bluuebunny/crossref_metadata_2025 huggingface dataset:
Disorders of Androgen Synthesis – from Cholesterol to Dehydroepiandrosterone
Authors: Miller Walter L.
Published: August 2005

Androgens and estrogens are primarily made from dehydroepiandrosterone (DHEA), which is made from cholesterol via four steps. First, cholesterol enters the mitochondria with the assistance of the steroidogenic acute regulatory protein (StAR). Mutations in the StAR gene cause congenital lipoid adrenal hyperplasia (lipoid CAH), a potentially lethal disease in which virtually no steroids are made. Lipoid CAH is common among Palestinian Arabs and people from eastern Arabia, and among Korean and Japanese people. Second, within the mitochondria, cholesterol is converted to pregnenolone by the cholesterol side chain cleavage enzyme, P450scc; disorder of this enzyme is very rare, probably due to embryonic lethality. Third, pregnenolone undergoes 17α-hydroxylation by microsomal P450c17. 17α-Hydroxylase deficiency, manifesting as female sexual infantilism and hypertension, is rare except in Brazil. Finally, 17-OH pregnenolone is converted to DHEA by the 17,20 lyase activity of P450c17. The ratio of the 17,20 lyase to 17α-hydroxylase activity of P450c17 determines the ratio of C21 to C19 steroids produced. This ratio is regulated posttranslationally by at least three factors: the abundance of the electron-donating protein P450 oxidoreductase (POR), the presence of cytochrome b5 and the serine phosphorylation of P450c17. Mutations of POR are a new, recently described disorder manifesting as the Antley-Bixler skeletal dysplasia syndrome, and a form of polycystic ovary syndrome.
Mutations Associated with Beta-Thalassemia intermedia in Kuwait
Authors: Adekile Adekunle , Haider Mohammad , Kutlar Ferdane
Published: August 2005

Objective: To identify the β-globin gene mutations associated with β-thalassemia (β-thal) intermedia in Kuwait. Subjects and Methods: Eighteen patients from 13 unrelated families, mean age 12.7 ± 8.1 years, range 4–31 years, were involved in the study. They did not require regular blood transfusion. Complete blood count and cation exchange high-performance liquid chromatography hemoglobin quantitation were carried out using standard techniques. β-Thal mutations were identified with a combination of PCR amplification, allele- specific oligonucleotide hybridization or direct DNA sequencing. The patients were also screened for the α2-globin gene (–3.7 kb) deletion. Results: Of the 13 families, 4 were homozygous for the IVS-I-II (G→A) and 4 for the IVS-I-6 (T→C) mutations, while 1 each was a compound heterozygote for the following mutation combinations: CD 8 (–AA) and –101 (C→T); IVS-I-6 (T→C) and CD 19 (A→G); IVS-II-1 (G→A) and –28 (A→C); IVS-I-110 (G→A) and δβ⁰ deletion. Therefore, homozygosity for two typically mild mutations (IVS-II-1 and IVS-I-6) accounted for 61% of the genotypes in our patients. Conclusion: Our results indicate that screening should commence with these two common alleles in Kuwaiti patients presenting with β-thal syndrome. Early identification of intermedia patients will avoid the complications following an unnecessary hypertransfusion program.
Alpha-2-Globin Gene Polyadenylation (AATAAA→AATAAG) Mutation in Hemoglobin H Disease among Kuwaitis
Authors: Haider M. , Adekile A.
Published: August 2005

Objectives: In the Arabian Gulf region, hemoglobin (Hb) H disease usually results from homozygosity or compound heterozygosity involving the α2-globin gene polyadenylation (poly A) signal (AATAAA→AATAAG) mutation (αTα). Here we document the clinical and hemato logical characteristics of children with Hb H disease being followed in Kuwait. Subjects and Methods: Twenty-four patients (0.5–12 years old, mean 4.7 ± 3.5 years) with persistent microcytic, hypochromic anemia (and normal iron status as well as normal Hb A2 levels) were referred to the pediatric hematology clinic for further investigations. They were all screened for the α+-thalassemia (α+-thal; –3.7 kb) deletion using a standard PCR method. They were also screened for the α2-globin gene αTα allele and the 5nt deletion (–α5nt) in the first intervening sequence, which are common α-thal alleles in this population. They were followed up for periods ranging from 2 to 8 years. Results: Of the 24 patients, 4 (16.7%) also had sickle cell trait (Hb-AS), while 7 (29.2%) were glucose-6-phosphate dehydrogenase deficient. Only 1 patient had significant hepatosplenomegaly and 1 developed gallstones. While none was on chronic transfusion therapy, 8 (33.3%) had been transfused at least once and, in 3 instances, this was secondary to parvovirus B19 +ve aplastic crisis. The α-globin genotype was successfully determined in almost all patients. The results showed that 17 (70.8%) patients were homozygous for the poly A mutation (αTα/αTα), 6 (25.0%) were compound heterozygotes for this and the α+-thal (–3.7 kb) deletion (–α/αTα) and 1 (4.2%) was undetermined. There were no significant differences in the phenotypes of the 2 genotypes and their hematological features were identical. Conclusions: Hb H disease involving the poly A mutation is a mild thal intermedia phenotype among Kuwaitis. There are no serious complications and there is no need for regular blood transfusion.
Phenotypic and Molecular Characterization of Candida dubliniensis Isolates from Clinical Specimens in Kuwait
Authors: Ahmad Suhail , Mokaddas Eiman , Al-Sweih Noura , Khan Zia U.
Published: August 2005

Objective: This study was carried out to characterize Candida dubliniensis using phenotypic and molecular methods and to determine the occurrence of C. dubliniensis in clinical specimens in Kuwait. Materials and Methods: A total of 880 clinical specimens for isolation of fungi were processed according to standard procedures. Of these, 390 germ-tube-positive clinical isolates of Candida species were examined for rough colonies with hyphal fringes and chlamydospore production on simplified sunflower seed agar for their presumptive phenotypicidentification as C. dubliniensis. The identification of C. dubliniensis isolates was further confirmed by the Vitek 2 yeast identification system, semi-nested (sn) PCR amplification of high-copy rDNA and direct DNA sequencing of the internally transcribed spacer 2 (ITS2) region. Results: Of the 390 isolates of Candida species investigated, 12 were identified as C. dubliniensis, giving an overall occurrence of 3%. All the C. dubliniensis isolates formed rough colonies with hyphal fringes and abundant chlamydospores on sunflower seed agar, did not assimilate trehalose, lactate and α-methyl-D-glucoside, and were isolated from human immunodeficiency virus (HIV)-negative patients. Four C. dubliniensis isolates utilized D-xylose. The species-specific primer derived from the ITS2 sequence of C. dubliniensis and used together with the panfungal reverse primer in the reamplification step of the snPCR specifically amplified rDNA from reference and clinical C. dubliniensis isolates and not from C. albicans or other Candida species. The identity of two representative isolates was confirmed by DNA sequencing of the ITS2 region. Conclusions:The identity of 12 C. dubliniensis isolates was first established by phenotypic characteristics and then by snPCR using species-specific primers derived from ITS2 sequences. The recovery of C. dubliniensis from HIV-negative patients from Kuwait reinforces the existing view that this novel yeast species has a worldwide distribution and its occurrence is not restricted to any particular immunocompromised population.
Instability of Chimaeric Antibody Secretion by Anti-Carcinoembryonic Antigen Producing Hybridoma Cells after Gene Targeting
Authors: El-Abdallah Abir A. , Ford Christopher H.J.
Published: August 2005

Objective: To produce a chimaeric version of the 11-285-14 anti-carcinoembryonic antigen (CEA) monoclonal antibody using a gene targeting approach. Materials and Methods: A replacement vector was constructed to insert the human constant γ1 gene within the mouse heavy chain locus of 11-285-14 hybridoma cells. The mouse constant γ1 gene (1.5 kb) and the mouse µ intron fragment (2.2 kb) were amplified by PCR and cloned into a pKO Scrambler vector. The human constant γ1 gene fragment (2.2 kb) was cloned next to the intron fragment. Resistant colonies were screened by ELISA for the presence of the human isotype in their supernatants. Results: Of the 4,370 resistant colonies obtained, 87 colonies showed secretion of the human isotype at levels between 4 and 32 ng/ml. PCR and Southern blot results confirmed the correct integration of the human gene by homologous recombination within the heavy chain locus. Most of the producers ceased to express the human isotype within a few weeks after the initial positive ELISA results. Instability of secretion could not be explained by genetic instability in all the clones, which suggests the presence of other undefined epigenetic or physiologic mechanisms. Conclusion: Gene targeting resulted in transformants with unstable and low production rates of chimaeric anti-CEA antibody.
Very-Long-Chain Fatty Acids Activate Lysosomal Hydrolases in Neonatal Human Skin Tissue
Authors: Dhaunsi Gursev S. , Al-Essa Mazen , Muawad Wisam , Srivastava Braham S. , Rashwan Nabil
Published: August 2005

Objective: The aim of this study was to examine the in vitro effect of peroxisomal dysfunction on lysosomal enzymes, the autophagic machinery in the cell, in order to understand the mechanisms of pathogenesis of peroxisomal disorders. Materials and Methods: Foreskin samples were obtained immediately after circumcision of 1- to 2-day-old infants at the Maternity Hospital, Kuwait. Skin tissues were cleaned, cut into slices of 1–2 mm2 in size and treated with lignoceric acid (1–20 µg/ml), a very-long-chain fatty acid (VLCFA), in the presence or absence of 1–5 mM aminotriazole (ATZ). A battery of lysosomal enzymes were assayed following treatment of dermal tissue with VLCFA or ATZ. Results: Treatment of skin slices with lignoceric acid significantly increased (p < 0.001) the enzymic activities of acid lipase, acid phosphatase, α-glucosidase, α-galactosidase, N-acetyl-α-D-glucosaminidase (NAGA) and N-acetyl-α-D-galactosaminidase (NAGTA). ATZ (1–5 mM), an inhibitor of key peroxi somal enzyme catalase, also markedly increased the enzymic activities of acid phosphatase, α-glucosidase (23%) and α-galactosidase (18%) without any significant effect on NAGA or NAGTA. Western blot analysis further revealed that both VLCFA and ATZ significantly increased the protein expression of lysosomal enzymes, β-galactosidase and β-glucuronidase. Conclusion: Experimen tal dysfunction of peroxisomes mimicked by elevated VLCFA or ATZ-mediated catalase inhibition significantly increased the activities of lysosomal hydrolases in human dermal tissue, suggesting that activation of the lysosomal system could be one of the factors responsible for cellular damage during pathogenesis of peroxisomal diseases.
Chemotherapy-Induced Emesis in Elderly Cancer Patients: The Role of 5-HT3-Receptor Antagonists in the First 24 Hours
Authors: Aapro Matti , Johnson Judi
Published: August 2005

Objective: This review highlights the need to optimize 5-HT3-receptor-antagonist-based antiemetic therapy for elderly cancer patients, particularly during the first 24 h after receiving chemotherapy, based on knowledge of the chemotherapeutic regimen, comorbidity, polypharmacy, dosing convenience and age-related health. Background: The proportion of elderly people (over 65 years of age) in the general population is increasing. Compared with the general population, elderly people have a greater risk of serious diseases, such as cancer and cardiovascular disease. Their chemotherapy can be compromised by factors including comorbidity, declining organ function, polypharmacy, drug–drug interactions and cognitive impairments. The use of aprepitant in this elderly population with many concomitant medications is not discussed. Many chemotherapeutic regimens are highly emetogenic, and nausea and vomiting are rated among the most distressing side effects of chemotherapy. The emetogenic potential of various chemotherapy regimens is reviewed, demonstrating clear differences in severity and time of symptom onset. Such differences are particularly important during the first 24 h after administration, when control of emetic symptoms can help to prevent the occurrence of subsequent episodes. The matter is further complicated by inter-patient differences in susceptibility to nausea and vomiting resulting from multiple factors including gender, age and alcohol intake. Individual patient evaluation is essential to identify those patients most at risk. Elderly patients may also be particularly sensitive to the serious physiological and physical effects of nausea and vomiting. Education about symptom management needs to recognize specific learning barriers in the elderly, such as declining sensory perception or cognitive impairment. 5-HT3-receptor antagonists have long been the gold standard for treating chemotherapy-induced nausea and vomiting. Pharmacological differences between 5-HT3-receptor antagonists suggest the need for careful consideration of individual patient characteristics. Selection of the most appropriate agent will optimize antiemetic therapy for elderly cancer patients. Conclusion: Chemotherapy-induced emesis in elderly cancer patients needs optimal control by a 5-HT3-receptor antagonist with uncomplicated 24-hour efficacy and good tolerability. Choosing a 5-HT3-receptor antagonist with a long duration of action, low risk of drug–drug interactions and once-daily dosing is important to ensure effective prophylaxis against nausea and vomiting in the elderly and simplify management for patients with cognitive impairment, declining organ function and comorbidity.
Evaluation of the Nucleolar Organizer Regions in Alzheimer’s Disease
Authors: Dönmez- Hamiyet , Akalın Hilal , Karaman Yahya , Demirtaş Halil , İmamoğlu Nalan , Özkul Yusuf
Published: August 2005

Background: Alzheimer’s disease (AD) is a neurodegenerative disorder in middle and late age. Ribosomal RNA (rRNA) genes are located in the nucleolus (nucleolar organizer regions = NORs). There are increased deposits of β-amyloid protein in the brains of the patients with AD and aged individuals with Down’s syndrome (DS). The β-amyloid gene is located in the acrocentric chromosome 21 that is responsible for rRNA synthesis. Therefore, it is possible that there is a relationship between ribosomal genes and AD. Objective: To investigate the activities of ribosomal genes of AD patients by comparing the activities of NORs in AD patients and healthy controls with the silver-staining method. Methods: NOR surface/the total nucleus surface proportions in interphase nuclei, and silver stainability and satellite association (SA) of acrocentric chromosomes in the metaphases of cultivated lymphocytes of 20 AD patients and 20 healthy controls (10 elderly and 10 young) were evaluated. Results: A decrease in NOR surface/total nucleus surface proportions has been observed in the interphase nucleus of AD patients when compared with elderly controls (p = 0.035). When compared with the sizes of Ag+ segments of acrocentric chromosomes of AD patients and control groups, the Ag-staining size 1 of the chromosome 22 of AD patients was found to be more increased than that of the young controls (p = 0.018). There was no statistically significant difference between AD patients and control groups regarding the number of Ag+ acrocentric chromosomes, Ag+ chromosome 21 and SA frequency (p > 0.05). It has been found that there is only a slight increase in the total number of chromosomes in SA in AD patients when compared with elderly controls (p = 0.05). Conclusion: The decrease in NOR surface/total nucleus surface proportions of AD patients may indicate a reduction in the activity of the ribosomal genes of these patients.
Oral Amino Acids in Elderly Subjects: Effect on Myocardial Function and Walking Capacity
Authors: Scognamiglio Roldano , Piccolotto Roberto , Negut Christian , Tiengo Antonio , Avogaro Angelo
Published: August 2005

Background: With advancing age the risk of developing serious nutritional deficiencies increases, and disturbances to the actions of insulin and insulin-like growth factor, coupled with reduced protein/amino acid (AA) intake, impair protein synthesis in muscles. Objective: To assess the effects of administering oral AAs on walking capacity and perceived walking impairment, isometric muscular strength, and myocardial function at rest and during isometric exercise. Methods: One hundred elderly subjects (aged >65 years) with reduced physical activity were randomized to receive an oral AA mixture (12 g/day) or placebo for 3 months. At baseline and after 3 months of therapy we assessed physical capacity with the 6-min walk test, and perceived physical impairment with the walking impairment questionnaire (WIQ); we assessed maximal isometric muscular strength of the right hand with a handgrip dynamometer, and left ventricular ejection fraction (LVEF) using quantitative two-dimensional echocardiography at rest and during acute overload. Results: Three months of AA treatment resulted in significant increases in 6-min walk distance (268.8 ± 34.9 vs. 212 ± 40 m, p < 0.001), WIQ scores (distance: 68.3 ± 12 vs. 53 ± 14.8%, p < 0.001; speed: 72.2 ± 14.4 vs. 52.8 ± 12%, p < 0.001; stairs: 98.2 ± 24 vs. 72.4 ± 22%, p < 0.001), and in maximal muscular isometric strength (20.2 ± 2 vs. 14 ± 2.8 kg, p < 0.001). Moreover, peak stress LVEF was higher during AA administration when compared to placebo administration (67 ± 7 vs. 56 ± 9%, p < 0.01). Left ventricular response to exercise normalized during AA administration in 24 out of 32 (75%) patients with abnormal LV response at baseline, whereas it remained unchanged in the placebo group. Conclusion: An oral AA supply such as that used in this study improves ambulatory capacity, maximal isometric muscle strength and myocardial ability to match an acute overload in elderly subjects without affecting the main metabolic parameters. These functional gains may translate into increased perceived walking capacity.
Homolateral Hand and Foot Coordination in Trained Older Women
Authors: Capranica Laura , Tessitore Antonio , Olivieri Berardo , Pesce Caterina
Published: August 2005

Background: Age-related deterioration in homolateral hand and foot coordination might be due to the combined effects of aging and a sedentary lifestyle. Unfortunately, there is a lack of information regarding the effects of training programs on coordinated inter-limb behavior with advancing age. Objective: The aim of the present study was to verify differences in homolateral hand and foot coordination between trained and untrained older women. Methods: Fifteen sedentary older women were matched in age (61–70 years) with 15 older women who had trained for at least 7 years with 3 one-hour sessions/week of rhythmic gymnastics. The subjects performed simultaneous flexions and extensions of the homolateral wrist and ankle in the sagittal plane at a 1:1 ratio. Two homolateral conditions (preferred and non-preferred limbs) were tested in two coordination modes: in-phase (isodirectional) and anti-phase (non-isodirectional) at three test frequencies (80, 120, and 180 bpm, respectively). The time of correct execution within a maximum of 60 s was recorded for each test condition. Results: Sedentary older women maintained the required movements for a shorter time than older gymnasts, especially with increasing execution frequency and in the anti-phase condition. Older gymnasts showed no negative effects of increasing frequency on coordination performance in the in-phase mode, and frequency-related performance decrements of lower magnitude than sedentary older women in the anti-phase mode. Conclusion: The present results indicate that the beneficial effects of rhythm-based training can be better understood when both the spatial and temporal constraints of the inter-limb coordination performance are considered. In fact, trained women largely succeeded in maintaining temporal constraints of in-phase inter-limb coordination even at the highest execution frequency, whereas sedentary women performed worse than trained women already at the lowest frequency. Furthermore, only trained women still succeeded in the anti-phase conditions. Thus, it appears that regular and prolonged practice of rhythmic gymnastics enhances inter-limb performance over both a sedentary lifestyle as well as ageing.
Dependence of Mini-Nutritional Assessment Scores with Age and Some Hematological Variables in Elderly Institutionalized Patients
Authors: Alves de Rezende Carlos Henrique , Marquez Cunha Thúlio , Alvarenga Júnior Valter , Penha-Silva Nilson
Published: August 2005

Background: Nutritional imbalance is a serious problem in developing countries, especially for the older population, which makes simple and rapid instruments for nutritional evaluation very necessary in order to have a detailed picture of the undernutrition epidemiology in those places. Objective: This work aimed to evaluate the nutritional status of elderly institutionalized patients by use of the Mini-Nutritional Assessment (MNA) test and compare the MNA scores with some hematological variables. Methods: We performed a cross-sectional study in elderly institutionalized patients (153) of all nursing homes in the Brazilian city of Uberlândia, using the MNA questionnaire and quantitative analysis of erythrocytes, hematocrit, hemoglobin, serum iron and transferrin. The subjects were classified by gender, nutritional state and age range. The nutritional categories were compared by analysis of variance and the dependence between the considered variables was tested with the Spearman correlation analysis. Results: 60% of the subjects were female. The average age was 74.6 ± 9.5 and 78.5 ± 9.5 years for male and female individuals, respectively. 18.3% of the patients presented undernutrition, 45.7% presented risk of undernutrition, and 36.0% were well nourished. These three nutritional categories showed statistically significant differences among the MNA scores, age and all the hematological parameters, for the sum of both genders, but not for the age, iron and transferrin values of the male individuals and hematocrit and hemoglobin values of the female patients. Significant differences between genders were not observed only for the MNA and transferrin values. MNA values presented positive correlations with erythrocytes, hematocrit, hemoglobin, and serum iron levels, and also a negative correlation with age, which was attributed to a worsening of the nutritional state with age. Conclusion: Based on the MNA, 64% of the elderly institutionalized patients of Uberlândia presented risk of undernutrition and undernutrition, and their nutritional state is aggravating with the age increase, which is consistent with the age-dependent decrease observed in some hematological variables. Since the low MNA scores were not necessarily associated to subnormal mean values of the hematological variables, we can conclude that the low MNA values are predicting situations that still did not manifest pathologically in those variables.
Why Do Older People Report Fewer Headaches?
Authors: Thomas Elaine , Boardman Helen F. , Croft Peter R.
Published: August 2005

Background: We have previously confirmed a clear decline in headache prevalence with increasing age. This parallels the pattern in other painful conditions but the age-related decline in prevalence is greater for headache. Objective: To investigate whether the decline in headache prevalence with age was associated with the elimination of work-related factors, increases in other health problems or concomitant use of pain-relieving medicines. We discuss these and other possible explanations from the literature. Methods: Cross-sectional postal survey to a random sample of 5,000 adults with follow-up by (i) consultations with general practitioners and prescriptions issued during the 12 months subsequent to the survey and (ii) a follow-up postal survey at 12 months. Results: Headache prevalence was similar in working and retired respondents within age strata. Headache sufferers were more likely to consult their general practitioner for any reason (excluding headache) compared with non-sufferers and this was true for each age group. Headache sufferers were also more likely to be frequent consulters compared with non-sufferers in all except the oldest age group (age 66 years and over) where there was no difference. There was a clear increase in prescriptions for analgesics and non-steroidal anti-inflammatory drugs issued with increasing age. There was no difference in the percentage of daily medication users among headache sufferers compared with non-sufferers. Conclusion: Neither retirement from work nor the presence of other health problems account for the decline in headache prevalence with age. Whilst the data on concomitant use of pain-relieving medicines suggest this is also not a major factor in the age-related decline, the high use of such medicines in older age groups means we cannot rule out a link. Evidence from the literature suggests that there may be a number of age-related factors involved including changes in reporting of headache, biochemical changes, and the development of strategies to prevent and manage headaches.
Orthopaedic Injuries following Falls by Hospital In-Patients
Authors: Nadkarni J.B. , Iyengar K.P. , Dussa C. , Watwe S. , Vishwanath K.
Published: August 2005

Background: Falls are one of the most frequent episodes on the hospital wards. Objective: To identify orthopaedic injuries sustained by in-patients falling on the hospital wards and to find out what treatment these required along with the additional time and cost that this incurred. Methods: A retrospective analysis of 900 incident forms and case records was undertaken for a 3-year period. Fractures and other soft-tissue injuries sustained and time, place, and mode of injury were noted. Type of fractures sustained and specific treatment required including operative procedure needed were studied. The cost of each treatment and the total cost in terms of time and money were calculated. Results: We identified 42 patients with orthopaedic injuries; 53% of the falls were recorded on medical wards. A poor pre-fall mobility was an important factor in over 80% of the cases, and a variety of medical conditions pre-existed in the elderly ill patients. Eighteen patients (42%) sustained hip fractures, of whom 15 patients (36%) required surgical treatment. There were 9 deaths in total, 5 of them occurred in patients with hip fractures. The cost of treating the injuries amounted to about GBP 70,000. An additional hospital stay of 56 weeks in total was needed, most patients requiring between 1 and 5 weeks of additional stay. Conclusions: Falls in elderly in-patients can result in a variety of skeletal injuries. These may require major operative procedures and result in significant morbidity and can prove fatal. The treatment of these injuries is a substantial added expenditure to the trust.
Functional Disability Related to Diabetes mellitus in Older Hong Kong Chinese Adults
Authors: Chou Kee-Lee , Chi Iris
Published: August 2005

Objective: To investigate the associations between diabetes and disability in three domains and to determine whether the associations are mediated by diabetes-related complications. Design and Methods: A random representative sample of 2,003 non-institutionalized older Hong Kong Chinese was interviewed. The diabetic status was measured by the self-reported method. Disability was assessed by standardized questionnaire on basic activities of daily living (ADLs), instrumental ADLs, and mobility. Results: 12.3% of our participants reported having diabetes. Older adults with diabetes are more likely to report difficulty in 12 of 15 ADLs than older adults without diabetes. Older adults with diabetes are about twice as likely to report disability in higher functioning tasks only, as well as mobility and higher functioning tasks, and 3.5 times as likely to report disability in self-care tasks with or without any other mobility or higher functioning tasks than those without diabetes, after adjusting for age, gender, marital status and education. Adjustment for diabetic-related medical conditions, the first two associations attenuated slightly, but remained significant, whereas the last one became insignificant. The last results were different from what has been found in previous studies. Conclusion: Diabetes is strongly related to a wide range of disabilities in older Hong Kong adults and the underlying mechanisms might be different for different categories of disability.
A Population-Based Survey of Factors Relating to the Prevalence of Falls in Older People
Authors: Gill Tiffany , Taylor Anne W. , Pengelly Ann
Published: August 2005

Background: Research on older people’s perception regarding their quality of life and services and supports needed to maintain their independence was identified as a priority for the South Australian Department of Health in 2000–2001. This population survey was conducted to examine issues that older persons considered important in the areas of housing, transport, finances and information provision. Objective: The aim of this article is to present the characteristics of community-dwelling older adults who reported falling in the previous 12 months. Method: A random representative sample of community-dwelling adults, living in South Australia, and aged 65 years and over were selected based on a sample from the electronic white pages telephone directory. Overall, 2,619 interviews were conducted (70.5% response rate) using Computer-Assisted Telephone Interviewing technology. Results: Approximately 30% of older adults had experienced a fall in the previous 12 months. The characteristics of people who had fallen included those in the older age groups, with fair or poor general health, whose health had worsened in the last 12 months, with lower socioeconomic status, those born in an English-speaking country, needing assistance at home, and with a home in need of repair. Of the respondents who had experienced a fall in the previous 12 months, 71.8% did not consider that they were at risk of having another fall. Conclusion: There is a wide range of characteristics associated with community-dwelling older adults over the age of 65 who report falling in the previous 12 months. Perceptions of the risk of falling also vary. All factors need to be considered when targeting interventions to reduce the risk of both initial and multiple falls.
Footwear Characteristics and Foot Problems in Older People
Authors: Menz Hylton B. , Morris Meg E.
Published: August 2005

Background:Foot problems are common in older people, however the contribution of incorrectly fitting footwear and heel elevation to the development of foot pain and deformity has not been fully evaluated. Objectives: To examine the relationship between footwear characteristics and the prevalence of common forefoot problems in older people. Methods:Presence of foot pain and deformity were identified in 176 people (56 men and 120 women) aged 62–96 years (mean 80.09, SD 6.42) using a questionnaire and clinical assessment. Shoe fit was determined by comparing length, width and area measurements of shoes with foot measurements. Past and present use of high heels in women was documented, and heel elevation of footwear was measured. Results: Most subjects wore shoes narrower than their feet. Women wore shoes that were shorter, narrower and had a reduced total area compared to their feet than men. Wearing shoes substantially narrower than the foot was associated with corns on the toes, hallux valgus deformity and foot pain, whereas wearing shoes shorter than the foot was associated with lesser toe deformity. Wearing shoes with heel elevation greater than 25 mm was associated with hallux valgus and plantar calluses in women. Conclusion: Incorrectly fitting footwear is common in older people and is strongly associated with forefoot pathology and foot pain. These findings highlight the need for footwear assessment in the management of foot problems in older people.
An Improved Method for Determining Telomere Length and Its Use in Assessing Age in Blood and Saliva
Authors: Lahnert Peter
Published: August 2005

Background: It is disputed whether telomeres shorten with age. Objective: The proposition of this study was to answer this question. Methods: The question was answered by a simple method consisting of a color reaction combined with long-term electrophoresis and weak voltage. Results: The telomeres shorten and the shortening is much higher than previously assumed. Conclusion: The telomere theory of ageing and cancer is corroborated and for the first time it is possible to estimate age in blood or saliva.
The Client Satisfaction Questionnaire: Psychometric Properties in a Dutch Addict Population
Authors: De Wilde Eveline F. , Hendriks Vincent M.
Published: August 2005

Aims: The aim of this study is to investigate psychometric properties of the Client Satisfaction Questionnaire (CSQ-8) in a Dutch substance abuse population. Methods: The CSQ-8 and the Mental Health Thermometer (the standard Dutch satisfaction instrument) were sent to 927 patients of a Dutch substance abuse treatment centre. (response rate 28.3%; n = 262). Data were compared on several variables (i.e., age, gender, ethnicity, treatment type). For a subgroup of responders (n = 84), data were compared with pre-treatment problem severity and treatment need (the European Addiction Severity Index). Findings: Both internal consistency and concurrent validity were found to be high. Only treatment type had significant effects on CSQ-8 satisfaction scores. Scores were negatively skewed. Conclusion: The CSQ-8 is as suitable an instrument to be used in addict populations, as it is in other populations.
Group Psychotherapy for Opiate Addicts in Methadone Maintenance Treatment – A Controlled Trial
Authors: Scherbaum N. , Kluwig J. , Specka M. , Krause D. , Merget B. , Finkbeiner T. , Gastpar M.
Published: August 2005

A controlled trial was conducted evaluating cognitive-behavioural group psychotherapy as a measure to reduce concomitant drug use in methadone maintenance treatment (MMT). 73 opiate addicts were randomly assigned to local routine MMT or to routine MMT plus group psychotherapy (20 sessions over 20 weeks). Psychotherapy was delivered by therapists according to a manual. Drug use (urine screen) was compared at onset of psychotherapy, end of intervention period (6 months after study onset), and 6 months later. Data analysis was done according to intention-to-treat principles. Results indicated that patients in the psychotherapy group (n = 41) showed less drug use than control subjects (n = 32). This group difference was statistically significant at 6-month follow-up (p = 0.02). These findings underscore the usefulness of group psychotherapy in MMT. The delayed effect is comparable to other studies evaluating cognitive-behavioural psychotherapy.
Validity and Reliability of the German Version of the Short Understanding of Substance Abuse Scale
Authors: Moggi Franz , Giovanoli Anna , Sutter Marielle , Humphreys Keith
Published: August 2005

This paper presents the German version of the Short Understanding of Substance Abuse Scale (SUSS) [Humphreys et al.: Psychol Addict Behav 1996;10:38–44], the Verständnis von Störungen durch Substanzkonsum (VSS), and evaluates its psychometric properties. The VSS assesses clinicians’ beliefs about the nature and treatment of substance use disorders, particularly their endorsement of psychosocial and disease orientation. The VSS was administered to 160 treatment staff members at 12 substance use disorder treatment programs in the German-speaking part of Switzerland. Because the confirmatory factor analysis of the VSS did not completely replicate the factorial structure of the SUSS, an exploratory factor analysis was undertaken. This analysis identified two factors: the Psychosocial model factor and a slightly different Disease model factor. The VSS Disease and Psychosocial subscales showed convergent and discriminant validity, as well as sufficient reliability.
Completion of Long-Term Inpatient Treatment of Drug Abusers: A Prospective Study from 13 Different Units
Authors: Ravndal Edle , Vaglum Per , Lauritzen Grethe
Published: August 2005

Completion of treatment is an important predictor of favourable outcome. We need more knowledge about predictors of completion in the inpatient psychosocial treatment modality. This prospective study from 13 such programmes follows a consecutive sample of clients (n = 307) from admission to completion/dropout. Instruments: EuropASI, MCMI II, SCL-25. The mean completion rate was 40% (20–71%), with no difference between clients with no (‘debutants’) or previous (‘veterans’) inpatient stays. Among ‘debutants’, the number of years of heroin use was negatively related to completion. Among ‘veterans’, age and amphetamine use were positively related, while the presence of a personality disorder and number of previous inpatient treatments were negatively related to completion. Specific strategies for involving clients with personality disorders are needed. After three inpatient stays, other types of treatment should be offered.
The Swedish DOC System – An Attempt to Combine Documentation and Self-Evaluation
Authors: Jenner Håkan , Segraeus Vera
Published: August 2005

This article addresses the issue of how documentation can become a regular and competence-raising activity in treatment settings. A documentation system in Sweden (the DOC system) is used as an illustrative example. Two propositions are put forward and discussed: it is important that (1) the documentation be in accordance with the interests of the practitioners, and (2) that the documentation be used for self-evaluation, in order to enhance the practitioners’ competence. Based on experiences using the DOC system, some general observations about how to implement the forms and self-evaluation are presented. Finally, some research prospects are outlined.
Use of Illegally Acquired Medical Opioids by Opiate-Dependent Patients in Detoxification Treatment
Authors: Scherbaum N. , Kluwig J. , Meiering C. , Gastpar M.
Published: August 2005

Take-home dosages in maintenance treatment are of great therapeutic importance, but they include the risk of the substitute being distributed illegally. We reviewed the extent of consumption of illegally acquired medical opiates by 142 opiate- or poly-addicted patients consecutively admitted to a detoxification ward. 76 (53.5%) of them admitted to taking illegally acquired medical opiates, usually methadone, at least once. The cumulative duration was 30 days (median). Motivation was usually due to difficulties in acquiring heroin, however one third reported use in an attempt at self-detoxification or as transition before entering maintenance treatment. Maintenance patients were usually the source of the opiates. The results prove the necessity of stringent conditions for take-home dosages, and illustrate deficits in the health care system.
A Randomised Clinical Trial of In-Patient versus Combined Day Hospital Treatment of Alcoholism: Primary and Secondary Outcome Measures
Authors: Weithmann Gerd , Hoffmann Markus
Published: August 2005

In Germany, the treatment system for alcoholics is predominantly in-patient (IP) oriented, but no randomised trials of setting effects have been conducted until now. We examined if detoxification treatment offered in a day clinic setting would lead to results comparable to the usual IP treatment. After initial IP detoxification, patients (n = 109) at a standard withdrawal treatment unit were randomly assigned to IP or day hospital groups. In both settings, identical psychosocial treatment was given. In this article, results of primary (percent days abstinent and drinks per drinking day) and secondary outcome measures (relapses during treatment, premature termination, additional hospitalisation during follow-up, percent of voluntary abstinent days and continuous abstinence) are reported. Outcome measures were assessed quarterly during a 1-year follow-up period. Patients improved significantly after both treatments, but we found no significant setting or setting × time interaction effects for any primary or secondary outcome measure.
Influence of Socio-Economic Status, Parents and Peers on Smoking Behaviour of Adolescents
Authors: Madarasová Gecková Andrea , Stewart Roy , van Dijk Jitse P. , Orosová Ol’ga , Groothoff Johan W. , Post Doeke
Published: August 2005

With the aim of analysing the importance of psycho-social factors in predicting adolescents’ smoking behaviour, a model of the interrelations between socio-economic status, parents’, peers’ and adolescents’ own smoking behaviours was tested. The sample consisted of 2,616 adolescents. LISREL analyses were used to support the model; males and females were evaluated separately. Peers’ smoking is the strongest predictor of adolescent smoking. Parents’ smoking behaviour influences adolescents’ smoking directly, but also indirectly through the parents’ influence on peers’ smoking behaviour. Socio-economic status influences adolescent smoking indirectly through its influence on parents’ and peers’ smoking behaviour. Our model is significant in both males and females and explains 42–51% of the variance in adolescent smoking behaviour. Accentuation of peers’ influence on adolescents’ smoking behaviour without considering the interrelations between the influence of socio-economic status, parents and peers may lead us to incorrect conclusions in research as well as in prevention.
Effect of Caries Experience in Primary Molars on Cavity Formation in the Adjacent Permanent First Molar
Authors: Leroy R. , Bogaerts K. , Lesaffre E. , Declerck D.
Published: August 2005

This study sought to address the influence of a sound versus affected first and/or second deciduous molar on the incidence of visible caries experience in the adjacent permanent first molar. Clinical and questionnaire data were obtained from a 6-year prospective oral health screening project in Flanders, Belgium (Signal-Tandmobiel® project), where 4,468 children (born in 1989) were examined annually during their primary school time. A multiple survival model allowing for dependent data with possible censoring was applied. The impact of timing of tooth emergence (determining the period at risk), gender, presence of sealants and reported oral hygiene habits was also considered. Cavity formation in permanent first molars was clearly influenced by the status of the adjacent primary molars;the effect of the second deciduous molar was most pronounced. Moreover, if both deciduous molars experienced caries and the child presented with poor oral hygiene, a peak in cavity formation of the permanent first molar 1–2 years after emergence was noticed. On the other hand, if a child presented with good oral hygiene, no peak was observed;caries risk increased slightly over time. No significant benefit from restoring primary molars could be demonstrated, possibly because of methodological limitations.
Approximal Caries Increment in Two Cohorts of Schoolchildren after Discontinuation of a Professional Flossing Program with Chlorhexidine Gel
Authors: Gisselsson Hans , Emilson Claes-Göran , Birkhed Dowen , Björn Anna-Lisa
Published: August 2005

We have in two earlier studies evaluated the effect of professional flossing with chlorhexidine (CHX) gel treatment, in 4- to 7-year-old preschool children and in 12- to 15-year-old teenagers. The mean caries reduction after 3 years was around 40% compared to placebo gel or no gel treatment. The aim of the present investigation was to follow up these two clinical studies. The preschool children were followed up to the age of 16 years and the teenager group to the age of 19. Of the total number of original children, 71 and 80% were available at the age of 16 and 19 years, respectively. At the 9-year follow-up, when the children were 16 years old, the former CHX group had still significantly lower mean DFS than the control group (p < 0.05). The differences in caries increment occurred between 7 and 12 years of age, whereas the number of new caries lesions during the next 4 years were almost the same in the three groups. At the 4-year follow-up, when the teenagers were 19 years old, DFS was 6.9 in the former CHX group compared to 10.4 in the control group (p < 0.05). The main conclusion of these two follow-up studies after 9 and 4 years, respectively, is that caries reductions obtained at the end of professional flossing with a 1% CHX gel were maintained.
Oral Sugar Clearance in Individuals with Oral Motor Dysfunctions
Authors: Gabre P. , Norrman C. , Birkhed D.
Published: August 2005

Feeding problems due to impaired oral motor functions resulting in prolonged meals are common among persons with brain damage. The aim of the present investigation was to study the oral sugar clearance in 16 individuals with oral motor dysfunction (OMD) and 16 individuals with normal oral functions (control group). Repeated saliva samples were collected on filter paper discs at two locations before and during 30 min after intake of a glucose tablet. The individuals with OMD had significantly higher initial glucose concentrations in saliva and longer glucose elimination time compared to the control group. For some of the subjects with OMD, sugar clearance was extremely slow. The sugar clearance time was positively related to the severity of drooling problems, but not to the degree of dysphagia. The results from this study indicate that individuals with OMD have an increased risk of dental caries.
Analysis of Fingernails and Urine as Biomarkers of Fluoride Exposure from Dentifrice and Varnish in 4- to 7-Year-Old Children
Authors: Pessan J.P. , Pin M.L.G. , Martinhon C.C.R. , Silva S.M.B. , Granjeiro J.M. , Buzalaf M.A.R.
Published: August 2005

The use of fingernails and urine as biomarkers of exposure to fluoride (F) from fluoridated dentifrice and varnish was evaluated in twenty 4- to 7-year-old children, who were divided into two groups: group A (9 caries-free children) and group B (11 children with past caries experience). They used a placebo dentifrice for 28 days, fluoridated dentifrice (1,570 ppm F) for the following 28 days, and placebo dentifrice for an additional 28 days, then returned to their usual dentifrices. Group B children also received 4-week applications of a varnish (2.26% F) while using the fluoridated dentifrice. Urinary collections were performed 24 h before the use of fluoridated dentifrice and 24 h (group A) or 48 h (group B) after. Fingernails were clipped every 2 weeks, for 26 weeks. Total F intake from diet and dentifrice was estimated. Fingernail F concentrations did not vary significantly throughout the study. Twenty-four-hour urinary F outputs (mean ± SD, µg) were: 414 ± 200 and 468 ± 253 for placebo and F dentifrices, respectively (group A) and 402 ±206, 691 ± 345, 492 ± 243 for placebo dentifrice, F dentifrice plus F varnish and F dentifrice, respectively (group B). The use of F dentifrice did not cause a significant increase in the urinary F output. However, when F varnish was used, a transitory increase in the urinary F output was detected (p = 0.001), returning to baseline levels in the last 24 h. Thus, F varnish is a safe method for topical F application even in children that use F dentifrice regularly. According to our protocol, urine was a suitable biomarker of exposure to F from dentifrice plus varnish, but not from dentifrice alone, while nails were not.