bluuebunny/crossref_metadata_2025 huggingface dataset:
‘It is a different war to fight here in Sweden’– the impact of involuntary migration on the health of refugee families in transition
Authors: Samarasinghe Kerstin , Arvidsson Barbro
Published: March 2003

‘It is a different war to fight here in Sweden’– the impact of involuntary migration on the health of refugee families in transition

Involuntary migration and adaptation to a new cultural environment is known to be a stress factor. The aim of the study was to explore the impact of involuntary migration on the family health in order to identify specific health care issues related to refugee families in transition living in Sweden. Data was collected through interviews with 16 members of 10 different refugee families from Balkan countries, Kurdistan and Africa for which permission was obtained from the chairman of the local ethnic organizations in a municipality in the southern part of Sweden. In interpreting the material, analysis was made using a contextual approach with reference to phenomenography. The analysis resulted in four qualitatively different descriptive categories characterizing the health of the families: a distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted. Stressors seeking asylum, facing unemployment and changed roles, interacted negatively within the family. A friendly and understanding attitude from the host country was the main factor in promoting the health of the refugee families. Nursing interventions should therefore assist the families accordingly in order to promote the stability of the family system.
Clinical and social changes in severely mentally ill individuals admitted to an outpatient psychosis team: an 18‐month follow‐up study
Authors: Bengtsson‐Tops Anita , Hansson Lars
Published: March 2003

Aim: The study investigated clinical and social changes during an 18‐month follow‐up period in a group (n = 76) of schizophrenic outpatients admitted to a newly implemented outpatient psychosis team. Changes related to level of contact with the psychosis team were also examined as well as aspects of the content of the treatment interventions and work situation from a staff perspective.

Methods: Structured face‐to‐face interviews with the patients were performed at baseline and after 18 months. The Camberwell Assessment of Need instrument, the Lancashire Quality of Life Profile and the Interview Schedule for Social Interaction were used on both interview occasions along with Global Assessment of Functioning Scale and Brief Psychiatric Rating Scale. Thematic open‐ended questions were used in staff interviews.

Results: Psychiatric symptoms, number of needs and number of met needs decreased, and perceived quality of life improved for the total sample during the follow‐up period. Patients only in contact with a psychiatrist in the psychosis team improved more in symptoms and spent fewer days in hospital during follow‐up time compared with those who had combined psychiatric and supportive contacts, and were also more satisfied with their medication. Patients with a combined contact deteriorated in psychosocial functioning compared with the group only in contact with a psychiatrist. Some of the elements in treatment interventions and work situation as well as hindrances in providing community‐based care adapted to the patients' needs were identified.

Conclusions: Community‐based psychiatric services, to a larger extent, need to embrace evidence‐based interventions and to perform regular, structured and comprehensive need assessments in order to ensure the effectiveness of interventions. Attention should be paid to staff motivation and education as well as to providing practical guidelines, supervision and support.
Improvements in pain relief, handling time and pressure ulcers through internal audits of hip fracture patients
Authors: Hommel Ami , Ulander Kerstin , Thorngren Karl‐Göran
Published: March 2003

The aim of this project was to improve the outcome of hip fracture patients by optimizing preoperative pain relief, diminishing the time from admission to operation and reducing the occurrence of pressure ulcers. A retrospective study of all medical records of hip fracture patients from the last 4 months in 1998 was compared with prospective registrations during the same period in 1999 and 2000 after the introduction of quality improvements. The number of patients who waited for more than 1 hour to get pain relief was almost halved after improvements. In 1998, close to half of the patients had to wait more than 24 hours for an operation. After attention was given to quality improvements, 36% of the patients in 1999 and 34% of the patients in 2000 had to wait more than 24 hours. In addition, 18% of the patients in 1999 and 24% of the patients in 2000 vs. 11% in 1998 were operated on within 12 had to wait more than 24 hours. Pressure ulcers were considerably reduced. In total, 19% of the patients in 1998, 8% in 1999 and 4.5% in 2000 had pressure ulcers at discharge from the hospital. The outcome for hip fracture patients was improved through attention to quality improvements with all staff involved and focused on these patients.
Microsatellite markers for Bromus tectorum (cheatgrass)
Authors: Ramakrishnan Alisa P. , Coleman Craig E. , Meyer Susan E. , Fairbanks Daniel J.
Published: March 2003

Bromus tectorum (cheatgrass) is a flourishing invasive weed in the western United States. The objective of our study is to characterize its genetic diversity. We made a B. tectorum genomic library in lambda phage and screened approximately 4000 clones for poly CA and poly CT dinucleotide repeats. Of 38 sequences with dinucleotide repeats isolated from the library, we designed primer sets for 18 loci. A preliminary screen of 40 individuals from four populations indicated that seven loci were polymorphic. These loci will be valuable for elucidation of cheatgrass genetic diversity and population structure.
Development of hypervariable microsatellite loci for use in eastern phoebes (Sayornis phoebe) and related Tyrannids
Authors: Watson Christy J. W. , Allen Beheler Amanda , Rhodes Olin E.
Published: March 2003

In order to complement on‐going research on reproductive strategies and dispersal in the eastern phoebe (Sayornis phoebe), we developed five polymorphic microsatellite loci which would permit us to assign parentage to offspring and to evaluate population genetic structure. The number of alleles per locus ranged from 3 to 15; probability of exclusion, with a known maternal genotype, was 0.995. Preliminary screening revealed that primers were polymorphic in other Tyrannidae.
Polymorphic markers for the sea cucumber Parastichopus californicus
Authors: John Nelson R. , Cooper Glenn , Garner Trent , Schnupf Pamela
Published: March 2003

Five polymorphic markers were isolated from a Parastichopus californicus genomic DNA library. In addition, a method was developed to extract DNA from both muscle and skin tissue. The number of alleles at these loci ranged from three to 14. Observed heterozygosity ranged from 0.2 to 0.9. These markers, the first of their type for a sea cucumber species, will prove useful for exploration of the population structure of P. californicus.
Eighteen polymorphic microsatellite markers for the highly endangered Spanish imperial eagle (Aquila adalberti) and related species
Authors: Martínez‐Cruz Begoña , David Victor A. , Godoy José A. , Negro Juan J. , O'Brien Stephen J. , Johnson Warren E.
Published: March 2003

Here we describe the development of 18 polymorphic microsatellite markers for the endangered Spanish imperial eagle (Aquila adalberti). Microsatellites were tested in five other raptor species. These markers were revealed as good molecular tools for genetic population studies, individual identification and parentage assessment in Spanish imperial eagle and closely related species.
Identification and characterization of nine polymorphic microsatellite loci in the North American pika, Ochotona princeps
Authors: Peacock Mary M. , Kirchoff Veronica S. , Merideth Susan J.
Published: March 2003

Nine polymorphic microsatellite loci were developed for the North American pika (Ochotona princeps) from di‐ and tetranucleotide repeat‐enriched genomic libraries. Polymorphism was assessed for 165 individuals from eight geographical locations in the western United States. All loci were polymorphic. The number of alleles per locus ranged from three to 14, with observed heterozygosity between 0.189 and 0.822. All loci were in Hardy–Weinberg equilibrium (< 0.05). Regional differences were evident with unique alleles at multiple loci in six of eight populations.
Polymorphic microsatellites in the black‐legged kittiwake Rissa tridactyla
Authors: Tirard Claire , Helfenstein Fabrice , Danchin Etienne
Published: March 2003

We isolated seven microsatellite sequences from a library of recombinant clones in Rissa tridactyla (Laridae). We investigated their polymorphism in one population from France. Preliminary results indicate that these markers should prove valuable tools for the study of mating systems, population genetic structure and dispersal abilities in this seabird species. We present the results of cross‐species amplification for two seabird species: Uria aalge (Alcidae) and Stercorarius parasiticus (Stercorariidae). Some of the microsatellites isolated in R. tridactyla might be useful for studies on other seabird species.
Characterization of 38 polymorphic microsatellite markers for rainbow trout (Oncorhynchus mykiss)
Authors: Palti Y. , Fincham M. R. , Rexroad C. E.
Published: March 2003

Thirty‐eight new microsatellite markers were developed for genome mapping and population genetics studies in rainbow trout (Oncorhynchus mykiss). The amount of polymorphism, percentage of heterozygosity and ability of each marker to amplify genomic DNA from other salmonids were recorded. Five markers were observed to be duplicated in the rainbow trout genome by containing more than one allele in homozygous (clonal) fish.
Isolation and characterization of microsatellite loci in Bemisia tabaci
Authors: De Barro P. J. , Scott K. D. , Graham G. C. , Lange C. L. , Schutze M. K.
Published: March 2003

Bemisia tabaci (Hemiptera: Aleyrodidae) is a haplo‐diploid species with a global distribution demonstrating strong geographical structure with eight recognizable genetic groups. Fifteen microsatellite loci (335 alleles, 6–44 alleles per locus) were derived from four of the eight groups and were then screened across 33 populations. These loci clearly differentiate the populations. The microsatellites amplified best in individuals from genetic groups rep‐resenting the Mediterranean, Middle East, Asia (three groups) and Australasia/Oceania and amplified less well with populations from sub‐Saharan Africa and the New World. This differential amplification pattern is a direct result of the relatedness to the microsatellite source material.
Polymorphic microsatellite loci for tiger salamanders,Ambystoma tigrinum
Authors: Mech S. G. , Storfer A. , Ernst J. A. , Reudink M. W. , Maloney S. C.
Published: March 2003

Microsatellites have been developed for few amphibian species. However, developing genetic markers for population genetic studies in amphibians is critical because amphibians are declining globally. The tiger salamander,Ambystoma tigrinum, is widespread throughout the United States and includes the endangered subspecies,A. t. stebbinsi. We present primers and amplification conditions for 10 polymorphic microsatellite loci that have produced successful results in three subspecies ofA. tigrinum. Number of alleles per locus ranged from one to 11 and heterozygosity ranged from 0 to 0.815 depending on the subspecies and locus analysed. These markers should prove useful for future studies of genetic diversity and population subdivision.
Characterization and isolation of DNA microsatellite primers for Arapaima gigas, an economically important but severely over‐exploited fish species of the Amazon basin
Authors: Farias Izeni P. , Hrbek Tomas , Brinkmann Henner , Sampaio Iracilda , Meyer Axel
Published: March 2003

Arapaima gigas is a CITES II listed species, but it is also one of the most important food fish of the Amazon basin with a historically very large commercial and subsistence fishery. By the 1980s it became commercially extinct in many areas, and in early 2001 the Brazilian government banned all fishing, although this has not prevented illegal fishing. Therefore we developed 14 variable microsatellite markers for A. gigas to gain a knowledge of its population structure, which is needed to implement a sound management policy, and also to provide us with the forensic tools to manage and monitor this over‐exploited fish.
Working and learning in hospitals: junior doctors adrift in fragmented communities
Authors: McKee Anne
Published: March 2003

This paper is based upon an ethnographic study of senior house officers (SHOs; second and third year residents) intending to become general practitioners (GPs; family doctors who practise in the community). GPs/SHOs in four very different hospitals and their associated training schemes were case‐studied. The methods included structured and semi‐structured interviews, observations of training events and occupational experience, shadow studies and focus groups. Major changes in hospitals have transformed the experience of working and learning for both GPs/SHOs and consultants. Continuity of care and the stability of medical teams appears to have given way to episodic care provided by frequently changing teams, led by consultants who are subspecialists within their own field. Does hospital training still provide the breadth of clinical experience appropriate for general practice? In hospital‐based training, GPs/SHOs who are doing a ‘real’ job make ‘real’ mistakes. They do so in a climate that is increasingly intolerant of error. They receive very different messages about the acceptability of mistakes and their place in the learning process. What appears to be missing is an educational framework for recognizing and understanding both the nature of a mistake and its clinical and educational implications. The persistent message from those involved in hospital training was that it could be improved. It seems that what is needed is a radical reconsideration and reconceptualization of how to address the learning and teaching issues of providing training that prepares GPs/SHOs for the real demands practice.
Behavioural responses to ectoparasites: time‐budget adjustments and what matters to Blue TitsParus caeruleusinfested by fleas
Authors: Tripet Frédéric , Glaser Markus , Richner Heinz
Published: March 2003

Blue Tit nests are often heavily infested by fleas, which feed on the incubating female and the nestlings. Depending on habitat quality, the drawing of blood by fleas reduces offspring quality, or it is compensated by an increase in food provisioning by the adults and may reduce their future reproduction. Given these fitness costs, tits are expected to have evolved behavioural responses enabling them to remove, destroy or minimize the contact with fleas. To identify these traits, we video‐recorded the changes in frequency and duration of the hosts’ potential anti‐flea behavioural defences in nests experimentally infested with low and high flea densities. We also investigated whether flea load affected the number of male feeds delivered to incubating females, and whether the parents increased their rate of food provisioning to the nestlings equally at high flea density. Flea density significantly affected the nest sanitation and sleeping behaviour of Blue Tit females but had no significant effect on grooming. Female Blue Tits increased the frequency but decreased the duration of bouts of these behavioural traits, and hence their time‐budgets, based on per hour duration of behaviour, were not significantly affected by flea density. High flea density reduced nestling weight at the early nestling stage but these costs were fully compensated by an increase in female feeding effort. Males did not increase their frequency of food provisioning to incubating females nor to nestlings in heavily infested nests. The results are discussed in the light of parasite‐mediated selection on host behaviour and the reciprocal host selection on flea life‐history and behavioural traits.
The effect of age and year on the survival of breeding adult Great SkuasCatharacta skuain Shetland
Authors: Ratcliffe Norman , Catry Paulo , Hamer Keith C. , Klomp Nicholas I. , Furness Robert W.
Published: March 2003

The survival rates of breeding adult Great SkuasCatharacta skuawere examined at Foula, the largest colony in the world, where numbers have been declining since the late 1970s. Resightings of colour‐ringed breeding adults over a 12‐year period were analysed using Cormack‐Jolly Seber models to estimate survival rates. Annual survival rates averaged 0.89 but varied among years between 0.82 and 0.93, with annual variations being temporally associated with variations in sandeel abundance during the breeding season. Most birds appeared to die outside the breeding season and so it is possible that nutritional stress and reproductive costs of breeding in years of poor food supply affect survivorship on migration or in the wintering range. Survival rates of adult Great Skuas were affected by their age according to a quadratic equation, with survival increasing significantly with age from 0.73 in 5‐year‐old‐birds to between 0.85 and 0.96 in birds from 7 to 22 years old, with a sharp decline to between 0.75 and 0.87 in birds over 22 years old. Year effects were evident when controlling for age, indicating that annual variations in survival rates are not explained by changes in age‐composition of the marked population among years.
Are House Wren Troglodytes aedon eggs unusually strong? Test of the predicted effect of intraspecific egg destruction
Authors: Picman Jaroslav , Honza Marcel
Published: March 2003

As a result of opposing selective forces, the external strength of avian eggs should be near some size‐specific optimum. However, in certain situations there should be selection on females to lay unusually strong eggs. According to one hypothesis, intraspecific egg destruction should favour increased egg strength as a means of defence against conspecific intruders. This hypothesis predicts that House Wrens Troglodytes aedon, a species well known for its tendency to destroy conspecific clutches, should be under selection for unusually strong eggs. However, the intensity of selection for strong eggs should also be modified by efficacy of nest defence against conspecific intruders in a given species (i.e. efficient nest defence by the breeding pair should weaken selection for unusually strong eggs). The goals of our study were: (1) to establish whether House Wren eggs are stronger than expected for their size; (2) to determine which structural mechanisms are responsible for their unusual strength; and (3) to test a hypothesis that, between wren species, the efficacy of nest defence and the intensity of egg‐destroying behaviour affect the intensity of selection for unusually strong eggs. Our results demonstrated that: (1) House Wren eggs are 1.9 times stronger than expected for their size; (2) their unusual strength is achieved mostly by their unusually thick shells; and (3) eggs of the House Wren (extensive paternal nest defence; male egg‐destroying behaviour suppressed during incubation) are significantly weaker structurally than eggs of the Marsh Wren Cistothorus palustris (reduced paternal nest defence; male egg‐destroying behaviour present throughout incubation). These results are consistent with the hypothesis that the intraspecific egg‐destroying behaviour and the efficacy of nest defence by the breeding adults have played a role in the evolution of strength of House Wren eggs.
Foraging interactions between Wandering Albatrosses Diomedea exulans breeding on Marion Island and long‐line fisheries in the southern Indian Ocean
Authors: Nel Deon. C. , Ryan Peter G. , Nel Jeanne L. , Klages Norbert T. W. , Wilson Rory P. , Robertson Graham , Tuck Geoff N.
Published: March 2003

Wandering Albatrosses Diomedea exulans are frequently killed when they attempt to scavenge baited hooks deployed by long‐line fishing vessels. We studied the foraging ecology of Wandering Albatrosses breeding on Marion Island in order to assess the scale of interactions with known long‐line fishing fleets. During incubation and late chick‐rearing, birds foraged further away from the island, in warmer waters, and showed high spatial overlap with areas of intense tuna Thunnus spp. long‐line fishing. During early chick‐rearing, birds made shorter foraging trips and showed higher spatial overlap with the local Patagonian Toothfish Dissostichus eleginoides long‐line fishery. Tracks of birds returning with offal from the Toothfish fishery showed a strong association with positions at which Toothfish long‐lines were set and most diet samples taken during this stage contained fishery‐related items. Independent of these seasonal differences, females foraged further from the islands and in warmer waters than males. Consequently, female distribution overlapped more with tuna long‐line fisheries, whereas males interacted more with the Toothfish long‐line fishery. These factors could lead to differences in the survival probabilities of males and females. Non‐breeding birds foraged in warmer waters and showed the highest spatial overlap with tuna long‐line fishing areas. The foraging distribution of Marion Island birds showed most spatial overlap with birds from the neighbouring Crozet Islands during the late chick‐rearing and non‐breeding periods. These areas of foraging overlap also coincided with areas of intense tuna long‐line fishing south of Africa. As the population trends of Wandering Albatrosses at these two localities are very similar, it is possible that incidental mortality during the periods when these two populations show the highest spatial overlap could be driving these trends.
Assessment of census techniques for interspecific comparisons of tropical rainforest bird densities: a field evaluation in the Western Ghats, India
Authors: Shankar Raman T. R.
Published: March 2003

Studies comparing different bird censusing methods are useful for assessing relative biases, synthesizing data across studies, and designing bird population monitoring programmes. A field study was carried out in mid‐elevation tropical rainforest in the Western Ghats to compare bird density estimates from line transect, point count and territory spot‐mapping methods. Interspecific comparisons were made using data for 13 common resident bird species, including two endemics. Variable‐width line transect density estimates were highly correlated with, but slightly (17%) higher than, those produced by territory spot‐mapping. Although densities from variable‐width point counts and spot‐mapping were highly positively correlated, the estimates were 95% higher on average in the former. Higher density estimates relative to spot‐mapping were produced mainly for the most abundant species, probably due to their mobility and the inclusion of additional individuals that enter the count area during the count period. Fixed‐width strip transects and point counts produced density estimates that were highly correlated with, but significantly lower than, variable‐width estimates. Wherever possible, territory spot‐mapping and line transects are recommended for density estimates; the former may yield additional information on spatial distribution of birds. Fixed‐width transects or point counts, being easier to apply, may be used for large‐scale monitoring programmes. Interspecific variation in flocking systems and the poor visibility in dense rainforest vegetation indicate the need for care in collection of data on flock size and its variation, which is necessary for estimating the density of individuals. The variation across methods suggests the need for further research using multiple methods across years and marked individuals to verify territoriality and accuracy.
Effects of viewing distance on accommodative and pupillary responses following a three‐dimensional task
Authors: Iwasaki Tsuneto , Tawara Akihiko
Published: March 2003

We have investigated accommodation and pupil responses after viewing stereoscopic images related to the resting position of accommodation. After a 10‐min visual task viewing stereoscopic three‐dimensional images, measurements of dynamic accommodation and pupil response were made using an infrared optometer and a pupil analyser. Four conditions were given for the viewing distance: 0.4 m (closer than the subjects' resting position), 1 m (approximating to their resting state), and 1.5 and 3 m (farther than the resting position). For the 0.4‐ and 1‐m groups, a delay in the accommodation response for near‐to‐far movement was shown after the task, from 817 to 1120 ms and from 830 to 898 ms, respectively, but there was no change in the pupillary response. In the 1.5‐ and 3‐m groups, on the other hand, a significant delay in the accommodation response for far‐to‐near movement was shown, from 827 to 912 ms and from 857 to 1150 ms, respectively, and greater miosis was found, from 7.2 to 9.2 mm2 and from 8.0 to 10.4 mm2. The data reveal that there are different after‐effects on accommodation and pupillary functions when subjects perform the task within their accommodative resting position, than when the task is performed outside the resting position.
A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca
Authors: Farrell J. , Patel S. , Grierson D. G. , Sturrock R. D.
Published: March 2003

Purpose: To evaluate the effects of dissolvable collagen punctal plugs on the symptoms, tear stability and volume in aqueous deficient dry eyes.

Methods: Sixty‐two aqueous deficient dry eye patients of mixed aetiology underwent lacrimal punctal occlusion with dissolvable collagen plugs. The subjects were randomly allocated to one of two treatment groups: group I (n = 36) had their lower puncta occluded and group II (n = 26) had both their upper and lower puncta occluded. The effectiveness of this treatment was clinically assessed by (1) scoring subject symptoms and (2) measuring the tear parameters of tear thinning time (TTT) and tear meniscus height (TMH) as indicators of tear stability and volume, respectively. Following baseline measurements, patients were reviewed at time intervals of 5 and 12 days post‐occlusion. A group of age‐ and gender‐matched normals (n = 45) was recruited for comparison (group III).

Results: Tear volume and stability were significantly higher in group III compared with I and II at baseline. In the treated groups on both days 5 and 12: (1) symptom score reduced significantly from a median value of 7 to 3 (p = <0.001); (2) tear stability increased significantly from a median value of 3 to 5 s by day 5 (p ≤ 0.001); reduced between days 5 and 12 (p < 0.05) and remained below the stability in group III at all times; (c) tear volume increased significantly by day 5 in both treatment groups from a median value of 0.13 to 0.20 mm (p≤0.001), remained stable by day 12 in group II but reduced in group I (p < 0.05); (d) the increase in tear volume was negatively correlated with pre‐treatment tear volume; (e) symptom score correlated with both baseline tear volume and stability.

Conclusion: Collagen plugs improved tear status in the aqueous deficient dry eyes. Occluding both upper and lower puncta with temporary collagen plugs offers no practical beneficial gain compared with occluding just the lower punctum.
Practice development: purpose, methodology, facilitation and evaluation
Authors: Manley Kim , McCormack Brendan
Published: March 2003

Different approaches to practice development are associated with different assumptions, and these need to be made explicit if ­practice development is to be transparent, rigorous and systematic in its intentions and approaches

A practice development methodology underpinned by critical social science is advocated because it focuses on achieving sustain­able change through practitioner enlightenment, empowerment and emancipation and an associated culture, rather than focusing only on technical practice development

Implications of different worldviews about practice development for facilitation and outcome evaluation are highlighted

Emancipatory practice development underpinned by critical social science is argued as synonymous to emancipatory action research
The Role of Lutein in Disease Prevention
Authors: Johnson Elizabeth J.
Published: March 2003

Lutein is a non‐provitamin‐A carotenoid found in dark green, leafy vegetables. Lutein, being fat‐soluble, follows the same intestinal absorption path as dietary fat and is affected by the same factors that influence fat absorption. Unlike β‐carotene, another major carotenoid in diet and tissue, the bioavailability of lutein appears to be less influenced by food processing. Lutein has been strongly implicated as being protective against age‐related macular degeneration (AMD) and cataracts. In the eye, lutein may act as a blue‐light filter, protecting the underlying tissues from phototoxic damage. The mechanism by which lutein is involved in the prevention of eye diseases and other diseases, such as breast cancer and cardiovascular heart disease (CHD), may also be related to its role as an antioxidant.
The Role of Nutrition Therapy in the Management of Diabetes Mellitus
Authors: Sheard Nancy F. , Clark Nathaniel G.
Published: March 2003

Diabetes mellitus is the seventh leading cause of death in the United States, with a total annual economic cost estimated at $98 billion. Diabetes is caused by either a lack of insulin secretion or by insulin resistance. The resultant metabolic disturbance leads to hyperglycemia and dyslipidemia in the short term, as well as long‐term complications such as retinopathy, neuropathy, and nephropathy. In addition, individuals with diabetes are 2 to 4 times more likely to develop coronary artery disease or to suffer a stroke. Findings from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) clearly indicate that the maintenance of near‐normal blood glucose concentration dramatically reduces the chronic complications associated with this disorder. In addition, reducing elevated blood lipid levels has been shown to lower the incidence of acute coronary events in other at‐risk populations. Finally, obesity, yet another diet‐related disorder, is strongly associated with the development of Type 2 diabetes. Thus, nutrition therapy plays an important role in both the development and the management of diabetes. Appropriate modification and monitoring of food intake can assist with weight management as well as with the control of both blood glucose and lipid levels. Although insulin and/or oral medications are frequently required to treat diabetes, nutrition therapy remains an important tool in the management of this disease and should always be considered the cornerstone of therapy.
Protein Restriction in Renal Disease
Authors: Castaneda Carmen
Published: March 2003

Abstract Early stages of renal disease alter the metabolism of nutrients and their end products. In addition, food intake is limited because of gastrointestinal distress, depression, superimposed illness, and restrictive diets. Treatment of chronic renal failure (CRF) is multifactorial and should focus on dealing with uremia, muscle wasting, metabolic acidosis, blood pressure, and adequate energy intake. Protein intake is a modulator of renal function. Conventional protein restriction of about 0.6 g/kg body weight/day has been recommended in patients with moderate CRF to reduce signs and symptoms of uremia and to delay the progression of renal disease. Like healthy individuals, CRF patients seem able to activate normal compensatory responses to dietary protein restriction in order to maintain lean body mass and nutritional status. Low‐protein diets do not seem to worsen survival during dialysis. In contrast, high dietary protein intake results in metabolic acidosis and anorexia. Anorexia, in turn, limits energy intake and reduces the efficiency of protein utilization. Thus, a low‐protein diet that approaches the minimal requirement for reducing anorexia while preventing malnutrition is a clinical challenge for the treatment of CRF patients not yet on dialysis. To successfully achieve the goals of protein‐restricted regimens, intensive nutritional counseling (at no less than 1‐ to 3‐month intervals) should be a routine component of care in this patient population.
Cranio‐caudal differences in granulation tissue formation: an experimental study in the rat
Authors: MÄRTSON MATIS , VILJANTO JOUKO , LAIPPALA PEKKA , SAUKKO PEKKA
Published: March 2003

This study examined potential regional differences in the deposition of granulation tissue in cellulose sponges placed in the dorsum of rats. Four cellulose sponge implants, 10 × 10 × 5 mm in size, two in cranial and two in caudal positions, were used to induce granulation tissue formation in the back of the rat. A cranio‐caudal difference in connective tissue formation was assessed from 1 to 24 weeks after implantation. Granulation tissue ingrowth, measured histomorphometrically, was enhanced at 2 weeks and the surrounding capsule was thinner from 1 to 3 weeks in implants located in the cranial part of the back. In the cranial position, the number of fibroblasts, assessed semiquantitatively, was higher and the ratio of inflammatory cells to fibroblasts lower at 2–3 weeks. Also, the ratio of hydroxyproline content to total nitrogen content was higher after the first week in cranial specimens. Thus, a distinct cranio‐caudal difference in the proliferative phase was observed. These results show the obvious practical considerations underlying the need for randomization or comparison between implants from exactly corresponding cranio‐caudal locations.
Systemic treatment of venous leg ulcers with high doses of pentoxifylline: efficacy in a randomized, placebo‐controlled trial
Authors: Falanga Vincent , Fujitani Roy M. , Diaz Carlos , Hunter Glen , Jorizzo Joseph , Lawrence Peter F. , Lee Bok Y , Menzoian James O , Tretbar Lawrence L. , Holloway G. Allen , Hoballah Jamal , Seabrook Gary R. , McMillan Donald E. , Wolf William
Published: March 2003

Several small studies have indicated that the systemic administration of pentoxifylline may accelerate healing of venous leg ulcers. The goal of this study was to further evaluate these findings in a larger scale placebo controlled trial and to explore the effect of the dose of pentoxifylline on healing. The study used a prospective, randomized, double‐blind, parallel group placebo controlled design in a multicenter outpatient setting. Patients with one or more venous ulcer were enrolled, with all patients receiving standardized compression bandaging for treatment for their ulcers. Patients were also randomized to receive either pentoxifylline 400 mg, pentoxifylline 800 mg (two 400 mg tablets), or placebo tablets three times a day for up to 24 weeks. The main outcome measure was time to complete healing of all leg ulcers, using life table analysis. The study was completed as planned in 131 patients. Patients receiving 800 mg three times a day of pentoxifylline healed faster than placebo (p = 0.043, Wilcoxon test). The median time to complete healing was 100, 83, and 71 days for placebo, pentoxifylline 400 mg, and pentoxifylline 800 mg three times a day, respectively. Over half of all patients were ulcer free at week 16 (placebo) and at week 12 in both pentoxifylline groups. Whereas the placebo group had only achieved complete healing in half of the cases by week 16, all of the subjects remaining in the group receiving the high dose of pentoxifylline had healed completely. Treatment with pentoxifylline was well tolerated with similar drop‐out rates in all three treatment groups. Complete wound closure occurred at least 4 weeks earlier in the majority of patients treated with pentoxifylline by comparison to placebo. A higher dose of pentoxifylline (800 mg three times a day) was more effective than the lower dose. We conclude that pentoxifylline is effective in accelerating healing of leg ulcers.
Expression of matrix metalloproteinases and tissue inhibitor of matrix metalloproteinases in mesothelial cells and their regulation by transforming growth factor‐β1
Authors: Ma Chunfeng , Tarnuzzer Roy W. , Chegini Nasser
Published: March 2003

Tissue injury and pelvic inflammation often results in peritoneal scar tissue formation. The objective of this study was to determine whether mesothelial cells which line the peritoneal cavity express matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs), and if their expression is regulated by transforming growth factor‐β1, a key regulator of tissue fibrosis. For this purpose we used Met‐5A cells, a cell line derived from human normal mesothelial cells, and for comparative analysis we used U‐937 cells, a human monocytic/macrophage cell line. The cells were treated with transforming growth factor‐β1 (1 ng/ml) for various time periods and the levels of MMP and TIMP mRNA and protein expression were determined using quantitative reverse transcription‐polymerase chain reaction and enzyme‐linked immunosorbent assay, respectively. The results indicate that the mesothelial cells and macrophages express MMP‐1 (collagenase‐1), MMP‐3 (stromelysin‐1), TIMP‐1 and TIMP‐2 mRNA and protein at various levels, with significantly higher TIMPs than MMPs, and higher MMP‐1 than MMP‐3 (p < 0.001). The mesothelial cells express significantly less MMP‐1, higher MMP‐ 3 and similar levels of TIMP mRNA compared to macrophages. In a time‐dependent manner, treatment of the mesothelial cells with transforming growth factor‐β1 resulted in a significant decrease in the expression of MMP‐1, while increasing the expression of TIMP‐1 mRNA (p = 0.05). In contrast, MMP‐3 and TIMP‐2 expression was unaffected in mesothelial cells and in macrophages, compared to untreated controls. There was a significant increase in secreted MMP‐1 and TIMP‐2 by mesothelial cells following transforming growth factor‐β1 treatments in a time‐dependent manner (p = 0.05 and p = 0.01), without affecting the secretion of these proteins by macrophages. A major portion of MMP‐1 in the culture conditioned media of both cell types was found in complex with TIMP‐1. The ratios of MMP‐1/TIMPs production were significantly higher than MMP‐3/TIMPs in mesothelial cells and macrophages, and progressively decreased following transforming growth factor‐β1 treatments (p < 0.05). In conclusion, these results indicate that mesothelial cells express MMP and TIMP mRNA and protein, and their expression is differentially regulated by transforming growth factor‐β1, a mechanism that in part may influence the outcome of peritoneal tissue repair and adhesion formation.
Expression of apoptosis‐associated genes by human dermal scar fibroblasts
Authors: Messadi Diana V. , Le Anh , Berg Steve , Jewett Anahid , Wen Zhuang , Kelly Paul , Bertolami Charles N.
Published: March 2003

The purpose of this study was to determine if aberrant apoptosis plays a role in pathologic wound healing as manifested by hypertrophic scarring and keloid formation. Apoptosis has recently been found to participate in the transition between granulation tissue and the development of definitive scar. The question that remains to be answered is what stimuli initiate apoptosis during wound healing. Hitherto, regulatory factors and pathways involved have been largely undefined. We investigated heterogeneity among fibroblasts derived from normal skin and keloid scar, by examining apoptotic profiles and pathways for these cells. Quantitative analysis of apoptotic cells using an Annexin‐V‐FITC binding assay showed that normal skin fibroblast cultures were found to have a two‐fold higher percentage of apoptotic cells than did keloid fibroblast cultures. To study apoptotic pathways and related death‐associated genes, a ribonuclease protection assay was performed for fibroblasts exposed to anti‐Fas antibody and tumor necrosis factor‐α to activate the Fas/TNF receptor apoptotic pathway. Compared with normal skin fibroblasts, keloid fibroblasts exhibited decreased expression of apoptosis‐associated genes.
Genetic modification of cultured skin substitutes by transduction of human keratinocytes and fibroblasts with platelet‐derived growth factor‐A
Authors: Supp Dorothy M , Bell Sheila M , Morgan Jeffrey R , Boyce Steven T
Published: March 2003

Gene therapy promises the potential for improved treatment of cutaneous wounds. This study evaluated whether genetically modified cultured skin substitutes can act as vehicles for gene therapy in an athymic mouse model of wound healing. Human keratinocytes and fibroblasts were genetically engineered by retroviral transduction to overexpress human platelet‐derived growth factor‐A chain. Three types of skin substitutes were prepared from collagen‐glycosaminoglycan substrates populated with fibroblasts and keratinocytes: HF–/HK–, containing both unmodified fibroblasts and keratinocytes; HF–/HK+, containing unmodified fibroblasts and modified keratinocytes; and HF+/HK–, containing modified fibroblasts and unmodified keratinocytes. Skin substitutes were cultured for two weeks before grafting to full‐thickness wounds on athymic mice. The modified skin substitutes secreted significantly elevated levels of platelet‐derived growth factor throughout the culture period. Expression of retroviral platelet‐derived growth factor‐A mRNA was maintained after grafting to mice, and was detected in all HF–/HK+ grafts and one HF+/HK– graft at two weeks after surgery. Although no differences were seen between control and modified grafts, the results suggest that genetically modified cultured skin substitutes can be a feasible mechanism for cutaneous gene therapy. The cultured skin model used for these studies has advantages over other skin analogs containing only epidermal cells; because it contains both fibroblasts and keratinocytes, it therefore offers greater opportunities for genetic modification and potential modulation of wound healing.
Recombinant human platelet‐derived growth factor‐BB (becaplermin) for healing chronic lower extremity diabetic ulcers: an open‐label clinical evaluation of efficacy
Authors: Embil John M , Papp Kim , Sibbald Gary , Tousignant Jacqueline , Smiell Janice M , Wong Betty , Lau Cathy Y ,   THE CANADIAN BECAPLERMIN STUDY GROUP
Published: March 2003

Topically applied recombinant human platelet‐derived growth factor‐BB (becaplermin) is a new pharmacologically active therapy for chronic, neuropathic, lower extremity diabetic ulcers. In previous studies, becaplermin gel was administered once daily but dressings were changed twice daily. In the present study of 134 patients with diabetes mellitus and full thickness lower extremity ulcers, dressings were changed only once per day, simplifying the treatment regimen. Efficacy criteria included the percentage of patients achieving complete healing within the 20‐week treatment period, the time to achieve complete healing, the rate of ulcer recurrence during the 6‐month period following healing, and treatment compliance. Complete healing of ulcers was achieved in 57.5% of patients, with a mean time to closure of 63 days and a recurrence rate of 21% at 6 months. Of the potential factors affecting ulcer healing, only drug compliance (p < 0.001), dressing compliance (p < 0.01), the presence of infection (p < 0.01), baseline ulcer area (p < 0.05), and baseline total wound evaluation score (p < 0.05) were significantly associated with healing. Results of this study further confirm the efficacy and safety of becaplermin gel for the treatment of lower extremity diabetic ulcers.
Increased fibrovascular invasion of subcutaneous polyvinyl alcohol sponges in SPARC‐null mice
Authors: BRADSHAW AMY D. , REED MAY J. , CARBON JULIET G. , PINNEY EMMETT , BREKKEN ROLF A. , SAGE E. HELENE
Published: March 2003

The expression of SPARC (secreted protein acidic and rich in cysteine/osteonectin/BM‐40) is elevated in endothelial cells participating in angiogenesis in vitro and in vivo. SPARC acts on endothelial cells to elicit changes in cell shape and to inhibit cell cycle progression. In addition, SPARC binds to and diminishes the mitotic activity of vascular endothelial growth factor. To determine the effect(s) of SPARC on angiogenic responses in vivo, we implanted polyvinyl alcohol sponges subcutaneously into wild‐type and SPARC‐null mice. On days 12 and 20 following implantation, SPARC‐null mice showed increased cellular invasion of the sponges in comparison to wild‐type mice. Areas of the sponge with the highest cell density exhibited the highest numbers of vascular profiles in both wild‐type and SPARC‐null animals. The endothelial component of the vessels was substantiated by immunoreactivity with three different markers specific for endothelial cells. Although sponges from SPARC‐null relative to wild‐type mice were populated by significantly more cells and blood vessels, an increase in the ratio of vascular to nonvascular cells was not apparent. No differences in the percentage of proliferating cells within the sponge were detected between wild‐type and SPARC‐null sections. However, elevated levels of vascular endothelial growth factor were associated with sponges from SPARC‐null versus wild‐type mice. An increase in vascular endothelial growth factor production was also observed in SPARC‐null primary dermal fibroblasts relative to those of wild‐type cells. In conclusion, we have shown that the fibrovascular invasion of polyvinyl alcohol sponges is enhanced in mice lacking SPARC, and we propose that increased levels of vascular endothelial growth factor account, at least in part, for this response.
Angiogenesis induction and regression in human surgical wounds
Authors: Brown Nicola J. , Smyth Edward A. E. , Cross Simon S. , Reed Malcolm W. R.
Published: March 2003

Angiogenesis in human wound healing is not well characterized, with only sparse information available regarding the maturation and fate of vessels formed as a consequence of human tissue repair. Therefore, this study aimed to establish the temporal profile of angiogenesis in human dermal wounds. Punch biopsies were obtained under local anesthesia from 45 patients following breast surgery. Scars were predominantly between 2 and 52 weeks after surgery but in five patients were > 52 weeks. Control samples were taken from breast skin peroperatively (n=24). Quantification of vascular density was performed using the Chalkley grid, following antibody staining for platelet endothelial cell adhesion molecule. Vascular patterns, wound cellularity and morphology were also determined. Cumulative microvessel density was increased in all samples when compared to controls (p < 0.05). This was greatest 2 to 24 weeks following surgery 17 (15–21) median (range), decreased thereafter, but remained elevated compared to controls even in the mature scars > 52 weeks. Control tissue showed an ordered morphological arrangement of dermal structures, collagen, and elastic fibers. However, wounding resulted in marked structural distortion for up to 15 weeks. In conclusion, this study shows for the first time the prolonged persistence of both microvessels and cellularity (fibroblastic cells), in addition to structural distortion in human dermal wounds, which is in contrast to previous in vitro and in vivo studies. (WOUND REP REG 2002;10:245–251)