phobic disorders. The diagnostic criteria for the episodes including psychotic symptoms are explored. The high rates of affective disorders is of clinical (i.e. treatment) importance as well as being of academic interest with regard to the genetics of psychiatric disorders.
Visuo‐spatial and linguistic abilities in a twin with Williams syndrome
Authors: Volterra V. , Longobardi E. , Pezzini G. , Vicari S. , Antenore C.
Published: March 2003

The present study reports a case of dizygotic twins, one boy with Williams syndrome (WS) and one typically developing girl, and compares their neuropsychological profiles. The goal of the present authors was to verify whether the child with WS displayed a cognitive profile which is unique to the syndrome. Several tests designed to assess visuo‐perceptual, visuo‐motor, linguistic and memory abilities were administered to both children when they were 10.9 years old. Compared to his sister, the boy with WS displayed a homogeneous developmental delay in both non‐verbal and verbal abilities. He achieved a level of performance similar to his sister only in facial recognition, phonological word fluency and memory for phonologically similar words. Furthermore, despite the overall delayed performance of the boy, both the twins displayed a cognitive profile characterized by strength in lexical comprehension and relative weakness in visuo‐motor abilities.
Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability
Authors: Nøttestad J. AA. , Linaker O. M.
Published: March 2003

Before total deinstitutionalization in Norway, many believed that the ordinary health care system could give people with intellectual disability the same or even better health care than that which they received in institutions. It was said that institutions created psychiatric problems, and that these would diminish or even disappear with the closing of these establishments. The present study is a prospective cohort study without a control group. It examines the frequency of mental health problems and the psychiatric health services which 109 subjects aged between 16 and 65 years received before (1987) and after (1995) deinstitutionalization. Mental health problems were defined as behavioural disturbances, and psychiatric disorders and symptoms. Psychiatric disorders were identified with the Psychopathology Instruments for Mentally Retarded Adults (PIMRA), which were filled in by the carers. Behaviour disturbances were identified as having occurred or not during the previous year. Psychiatric problems remained frequent, and there was a significant increase in behavioural problems in spite of total deinstitutionalization and improved physical living conditions. Access to qualified help, such as psychologists and psychiatrists, had been substantially reduced. Most mental health problems among people with intellectual disability are not solved by reorganization or deinstitutionalization, and such measures are no substitution for professional assistance.
Characteristics of older adults with intellectual disabilities referred for crisis intervention
Authors: Davidson P. W. , Houser K. D. , Cain N. N. , Sloane‐Reeves J. , Quijano L. , Matons L. , Giesow V. , Ladrigan P. M.
Published: March 2003

The aim of the present study was to identify the age correlates of behavioural crises in adults with intellectual disability (ID) living in the community. The cohort consisted of 185 clients (IQ < 70), ranging in age from 20 to > 70 years, who were referred to a crisis intervention programme specializing in services to individuals with dual diagnosis over a 7‐year period. A retrospective cross‐sectional analysis of historical and contemporaneous variables was completed. Referrals for crisis intervention were not related to the age of the client. Aggression and non‐compliant behaviour occurred with similar frequency in all age groups. Other behaviours, including withdrawal, self‐injury, stereotypy and symptoms of psychiatric disorders, occurred less often in older clients. Severity of ID affected the pattern of behavioural crises that resulted in referral. The results suggest that people with ID residing in community settings still experience behavioural crises as they grow older. Confirmation of the trends reported in the present study might signal a need for accelerating the development of comprehensive age‐span community mental health and behavioural supports.
Autism in Down’s syndrome: a family history study
Authors: Ghaziuddin M.
Published: March 2003

Several recent reports have described the occurrence of autism in subjects with Down’s syndrome (DS). However, relatively little is known about the family history of these subjects, especially with reference to autism. In order to address this issue, the present author examined 11 subjects with DS and autism (DSM‐III‐R; nine males), and compared them with seven controls with DS but without autism (DSM‐III‐R; three males). Details about family psychiatric history were obtained from both groups with an emphasis on autism and related disorders. Subjects with both DS and autism had an excess of first‐degree relatives who met the description of the broader phenotype of autism. Seven (64%) of the subjects with autism had an affected parent as against one (14%) of the control group. Similarly, four out of 11 siblings (36%) in the DS with autism group showed features suggestive of the broader autistic phenotype compared to none in the control group. These findings suggest that, at least in some cases, autism‐specific genetic factors may be important even when autism occurs in the presence of known medical conditions. Further studies of the mechanism of comorbidity of autism with medical conditions may help clarify the aetiology of the disorder.
Self‐assessment of relationships with peers in children with intellectual disability
Authors: Zic A. , Igrić L.
Published: March 2003

Interaction with peers is important for the development of children, but children with special needs may feel rejected by their peers. The present study examines self‐assessment of relationships with peers by children with intellectual disability (ID; n = 20) and children from the general population (n = 20). All participants attended a regular primary school and were aged between 7 and 10.5 years; both sexes were represented in the samples. The Behavior Rating Profile was applied. The results of the children with ID on the ‘Student Rating Scale: Peers’ did not show statistically significant differences from the results of children from general population, with both groups responding similarly to the self‐perception scale. However, the sociometric results obtained from their peers clearly show that children with ID are not accepted by their classmates. Peers frequently and more often refuse to study, sit together in class or socialize after classes with children with ID than is the case for children without ID. Despite the high frequency of rejection, it is concluded that children with ID of younger primary school age have average confidence in their own abilities and in the success of their relationships with their peers. Further education among the children who reject them could have a negative impact on their self‐esteem.
A microswitch for vocalization responses to foster environmental control in children with multiple disabilities
Authors: Lancioni G. E. , O'Reilly M. F. , Oliva D. , Coppa M. M.
Published: March 2003

The present study assessed whether two children with multiple disabilities could learn to successfully operate a special microswitch through vocaliza‐ tion responses so as to obtain environmental stimulation. The study was carried out using a non‐concurrent multiple baseline design across individuals. The treatment phase of the second child started after he had received twice the number of baseline sessions used for the first child. The results were positive, with both children increasing the frequencies of their vocalization responses during the treatment. The importance of using such responses (which do not require excessive efforts and are highly valued) for operating a microswitch with children with multiple disabilities is discussed.
Assessing the need for reactive behaviour management strategies in children with intellectual disability and severe challenging behaviour
Authors: Adams D. , Allen D.
Published: March 2003

The need for reactive behavioural management strategies for aggressive behaviours in adults with intellectual disability has been clearly established, but equivalent information concerning children with challenging behaviour is lacking by comparison. The present study was conducted in order to assess this need. A retrospective study was conducted to ascertain the nature of aggressive behaviours amongst a cohort children referred to a specialist support service. Aggressive behaviours were found to occur at high rates within the study group. Almost 60% of the children displayed aggression that occurred at least daily, and the behaviours resulted in serious consequences for carers in almost one‐third of the group. Physical interventions were already in use in 56% of cases, but were largely improvised by carers. The need to include reactive behavioural training as part of an overall intervention package for carers of children with challenging behaviour appeared to be supported by the present results. The implications for training design are discussed.
Visual impairment in adult people with intellectual disability: Literature review
Authors: Warburg M.
Published: March 2003

The present paper reviews studies on the prevalence of visual impairment (VI) in adults with intellectual disability (ID). Every publication describes an alarming prevalence of blindness and VI. Cataract and keratoconus were common. Many cases of poor distance vision were treatable by ordinary spherical or astigmatic glasses, but few people had had such prescriptions. Elderly residents in community and institutional care often did not receive glasses for near vision. Professional assessments disclosed higher prevalences of VI than questionnaires mailed to the care personnel. The prevalence of VI increased dramatically with the severity of ID and with age. Regular professional assessment of eye disorders, visual acuity and refraction are warranted in residents in both hospital and community care.
Behavioural aspects of Pollitt syndrome: a 32‐year follow‐up of a case described by R. J. Pollitt and colleagues in 1968
Authors: Murrin K. L. , Clarke D. J.
Published: March 2003

In 1968, R. J. Pollitt and colleagues described a syndrome characterized by abnormally brittle, sulphur‐deficient hair (trichothiodystrophy), intellectual disability (ID) and growth retardation. One of the two siblings originally described by the above authors has recently been re‐assessed by the present authors following a referral for advice about ritualistic behaviours. Her current clinical features are described, and the literature concerning trichothiodystrophy and ID is summarized.
Paid employment of mothers and fathers of an adult child with multiple disabilities
Authors: Einam M. , Cuskelly M.
Published: March 2003

Background Paid employment is increasingly undertaken by mothers as their children age, with the majority of women being in employment by the time their offspring are adult. Opportunities to engage in employment appear to be reduced for mothers of children with disabilities; however, little is known about the employment of mothers or fathers of adults with disabilities.

Method Data were collected regarding the employment decisions of parents of a young adult with multiple disabilities and contrasted with those of parents whose children were all developing normally. Twenty‐five mothers and 12 fathers of a young adult with multiple disabilities were interviewed, as were 25 comparison mothers and 19 comparison fathers. Data collected included hours of work, reasons for employment status, attitudes towards work and child care, and psychological well‐being.

Results Clear differences were found between the two groups. Mothers and fathers of a child with multiple disabilities showed different engagement patterns with the paid workforce from comparison parents. Hours of work for fathers of a young adult with multiple disabilities showed a bi‐modal distribution, with some fathers working fewer hours than usual and others working very long hours. For mothers in both groups, the number of hours in paid employment was negatively associated with reports of psychological problems.

Conclusions Increased attention needs to be given to the employment opportunities of parents of children with disabilities since employment appears to play a protective role for mothers, in particular. Services provided to adults with disabilities will need to change if parents are to have the same life chances as parents without adult offspring with a disability.
Difficulties in conducting a randomized controlled trial of health service interventions in intellectual disability: implications for evidence‐based practice
Authors: Oliver P. C. , Piachaud J. , Done J. , Regan A. , Cooray S. , Tyrer P.
Published: March 2003

Background In an era of evidence‐based medicine, practice is constantly monitored for quality in accordance with the needs of clinical governance (Oyebode et al. 1999). This is likely to lead to a dramatic change in the treatment of those with intellectual disability (ID), in which evidence for effective intervention is limited for much that happens in ordinary practice. As Fraser (2000, p. 10) has commented, the word that best explains ‘the transformation of learning disability practice in the past 30 years is “enlightenment”.’ This is not enough to satisfy the demands of evidence, and Fraser exhorted us to embrace more research‐based practice in a subject that has previously escaped randomized controlled trials (RCTs) of treatment because of ethical concerns over capacity and consent, which constitute a denial of opportunity which ‘is now at last regarded as disenfranchising’.

Conclusions The present paper describes the difficulties encountered in setting up a RCT of a common intervention, i.e. assertive community treatment, and concludes that a fundamental change in attitudes to health service research in ID is needed if proper evaluation is to prosper.