bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis B immunoglobulin in combination with lamivudine for prevention of hepatitis B virus reactivation in children undergoing bone marrow transplantation
Authors: Tavil Betul , Kuşkonmaz Barış , Kasem Muhammed , Demir Hulya , Çetin Mualla , Uçkan Duygu
Published: August 2006

Abstract:  There is little information in literature about the use of hepatitis B immunoglobulin (HBIg) in recipients of bone marrow transplantation (BMT). Here, we report two children who received IV HBIg (Hepatect‐CP) and lamivudine treatment during BMT course for either patient or donor hepatitis B virus (HBV) viremia. A four‐year‐old girl underwent a fully human leukocyte antigen‐matched allogeneic BMT for thalassemia major from her mother positive for hepatitis B surface antigen (HBsAg). A 12‐yr‐old boy with chronic myeloid leukemia, positive for HBsAg and HBV‐DNA received a fully HLA‐matched allogeneic BMT from his sister in the first chronic phase of the disease. HBIg was successfully used in both cases to prevent HBV reactivation of the recipients. The results of our observations are encouraging and we suggest that HBIg in combination with lamivudine may be used in such cases especially in post‐transplant early period to prevent HBV reactivation.
Current role of liver transplantation for methylmalonic acidemia: A review of the literature
Authors: Kasahara Mureo , Horikawa Reiko , Tagawa Manabu , Uemoto Shinji , Yokoyama Satoshi , Shibata Yumiko , Kawano Takafumi , Kuroda Tatsuo , Honna Toshiro , Tanaka Koichi , Saeki Morihiro
Published: August 2006

Abstract:  To evaluate the current role of liver transplantation (LT) for methylmalonic acidemia (MMA), we reviewed the literature on outcomes of this treatment, and describe three of our own cases of living‐donor liver transplantation (LDLT). The total number of LT cases identified was 18. Transplantation mode was deceased donor LT in 12, including five combined liver‐kidney transplantations (CLKT) from deceased donors, and LDLT in six. Three hospital mortalities were noted, because of metabolic decompensation, sepsis and aspergillosis. Although mean postoperative serum MMA level decreased to 13.8% ± 9.2% (range 1.25–26.1%) of preoperative levels, four patients (22.2%) had renal insufficiency after isolated LT and three (16.7%) had postoperative neurological disability. Continuing metabolic damage to the kidney and brain may occur even after successful LT. Further evaluation is required to determine the long‐term suitability of this treatment modality.
School re‐entry of the pediatric heart transplant recipient
Authors: Weil Constance M. , Rodgers S. , Rubovits S.
Published: August 2006

Abstract:  Pediatric cardiac transplant has become increasingly frequent in the last decade and survival rates have improved remarkably. Outcome research on this population suggests that the majority of children have the capacity for healthy adaptation although 25–40% have been shown to have some type of psychiatric difficulties. As school plays a major role in these children's lives, early intervention and close liaison with schools is indicated to reduce psychological morbidity, enhance adaptation within the school environment and enhance overall adjustment. This paper proposes a model for a school re‐entry program for this population. The school re‐entry program is aimed at children who are undergoing cardiac transplant and will be entering or re‐entering the school system. They may range in academic age from preschool to college level and have been attending private or public schools with placements in regular education programs, regular education programs with resource support, special education programs, and alternative school programs. Others may not have been attending school because of the severity of their medical condition and have been receiving in‐home tutoring.

Each child is offered school re‐entry assistance by a multi‐disciplinary team composed of members from the Cardiology Transplant Service. The re‐entry program includes cognitive and psychosocial assessment, liaison with the child's school pre‐ and post‐transplant, academic planning and provision of academic, emotional, and behavioral support before, during, and immediately after transplant, a school re‐entry visit, and an ongoing school consultation. The goal is to address issues necessary for a successful school re‐entry including appropriate academic placement and support, psychosocial adjustment, education of school personnel and ongoing health needs of the student. The next step is to formally evaluate the efficacy of this program in successful school re‐entry.
Autologous hematopoietic stem cell transplant with melphalan and thiotepa is safe and feasible in pediatric patients with low normalized glomerular filtration rate
Authors: Termuhlen Amanda M. , Grovas Alfred , Klopfenstein Kathryn , Rosselet Robin , Gross Thomas G.
Published: August 2006

Abstract:  Normalized glomerular filtration rate (nGFR) <60 mL/min/1.73 m2 often precludes hematopoietic stem cell transplant (HSCT) in pediatric patients. Three patients with nGFR < 60 mL/min/1.73 m2 enrolled on an institutional phase I trial of HSCT preparative therapy for advanced and recurrent solid tumors with escalating melphalan, ranging from 135 to 180 mg/m2, thiotepa (600 mg/m2), and vincristine (2 mg/m2). An additional patient with low nGFR was treated with the same preparative therapy. None of the patients developed acute renal failure, excess toxicities during HSCT or delayed engraftment. These cases demonstrate that it is feasible and safe to perform HSCT in pediatric patients with low nGFR using melphalan‐ and thiotepa‐based preparative therapy.
Cyclosporin twice or three times daily dosing in pediatric transplant patients – It is not the same!
Authors: Filler Guido , De Barros Viviane Rocha , Jagger Justin E , Christians Uwe
Published: August 2006

Abstract:  Not infrequently, physicians elect to divide CyA‐ME from b.i.d. to t.i.d. dosing in an effort to minimize toxicity. Equivalent exposure is assumed. Few studies have compared 24‐h PK profiles on both dosing regimes in the same patient. We retrospectively studied a heterogeneous population of seven pediatric patients (one heart transplant, five renal transplants and one FSGS patient) on both dosing regimes who had complete 24‐h PK profiles on CyA‐ME. Four patients were converted from b.i.d. to t.i.d. and three patients from t.i.d. to b.i.d. dosing. There was no difference in the dose/kg (5.66 ± 2.52 mg/kg on b.i.d. dosing and 5.75 ± 1.81 mg/kg on t.i.d. dosing, p = 0.8578, two‐sided t‐test). When comparing the dose‐normalized AUCs over 24 h, every single patient demonstrated lower CyA‐ME exposure on t.i.d. than on b.i.d. dosing with an average relative bioavailability that was 37.9% lower on t.i.d. than on b.i.d. dosing. The median dose‐normalized AUC0→24h dropped from 1620 ng × h × kg/mL × mg (range: 1253–4319) on b.i.d. to 1016 ng × h × kg/mL × mg (range: 712–1485, p = 0.02, Wilcoxon's matched pairs test) on t.i.d. dosing. Our results indicate t.i.d. dosing of CyA‐ME results in significantly lower exposure when the same total dose is administered in two divided doses. This reduced exposure may potentially increase the risk for rejection.
A field test of the Cougar Home Safety Assessment (version 2.0) in the homes of older persons living alone
Authors: Fisher Grace S. , Baker Alison , Koval Dana , Lishok Christine , Maisto Emily
Published: August 2006

Objective:  The purpose of this study was to develop and field test the Cougar Home Safety Assessment version 2.0 (Cougar 2.0).

Method:  First, the Cougar 2.0 was adapted and developed from the Cougar 1.0 — a tool made for a prior study. The Cougar 2.0 was then field tested in the residences of 44 older adults who lived alone. Additionally, the residents and a panel of occupational therapy home care specialists completed questionnaires about the assessment.

Results:  A number of concerning safety hazards were identified. An overall mean safety score of 89% was obtained. Fire risk criteria were the most unsafe. Favourable face validity feedback was obtained.

Conclusion:  There is a need for occupational therapy home safety assessment for older people who live alone. The Cougar 2.0 appears to be a valid tool in this regard. The Cougar Home Safety Assessment series is available at: http://www.misericordia.edu/misericordia_pg_sub.cfm?sub_page_id=935&subcat_id=108&page_id=338
Diversity and inclusion within an occupational therapy curriculum
Authors: Trentham Barry , Cockburn Lynn , Cameron Debra , Iwama Michael
Published: August 2006

Occupational therapy professionals and users of occupational therapy services are becoming increasingly aware of the issues of diversity encompassing their lived experiences, values and meaning systems. This paper situates a discussion of diversity and curriculum development in terms of inclusiveness of people's diverse lived experiences, which include complex combinations of ethnicity, religion, sexual orientation, gender, socioeconomic status and other factors. A pedagogical context is provided based on understandings of culture, inclusiveness and diversity in the healthcare literature. The experience of one occupational therapy department's efforts to create a learning environment that is inclusive of all its participants is used to illustrate effective educational and structural strategies. Despite noble aspirations, much remains to be accomplished regarding how the profession defines competencies in terms of transcultural evaluation standards, outcomes and indicators.
Indirect evidence of ectopic pancreatic fascioliasis in a human
Authors: Lee Ok‐Jae , Kim Tae‐Hyo
Published: August 2006

Fascioliasis is not common in humans and, furthermore, its ectopic migration into the pancreas is extremely rare. A definitive diagnosis of ectopic fascioliasis is based on the demonstration of flukes in the affected organ. If the flukes invade the parenchyma, however, imaging studies are limited in the detection of worms and surgical identification is required. We encountered a clinical case of probable ectopic pancreatic fascioliasis diagnosed through indirect evidence. A 46‐year‐old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. Peripheral eosinophilia, hyperamylasemia and hyperlipasemia were documented. Abdominal computed tomography (CT) revealed multiple, hypodense foci which had coalesced, forming irregular nodules in the medial and lateral segments of the left lobe of the liver, and similar 2‐ to 3‐cm sized, hypodense lesions in the body and isthmus of the pancreas. IgG antibody against Fasciola hepatica was positive. Bithionol was given orally, and the patient’s symptoms and biochemistry then improved, with reversal of eosinophilia. Radiological studies showed normalization of the liver and pancreas at the 10th week, and the serology for Fasciola hepatica was negative at the fifth month.
Three‐year audit of the hyperphenylalaninaemia/phenylketonuria spectrum in Victoria
Authors: Boneh Avihu , Francis Dorothy EM , Humphrey Maureen , Upton Helen J , Peters Heidi L
Published: August 2006

Aim:  To determine the prevalence, the types and severity of hyperphenylalaninaemia (including phenylketonuria (PKU)) in Victoria and to report on a new treatment modality of PKU.

Methods:  We reviewed the medical records of all patients diagnosed with high blood phenylalanine levels by newborn screening between November 2001 and October 2004.

Results:  We identified 17 newborn babies with high levels of blood phenylalanine (total samples: 190 835). Dihydrobiopterin reductase deficiency was excluded in all babies. Five babies had persistent phenylalanine levels of 200–300, and do not receive any dietary or pharmaceutical therapy. One baby was diagnosed as having pyruvoyl tetrahydro‐pterin synthase deficiency. Following reports of tetrahydrobiopterin (BH4)‐responsive PKU, we have performed a BH4 load (20 mg/kg, 6R‐5,6,7,8‐tetrahydro‐l‐biopetrin dehydrochloride; Schricks Laboratories, Jona, Switzerland) in 10 newborn babies with PKU (one baby with a phenylalanine level of 2600 µmol/L was started on diet without prior load). Three babies had a significant response to BH4 (>35% decrease in phenylalanine level). Protein restriction (1.2 g/kg/day) and introduction of phenylalanine‐free formula, in addition to BH4 treatment, were necessary in one patient. The other patients maintain good metabolic control with BH4 treatment only (at ∼11 mg/kg/day) and an intake of 2–3 g protein per day. Of the nine babies who are on a full PKU diet, three have high phenylalanine tolerance (consistently >40 mg/kg/day).

Conclusion:  There is a spectrum of severity of hyperphenylalaninaemia in the population. The detection of BH4‐responsive PKU patients offers them a less restrictive dietary regimen and an improved quality of life, and may enable near normal life‐style in adolescence.
Does necrotising enterocolitis impact the neurodevelopmental and growth outcomes in preterm infants with birthweight ≤1250 g?
Authors: Soraisham Amuchou S , Amin Harish J , Al‐Hindi Mohammed Y , Singhal Nalini , Sauve Reginald S
Published: August 2006

Aim:  To compare the long‐term growth and neurodevelopmental outcomes at 36 months adjusted age in preterm infants (birthweight (BW) ≤ 1250 g) with necrotising enterocolitis (NEC) with BW‐matched controls.

Methods:  This is a case control study performed at a regional tertiary care neonatal intensive care unit. Infants with stage II or III NEC admitted to a regional tertiary care neonatal unit between 1995 and 2000 were identified. Each infant with NEC was matched by BW (±100 g) to next two infants admitted in the unit without NEC. Growth and neurodevelopmental outcomes at 36 months are compared.

Results:  In total, 51 infants with NEC and 102 controls met study eligibility criteria and 146/153 (94.3%) were prospectively followed for 36 months. Infants with NEC had more culture‐proven sepsis (35.3% vs. 10.8%, P < 0.001); patent ductus arteriosus requiring therapy (64.7% vs. 45%, P = 0.02), chronic lung disease (60.7% vs. 45%, P = 0.04) and longer hospital stay (84 days vs. 71 days, P < 0.0001). There were no significant differences in growth outcomes between the two groups at 36 months. Overall 24% of infants with NEC had one major neurodevelopmental disability compared with 10% among control infants. Infants who developed NEC had significantly higher cognitive delay (i.e. cognitive index <70) and visual impairment. A logistic regression model identified NEC as a predictor of cognitive delay.

Conclusion:  Preterm infants who develop NEC are at a significantly higher risk for developing neurodevelopmental disability. We recommend close neurodevelopmental follow up for all ≤1250 g infants who develop stage II or III NEC.
Rotavirus and other enteropathogens in childhood acute diarrhoea: A study of two centres in Malaysia
Authors: Lee Way S , Rajasekaran Ganeswrie , Pee Susan , Karunakaran Rina , Hassan Hamimah H , Puthucheary Savithri D
Published: August 2006

Aim:  To study the role of rotavirus in children hospitalised for acute gastroenteritis (AGE) in two urban hospitals in Malaysia.

Methods:  A 12‐month prospective study (January to December 2002), in children younger than 14 years with AGE hospitalised to the paediatric units of University of Malaya Medical Centre (UMMC), Kuala Lumpur; and Hospital Sultanah Aminah (HSA), Johor Bahru, Malaysia was conducted.

Results:  In 2002, 399 and 1307 children with AGE were admitted to UMMC and HSA, respectively. Two hundred and eighty‐eight (72%) stool samples from UMMC and 901 (69%) samples from HSA were analysed. Rotavirus was the most common aetiological agent identified in both centres (average 32%; UMMC 35%, HSA 30%, P = 0.94). The peak age group for rotavirus‐related hospitalisation was 24–35 months for UMMC and 12–23 months for HSA. Nine percent of patients hospitalised for rotavirus infection in UMMC and 22% of patients in HSA were older than 5 years of age. An outbreak of rotavirus infection within the communities served by both centres resulting in an increase in hospital admissions of rotavirus gastroenteritis was observed in both units from January to March 2002.

Conclusion:  The peak age group for rotavirus‐related hospital admission in this study was much older, between 12 to 35 months. It is uncertain whether this was related to the outbreak of rotavirus gastroenteritis observed within two urban areas from January to March 2002 causing re‐infection with rotavirus in older children.
Use of the Internet by parents of paediatric patients
Authors: Wainstein Brynn K , Sterling‐Levis Katy , Baker Sally A , Taitz Jonathan , Brydon Michael
Published: August 2006

Aim:  We aimed to determine the rate of Internet use for obtaining medical information by health‐care patients at a tertiary paediatric hospital, whether the Internet may influence patients’ attitudes to health‐care services and health‐care providers and whether patients would prefer the assistance of a professional informatics officer.

Methods:  An anonymous questionnaire randomly distributed to 450 subjects at Sydney Children’s Hospital, Sydney, Australia.

Results:  A total of 294 (65%) questionnaires were returned. Overall Internet use for medical information was 64% (189/294). Most (97%; 183/189) respondents reported ‘wanting to know more’ as the reason they sought information on the Internet. Eighty‐eight per cent (167/189) of respondents reported that they trust their doctor more than the Internet. Twenty‐one per cent (39/189) had presented their doctor with information about which he/she was unaware and 18% (34/189) had altered a health‐care decision because of information found on the Internet. The Internet had influenced questions asked of doctors in 83% (156/189). Eighty‐six per cent (252/294) of all respondents were in favour of professional assistance to obtain medical information.

Conclusion:  A large number of patients use the Internet to find information that influences their attitudes to health care. The services of a medical informatics professional would likely benefit both patients and doctors.
Parental attitudes to the identification of their infants as carriers of cystic fibrosis by newborn screening
Authors: Lewis Sharon , Curnow Lisette , Ross Margaret , Massie John
Published: August 2006

Aim:  To investigate parental attitudes to cystic fibrosis (CF) carrier detection of their infant by newborn screening (NBS).

Methods:  Data were collected from a postal questionnaire sent to parents of infants identified as CF carriers by NBS in 1996–1997 (inclusive) and 2001 in Victoria, Australia (n = 66).

Results:  Almost all parents remembered their child being identified as a CF carrier (97%: 1996/1997; 100%: 2001); yet the majority were unaware at the time that NBS could detect carriers (70%: 1996/1997; 49%: 2001). More parents in the later cohort reported having carrier testing compared with the earlier cohort (85% and 53% respectively) but recall was more uncertain in the earlier cohort when validated against health records. Cascade testing was not utilised frequently by other family members in either cohort. Residual risk of being a carrier if testing was negative was not well understood by parents. Some parents (28%: 1996/1997; 18%: 2001) had residual anxiety about the current health of their charrier child and their future reproductive decision making. Most parents were satisfied with the information provided to them at the time of the sweat test. Few differences were seen between the cohorts.

Conclusion:  Although the NBS process for CF in Victoria is working efficiently for the majority of families whose infant is identified as a carrier there are areas that can be improved. We recommend that greater attention should be given to informing parents that a consequence of NBS is CF carrier detection and strategies to improve utilisation of cascade testing should be developed.
Prevalence of complementary and alternative medicine and use among children in South Australia
Authors: Smith Caroline , Eckert Kerena
Published: August 2006

Aim:  To determine the use of complementary and alternative medicines and therapies (CAM) and common treatment modalities in children.

Methods:  This is a cross‐sectional, population‐based survey of 2985 adult and 911 children aged 15 years or less, conducted in South Australia in Spring 2004. The outcome measures are CAM use in children in the previous 12 months.

Results:  Overall, the 12‐month prevalence of CAM use in children was 18.4% (95% confidence interval 15.9–21.0). A wide variety of CAM modalities were used by children including ingestible therapies (33%), chiropractic (34%) and massage (20%). Common reasons for use of CAM were to prevent illness or to maintain health (39%) and for musculoskeletal conditions (22%), respiratory problems (20%) and skin complaints (18%). There was little difference in the use of CAM treatment modality across child ages.

Conclusion:  Approximately one in five children used CAM in the past 12 months in South Australia. Our findings further highlight the importance of increasing public awareness about the need to inform doctors and primary health‐care providers of CAM use in children. Health professionals working with children should ask parents about their children’s use of CAM. There is a need for further research examining the safe and judicious use of CAM in children.
Attention‐deficit/hyperactivity disorder: Are we medicating for social disadvantage? (For)
Authors: Isaacs David
Published: August 2006

Abstract:  The diagnosis of attention‐deficit/hyperactivity disorder (ADHD) is based on well defined criteria, which describe a number of symptoms. It is important to consider the context of the symptoms, in terms of the influence of the child’s family and school. Although stimulant medications benefit selected children they may not benefit all children with symptoms of ADHD. The incidence of ADHD increases with social disadvantage. There is a potential danger of using stimulant medication alone to treat children with complex psychosocial problems, associated with social disadvantage, including Aboriginal children. We desperately need better training in the management of ADHD and better access to child psychiatrists.
Attention‐deficit/hyperactivity disorder: Are we medicating for social disadvantage? (Against)
Authors: Efron Daryl
Published: August 2006

Abstract:  The functional impairments seen in attention deficit hyperactivity disorder (ADHD) are the result of a complex interplay between biological vulnerability and environmental influences. In children with ADHD from social disadvantaged families the latter often appear to predominate. Stimulant medication is the intervention with the largest demonstrable effect size in decreasing the core symptoms of ADHD, irrespective of social context. However, medication alone will not effectively treat common comorbidities, such as oppositional behaviour, anxiety, or learning disabilities. Nor can medication be expected to diminish major family discord or psychosocial adversity. Stimulant medication is one key therapy modality in children with ADHD. Data on prescribing rates do not support the assertion that there is systematic overprescribing of stimulants in Australia. There is, however, a serious problem with access to family support and appropriate services in schools for children with ADHD. Paediatricians have a responsibility to provide evidence‐based medical treatment for children with ADHD (i.e. stimulant medication), while advocating across sectors for services to enhance family resilience and function.
White button mushroom food hypersensitivity in a child
Authors: Ho Marco HK , Hill David J
Published: August 2006

Abstract:  We reported a child with anaphylaxis to edible white button mushroom, a disorder not previously described.
Successful management of lymphangiomatosis and chylothorax in a 7‐month‐old infant
Authors: Burgess Scott , Harris Margaret , Dakin Carolyn , Borzi Peter , Ryan Christopher , Cooper David
Published: August 2006

Abstract:  A 7‐month old infant presented with an effusion and multiple lesions in his spleen. A diagnosis of lymphangiomatosis was made based on chylous effusion and an MRI demonstrating numerous enhancing lesions within the spleen on T2‐weighed images. Conservative measures, including the withdrawal of feeds and octreotide, did not significantly reduce the rate of chyle production and increasing requirement for respiratory support. Resection of the patient’s spleen and partial pleurectomy were associated with a dramatic improvement in his condition. At 27 months the patient was well with no evidence of further lymphangiomas or a recurrence of his chylothoraces.
Low serum high‐density lipoprotein cholesterol in obese subjects with normal serum triglycerides: the role of insulin resistance and inflammatory cytokines
Authors: Mooradian A. D. , Albert S. G. , Haas M. J.
Published: August 2006

Background:  The cause of obesity‐related low HDLc in the absence of hypertriglyceridemia is not known.

Subjects & methods:  A total of 32 subjects with a body mass index (BMI)(kg/m2) greater than 30 and normal serum triglycerides (<150 mg/dl) were identified.

Results:  People with low HDLc (n = 16) compared to those with normal HDLc (n = 16) had higher BMI (37.53 ± 4.54 vs. 33.99 ± 3.65 kg/m2, p < 0.021), higher body fat weight (42.59 ± 9.51 vs. 34.76 ± 8.7 kg, p < 0.023), and higher insulin resistance index (3.75 ± 2.51 vs. 1.95 ± 1.10, p < 0.013). Seven subjects with low HDLc and none of those with normal HDLc, had elevated serum tumor necrosis factor alpha and/or interleukin‐6 (p < 0.010).

Conclusions:  Low HDLc levels can occur in obesity independently of elevated serum triglycerides and may be secondary to elevated serum levels of inflammatory cytokines.
Genetic variation and decreased risk for obesity in the Atherosclerosis Risk in Communities Study
Authors: Hart Sailors M. L. , Folsom A. R. , Ballantyne C. M. , Hoelscher D. M. , Jackson A. S. , Linda Kao W. H. , Pankow J. S. , Bray M. S.
Published: August 2006

Aim:  To investigate the effects of variation in the leptin [LEP (19A>G)] and melanocortin‐4 receptor [MC4R (V103I)] genes on obesity‐related traits in 13 405 African‐American (AA) and white participants from the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:  We tested the association between the single‐locus and multilocus genotypes and obesity‐related measures [body mass index (BMI), body weight (BW), waist–hip ratio, waist circumference and leptin levels], adjusted for age, physical activity level, smoking status, diabetic status, prevalence of coronary heart disease, hypertension, stroke or transient ischaemic attack.

Results:  AA and white female carriers of the MC4R I103 allele exhibited significantly lower BW than non‐carriers of this allele (p < 0.05 and p < 0.01 respectively). AA female carriers of both the LEP A19 allele and the MC4R I103 allele were 63% [odds ratio (OR) = 0.37, 95% confidence interval (CI) (0.18–0.78)] less likely to be obese, and white female carriers of the same two alleles were 46% [OR = 0.54, 95% CI (0.32–0.91)] less likely to be obese, than non‐carriers of the variant alleles. Female carriers of both the LEP A19 and MC4R I103 alleles had significantly lower BW (p < 0.05), BMI (p < 0.05) and plasma leptin (p < 0.01) than the non‐carriers of both the alleles. Carriers of the two variant alleles had lower BMI over the 9‐year course of the ARIC study and significantly lower weight gain from age 25 years. No significant joint effect of these two variants was observed in males.

Conclusion:  These results suggest that variation within the LEP and MC4R genes is associated with reduced risk for obesity in females.
Improvement of insulin sensitivity and β‐cell function by nateglinide and repaglinide in type 2 diabetic patients – a randomized controlled double‐blind and double‐dummy multicentre clinical trial
Authors: Li J. , Tian H. , Li Q. , Wang N. , Wu T. , Liu Y. , Ni Z. , Yu H. , Liang J. , Luo R. , Li Y. , Huang L.
Published: August 2006

Aim: To evaluate the efficacy of nateglinide vs. repaglinide in blood glucose (BG) control and the effect on insulin resistance and β‐Cell function in patients with type 2 diabetes.

Methods: A randomized controlled double‐blind and double‐dummy multicentre clinical trial was conducted. A total of 230 Chinese patients with type 2 diabetes were enrolled in five clinical centres. The patients were divided randomly into group A [repaglinide 1.0 mg three times daily (t.i.d.), n = 115] or group B (nateglinide 90 mg t.i.d., n = 115). At baseline and end of the 12‐week clinical trial, standard mixed meal tolerance tests were performed.

Results: A total of 223 patients (96.9%) completed the trial. There was no significant difference between repaglinide and nateglinide groups in the effects of reducing fasting blood glucose (FBG), 30‐, 60‐ and 120‐min BG during 12 weeks (p > 0.05). At week 12, no significant difference was shown between the two groups in BG or haemoglobin A1c(HbA1c) (p > 0.05). However, the effect on HbA1cin repaglinide group was stronger than that in nateglinide group (p < 0.05). After 12‐week treatment, area under the curve (AUC) of BG decreased (p < 0.05), and AUC of insulin and C‐peptide (CP) increased in both groups (p < 0.05). The effects of nateglinide on AUC of BG, insulin and CP were similar to that of repaglinide (p > 0.05). There was no significant difference between the two groups in AUC of BG, insulin or CP in week 12 (p > 0.05). Furthermore, homeostasis model assessment of insulin resistance (HOMA‐IR) and β‐cell function indexes measured by HOMA‐β, ΔI30/ΔG30and (ΔI30/ΔG30)/HOMA‐IR were improved significantly in both groups during 12 weeks (p < 0.05). The effects of improving HOMA‐IR and β‐cell function indexes in nateglinide group were comparable with that of repaglinide group (p > 0.05).

Conclusions: The efficacy of repaglinide and nateglinide in FBG, postprandial glucose excursion and early‐phase insulin secretion is similar. But the effect of repaglinide 1.0 mg t.i.d. on HbA1cis stronger than that of nateglinide 90 mg t.i.d.. This trial had shown that nateglinide and repaglinide could comparably improve insulin sensitivity and β‐cell function.
The implications of anthropometric, inflammatory and glycaemic control indices in the epidemiology of the metabolic syndrome given by different definitions: a classification analysis
Authors: Panagiotakos D. B. , Pitsavos C. , Das U. N. , Skoumas Y. , Stefanadis C.
Published: August 2006

Background:  Individuals with the metabolic syndrome (MS) are at high risk for coronary heart disease. In this study, we evaluated the levels of inflammatory, lipidaemic and glycaemic control markers in subjects with and without MS, as given by different definitions.

Methods:  During 2001–2002, we randomly enrolled 1514 men (18–87 years old) and 1528 women (18–89 years old), without any clinical evidence of cardiovascular disease, from the Attica area, Greece. Among several variables, we also measured inflammatory markers, total antioxidant capacity, glucose and insulin levels and various lipids. MS was defined according to either the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III criteria or the International Diabetes Federation (IDF) Epidemiology Task Force group. In all the analyses, subjects with diabetes were excluded.

Results:  The prevalence of the MS was 17.9% according to the NCEP definition and 48.9% according to the IDF definition (p < 0.001). The prevalence of MS was higher in men compared with women according to both definitions (p for gender differences <0.001). Moreover, 3.9% of the total study sample fulfilled only the NCEP criteria, but not the IDF, while 38.6% fulfilled only the IDF criteria. Subjects who were defined as having MS using the IDF criteria were younger, had higher body mass index, C‐reactive protein, fibrinogen, tumour necrosis factor‐α levels, total antioxidant capacity and lower glucose and insulin levels.

Conclusions:  Prevalence of the MS is very high among Greek adults when the IDF definition is used, while it is still considerable when we adopt the NCEP criteria. It is evident that subjects who fulfilled the IDF criteria showed increased levels of inflammatory markers compared with those who fulfilled the NCEP ATP III criteria.
The prevalence of co‐morbid depression in adults with Type 2 diabetes: a systematic review and meta‐analysis
Authors: Ali S. , Stone M. A. , Peters J. L. , Davies M. J. , Khunti K.
Published: August 2006

Aim  To conduct a systematic literature review in order to estimate the prevalence and odds ratio of clinically relevant depression in adults with Type 2 diabetes compared with those without.

Methods  medline, embase and psycinfo databases were searched using MeSH terms and free text to identify relevant controlled studies. Published reference lists were also examined. Study selection and appraisal were conducted independently by two reviewers and a meta‐analysis was performed to synthesize and analyse the data.

Results  Ten controlled studies including a total of 51 331 people were published between January 1980 and May 2005. The prevalence of depression was significantly higher in patients with Type 2 diabetes compared with those without [17.6 vs. 9.8%, OR = 1.6, 95%, confidence interval (CI) 1.2–2.0]. However, in most studies, patients with diabetes differed from those without on variables known to be associated with an increased risk of depression. The prevalence of depression was higher in females with diabetes (23.8%) compared with males (12.8%); however, the odds ratio for depression in patients with Type 2 diabetes compared with those without was higher in males (OR = 1.9, 95% CI 1.7–2.1) than females (OR = 1.3, 95% CI 1.2–1.4). Failure to report potential confounders prevented a more rigorous meta‐analysis of risk.

Conclusion  We identified raised rates of depression in people with Type 2 diabetes, however, there is a need for well‐controlled and better‐reported studies to inform the development of effective treatments for depression in these patients.
Genetic influences of the intercellular adhesion molecule 1 (ICAM‐1) gene polymorphisms in development of Type 1 diabetes and diabetic nephropathy
Authors: Ma J. , Möllsten A. , Prázny M. , Falhammar H. , Brismar K. , Dahlquist G. , Efendic S. , Gu H. F.
Published: August 2006

Aim  The intercellular adhesion molecule‐1 (ICAM‐1) gene is located on chromosome 19p13, which is linked to Type 1 diabetes (T1D). ICAM‐1 expression is related to development of T1D and diabetic nephropathy. The present study aims to evaluate the genetic influence of ICAM‐1 gene polymorphisms on the development of T1D and diabetic nephropathy.

Methods  Five valid single nucleotide polymorphisms (SNPs) were genotyped in 432 T1D patients (196 patients had diabetic nephropathy) and 187 non‐diabetic control subjects by using dynamic allele‐specific hybridization (DASH) and pyrosequencing.

Results  SNPs rs281432(C/G) and rs5498 E469K(A/G) had high heterozygous indexes. They were significantly associated with T1D [P = 0.026, OR = 1.644 (95% CI 1.138–2.376) and P < 0.001, OR = 2.456 (1.588–3.8)]. Frequencies of the C allele in SNP rs281432(C/G) and the A allele in SNP rs5498 E469K(A/G) increased stepwise from non‐diabetic control subjects to T1D patients without diabetic nephropathy and T1D patients with diabetic nephropathy. Further analysis for these two SNPs indicated that T1D patients had increased frequency of the common haplotype C‐A, in comparison with non‐diabetic control subjects (38.1 vs. 32.1%, P = 0.035).

Conclusion  The present study provided evidence that SNPs rs281432(C/G) and rs5498 E469K(A/G) in the ICAM‐1 gene confer susceptibility to the development of T1D and might also be associated with diabetic nephropathy in Swedish Caucasians.
The Gly482Ser variant of the PPARGC1 gene is associated with Type 2 diabetes mellitus in northern Chinese, especially men
Authors: Sun L. , Yang Z. , Jin F. , Zhu X. Q. , Qu Y. C. , Shi X. H. , Wang L.
Published: August 2006

Aims  To investigate the prevalence of the Gly482Ser polymorphism of the PPARGC1 gene in a northern Chinese population and to clarify the susceptibility of individuals with the Gly482Ser polymorphism to insulin resistance and related diseases.

Methods  We studied the association of the Gly482Ser polymorphism identified in the PPARGC1 gene with Type 2 diabetes mellitus (T2DM) in 390 unrelated patients with T2DM and 525 control subjects with normal glucose tolerance. Clinical parameters and measures of insulin resistance were recorded. Genotypes were determined by the polymerase chain reaction—restriction fragment length polymorphism (PCR‐RFLP) method, which was further confirmed by direct sequencing in 20 randomly selected cases.

Results  The Gly482Ser polymorphism was common in the northern Chinese population. Univariate analysis indicated no statistically significant differences in allele frequencies or genotype frequencies of the Gly482Ser polymorphism in diabetic and control subjects (minor 482Ser allele frequency 44.4 vs. 41.4%, P = 0.169). However, logistic regression analysis demonstrated a positive 1.645‐fold higher risk of the Ser/Ser genotype for T2DM (P = 0.039, 95% CI = 1.026–2.632). After stratification by gender, the risk of Type 2 diabetes in men was increased 1.852‐fold (95% CI = 1.125–3.049) in those with the Ser/X genotype compared with those with the Gly/Gly genotype (P = 0.015). No associations were observed between the Gly482Ser polymorphism and parameters of insulin resistance, obesity and hypertension.

Conclusion  The Gly482Ser variant of the PPARGC1 gene might contribute to susceptibility to T2DM in northern Chinese subjects. The Ser/X genotype of the Gly482Ser polymorphism in the PPARGC1 gene appears to be a risk factor for T2DM in northern Chinese men.
Coronary calcification, homocysteine, C‐reactive protein and the metabolic syndrome in Type 2 diabetes: the Prospective Evaluation of Diabetic Ischaemic Heart Disease by Coronary Tomography (PREDICT) Study
Authors: Godsland I. F. , Elkeles R. S. , Feher M. D. , Nugara F. , Rubens M. B. , Richmond W. , Khan M. , Donovan J. , Anyaoku V. , Flather M. D. ,   for the PREDICT Study Group
Published: August 2006

Aims  The PREDICT Study aims to determine: (i) the association between cardiovascular risk factors and coronary artery calcification score (CACS) obtained by electron beam tomography and (ii) the predictive value of CACS for coronary heart disease (CHD) events in Type 2 diabetes.

Methods  Having previously reported relationships between CACS and conventional risk factors, we have now studied the novel risk factors, plasma high‐sensitivity C‐reactive protein (CRP) and homocysteine, insulin resistance, serum apoprotein A1 and B concentrations, the serum triglyceride/high‐density lipoprotein cholesterol ratio and metabolic syndrome (International Diabetes Federation definition) in 573 subjects of the PREDICT Type 2 diabetes cohort.

Results  In univariate analyses, the only significant positive novel correlate of CACS was homocysteine (P = 0.0004). CRP was increased in those with detectable calcification, but decreased with increasing calcification score (P = 0.006). In a multivariate model that included all significant univariate correlates, CACS was independently associated with age (P < 0.0001), waist–hip ratio (P < 0.02), male gender (P < 0.05) and duration of diabetes (P < 0.05), but the association with homocysteine was no longer significant. The negative association between CACS and CRP remained in multivariate analysis, and was independent of statin use.

Conclusions  Age was the major factor influencing CACS in Type 2 diabetes, with weaker contributions from waist hip–ratio and duration of diabetes. Other novel cardiovascular risk factors appear to have little positive effect.
Postchallenge glucose rises with increasing age even when glucose tolerance is normal
Authors: Rhee M. K. , Ziemer D. C. , Kolm P. , Phillips L. S.
Published: August 2006

Aims  Ageing increases the likelihood of developing diabetes, with associated cardiovascular disease. In a cross‐sectional study, we sought to determine whether age is associated with an increase in glucose concentrations 1 h after an oral glucose challenge (1‐h OGTT), even when glucose tolerance is normal (NGT).

Methods  Among subjects in the NHANES II database, 2591 subjects with NGT and documented 1‐h OGTT glucose concentrations were studied. The relationship between age and 1‐h OGTT glucose concentrations was assessed in a multivariable linear regression analysis.

Results  In a multivariable linear regression analysis, each 10‐year increase in age conferred an additional 0.20 mmol/l increase in the 1‐h OGTT glucose (P < 0.0001). Moreover, an interaction between age and gender was found such that 1‐h OGTT glucose concentrations rose more rapidly with increasing age in men than in women. The impact of age on 1‐h OGTT glucose was independent of both fasting and 2‐h OGTT glucose concentrations.

Conclusions  One‐hour OGTT glucose concentrations rise significantly with age even in subjects with NGT. Further investigation is warranted to explore the pathophysiological significance of such age‐related impairment of glucose handling, which might increase the risk of cardiovascular disease even when patients do not meet criteria for the diagnosis of diabetes or prediabetes.
A NEW ROLE FOR CONSUMERS’ PREFERENCES IN THE PROVISION OF HEALTHCARE
Authors: Telser Harry , Zweifel Peter
Published: August 2006

In the present allocation of resources in healthcare, preferences of consumers as the ultimate financiers of healthcare services are judged to be of little relevance. This state of affairs is being challenged because the past decade has seen great progress in the measurement of preferences, or more precisely, willingness‐to‐pay (WTP) as applied to healthcare services. This article reports evidence on WTP of the Swiss population with regard to three hypothetical modifications of the drug benefit to be covered by social health insurance: delaying access to the most recent therapeutic innovations (among them, drugs) by two years in exchange for a reduction of the monthly premium; substituting original preparations by generics, again in return for a lowered premium; and the exclusion of preparations for the treatment of minor complaints from the drug benefit. Using discrete‐choice experiments, WTP and its determinants are estimated. Average WTP for avoiding such a delay (which acts across the board) is much higher than for eschewing the exclusive use of generics (which are claimed to be largely equivalent to the original) or the retention of ‘unimportant’ drugs in the list of benefits – a rating predicted by economic theory. In addition, a great deal of preference heterogeneity between the French‐speaking minority and the German‐speaking majority was found, pointing to considerable efficiency losses caused by uniformity of social health insurance.
EQUITY OF ACCESS TO INNOVATIVE MEDICINES: MISSION IMPOSSIBLE?
Authors: Attridge Jim
Published: August 2006

This paper reviews the literature on the nature of innovation in the biopharmaceutical sector in the context of current approaches to the funding and provision of medicines. From this starting point the paper explores the relationship between market diffusion models, cost containment and equity of access across national populations.
DIRECT‐TO‐CONSUMER ADVERTISING (DTCA) OF PHARMACEUTICALS: AN UPDATED REVIEW OF THE LITERATURE AND DEBATE SINCE 20031
Authors: Auton Frank
Published: August 2006

The pharmaceutical sector is unusual amongst global regulated industries inasmuch as it is usually forbidden from advertising to the users of its products. This paper reports on research updating my 2003 review

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of the evidence and arguments for and against the direct‐to‐consumer advertising (DTCA) of prescription drugs. It not only covers the two countries where significant DTCA is permitted (USA and New Zealand), but also the administrations in which there is active discussion of possibilities to ease or amend some of the current restrictions (Europe, Australia and Canada).
YES MINISTER: INVALUABLE MATERIAL FOR TEACHING THE PUBLIC CHOICE OF BUREAUCRACY
Authors: Considine John
Published: August 2006

Conveying the logical consequences of modelling the individual as self‐interested in the public sector bureaucracy is not an easy task. One has to avoid, without dismissing, normative judgments and issues of empirical validity in order to focus on the logical consequence. Illustrating the theory in a memorable way is also difficult. This paper argues thatYes Ministerprovides ideal material for the task.
AUDIT MARKET FAILURE
Authors: Koehler Benedikt
Published: August 2006

The auditing profession has called for the current regime of unlimited liability to be replaced with liability caps. The Department of Trade and Industry has tabled proposals to reform the structure of the market for audit services. These proposals fall short of meeting the demand for liability limitation but modify the current regime inasmuch as auditor liability, though uncapped, would be proportional to the damage caused by audit failure. This step is unlikely to remedy audit market failure. This article argues the distortion of market incentives in audit markets can be traced to government intervention and the remedy lies in replacing government intervention with competition.
THE GREAT CONTRACTION
Authors: Kocher W. Spencer
Published: August 2006

Many historians in the United States (and many teachers in US high schools and colleges) still attribute the Great Depression to the following: the breakdown of capitalism; excessive reliance on laissez‐faire policies; inequality of wealth; overproduction and stock market speculation. These purported causes led to the implementation of the New Deal: well‐intended, but ultimately ineffective, policies that actually prolonged the duration of the depression. A retrospective analysis of the actions taken by the Federal Reserve, in fact, demonstrate that the Great Depression was caused, in large part, by a massive contraction of the money supply.
GORDON BROWN COUNTS DEAD CHILDREN: THE TRUE IMPACT OF INHERITANCE TAX
Authors: Pratten Cliff
Published: August 2006

In the Budget and the supporting documents Gordon Brown and the Treasury reported that only 6% of estates pay Inheritance Tax and that the tax is a fair and targeted system. This article shows that for several reasons the tax affects far more than 6% of the community, is iniquitous and poorly targeted.
Central Banking by Committee
Authors: Sibert Anne
Published: August 2006

A small economics literature on monetary policy making by committee is complemented by the literature on groups in the other social sciences. I review some of this work, focusing on the effect of size on group performance and whether committees are more moderate than individuals. Studies document that an individual's effort decreases with group size unless their contributions can be identified and evaluated and that committee membership is polarizing, tending to make committees more extreme. A particularly harmful form of group polarization occurs when a striving for consensus causes members to stop paying sufficient attention to alternative actions. The literature suggests that monetary policy committees should have a clear objective, publish individual votes and not have many more than five members. They should be structured so that members do not act as part of a group, perhaps by having short terms in office and members from outside the central bank. External scrutiny of the decision‐making process should be encouraged.