bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnant and Imprisoned in the United States
Authors: International Amnesty
Published: March 2003

This article is excerpted from a report by Amnesty International, entitled“Not Part of My Sentence”: Violations of the Human Rights of Women in Custody, March 1999. The article describes violations of the human rights of pregnant women and mothers who are incarcerated in prisons and jails in the United States. Many of the practices employed are not in compliance with international standards and are also prohibited by federal and state laws in the United States. In 1997–1998, more than 2200 pregnant women were imprisoned and more than 1300 babies were born in prisons. In at least 40 states, babies are taken from their imprisoned mothers almost immediately after birth or at discharge from the hospital. International standards restrict the use of restraints to limited situations. Restraints are used as a matter of course in the United States, including on women in labor or immediately after birth, who may be taken to a hospital in handcuffs and chained by a leg to the bed. Amnesty International calls for governments and authorities to take urgent action that will ensure that the laws, regulations, policies, and practices for which they are responsible rigorously conform to international standards and respect the human rights of women deprived of their liberty.
Strategies to Address Global Cesarean Section Rates: A Review of the Evidence
Authors: Walker Ruth , Turnbull Deborah , Wilkinson Chris
Published: March 2003

Background: The steadily increasing global rates of cesarean section has become one of the most debated topics in maternity care. This paper reviews and reports on the success of strategies that have been developed in response to this continuing challenge. Methods: A literature search identified studies conducted between 1985 and 2001 from the Cochrane Database of Systematic Reviews, Medline, Sociofile, Current Contents, Psyclit, Cinahl, and EconLit databases. An additional search of electronic databases for Level 1 evidence (systematic reviews), Level 2 (randomized controlled trials), Level 3 (quasi‐experimental studies), or Level 4 (observational studies) was performed. Selection criteria used to identify studies for review included types of study participant, intervention, outcome measure, and study. Results: Interventions that have been used in an attempt to reduce cesarean section rates were identified; they are categorized as psychosocial, clinical, and structural strategies. Two clinical interventions, (external cephalic version, vaginal birth after a previous cesarean) and one psychosocial intervention (one‐to‐one trained support during labor) demonstrated Level 1 evidence for reducing cesarean section rates. Conclusions: Although the evidence for one‐to‐one care and external cephalic version came from both developed and developing settings, the systematic review for vaginal birth after a cesarean was restricted to studies conducted in the United States. The effective implementation of the preceding strategies to reduce cesarean rates may depend on the social and cultural milieu and on associated beliefs and practices. (BIRTH 29:1 March 2002)
Postnatal Quality of Life Assessment: Introducing the Mother‐Generated Index
Authors: Symon Andrew , MacDonald Anna , Ruta Danny
Published: March 2003

Background: The extent of postnatal morbidity has become increasingly apparent over the last 15 years, but currently no tool is available that measures postnatal quality of life. This pilot study introduces a subjective tool, the Mother‐Generated Index, which assesses the woman's quality of life and identifies those aspects that are of most concern to her. Methods: The Mother‐Generated Index was administered by structured interview to 60 participants at 6 to 8 weeks and to 43 participants at 8 months postpartum. Validation was sought through concurrent use of the Edinburgh Postnatal Depression Scale, the SF12, and two indexes related to maternal and neonatal physical morbidity. The Mother‐Generated Index gives a primary index (quality of life) score, which is reported here, and a secondary index, which identifies the areas considered most important by the mother. Results: The primary index was more sensitive at 8 months. The highest and lowest quartile scores were compared. Statistically significant differences in were found in the mothers' Edinburgh Postnatal Depression scores at 6 to 8 weeks, and in their Edinburgh Postnatal Depression and SF12 mental component scores and their physical morbidity index at 8 months. Although physical problems were only a small feature at 8 months, social and psychological issues were prominent in both groups. Age, parity, and mode of delivery had no significant effect on the women's scores or the areas they identified as most important. Conclusion: Quality of life of is a complex and personal area, affected by many different aspects of health and well‐being. From this pilot study the primary index appears to be a useful step in assessing a mother's quality of life. It identifies which areas of her life are most important to her, and allows her to indicate where she would like to see improvements. (BIRTH 29:1 March 2002)
Baby Friendly Hospital Practices: Cesarean Section is a Persistent Barrier to Early Initiation of Breastfeeding
Authors: Rowe‐Murray Heather J. , Fisher Jane R.W.
Published: March 2003

Background: Documented barriers to the implementation of Step 4 of the Baby Friendly Hospital Initiative, which relates to early initiation of breastfeeding, have not considered the impact of operative intervention in delivery on achievement of the goal. This study was designed to test the hypothesis that hospital practices in the immediate postpartum period that are associated with operative intervention in delivery can affect first mother‐infant contact and initiation of breastfeeding.

Methods:  In a prospective, longitudinal study, a sociodemographically representative sample of 203 primiparous women was recruited. Participants were interviewed at 2 days postpartum in metropolitan hospitals in Melbourne, Australia, and medical records were inspected. At 8 months postpartum 81 percent of participants completed a postal questionnaire. Three mode‐of‐delivery groups (spontaneous vaginal delivery, instrumentally assisted vaginal delivery and cesarean section) and 4 hospital‐of‐delivery groups (including one accredited Baby Friendly Hospital) were compared.

Results:  Two way ANOVA revealed that women who had a cesarean section experienced a significant delay in initiating breastfeeding compared with women giving birth vaginally, with or without instrumental assistance (p<0.001). Significant differences in this aspect of care were also observed among hospitals, with the Baby‐Friendly hospital performing significantly better than the other three hospitals (p <0.001). An effect due to mode of delivery alone was demonstrated that could not be abolished by differences in hospital practices (p=0.231). Nevertheless, shorter elapsed time between birth and initiation of breastfeeding was not significantly associated with continuation of breastfeeding at 8 months postpartum (p=0.642).

Conclusions:  The findings confirmed that cesarean section was a significant barrier to the implementation of Baby Friendly Hospital Initiative Step 4 and that hospital practices were amenable to changes that enabled its implementation regardless of the mode of delivery. (BIRTH 29:2 June 2002)
H. pylori and cagA: Relationships with Gastric Cancer, Duodenal Ulcer, and Reflux Esophagitis and Its Complications
Authors: Graham David Y. , Yamaoka Yoshio
Published: March 2003

Background.

Helicobacter pylori infection is accepted to be associated with two mutually exclusive diseases: duodenal ulcer and gastric cancer. Attention has recently focused on possible relationships between H. pylori and gastroesophageal reflux disease and its complications such as adenocarcinoma of the gastric cardia. The aim of this study was to provide a framework for explaining the seemingly paradoxical associations between H. pylori and various gastrointestinal diseases.

Methods.

Available data regarding H. pylori infection, cagA, acid secretion, corpus gastritis, and gastroesophageal reflux disease (GERD) and its complications are reviewed, and testable hypotheses are presented.

Results.

Linking the type of H. pylori (cagA‐positive vs. cagA‐negative), the pattern and intensity of inflammation, and acid secretion explains the apparent paradoxes in the associations between H. pylori and gastric cancer, duodenal ulcer, and GERD. Although H. pylori is inhibited by bile, a duodenal acid load sufficient to lower the average pH to precipitate bile acids overcomes that inhibition. H. pylori that contain a functional cag pathogenicity island produce a vigorous inflammatory response. The severity of mucosal inflammation predicts likelihood of different outcomes (e.g., in the bulb with likelihood of developing duodenal ulcer, and in the corpus with the degree of reduction in acid secretion and the rate of development of multifocal atrophic gastritis). Development of H. pylori corpus gastritis is promoted by profound inhibition of acid secretion (e.g., childhood infections or a high level of antisecretory therapy). The CagA protein, or the cagA gene, is a marker for enhanced inflammation, but CagA is not directly involved in the pathogenesis of gastric cancer or duodenal ulcer disease, nor is it a reliable indicator of the presence of a functional cag pathogenicity island.

Conclusion.

The relationship between the type of H. pylori infection, presence or absence of a functional cag pathogenicity island, corpus inflammation, and acid secretion explains the duodenal ulcer/gastric cancer paradox and the relationship between H. pylori infection and the complications of GERD. The predicted rank order for the presence of GERD and its complications (peptic stricture, Barrett’s esophagus, and adenocarcinoma of the gastric cardia) is highest in the population without H. pylori infection, less in those with H. pylori infection, and least in those infected with cagA‐positive H. pylori. Controversy and confusing epidemiological observations will continue unless future studies provide data on the gastric corpus histology (or acid secretion) as well as regarding the presence or absence of a functional and intact cag pathogenicity island of the infecting organism.
In Vitro Aging of Helicobacter pylori: Changes in Morphology, Intracellular Composition and Surface Properties
Authors: Enroth Helena , Wreiber Karin , Rigo Robert , Risberg Dag , Uribe Andres , Engstrand Lars
Published: March 2003

Background.

During the conversion from the bacillary into the coccoid form, Helicobacter pylori organisms are known to change extensively. The aim of this study was to determine some of the changes that occur regarding morphology, intracellular composition and surface properties during the aging of bacteria in vitro.

Materials and Methods.

H. pylori from agar plate cultures of different ages was used in this study. The intracellular composition of the two morphological forms of the bacteria was tested by density centrifugation, DNA extraction and quantitative OD, mRNA and ATP measurements. Immunoblotting was used to observe changes in secreted/superficial protein patterns, and hydrophobicity measurements were used to observe changes in surface properties.

Results.

All bacillary H. pylori organisms changed morphology gradually over 10 days of culture. Rods had a higher density than cocci; bacteria stored in PBS had the highest density and bacteria stored in water had the lowest. The quantitative DNA, RNA and ATP content were reduced in the aging bacteria. Fewer immunogenic proteins were expressed, and an increased surface hydrophobicity was observed in the older cultures.

Conclusion.

This study highlights several aspects of H. pylori aging in vitro and shows some of the differences that exist between bacillary and coccoid forms. This information is important for understanding the transmission and survival of H. pylori outside the human host, as the degradative changes in the intracellular composition and the surface properties shown here point to dead bacteria, and not to a viable but nonculturable form.
Predominance of a Single Strain of Helicobacter pylori in Gastric Antrum
Authors: Hua Jiesong , Ng Han Chong , Yeoh Khay Guan , Ho Bow
Published: March 2003

Background.

Diversity of DNA among H. pylori strains isolated from different patients can serve as a useful marker for differentiating strains. DNA profiles of H. pylori obtained from sequential gastric biopsies were identical in most patients indicating that a given strain can persist from months to years. Patients colonized with more than two strains isolated mainly from different anatomical sites have been reported. This work examined whether the gastric antrum of patients with dyspepsia is colonized by single or multiple strains of H. pylori as well as the in vitro competition of different strains of H. pylori.

Materials and Methods.

Two antral biopsy specimens from each of the 124 patients were cultured for H. pylori. DNA fingerprinting of H. pylori isolates was performed using random amplified polymorphic DNA (RAPD) analysis. To elucidate the possible interaction among H. pylori isolates, bacterial populations of two H. pylori strains cogrown in broth medium over 21 days were enumerated and DNA fingerprinting was compared.

Results.

A total of 58 patients showed the presence of H. pylori in both antral specimens, while five patients had H. pylori in only one of the two samples. These 58 patients were shown to harbor a single strain of H. pylori as analyzed by RAPD fingerprinting. In vitro studies of bacterial interaction of two different strains of H. pylori showed growth competition resulting in the predominance of a single strain.

Conclusions.

The results support the concept that a single strain predominates in the gastric antrum site of patients studied.
Pretreatment Antibiotic Resistance inHelicobacter pyloriInfection: Results of Three Randomized Controlled Studies
Authors: Realdi Giuseppe , Dore Maria P. , Piana Andrea , Atzei Antonella , Carta Monica , Cugia Luigi , Manca Alessandra , Are Bianca M. , Massarelli Giovanni , Mura Ida , Maida Alessandro , Graham David Y.
Published: March 2003

Background.Although combinations of antibiotics and antisecretory drugs are useful for treatment ofHelicobacter pyloriinfection, treatment failure is common. The aim of this study was to evaluate the relation between pretreatment antibiotic resistance and outcome by using six different treatment regimens forH. pyloriinfection.

Patients and Methods.Three hundred sixty‐nine consecutiveH. pylori–infected patients with dyspeptic symptoms were enrolled in three consecutive randomized, controlled, single‐center clinical trials: trial A, 128 patients; trial B, 125 patients; trial C, 116 patients. Treatments consisted of (A) a 15‐day course of dual therapy (omeprazole, 20 mg bid, and amoxicillin, 1 gm bid, or clarithromycin, 500 mg tid) (OA vs OC); (B) a 7‐day triple therapy of omeprazole, 20 mg bid, plus metronidazole, 500 mg bid, and amoxicillin, 1,000 mg bid, or clarithromycin, 500 mg tid (OMA vs OMC); or (C) omeprazole, 20 mg bid, plus metronidazole, 500 mg bid, plus tetracycline, 500 mg qid, or doxycycline, 100 mg tid (OMT vs OMD). Diagnostic endoscopy was made in all patients before and 5 to 6 weeks after therapy. Six biopsies were taken from each patient for histology, rapid urease test, andH. pyloriculture; antibiotic susceptibility testing was performed using the E‐test method.

Results.Overall cure rates were poor for both dual therapies OA and OC (38% and 37%, respectively) and for triple therapies OMA, OMC, and OMD (57%, 55%, and 58%, respectively). The OMT combination was successful in 91% (95% confidence interval [CI], 80.4%–97%). Metronidazole resistance was present in 29.7% (95% CI, 24%–35%), amoxicillin resistance was present in 26% (95% CI, 21%–32%), clarithromycin resistance was present in 23.1% (95% CI, 18%–29%), tetracycline resistance was present in 14% (95% CI, 10%–20%), and doxycycline resistance was present in 33.3% (95% CI, 21%–47%). Antibiotic resistance markedly reduced the cure rates and accounted for most of the poor results with the triple therapies: 89% versus 23%; 77% versus 26%; 100% versus 60%; and 67% versus 23% for OMC, OMA, OMT, and OMD, respectively. OMT appeared to be the best because of the high success rate with metronidazole‐resistantH. pylori(71%) and in low‐level tetracycline resistance.

Conclusions.Pretreatment antibiotic‐resistantH. pylorican, in part, explain the low cure rate of the infection and the variability in outcome in reported trials.
Prevalence of Helicobacter pylori Resistance to Metronidazole, Clarithromycin, Amoxicillin, Tetracycline, and Furazolidone in Brazil
Authors: Mendonça Sergio , Ecclissato Christina , Sartori M.S. , Godoy Anita Paula Ortiz , Guerzoni Rosângela Aparecida , Degger Maristela , Pedrazzoli José
Published: March 2003

Background. Helicobacter pylori infection is associated with a wide range of digestive diseases and is very prevalent in developing countries, although few data exist on the susceptibility of H. pylori to antimicrobials commonly used in eradication schedules in these countries. The aim of this study was to evaluate the resistance of H. pylori to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone in dyspeptic Brazilian patients.

Material and Methods. Ninety consecutive H. pylori–positive patients were enrolled. Resistance was evaluated by an agar dilution test.

Results. Resistance to metronidazole was detected in 38 patients (42%); to amoxicillin in 26 individuals (29%); to clarithromycin in 6 patients (7%); to tetracycline in 6 patients (7%); and to furazolidone in 4 individuals (4%). Thirteen strains were resistant to two agents, and eight strains were resistant to three antimicrobials.

Conclusions. These results confirm the need for culture and susceptibility testing to define H. pylori resistance patterns in particular geographical areas before the general use of an eradication schedule. They also suggest the possibility of resistance to such antimicrobials as amoxicillin or tetracycline in geographical areas with a high prevalence of H. pylori infection and still not fully evaluated for antimicrobial susceptibility.
Clinical Usefulness of Urine‐based Enzyme‐linked Immunosorbent Assay for Detection of Antibody to Helicobacter pylori: A Collaborative Study in Nine Medical Institutions in Japan
Authors: Kato Mototsugu , Asaka Masahiro , Saito Masao , Sekine Hitoshi , Ohara Shuichi , Toyota Takayoshi , Akamatsu Taiji , Kaneko Taimei , Kiyosawa Kendo , Nishizawa Osamu , Kumagai Toshiko , Katsuyama Tsutomu , Abe Masahiro , Kosaka Masaaki , Hariya Shojiro , Minami Kunihiro , Sanai Yasuhiro , Sawamura Masayuki , Tachikawa Tetsuya
Published: March 2003

Background. A urine‐based enzyme‐linked immunosorbent assay (ELISA) kit for detection of antibody to Helicobacter pylori has been developed in Japan. Urine samples can be obtained noninvasively and are easier and safer to handle than are serum samples. The aim of this study was to examine the clinical usefulness of this urine‐based ELISA kit.

Materials and Methods. A pair of random, single‐void urine and serum samples was collected from each of 1,061 subjects, including 238 patients with gastroduodenal disease. The sensitivity and specificity of the urine‐based ELISA was compared with those of three commercially available serum‐based ELISA kits. For those patients with gastroduodenal disease, the urine‐ and serum‐based ELISA results were also compared with those for other diagnostic methods using endoscopic biopsy specimens, such as culture, histology, and rapid urease tests.

Results. Based on the three serum‐based ELISA results, the sensitivity, specificity, and accuracy of the urine‐based ELISA were 97.7%, 95.6%, and 96.8%, respectively. On the basis of the biopsy test results, the sensitivity (96.2%), specificity (78.9%), and accuracy (91.0%) of the urine‐based ELISA were almost equivalent or superior to all three serum‐based ELISAs tested. In addition, 10 of the 12 false‐positive cases for urine‐based ELISA were confirmed to be true positives for antibodies to H. pylori by Western blot analysis and inhibition ELISA.

Conclusions. The urine‐based ELISA (URINELISA H. pylori Antibody) is very accurate and should be useful as an alternative to serum‐based ELISAs for screening of H. pylori infection.
Circulating T‐Cell Response to Helicobacter pylori Infection in Chronic Gastritis
Authors: Ren Zhigang , Pang Gerald , Lee Roger , Batey Robert , Dunkley Margaret , Borody Tom , Clancy Robert
Published: March 2003

Background. Helicobacter pylori elicits a specific humoral and cellular immune response. There is increasing evidence that the type of T‐cell response contributes to clinical outcome in H. pylori infection.

Materials and Methods. The host response to H. pylori infection in 34 subjects with chronic gastritis was examined in terms of T‐cell proliferation and cytokine production in whole‐blood cultures stimulated or unstimulated with H. pylori acid‐glycine extract antigens (AGE).

Results. The proliferative response in whole‐blood cultures was similar for both H. pylori–positive and –negative subjects stimulated with H. pylori AGE. While an increase in interferon‐γ (IFN‐γ) production was observed from both H. pylori–positive and –negative subjects with gastritis, significantly higher levels of IFN‐γ were detected in the former when stimulated with H. pylori AGE. In contrast, interleukin 4 (IL‐4) was undetectable regardless of antigen stimulation. However, if an in situ IL‐4 antibody capture assay was used, antigen‐independent production of IL‐4 was detected, but there was no difference between H. pylori–positive and –negative subjects with gastritis. After eradication of H. pylori, antigen‐induced production of IL‐4 was increased, with no decrease in the levels of secretion of IFN‐γ. IL‐4 production was dependent on CD4+ T cells, as addition of anti‐CD4 but not anti‐CD8 mouse monoclonal antibody or matched IgG isotype to the whole‐blood culture inhibited the production of IL‐4.

Conclusion. The results suggest that a shift toward a balanced Th1‐Th2 response due to an increase in antigen‐induced IL‐4 production from CD4+ T cells follows eradication. We suggest that the downregulation of mucosal inflammation consequent on reduction in antigen levels or removal of downregulation after eradication of H. pylori contributes to this shift in cytokine balance.
Ranitidine Bismuth Citrate Can Help to Overcome Helicobacter pylori Resistance to Clarithromycin In Vivo
Authors: Mégraud Francis , Roberts Peter , Williamson Russell
Published: March 2003

Background. Helicobacter pylori eradication usually fails when clarithromycin is used against resistant strains.

Objective. The objective of this study was to test whether the apparent synergy found in vitro between ranitidine bismuth citrate (RBC) and clarithromycin also exists in vivo against resistant strains.

Methods. H. pylori was cultured and clarithromycin susceptibility was determined before and after treatment, from duodenal ulcer patients receiving RBC and clarithromycin or omeprazole and clarithromycin for 2 weeks in a multicenter randomized clinical trial.

Results. The overall eradication rate was 88.7% in the RBC group (71 patients) and 52.7% in the omeprazole group (74 patients). The demographic characteristics of the two groups were not different. Clarithromycin‐resistant strains were isolated in 22 cases (15.1%). A difference between the eradication rates of susceptible and resistant strains was found in the omeprazole group but not in the RBC group. After treatment, resistance to clarithromycin developed in three of the seven strains (42.3%) cultured from the patients of the RBC group, compared with 11 of the 26 strains (42%) of the omeprazole group. That is, clarithromycin‐resistant strains were found in 6% and 27% in the RBC group and the omeprazole group, respectively, on considering the global results.

Conclusion. A synergy between RBC and clarithromycin may exist in vivo and, while clarithromycin resistance is increasing, it is an argument for using RBC in triple therapies.
The Accuracy of Serologic Diagnosis of Helicobacter pylori Infection in School‐aged Children of Mixed Ethnicity
Authors: Tindberg Ylva , Bengtsson Carina , Bergström Mats , Granström Marta
Published: March 2003

The present study evaluated two non‐invasive diagnostic methods for H. pylori infection in children, i.e. an in‐house ELISA using sonicated Campylobacter jejuni antigen for absorption of cross‐reacting antibodies and an immunoblot kit (Helico Blot 2.0, Genelabs, Singapore). 13C ‐Urea breath test (13C‐UBT) was used as reference method. Sera and questionnaires were collected from 695/858 (81%) Swedish school children with mixed ethnic backgrounds within a cross‐sectional, community‐based study. Of 133 children with an ELISA OD value of ≥ 0.1, all were screened with immunoblot and 107 made a 13C‐UBT. The negative controls were 34/37 children from three school classes with an ELISA OD value of < 0.1 and volunteering for a 13C‐UBT. An adjusted cut‐off level for the ELISA of OD value 0.22 resulted in a sensitivity of 97.8%, a specificity of 95.8% and a concordance index of 97.2%. The Helico Blot 2.0 had a sensitivity of 97.8%, a specificity of 93.8% and a concordance index of 96.5%. The best concordance was seen for the 26.5 kDa (98.6%), 30 kDa (95.7%) and 19.5 kDa (91.5%) antigens. The corresponding concordance index for CagA was 78%, for VacA 73.8% and for the 35kDa antigen 68.8%. A significant difference in the distribution of the 19.5 and 26.5 kDa bands but not of CagA/VacA was noted by ethnic background. With an adjusted cut‐off level for the enzyme‐linked immunosorbent assay (ELISA), both non‐invasive methods were found to have an adequate performance in a pediatric population. The differences in antibody response patterns by ethnic background represent a caveat in the interpretation of serological studies.
Helicobacter pylori and Early Duodenal Ulcer Status Post‐Treatment: a Review
Authors: Meyer Joette M. , Silliman Nancy P. , Dixon Cheryl A. , Siepman Nancy Y. , Sugg Jennifer E. , Hopkins Robert J.
Published: March 2003

Background.

Data submitted to the FDA were reviewed to analyze the relationship between Helicobacter pylori infection and the incidence of early duodenal ulcers, within 6 weeks, following treatment.

Materials and Methods.

Retrospective analyzes were performed on data from three H. pylori development programs submitted to the FDA: ranitidine‐bismuth‐citrate (RBC), lansoprazole (L) and omeprazole (O). Efficacy assessments for the RBC, L and O programs were made at end of a 4‐week treatment period, 4–6 weeks following the end of a 14‐day treatment period, and 4 weeks following the end of a 4‐week treatment period, respectively.

Results.

Overall, there was a 15%, 21% and 23% decrease in the number of patients in the RBC, L and O programs, respectively, with ulcers among H. pylori cleared/eradicated patients post‐treatment compared with patients with persistent infection. Among patients who did not have cleared/eradicated H. pylori in the RBC and O programs, where antisecretory agents were continued beyond the antimicrobial treatment period, the number of ulcers was lower in the antisecretory plus antimicrobial subgroups compared with the antimicrobial alone subgroups (37% vs. 46% for RBC and 33% vs. 42% for O). Among patients with cleared/eradicated H. pylori, the number of patients with ulcers in the antimicrobial alone subgroups and antisecretory plus antimicrobial subgroups were similar within each program. Antimicrobials alone had significantly lower rates of ulcers among patients with cleared/eradicated H. pylori as compared with patients without clearance/eradication.

Conclusions.

The early incidence of duodenal ulcers is significantly decreased in patients with H. pylori clearance/eradication.
Interactions Among Gastric Somatostatin, Interleukin‐8 and Mucosal Inflammation in Helicobacter pylori‐Positive Peptic Ulcer Patients
Authors: Yamamoto Sayuri , Kaneko Hiroshi , Konagaya Toshihiro , Mori Shozaburo , Kotera Hiroshi , Hayakawa Toshihiko , Yamaguchi Chikara , Uruma Motoaki , Kusugami Kazuo , Mitsuma Terunori
Published: March 2003

Background. To investigate whether Helicobacter pylori infection, but not drugs, affects gastric somatostatin, interleukin‐8 (IL‐8), histological inflammation through eradication therapy, and interactions among these parameters.

Methods. Twenty‐eight H. pylori‐positive patients (21 males; mean age 47.0 years) with either gastric ulcer (GU: n = 11) or duodenal ulcer (n = 17) diagnosed endoscopically were treated with dual therapy. Eradication was defined as negative microbiologic tests and 13C‐urea breath test. Levels of antral and gastric juice somatostatin and mucosal IL‐8 were measured by radioimmunoassay and enzyme‐linked immunosorbent assay, respectively. Histology was assessed by the Sydney system.

Results.  H. pylori was eradicated in 15 patients (10 males, 6 GU) out of 28 (54%). The patients’ backgrounds did not affect the eradication of H. pylori. Successes in eradication significantly increased antral and juice somatostatin contents, and dramatically decreased IL‐8 levels and histological gastritis. In contrast, persistent H. pylori infection did not affect somatostatin and histological gastritis. An inverse correlation was present between changes in somatostatin levels and histological activity. No relationship was observed in changed values between antral somatostatin and IL‐8.

Conclusions.  These results indicate that eradication of H. pylori, but not the drugs used, induced an increase in somatostatin levels in the antrum and gastric juice, suggesting a close relationship between H. pylori and gastric somatostatin regulation. A close correlation between an increase in gastric somatostatin levels and the normalization of histological activity was present, suggesting that certain peptide‐immune interactions in the gastric mucosa exist in H. pylori infection.
Distribution of Distinct vacA, cagA and iceA Alleles in Helicobacter pylori in Hong Kong
Authors: Wong Benjamin Chun Yu , Yin Yan , Berg Douglas E. , Xia Harry Hua‐Xiang , Zhang Jian Zhong , Wang Wei Hong , Wong Wai Man , Huang Xiao Ru , Tang Vera Shun Yim , Lam Shiu Kum
Published: March 2003

Background.

There is a substantial genetic heterogeneity among Helicobacter pylori strains, and certain genotypes have been suggested to be associated with the virulence of this pathogen. The aim of this study was to investigate the distribution of H. pylori vacA, cagA and iceA genotypes and their association with duodenal ulcer disease in Hong Kong.

Materials and Methods.

Gastric biopsies of 72 H. pylori infected patients were analyzed by specific polymerase chain reactions.

Results.

Of the 72 cases, 69 (95.8%) had vacA signal sequence s1c strains, and three (4.2%) had s1a strains. vacA middle region sequences, m1b and m2, were detected in 23 (31.9%) and 46 (63.9%), respectively. Six (8.3%) cases contained multiple vacA subtypes. vacA s2 allele was only observed in three (4.3%) cases, which were also infected with s1c subtype. cagA was present in 64 (88.9%) of 72 patients, and iceA1 subtype was detected in 46 (63.9%) cases. Neither cagA nor vacA and iceA were associated with duodenal ulcer disease.

Conclusion.

The distribution of vacA, cagA and iceA alleles in H. pylori strains in Hong Kong is similar to that in east Asia. There is a difference in the distribution of genotypes between strains in Hong Kong and those in mainland China, although strains in the two regions exhibit a very close relation. The association of these virulence genes and duodenal ulcer disease needs reappraisal, particularly under geographic considerations.
The Effects of Nocturnal Acid Breakthrough on Helicobacter pylori Eradication
Authors: Il Kim Jin , Park Soo‐Heon , Kwang Kim Jae , Sik Chung In , Won Chung Kyu , Sik Sun Hee
Published: March 2003

Background. The effects of nocturnal gastric acid breakthrough (NAB) on Helicobacter pylori eradication are still unknown in peptic ulcer patients. The purposes of this study were to compare the effect of lansoprazole 30 mg twice a day (bid) to lansoprazole 60 mg once a day (qd) on the prevalence of NAB, and to determine whether NAB affects the eradication of H. pylori in peptic ulcer patients.

Methods.  Experiments were carried out in 67 patients with H. pylori‐positive peptic ulcers. They were randomized into two groups, one treated with a combination of lansoprazole 60 mg, clarithromycin 1.0 g, and amoxycillin 2.0 g once a day before breakfast (qd group), and the other, divided doses of the drugs were given before breakfast and dinner (bid group) for 2 weeks.

Results.  NAB occurred in 31 patients, 55.2% in qd group, and 39.5% in bid group (p = .226). H. pylori eradication was achieved in 61.3% in NAB positive group and 83.3% in NAB negative group (p = .055). The mean duration of NAB for H. pylori eradication group was 99.3 ± 22.7 min, and 293.2 ± 49.8 min for H. pylori persistence group (p < .05). The median intragastric pH of the H. pylori eradication and persistence group was 5.7 ± 0.2 and 4.2 ± 0.4, respectively (p < .05).

Conclusions.  Neither the morning dose and the divided dose regimen of lansoprazole affected the intragastric acidity and occurrence of the NAB. NAB did not influence H. pylori eradication in peptic ulcer patients, but the duration of NAB and total intragastric median pH were found to influence the H. pylori eradication.
Oxidative Stress in Gastric Mucosa of Asymptomatic Humans Infected with Helicobacter pylori: Effect of Bacterial Eradication
Authors: Felley C. P. , Pignatelli B. , Van Melle G. D. , Crabtree J. E. , Stolte M. , Diezi J. , Corthesy‐Theulaz I. , Michetti P. , Bancel B. , Patricot L. M. , Ohshima H. , Felley‐Bosco E.
Published: March 2003

Background. Inducible nitric oxide synthase (iNOS) and interleukin 8 (IL‐8) are positive in approximately 50% of Helicobacter pylori‐related diseases but it is not clear whether oxidative stress is also present in H. pylori asymptomatic humans. Our aim was to study the expression of iNOS, superoxide dismutase, catalase and IL‐8 production in H. pylori‐infected asymptomatic humans, and to investigate the effect of eradication of H. pylori.

Materials and Methods. Biopsies of corpus and antrum of asymptomatic H. pylori positive and negative humans served for determination of the gastritis score and H. pylori status; iNOS was measured by reverse transcriptase polymerase chain reaction and immunohistochemistry and superoxide dismutase and catalase by immunohistochemistry. IL‐8 in biopsies was assessed by enzyme‐linked immunosorbent assay.

Results. Immunostaining of iNOS, catalase and superoxide dismutase was significantly associated with H. pylori infection and was localized to inflammatory cells. IL‐8 concentrations were greater in the H. pylori positive than H. pylori negative group and decreased after bacterial eradication. A decrease in staining for iNOS and catalase was observed after H. pylori eradication.

Conclusions. INOS and antioxidant enzymes are present in gastric biopsies of asymptomatic H. pylori positive humans. Eradication caused a significant decrease in staining for iNOS and catalase. These results indicate that oxidative stress occurs in asymptomatic patients and can be modulated by H. pylori eradication.
Clinical Application of 20 MHz Endosonography and Anti‐Helicobacter pylori Immunoblots to Predict Regression of Low‐grade Gastric MALToma by H. pylori Eradication
Authors: Sheu Bor‐Shyang , Shiesh Shu‐Chu , Wang Jin‐Town , Yang Hsiao‐Bai , Lin Shih‐Ting , Wu Jiunn‐Jong
Published: March 2003

Aim. We tested whether serial 20 MHz endosonography (EUS) and anti‐Helicobacter pylori immunoblots can predict the complete regression of gastric MALToma by H. pylori eradication.

Methods. The serums of 17 MALToma patients, including 15 with low grade and two with high grade, were collected before therapy. Fifteen patients with low‐grade MALToma and 18 nonMALToma patients, all infected with H. pylori, have been followed with serum sampling, endoscopy, and EUS on enrollment, on the 2nd, 6th, and 12th months after anti‐H. pylori therapy. All sera were tested for anti‐H. pylori immunoblots, including 19.5, 26.5, 30, 35, 89, 116 KDa (CagA), FldA. The DNAs were extracted serially from the biopsy of MALToma patients before and after therapy to perform polymerase chain reaction (PCR) for the immunoglobulin heavy‐chain gene monoclonality.

Results. MALToma patients had higher prevalence rates of anti‐FldA protein, 19.5 and 30 KDa antibodies of H. pylori (p < 0.01). After H. pylori eradication, MALToma patients had negative seroconversion of 19.5, 26.5, 30, and 35 KDa antibodies (p < 0.05), but not in CagA and FldA. The PCR monoclonality occurred in 80% (12/15) of the MALToma patients before therapy, but did not correlate with any seroconversion of anti‐H. pylori immunoblots after therapy (p > 0.05). Complete regression of MALToma was observed in 73.3% (11/15) of patients. Evaluation with 20 MHz EUS, for the initial tumor depth and its normalization on the 6th month had 90.9% sensitivity and 100% specificity to predict the complete regression.

Discussion. The negative seroconversions of the smaller‐molecular‐weight proteins, but not CagA and FldA, correlate with regression of MALToma by H. pylori eradication. 20 MHz EUS can effectively predict the therapeutic response of MALToma.
Quality of Life in Cancer Patients
Authors: McMillan Susan C. , Weitzner Michael
Published: March 2003

PURPOSE
: Improving or maintaining the quality of life for persons with cancer is a major goal of end‐of‐life care; however, to measure quality‐of‐life outcomes, a valid and reliable measure is needed. The purpose of this project was to report the psychometric properties of the revised Hospice Quality of Life Index (HQLI), including validity and reliability for hospice patients with cancer.

DESCRIPTION
: Data were collected from home care hospice patients with cancer (n = 255) and a group of apparently healthy adults in the community (n = 32). The revised HQLI is a 28‐item self‐report instrument that includes three subscales: Psychophysiological Well‐being, Functional Well‐being, and Social/Spiritual Well‐being.

RESULTS
: Evidence for validity was provided in three ways. First, factor analysis confirmed the three subscales (Psychophysiological, Functional, and Social/Spiritual Well‐being). Second, a weak significant correlation was found between the Easterm Cooperative Oncology Group Performance Status Rating scores and HQLI scores (r= .26; P= .00). Third, the HQLI was able to discriminate between hospice patients with cancer and apparently healthy adults (λ= .34; P= .00). In addition, the mean scores of these two groups were significantly different (t= 6.64; P= .00). However, only a minimal difference in scores was found on the Social/Spiritual Well‐being subscale between the cancer and healthy groups. Reliability for the revised HQLI was high for both the total scale (α= .88) and the subscales (α =.82–.85).

CLINICAL IMPLICATIONS
: Emphasis has been placed recently on understanding quality of life from the patient's perspective. The development of a valid and reliable tool can guide care givers in providing meaningful quality‐of‐life care. The HQLI provides patients the opportunity to express beliefs about quality‐of‐life issues and to maintain direction over a critical aspect of their care. Of note from this study, the significant difference between groups in functional well‐being and minimal difference in social/spiritual well‐being suggest that patients are able to appraise their functional abilities realistically and still maintain their social network and spiritual beliefs. Indeed, it may be that patients give family relationships and spiritual beliefs greater focus during a terminal illness.
The Role of the Physician as an Information Source on Mammography
Authors: Metsch Lisa R. , McCoy Clyde B. , McCoy H. Virginia , Pereyra Margaret , Trapido Edward , Miles Christine
Published: March 2003

purpose
: The value of mammography for asymptomatic women younger than 50 years of age has been under debate, and it had been suggested that each woman should decide for herself whether to start having mammograms in her 40s. This decision‐making process requires women to have knowledge of screening guidelines. This study reported key determining informational factors that led women age 40 and older to obtain a mammogram.

description of study
: To examine the relationship between sources of information and utilization of mammography, the authors conducted a communitywide telephone survey, in English and Spanish, of a stratified random sample of 999 white, black, and Hispanic women in Dade County, Florida. The survey was designed to measure knowledge, attitudes, practices, and beliefs about breast cancer, its prevention, and its early detection. Data for 784 women 40 years and older are analyzed and reported here.

results
: The most commonly cited source of information was the media (90.2%). In a logistic regression, having had a checkup in the past year was the strongest predictor of having had a recent mammogram as opposed to a distant one (OR 4.17; 95% CI 2.92–5.95). Women who named their physician as an important source of information about health and prevention were also more likely to have had a recent examination (OR 1.85; 95% CI 1.27–2.69).

clinical implications
: This analysis of the relationship between the source of information and utilization of mammography suggests that physicians, as sources of information, serve to motivate women to obtain a mammogram. This is true even after taking into account the patient's age and utilization of the healthcare system for preventive care in general. For this reason, it is imperative that clinicians be aware of national guidelines for breast cancer screening; of the risks and benefits of screening measures; and of the implications of a positive and negative test result. In addition, clinicians must realize the importance of follow‐up to remind the patient to obtain a mammogram or other screening test and should develop strategies to provide this service.
The Impact of Radiation Therapy on Quality of Life in Patients withCancer
Authors: Liu Li , Meers Kathy , Capurso Anita , Engebretson Tilmer O. , Glicksman Arvin S.
Published: March 2003

purpose
: This study was conducted to evaluate the physical and mental status change during and after a course of radiation treatment in patients with cancer.

description of study
: Twenty‐four patients with various malignant diseases were enrolled, including 9 men and 15 women, whose median age was 64.5, to receive radiation therapy. All patients also received psychosocial support from nurses, social workers, and/or organized support groups. The Rand 36‐item survey 1.0 (SF‐36) was completed at the beginning, the second week, the completion of treatment, and 1 and 3 months after treatment for the evaluation of physical component scores and mental component scores. Karnofsky performance scale and toxicity scores were determined by the treating nurses and physicians.

results
: The physical component scores of evaluated patients before treatment were approximately 20% lower than those of the general U.S. population, whereas mental component scores were similar to those of the general U.S. population. After treatment started, Karnofsky performance scale decreased concurrently with an increased rate of toxicity. Both physical and mental component scores were relatively stable throughout the course of evaluation. Mental component scores were the only predictor of toxicity during the treatment. Karnofsky performance scale dropped to their lowest point at the completion of treatment and then improved at 1‐month follow‐up.

clinical implications
: The patients who had higher mental component scores before treatment appeared to have higher, and improving, physical component scores throughout the course of evaluation. Along with complementary social support, the implementation of psychosocial support early and throughout the course of treatment may result in physical benefits and improving overall quality of life. Care should also be taken to make psychosocial support available to patients after the completion of treatment.
Presurgery Experiences of Prostate Cancer Patients and Their Spouses
Authors: Gray Ross E. , Fitch Margaret I. , Phillips Catherine , Labrecque Manon , Klotz Laurence
Published: March 2003

purpose
: In this article, the authors describe the experiences of men with prostate cancer and their spouses between diagnosis and surgery.

description
: As part of a longitudinal qualitative study, semistructured interviews were held with 34 prostate cancer patients who were waiting for surgery. Separate interviews were held with their spouses.

results
: Six main components of experience were evident from the analysis of transcripts related to the presurgery period: 1) the news of a diagnosis of prostate cancer came initially as a shock for both partners, the impact of which lessened over time; 2) the new reality of illness necessitated readdressing the marital relationship, most often resulting in a sense of renewed connection and commitment; 3) the illness crisis precipitated a search for information to guide decisions about treatment; 4) there was a need for couples to decide who to inform about the cancer diagnosis and how much to say about it; 5) couples attempted to seek a semblance of normality in their lives, especially after treatment decisions had been made; and 6) despite attempts to minimize the potential impact of upcoming surgery, anxiety was typically experienced at least intermittently by one or both partners.

clinical implications
: Physicians, nurses, social workers, and other health professionals need to facilitate attempts by the patient to gather and synthesize information. Cancer specialists can play a positive role in reducing distress in couples, and, thus, the attention of the specialists to communication issues is critical. The strain of waiting for surgery must be considered when treatment recommendations are made; watchful waiting protocols require further study from a psychological perspective. Clinicians need to be alert to the balance between being positive and carrying on as normal, and acknowledging and dealing with the distress that arises.
Healing Icons: Art Support Program for Patients with Cancer
Authors: Heiney Sue P. , Darr‐Hope Heidi
Published: March 2003

objectives: The purpose of this report is to describe the structure and process of an art support program for patients with cancer who are age 16 and older.

materials and methods: Healing Icons is a six‐session art support program for cancer patients. During the program participants create a three‐dimensional mixed‐media art piece to convey a unique personal perspective on receiving a diagnosis of and being treated for cancer. Concurrently, the patients spontaneously share common experiences about their cancer, which leads to strong emotional bonds. The purpose and goals of the program, method of implementation, and evaluation are described. Information and suggestions that clinicians might find useful in developing similar programs are discussed. Patient participants, their families, and staff in the cancer center have reported positive clinical evaluations.

conclusions: The benefits of Healing Icons are derived from the therapeutic factors present in a traditional support group blended with the creative process. This kind of program opens new avenues for expressing feelings and thoughts but should be structured in such a way that group processes are not allowed to negatively impact participants. Healthcare professionals interested in collaborating with artists on similar programs for cancer patients may approach artists through local art councils, art schools, and artists guilds. Brainstorming sessions with artists would help to capitalize on the expertise of artists within the community. Initiating a pilot project would help gauge patient interest and would provide valuable feedback from the healthcare team. Research is needed to validate the clinical outcomes derived from this program, as empirical findings would greatly enhance the clinical evaluations.