bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of vascular endothelial growth factor and brain‐derived neurotrophic factor on cavernosal nerve regeneration in a nerve‐crush rat model
Authors: Hsieh P.‐S. , Bochinski D.J. , Lin G.T. , Nunes L. , Lin C.S. , Lue T.F.
Published: August 2003

OBJECTIVE

To test the hypothesis that an intracavernosal injection with brain‐derived neurotrophin factor (BDNF) and vascular endothelial growth factor (VEGF) can facilitate nerve regeneration and recovery of erectile function after cavernosal nerve injury.

MATERIALS AND METHODS

The study included 25 Sprague‐Dawley rats; four had a sham operation, seven bilateral nerve crushing with no further intervention, and 14 bilateral nerve crushing with either an immediate (seven) or delayed for 1 month (seven) intracavernosal injection with BDNF+VEGF. Erectile function was assessed by cavernosal nerve electrostimulation at 3 months, and neural regeneration by NADPH‐diaphorase staining and tyrosine hydroxylase (TH) staining of penile tissue and major pelvic ganglia (MPG).

RESULTS

After nerve crushing, the functional evaluation at 3 months showed a lower mean (sd) intracavernosal pressure (ICP) with cavernosal nerve stimulation, at 33.9 (15.3) cmH2O, than in the sham group, at 107.8 (18.1) cmH2O. With an immediate injection with BDNF+VEGF the ICP was significantly higher than in the controls, at 67.8 (38.5) cmH2O. Even delayed injection with BDNF+VEGF improved the ICP, to 78.0 (21.8) cmH2O. Histological analysis of specimens stained for NADPH and TH showed a significant change in the morphology of terminal branches of the cavernosal and dorsal nerves, and the staining quality of the neurones in the MPG. The number of positively stained nerve fibres tended to revert to normal after treatment with BDNF+VEGF.

CONCLUSION

An intracavernosal injection with BDNF+VEGF appears to both prevent degeneration and facilitate regeneration of neurones containing neuronal nitric oxide synthase in the MPG, dorsal nerve and intracavernosal tissue. Therefore it might have therapeutic potential for enhancing the recovery of erectile function after radical pelvic surgery.
Laparoscopic computer‐assisted pyeloplasty: the results of experimental surgery in pigs
Authors: Hubert J. , Feuillu B. , Mangin P. , Lobontiu A. , Artis M. , Villemot J.P.
Published: August 2003

The attraction of using the Da VinciTM robotic system is considerable, despite the great costs involved. The three‐dimensional view and the wide degree of freedom of movement allows, as we are told, a procedure which can be learned more quickly than standard laparoscopic surgery. The authors from France describe their early experience with the technique and provide an overview of other robotic methods.

OBJECTIVE

To evaluate the experimental feasibility of laparoscopic computer‐assisted pyeloplasty for pelvi‐ureteric junction obstruction.

MATERIALS AND METHODS

Fourteen pyeloplasties were undertaken in pigs using a laparoscopic transperitoneal approach and the robotic surgical system (da VinciTM, Intuitive Surgical Inc., Sunnyvale, CA, USA).

RESULTS

The robotic surgical system provides real‐time three‐dimensional stereoscopic vision. Manipulating the intracorporeal endo‐wristed instruments from a remote console allows laparoscopic manoeuvres that are as easy as those during open surgery. Surgeons with no particular experience in laparoscopic surgery could learn complex surgery easily and quickly.

CONCLUSION

This technique provides faster training and the possibility of undertaking complex laparoscopic procedures, especially reconstructive, with less fatigue for the surgeon.
Alveolar bone loss associated with glucose tolerance in Japanese men
Authors: Marugame T. , Hayasaki H. , Lee K. , Eguchi H. , Matsumoto S.
Published: August 2003

Aims Type 2 diabetes is known to affect alveolar bone loss (ABL). The purpose of this study was to examine whether impaired glucose tolerance (IGT) is associated with ABL, as is diabetes.

Methods A case–control study was performed with 664 Japanese men aged 46–57 years. Panoramic radiographs revealed 513 severe ABL cases, 22 moderate ABL cases, and 129 controls with good alveolar bone. Diabetes status was classified into normal glucose tolerance (NGT), impaired fasting glucose (IFG), IGT, and newly diagnosed diabetes according to the fasting plasma glucose and 75‐g oral glucose tolerance test (OGTT). Diabetes under treatment was excluded. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from ordinal logistic regression analysis. Statistical adjustment was made for total cholesterol, HDL‐cholesterol, triglyceride, rank in the Self Defence Forces (SDF), cigarette‐years, alcohol use, body mass index, previous 10 years’ brushing habits and instrument use other than toothbrush, and history of periodontal treatment.

Results A significant, approximately three‐fold increase in the crude OR (crude OR = 3.28; 95% CI = 1.16–9.27) and non‐significant 2.6‐fold increase in the adjusted OR (adjusted OR = 2.55; 95% CI = 0.86, 7.54) of ABL was observed among men with newly diagnosed Type 2 diabetes compared with the reference group (NGT combined with IFG). However, there was no association between IGT and ABL (adjusted OR = 0.99; 95% CI = 0.59,1.64).

Conclusions Type 2 diabetes, but not IGT, was positively associated with ABL. Preventive maintenance against periodontitis is important in middle‐aged men with diabetes.
Activation of the innate immune system as a predictor of cardiovascular mortality in Type 2 diabetes mellitus
Authors: Pickup J. C. , Mattock M. B.
Published: August 2003

Aims Activation of innate immunity may play a major role in the development and pathophysiology of Type 2 diabetes; we therefore investigated whether a marker of innate immunity (serum sialic acid) predicts cardiovascular disease (CVD) and all‐cause mortality in Type 2 diabetes.

Methods Type 2 diabetic subjects (n = 128, age 31–64 years at outset) participating in the Lewisham Diabetes Survey were followed up for a mean of 12.8 years. Baseline measurements were made of serum sialic acid and known or putative risk factors for CVD. Cause of death was coded from death certificates, post mortem examination and hospital records.

Results Fifty‐six (43%) subjects had died after 12.8 years. The major cause of death was CVD (71.4%), predominantly coronary heart disease (62.5%). Baseline variables significantly associated with CVD mortality were sialic acid and CVD (borderline significance smoking and cholesterol). In multivariate analysis, significant independent predictors of CVD mortality were sialic acid [standardized relative risk (95% confidence interval) 1.53 (1.12, 2.10)], age, male sex and existing CVD.

Conclusions Activated innate immunity (low‐grade inflammation) is a risk factor for CVD mortality in Type 2 diabetes, independently of other known risk factors, including existing CVD. Since activation of the innate immune system predicts Type 2 diabetes, it may be a common antecedent of both Type 2 diabetes and CVD.
Effects of atorvastatin on glucose homeostasis, postprandial triglyceride response and C‐reactive protein in subjects with impaired fasting glucose
Authors: Costa A. , Casamitjana R. , Casals E. , Álvarez L. , Morales J. , Masramón X. , Hernández G. , Gomis R. , Conget I.
Published: August 2003

Aims To investigate the effects of atorvastatin on glucose homeostasis, the basal and postprandial lipid profiles and the CRP levels (C reactive protein) in subjects with impaired fasting glucose (IFG).

Methods Thirty‐three subjects (22 men and 11 women) were included in our study. All displayed an IFG (fasting plasma glucose between 6.1 and 7.0 mmol/l) on at least two occasions during the last 6 months prior the study. They were randomly assigned to receive either 40 mg atorvastatin/day (n= 16) or placebo (n= 17) over 16 weeks, in a double‐blind design. Before and after the end of the study all participants underwent on three consecutive days: a 75‐g oral glucose tolerance test, a frequent sampling intravenous glucose tolerance test with Minimal Model analysis and a meal tolerance test (glucose, insulin and triglycerides). CRP was measured before and after the treatment period.

Results CRP decreased significantly in the atorvastatin‐treated group compared with the placebo group (percent change respect initial values; −42.3 %[−21.5 to − 63.1] and −9.6%[15.0 to −34.0], respectively, p < 0.01). Atorvastatin treatment did not produce any change in oral glucose tolerance categories or induce any change in glucose and insulin response in OGTT. The statin produced a trend towards a significant improvement in insulin sensitivity as expressed by a change in Si from baseline to the end of treatment. Atorvastatin reduced the postprandial response of triglycerides to the meal test compared with placebo (19–26 % across the meal test, p < 0.05) correlating with the amelioration observed in Si (−0.34, p < 0.05; percentage changes).

Conclusion Our results suggest that the use of statins in subjects with IFG seems to include other potentially beneficial actions in addition to their cholesterol‐lowering effects.
Motivational/solution‐focused intervention improves HbA1c in adolescents with Type 1 diabetes: a pilot study
Authors: Viner R. M. , Christie D. , Taylor V. , Hey S.
Published: August 2003

Aims We piloted a motivational and solution‐focused therapy group intervention to improve glycaemic control in young people 11–17 years with poorly controlled Type 1 diabetes (mean annual HbA1c > 8.5%).

Methods Seventy‐seven subjects agreed to be assessed for a pilot non‐randomized controlled trial. Subjects completed psychological questionnaires and were given feedback designed to encourage entry into the intervention. Twenty‐one young people opted to enter the intervention groups (cases). Two intervention groups consisting of five to six subjects were conducted in each age band 10–13 years and 14–17 years. Twenty of those who did not opt to join the groups were randomly selected to act as controls. Cases and controls were well matched for age, HbA1c, duration of diabetes and socio‐economic status.

Results The intervention produced a significant improvement of 1.5% in HbA1c in cases (P < 0.05) at 4–6 months post intervention compared with no change in controls. This improvement was partly maintained at 7–12 months post intervention.

Conclusions These pilot data suggest that a motivational/solution‐focused group intervention is promising in improving HbA1c in adolescents and should be investigated further in a randomized controlled trial.
The albuminuric action of atrial natriuretic peptide is not modified by ACE‐inhibition with perindopril in Type 2 diabetes
Authors: Moore K. B. , McKenna K. , Tormey W. P. , McDonald D. , Thompson C. J.
Published: August 2003

Aims Atrial natriuretic peptide (ANP) increases urine albumin excretion (UAER) in humans with Type 1 diabetes. The aim of this study was to establish if ANP increases UAER in microalbuminuric subjects with Type 2 diabetes and to examine whether the albuminuric action of ANP was inhibited by pre‐treatment with the ACE‐inhibitor perindopril.

Methods Seven microalbuminuric, normotensive males with Type 2 diabetes were entered into a randomised, double‐blind, three‐armed study of (i) intravenous infusion of ANP (0.25 µg/kg/min in 0.9% NaCl) after 3 weeks’ pre‐treatment with placebo, (ii) intravenous infusion of vehicle (0.9% NaCl only) after 3 weeks’ pre‐treatment with placebo, or (3) intravenous infusion of ANP (0.25 µg/kg/min in 0.9% NaCl) after 3 weeks’ pre‐treatment with perindopril, 4 mg daily.

Results Baseline parameters were similar on all three study days. During the placebo/vehicle arm there was no change in urine flow rate (UFR, P = 0.61), urine cyclic guanosine monophosphate (UcGMP P = 0.48) or UAER (P = 0.99). During the placebo/ANP arm there was a rise in UFR [13.7 ± 2.8 (mean ± sd) to 25.7 ± 7.7 mL/min, P < 0.001], UcGMP (60.0 ± 36.6 to 160.8 ± 118.5 µmol/mmolCr, P = 0.045) and UAER {5.13 [2.4–11.6][median (range)] to 71.6 [21.6–175.1] mg/mmolCr, P < 0.001}. Pre‐treatment with perindopril did not alter the changes in UFR (P = 0.63), UcGMP (P = 0.46) or UAER (P = 0.99) to infusion of ANP, compared with the placebo/ANP arm.

Conclusion ANP increases UAER in microalbuminuric patients with Type 2 diabetes and the albuminuric action of ANP is not inhibited by pre‐treatment with the ACE inhibitor perindopril.
Irish diabetes detection programme in general practice
Authors: Smith S. M. , Holohan J. , McAuliffe A. , Firth R. G.
Published: August 2003

Objectives To assess the prevalence of undiagnosed diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in patients over the age of 40 years attending their general practitioner (GP) in Ireland, through opportunistic screening, using a three‐step screening tool involving self‐determined high‐risk groups, random venous plasma glucose (RVPG) measurement and oral glucose tolerance tests.

Design In participating general practices, 100 consecutive patients > 40 years, completed a screening questionnaire relating to diabetes‐related symptoms and risk factors. Patients with previously diagnosed diabetes were not excluded from the study and the screening instrument included a question about known diabetes. Patients without known diabetes mellitus (DM) and with at least two risk factors and/or symptoms underwent a RVPG test. Those with an RVPG above 5.5 mmol/l underwent an oral glucose tolerance test.

Results Forty‐one practices returned 3821 questionnaires. The prevalence of Type 2 diabetes mellitus in the study population was 9.2% (353), of whom 23.5% (83) were previously undiagnosed. DM was detected on the basis of an RVPG > 11.1 mmol/l in 0.8% (32) of the studied population. DM was detected on the basis of the oral glucose tolerance test in 1.3% (51) of the population. One per cent (39) had a fasting plasma glucose (FPG) ≥ 7.0 mmol/l, 0.6% (24) had a 2‐h > 11.0 mmol/l and 0.3% (12) had both. Diabetes would not have been detected in 12 people had the 2‐h test been omitted. The prevalence rate for IFG and/or IGT was 3.9% (148). Of the 103 patients with IGT, 83 (81%) would have been missed had the GTT been omitted.

Conclusion Opportunistic diabetes screening in general practice using a screening questionnaire followed by RVPG testing and GTT for those above 5.5 mmol/l is feasible, with a high participation rate. The use of GTTs rather than fasting glucose testing alone improves patient identification, in particular those with IGT who are at higher cardiovascular risk.
The risk of stillbirth in pregnancies before and after the onset of diabetes
Authors: Wood S. L. , Jick H. , Sauve R.
Published: August 2003

Aims There is significant controversy as to whether or not stillbirth is increased in pregnancies prior to the onset of diabetes. An observed increase may be indicative of risks associated with untreated gestational diabetes. It is generally accepted that the risk of stillbirth in pregnancies that occur after the onset of diabetes has been diminished by modern obstetric care. However, the degree of residual risk is not well quantified. This study sought to examine the rates of stillbirth before and after the onset of diabetes compared with the general population.

Methods Retrospective cohort and nested case–control study. The study population was drawn from the UK‐based General Practice Research Database, comprising some 300 practices, with data collection from the late 1980s until September 1999. From the base population, 913 diabetic women who had had a pregnancy were identified and 10 000 subjects without diabetes were randomly chosen as controls. Stillbirth was defined as death in utero after 20 weeks or with birth weight > 500 g.

Results The stillbirth rates were higher in prediabetic pregnancies (19.7/1000), and in those occurring after the diagnosis of diabetes (33.7/1000), compared with the non‐diabetic population (5.5/1000). Stillbirths were matched to four live births by maternal age and year of birth. Prediabetic pregnancy and pregnancy after the onset of diabetes were strongly associated with stillbirth: odds ratio (OR) = 4.68 (1.67, 13.08) and OR = 4.39 (2.22, 8.64), respectively.

Conclusions The risk of stillbirth was increased in both prediabetic and post‐diabetic pregnancy.
Pregnancy in women with Type 2 diabetes: 12 years outcome data 1990–2002
Authors: Dunne F. , Brydon P. , Smith K. , Gee H.
Published: August 2003

Aim Twelve years’ outcome analysis of pregnancies in women with Type 2 diabetes in a multiethnic geographically defined area.

Methods Information about 182 women delivered between 1990 and 2002 was ascertained from a regional computerized database. The main outcome measures were rates of miscarriage, stillbirth, neonatal/postnatal deaths, congenital malformations, birth weight, mode of delivery, and neonatal unit care as well as maternal morbidities of polyhydramnios, postpartum haemorrhage, pregnancy‐induced hypertension/pre‐eclampsia.

Results Among 182 singleton pregnancies, 161 (88%) resulted in a live outcome. There were 16 (8.8%) spontaneous miscarriages, two (1.2%) stillbirths, and three (1.6%) terminations. Congenital malformations occurred in 18 pregnancies (99/1000). There were two early and one late neonatal deaths and two further deaths in the postnatal period. Twenty‐eight percent of infants were large for gestational age, with 15 (9.3%) greater than 4 kg. Fifty‐three percent were delivered by caesarean section and 68 (37%) required admission to neonatal unit (NNU) care. Hypertension/pre‐eclampsia was two times, polyhydramnios three times, and postpartum haemorrhage six times more common than in non‐diabetic women.

Conclusions Women with Type 2 diabetes have a less satisfactory pregnancy outcome compared with the general population. Infants have a two‐fold greater risk of stillbirth, a 2.5‐fold greater risk of a perinatal mortality, a 3.5‐fold greater risk of death within the first month and a six‐fold greater risk of death up to 1 year compared with regional/national figures. They have an 11 times greater risk of a congenital malformation. We need to develop better educational and screening strategies if we are to improve.
Assessing progression and efficacy of treatment for diabetic retinopathy following the proliferative pathway to blindness: implication for diabetic retinopathy screening in Taiwan
Authors: Liu W‐J. , Lee L‐T. , Yen M‐F. , Tung T‐H. , Williams R. , Duffy S. W. , Chen T. H‐H.
Published: August 2003

AimsThe natural history and treatment efficacy of diabetic retinopathy (DR) play important roles in the evaluation of screening. Therefore, the natural history of DR and rates of transition after treatment (including metabolic control and laser photocoagulation) from no diabetic retinopathy (NDR) to blindness were quantified.

MethodsWe studied a cohort of 795 patients with diabetes mellitus (DM) receiving fundus examination in the ophthalmology out‐patient department of one medical centre between 1 January 1990 and 31 December 1992 in Taiwan. Follow‐up data until 31 December 1998 were collected by chart review. Two multistate Markov models were proposed to assess the efficacy of the treatment regime in reducing progression to blindness.

ResultsThe average times spent in states (i) no diabetic retinopathy (NDR), (ii) background diabetic retinopathy (BDR), (iii) preproliferative diabetic retinopathy (PPDR), and (iv) proliferative retinopathy (PDR) were 10.86 years, 8.33 years, 1.67 years, and 2.17 years, respectively. Early detection of PPDR may lead to a 60% reduction in PDR and an 83% reduction in blindness. Simulated results based on these parameters show that an annual screening programme, a biennial screening regime and a 4‐yearly screening regime can lead to 54% (95% confidence interval (CI): 44–62%), 51% (95% CI: 41–59%), and 46% (95% CI: 36–54%) reductions in blindness, respectively.

ConclusionsAssessing the progression of DR following the proliferative pathway in this study suggests that screening for DR is worthwhile and that a 4‐year interscreening interval for patients as yet without DR may be justified.
Is digital image compression acceptable within diabetic retinopathy screening?
Authors: Basu A. , Kamal A. D. , Illahi W. , Khan M. , Stavrou P. , Ryder R. E. J.
Published: August 2003

Aims The National Screening Committee (NSC), whilst recommending the use of digital mydriatic retinal photography for diabetic retinopathy screening, has not yet accepted the use of digitally compressed images for grading. By greatly reducing the file size, however, compression of images is invaluable for storage and for its rapid transmission across computer networks. We undertook a study to compare the different levels of JPEG compression with the original bit‐mapped image to determine whether there was any loss of clinical detail following compression.

Methods Three hundred and thirty images were analysed in this study. These images had been captured from 66 eyes consecutively photographed in a diabetic retinopathy screening programme, using a Sony DXC‐950 P 3CCD colour video camera mounted on a Canon CR6‐45NMf fundus camera. Single 45° macula‐centred images were taken from each eye. The images were compressed using the JPEG algorithm within Adobe Photoshop (version 4.0) and then displayed with a Sony Trinitron colour monitor. Four different levels of compression were used, JPEG‐1, JPEG‐2, JPEG‐3, JPEG‐4, and an objective analysis was undertaken using ‘lesion counts’. The compressed images were assessed separately and blindly and the results compared with their original BMP images.

Results Eight BMP images could not be evaluated (five right eye and three left eye). A total of 290 images were therefore used in the final evaluation. All the JPEG‐1 images with file sizes between 16 and 24 kb were found to be ‘pixelated’, while the JPEG‐4 images (66–107 kb) appeared similar to the original BMP (1.3 Mb) images. Both JPEG‐2 and JPEG‐3 images had significantly lower counted lesions than the BMP images.

Conclusions From our findings we can conclude that only some degree of image compression (compression ratios of 1 : 20 to 1 : 12) with file sizes of 66–107 kb is permissible using JPEG format, whereas the images obtained after higher compression ratios may not be suitable for diabetic retinopathy screening.
Comparative metabolic effects of hydrochlorothiazide and indapamide in hypertensive diabetic patients receiving ACE inhibitor therapy
Authors: Krum H. , Skiba M. , Gilbert R. E.
Published: August 2003

Background ACE inhibitors, when used as monotherapy, are frequently unable to adequately control blood pressure in diabetic patients. A diuretic may be added; however, thiazide diuretics, but not indapamide, have been associated with adverse metabolic effects. Whether these effects also apply to thiazides when administered in the currently used lower doses, and whether they differ from indapamide in their metabolic effects, particularly when used in combination with an ACE inhibitor in diabetic patients, has not been previously studied.

Methods We conducted a prospective, randomized, open‐label, blinded endpoint crossover study comparing the metabolic responses to the addition of either hydrochlorothiazide (HCTZ) or indapamide, in 18 diabetic hypertensive patients receiving ACE inhibitor monotherapy for hypertension. Patients stabilized on fosinopril 20 mg/day were randomized to receive either HCTZ 12.5 mg od or indapamide 2.5 mg od for 8 weeks, then crossed over to the alternate therapy for a further 8‐week period. Blood pressure, heart rate and metabolic assessments were performed at the end of each 8‐week treatment period.

Results Seated and standing systolic and diastolic blood pressures were not different between HCTZ or indapamide when added to fosinopril, nor was the fasting lipid profile or urinary albumin : creatinine ratio. Plasma potassium was lower with indapamide compared with HCTZ treatment (indapamide 4.3 ± 0.1 mmol/l; HCTZ 4.5 ± 0.1 mmol/l, P < 0.01) and HbA1c was higher with indapamide than with HCTZ therapy (indapamide 7.8 ± 0.4%; HCTZ 7.2 ± 0.3%, P < 0.01).

Conclusions Hydrochlorothiazide 12.5 mg/day, when added to background ACE inhibitor therapy with fosinopril in hypertensive diabetic patients, resulted in a metabolic profile that was similar, if not superior on certain parameters, in comparison with indapamide 2.5 mg/day.
An unusual cause of hyperinsulinaemic hypoglycaemia syndrome
Authors: Manning P. J. , Espiner E. A. , Yoon K. , Drury P. L. , Holdaway I. M. , Bowers A.
Published: August 2003

Endogenous hyperinsulinism as a cause for hypoglycaemia can be attributed to a number of different causes including insulinoma, sulphonylurea drugs and the newly described disorder non‐insulinoma pancreatogenous hypoglycaemia (NIPH). The calcium stimulation test is increasingly used as a method for not only localizing insulinoma but also for distinguishing the above entities. We describe a case in which felonious sulphonylurea administration was used to mimic either an insulinoma or NIPH. Importantly, this case demonstrates that, contrary to previous reports, the insulin response to calcium stimulation in such cases may be uniformly positive and should alert the physician to possible surreptitious sulphonylurea ingestion.
Incidence of sight‐threatening retinopathy in Type 1 diabetes in a systematic screening programme
Authors: Younis N. , Broadbent D. M. , Harding S. P. , Vora J. P.
Published: August 2003

Aim To measure the cumulative incidence of any retinopathy, maculopathy and sight‐threatening diabetic retinopathy (STDR), and calculate optimal screening intervals by retinopathy grade at baseline for patients with Type 1 diabetes attending an established systematic retinal screening programme.

Methods All patients with Type 1 diabetes registered with enrolled general practitioners, excluding only those attending an ophthalmologist, were studied if retinopathy data was available at baseline and at least one further screen event. Screening utilized non‐stereoscopic 3‐field mydriatic photography and modified Wisconsin grading. STDR was defined as moderate pre‐proliferative retinopathy or greater and/or significant maculopathy in any eye.

Results Patients (n = 501) underwent 2742 screen events. Cumulative incidence of STDR in patients without baseline retinopathy was 0.3% (95% CI 0.0–0.9) at 1 year, rising to 3.9% (1.4–5.4) at 5 years. Rates of progression to STDR in patients with background and mild pre‐proliferative retinopathy at 1 year were 3.6% (0.5–6.6) and 13.5% (4.2–22.7), respectively. Progression to STDR was greater in patients with a higher grade of baseline retinopathy (P = 0.001) or a longer disease duration (P = 0.003). For a 95% likelihood of remaining free of STDR, mean screening intervals by baseline status were: no retinopathy 5.7 (95% CI 3.5–7.6) years, background 1.3 (0.4–2.0) years and mild pre‐proliferative 0.4 (0–0.8) years.

Conclusions Screening at 2–3 year intervals, rather than annually, for patients without retinopathy in Type 1 diabetes is feasible because of the low risk of progression to STDR, and may result in significant cost savings for a screening programme. Patients with higher grades of retinopathy require screening at least annually or more frequent.
Preventing Type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view
Authors: Zimmet P. , Shaw J. , Alberti K. G. M. M.
Published: August 2003

The last two decades have seen an explosive increase in the number of people with diabetes globally. There is now an urgent need for strategies to prevent the emerging global epidemic. Several recent successful intervention studies, both lifestyle and pharmacological, targeting subjects with impaired glucose tolerance (IGT) have stimulated enthusiasm for prevention of Type 2 diabetes. Lifestyle interventions reduced the incidence of diabetes by over 50% in the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. Can the findings of these two studies be applied globally? Underpinning the enthusiasm, there needs to be a realistic approach to interventions in both developed and developing nations, and in ethnic groups where a better understanding of the socio‐economic, cultural and demographic issues and perceptions surrounding chronic diseases such as diabetes is required. Whether the strategies used in these two studies can be translated into a ‘real world’ scenario is doubtful. In practice, it is more than likely that a number of strategies will be needed to compliment the lifestyle approach. These will include pharmacological approaches with metformin, acarbose and other agents used to treat diabetes and its complications, currently under investigation. Longer‐term follow‐up studies will also clarify whether both lifestyle and pharmacological interventions actually prevent Type 2 diabetes, or merely delay its onset.
Growth in a context of cultural marginality: North American nurse educators in Japan
Authors: Furuta B. S. , Petrini M. A. , Davis A. J.
Published: August 2003

Background: Concepts of marginality and partnership emerged from a questionnaire completed by 12 North American nurse educators working long term in Japan. Methods: To study individual perceptions regarding current professional and personal experiences, including language competency, roles and responsibilities in a different culture, contributions made, and management of daily living. Respondents also made recommendations to others who accepted similar assignments. Results: The data revealed growth accomplished and challenges encountered as a result of marginal status in the Japanese context with varying levels of socio‐cultural adaptation.
Surviving Ebola: understanding experience through artistic expression
Authors: Locsin R. C. , Barnard A. , Matua A. G. , Bongomin B.
Published: August 2003

Background: A dearth of knowledge and information exist about the understanding of the experience of surviving a life‐threatening illness such as Ebola Hemorrhagic Fever (Ebola). Objectives: To understand the ways in which survivors of Ebola understood the experience of surviving a life‐threatening illness. Methods: Eleven participants were asked to illustrate their understanding of the experience of surviving Ebola*. Using drawings and interviews as data, a phenomenographic approach was used to guide the research process and to analyse data. Results: Analysis revealed four ways of understanding the experience. These are described as categories of descriptions or conceptions, namely, escape in peaceful awareness, hope for a world outside of fear, persistence in defying death, and constant fear of dying. Importantly, the structure and referential aspects of the experiences are portrayed in the form of an outcome space, which is the understanding of the experience of living as survivors of Ebola, described as both ‘living in fear of the predatory spectre’, while simultaneously ‘living in constant hopefulness’. This experience is illustrated as paradoxically living in fear while concurrently hoping for life. Discussion: Understanding the experience of survivors of a life‐threatening illness is significant to nursing and its practice. Critical to this significance is its influence on the practice of compassionate and competent nursing.
Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions
Authors: McFarland D. M.
Published: August 2003

Background: Cervical cancer is the most common cancer in Botswana. Little is known about women's use of Papanicolaou (Pap) cervical smear tests. Aim: The study is to explore knowledge and beliefs of 30 women about cervical cancer and Pap smear tests using the Health Belief Model. Method: Women were recruited from all income levels using network sampling. Data were collected using a demographic questionnaire and semi‐structured interview guide. Data analysis included descriptive statistics for demographic data and content analysis for interview data. Findings: Knowledge of cervical cancer and the Pap smear test was inadequate among women with low incomes. Pap smear utilization was also limited among low‐income women. Of the 18 women who had at least one Pap smear test in their lifetime, eight (44%) had opportunistic testing as a result of having gynaecological symptoms. Twelve women (40%) had never had Pap smear tests. Major barriers to Pap smear screening included inadequate knowledge about Pap smear testing, providers’ negative attitudes, and limited access to doctors. Conclusion: The study has implications for health education and health policy and for nurses’ involvement in both.
The phenomenon of caring from the novice student nurse's perspective: a qualitative content analysis
Authors: Kapborg I. , Berterö C.
Published: August 2003

Background: Caring has been seen as a nursing term/concept, including all the aspects that are used to deliver nursing care to patients. Sometimes caring has been conceptualized as a relational expression of human concern and as a collection of human activities that assists others. Aim: This study is to identify and describe the nature of the concept ‘caring’ from the novice student nurse's perspective. Methods: A total of 127 Swedish novice student nurses wrote comments in essay form to the question: ‘what is your image of the concept caring?’ Data were analysed using qualitative content analysis, with the use of the theoretical framework: ‘doing’ and ‘being’. Findings: Three categories of caring were identified as ‘doing’, ‘being’ and ‘professionalism’. The phenomena of caring and the caring process could be illustrated as including hand (doing), heart (being) and brain (professionalism). Conclusions: It is now time to make care more visible as a principle of practice and of moral action. This could be explicit in a clear professional framework and incorporated more fully into nursing education programmes. Caring is to take care of the entire human being physically, emotionally and intellectually. Nurses need to use hand, heart and brain in order to fulfil their commitments.
Achievements and challenges of formulating a strategic plan for nursing development at the national level in Bahrain
Authors: Al‐Gasseer N. , Al‐Darazi F. , Al‐Kuwaiti B. , Al‐Gaud K. , Al‐Muhandis B. , Murad L.
Published: August 2003

Background: In this paper (initially presented at a symposium during the ICN Centennial Conference, 27 June−1 July 1999, London), we describe nurses’ experiences in formulating a strategic plan for nursing development at the national level in Bahrain. Aim: Specifically, we address the process undertaken to produce a comprehensive and integrated strategic plan directed at what nurses in Bahrain need to do in order to contribute to cost‐effective and high‐quality health service. Conclusions: The following strategies are addressed: regulation of nursing; reform of nursing education; development of nursing services; development of a nursing information system, and development of nursing leadership.
Broad‐scale reciprocity in an avian seed dispersal mutualism
Authors: Burns K. C.
Published: August 2003

Aim Coevolved relationships between individual species of birds and plants rarely occur in seed dispersal mutualisms. This study evaluates whether reciprocal relationships may occur between assemblages of bird and plant species.

Location Vancouver Island, British Columbia, Canada (48°50′‐N, 125°22′‐W).

Methods The distribution and fruiting phenologies of seven shrub species were compared to seasonal changes in habitat selection and seed dispersal by six fruit‐eating bird species.

Results Shrub species inhabiting forest understorey habitat had earlier fruiting phenologies than shrub species inhabiting forest edge habitat along lake and bog margins. Birds showed a parallel pattern in habitat selection, being more abundant in the forest understorey early in the fruiting season, and more abundant in the forest edge later in the season. Rates of seed deposition covaried with avian habitat selection, in such a way that birds directed seed dispersal into habitats preferred by shrubs.

Conclusions These results depict a broad‐scale pattern in the abundance of birds and fruits indicative of reciprocal interactions. Seasonal changes in seed dispersal to each habitat appear to reinforce the relationship between shrub habitat affinities and fruiting phenologies. Phenological differences between habitats may also reinforce seasonal changes in avian habitat selection. Therefore, although reciprocal interactions between pairs of bird and plant species are rare, broad‐scale reciprocal relationships may occur between assemblages of bird and plant species.
Body size and area‐incidence relationships: is there a general pattern?
Authors: Biedermann Robert
Published: August 2003

AimThis paper tests firstly for the existence of a general relationship between body size of terrestrial animals and their incidence across habitat patches of increasing size, and secondly for differences in this relationship between insects and vertebrates.

LocationThe analysis was based on the occupancy pattern of 50 species from 15 different landscapes in a variety of ecosystems ranging from Central European grassland to Asian tropical forest.

MethodsThe area‐occupancy relationship was described by incidence functions that were calculated using logistic regression. A correlation analysis between body size of the species and the patch area referring to the two given points of the incidence function was performed. In order to test for an effect of taxon (insects vs. vertebrates), an analysis of covariance was conducted.

ResultsIn all species, the incidence was found to increase with increasing patch area. The macroecological analysis showed a significant relationship between the incidence in habitat patches and the body size of terrestrial animals. The area requirement was found to increase linearly with increasing body size on a log‐log scale. This relationship did not differ significantly between insects and vertebrates.

ConclusionsThe approach highlighted in this paper is to associate incidence functions with body size. The results suggest that body size is a general but rather rough predictor for the area requirements of animals. The relationship seems valid for a wide range of body sizes of terrestrial animals. However, further studies including isolation of habitats as well as additional species traits into the macroecological analysis of incidence functions are needed.
Distinguishing between signal and noise in faunal responses to environmental change
Authors: Fleishman Erica , Mac Nally Ralph
Published: August 2003

Aim We tested whether variation in snapshots of butterfly species composition and species richness taken from one to six years apart could be interpreted as an ecologically meaningful trend or whether they might merely reflect stochasticity.

Location Field research was conducted in the Toquima Range and Shoshone Mountains, Lander and Nye counties, Nevada, USA.

Methods We obtained data for 49 sites in the Toquima Range from 1996 to 2002 and 39 sites in the Shoshone Mountains from 2000 to 2002. Sites spanned the gradient of local topographic and climatic conditions in those mountain ranges. Data on species composition and species richness were based on comprehensive field inventories. We calculated similarity of species composition using the Jaccard index. We conducted one‐factor repeated‐measures analyses of variance to test whether the distribution of similarity of species composition and the distribution of mean species richness depended on the number of years between inventories.

Results In both mountain ranges, much less of the difference in species composition was attributable to turnover of species composition within sites over time than to spatial differences among sites. Annual species richness in the Toquima Range was more variable than in the Shoshone Mountains, but again far less of the variation in species richness was attributable to year than to differences among sites.

Main conclusions Despite the fact that desert ecosystems are not expected to be highly resilient to global environmental change, there may be a time lag between deterministic environmental changes and a detectable faunal response, even in taxonomic groups that are known to be sensitive to changes in climate and vegetation. Although information on species richness and similarity of species composition are among the most practical data to collect in managed landscapes, these measures may not be highly sensitive to environmental changes over the short to moderate term.
Dispersal and the interspecific abundance‐occupancy relationship in British birds
Authors: Gaston Kevin J. , Blackburn Tim M.
Published: August 2003

AimTo test the prediction that deviations of species from the positive interspecific relationship between abundance and occupancy (a measure of geographical range size) are related to differences in dispersal.

LocationGreat Britain.

MethodsQuantitative data on the abundances, occupancy and dispersal distances of British birds are compared using phylogenetic comparative methods.

ResultsMeasures of natal and adult dispersal distance, and the intraspecific variance in these parameters, explain little variation in occupancy in addition to that accounted for by population size. Individual dispersal variables failed to explain significant variance when added individually to a model with population size as a predictor. Migrants and species using wet habitats tend to disperse further than residents and dry habitat species. Analysing these four groups separately revealed effects of dispersal only on the occupancy attained by dry habitat species.

ConclusionsThe only consistent predictor of occupancy in these analyses was population size.
From intent to impact: developing clinical leaders for service improvement
Authors: Hardacre Jeanne E. , Keep Jane
Published: August 2003

This article describes an approach to evaluating a leadership‐development programme which considers the impact of the programme on individuals, their organizations and the services they manage. Participants were clinical leaders from the health system in Eire, aiming to further develop their leadership skills, awareness and potential. The programme was used as a vehicle for linking personal development, as a leader, with leading improvements at work. Based on the principles of action learning, the programme was underpinned by the application of learning to practice, and the evaluation process was integral to the design and delivery of the development activities. Perceptions of the participants and key stakeholders were used as a baseline to identify desired changes in culture, structure, behaviour and processes in the services where participants worked. Participants used action learning and the content of programme modules to lead changes in their service areas. Perceptions of services at the beginning of the programme were compared with those at the end by using a visual analogue scale, a process that provided an indication of the extent of service improvement and change achieved in organizations by participants. The quantitative data was complemented by qualitative data which reported the personal development of participants’ leadership skills and awareness. Lessons for future evaluation of leadership‐development programmes are suggested. Sufficient time needs to be built into the design and delivery of programmes to embed ongoing evaluation within the development process. Time spent on this at early stages aids an in‐depth understanding and high level of ownership of the evaluative process by participants. To gain optimum benefit from stakeholder rating, the choice of stakeholders involved needs to take account of unavoidable stakeholder attrition. Methods for identifying organizational support for change, the relative involvement of chosen stakeholders in the change process, and external sources of data to triangulate the reported outcomes, would also enhance the overall evaluation approach.
The construction of plagiarism in a school of nursing
Authors: Paterson Barbara , Taylor Lynn , Usick Brandy
Published: August 2003

Despite clear policies for handling reported occurrences of plagiarism, and the inclusion of antiplagiarism statements in course syllabi and university calendars, reports of both student and faculty plagiarism in universities has increased dramatically in the past decade. Critics indicate that current approaches to prevent plagiarism in universities are limited by their focus on the individual and by their failure to consider the contextual influences in university settings. Eight faculty members and 10 students in a university school of nursing were interviewed about their understanding of, and response to, plagiarism. The participants viewed plagiarism primarily as a student problem caused by moral breakdown or ignorance. Faculty indicated that they most often overlooked university policy for reporting plagiarism if the offence was deemed as unintentional or caused by personal stress. Students were aware that plagiarism was wrong, but undergraduate students frequently conceptualized it as an ‘academic quirk’. The article concludes with a discussion of the implications of the research findings to university schools of nursing.
Mature‐aged medical students: a qualitative study
Authors: Chur‐Hansen Anna
Published: August 2003

Mature‐aged entry students have been found, in previous research, to experience difficulties not always shared by their younger classmates. The majority of research has used quantitative approaches to explore these differences. The aim of this qualitative study was to explore the experiences of mature‐aged medical students in relation to their learning at university. Four students from one Australian medical school were interviewed about their experiences, and the data were analysed qualitatively. Ten themes were identified: perceived differences between mature‐aged and younger students; financial difficulties; social support; relationship problems; illness; negative emotions; discrimination; necessary personality traits; supportive relationships; and the emotions experienced on being able to study medicine. These students undergo a number of substantial stressors as a result of their studies. Given the desirable qualities that they possess, medical educators should be developing strategies to encourage such students and minimize the obstacles they face.
Practice into theory: learning to facilitate new health and social care partnerships in London
Authors: Meads Geoffrey D. , Chesterman Daniel , Goosey David , Whittington Colin
Published: August 2003

The contemporary relationship between theory and practice in interprofessional learning and development is explored in the context of the United Kingdom (UK) government's multiple reform policies for ‘modernizing’ health and social care. As part of a 1‐year action research programme, four local case studies in London are described. These illustrate the new collaborations being created and point to the importance of understanding, as a priority for future research and organizational developments in primary care, the changing and complex roles of non‐statutory stakeholder agencies and process facilitation. Both are emerging as critical factors for effective policy implementation. Overall, the London‐wide programme indicates the dysfunctional nature of excessively linear conceptual models, and the need, in practice, to espouse eclectic and dynamic approaches to theories for learning in health and social care.