bluuebunny/crossref_metadata_2025 huggingface dataset:
Bioencapsulation of erythromycin using adult brine shrimp, Artemia franciscana (Latreille)
Authors: Majack T J. , Rust M B. , Massee K C. , Kissil . G. W. , Hardy R W. , Peterson M E.
Published: March 2003

Live adult brine shrimp, Artemia franciscana (Latreille), were enriched with erythromycin to determine if Artemia could accumulate therapeutic levels for subsequent feeding to young fish. Three trials were conducted to determine the erythromycin incorporation and survival rates of enriched Artemia when fed either liposomes containing erythromycin or various erythromycin suspensions. Erythromycin concentration in Artemia fed a liposome suspension was low (∼ 5 μg mL−1) relative to Artemia fed the direct suspension (> 100 μg mL−1) over the same time period. When enriched with suspensions up to 1 g erythromycin L−1 sea water for 14 h, Artemia survival was not significantly affected (P > 0.05) relative to controls. Using a suspension of 1 g L−1, tissue erythromycin concentrations of 109 ± 16 μg erythromycin mL−1 Artemia homogenate (mean ± SEM) were achieved after 12 h. Concentrations above 170 μg mL−1 were obtained using suspensions of 2–5 g L−1, but Artemia survival significantly (P < 0.05) decreased.
Cell membrane glycoconjugates on virulent and avirulent strains of the haemoflagellate Cryptobia salmositica (Kinetoplastida)
Authors: Feng S , Woo P T K
Published: March 2003

The glycoconjugates on the cell membranes of Cryptobia salmositica (virulent and avirulent strains) were analysed using 13 highly purified lectins. The virulent strain of C. salmositica was agglutinated by two of these lectins (Concanavalin A (Con A) Canavalia ensiformis, specific for α‐mannose and α‐D‐glucosyl residues; Pisum sativau agglutinin (PSA), specific for N‐acetyl α‐D‐galactosaminyl) but the avirulent strain of C. salmositica was agglutinated by 11 lectins. No agglutination of C. salmositica (virulent and avirulent strains) was observed with lectin Tetragonolobus purpureas agglutinin (TPA, specific for α‐L‐fucose). Glycoprotein analysis with digoxigenin or biotin labelled lectins showed strain specific staining patterns for C. salmositica; with the avirulent strain showing stronger reactions than the virulent strain. These results indicate that the surface carbohydrate residues changed with attenuation of the pathogen and this change may be related to its loss of virulence.
Gill pathology caused by infestations of adult and preadultDissonus manteriKabata (Copepoda: Dissonidae) on coral trout,Plectropomus leopardus(Lacépède), (Serranidae)
Authors: Bennett S M , Bennett M B
Published: March 2003

Adult and preadultDissonus manteriattached to the gills ofPlectropomus leoparduscause significant pathology in the form of large hyperplastic nodules on the afferent (leading) edges of gill filaments. Nodules result from the dual actions of parasite attachment and feeding. The host response is characterized by severe epithelial hyperplasia, supplemented by fibroplasia and inflammation. Parasites attach close to the gill arch near the base of filaments. They have little effect on gill vasculature as the maxillipeds penetrate the filament superficial to the efferent filament artery and do not interfere with the blood vessels of the secondary lamellae. Tissue proliferation is limited to the wide portion of filament ‘edge’ epithelium in the proximal third and also does not extend to the secondary lamellae. Nodules are most numerous towards the ends of hemibranchs and are generally absent from the central regions. Leading hemibranchs bear significantly more nodules than their trailing counterparts. Of the total number of nodules, 20.5% are located on the pseudobranchs. Distribution patterns are considered to be primarily the result ofD. manteriavoiding strong water currents, although this cannot explain the difference between numbers on leading and trailing hemibranchs.
Ultrastructural pathology of Baltic salmon, Salmo salar L., yolk sac fry with the M74 syndrome
Authors: Lundström J , Börjeson H , Norrgren L
Published: March 2003

The ultrastructural pathology in liver, brain, skeletal and cardiac muscle of Baltic salmon yolk sac fry with the M74 syndrome is described. In the clinical stage of disease, the main pathological findings in the liver were a depletion of glycogen, condensation of nuclear chromatin, hydropic degeneration of mitochondria and a dilation of the bile canaliculi. In the terminal stage, additional findings were lipid accumulation and myelin whorls in the cytoplasm. The rough endoplasmic reticulum (RER) was degranulated and vesiculated and in some individuals, it formed concentric membranous whorls. Mitochondria showed several additional lesions, such as matrix densities, pleomorphism and cristae abnormalities. Skeletal myocytes were degenerated, and intracellular lipid accumulation was seen in the myocardium. In the brain, an increased frequency of cells exhibiting pyknosis or karryorhexis was recorded. The cytoplasm of these cells formed an amorphous mass of moderate density. The evaluation of brain and skeletal muscle was complicated by sporadic occurrence of pathological findings in the reference material, i.e. clinically healthy Baltic salmon yolk sac fry. As these yolk sac fry are suspected to have a subclinical thiamine deficiency, reference material in future studies should include salmon yolk sac fry from Atlantic populations or originating from reared broodstock.
Comparison of the efficiency and sensitivity of virus isolation and molecular methods for routine diagnosis of infectious haematopoietic necrosis virus and infectious pancreatic necrosis virus
Authors: Barlič‐Maganja D , Štrancar M , Hostnik P , Jenčič V , Grom J
Published: March 2003

Infectious haematopoietic necrosis virus (IHNV) and infectious pancreatic necrosis virus (IPNV) are widely distributed fish pathogens in Europe. A reverse transcriptase–polymerase chain reaction (RT–PCR) assay was developed for the detection of both viruses as an alternative method to virus assay in cell culture. Oligonucleotide primers corresponding to highly conserved regions of glycoprotein G‐gene sequences were used for IHNV. For the detection of IPNV the VP2‐coding region was selected for RT–PCR amplification. Products of the expected size were amplified from total ribonucleic acid (RNA) extracts of infected cells. The optimized RT–PCR methods successfully detected viral RNA from ovarian and seminal fluids and other organs. To enhance the sensitivity and specificity of RT–PCR, a semi‐nested PCR assay was tested using additional specific inner primers for reamplification of products obtained by RT–PCR. Because of the possibility of template carry‐over contamination, a closed one step RT–PCR method was tested. This technically simplified approach was then combined with the PCR–enzyme linked immunosorbent assay (ELISA) method for the detection of amplification products and verification using specific biotinylated probes. The test provides an additional tool for the detection of IHNV and IPNV which is rapidly and easily performed and is highly sensitive, especially for the detection of IHNV in fish samples coinfected with IPNV. The PCR–ELISA method for the detection of RT–PCR products enables the screening of large numbers of samples and offers the possibility for automatisation of diagnostic work.
Investigation of humoral immune factors from selected groups of southern bluefin tuna, Thunnus maccoyii (Castelnau): implications for aquaculture
Authors: Watts M , Munday B L , Burke C M
Published: March 2003

Serum immunoglobulin, lysozyme and classical and alternative complement activity were analysed in different groups of wild and captive southern bluefin tuna (SBT), Thunnus maccoyii (Castelnau), from ambient water temperatures of 12 ± 1 and 20 ± 1 °C. Groups held captive for the longest time were found to have the highest levels of these humoral immune mediators, despite a drop in ambient temperature from 20 ± 1 to 12 ± 1 °C during the captivity period. Therefore, it may be that the immune response in these endothermic fish is not inhibited by low temperature to the extent seen in poikilothermic fish. Also, length of time in captivity appears to be associated with increased antigen exposure to maintain high levels of humoral immune mediators in these groups. Lysozyme activity was optimal at pH 5.8 and 6.2, suggesting that two isoforms, with different pH optima, are present. The SBT serum was found to lyse sheep erythrocytes by both classical and alternative complement pathways. Classical pathway activity occurred in the absence of prior sensitization with antiserum to sheep red blood cells, suggesting that natural antibodies may be present (or lectin or C‐reactive protein mediated activation). Complement activity was relatively resistant to freezing at −20 °C but heating at between 45 and 50 °C for 20 min destroyed all complement activity.
Effects of monensin dose and treatment time on xenoma reduction in microsporidial gill disease in rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Becker J A , Speare D J , Daley J , Dick P
Published: March 2003

The objectives of the study were (1) to determine an acceptable dose of dietary monensin against microsporidial gill disease (MGD) of salmon caused by Loma salmonae and (2) to determine the life stage of L. salmonae at which the action of monensin was most effective at reducing clinical disease. Rainbow trout (RBT) were fed monensin diets at concentrations of 0, 10, 100, 1000 and 5000 ppm starting 1 week before per os exposure to L. salmonae infected gill material. Lethal sampling occurred at weeks 6, 7, 8 and 9 post‐exposure (PE). The acceptable dose of dietary monensin was determined to be 1000 ppm because it was the lowest concentration that produced a significant and constant reduction in xenoma formation. RBT were fed monensin at 1000 ppm beginning at 0, 1, 2 and 3 weeks before exposure and at 1, 2 and 3 weeks after exposure and continuing until week 9 PE. Fish in which treatment was initiated at the time of exposure or 1 week before, showed the greatest reduction in xenoma production when compared with the untreated RBT.
Feeding problems in a child with cerebral palsy
Authors: Waller Elizabeth
Published: March 2003

This case study describes the feeding problems that occurred in a child with cerebral palsy as a result of severe gastro‐oesophageal reflux, oral‐motor dysfunction and behavioural aversion. Nutritional management over the first(r)2 years of life is discussed. It illustrates the benefit of working in a multi‐disciplinary team.
Visual analogue scales: a screening tool for assessing nutritional need in head and neck radiotherapy patients
Authors: Macqueen  , Frost
Published: March 2003

Background: It has been estimated that more than 80% of head and neck cancer patients have significant weight loss during multimodal treatment, leading to poor wound healing, impaired immune function and a decreased tolerance to therapy. This study assesses the use of visual analogue scales (VAS) as a clinical screening tool to identify the nutritional needs of head and neck cancer patients during radical radiotherapy.
Methods: Twenty patients with squamous cell carcinoma (10 larynx, 10 pharynx) were assessed four times during their radiotherapy. They completed a VAS, subjectively assessing their appetite, ability to take solids and liquids and sense of taste on a 5‐point scale, with very poor and very good as the anchor points. Three‐day food diaries, weight, anthropometry and basal metabolic rate were also recorded.
Results: The results indicate that although there were no significant differences between the larynx and pharynx groups at the start of radiotherapy, significant differences were apparent by the end of treatment. The VAS showed a significant correlation with energy intake from normal food. This correlation was stronger for solids and appetite than for liquids and taste.
Conclusion: The VAS can quickly identify when radiotherapy patients require nutritional intervention and support.
An audit of dietary treatment modalities and weight loss outcomes in a specialist obesity clinic
Authors: Grace  , Summerbell  , Kopelman
Published: March 2003

Background: Obesity resistant to conventional treatment is often treated in specialist obesity clinics. Very little is known about treatment outcome or best management in this sector of the obese population and there appears to be a deficit of published audits from specialist obesity clinics.
Method: Our clinic population was characterized in terms of BMI, gender, ethnicity and age as well as previous weight loss attempts, referral source and reasons for referral. The treatment modality was noted and outcome measured in terms of weight change; losses of 5% or more from presenting body weight were defined as weight loss.
Results: It was found that 33% of the attending clinic population (
n=166) lost weight during their treatment phase, although no data was available on the long‐term maintenance of this loss. Forty‐three per cent lost 0–4% of their body weight, while 25% gained weight during their treatment phase. In the group that gained weight a greater number of patients (24%) reported depressive symptoms and required psychiatric or psychological intervention and/or antidepressive medication compared to only 4% of those patients who had lost weight. The most frequently used dietary modality was the low‐fat diet, however, all of the treatment methods resulted in weight loss in some patients but not in others. Of particular interest were those patients who tried a number of different treatment methods before finding one which resulted in weight loss.
Conclusion: This audit confirms that different treatment methods suit different individuals and highlights the importance of tailoring dietary advice to the individual patient.
The long‐term effect of advice on low‐fat diets in terms of weight loss: an interim meta‐analysis
Authors: Summerbell  , Jones  , Glasziou
Published: March 2003

Introduction: There is a wealth of evidence from a number of sources that body weight and the proportion of energy from dietary fat are directly related. However, some randomized controlled trials (RCTs) of low‐fat diets versus other types of low‐energy diets have found no difference in weight loss between treatment groups. Thus, the overall aim of this systematic review and meta‐analysis is to assess the effectiveness of low‐fat diets as a means of achieving sustained weight loss, using all available randomized clinical trials.
Methods: The Cochrane Library,
MEDLINE
,
EMBASE
,
BIOSIS
and bibliographies will be systematically searched for relevant studies. Key journals will be hand searched and experts approached for additional studies.
Interim results: The interim meta‐analyses suggest that, in overweight and/or obese clients,
ad libitum low‐fat diets are not more efficacious than other types of low‐energy diets in terms of weight loss, and also that, in the same population, low‐energy low‐fat diets are not more efficacious than low‐energy diets which are not low in fat, in terms of weight loss. However, the studies included in the two interim meta‐analyses revealed significant heterogeneity which will be examined in greater detail in the final meta‐analysis.
Conclusion: From our interim analyses of the data, we conclude that low‐fat diets are as efficacious as other types of low‐energy diets in promoting weight loss in the overweight and obese. Updates and the final report of this systematic review will be published in the Cochrane Library (
The Cochrane Library 1997
, Issue 4).
Combining diet with physical activity in the treatment of obesity
Authors: Thorogood
Published: March 2003

As the prevalence of obesity is rising in the population the average energy consumption is falling. It is clear that the missing link is the amount of energy expended. The current recommendations for minimum energy expenditure are 30 min of moderate exercise, such as brisk walking, five times a week, but many people, especially middle‐aged and older women, take little or no exercise. A recent Effective Health Care review on the treatment of obesity concluded that a combination of diet and exercise was more beneficial than diet alone.

A systematic review of trials of physical activity promotion concluded that interventions encouraging moderate rather than vigorous intensity exercise, that could be done without recourse to special exercise facilities, were the most likely to succeed. The currently popular ‘Prescription for Exercise’ schemes in the UK have had, at best, limited success. However, evidence is emerging from recent trials of physical activity promotion of new ways to improve initial attendance and long‐term uptake of physical activity.
Effective professional practice: protocol for a systematic review of health professionals’ management of obesity
Authors: Harvey  , Glenny  , Kirk  , Summerbell
Published: March 2003

While much attention has been paid to interventions to help overweight and obese people lose weight, relatively little is known about the contribution of health professionals to obesity reduction. As in other clinical areas, variations in the provision of health care for overweight and obese people may affect health outcomes. In this area in particular, there is reason to believe that practice may be adversely affected because of some providers’ negative attitudes towards the patient group.

This work aims to identify strategies that are effective in improving health professionals’ management of obesity or the delivery of health care services for overweight and obese people. In contrast to recent systematic reviews of patient‐targeted approaches, this review focuses specifically on interventions designed to improve health professionals’ practice. It is undertaken in association with the Cochrane Effective Practice and Organisation of Care (EPOC) Group. The protocol for this review is described.
Diet and disadvantage: observations on infant feeding from an inner city
Authors: Daly A. , MacDonald A. , Booth I. W.
Published: March 2003

Background: There are few detailed nutritional studies analysing dietary intakes and weaning practices of inner city infants aged 0–12 months. Pasteurized cow's milk (PCM) is not recommended as a main drink until after 1 year of age, although early usage is still common. Premature introduction of pasteurized cow's milk is associated with increased risk of iron deficiency anaemia.
Methods: We therefore prospectively examined the dietary effect of early introduction of pasteurized cow's milk on the nutritional intake of 100 infants (mean age at recruitment 7.8 months), whose mothers had already elected to introduce cow's milk before the recommended age of 12 months in a deprived inner city area. In addition, a retrospective questionnaire on feeding practices and food choices was administered and information on parental education and employment was collected, together with a 3‐day dietary diary of weighed intakes at recruitment.
Results: The results indicate that weaning practices are handed down from family and friends and are intuitive rather than informed. Over 80% of the infants had intakes of iron, zinc and vitamin D below the reference nutrient intake (RNI) and a further 41% had low vitamin C intakes. Prior to introduction of PCM, there was also misuse of infant formula. Twenty per cent added an extra scoop of powder to the feeds, 10% added milk powder to the bottle before addition of water and 30% used microwave ovens to heat the infant bottle.
Conclusion: Feeding practices in a deprived inner city area differed substantially from guidelines and infants were at risk of developing nutrient deficiencies as well as poor feeding practices.
A study of a single high potency multivitamin preparation in the management of cystic fibrosis
Authors: Leonard C. H. , Ross‐Wilson C. , Smyth A. R. , Polnay J. , Range S. P. , Knox A. J.
Published: March 2003

Background: ADEKs® is a new multivitamin preparation formulated specifically for cystic fibrosis (CF) patients, containing all four fat‐soluble vitamins. There is no data currently available on its use in CF.
Method: We carried out a retrospective study to evaluate ADEKs® in 54 CF patients attending the specialist CF Unit at Nottingham City Hospital. Plasma vitamin A and E levels were collected from annual review reports when taking ADEKs® and a year previously when using other vitamin preparations. Dietary assessment data was available for 24 of these patients (11 children, 13 adults).
Results: ADEKs® was taken for a median of 9.5 months by 19 children (mean age 11.3 years; range 7–15 years) and for 4 months by 35 adults (mean age 24 years; range 17–36 years). Median plasma vitamin A levels were significantly higher (
P<0.05) for all age groups (27% increase for 7–10 year olds, 48% increase for 11–15 year olds, 100% increase for 16+ year olds) following the change from other vitamin supplements to ADEKs®. Median plasma vitamin E levels were also significantly higher (59% increase for 7–10 year olds; 16% increase for 11–15 year olds; 26% increase for 16+ year olds). Fifteen (28%) and 9 (17%) patients went from below to within the normal plasma reference range for vitamins A and E, respectively, when changed onto ADEKs®. Four (7%) and 11 (20%) patients had values above the normal plasma range for vitamins A and E, respectively, whilst on ADEKs®.
Conclusion: This study suggests that ADEKs® tablets are useful for CF patients aged over 10 years as plasma vitamin A and E levels were improved. The use of a single vitamin preparation such as ADEKs® is likely to improve compliance. We have reservations over its use amongst the 7–10 year olds because of high plasma vitamin A (3/9) and E (7/9) levels, although further research may ultimately endorse its future use within this group.
Enhanced enteral nutrition in head injury: effect on the efficacy of nutritional delivery, nitrogen balance, gastric residuals and risk of pneumonia
Authors: Taylor S. J. , Fettes S. B.
Published: March 2003

Background: Early enhanced enteral nutrition (EN) improves clinical outcome in severe head injury. However, poor gastric emptying and certain aspects of intensive care may inhibit delivery of optimum nutrition.
Aim: To determine the important causes of interruption to EN and whether attempting early adequate EN could enhance nutritional intake in severe head injury.
Methods: Eighty‐two patients were randomized to receive either standard EN or early adequate EN. Data was collected on nutritional intake, causes of interruption to EN, nitrogen balance, volume of gastric residuals and incidence of pneumonia.
Results: The median percentage of energy and nitrogen delivered was greater in intervention patients compared to controls over the first week post‐injury (
P
< 0.02). During the first 96 h post‐injury, patients received EN during 57% of the potential feeding time. Intervention patients received a higher fluid volume (
P < 0.02) but did not have a higher incidence of pneumonia.
Conclusion: Taking into account the importance of initiating and maintaining adequate EN, prioritizing procedures in intensive therapy units could further improve nutritional intake in severe head injury.
Reducing pancreatic enzyme dose does not compromise growth in cystic fibrosis
Authors: Beckles Willson N. , Taylor C. J. , Ghosal S. , Pickering M.
Published: March 2003

Background: Reports linking high pancreatic enzyme dosages with bowel stricturing in children with cystic fibrosis (CF) led us to review our policy for pancreatic enzyme supplementation.
Methods: Twenty‐five prepubertal children with CF, aged 3–10 years, underwent a programme of pancreatin reduction. They were encouraged to decrease their enzyme intake by matching their pancreatin dose more closely to fat intake. Patients were reviewed at regular intervals by a paediatric dietician who promoted nutrition aiming for an energy intake of 120–150% of the estimated average requirement (EAR) and > 120% of the upper reference nutrient intake (URNI) for protein. Growth during the 12 months prior to enzyme restriction was compared with the subsequent year's growth.
Results: The initial mean pancreatin dose of 26 446 uLipase kg−1 day−1 (range 7305–53 088) was reduced to 12 583 uLipase kg−1 day−1 (range 4705–32 051). Growth was sustained on the lower enzyme dose (mean height velocity: 5.75±1.1 cm yr−1 vs. 6.12±1.4 cm yr−1, P> 0.05). There was a small but significant improvement in mean weight gain post pancreatin reduction (3.14±1.5 kg yr−1) compared with the preceding year (2.12±1.1 kg yr−1, P< 0.01). Nutritional analysis, including a 3‐day food diary and measurement of nutritional indices, showed that energy, protein and micronutrient intakes were maintained. Children were not forced to alter their intake of dietary fat by the reduction in pancreatin dose.Conclusions: A substantial reduction in pancreatin dosage can be achieved without an adverse effect on either growth or nutrition.
The relationship between television food advertisements recalled and actual foods consumed by children
Authors: Hitchings E. , Moynihan P. J.
Published: March 2003

Introduction: A probable influence on children's food choices is television advertising, although there is very little information on the relationship between food advertisements shown and foods consumed by British children.
Methods: Forty‐four children aged 9–11 years, from private and state schools in Newcastle‐upon‐Tyne from a variety of social class areas were interviewed to determine which television advertisements for food they remembered. The study sample was small and not known to be representative. Brand‐specific information on food intake was obtained using a 3‐day food diary. Parents were interviewed regarding food requests received. Spearman's correlation was carried out between the number of foods for which advertisements could be remembered and the number of times these foods were consumed.Results: A relationship was found between the foods for which the children could remember the advertisement and the number of these foods which the child ate (r=0.58). For individual food groups the relationship between foods remembered and foods consumed was strongest for soft drinks (r=0.68) and crisps and savoury snacks (r=0.61). Four out of 10 of the most frequently requested foods were amongst the 10 most frequently recalled television food advertisements.Conclusions: The results support the hypothesis that television advertisements influence food choice.
Assessment of body mass index for the residents of a long‐stay institution for people with learning disability
Authors: Lea A
Published: March 2003

Background: Body mass index (BMI) was used to assess the population of Royal Earlswood, a long‐stay institution for people with learning disability.

Method: Height and weight measurements were taken for each resident. Where available, previous weight records were used to compare the study BMI measurement with that 3 years previously – the time at which the Dietetic Service was first set up.

Results: This study indicated that 56.4% of the residents in Royal Earlswood had a BMI that was outside of the ideal range. The Dietetic Service knew of 60% of these residents, and the weight status of over three‐quarters of those receiving dietary advice had already been improved. The remaining 40% had not previously been identified as having an unhealthy weight.

Conclusions: This paper supports previous research in demonstrating that people with learning disability are more likely than the general population to have a body weight that is outside the healthy range. In this study dietetic input is generally shown to have influenced BMI beneficially.
Intake of vitamins B1, B2, C, A and E estimated on the basis of analysis of weekly diets of 19 Finnish hospitals
Authors: Mattila P. , Kumpulainen J.
Published: March 2003

Contents of vitamins B1, B2, C, A and E were determined and intakes of these vitamins calculated in homogenized weekly diets collected from 19 central hospitals throughout Finland. In addition, the possibility of using the hospital diet data to estimate the level of average daily vitamin intake in Finland was evaluated. This was facilitated by comparing the daily food consumption in hospitals with the average daily food consumption in Finland and assessing the average vitamin intake of Finnish people accordingly. Intakes of vitamins A, B2;and C (1600 RE, 2.9 mg and 148.9 mg day−1, respectively) exceeded the recommendations for hospital diets. On the other hand, mean intakes of vitamins E and B1(8.9 and 1.0 mg day−1, respectively) were slightly below the recommendations. Comparison of daily food consumption from hospital diets with the average daily food consumption in Finland suggests that average Finnish intakes of vitamins B1and E are close to the intake values obtained from the hospital diets studied.
Sex differences in weight perception and nutritional behaviour in adults with cystic fibrosis
Authors: Walters S.
Published: March 2003

Introduction

Good nutritional status in cystic fibrosis (CF) is associated with improved clinical status and survival. In some conditions where dietary and pharmacological treatment are important (e.g. diabetes), a combination of eating disorders and failure of treatment compliance has been reported. Cases of eating disorders have been reported in CF. Societal pressures on young women to remain slim may compromise optimum clinical management as women are content to remain underweight.

Objective

To determine whether women have different perception of their weight than men with CF and whether this manifests in different nutritional behaviour.

Methods

Confidential postal questionnaire to 1870 adults with CF in 1994 known to the Association of Cystic Fibrosis Adults (UK). Participants were asked their own weight and height, and their perception of their weight. Very underweight was defined as < 85% ideal body weight, underweight as 85–94%, normal weight as 95–104%, overweight as 105–114% and very overweight as 115% and over.

Results

A significantly higher proportion of women than men who are very underweight (29% vs. 11%) or underweight (41% vs. 15%) saw themselves as being of normal weight or overweight. Conversely, a significantly higher proportion of men than women who were normal weight (42% vs. 19%) saw themselves as underweight. All P‐values < 0.01.

A significantly higher proportion of people who perceived themselves to be underweight were taking oral or enteral food supplements compared with those who did not (77% vs. 30%, P < 0.05). Multiple logistic regression showed that perception of self as underweight was the strongest predictor of taking oral or enteral food supplements (adjusted odds ratio 2.42), even after adjustment for age, sex, overall severity score, body mass index, and seeing a dietitian in the last year.

Conclusion

Young women with CF tend to overestimate their weight, and young men with CF underestimate their weight when compared with their actual body weight. Perception of self as underweight is reflected in nutritional behaviour, being a significant predictor of taking oral and enteral food supplements. People working with young patients with CF should be aware of these sex differences in weight perception, and work with young women and young men with CF to achieve a realistic perception of body weight and realistic nutritional goals. There is a need for further research into body image, weight perception, eating behaviour and adherence to pancreatic enzyme supplementation and oral and enteral food supplementation in young patients with CF.
Survey of UK dietetic departments: diet in secondary prevention of myocardial infarction
Authors: Hooper L.
Published: March 2003

Aim

To collate information on current British dietetic practice in the area of diet in secondary prevention of myocardial infarction, and to compare this with best evidence.

Methods

A questionnaire was sent to all Chief Dietitians, to be completed by the whole department, asking about current dietary advice and practice, referrals and written dietary information for people following myocardial infarction.

Results

Fifty‐seven per cent of questionnaires were returned. Dietary fat advice was prioritized by 84% of departments, fruit and vegetables by 49%, oily fish by 45% and fibre by 28%. Most dietitians (81%) felt that this advice would protect from further cardiovascular disease. Percentages of post‐myocardial infarction patients given advice by a dietitian varied (median 60%), reasons for non‐referral included patients having normal lipids or weight. More were given dietary advice by another health professional (median 90%); however, most dietitians were unsure about the quality of this advice. Diet sheets were felt to reflect advice priorities, but where sheets were sent they were much less likely than departments to prioritize oily fish or fruit and vegetable advice.

Conclusion

Dietetic practice for people following myocardial infarction is out of line with current best evidence. Almost half of departments correctly prioritize oily fish advice, but often only see patients with raised lipids or weight. This is not the most effective strategy for preventing deaths.
Visual behaviour and dyadic interaction between people with intellectual disability and people who are non‐disabled
Authors: O'Brien P. , Tuck B. , Cummins R. , Elkins J.
Published: March 2003

Patterns of visual dominance in human interaction have been studied by a number of authors. The purpose of the present research was to investigate the implications of these studies for interaction between people who are disabled and people who are non‐disabled. It was predicted that disability would differentiate the two groups, with non‐disabled partners dominating the visual interaction. Two studies are reported. The first looked at visual interaction through the two looking modes of looking while listening and looking while speaking between 16 dyads where one partner was intellectually disabled and the other non‐disabled. In the second study, eight subjects who were intellectually disabled and who had participated in the first study interacted with another person who had an intellectual disability. Their looking modes were then compared between conversing with a non‐disabled partner in study 1 and with those of their partner with intellectual disability in study 2. The outcome of the studies showed that subjects who were intellectually disabled did not discriminate in looking mode between partners of different intellectual levels. Conversely, subjects who were non‐disabled spoke and looked significantly more when conversing with their partner who was intellectually disabled. It has been argued that overlooking and overspeaking could arise from the need for the non‐disabled person to gain some sign of affiliation from their partner, or alternatively, that it might reflect a dominant non‐disabled person attempting to facilitate a cooperative style.
Measuring the consumer satisfaction of class members of a law suit
Authors: Dudley J. R. , Calhoun M. L. , Ahlgrim‐Delzell L. , Conroyna J.
Published: March 2003

The present article describes a study of consumer satisfaction in a group of class members who are part of a mental disability law reform suit. Consumer satisfaction was considered one aspect of compliance with this lawsuit. The class members have a primary diagnosis of intellectual disability, and in most cases, a secondary diagnosis of mental illness. Conducting consumer satisfaction studies among people with intellectual disabilities is often challenging because some of these consumers have difficulty articulating their needs and concerns. An interview schedule with simple quantitative and qualitative satisfaction questions was used. The present study investigated the satisfaction of a subgroup of these class members prior to and after having a court‐supported service plan. The results reveal that these consumers became considerably more satisfied, and many of their specific satisfactions and dissatisfaction were identified. The results suggest that both quantitative and qualitative consumer responses can be helpful in determining compliance with court issues.
Diogenes' syndrome in patients with intellectual disability: ‘a rose by any other name’?
Authors: Williams H. , Clarke R. , Fashola Y. , Holt G.
Published: March 2003

Diogenes' syndrome is characterized by marked self‐neglect, domestic squalor, social withdrawal and hoarding of rubbish (syllogomania). The syndrome has been reported to occur in association with a wide variety of conditions, but the present authors were unable to find any previous reports of Diogenes' syndrome in patients with intellectual disability.
Prader–Willi syndrome and psychotic symptoms: I. Case descriptions and genetic studies*
Authors: Bouras N. , Clarke D. , Boer H. , Webb T. , Scott P. , Frazer S. , Vogels A. , Borghgraef M. , Curfs L. M. G.
Published: March 2003

Six people with Prader–Willi syndrome (PWS) who developed psychoses are described. Along with other literature reviewed in the present paper, the results imply an association between PWS and psychotic symptoms. Genetic studies were possible in five cases and SNRPN expression was examined in three cases. Maternal uniparental disomy and 15qllq13 deletions were found, demonstrating that psychotic symptoms are not associated with a single type of genetic abnormality.
Aetiology of intellectual disability – the Finnish classification: development of a method to incorporate WHO ICD‐10 coding
Authors: Wilska M. , Kaski M.
Published: March 2003

The present authors made an attempt to ease the diagnostic work of physicians who have patients with intellectual disability by creating an aetiological classification system based on the time and mechanism of injury to the central nervous system (CNS). The current paper presents the work‐up needed for understanding at least the timing of the causative factor/factors. The timing principle opens a direct course to family counselling. This method has been very well accepted during its 18 years of use in Finland, and therefore, it was felt that it would be helpful to organize the relevant ICD‐10 diagnoses according to the timing principle. This method has been published as a manual. An image of a tree became the obvious metaphor for this system. The genetic category forms the main root and stem, from which multiple branched roots and limbs emerge. The individual diagnoses appear as root nodules and leaves. The system is flexible, making it possible to add new branches for groups of diagnoses when improved diagnostic methods create these options (e.g. microdeletions). The aetiological diagnoses change accordingly. Over the course of further development, new incidents damaging the CNS may affect the functional level of an individual and require additional diagnoses. It is a constant challenge for physicians to keep the diagnoses of their patients up to date. The image of the tree helps professionals to think in terms of timing, and thus, makes family counselling easier. It is also helpful in the education of medical professionals.
Stress and residential staff who work with people who have an intellectual disability: a factor analytic study
Authors: Rose J.
Published: March 2003

The present study describes the development of a questionnaire, and the subsequent collection of data, to gather information on the demands and supports which influence stress (as measured by anxiety and depression scales) in direct care staff who work with people with intellectual disability. The results from the questionnaire were also used to explore the relationships between the factors derived from the questionnaire and to consider how these may be influential in building organizational models. The questionnaire was specifically constructed to measure the demands and supports experienced by direct care staff. The participants included 216 staff working in community residential services for people with intellectual disability. These individuals included staff working for two British health trusts and similar staff working for one local authority. The questionnaire consisted of 33 demands items and 23 supports items. Separate factor analyses were conducted on the demands and supports scales. Analyses of the reliability and validity of the resulting factors were conducted. Stepwise multiple regressions were conducted to further explore the relationship of factors with the measures of anxiety and depression. Four factors were extracted from the demands scale and three factors from the support scale. There was some concern over levels of reliability and validity for individual factors; however, the reliability of the main scales appeared to be satisfactory. All but one support factor correlated significantly with levels of anxiety and depression. The factors explained a modest amount of the variance in the regressions. While there are some concerns about the psychometric properties of the questionnaire, it is argued that the scales and factors can be used to confirm and further understanding of the relationship between groups of demands, supports and stress in staff. The usefulness of the questionnaire as a means of diagnosing specific sources of demand and support is considered. It is suggested that the questionnaire could form the basis for assessment and subsequent intervention in houses where staff are reporting relatively high levels of anxiety and depression.
Hepatitis B and C in institutions for individuals with intellectual disability
Authors: Vellinga A. , Van Damme P. , Meheus A.
Published: March 2003

People with intellectual disability are a well‐known high‐risk group for hepatitis B virus (HBV) infection. Hepatitis B virus is a major public health problem, but it is often neglected because of its largely asymptomatic course with long‐term complications. Safe and effective vaccines have been available for over 15 years. However, universal vaccination strategies have not or have not completely been implemented to date, even though epidemiological data have indicated the effectiveness and efficacy of vaccination, and economic evaluations have shown that it is cost effective. Hepatitis C virus (HCV), which was discovered in 1989, has similar risk factors and is also a cause of chronic hepatitis. The prevalence of HCV amongst individuals with intellectual disability has not been clearly established. An overview of the literature on the prevalence of HBV and HCV in this population, as well as risk factors, transmission and prevention is presented in the present review. The literature cited in the present article was obtained by searches in MedLine using the following keywords and keyword combinations: hepatitis, hepatitis B virus, hepatitis C virus, mentally retarded, mentally handicapped, developmentally retarded, intellectual disability, institutionalization, Down’s syndrome and hepatitis B vaccination. The search was done from 1980 to 1998. Beside this, the older articles found in the references were included if these were considered necessary for completeness.
Chronological age and crystallized intelligence of people with intellectual disability
Authors: Facon B. , Facon‐Bollengier T.
Published: March 2003

The influence of chronological age (CA) and fluid intelligence on the crystallized intelligence level of people with intellectual disability was studied in a group of 102 participants aged between 6 and 20 years. The results, which were based on their performance in 12 fluid and crystallized intelligence markers, indicate that the fluid intelligence factor and CA explain an important fraction of crystallized intelligence factor variance (43% and 21%, respectively). This finding provides support for the hypothesis that CA‐related experience exerts a significant effect on the crystallized component of intelligence in people with intellectual disability.
People with intellectual disability, sensory impairments and behaviour disorder: a case series
Authors: Carvill S. , Marston G.
Published: March 2003

BackgroundSensory impairments (SIs) are more prevalent in people with intellectual disability (ID). Both conditions lead to higher rates of emotional and behavioural problems than in the general population. The identification of psychiatric disorders in this group can be difficult, particularly in those with severe ID and limited communication skills.

MethodThe present paper presents a series of 18 case reports of individuals with ID, SI and behavioural problems.

ResultsThe majority of cases were young male caucasians with congenital rubella syndrome and autistic spectrum disorder, referred because of self‐injurious behaviour (SIB) or aggression. Nine cases were treated with autidepressants, five underwent environmental changes and two had medication reduced. All showed some improvement.

ConclusionsThe benefits of comprehensive assessments, the use of standardized assessment tools and trials of treatments are discussed in the context of making psychiatric diagnoses.
Behaviour problems in adult women with Rett syndrome
Authors: Mount R. H. , Hastings R. P. , Reilly S. , Cass H. , Charman T.
Published: March 2003

BackgroundDespite considerable interest in the genetic, physical and neurological aspects of Rett syndrome (RS), there have been few studies of associated behavioural and emotional features. Furthermore, few case studiesor surveys have included adult women with RS. The main aim of the present study was to compare behaviour problems in a sample of women with RS against data from normative samples.

MethodsThe primary carers of 50 women with RS completed the community version of the Aberrant Behavior Checklist.

ResultsWomen with RS were rated as having lower levels of irritability, hyperactivity and inappropriate speech behaviours than normative samples of adults with intellectual disability.

ConclusionsA number of factors may affect the presentation of behaviour problems in women with RS (e.g. cognitive impairments or physical disabilities). Therefore, more research is needed in order to generate information about the behavioural phenotype of RS. The implications of the present data for future research are also discussed.
On the success, cost and efficiency of modern medicine: an international comparison
Authors: Kjellstrand  , Kovithavongs  , Szabo
Published: March 2003

Kjellstrand CM, Kovithavongs C, Szabo E (University of Alberta, Edmonton, Canada). On the success, cost and efficiency of modern medicine: an international comparison. J Intern Med 1998; 243: 3–14.

Objective

To study the success and cost of modern medicine in industrialized, rich countries from 1980 to 1990.

Design

Cost per capita and per cent of gross domestic product (GDP) spent on health was related to: (i) mortality in six diseases amenable to treatment by modern medicine; (ii) the sum of those six diseases (avoidable disease); (iii) death due to other, unavoidable diseases; (iv) maternal and infant mortality; (v) life expectancy at birth; (vi) renal dialysis and transplantation rates. Efficiency was studied by comparing a country's avoidable mortality rates multiplied by expenses, to the mean for all countries.

Results

During the 10 years, avoidable death rate decreased 38% but unavoidable death rate only 10%. Life expectancy increased 3%. Cost per capita increased 107% but health expenditures, as per cent of GDP only 10%. There was a reasonable correlation between expenses and avoidable mortality but none between expenses and unavoidable death rate. In 1990 avoidable mortality was lowest in Canada, and highest in Japan. Cost was lowest in New Zealand, and highest in the USA. The efficiency index was highest for Australia, and lowest in the USA.

Conclusion

Modern medicine as we have studied it is successful. Avoidable death rate shows a steep uninterrupted decline over the last 50 years while unavoidable death rate shows only small decreases. Cost as per cent of GDP has increased only moderately. There is a correlation between expenses and mortality from avoidable but not from unavoidable diseases, and a large variation in efficiency.