bluuebunny/crossref_metadata_2025 huggingface dataset:
Upregulation of transferrin receptor 2 and ferroportin 1 mRNA in the liver of patients with chronic hepatitis C
Authors: TAKEO MASAKI , KOBAYASHI YOSHINAO , FUJITA NAOKI , URAWA NAOHITO , IWASA MOTOH , HORIIKE SHINICHIRO , TANAKA HIDEAKI , KAITO MASAHIKO , ADACHI YUKIHIKO
Published: April 2005

Background:  Iron accumulation has been reported to be associated with progression of liver injury. The mechanism of iron accumulation in the liver is not known. In the present study, hepatic messenger RNA (mRNA) expression of transferrin receptor (TfR)1, TfR2, and ferroportin (FP)1 was measured in patients with chronic hepatitis (CH).

Methods:  Eleven patients with CH‐B and 43 patients with CH‐C were enrolled. All patients underwent liver biopsy. Hepatic expression of TfR1, TfR2 and FP1 mRNA was analyzed using a real‐time polymerase chain reaction. Total hepatic iron score (THIS) was evaluated by Prussian blue staining.

Results:  Serum ferritin concentration is significantly higher in CH‐C than in CH‐B. Values of THIS of ≥5 were observed only in CH‐C patients (44% of CH‐C patients). The expression level of TfR2 mRNA was 10–26‐fold higher than the TfR1 mRNA expression level. The TfR2 and FP1 mRNA expression was significantly higher in CH‐C than in CH‐B patients. Hepatic expression of TfR2 and FP1 mRNA was well correlated with THIS.

Conclusions:  Hepatic iron accumulation is more severe in patients with CH‐C. Upregulation of hepatic iron transporters may contribute to the hepatic iron accumulation in CH‐C.
Severe acute respiratory syndrome‐related diarrhea
Authors: KWAN AMBROSE CHI‐PONG , CHAU TAI‐NIN , TONG WING‐LOK , TSANG OWEN TAK‐YIN , TSO EUGENE YUK‐KEUNG , CHIU MING‐CHI , YU WAI‐CHO , LAI THOMAS SIK‐TO
Published: April 2005

Background:  Severe acute respiratory syndrome (SARS) is an emerging infectious disease and diarrhea has been reported in up to 76% of cases. The purpose of the present paper was to carry out a retrospective study of the clinical and demographic data of SARS patients with diarrhea in Princess Margaret Hospital.

Methods:  From 1 to 31 March 2003, hospital records from 240 patients with confirmed SARS were studied. Patients with watery stool of ≥3 times/day for at least 3 consecutive days were defined as the diarrhea group. Clinical and demographic data were compared between the diarrhea and non‐diarrhea groups. Chest X‐ray (CXR) scores during the peak of diarrhea period were recorded by a respiratory physician. These CXR scores were correlated with the peak frequency of diarrhea by Spearman's correlation coefficient.

Results:  Diarrhea occurred in 20.4% of patients after admission. Female patients were predominant with a female to male ratio of 6:1 (P < 0.001) and 69.4% of patients were living in Amoy Gardens Estate (P = 0.01). The proportions of patients requiring ventilatory care and mortality in the diarrhea group were 8.2% and 2%, respectively, which were significantly lower than those in the non‐diarrhea group (27.6% and 16.2%, P < 0.005). The CXR scores during the peak of diarrhea were not correlated with the maximum frequency of diarrhea (r = −0.09, P = 0.5).

Conclusions:  A total of 20.4% of SARS patients had the complication of diarrhea after hospital admission. Both female sex and being a resident of Amoy Gardens Estate were associated with diarrhea. The diarrhea group had a better prognosis.
Diagnosis of gastroesophageal reflux disease using a new questionnaire
Authors: SHIMOYAMA YASUYUKI , KUSANO MOTOYASU , SUGIMOTO SAYAKA , KAWAMURA OSAMU , MAEDA MASAKI , MINASHI KEIKO , KURIBAYASHI SHIKOU , HIGUCHI TATSUYA , ZAI HIROAKI , INO KYOKO , HORIKOSHI TSUTOMU , MOKI FUMITAKA , SUGIYAMA TADASHI , TOKI MUNETOSHI , OHWADA TSUNEO , MORI MASATOMO
Published: April 2005

Background and Aim: An early and accurate evaluation by a general practitioner is needed to screen out non‐gastroesophageal reflux disease (GERD) patients. A recent questionnaire (QUEST) highlighted problems with specificity and complexity, so the aim of the present study was to design a simplified questionnaire.

Methods: When admitted to hospital to undergo an upper gastrointestinal endoscopy for suspected GERD, 333 patients completed a 50‐item questionnaire requiring ‘yes/no’ answers to different combinations of questions relating to symptoms of upper gastrointestinal tract conditions (e.g. GERD, ulcers and functional dyspepsia) and psychosomatic symptoms. The endoscopic diagnosis was then correlated with the rate of positive answers to each question.

Results: Based on the analysis of the 50 items, the 8–10 questions most often answered affirmatively by each of the GERD and non‐GERD groups were chosen for the simplified questionnaire. Three draft questionnaires were compiled. After calculating the sensitivity, specificity and accuracy in relation to the diagnosis of GERD and other conditions, it was found that questionnaire B (selection of persons answering ‘yes’ to at least one of questions 1–5 and exclusion of persons answering ‘yes’ to at least three of questions 7–10) had a high sensitivity, high specificity and low false positive rate.

Conclusion: A novel questionnaire was developed. It was designed to detect the symptoms of GERD while simultaneously excluding non‐GERD patients. This simplified nine‐item simplified questionnaire had a sensitivity of 79.8%, a specificity of 53.6% and an accuracy of 63.4%.
Influence of juxtapapillary diverticulum on hepatic clearance in patients after endoscopic sphincterotomy
Authors: TZENG JENG‐JIE , LAI KWOK‐HUNG , PENG NAN‐JING , LO GIN‐HO , LIN CHIUN‐KU , CHAN HOI‐HUNG , HSU PING‐I , CHENG JIN‐SHIUNG , WANG E‐MING
Published: April 2005

Background and Aim:  The role of juxtapapillary diverticulum ( JPD) in biliary stone formation is controversial. This study was designed to understand the relationship between the size of JPD, hepatic clearance and recurrent bile duct stones in patients after endoscopic sphincterotomy.

Methods:  Five hundred and twenty patients with choledocholithiasis who had received endoscopic sphincterotomy were enrolled. They were divided into three groups: group A (n = 268) without diverticula; group B (n = 156) with small diverticula; and group C (n = 96) with large diverticula. All patients were regularly followed with interviews, liver function test and sonogram to detect the recurrent bile duct stones. Quantitative cholescintigraphy was performed in 176 cholecystectomized patients to evaluate the hepatic clearance. Sphincter of Oddi manometry was performed to exclude incomplete sphincterotomy if quantitative cholescintigraphy was abnormal.

Results:  After 9–111 months of follow‐up, 76 patients had recurrent bile duct stones. There was a significant higher bile duct stone recurrence in group C than in group A (P < 0.01), but no statistical difference was noted between group B and group A (P = 0.2). Patients with JPD were older than those without (P < 0.05). Of 176 cholecystectomized patients, two were excluded because sphincter of Oddi basal pressure was more than 10 mmHg. In the remaining 174 patients, the E45′ was significantly lower in group C than in group A (41.2% ± 18.6%vs 49.1% ± 14.1%; P < 0.05), and there was no significant difference between group B and group A.

Conclusions:  JPD is a predisposing factor of delayed biliary emptying and it increases the chance and incidence of recurrent bile duct stones.
Distribution of Helicobacter pylori cagA, cagE and vacA in different ethnic groups in Kuala Lumpur, Malaysia
Authors: TAN HUCK JOO , RIZAL ABDUL MANAF , ROSMADI MOHAMED‐YUSOFF , GOH KHEAN‐LEE
Published: April 2005

Background and Aims:  There is a geographic variation in Helicobacter pylori (HP) genotypes and virulence factors. Cytotoxin associated genes A (cagA) and E (cagE), and certain vacuolating cytotoxin (vacA) genotypes are associated with peptic ulcer disease (PUD). There is also a different prevalence of PUD among different ethnic groups in Malaysia. The present study compared the distribution of vacA alleles and cagA and cagE status in three ethnic groups residing in Kuala Lumpur, Malaysia, and their association with clinical outcome.

Methods:  All patients with cultured positive HP were recruited prospectively. DNA was extracted and polymerase chain reaction was carried out to determine the cagA and cagE status and vacA alleles.

Results:  The results of 127 patients (72 men and 55 women) were included. The mean age was 55.53 ± 12.52 years. The ethnic distribution was 59 Chinese, 38 Indian and 30 Malay patients. The predominant genotype was s1a among the Malay (76.6%) and Indian patients (71.0%), and s1c among the Chinese patients (66.1%). The vacA middle region sequence m1 was detected in 66.7% of Malay, 54.2% of Chinese and 76.3% of Indian patients. Of the Malay, Chinese and Indian patients, 76.6%, 86.4% and 86.8%, respectively, were cagA positive, and 70.0%, 39.0% and 81.6%, respectively, were cagE positve. HP cagA, cagE and vacA were not associated with PUD.

Conclusion:  There is a distinctive difference in the HP strains among the three ethnic groups in Malaysia. There was no association between cagA, cagE or vacA genotypes and clinical outcome in the patients. None of these markers are helpful in predicting the clinical presentation of a HP infection.
Combination therapy with interferon‐α and ribavirin in patients with dual hepatitis B and hepatitis C virus infection
Authors: HUNG CHAO‐HUNG , LEE CHUAN‐MO , LU SHENG‐NAN , WANG JING‐HOUNG , TUNG HUNG‐DA , CHEN CHIEN‐HUNG , CHANGCHIEN CHI‐SIN
Published: April 2005

Background:  Patients with dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection have responded poorly to interferon (IFN) monotherapy. The purpose of the present paper was to assess the effect of combined IFN‐α and ribavirin therapy in patients infected with both hepatitis B and C.

Methods:  Thirty‐six patients received 3 or 5 MU IFN‐α‐2b thrice weekly and oral ribavirin (800–1200 mg/day) for 24 weeks. All patients had positive hepatitis B surface antigen, antibody to HCV, and HCV‐RNA. Before treatment, one patient had positive hepatitis B e antigen. Eighteen patients had positive HBV‐DNA tested by Amplicor (Cobas Amplicor Monitor, Roche Diagnostics, Branchburg, NJ, USA), with a mean HBV‐DNA level of 3.1 ± 0.9 log copies/mL. Another 72 patients with HCV infection alone served as controls.

Results:  Adverse events led to withdrawal in three patients receiving 5 MU IFN. Based on an intent‐to‐treat analysis, the biochemical response and serum HCV clearance rate at the end of 48 weeks follow up was similar in patients with dual infection and HCV infection alone (56% vs 72%; and 69% vs 71%, respectively). There was no significant difference in sustained HCV clearance rate between the 3‐MU group (n = 13) and the 5‐MU group (n = 23; 85% vs 61%). At the end of 48 weeks follow up, two (11%) of 18 pretreatment viremic patients had negative serum HBV‐DNA (<200 copies/mL), while eight of those without pretreatment viremia had reoccurrence of HBV‐DNA.

Conclusions:  Combination therapy with IFN‐α and ribavirin was effective in achieving sustained HCV clearance in patients with dual HBV and HCV infection, comparable to those with hepatitis C infection alone. Combination therapy using 3 MU IFN‐α seemed as effective as 5 MU, and was well tolerated in the study population. However, large‐scale control trials are necessary to clarify these findings.
Biliary excretion of olmesartan, an anigotensin II receptor antagonist, in the rat
Authors: TAKAYANAGI MOTOE , SANO NAOYO , TAKIKAWA HAJIME
Published: April 2005

Background and Aim:  Olmesartan (RNH‐6270) is a newly developed anigotensin II receptor antagonist, and has been reported to be excreted into feces. To examine the mechanism of the biliary excretion of olmesartan, we studied its biliary excretion in rats.

Methods:  The biliary excretion of olmesartan in Eisai hyperbilirubinemic rats (EHBR), a multidrug resistance protein 2‐deficient rat, was compared with control rats, and the effect of organic anions and cation and bile acids on the biliary excretion of olmesartan was studied in control rats.

Results:  The biliary excretion of olmesartan was markedly delayed in EHBR. The biliary excretion of olmesartan was inhibited by sulfobromophthalein, cefpiramide and pravastatin, but was not inhibited by taurocholate or tauroursodeoxycholate. Vinblastine inhibited and phenothiazine treatment increased the biliary excretion of olmesartan.

Conclusions:  These findings suggest that olmesartan is excreted into the bile mainly by multidrug resistance protein 2 and partly by P‐glycoprotein.
Risk factors for the development of hepatocellular carcinoma among patients with chronic hepatitis C who achieved a sustained virological response to interferon therapy
Authors: TOKITA HAJIME , FUKUI HIDEO , TANAKA AKIHISA , KAMITSUKASA HIROSHI , YAGURA MICHIYASU , HARADA HIDEHARU , OKAMOTO HIROAKI
Published: April 2005

Background and Aim:  Hepatitis C virus (HCV)‐infected patients who responded to interferon (IFN) treatment with clearance of serum HCV RNA may rarely develop hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the risk factors for liver carcinogenesis among such patients.

Methods:  In total, 126 patients with chronic hepatitis C (CHC) who achieved a sustained virological response (SVR) to IFN monotherapy, which was defined as the absence of detectable HCV RNA in the serum at 6 months after completion of treatment, were enrolled and possible risk factors for HCC were analyzed.

Results:  During the observation period of 66 ± 36 months after cessation of IFN treatment, five (4.0%) of the 126 patients developed HCC. The cumulative incidence of HCC at 3, 5 and 10 years was estimated to be 0.9, 4.7 and 7.5%, respectively. The cumulative incidence of HCC was significantly higher among patients with severe fibrosis (F3 or F4) than among patients with no or mild fibrosis (F0 to F2) in the liver before treatment (P = 0.007); among patients with alcohol intake of ≥ 27 g/day than among patients with that of < 27 g/day (P = 0.015); and among patients who were ≥ 65 years old than among patients who were < 65 years old at the start of treatment (P = 0.026).

Conclusions:  Patients with CHC who had severe fibrosis, who had regularly taken moderate amounts of alcohol, or who were ≥ 65 years at the start of IFN treatment should be carefully followed to detect small and controllable HCC, even after eradication of HCV.
Clinical significance of microsatellite instability in the inflamed mucosa for the prediction of colonic neoplasms in patients with ulcerative colitis
Authors: TAHARA TOSHIYUKI , INOUE NAGAMU , HISAMATSU TADAKAZU , KASHIWAGI KAZUHIRO , TAKAISHI HIROMASA , KANAI TAKANORI , WATANABE MAMORU , ISHII HIROMASA , HIBI TOSHIFUMI
Published: April 2005

Background and Aim:  Although molecular mechanisms underlying ulcerative colitis (UC)‐associated neoplasms have been studied for years, understanding of these mechanisms remains incomplete and no good predictable marker for development of colonic neoplasms in patients with UC has been established. The aim of this study was to assess if microsatellite instability (MSI) contributes to the development of colonic neoplasms in patients with UC.

Methods:  We have examined MSI in chronic inflamed and neoplastic colonic mucosa of UC patients. We have also obtained serial biopsied colonic tissues retrospectively 2–12 years before the final diagnosis from patients with high level MSI (MSI‐H+) UC‐associated neoplasms, and analyzed MSI using them at different periods.

Results:  Eight of 12 UC‐associated colon cancers (67%), four of six UC‐associated high grade dysplasias (67%), and two of six UC‐associated low grade dysplasias (33%) revealed MSI‐H+ phenotypes. In contrast, 15 of 59 lesions (25%) in inflamed UC mucosa without colonic neoplasm revealed MSI‐H +. Interestingly, all four patients with MSI‐H+ phenotypes at the final diagnosis of UC‐associated colon cancer or dysplasia had already had MSI‐H+ at the stage of chronic colitis, 2–12 years before the final diagnosis.

Conclusion:  These results support the notion that MSI contributes to the carcinogenesis of UC‐associated neoplasms, and indicate that this analysis in inflamed colonic mucosa at surveillance colonoscopy is useful for identifying UC patients who have high risk for neoplastic progression.
Risk of colorectal cancer in ulcerative colitis in India
Authors: VENKATARAMAN SUBRAMANIAN , MOHAN VIVEK , RAMAKRISHNA BALAKRISHNAN S , PETER SHAJAN , CHACKO ASHOK , CHANDY GEORGE , KURIAN GEORGE , KURIAN SUSY , MATHAN MINNIE , MATHAN VADAKKENADAYIL I , PATRA SUSAMA , PULIMOOD ANNA , ROLSTON DAVID DK
Published: April 2005

Background:  The risk for colorectal cancer (CRC) in ulcerative colitis (UC) in India is not known.

Method:  Retrospective cohort from a tertiary level hospital in South India. Analysis of archived records of all patients with UC who underwent colonoscopy and segmental biopsies over the last 25 years. Incidence densities and risk of developing high grade dysplasia or CRC was calculated and chi‐squared test was performed for risk factors of interest.

Results:  Complete records were available for 532 patients, 336 (63.2%) male. The mean (± SEM) duration of illness was 6.04 ± 0.29 years. In total, 234 patients (44%) had pancolitis, 121 (22.7%) had left‐sided colitis and 177 (33.3%) had proctitis or proctosigmoiditis. Overall, five (0.94%) patients developed carcinoma and one (0.19%) patient had high grade dysplasia. The incidence density and risk of developing either CRC or high grade dysplasia was zero in the first 10 years of disease. In those with disease duration of 10–20 years, incidence density was 2.34 per 1000 person years’ duration (PYD) for all patients with colitis and 4.5 per 1000 PYD for patients with pancolitis alone. This corresponded to risks of 2.3% and 4.4%, respectively. For those with disease duration longer than 20 years, incidence density was 2.73 per 1000 PYD for all patients and 4.9 per 1000 PYD for patients with pancolitis. This corresponded to risks of 5.8% and 10.2%, respectively. Duration of disease beyond 10 years and extent of colitis were the only risk factors significantly associated with CRC.

Conclusions:  The risk of developing CRC is Indian patients with UC is lower than that reported from the West. Strategies for cancer surveillance in Indian patients with UC need to be tailored accordingly.
Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease
Authors: PULIMOOD ANNA B , PETER SHAJAN , RAMAKRISHNA BS , CHACKO ASHOK , JEYAMANI R , JEYASEELAN L , KURIAN GEORGE
Published: April 2005

Background and Aim:  The differentiation between Crohn's disease (CD) and tuberculosis (TB) of the intestine can be difficult in areas where both diseases occur. The present study examined histological criteria that would enable the diagnosis in mucosal biopsies.

Methods:  Colonoscopic biopsies from 33 patients with TB and 31 patients with CD were examined for several specific histological features and their distribution.

Results:  The salient distinguishing features of TB were granulomas larger than 400 µm in maximum dimension, more than four sites of granulomatous inflammation per site, caseation, a band of epithelioid histiocytes in ulcer bases and location of granulomas in the caecum. The salient features of CD were granulomas not showing any of the above features, focally enhanced colitis, pericryptal granulomatous inflammation, and the presence of architectural alteration/activity/chronic inflammation/deep ulceration at sites that did not show granulomatous response in the same or adjacent segments. Although granulomas in CD were distributed throughout the colon, they were more frequent in the rectosigmoid than in TB. All biopsies from endoscopically abnormal sites did not show distinguishing features of TB or CD, emphasizing the need for multiple biopsies. There was an accrual in the number of diagnoses made with increasing numbers of biopsies from rectum to ileum.

Conclusions:  Histology of mucosal biopsies can aid in the differentiation of TB from CD, but multiple biopsies from different colonic segments are important for complete evaluation.
Human parvovirus B19 infection in patients with chronic hepatitis B or hepatitis C infection
Authors: HSU TSAI‐CHING , CHEN TZY‐YEN , LIN MING‐CHENG , TZANG BOR‐SHOW , TSAY GREGORY J
Published: April 2005

Background and Aim:  Parvovirus B19 has been reported to be detected in the sera of patients with acute or chronic hepatitis. The prevalence and clinical significance of B19 DNA in serum samples from patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were investigated.

Methods:  Serum samples from 54 patients with HBV infection, 51 with HCV infection and 53 normal controls were examined for anti‐B19 antibodies and B19 DNA by enzyme‐linked immunosorbent assay (ELISA), the nested polymerase chain reaction (PCR), Southern blotting and direct nucleotide sequencing, respectively.

Results:  Anti‐B19 IgM and IgG antibodies were detected in 19 (35.2%) and 46 (85.2%) of 54 serum samples from patients with HBV infection, and eight (15.7%) and 36 (70.6%) of 51 serum samples from patients with HCV infection. B19 DNA was detected in serum samples of 20 (37%) of 54 patients with HBV infection and 12 (23.5%) of 51 patients with HCV infection, but not in 53 serum samples from normal controls. The occurrence of liver dysfunction was not affected by B19 infection in patients with HBV and HCV infection (P > 0.05). All of the 20 serum samples with B19 DNA from patients with chronic HBV infection and all of the 12 serum samples with B19 DNA from patients with chronic HCV infection exhibited TW‐3 subtype and TW‐9 subtype, respectively. The variant subtypes of B19 were found to be distinctive in patients with HBV or HCV infection.

Conclusions:  These data revealed that human parvovirus B19 infection was frequently found in patients with chronic HBV or HCV infection. The variant genotypes were present in patients with different chronic hepatitis. The coinfection of B19 with HBV or HCV did not increase the frequency of liver dysfunction in patients with chronic hepatitis. Long‐term longitudinal studies are required to determine the natural course of parvovirus B19 infection and whether its coinfection affects the natural history of chronic hepatitis B or hepatitis C.
LAPAROSCOPIC CHOLECYSTECTOMY: AN AUDIT OF OUR TRAINING PROGRAMME
Authors: Lim Swee Ho , Salleh Ibrahim , Poh Beow Kiong , Tay Khoon Hean
Published: April 2005

Background:  Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practice but it also has an inherently steep learning curve. The training of surgeons in this procedure presents a challenge to teaching hospitals, which essentially have to strike a balance between effective training and safety of the patient. The present study aims first to assess the safety of the structured training programme for this procedure at the Department of Surgery, Changi General Hospital, Singapore. Secondly, it seeks to audit the conversion and bile duct injury rates among the laparoscopic cholecystectomies performed by the department, and the factors which influence these.

Methods:  Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18‐month period were reviewed retrospectively and the relevant data prospectively collected. Demographics, as well as details of cases of conversion to open operation and of bile duct injury were identified and the reasons for each recorded.

Results:  A total of 443 patients underwent laparoscopic cholecystectomy in the 18‐month period. The most common indication for surgery was biliary colic/dyspepsia (61.4%), followed by cholecystitis, cholangitis, pancreatitis and common bile duct stone. The overall conversion rate was 11.5%. Three hundred and fifty‐five patients were operated on by consultant surgeons, while 88 were by registrars who had been through the structured training programme. There was no statistically significant difference found in the conversion rates between these two groups (P = 0.284). Twenty‐two of the 268 female (8.2%) patients had conversion to open operation, while 29 of the 175 male patients (16.6%) underwent conversion (P = 0.007). Amongst cases of cholecystitis and cholangitis, the conversion rate for patients operated on within 7 days of onset of symptoms was 35%, while those operated on 8 or more days later had a conversion rate of 29.7% (P = 0.639). There was a solitary case of bile duct injury among the 443 cases, equating to a bile duct injury rate of 0.23%.

Conclusion:  A structured training programme involving stepwise progression of training, with close supervision by consultant surgeons and a built‐in system of audit can effectively train junior surgeons in laparoscopic cholecystectomy without exposing patients to undue risks.
The use of physical restraints on paediatric intensive care units
Authors: OFOEGBU BIBIAN N. , PLAYFOR STEPHEN DEREK
Published: April 2005

Background : Physical restraints are used in critical care units in an attempt to reduce the risk of treatment interference. Their use remains controversial and there are concerns regarding the effectiveness and safety of restraint techniques. There are few data available on the prevalence of physical restraint use in Paediatric Intensive Care Units (PICU) in the UK and we have therefore conducted a cross‐sectional survey to define current clinical practice.

Methods : A postal questionnaire was sent to all UK PICU with questions on the use of physical restraint techniques, including the use of splints across the joints of limbs and of securing limbs to the bed. Consent issues were also addressed.

Results : Of those units responding 68% reported that physical restraint techniques were used within those units. Ten units (36% of those responding) reported the use of manual holding of patients, 16 units (57% of those responding) reported the use of splints across the joints of limbs, three units reported the use of swaddling as a restraint technique while one unit secured limbs of patients to the bed. None of the units obtained written consent prior to the use of physical restraints and 53% obtained verbal consent.

Conclusions : Physical restraint is a commonly used technique on PICU in the UK. There is considerable variation in clinical practice and current clinical guidelines which are available do not deal specifically with children. Prospective randomized trials would be necessary to fully investigate the role of physical restraints amongst critically ill children.
Women's Gendered Identities and the Restructuring of Rural Alberta
Authors: Heather Barbara , Skillen Lynn , Young Jennifer , Vladicka Theresa
Published: April 2005

Research conducted in rural Alberta from 200–2001 captured women's accounts of their lives after restructuring in the health and agriculture sectors during the 1990s. Thirty‐four public health nurses, home care nurses, and farm women from three Alberta health regions were interviewed individually and in focus groups which covered five Alberta health regions. The women reported that restructuring had affected their decisions, their organization of paid and unpaid work, and the quality of their lives. Rural women perceived themselves as caregivers and organizers in their homes and communities. As well, they saw themselves as key figures in the fight to save the farms and the communities in which they lived. While accepting the expectations of rural women, they also expressed frustration and anger over the endless and largely unrecognized, work that resulted. The conflicts between paid and unpaid work, and between the fight to preserve the well‐being of the community and their own well‐being, became particularly clear among the farm women who also worked as nurses. Their sense of themselves as farm women, nurses, and as good community members, led to decisions that in many cases affected their physical and mental health; but they knew that if they did not contribute, they risked losing the way of life they valued. While patriarchal power inherent in social structures has been well documented, we argue theoretical explanations that incorporate the power of agency to place women in situations where they have little choice in the reproduction of their own oppression have not been sufficiently recognized in the literature.
Bluebells and Bias, Stitchwort and Statistics
Authors: Du Feu Chris
Published: April 2005

Infants are not too young to engage in real, useful statistical work. This activity allowed comparisons between distributions of two species of flowers in three different habitats.
Constructivism in the Statistics Classroom: From Theory to Practice
Authors: Mvududu Nyaradzo
Published: April 2005

This article discusses the theory and practice of constructivism and suggests a way to move from the theory into the practice of it.
Variation as Unalikeability
Authors: Perry Mike , Kader Gary
Published: April 2005

This article discusses concepts of variability and suggests a possible alternative measure that appears to support some students’ intuition.
Population in Motion: Salvadorean Refugees and Circulation Migration
Authors: BAILEY ADRIAN J. , HANE JOSHUA G.
Published: April 2005

The profound socio‐political crisis in El Salvador fully revealed itself in the events of 1979 and 1980, developing into an open civil war beginning on 10 January 1981. The conflict generated a series of profound changes in the social structure of the country (Segundo Montes, 1988:107).
Symbiosis Between Slavery and Feminism in Gertrudis Gómez de Avellaneda's Sab?
Authors: PASTOR BRIGIDA
Published: April 2005

Abstract— Gertrudis Gómez de Avellaneda's novel Sub (1841) has been subject to many interpretations. Early criticism considered it as little more than a sentimental and shocking romantic story: the impossibly unconventional love of a black slave for a white woman. Later critics'have sought to establish Snb as a pioneering antislavery novel. This article will attempt to demonstrate that Avellaneda's main purpose was not to narrate a doomed love, nor to present a denunciation of slavery, but to express her feminist ideology, establishing the parallelism between the situation of black slaves and the oppression of white women in the bourgeois society of her time. However, we cannot say that Avellaneda created a symbiosis between slavery and feminism; the theme of slavery is only a metaphor, doubly shocking because it exposes her own emancipating ideas in an oppressive society that did not forgive those voices ivhich dared to transgress its norms. 0 1997 Society for Latin American Studies.
Local Politics and Depolitisation in Chile
Authors: PONT‐LEZICA DIANA MOSOVICH
Published: April 2005

Abstract—This study focuses on the consequences at the local level of decentralisation and state disengagement policies in Chile. We proceed in two stages. First, we analyse whether the nature of urban collective goods and services has changed from political to economic. Next, we study the effect of these policies on community/ authority relations, and more broadly, on local politics. A case study of the city of Conception serves to explore our questions. We conclude that the local community has adapted to the economic nature of collective goods and has developed the necessary organisation, technical and leadership skills. Power politics however have not disappeared but are now in higher institutional levels. Politicians do not seem to have followed the trend and thus have still to open to democratic participation and legitimate representation as expressed by the citizens' aggregated interests.
The Recent Appearance of Favelas in São Paulo City: an Old Problem in a New Setting
Authors: LLOYD‐SHERLOCK PETER
Published: April 2005

Abstract— While favelas have been an important feature of many Brazilian cities over the past 50 years, they were relatively insignificant in São Paulo until the mid‐ 1970s. Since then, São Paulo's favelas have experienced a dramatic expansion and some estimates now put their total population in the region of two million. This article examines potential explanations for this sudden change, including migration, changes in the housing market, relative prices and state intervention.
Export Growth and Development to Poor Rural Regions: a Meso‐Scale Analysis of the Upper Limari
Authors: GWYNNE ROBERT N. , ORTIZ JORGE
Published: April 2005

Abstract
—
The aim of this article is to explore the recent social and economic evolution of a rural region that was formerly one of the poorest in Chile but has been transformed by a productive specialisation in table grapes for export markets. The region is that of the Upper Limari in Chile's semi‐arid Norte Chico. The analysis focuses on changes in four interrelated variables: productive investments; land markets; labour markets; and population distribution. Rapid growth in investment, the emergence of dynamic land markets, dramatic increases in labour productivity have transformed the agricultural sector. Small‐scale farming has survived poorly due to lack of capital, technical problems and lack of bargaining power with the international fruit companies. The large‐scale farmers have enjoyed better conditions and a reconcentration of land has occurred. However, the emergence of new productive activities in an area where labour alternatives have been historically scarce has provided new sources of income. Population is increasing in rural settlements linked to irrigated agroexportation and quality of life indicators have improved. Rural depopulation is not a feature of the region as a whole.
Exports and terms of trade in Argentina, 1811–1870
Authors: NEWLAND CARLOS
Published: April 2005

Abstract
—
This research note analyses the evolution of the Argentine external sector between 1811 and 1870. New series of exports and terms of trade are presented. These show the vulnerability of the economy to external and internal shocks, but also the continuous growth of total exports and per capita exports along the period.
Race in the Andes: Global Movements and Popular Ontologies
Authors: WEISMANTEL MARY , EISENMAN STEPHEN F.
Published: April 2005

Abstract
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Race, long discounted in Andean ethnography as relatively unimportant, is a social fact of great salience in the Andes. This essay introduces the articles in the special issue on race in the Andes with an overview of the interrelated intellectual histories of racism in the Andes, Europe and North America, from colonial proto‐racism, to the totalising theories of the 19th century, to the heterogeneous ‘neo‐racism’ found in the Andes today, in which both these earlier ideas and contemporary cultural racisms are at home. It concludes with a discussion of an oppositional ideology found in some indigenous communities, in which race is somatic but not biological in origin.
Defining Folklore: Mestizo and Indigenous Identities on the Move
Authors: MENDOZA ZOILA S.
Published: April 2005

Abstract –

This article analyses how the performance of folkloric music and dance defines and redefines ethnic/racial distinctions and identities in the Andes. It focuses on the promotional activities of urban‐based institutions in Cusco called instituciones culturales, particularly how these activities have shaped folkloric performance. The article calls attention to the continuing importance of race as a central category of social differentiation, showing how folkloric performances embody ethnic/racial identities.
‘Dirty Indians’, Radical Indígenas, and the Political Economy of Social Difference in Modern Ecuador1
Authors: COLLOREDO‐MANSFELD RUDI
Published: April 2005

Abstract
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This article examines alternative conceptions of social difference in Otavalo, Ecuador. On the one hand, in the northern Andes, the language of ethnicity has become a potent force, connected to an indigenous political movement and the profits of handicraft dealing. On the other, ‘race’ and an ‘hygienic racism’ preoccupied with pernicious stereotypes about ‘dirty Indians’ continue to define the social and political landscape. Contrasting these notions of social difference, I show how the indigenous movement in Ecuador receives less support from native peasants who see the world in polarised ‘racial’ terms.
Counter‐insurgency strategy, the PCP‐Sendero Luminoso and the civil war in Peru, 1980–1996
Authors: TAYLOR LEWIS
Published: April 2005

Abstract—This paper examines the main trends occurring in the counter‐insurgency campaign waged since 1980 by the Peruvian state against the Partido Comunista del Perú‐Sendero Luminoso. The argument is structured around the counter‐insurgency model advocated by Robert Thompson, which is employed to illustrate how and why the Peruvian state was losing the civil war in the 1980s and has registered a far greater degree of success in the 1990s.
From dictatorship to democracy: the US and regime change in Paraguay, 1954–1994
Authors: MORA FRANK O.
Published: April 2005

Abstract— This paper seeks to analyse the external sources of democratisation in Paraguay, specifically how the US contributed to regime change in that country. In the small and vulnerable countries of Latin America, like in Central America, the Dominican Republic, Haiti, and Paraguay, where the US played a portentous role in the rise, consolidation and demise of authoritarian regimes during the Cold War, Washington has also rendered a vital, but often neglected role, in protecting and enhancing democratic rule. This paper also provides an analysis of the different forms of leverage exercised by the US before and during Paraguay's transition.
Religion and the Media in a Battle for Ideological Hegemony: the Universal Church of the Kingdom of God and TV Globo in Brazil
Authors: BIRMAN PATRICIA , LEHMANN DAVID
Published: April 2005

Abstract –Starting out from a celebrated 1995 controversy which arose from a late‐night incident on Brazilian TV, the relationships between neo‐Pentecostalism and established culture are explored. Taking into account traditions of legal rhetoric and of political adherence, the paper shows that what appears at one level as a religious conflict is at another level a conflict over political power, over the rhetoric and imagery of power, and for control of the popular imaginary.
Theory, Practice and‘External Actors’in the Making of New Urban Social Movements in Brazil
Authors: ASSIES WILLEM
Published: April 2005

Abstract
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Spontaneity and authenticity have often been key words in the analysis of the‘new urban social movements’that emerged in Brazil in the course of the 1970s. The movement discourse was often taken at face value and the involvement of other than‘popular’institutional and social actors tended to be concealed. Though in some analyses attention has been directed to the role of the Catholic Church and other institutional actors, very little has been said about the personnel involved and their class position. This article focuses on the latter aspect and in this manner draws attention to the role of segments of the emerging new middle classes in the social construction of the movements. It is argued that processes of professional affirmation in the context of the political conjuncture of the democratisation process contributed to a radical politicisation of segments of the emerging new middle classes. Such processes were related to the theoretical reflection on the new movements and the emergence of a‘militant perspective in research’which imbricated with the development of grassroots activism, amplified its impact, and furthered expectations over its role in the democratisation process. It thus contributed to the shaping of the movements. With the return to civilian rule and the changing configuration of state‐society relations the relations between middle class and popular grassroots activism changed and this initially reflected in disenchanted accounts of the new movements and their failure to live up to expectations. Analysis of such processes provides an insight into the epistemo‐politics of research and theory production on social movements.
Restraining Women: Gender, Sexuality and Modernity in Salvador da Bahia
Authors: McCALLUM CECILIA
Published: April 2005

Abstract
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The paper explores constructions of masculinity and feminity in the speech and practice of residents of a low‐income settlement in Salvador, Bahia. In local talk about sexual mores and parenting, the dominant theme is the ‘liberal’ and ‘decadent’ character of the modern age. Modernity is equated with a loss of social control over female sexuality and reproduction. Embedded in this vision is a powerful gender ideology that conditions the construction of gender identities. Analysis reveals that the negotiation of identity is a complex and contested field. But against the postmodernist trend in contemporary gender studies, the paper argues that it is necessary to locate multiple and contested gender identities in the overarching gender system. This is rooted in gender ideology, in sexual practice and in the systematic features of social and economic life. Far from signalling transformation in the gender system, talk about women's loss of restraint and respectability functions as a brake upon pressure for change.
Technocracy Questioned: Assessing Economic Stabilisation in Nicaragua
Authors: GESKE DIJKSTRA A.
Published: April 2005

Abstract
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The Chamorro government (1990–1996) has finally achieved stabilisation in Nicaragua. At first sight, this government has been a classic example of technocracy, implementing stabilisation and structural adjustment policies as recommended by the IMF and the World Bank. The paper argues that the IMF and the World Bank did have a considerable influence on economic policies, but that these policies suffered from limitations. The priority of internal stabilisation implied that insufficient attention was paid to the external balance, and the liberalisations and privatisations did not create a competitive market economy, but tended to favour a small group. Furthermore, the foreign aid that accompanied the programmes permitted this discretionary government behaviour.
A Grass Roots View of Religious Change Amongst Women in an Indigenous Community in Chiapas, Mexico
Authors: ROSTAS SUSANNA
Published: April 2005

Abstract
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This paper discusses the changing position of women in an indigenous community in Chiapas, Mexico. It argues that women are gaining new agency and an increased pride in their ethnicity as they become members of the various sects that are taking root in the community. Affiliation to a sect provides them with an institution that they can call their own thus satisfying their felt need to be part of the longer‐term economic and political changes that are occurring while still being shielded from them.
From Family Feud to Organised Crime: The Cultural Economy of Cannabis in Northeast Brazil
Authors: BICALHO ANA MARIA DE SOUZA MELLO , HOEFLE SCOTT WILLIAM
Published: April 2005

Abstract
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Traditional family feuding and banditry as well as envy‐inspired violence associated with capitalised irrigation have been intensified by the introduction of cannabis farming and organised crime in the Sertão of Northeast Brazil to the point that today the cannabis producing zone is one of the most violent places in the world. These three interrelated forms of contemporary violence arose, respectively, in the pre‐1940 frontier setting, in the 1940 to 1980 period of rapid Brazilian industrialisation which depressed peasant sectors and stimulated the rise of capitalised irrigation and in the post‐1980 period of economic stagnation and social‐political crisis in Brazil which depressed consumer markets and induced the State to liberalise foreign trade policy to the detriment of periphery regions like the Northeast.
When Oil Prices were Low: Petroleos de Venezuela (PdVSA) and Economic Policy‐making in Venezuela since 1989
Authors: PHILIP G.
Published: April 2005

Abstract
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There has been a considerable literature on the role of institutions in economic performance in general, in Latin America as a whole, and in Venezuela in particular. Venezuelan state institutions have been seen as highly patrimonialist and poorly performing, despite the advantages of long‐standing democracy and large‐scale resource wealth. This discussion calls attention to the highly significant ‘special case’ of the oil sector where the state company, PdVSA, has been bureaucratically autonomous and relatively efficient. Such a situation creates rather unusual policy‐making problems given the fact that the economy is structured around oil income, in many respects to its disadvantage. There has been a considerable literature on economic policy reform in Venezuela which has hardly mentioned the oil sector at all. This article discusses the oil industry under Presidents Perez (1989–93) and Caldera (since 1994) to rectify the balance and to use insights derived from the study of the oil sector to offer some fresh perspectives on Venezuelan political history since 1989.
Law and Disorder: The Brazilian Landless Farmworkers' Movement
Authors: HAMMOND JOHN L.
Published: April 2005

Abstract
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The Brazilian Landless Farmworkers' Movement (MST) occupies idle farmland and demands that it be expropriated under the terms of Brazil's agrarian reform law. The MST uses illegal tactics in the field to force the government's hand and at the same time asserts its legitimacy with legalism and invocation of public sentiment in favor of land reform. It confronts repression promoted by the landowning class and increasingly from the state itself. Through the combination of militant and legal tactics it has won expropriation of many farms and turned them into successful agricultural enterprises.
Civil and Uncivil Actors in the Guatemalan Peace Process
Authors: KRZNARIC ROMAN
Published: April 2005

Abstract This paper examines the Guatemalan peace process by focusing on different actors in civil society. It considers the peace negotiations between the government/ military and the guerrillas, rather than the realm of electoral procedures, to be the main locus of political transition. Challenging the work of many elite‐centred theorists of democratisation who claim that civil society is an ephemeral and largely insignificant actor in transitions, the analysis considers both popular actors and business associations, one of the major‘ uncivil’ actors in Guatemalan civil society, and shows that civil society can have an impact on transitions on multiple levels. In attempting to explain the degree of impact, the paper illustrates the need to examine both the surrounding political opportunity structure and internal factors such as organisation, strategy and leadership.
Homosexuality and the Repression of Intellectuals in Fresa y chocolate and Máscaras
Authors: WILKINSON STEPHEN
Published: April 2005

Abstract The aim of this article is to examine and compare how the repression of homosexuals and intellectuals is portrayed in two recent Cuban fictional narratives: the film, Fresa y chocolate (Strawberry and Chocolate) (Gutierrez Alea et al., 1993) and the detective novel, Mascaras (Masks) (Padura Fuentes Mascaras, Tusquets, Barcelona, 1997). It discusses how these narratives document the history of both these phenomena and evaluates how they might contribute to a better understanding of the process of fundamental social and cultural transformation which the Revolution is experiencing following the collapse of the Soviet Union.
The Political Constraints on Economic Policy in Post‐1982 Mexico: The Case of Pemex
Authors: PHILIP GEORGE
Published: April 2005

AbstractFourteen years of market‐oriented reform in Mexico have led to many economic changes. However during 1982–1994 there was relatively little change in the hydrocarbon sector. This article seeks to explain the slowness of reform essentially in political terms. While political constraints on reforming the hydrocarbons sector were genuine, it is also clear that the De la Madrid and Salinas governments chose to avoid controversial decisions in this sector as far as possible. Risk aversion seems, at least in this context, to have been a characteristic of Mexican authoritarianism during 1982–1994. Because of the inherent importance of the oil and gas sector to the Mexican economy, the slow growth of production since 1982 (largely resulting from extreme policy caution) provides a part of the explanation for the slow growth of the Mexican economy as a whole.