bluuebunny/crossref_metadata_2025 huggingface dataset:
Needs for oral care among people with intellectual disability not in contact with Community Dental Services
Authors: Cumella S. , Ransford N. , Lyons J. , Burnham H.
Published: March 2003

Previous research has found an unmet need for oral care among people with intellectual disability. The key factors which have been indicated are low expectations, fear of treatment, lack of awareness among carers and problems in accessing dental services. The withdrawal of many general dental practitioners (GDPs) from the National Health Service (NHS) may have exacerbated the latter problem in the UK. The aims of the present study were: (1) to assess the extent of unmet clinical needs in a group of adults with intellectual disability living in the community who were not in contact with the Community Dental Service (CDS); and (2) to explore their perceptions of teeth and contact with dentists to identify how oral care can be improved. Interviews were completed with subjects and/or carers and a dental examination was completed. There were higher levels of untreated caries (decay), and gingival or periodontal (gum) problems among the sample than in either the general population, or in a previous survey of CDS users at day centres and residential facilities. The subjects were largely unaware of dental problems, and used the appearance and absence of pain to judge the condition of their teeth. They depended greatly on their carers for decision‐making and support with regard to visiting the dentist and tooth‐brushing. Carers requested training in oral care and the use of dental services, and support in dealing with clients who have problems tolerating tooth‐brushing. The subjects had experienced a wide variation in the treatment provided by dentists, but had not found it difficult to access a dentist despite recent reductions in the availability of NHS dental care. They expressed a particular need for a good relationship with their dentist and for their dentist to have personal skills in relating to people with an intellectual disability. Dental screening checks and oral care training for carers should be made easily available. Care plans should include tooth‐brushing and dietary issues for all clients who have their own natural teeth. There are significant training issues for dentists in developing personal skills in total communication, disability awareness and attitudes which value people with intellectual disability.
Mental health services for people with intellectual disability: a conceptual framework
Authors: Moss S. , Bouras N. , Holt G.
Published: March 2003

The present paper discusses the application of the ‘matrix model’ to mental health services for people with intellectual disability. There is great variability between the service models in this area, which makes comparisons and conclusions difficult. The present model facilitates the breaking down of these complexities into understandable parts so that future directions for research, service planning and delivery can be logical, coherent and evidence‐based.
Use of the atypical antipsychotics Olanzapine and Risperidone in adults with intellectual disability
Authors: Williams H. , Clarke R. , Bouras N. , Martin J. , Holt G.
Published: March 2003

The present study was designed to monitor the use of atypical antipsychotics in adults with intellectual disability and to evaluate the clinical effectiveness of these drugs. Twenty‐one patients were commenced on an atypical antipsychotic: 12 on Olanzapine and nine on Risperidone. The ICD‐10 diagnoses of the subjects were mild (13 cases) or moderate (8 cases) mental retardation, and psychiatric disorders (17 cases) with significant impairment of behaviour in 10 cases. Tolerability was good for 15 patients experiencing minimum or no side‐effects, and medication was only stopped as a result of side‐effects in one case. Clinical global outcome was rated as minimally improved or better for 16 cases. The present findings suggest that the atypical antipsychotics Olanzapine and Risperidone are well tolerated by patients with intellectual disability and psychiatric disorders, and are broadly effective against target symptoms.
Neuropsychological assessment of patients with severe neuromotor and verbal disabilities
Authors: Sabbadini M. , Bonanni R. , Carlesimo G. A. , Caltagirone C.
Published: March 2003

In people with cerebral palsy, severe neuromotor disability and communication problems make standard neuropsychological tests impossible. Therefore, alternative methods and specific aids must be developed to allow patients to autonomously respond to the examiner's questions. In the present individuals and study, a neuropsychological evaluation was made of a group of eight individuals with cerebral palsy, and severe neuromotor and verbal disabilities, and a group of 19 normal subjects matched for mental age. The tests were administered using an autonomous selection method in which the patient selects the various responses through specific aids without the examiner's interference. Patients' group performances in visuo‐spatial and memory tests were on average lower than the mean of the control group. In the verbal domain, patients' scores were comparable to those of normal children in all tests but one assessing the comprehension of syntactically complex sentences. An analysis of the patients' individual performances also revealed heterogeneous cognitive profiles: some patients presented a homogeneously distributed cognitive impairment and others a more selective one. This finding is particularly important for planning differentiated learning programmes, and identifying suitable communicative instruments in rehabilitative and educational settings.
Factors associated with expressed satisfaction among people with intellectual disability receiving residential supports
Authors: Gregory N. , Robertson J. , Kessissoglou S. , Emerson E. , Hatton C.
Published: March 2003

The aim of the present study was to identify factors associated with variations in the levels of expressed satisfaction among adults with intellectual disability (ID) receiving residential supports. Semi‐structured interviews were conducted with 96 people with ID. Forty‐five subjects lived in village communities and 51 received community‐based residential supports. Ratings were made of the participants' expressed levels of satisfaction in seven domains: (1) their home; (2) daytime activities; (3) social and recreational activities; (4) support from services; (5) friendships and relationships; (6) choices available to them; and (7) risks. The data indicated that: (1) interviewees living in village communities expressed greater satisfaction with friendships and relationships than interviewees living in community‐based residential supports; (2) in the other six domains of life satisfaction which were investigated, there were no statistically significant differences between groups; (3) interviewees expressed greater satisfaction with their accommodation and day activities than with friendships, risks and support received; and (4) a wide range of variables relating to the personal characteristics of the interviewees and support received were associated with variations in levels of expressed satisfaction. Variation in the levels of expressed satisfaction was reliably associated with variables relating to the personal characteristics of the interviewees and the nature of the support received.
Bullying and people with severe intellectual disability
Authors: Sheard C. , Clegg J. , Standen P. , Cromby J.
Published: March 2003

Although bullying has been shown to reduce quality of life in many spheres, anti‐bullying strategies have yet to be incorporated into services for adults with severe intellectual disability (ID). The present study employed a survey of staff and parent concerns about 54 previously surveyed students who had left a school for pupils with severe ID. A content analysis of follow‐up interviews was performed in 10 cases. Staff identified 19% of the survey sample as bullying others and 11% as being picked on. Neither gender nor communication ability had an impact. There was no significant change in bully or victim status over time, although some people did change. Parents or staff raised bully/victim problems in more than half of the interviews. There is sufficient evidence of bullying behaviour to warrant the adoption of anti‐bullying strategies.
Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability
Authors: Evenhuis H. M. , Theunissen M. , Denkers I. , Verschuure H. , Kemme H.
Published: March 2003

A screening of hearing and visual function was performed using clinical assessment methods in a Dutch institutionalized population of 672 people with mild to profound intellectual disability (ID). Because the studied population was not comparable to the total Dutch population with ID, subgroups were distinguished according to level of ID, age younger and older than 50 years, and the presence or absence of Down's syndrome (DS). The prevalences of both hearing and visual impairment were considerably increased in all subgroups, as compared with the general population. In the least affected group, i.e. those < 50 years with a mild or moderate ID by other causes than DS, the prevalences of hearing and visual impairment were 21% and 4%, respectively (as opposed to 2–7% and 0.2–1.9% in the general Dutch population <50 years, respectively). The prevalence of hearing impairment showed a sharp and highly significant increase in individuals with DS and subjects ≥ 50 years. To a lesser extent, young adults with severe or profound ID had an increased risk of hearing impairment. Visual impairment and blindness were specifically highly prevalent in people with severe or profound ID (51% < 50 years of age). Down's syndrome and an age ≥ 50 years were also significant risk factors for visual impairment. There was an alarmingly high prevalence of combined sensory impairment, especially in those with severe or profound ID (20%). Although hearing impairment had been diagnosed prior to this screen in 138 people and visual impairment in 65 individuals, a first diagnosis of hearing impairment was made in 128 subjects and of visual impairment in 90 cases. This highlights the tendency for sensory impairments to go unnoticed in people with ID, which is not restricted to those with severe or profound ID. Therefore, the present authors stress the importance of regular screening as outlined in the existing IASSID international consensus statement.
Injury risk in young people with intellectual disability
Authors: Sherrard J , Tonge B. J , Ozanne‐Smith J
Published: March 2003

Epidemiological studies have established injury as a major public health problem for young people in the general population, but minimal population‐based injury information exists on those with intellectual disability (ID). The present study investigated risk factors for injury to subjects in the Australian Child and Adolescent Development (ACAD) programme, which is examining emotional and behavioural problems in young people with ID. Extensive biopsychosocial data for the ACAD programme were collected at two time intervals (i.e. 1990–1991 and 1995–1996). Carer report of medically attended injury over one year was collected for the first time period (1995–1996) on a sample of 465 ACAD subjects (aged 5–29 years) representative of young people with ID (IQ < 70) to determine risk factors for injury using the ACAD biopsychosocial data. Psychopathology [odds ratio (OR) = 3.4] epilepsy (OR = 2.4) and an overly sociable temperament (OR = 2.2) are associated with injury in young people with ID. Social and family factors had minimal influence on injury risk in this population. Those who are highly disruptive, self‐absorbed, anxious, have problems relating socially, have communication disturbance or have attention deficit hyperactivity symptoms are particularly at increased risk for injury. The present study demonstrates a largely under‐recognized public health problem of a high unintentional injury risk for young people with ID, and identifies substantial and important risk factors for injury. Injury prevention programmes, with a particular focus on those with highly disturbed behaviours or epilepsy, are warranted in this population.
A survey of the prevalence of stereotypy, self‐injury and aggression in children and young adults with Cri du Chat syndrome
Authors: Collins M. S. Ross , Cornish K.
Published: March 2003

BackgroundThe aim of the present study was to determine the prevalence and frequency of stereotypy, self‐injurious behaviour (SIB), and aggression in children and adults with Cri du Chat syndrome (CCS), and to investigate the relationship between SIB, aggressive behaviour and stereotypy in these individuals.

MethodsSixty‐six families of children and adults diagnosed with CCS completed the Behaviour Problems Inventory. Additional information relating to gender, chronological age, type of school/post‐school occupation and medication was also included in the survey.

ResultsStereotyped behaviour was reported for 82% of subjects, more than half the sample displaying it on a daily basis. The occurrence percentage of 15 topographies of SIB suggested that head banging, hitting the head against body parts, self‐biting and rumination are the most frequently occurring behaviours in CCS. Aggressive behaviour was reported for 88%, with a statistically significant negative correlation between age and the number of aggressive behaviours reported.

ConclusionsThe present findings suggest that specific types of stereotypy and SIB are observed frequently in CCS.
Religious and secular students’ sense of self‐efficacy and attitudes towards inclusion of pupils with intellectual disability and other types of needs
Authors: Lifshitz H. , Glaubman R.
Published: March 2003

Background

The aim of the present study was to investigate whether Judaism’s positive attitudes toward people with disabilities would influence greater willingness towards inclusion of such people in regular classes and a greater sense of self‐efficacy in working with them.

Methods

The present authors compared religious (n = 175) and secular (n = 420) Jewish students at a teacher’s college with regard to these variables. The authors used the Regular Education Initiative questionnaire, which investigates teachers’ self‐efficacy and attitudes towards including pupils with different types of disabilities in regular education. They analysed the results according to the college students’ major and the type of disability (five types at three levels of severity).

Results

The results indicate that religious students are more willing than non‐religious students to consider the inclusion of people with four types of disabilities and have a greater sense of efficacy for dealing with all types of disabilities. The hypothesis that the milder the disability, the higher would be the teacher’s sense of self‐efficacy and her/his willingness for such children to be included in a regular class was sustained. The religious special education students were the only ones who exhibited willingness to include pupils with intellectual disability, and moderate and severe emotional disturbances. Students who majored in special education scored higher than all their counterparts on both measures. The results also sustain the hypothesis that there would be a positive correlation between both measures.

Conclusions

To facilitate inclusive education amongst teachers and students, the present authors recommend an intervention programme designed to help students acquire knowledge and strategies about inclusion. They also suggest enriching this programme with Jewish religious sources, which reflect positive attitudes toward people with disabilities.
Responsiveness to staff support: evaluating the impact of individual characteristics on the effectiveness of active support training using a conditional probability approach
Authors: Smith C. , Felce D. , Jones E. , Lowe K.
Published: March 2003

Background Active support training was fully conducted in 38 community houses accommodating 106 adults with intellectual disabilities (ID; group 1), but not in a further 36 accommodating 82 adults with ID (group 2). The aims of the present study were to analyse whether staff became more effective in supporting resident activity after the implementation of active support, and whether there was evidence of differential responsiveness by people with differing status in relation to adaptive behaviour, psychiatric diagnosis, challenging behaviour or autism.

Methods Observations of staff:resident interaction and resident engagement in activity were taken before and after active support training. Changes in Yule's Q statistics, indicating the likelihood that resident engagement in activity followed staff giving residents verbal instruction or non‐verbal assistance, were compared for the two groups. In addition, changes in similar statistics were compared for residents within group 1: (1) with Adaptive Behaviour Scale (ABS) scores above and below 180; and (2) with and without severe challenging behaviour, the triad of social impairments and mental illness.

Results Yule's Q for engagement given non‐verbal assistance significantly increased post‐training among group 1, but not among group 2. Similar significant increases were found among group 1 residents with ABS scores below 180 without challenging behaviour, with and without the triad of social impairments, and without mental illness, but not with an ABS score above 180, with challenging behaviour and with mental illness.

Conclusion The present analysis reinforces previous studies on the effectiveness of active support training for adults with more severe ID (i.e. with ABS scores below 180). Active support was as effective for people with the triad of social impairments as for those without it. However, the effectiveness of support offered to people with challenging behaviour or mental illness did not significantly increase.
Glasgow Anxiety Scale for people with an Intellectual Disability (GAS‐ID): development and psychometric properties of a new measure for use with people with mild intellectual disability
Authors: Mindham J. , Espie C. A.
Published: March 2003

Background  Self‐rating scales are widely used in general adult practice; however, there is no reliable and valid method for assessing state anxiety in people with intellectual disability (ID). The present study describes the development and psychometric evaluation of a new scale, the Glasgow Anxiety Scale for People with an Intellectual Disability (GAS‐ID).

Methods  First, an item pool was generated from focus groups, a review of the literature and clinician feedback. Secondly, a draft scale was administered to 19 anxious and 16 non‐anxious people with ID for further validation and appraisal of reliability. Thirdly, the scale was completed by 19 anxious, non‐ID people for cross‐validation with the Beck Anxiety Inventory (BAI). Finally, physiological concomitants were validated by pulse‐oximetry.

Results  The 27‐item GAS‐ID discriminated anxious from non‐anxious participants, had good test–retest reliability (r = 0.95) and internal consistency (α = 0.96), and was reasonably correlated with the BAI (ρ = 0.75). The correlation between the physiological subscale of the GAS‐ID and changes in pulse rate was moderately significant (ρ = 0.52).

Conclusions  This preliminary study suggests that the GAS‐ID offers a psychometrically robust and practical (5–10 min) approach to the appraisal of anxiety in this population.
Resistance to activated protein C, highly prevalent amongst users of oral contraceptives with venous thromboembolism
Authors: Bennet L. , Odeberg H.
Published: March 2003

Bennet L, Odeberg H (Blekinge Hospital, Karlskrona, Sweden). Resistance to activated protein C, highly prevalent amongst users of oral contraceptives with venous thromboembolism. J Intern Med 1998; 244: 27–32.

Objective

Inherited resistance to activated protein C (APC resistance), which is caused by a single point mutation in the factor V gene, is a frequent risk factor for venous thromboembolism. The aim of this study was to determine the prevalence of APC resistance and other coagulation disorders in fertile women with venous thromboembolism and also the risk factors these women had been exposed to in connection with thromboembolic events.

Design

A retrospective, case‐control study of 36 month duration.

Setting

The study was carried out at Blekinge Hospital, Karlskrona, Sweden.

Subjects

The study population comprised 27 fertile women age 16–47 years with thromboembolic complications, referred to the department of Internal Medicine at Blekinge Hospital in Karlskrona during a 36‐month period.

Results

APC resistance was found in 10 out of 27 women. APC resistance was associated with treatment with oral contraceptives in five out of six women and with pregnancy in one of seven women.

All women with resistance to APC developed venous thrombosis in association with a predisposing situation (risk situation) such as surgery, trauma, immobilization, pregnancy, inflammatory state or the use of oral contraceptives. Amongst women not resistant to APC, all but one developed thrombosis in connection with a risk situation.

Conclusion

APC resistance was found to be highly prevalent amongst fertile women with a history of thromboembolic complication occurring during their use of oral contraceptives.
Low recurrence rate after deep calf‐vein thrombosis with 6 weeks of oral anticoagulation
Authors: Astermark J. , Björgell O. , Lindén E. , Lethagen S. , Nilsson P. , Berntorp E.
Published: March 2003

. Astermark J, Björgell O, Lindén E, Lethagen S, Nilsson P, Berntorp E (University Hospital, Malmö, Sweden). Low recurrence rate after deep calf‐vein thrombosis with 6 weeks of oral anticoagulation. J Intern Med 1998; 244: 79–82.

Objectives

To evaluate the recurrence rate after deep calf‐vein thrombosis treated with 6 weeks of oral anticoagulation.

Design and subjects

A 2 year follow‐up of 126 consecutive patients admitted to the Department of Internal Medicine with venographically verified deep calf‐vein thrombosis.

Results

One hundred and twenty‐six patients were treated with warfarin for 6 weeks, 18 of them having had a previous episode of venous thrombosis (DVT). Eleven patients (8.7%) suffered a recurrent thromboembolic episode within 2 years, four of which were within the first 3 months. Eight of those without a history of DVT had a recurrence (7.4%). Three of these were activated protein C (APC)‐resistant, one was protein C‐deficient and one had malignant melanoma.

Eight patients (6.3%) reported minor haemorrhagic complications, but no major bleeding was seen.

Conclusion

Our data support the use of a 6 week regimen of secondary oral prophylaxis after a first episode of deep calf‐vein thrombosis in patients without a permanent risk factor. Whether individuals with inherited thrombophilia require prolonged treatment remains to be evaluated.
Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non‐insulin‐dependent diabetes mellitus patients with hypertension
Authors: Östman  , Asplund  , Bystedt  , Dahlöf  , Jern  , Kjellström  , Lithell  ,   FOR THE SWEDISH QUINAPRIL GROUP
Published: March 2003

Objective

To compare the long‐term effects of the angiotensin‐converting enzyme (ACE)‐inhibitor quinapril and the cardioselective beta‐adrenergic blocking agent metoprolol on glycaemic control, with glycosylated haemoglobin (HbA1c) as the principal variable, in non‐insulin‐dependent diabetes mellitus (NIDDM) patients with hypertension.

Design

A randomized, double‐blind, double‐dummy, multicentre study during 6 months preceded by a 4 week wash‐out and a 3 week run‐in placebo period. Quinapril (20 mg) and metoprolol (100 mg, conventional tablets) were given once daily. No change was made in the treatment of diabetes (diet and hypoglycaemic agents).

Subjects

Seventy‐two patients fulfilling the criteria were randomized and entered the double‐blind period. Twelve patients did not complete the study. Sixty patients, 26 on quinapril and 34 on metoprolol, were available for the final analysis.

Main outcome measures

The effect was assessed by changes in HbA1c, the fasting serum glucose and the post‐load serum glucose, C‐peptide and insulin levels during the oral glucose tolerance test.

Results

In the quinapril group, the fasting serum glucose, oral glucose tolerance and the C‐peptide and insulin responses, determined as the incremental area under the curves (AUC), showed no change, but the mean HbA1clevel increased from 6.2 ± 1.1% to 6.5 ± 1.3% (P< 0.05). In the metoprolol group, the rise in the mean level of HbA1c, from 6.3 ± 1.0% to 6.8 ± 1.3% (P< 0.01), tended to be more marked than after quinapril, although there was no significant difference between the increments. The mean fasting serum glucose showed an increase from 9.1 ± 1.9 mm to 10.1 ± 2.8 mm (P< 0.01) which correlated significantly with the duration of diabetes (P< 0.01) and the increase in fasting serum triglycerides (P< 0.001). Moreover, in the metoprolol group we found significant decreases in the oral glucose tolerance as well as C‐peptide and insulin responses to the glucose load.

Conclusions

Treatment with quinapril for 6 months appears to have advantages over metoprolol in NIDDM patients with hypertension. Although treatment with quinapril or metoprolol over 6 months was concomitant with a rise in the HbA1c, increased fasting blood glucose, decreased oral glucose tolerance and decreased C‐peptide and insulin responses to a glucose challenge were observed only in patients treated with metoprolol.
Molecular biology of the MEN2 gene
Authors: Santoro  , Melillo  , Carlomagno  , Visconti  , De Vita  , Salvatore  , Lupoli  , Fusco  , Vecchio
Published: March 2003

Santoro M, Melillo RM, Carlomagno F, Visconti R, De Vita G, Salvatore G, Lupoli G, Fusco A, Vecchio G (Università di Napoli, Naples, Italy). Molecular biology of the MEN2 gene (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 505–8.

Cancer is a genetic disease caused by ‘gain of function’ mutations of oncogenes and ‘loss of function’ mutations of tumour suppressors and of genes involved in DNA repair mechanisms. The RET gene encodes a tyrosine kinase receptor for molecules belonging to the glial cell line‐derived neurotrophic factor (GDNF) family. RET is a paradigmatic example of how different mutations of a single gene can lead to different neoplastic phenotypes. Indeed, gene rearrangements, often caused by chromosomal inversions, activate the oncogenic potential of RET in a fraction of human thyroid papillary carcinomas. On the other hand, different point mutations activate RET in familial multiple endocrine neoplasia syndromes familial medullary thyroid carcinoma (FMTC), MEN‐2A and MEN‐2B. Little information is so far available on the biochemical mechanisms by which the potent transforming and mitogenic signals of RET are delivered to the nucleus. However, recent data indicate coupling to the Shc‐Ras‐MAPK pathway as a necessary step in RET signal transduction.
Folate administration reduces circulating homocysteine levels in NIDDM patients on long‐term metformin treatment
Authors: Aarsand  , Carlsen
Published: March 2003

Aarsand AK, Carlsen SM (Norwegian University of Science and Technology, Trondheim, Norway.) Folate administration reduces circulating homocysteine levels in NIDDM patients on long‐term metformin treatment. J Intern Med 1998; 244: 169–74.

Objectives

Metformin treatment increases circulating homocysteine levels. We studied whether administration of folate reduces serum total homocysteine levels in patients on long‐term metformin treatment.

Design

A prospective, randomized, double‐blind, placebo‐controlled study lasting for 12 weeks and taking place in a university hospital setting.

Subjects

Thirty patients treated with a metformin dose of at least 1000 mg day−1 for a minimum of 1 year were included. At baseline serum total homocysteine levels were within the reference range. One patient who withdrew and one who died were excluded from the statistical evaluation. Twenty‐six of the remaining patients suffered from NIDDM, the other two from hyperlipidaemia.

Intervention

Patients were randomized into two groups at week 0. The folate group received 0.25 mg day−1 of folate in addition to 60 mg day−1 of Fe2+, while the placebo group received only 60 mg day−1 of Fe2+.

Main outcome measures

Fasting homocysteine, cysteine, cysteinylglycine, vitamin B12 and folate were measured at week 0, 4 and 12. Changes from week 0 to week 4 and from week 0 to week 12 were calculated.

Results

Folate administration reduced serum levels of total homocysteine in the folate group as compared with the placebo group by 13.9% (P < 0.01) and 21.7% (P < 0.001) at week 4 and 12, respectively. In the folate group versus the placebo group serum levels of vitamin B12 increased by 9.9% (P= 0.010) and 9.6% (P= 0.043) while folate levels increased by 96.9 and 89.9% at week 4 and 12, respectively.

Conclusion

The present study indicates that the homocysteine‐increasing effect of metformin can be counteracted by folate administration.
Acute lung injury due to parvovirus pneumonia
Authors: Wardeh  , Marik
Published: March 2003

Wardeh A, Marik P, (Department of Critical Care, St. Vincent Hospital, Massachusetts, USA and the University of Massachusetts and Medical Intensive Care Unit St. Vincent Hospital, Massachusetts, USA). Acute lung injury due to parvovirus pneumonia (Case Report). J Intern Med 1998; 244: 257–60.

Objective

Human parvovirus B19 is responsible for the common childhood exanthematous illness, erythema infectiosum. Adults infected with B19 have been reported to develop a febrile illness associated with arthritis. Life threatening parvovirus infections in non‐immunocompromised adults have not been reported to date. We report a previously healthy middle aged female who developed severe parvovirus pneumonia. The patient recovered with supportive care provided in the ICU. Parvovirus may represent an under diagnosed cause of community acquired pneumonia.
The lymphocytic alveolitis in sarcoidosis is associated with increased amounts of soluble and cell‐bound adhesion molecules in bronchoalveolar lavage fluid and serum
Authors: Berlin M. , Lundahl J. , Sköld C. M. , Grunewald J. , Eklund A.
Published: March 2003

Berlin M, Lundahl J, Sköld CM, Grunewald J, Eklund A (Karolinska Hospital and Karolinska Institute, Stockholm, Sweden). The lymphocytic alveolitis in sarcoidosis is associated with increased amounts of soluble and cell‐bound adhesion molecules in bronchoalveolar lavage fluid and serum. J Intern Med 1998; 244: 333–340.

Objectives

Pulmonary sarcoidosis is a chronic inflammatory disorder of unknown aetiology accompanied by a lymphocytic alveolitis. It is likely that a selective and temporal expression of adhesion molecules plays a crucial role in the recruitment of cells to the inflammatory site. We investigated the expression of adhesion molecules on alveolar T‐lymphocytes and in bronchoalveolar lavage (BAL) fluid and serum to elucidate mechanisms behind the accumulation of cells in the lung in sarcoidosis.

Design

In a cross‐sectional study in patients with active and inactive sarcoidosis and in healthy volunteers, we examined, in serum and in BAL fluid, the soluble adhesion molecules, VCAM‐1, ICAM‐1, and P‐, E‐ and L‐selectin. In addition, the expressions of α4‐β1 (VLA‐4) and α5‐β1 (VLA‐5) integrins on alveolar T‐lymphocytes were analysed.

Setting

The subjects attended the outpatient clinic at the Division of Respiratory Medicine, Karolinska Hospital, Stockholm, Sweden.

Subjects

Nineteen sarcoidosis patients, nine with clinically active disease, and 13 healthy volunteers were included in the study. The sarcoidosis diagnosis was based on a typical histological and/or clinical (symptoms, radiograph, lung function) picture.

Results

In sarcoidosis patients, particularly in those with active disease, an increase of the expressions of β1‐integrins was accompanied by elevated concentrations in BAL fluid of soluble VCAM‐1. In serum, the levels of E‐selectin and ICAM‐1 were significantly higher in patients with active disease than in those with inactive disease and controls.

Conclusions

The findings offer some mechanistic explanations as to how the cell‐rich alveolitis in sarcoidosis occurs, and furthermore suggest additional markers, such as s‐ICAM‐1, for assessment of disease activity.
Poikilothermia syndrome
Authors: Kurz  , Kurz  , Sessler  , Sessler  , Sessler  , Sessler  , Tayefeh  , Goldberger
Published: March 2003

Abstract. Kurz A, Sessler DI, Tayefeh F, Goldberger R (Outcomes Research Group; University of Vienna, Austria; University of California, San Francisco, USA; Ludwig Boltzmann Institute for Clinical Anaesthesia and Intensive Care, Vienna, Austria; and Columbia University College of Physicians and Surgeons, New York, USA). Poikilothermia syndrome (Case Report). J Intern Med 1998; 244: 431–6.

Poikilothermia syndrome is a rare cause of intrinsic thermoregulatory failure. Patients with this syndrome regulate body temperature poorly, if at all. Recently, a patient was referred to us who had clinical evidence of poikilothermia syndrome, as well as long‐standing multiple sclerosis. Computerized tomography and magnetic resonance scanning failed to identify a hypothalamic lesion. The patient was gradually warmed to sweating, and then cooled to vasoconstriction and shivering. The core‐temperature thresholds triggering each defence were calculated, after compensating for the changes in skin temperature. The calculated sweating threshold was 38.3 °C (normal: 37.0 ± 0.3 °C). The vasoconstriction threshold was 34.4 °C (normal: 36.4 ± 0.3 °C). The sweating‐to‐vasoconstriction interthreshold range was thus ≊4 °C, which is between 10 and 20 times the normal value. The shivering threshold was 31.8 °C (normal: 35.6 ± 0.3 °C). The vasoconstriction‐to‐shivering range was thus ≊2.5 °C which is more than twice the normal value. The pattern of thermoregulatory failure in this patient resembled that resulting from general anaesthesia.
Decreased heart rate variability in patients with type 1 diabetes mellitus is related to arterial wall stiffness
Authors: Jensen‐Urstad K. , Reichard P. , Jensen‐Urstad M.
Published: March 2003

Objective. Low heart rate variability (HRV) is, in several patient groups, related to poor prognosis. The underlying mechanisms are still unclear. The aim was to study if there is a relationship between HRV, which is a measure of baroreceptor function, and atherosclerosis.

Design. The relationship between heart rate variability and carotid arterial wall stiffness was studied in subjects with type 1 diabetes mellitus in which autonomic dysfunction and early atherosclerosis are common. HRV was assessed from power spectral analysis of 24‐h Holter recordings and arterial wall stiffness was assessed from an ultrasound study of the right common carotid artery.

Setting. A university hospital.

Subjects. Fifty‐nine patients (41 ± 8 years) from the Stockholm Diabetes Intervention Study (SDIS) were investigated. These patients were randomized to intensified conventional treatment or standard treatment approximately 12 years before this study.

Results. Patients with stiffer arteries had lower HRV in all spectral bands (r=−0.32 to −0.40, P= 0.06–0.001). This relation remained on correcting for age. All spectral parameters of HRV correlated with the mean HbA1c from 10 years of study (r=−0.37 to −0.40, P= 0.004–0.001).

Conclusions. In patients with type 1 diabetes mellitus, heart rate variability and arterial wall stiffness are related to each other. The results suggests that the autonomic nervous system could be a link between diabetes and vascular disease.
A comparison of metoprolol and morphine in the treatment of chest pain in patients with suspected acute myocardial infarction – the MEMO study
Authors: Everts B. , Karlson B. , Abdon N.‐J. , Herlitz J. , Hedner T.
Published: March 2003

Objectives. To compare the analgesic effect of metoprolol and morphine in patients with chest pain due to suspected or definite acute myocardial infarction after initial treatment with intravenous metoprolol.

Design. All patients, regardless of age, admitted to the coronary care unit at Uddevalla Central Hospital due to suspected acute myocardial infarction were evaluated for inclusion in the MEMO study (metoprolol–morphine). The effects on chest pain and side‐effects of the two treatments were followed during 24 h. Pain was assessed by a numerical rating scale.

Results. A total of 265 patients were randomized in this prospective double‐blind study and 59% developed a confirmed acute myocardial infarction. In both treatment groups, there were rapid reductions of pain intensity. However, in the patient group treated with morphine, there was a more pronounced pain relief during the first 80 min after start of double‐blind treatment. The side‐effects were few and were those expected from each therapeutic regimen. During the first 24 h, nausea requiring anti‐emetics was more common in the morphine‐treated patients.

Conclusion. In suspected acute myocardial infarction, if chest pain persists after intravenous beta‐adrenergic blockade treatment, standard doses of an opioid analgesic such as morphine will offer better pain relief than increased dosages of metoprolol.
Comparison of secondary prevention measures after myocardial infarction in subjects with and without diabetes mellitus
Authors: Chowdhury T. A. , Lasker S. S. , Dyer P. H.
Published: March 2003

Abstract. Chowdhury TA, Lasker SS, Dyer PH (Birmingham Heartlands Hospital, Birmingham UK). Comparison of secondary prevention measures after myocardial infarction in subjects with and without diabetes mellitus. J Intern Med 1999; 245: 565–570.

Objectives. To survey and compare secondary prevention measures in diabetic and non‐diabetic patients following myocardial infarction (MI).

Design. Follow‐up of a cohort of patients who suffered their first MI 1 year previously.

Setting. Three district general hospitals.

Main outcome measures. Review 1 year post‐MI for signs of left ventricular failure (LVF), serum cholesterol, smoking status, weight, blood pressure and glycaemic control. Assessment of appropriate treatment with aspirin, beta‐blockers, angiotensin‐converting enzyme (ACE) inhibitors and lipid‐lowering therapy before discharge and at least 1 year post‐MI.

Results. A total of 189 non‐diabetic and 86 diabetic patients were studied. Most patients received beta‐blockers and aspirin appropriately, and most gave up smoking. In non‐diabetic subjects, cholesterol fell significantly (P < 0.05), as did the proportion of patients with cholesterol > 5.5 mmol L–1 (P < 0.05), whereas cholesterol did not fall significantly in diabetic subjects, due to a lower proportion of patients being on lipid‐lowering therapy (27.5 vs. 37.9%). A higher proportion of non‐diabetic patients with LVF were treated with ACE inhibitors compared with diabetic subjects (73.6 vs. 61.0%). Glycaemic control did not improve in the diabetic subjects.

Conclusions. Patients with diabetes do not receive optimal secondary prevention measures compared with their non‐diabetic counterparts. This issue needs to be addressed by all units dealing with patients with diabetes in order to reduce the mortality and morbidity of MI in such patients.
Declining prevalence of angina pectoris in middle‐aged men and women. A population‐based study within the Northern Sweden MONICA Project
Authors: Glader E.‐L. , Stegmayr B.
Published: March 2003

Abstract. Glader E‐L, Stegmayr B (University Hospital, Umeå, Sweden). Declining prevalence of angina pectoris in middle‐aged men and women. A population‐based study within the Northern Sweden MONICA Project. J Intern Med 1999; 246: 285–291.

Objectives. To describe trends in the prevalence of angina pectoris in northern Sweden, between 1986 and 1994.

Design. Cross‐sectional population studies.

Setting. Northern Sweden MONICA Project in Norrbotten and Västerbotten counties, Sweden.

Subjects. Randomly selected men and women in the age group 35–64 years, total of 2459 men and women.

Main outcome measures. Comparison of the prevalence of angina pectoris in 1986 and 1994 as measured by the Rose questionnaire.

Results. The proportion with a history of myocardial infarction decreased amongst the participants from 4.6% to 2.0% (P < 0.001) between 1986 and 1994. The prevalence of angina pectoris in men was essentially unchanged (3.4% in 1986 to 3.1% in 1994 (χ2 = 0.02; P = 0.87), whereas it declined significantly in women from 5.9% to 2.8% (χ2 = 6.32; P = 0.01). In both men and women, the highest prevalence of Rose‐positive persons was found in the oldest age group. In 1986 the Rose‐positive subgroup had a significantly higher proportion with high cholesterol (≥6.5 mmol L–1) as compared with the Rose‐negative subgroup, 64% vs. 48% (χ2 = 5.04; P = 0.02). In both surveys high blood pressure was more common in the Rose‐positive group (1986: χ2 = 13.2; P < 0.001 and 1994: χ2 = 9.8; P = 0.002).

Conclusions. In women, but not in men, the prevalence of angina pectoris decreased significantly between 1986 and 1994. During the same time period the proportion of people with high cholesterol decreased in northern Sweden. In both surveys, individuals with angina pectoris had more frequent hypertension.
The different effects of a Gln27Glu β2‐adrenoceptor gene polymorphism on obesity in males and in females
Authors: Hellström L. , Large V. , Reynisdottir S. , Wahrenberg H. , Arner P.
Published: March 2003

Objectives. To investigate the role of a polymorphism in codon 27 (Gln27Glu) of the β2‐adrenoceptor gene for obesity in males compared to previously investigated females with an association of this polymorphism to obesity.

Design. Population‐based study.

Setting. Medical department at a University Hospital.

Subjects. A total of 138 non‐related Swedish males with body mass indexes (BMI) in the range 19.4–53.4 kg m−2 were recruited as: healthy volunteers, healthy obese subjects and subjects undergoing surgery for uncomplicated gallstone or abdominal hernia. In order to investigate the impact of gender, the results were compared with a subset of an earlier investigated female population of 109 Swedish females. Obesity was defined as a BMI > 27 kg m−2.

Main outcome measures. Genotype examination of β2‐adrenoceptor polymorphism in codon 27 with polymerase chain reaction and restriction fragment length polymorphism.

Results. The allele frequency of Gln27 and Glu27 did not differ between males and females when obese and non‐obese subjects were investigated together. However, in obese males, the frequency of the Glu27 allele was significantly decreased (P = 0.034), whereas the frequency of this allele was increased in obese females (P = 0.013). No impact of the female androgen status on the distribution of the Gln27Glu polymorphism could be demonstrated in the obese females.

Conclusion. A positive association between obesity and the Glu27 genetic variant in the β2‐adrenoceptor exists in females, whereas in males there is a negative correlation between Glu27 and obesity. The findings suggest that different genetic factors contribute to obesity in males and females.
Evaluation of a computer‐based decision support system for treatment of hypertension with drugs: retrospective, nonintervention testing of cost and guideline adherence
Authors: Persson M. , Mjörndal T. , Carlberg B. , Bohlin J. , Lindholm L. H.
Published: March 2003

Abstract. Persson M, Mjörndal T, Carlberg B, Bohlin J, Lindholm LH (University of Umeå, Sweden). Evaluation of a computer‐based decision support system for treatment of hypertension with drugs: retrospective, nonintervention testing of cost and guideline adherence. J Intern Med 2000; 247: 87–93.

Objective. To evaluate a computerized decision support system (DSS) for drug treatment of hypertension, regarding quality, safety, and cost compared to actual antihypertensive drug treatment.

Design. The medical profiles of 338 hypertensive patients treated with drugs against hypertension were processed by the DSS. The drug treatment proposed by the system was then compared to actual treatment given by their physician.

Setting. Four health centres in the county of Västerbotten, in Sweden.

Subjects. A list of hypertensive patients was extracted from the computerized medical records of each health centre and every fifth patient’s medical profile was assessed by the system.

Interventions. None.

Main outcome measures. Drug used, drug used in relation to certain major diseases such as diabetes mellitus, asthma, ischaemic heart disease (IHD), and previous myocardial infarction. Adherence to hypertension guidelines, safety, and cost.

Results. The DSS suggested significantly more thiazides and significantly fewer calcium antagonists than the physicians had prescribed, with a total cost reduction of 33–40%, depending on doses chosen. The DSS drug profile was more adherent to guidelines in patients with major complicating diseases, suggesting an improvement in treatment quality for these patients by the DSS.

Conclusion. The DSS which fully implements current guidelines may improve the quality of antihypertensive treatment, concurrently leading to a considerable reduction in drug costs.
Comparison of biochemical markers for the detection of minimal myocardial injury: superior sensitivity of cardiac troponin – T ELISA
Authors: Lang K. , Börner A. , Figulla H. R.
Published: March 2003

Objectives. Patients with minimal myocardial injuries who present clinically with unstable angina, early stages of myocardial infarction or myocarditis require different therapy strategies to those without. The newer diagnostic assays for detecting myocardial lesions (cardiac Troponin T and cardiac Troponin I [cTnT, cTnI], glycogenphosphorylase – BB [GPBB]) are reported to be more sensitive and specific than common biochemical markers such as CK and myoglobin. Our study tested whether the recently developed four assays cTnT‐ELISA (in vitro), cTnT rapid bedside assay, cTnI rapid bedside assay, and GPBB (Immunoenzymetric assay) are effective in detecting minimal myocardial injuries caused by endomyocardial biopsy. We compared them with CK activity (CK‐cat), CK‐MB activity (CK‐MBcat), CK‐MB‐concentration (CK‐MB‐mass) and Myoglobin concentration (Myo‐conc.).

Patients and methods. Twenty‐four patients [six female, 18 male, age (mean): 47 years (20–65)] underwent diagnostic endomyocardial biopsy. Between four and six biopsies were taken from the mid‐right ventricular aspect of the interventricular septum of the heart. Blood was drawn before catheterization (baseline), 10 min after the biopsy, in the next morning, and in the morning of the second day after (days 1 and 2).

Results and Conclusion. Because of very low CKcat it was not possible to analyse CK‐MBcat with reliable precision. The assay for GPBB and cTnI rapid bedside assay did not indicate this minimal myocardial injury. The CK cat, CK‐MB mass, and myoglobin assays indicated significant increase at 10 min after biopsy but remained within reference range. cTnT rapid bedside assay indicated this minimal myocardial injury in 50% (P < 0.05). cTnT‐ELISA (in vitro) was increased above the reference limit in 54%. This increase was 3.6‐fold the upper reference limit (P < 0.01). In our study, due to superior discriminating power, cTnT‐ELISA (in vitro) was the most sensitive assay for minimal myocardial injuries.