bluuebunny/crossref_metadata_2025 huggingface dataset:
Implication of serum concentration monitoring in patients with lithium intoxication
Authors: CHEN KUN‐PO , SHEN WINSTON W. , LU MONG‐LIANG
Published: December 2003

Abstract  The aim of the present study was to determine the relationships between serum lithium level, duration of lithium intoxication, severity of symptoms, and the outcome of the disease. Subjects with a serum lithium level of ≥1.2 mEq/L were included in the study. Seventy‐eight patients with lithium intoxication were identified between 1 July 1999 and 31 December 2002. The demographic characteristics, clinical manifestations, and concomitant medications were recorded. Most patients with acute lithium intoxication had mild symptoms, independent of the serum lithium levels. In patients with chronic lithium intoxication, the frequency of severe symptoms was higher than in those with acute intoxication. None of the 78 intoxicated patients in the present survey died or suffered from persistent neurological sequelae. Patients with concomitant medications, older age, and existing neurological illness may have an increased susceptibility to lithium toxicity. Regular monitoring of serum lithium level is essential for lithium‐treated patients. Clinicians should pay attention to patients with pre‐existing neurological illness, older age, or receiving medications that may interact with lithium.
Effect of the combination of naltrexone and acamprosate on alcohol intake in mice
Authors: KIM SUNG‐GON , HAN BYEUNG‐DEUK , PARK JE‐MIN , KIM MYUNG‐JUNG , STROMBERG MICHAEL F.
Published: December 2003

Abstract  Both naltrexone and acamprosate have been utilized clinically in recovering alcoholics with varying success. In the experiment reported here the combination of naltrexone and acamprosate was examined in a limited access alcohol model using C57BL/6 mice to determine if there was evidence of additive or synergistic effects. The results of this experiment demonstrate that naltrexone, at the higher dose but not the lower dose, significantly reduced alcohol consumption. When combined with naltrexone, acamprosate reduced alcohol consumption across both doses of naltrexone. This effect was sensitive to both dose and number of days of exposure to the naltrexone/acamprosate combination.
Rapid improvement in academic grades following methylphenidate treatment in attention‐deficit hyperactivity disorder
Authors: YANG PINCHEN , CHUNG LI‐CHEN , CHEN CHENG‐SHENG , CHEN CHENG‐CHUNG
Published: December 2003

Abstract  In the present study a 16 week comparison study was conducted of behavioral, cognitive and educational measures in school‐age Taiwanese children with attention‐deficit hyperactivity disorder (ADHD) receiving open‐label methylphenidate (MPH). Subjects include 14 male and five female ADHD children. They received MPH twice per day continuously for 16 weeks. Measures of behavior, cognitive function (Wisconsin Card Sorting Test, Tower of London and Continuous Performance Test), Chinese and arithmetic learning achievement were compared with those of their baseline condition. After MPH, 68–78% of children showed improving behavior in classroom and at home. Among the neuropsychological tests, only the percentage of preservative error was improved (P = 0.022). Approximately 61–66% of children had improvement in academic learning (P = 0.013 for Chinese, 0.004 for arithmetic). The MPH treatment demonstrated improvement in domains of classroom/home behaviors and academic performance, but showed minimal change on neuropsychological functioning in Taiwanese ADHD children. The finding of academic gain was unexpected, which might be due to the greater interest in achievement and better compliance to cultural expectations by Taiwanese versus Western students, which translated into more rapid improvement in academic performance.
Three‐year follow up of women with and without borderline personality disorder: development of Cloninger's character in adolescence
Authors: HA KYOO SEOB , KIM SEOG JU , YUNE SOOK KYEONG , KIM JEONG HYUN , W. HWANG JAEUK , LEE NA YOUNG , SUNG YOUNG HOON , ABRAMS KELLEY YOST , LYOO IN KYOON
Published: December 2003

Abstract  The purpose of the present study was to examine the developmental patterns of Cloninger's biogenetic character traits in subjects with borderline personality disorder (BPD). Study subjects met Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised; DSM‐III‐R) criteria for BPD without comorbid axis I or II disorders, as determined by the Diagnostic Interview for Borderlines‐Revised, Structured Clinical Interview for the DSM‐III‐R, and Diagnostic Interview for Personality Disorders. The BPD subjects and age‐ and sex‐matched healthy comparison subjects were initially interviewed for Cloninger's biogenetic characters and re‐interviewed at an interval of 1 year for the following 3 years. There were significant differences in the developmental patterns of self‐directedness, cooperativeness, and self‐transcendence between BPD and healthy comparison subjects (significant group by time interaction: repeated measures manova, F = 17.3, d.f. = 3,240, P < 0.001; F = 28.5, d.f. = 3,240, P < 0.001; F = 4.7, d.f. = 3,240, P < 0.01, respectively). The BPD subjects had less changes in character‐related maturity with increasing age than did healthy comparison subjects. Post‐hoc tests with Duncan's statistics revealed that subjects with BPD had significantly lower scores on self‐directedness at all assessment time periods (P < 0.01) and lower scores on cooperativeness at the second‐year and third‐year follow‐up assessments as compared to healthy comparison subjects (P < 0.01). The BPD subjects had a distinctively different developmental pattern of Cloninger's character compared to healthy comparison subjects. The character development of BPD patients was more fixed and immature than those of healthy comparison subjects.
Neural damage due to temporal lobe epilepsy: Dual‐nuclei (proton and phosphorus) magnetic resonance spectroscopy study
Authors: OBATA TAKAYUKI , SOMEYA YASUHIRO , SUHARA TETSUYA , OTA YOSHIHISA , HIRAKAWA KIMIYOSHI , IKEHIRA HIROO , TANADA SHUJI , OKUBO YOSHIRO
Published: December 2003

Abstract  The aim of this study was to evaluate the usefulness of proton and phosphorus (1H and 31P) magnetic resonance spectroscopy (MRS) for temporal lobe epilepsy (TLE) patients, and to evaluate neural damage and metabolite dysfunction in the TLE patient brain. We performed 1H and 31P MRS of medial temporal lobes (MTL) in the same TLE patients (n = 14) with a relatively wide range of severity from almost seizure‐free to intractable, and calculated the ratio of N‐acetylasparate to choline‐containing compounds and creatine + phosphocreatine (NAA/Cho + Cr) in 1H MRS and inorganic phosphate to all main peaks (%Pi) in 31P MRS. There was no significant correlation between NAA/(Cho + Cr) and %Pi  in  each  side  (ipsilateral,  r = −0.20;  contralateral,  r =−0.19). The values of NAA/(Cho + Cr) showed a significant difference between ipsilateral and contralateral MTLs to the focus of TLE patients (P < 0.01, paired t‐test). Although %Pi also had a tendency to show the laterality of TLE, there was no significance. Ipsilateral (r = −0.90, P < 0.0001) and contralateral (r = −0.70, P < 0.005) NAA/(Cho + Cr) decreases and contralateral %Pi increase (r = 0.81, P < 0.001) had significant correlation with seizure frequency. 1H MRS provides more important information concerning neuronal dysfunction in MTL of TLE patients than 31P MRS.
Executive dysfunction can explain word‐list learning disability in very mild Alzheimer's disease: The Tajiri Project
Authors: HASHIMOTO RYUSAKU , MEGURO KENICHI , YAMAGUCHI SATOSHI , ISHIZAKI JUNICHI , ISHII HIROSHI , MEGURO MITSUE , SEKITA YASUYOSHI
Published: December 2003

Abstract  Elderly people with questionable dementia (i.e. a Clinical Dementia Rating (CDR) of 0.5) have been focused on as representing the borderline zone condition between healthy people and dementia patients. Many of them are known to have pathologic traits of very mild Alzheimer's disease (AD). Although they present mild memory disorder, the underlying mechanism has not been fully investigated. Herein is reported the mechanism of learning disability in very mild AD. Eighty‐six CDR 0.5 participants and 101 age‐ and education‐matched healthy controls (CDR 0) were randomly selected from a community in the town of Tajiri, Miyagi Prefecture. The word‐recall task of the Alzheimer Disease Assessment Scale–Japanese (i.e. learning and recall of 10 words) was administered. The numbers of words recalled in each trial and those never recalled throughout the trials were compared for the two CDR groups. The serial‐position function was depicted for three parts (i.e. primary, middle, and recency). The CDR 0.5 group recalled significantly fewer words than the CDR 0 group. The number of never‐recalled words was greater in the CDR 0.5 group. A remarkable difference was found in the middle part of the word list. The number of never‐recalled words of the CDR 0.5 group was greater in the middle part. The large number of never‐recalled words accounted for the poor learning performance of very mild AD participants. The results suggested that very mild AD participants have difficulty in learning and retaining words in the middle part of the word‐list because of a functional decline of the central executive system.
Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change
Authors: CHONG MIAN‐YOON , TAN CHAY HOON , FUJII SENTA , YANG SHU‐YU , UNGVARI GABOR S. , SI TIANMEI , CHUNG EUN KEE , SIM KANG , TSANG HIN‐YEUNG , SHINFUKU NAOTAKA
Published: December 2003

Abstract  The purpose of this international collaborative study was to investigate the prescription patterns of antipsychotic drugs for schizophrenia in East Asia and to analyze factors that affect these patterns. Prescription patterns for patients admitted for treatment of schizophrenia were surveyed using a standardized protocol from six East‐Asian region/countries: China, Hong Kong, Japan, Korea, Singapore and Taiwan. Patients’ social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications were systematically assessed and recorded. Prescriptions of the first‐ and second‐generation antipsychotic drugs were compared. A total of 2399 patients were recruited. The second‐generation drugs comprised 28.1% of all prescribed antipsychotics, and 46% of the antipsychotic prescriptions were in the context of polypharmacy. The mean dosage of antipsychotics for the whole sample was 675.3 + 645.1 mg chlorpromazine equivalents. Japan had a high frequency of prescribing high doses and polypharmacy; Singapore had a high utilization of depot injections while China had a higher prescription of clozapine. Using multiple logistic regression analysis, distinctions in the prescription patterns of antipsychotic drugs were found: first‐generation drugs were mainly for controlling aggressive behavior, while second‐generation drugs were targeted at the alleviation of positive, negative psychotic symptoms as well as disruptive behavior in schizophrenia. The present collaborative study highlighted differences in the prescription patterns, especially the under‐utilization of second‐generation antipsychotic drugs in East Asia. The pattern of antipsychotic medication use varied from country to country and is likely to be influenced by the prevailing health‐care system, the availability and cost of the drugs.
Abnormalities of P300 cortical current density in unmedicated depressed patients revealed by LORETA analysis of event‐related potentials
Authors: KAWASAKI TOSHIHIKO , TANAKA SHIN , WANG JIJUN , HOKAMA HIROTO , HIRAMATSU KENICHI
Published: December 2003

Abstract  The purpose of the present study was to investigate the neural substrates underlying event‐related potential (ERP) abnormalities, with respect to the generators of the ERP components in depressed patients. Using an oddball paradigm, ERP from auditory stimuli were recorded from 22 unmedicated patients with current depressive episodes and compared with those from 22 age‐ and gender‐matched normal controls. Cortical current densities of the N100 and P300 components were analyzed using low‐resolution electromagnetic tomography (LORETA). Group differences in cortical current density were mapped on a 3‐D cortex model. The results revealed that N100 cortical current densities did not differ between the two groups, while P300 cortical current densities were significantly lower in depressed patients over the bilateral temporal lobes, the left frontal region, and the right temporal–parietal area. Furthermore, the cortical area in which the group difference in P300 current density had been identified was remarkably larger over the right than the left hemisphere, thus supporting the hypothesis of right hemisphere dysfunction in depression.
Duration of untreated psychosis and pathways to psychiatric services in first‐episode schizophrenia
Authors: YAMAZAWA RYOKO , MIZUNO MASAFUMI , NEMOTO TAKAHIRO , MIURA YUTA , MURAKAMI MASAAKI , KASHIMA HARUO
Published: December 2003

Abstract  The aim of the present study was to examine the duration of untreated psychosis (DUP) in first‐episode schizophrenia patients in Japan and to investigate the available pathways to psychiatric services. Eighty‐three patients who visited Keio University Hospital (n = 54) or Oizumi Mental Hospital (n = 29) were evaluated retrospectively with regard to their DUP, living situation, social participation level, referral pathway, reason for seeking treatment, and their global assessment of functioning (GAF) score. The mean DUP was 13.7 months (median, 5.0 months) overall. No significant difference in DUP was found between subjects living alone and those living with others; however, employed patients had a significantly shorter DUP (8.1 months) than unemployed patients (18.7 months). Pathways to psychiatric services were totally different between the two institutions. Fifty‐two subjects (62.7%) came to the services directly: 40 patients (74.1%) came to the university hospital and 12 patients (41.4%) came to the mental hospital. At the mental hospital, nine patients (31.0%) had been admitted because of a legal obligation, and six (20.7%) had been referred through public health centers. None of the patients had been referred to either of the services by general practitioners. The main reason for seeking treatment was psychiatric symptom aggravation (59.3%) at the university hospital and acting out (64.3%) at the mental hospital. Some universal psychosocial factors appear to influence the DUP but the characteristics of specific psychiatric services may also affect treatment delays.
Reduced intracellular pH in the basal ganglia and whole brain measured by 31P‐MRS in bipolar disorder
Authors: HAMAKAWA HIROSHI , MURASHITA JUN , YAMADA NAOTO , INUBUSHI TOSHIRO , KATO NOBUMASA , KATO TADAFUMI
Published: December 2003

Abstract  The authors have previously reported that intracellular pH measured by phosphorus‐31 magnetic resonance spectroscopy (31P‐MRS) was decreased in the frontal lobes of patients with bipolar disorder. In the present study, phosphorus metabolism in the basal ganglia was examined in 13 patients with bipolar disorder and 10 matched controls by localized 31P‐MRS. While no significant alteration of peak area ratios was found for all phosphorus metabolites, intracellular pH was significantly reduced in the basal ganglia in patients with bipolar disorder (7.014 ± 0.045) compared with control subjects (7.066 ± 0.047, P < 0.05). Unexpectedly, non‐localized 31P‐MR spectra also showed significantly lower levels of intracellular pH (6.970 ± 0.025) than controls (6.986 ± 0.024, P < 0.05). These results suggest that decreased intracellular pH in the brain of patients with bipolar disorder is not caused by dysfunction of the frontal lobes but reflect altered metabolism at the cellular level.
Attitudes of psychiatrists toward patients with schizophrenia
Authors: ÜÇOK ALP , POLAT ASLIHAN , SARTORIUS NORMAN , ERKOÇ SAHAP , ATAKLI CEM
Published: December 2003

Abstract  A questionnaire was distributed to psychiatrists to investigate their attitudes toward patients with schizophrenia. A total of 42.7% of 60 respondents never informed patients of the diagnosis of schizophrenia and 40.7% informed on a case‐by‐case basis. The reason that psychiatrists gave for avoiding informing the patients/family members of the diagnosis was the idea that they would not understand the meaning (32.6%) and that they would drop‐out from treatment (28.3%). A total of 88.4% of respondents thought the term ‘schizophrenia’ was used in a pejorative manner in public. The findings revealed that stigmatizing attitudes of society are also shared by some psychiatrists.
Venlafaxine in children and adolescents with attention deficit hyperactivity disorder
Authors: MOTAVALLI MUKADDES NAHIT , ABALI OSMAN
Published: December 2003

Abstract  The primary purpose of this study was to describe tolerability and efficacy of venlafaxine in the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD). A 6‐week open trial of venlafaxine was conducted in 13 children and adolescents (mean age 9.9 ± 2.5 years) with ADHD, and without comorbid depression. Venlafaxine was initiated at a dose of 18.75 mg/day and flexibly titrated to 56.25 mg/day. The Conners parent scale and Clinical Global Improvement (CGI) severity item were performed at baseline and at the end of the 6‐week trial. All subjects completed the trial. Mean final dose of venlafaxine was 40.3 ± 7.0. Venlafaxine was significantly effective in reducing the total score of the Conners parent scale from baseline to endpoint (P < 0.002, Z =−3.113) and the CGI severity item (P < 0.05). Transient side‐effects such as somnolence (n = 2), stomachache (n = 2), and headache (n = 1) disappeared after second week of treatment. Also three subjects complained of sedation after raising the dose to 56.5 mg/day, therefore the dose was reduced to the previous level. These preliminary data suggest that venlafaxine may be an effective medication in the treatment of some children and adolescents with ADHD. Future double‐blind controlled trials should be undertaken.
Musical and auditory hallucinations: A spectrum
Authors: E. FISCHER CORINNE , MARCHIE ANTHONY , NORRIS MIREILLE
Published: December 2003

Abstract  Musical hallucinosis is a rare and poorly understood clinical phenomenon. While an association appears to exist between this phenomenon and organic brain pathology, aging and sensory impairment the precise association remains unclear. The authors present two cases of musical hallucinosis, both in elderly patients with mild–moderate cognitive impairment and mild–moderate hearing loss, who subsequently developed auditory hallucinations and in one case command hallucinations. The literature in reference to musical hallucinosis will be reviewed and a theory relating to the development of musical hallucinations will be proposed.
Implications from and for food cultures for cardiovascular disease: longevity
Authors: Suzuki Makoto , Wilcox Bradly J , Wilcox Craig D
Published: December 2003

A healthy cardiovascular system, with minimal arteriosclerosis, good endothelial function and well‐compensated ventricular function has been observed at advanced ages, and linked to a healthy lifestyle. This has consisted of a plant‐based diet, low in salt and fat, with monounsaturates as the principal fat. Other healthy lifestyle factors include regular physical activity (farming and traditional dance) and minimal tobacco use. The associated negative risk factors are low homocysteine, healthy cholesterol profile (Total:HDL ratio less than 3.5) and reasonable blood pressures throughout the life cycle. Hormone‐dependent cancers including breast, ovary, prostate and colon and osteoporotic complications, such as hip fracture rates, are also less frequent compared to the west. Protective factors may include high anti‐oxidant consumption, mainly flavonoids and carotenoids, through a high vegetable (e.g., onions) and soy intake. Related biological observations include low lipid peroxide, high superoxide dismutase activity and high serum hydroxyproline, a marker of bone formation. Dehydroepiandrosterone (DHEA) and its hormonal byproducts testosterone and oestrogen appear to be high in Okinawan serum compared with age‐matched Americans, possibly reflecting a slower age‐associated decline in the sex hormone axis in Okinawans. This may be linked to better cardiovascular and overall health. Further study is needed to delineate the reasons behind the impressive cardiovascular and overall health of the Okinawans.
Cardiovascular risk in the Asia–Pacific region from a nutrition and metabolic point of view: lipid
Authors: Tienboon Prasong
Published: December 2003

Hypercholesterolemia, especially low‐density lipoprotein cholesterol, is well‐known as a risk factor for coronary heart disease. The prevalence of hyperlipidemia in the Asia–Pacific regions, although not as high as in the North American and European regions, in adults and children varied from country to country. The ‘Cardiovascular Risk Factor of Chiang Mai children (CARFACC)’ study has shown the small ‘n’ and capital ‘N’ phenomenons, where in some individuals, blood lipid levels were tracked from childhood to adulthood. The new concept of programming by early nutrition on later adult health has now been accepted. The prevention of dyslipidemia during childhood should receive more attention.
Cardiovascular risk in the Asia–Pacific region from a nutrition and metabolic point of view: vitamin deficiencies
Authors: Wattanapenpaiboon Naiyana
Published: December 2003

In the past, recommended vitamin or micronutrient intakes have often been based on levels that were adequate to prevent clinical deficiencies from developing. Once these levels were reached, clinicians and nutrition scientists generally attributed little value to higher vitamin intake from supplements or food sources. Evidence has continued to mount showing that the intake and serum concentration of certain vitamins above those necessary to prevent clinical deficiencies, might importantly influence health status. This paper discusses the association of anti‐oxidant vitamins and cardiovascular disease, and the association of low intake or serum concentrations of folate, vitamin B6 and vitamin B12, and elevated serum homocysteine, resulting in an increase in vascular disease risk.
Diet and hypertension in the Asia–Pacific region: a brief review
Authors: Worsley Anthony
Published: December 2003

In this paper, the possible reasons for the prevalence of hypertension in the Asia–Pacific region are examined, along with its likely dietary, nutritional and sociocultural causes. This brief survey indicates the need for more comprehensive blood pressure monitoring and surveillance throughout the region. Findings from research conducted in the region and elsewhere suggest that a variety of aetiological factors predict the occurrence of hypertension, most of which are similar to those observed in western populations. However, several lines of research suggest that obesity, abdominal obesity and a number of dietary constituents, in addition to salt, may play relatively greater roles than in western populations. It is argued that hypertension may be prevented via a combination of individual, community and governmental approaches which promote social capital, environmentally sustainable food production and the public health.
Candidate foods in the Asia–Pacific region for cardiovascular protection: Oriental tea
Authors: Zhao Wenhua , Chen Junshi
Published: December 2003

Chinese tea and the major health effects include: antimicrobial, anti‐ultraviolet radiation, anticancer, lowering blood lipid and glucose, and protecting against coronary heart diseases. In contrast to the extensive studies on the protective effects of tea on cancer, fewer studies on the health effects of tea on cardiovascular diseases (CVD) have been published. This paper summarises the research results on the possible protective effects of tea on CVD available in China. The results from animal studies clearly demonstrated that tea pigments are effective in lowering blood lipid levels and preventing plaque formation in the aorta. However, the evidence of tea pigments in protecting ischemia heart disease (IHD) in humans is less convincing. One large well‐designed ecological study reported an inverse correlation between tea drinking and IHD mortality; but the inverse correlation disappeared after controlling possible confounding factors. However, the effects in improving blood lipid levels and rheology biomarkers in hyperlipidemia subjects or CVD patients by tea pigments seem promising. However, these studies were not well‐designed, controlled randomized clinical trials. This made the assessment difficult and inconclusive.
Implications from and for food cultures for cardiovascular disease: diet, nutrition and cardiovascular diseases in China
Authors: Zhao Wenhua , Chen Junshi
Published: December 2003

The change of lifestyle of Chinese people, along with the development of the national economy, has caused significant changes of the disease pattern in China. This includes the shift from predominantly communicable diseases to non‐communicable diseases, such as cancer, cardiovascular disease, diabetes and obesity. This paper summarises epidemiology research results on the relationship between diet, nutrition and cardiovascular diseases (CVD) available in China. Most data used in this paper are from correlation studies. While the information is very useful in generating hypotheses on dietary and nutritional risk factors for CVD, both prospective studies and population‐based intervention trials are needed to further verify these hypotheses. The information in this review clearly shows that diet and nutrition play important roles in the occurrence of CVD and hypertension in the Chinese population. Therefore, dietary means should be an important part of the strategies for the control of CVD and hypertension in China.
Candidate foods in the Asia–Pacific region for cardiovascular protection: relevance of grains and grain‐based foods to coronary heart disease
Authors: McBurney Michael I
Published: December 2003

This review elucidates the importance of healthy dietary and lifestyle habits to reduce morbidity and mortality associated with coronary heart disease (CHD), stroke and cardiovascular diseases. Given published evidence of the poor compliance, increased cost, and decreased benefit/risk ratios of medical therapies, individuals (and populations) are encouraged to adopt healthy life habits. The three most atherogenic dietary risk factors are saturated fat, cholesterol and obesity. Dietary patterns associated with the consumption of grains and grain‐based foods predict risk of CHD independently of other life habits. Epidemiological and intervention studies elucidating the strong protective associations of grains, cereal fibers and anti‐oxidant vitamins on CHD are reviewed. In summary, the consumption of grains and grain‐based cereals is repeatedly associated with the ingestion of many nutrients, e.g., dietary fiber and anti‐oxidants, that alter energy balance and nutrient intakes to positively affect cardiovascular health, especially when combined with healthy life habits.
Implications from and for food cultures for cardiovascular diseases: Japanese food, particularly Okinawan diets
Authors: Yamori Yukio , Miura Ayako , Taira Kazuhiko
Published: December 2003

Okinawans, who have a different ethnicity and food cultural history to other Japanese nationals, and an exceptional longevity have been studied at home and as migrant groups in Hawaii and Brazil. Biomarkers for fish and soy intake and intervention studies indicate that these foods, along with seaweed and green vegetables are candidates for chronic non‐communicable disease prevention.
Nutrition and diabetes in the Asia–Pacific region with reference to cardiovascular disease
Authors: Wahlqvist Mark L
Published: December 2003

In many parts of the Asia–Pacific region, diabetes prevalence is increasing and seems destined to become a major risk factor for cardiovascular disease. The phenomenon seems predicated on insulin resistance (IR), partly attributable to an early impact of abdominal (visceral) adiposity than in Caucasian populations. Food intake along with physical activity and emotional stress are all determinants of glycaemic status. The glycaemic index (GI) of foods indicates that a number of food factors other than glucose content are important for good glycaemic response to foods and meals. These include (i) low GI foods could also be ones low in fat, (ii) foods that have the lowest GI which include lentils, pasta, noodles, multigrain breads and some fruits (e.g. grapefruit, plums) and (iii) fruits are to be preferred to their juices. The nutritional management of diabetes is best served by counselling changes in a sociocultural context and step‐wise fashion by negotiation rather than prescription. It needs to be accompanied by advice to engage in regular physical activity, both aerobic and strength training. The same concept applies to the prevention of abdominal adiposity and diabetes mellitus type II in the Asia–Pacific region, but with particular reference to protective regional food.
Cardiovascular risk in the Asia–Pacific region from a nutrition and metabolic point of view: visceral obesity
Authors: Sullivan David R
Published: December 2003

The association between abdominal obesity and an increased risk of cardiovascular disease (CVD) is now well recognized. Both problems are becoming more prevalent within the Asia–Pacific region, but there are substantial differences within and between countries. The strength of the temporal relationship between obesity and CVD in the region has led to the suggestion that obesity is the driving force behind the continuing epidemic of CVD. This raises the question as to whether there are any special aspects to the Asia–Pacific epidemic of obesity and resultant problems as a result of genetic or developmental factors. It is clear that the experience of central obesity and its cardiovascular consequences in western society cannot be directly transposed to all countries in the region. Issues such as smoking, alcohol use and inactivity may carry different implications. The Asia–Pacific region has started from low baseline prevalence of both obesity and CVD, but this implies that the potential for major problems in the future is particularly severe.
Cardiovascular epidemiology in the Asia–Pacific region
Authors: Khor Geok Lin
Published: December 2003

By 2020, non‐communicable diseases including cardiovascular diseases (CVD) are expected to account for seven out of every 10 deaths in the developing countries compared with less than half this value today. As a proportion of total deaths from all‐causes, CVD in the Asia–Pacific region ranges from less than 20% in countries such as Thailand, Philippines and Indonesia to 20–30% in urban China, Hong Kong, Japan, Korea and Malaysia. Countries such as New Zealand, Australia and Singapore have relatively high rates that exceed 30–35%. The latter countries also rank high for coronary heart disease (CHD) mortality rate (more than 150 deaths per 100 000). In contrast, death from cerebrovascular disease is higher among East Asian countries including Japan, China and Taiwan (more than 100 per 100 000). It is worth noting that a number of countries in the region with high proportions of deaths from CVD have undergone marked declining rates in recent decades. For example, in Australia, between 1986 and 1996, mortality from CHD in men and women aged 30–69 years declined by 46 and 51%, respectively. In Japan, stroke mortality dropped from a high level of 150 per 100 000 during the 1920s–1940s to the present level of approximately 100 per 100 000. Nonetheless, CVD mortality rate is reportedly on the rise in several countries in the region, including urban China, Malaysia, Korea and Taiwan. In China, CVD mortality increased as a proportion of total deaths from 12.8% in 1957 to 35.8% in 1990. The region is undergoing a rapid pace of urbanization, industrialization and major technological and lifestyle changes. Thus, monitoring the impact of these changes on cardiovascular risks is essential to enable the implementation of appropriate strategies towards countering the rise of CVD mortality.
Cardiovascular risk in the Asia–Pacific region from a nutrition and metabolic point of view: abdominal obesity
Authors: Gill Timothy P
Published: December 2003

The level of obesity within the Pacific Islands is extremely high and so is the prevalence of weight‐related morbidity and mortality. In contrast, the level of obesity, as defined by the standard WHO classification, remains relatively low in most Asian countries, yet rates of obesity‐related disease, such as diabetes and cardiovascular disease are increasing rapidly. Many Asian races appear to be susceptible to the development of excessive abdominal fatness, even at low levels of body mass index (BMI). In addition, the health consequences of weight gain appear to occur at much lower levels of BMI and are more intense than in those of European origin. The exact reasons for these ethnic variations in the development of coronary heart disease (CHD) remain unclear. It is likely that genetic differences contribute to this variation in CHD risk, but different dietary and physical activity patterns may also play a role. The advent of modernisation has resulted in marked changes in the level of physical activity and the food supply available throughout the Asia–Pacific region. There has been a shift towards higher intakes of fats (particularly animal fats and vegetable oils) and sugars. Urbanisation and occupational restructuring have reduced daily physical activity levels. As a result, the population mean BMI and consequent illness is increasing in many countries within the region. Recent studies have shown that infants who were undernourished in utero and then born small have a greater risk of developing abdominal obesity and related morbidity as adults. As undernutrition coexists with overnutrition throughout the Asia–Pacific, focusing efforts to improve nutrition during pregnancy will need to be combined with programs to prevent weight gain in adults if CHD and other chronic diseases are to be effectively tackled in the region.
Okinawa: an exception to the social gradient of life expectancy in Japan
Authors: Cockerham William C , Yamori Yukio
Published: December 2003

This paper examines why the social gradient of life expectancy does not apply in Japan when Okinawa is considered. The social gradient thesis links differences in longevity to social rank, with people and populations in higher status hierarchical positions having lower mortality and longer life expectancies than those beneath them in the social scale. Japan has been cited as a major example of this thesis in that Japanese life expectancy improved dramatically as Japan rose to the top echelon of nations in economic rank in the late 20th century. Thus it follows that Japan’s most affluent and leading prefectures should be the major catalysts behind the nation’s rise in life expectancy as well to the number one position in the world. However, this is not the case as life expectancy in Okinawa, Japan’s poorest prefecture, exceeds that of Japan as a whole. We find that the social gradient of life expectancy does not apply at the prefectural level and question its validity for geographical areas. We suggest that healthy lifestyles, especially diet and the social support of family and friends, are more important than sense of hierarchy for longevity in Okinawa.
Candidate foods in the Asia–Pacific region for cardiovascular protection: fish, fruit and vegetables
Authors: Savige Gayle S
Published: December 2003

Cardiovascular disease is a major cause of morbidity and mortality. Epidemiological studies indicate fish eaters are less likely to die prematurely compared with non‐fish eaters. The protective properties in fish are likely to be related to its concentration of omega 3 fatty acids, calcium, selenium, vitamin D, taurine and coenzyme Q10. A high consumption of fruits and vegetables has been shown to protect against stroke and coronary heart disease. The presence of vitamins and minerals, as well as the complex array of non‐nutrient compounds, found in fruits and vegetables would play an important role in this protection.
Evidence‐based nutrition and cardiovascular disease in the Asia–Pacific region
Authors: Wahlqvist Mark L , Lukito Widjaja , Worsley Anthony
Published: December 2003

The Asia–Pacific region is undergoing a major change in both food and health patterns, with a connection between the two more than likely. Evidence for certain traditional Asia–Pacific foods as protective agents against chronic non‐communicable disease and cardiovascular disease (CVD), in particular, is growing at a time when their usage diminishes. The nature of the evidence to establish relevant Asia–Pacific food–health linkages will include randomised placebo‐controlled clinical trials, but is much more extensive and meaningful. Okinawans have probably achieved one of the most successful food cultures from a health point of view and serve as a reference point for the Asia–Pacific region. The expert working party has produced, in November 2000, the ‘Okinawan Recommendations on Nutrition and CVD in the Asia–Pacific region’.
History and characteristics of Okinawan longevity food
Authors: Sho Hiroko
Published: December 2003

Okinawan food culture in the Ryukyu island is one of the world’s most interesting culture because its consumers have the longest life expectancies and low disability rates. It is a product of cultural synthesis, with a core of Chinese food culture, inputs through food trade with South‐East Asia and the Pacific and strong Japanese influences in eating style and presentation. The Satsamu sweet potato provides the largest part of the energy intake (and contributes to self‐sufficiency), there is a wide array of plant foods including seaweed (especially konbu) and soy, and of herbaceous plants, accompanied by fish and pork, and by green tea and kohencha tea. Infusing multiple foodstuff and drinking the broth is characteristic. Raw sugar is eaten. The concept that ‘food is medicine’ and a high regard accorded medical practice are also intrinsic of Okinawan culture. Again, food‐centered and ancestral festivities keeep the health dimensions well‐developed. Pork, konbu and tofu (soy bean‐curd) are indispensable ingredients in festival menus, and the combination of tofu and seaweed are used everyday. Okinawan food culture is intimately linked with an enduring belief of the system and highly developed social structure and network.
Early life influences on later health: the role of nutrition
Authors: Moore Vivienne , Davies Michael
Published: December 2003

Individuals who were small at birth have an increased risk of cardiovascular disease in later life. Barker has put forward a hypothesis to explain this and other associations, known as the ‘fetal origins theory of adult disease’. It is proposed that chronic disease is the long‐term outcome of physiological adaptations the unborn baby makes when it is undernourished, a process referred to as ‘programming’. Maternal nutrition is thought to be a major influence on programming, and growth in childhood as well as obesity in later life may modulate the propensity for disease acquired in the womb. While robust evidence to support specific nutritional interventions during pregnancy is currently lacking, the theory in general affirms broader public health nutritional strategies and policies to improve the social and economic status of women.
Lifecycle nutrition and cardiovascular health: the aged
Authors: Kondo Kazuo , Lukito Widjaja , Savige Gayle S
Published: December 2003

As the world’s population ages, cardiovascular health becomes increasing important. The ageing process gradually leads to a decline in the structure and function of the cardiovascular system. Other factors associated with ageing can hasten this decline, for instance, lifestyles that have become more sedentary. Additionally, the prevalence of hypertension, dyslipidaemia and diabetes, major risk factors for cardiovascular disease increase with age. Nutrition throughout the lifecycle can help prevent the development of these conditions and appropriate food habits instigated later in life can improve the management of these conditions and their impact on cardiovascular health.
Candidate foods in the Asia–Pacific region for cardiovascular protection: nuts, soy, lentils and tempe
Authors: Lukito Widjaja
Published: December 2003

Cross‐cultural and intervention studies increasingly point the way to seeds like nuts, soy and lentils, and products of them like tempe being cardioprotective. Soy and its products (like tofu, tempe, soy drinks and soy desserts) are historically and currently some of the most important foods in the Asian region where diets remain predominantly plant‐based. The mechanisms by which these seeds may protect populations against cardiovascular disease are several. They include the minimisation of classical risk factors like positive energy balance leading to obesity, hypertension, dyslipidemia and insulin resistance with hyperglycaemia. However, in addition, they provide compounds like n‐3 fatty acids, isoflavones and arginine which are only now recognised for their ability to optimise other pathways which connect lifestyle to cardiovascular disease – like oxidant status, vascular reactivity and myocardial electrical stability and proneness to dysrhythmia. Thus, once an Asian food culture changes on its emphasis on these plant foods, it may place its consumers at cardiovascular risk.
Numerical modification of the Los Angeles classification of gastroesophageal reflux disease fails to decrease observer variation
Authors: Kusano Motoyasu , Sugimoto Sayaka , Kawamura Osamu , Minashi Keiko , Maeda Masaki , Shimoyama Yasuyuki , Ino Kyoko , Mimura Naoko , Higuchi Tatsuya , Kon Yoichi , Kikuchi Kazuma , Shirota Tohko , Mizuide Masahumi , Oshimoto Naoko , Toki Munetoshi , Ohwada Tsuneo , Mori Masatomo
Published: December 2003

Background:  We previously reported that a new endoscopic classification of gastroesophageal reflux disease, the Los Angeles classification, showed considerable observer variation depending on the experience of the endoscopist. In the present study, we evaluated some modifications of the classification to determine whether we could decrease observer variation.

Methods:  Fifty endoscopic photographs, each showing four images of the squamo‐columnar junction, were prospectively obtained from 50 consecutive patients with gastroesophageal reflux disease. Two groups of eight endoscopists divided by their endoscopic experience, group 1 (100–500 procedures) and group 2 (more than 500 procedures), assessed the photographs using classifications with the following modifications: (i) addition of grade O to describe healed mucosal breaks and setting grade B as more than 5 mm or 10 mm; or (ii) addition of grade O and setting grade D as 75–99% or 100% circumferential.

Results:  Changing the definition of grade B or grade D did not increase the kappa values for either group of observers.

Conclusions:  These modifications of the Los Angeles classification were unable to decrease observer variation.
Endoscopic treatment for benign biliary strictures: Can placement of a covered metallic stent be an option in refractory cases?
Authors: Enya Masamichi , Yasuda Ichiro , Mukai Tsuyoshi , Shinoda Tohru , Otsuji Kentaro , Iwasa Junpei , Nakai Minoru , Tomita Eiichi , Moriwaki Hisataka
Published: December 2003

Background:  Recently, endoscopic treatment has been attempted to counter benign biliary strictures. It is expected to be an alternative to surgical operation because of its lower morbidity and its convenience, but the long‐term results have not yet been sufficiently elucidated. Here, we evaluate the short‐ and long‐term results of endoscopic stenting in patients with benign biliary strictures, and also describe a new technique using a covered metallic stent (CMS) in the refractory cases.

Methods:  The charts of 22 consecutive patients with benign biliary stricture treated endoscopically at our institutions between December 1995 and December 2002 were analyzed retrospectively.

Results:  Stricture etiology was as follows: postoperative, nine; chronic pancreatitis, seven; primary sclerosing cholangitis (PSC), three; and other, three. The stent initially placed was a 7 Fr in 11 patients and a 10 Fr in 11 patients. Eighteen of 22 patients (82%) were successfully treated by the initial treatment, and stents were removed after a mean duration of 3.1 months (range: 1–14 months). In the remaining four patients, stents were exchanged once to four times after that, and a CMS was placed as the second endoprosthesis in two patients with chronic pancreatitis. These stents, including CMS, were finally removed from these four patients after a mean duration of 14.8 months (range: 8–22 months). Over a median follow‐up period of 26 months (range: 6–78 months), one recurrence has been observed, in which case a CMS was placed in a patient with chronic pancreatitis. The CMS was removed successfully 6 months after the insertion, and no recurrence was observed during the 6‐month follow‐up period.

Conclusions:  Endoscopic stenting for benign biliary stricture is an alternative to surgery because it shows satisfactory results. Placement of a CMS would also be an option in refractory strictures, such as those due in chronic pancreatitis, if the certainty of removal is proven by cumulative experience with a large number of patients.
Advance directives and emergency department patients: ownership rates and perceptions of use
Authors: Taylor D. McD. , Ugoni A. M. , Cameron P. A. , McNeil J. J.
Published: December 2003

Abstract

Background: Advance directives (ADs) are rarely avail­able in Australia to guide management but may become more important as our population ages.

Aims: The present study aimed to determine patient knowledge, perception and ownership rates of ADs and the factors that impact upon these variables.

Methods: A cross‐sectional survey of emergency department patients was undertaken. The main outcome measures were: (i) prior discussion about the extent of medical treatment and ADs, (ii) knowledge and perceptions of ADs, (iii) present AD ownership rates and (iv) likelihood of future AD ownership. Generalized linear models were used for analysis.

Results: Four hundred and three patients were enrolled. The mean age of patients was 73 years and 239 (59.3%) were male. Two hundred and forty patients (59.6%) had discussed the extent of treatment. Only 81 patients (20.1%) had discussed the use of an AD. One hundred and thirty‐seven patients (34.0%) knew of one type of AD and 333 patients (82.6%) thought some ADs were a good idea. Only 32 patients (7.9%) owned an AD, although 276 (68.5%) would consider owning one. The main reason for never obtaining an AD was ‘always wanting full treatment’ (93 patients, 23.1%). Level of education was the only characteristic that impacted significantly upon an outcome measure. Patients with a higher level of education were more likely to have known and spoken about ADs, to own an AD and to consider owning one.

Conclusions: AD knowledge and ownership rates were low. However, most patients perceive them favourably and many would consider owning one. Intervention strategies to improve AD awareness are indicated. This may empower patients to more effectively participate in their own advance care planning. (Intern Med J 2003; 33: 586−592)
Management of dyspepsia at the beginning of the twenty‐first century
Authors: Duggan A.
Published: December 2003

Abstract

Dyspepsia remains a frequent intercurrent management problem for the non‐gastroenterologist. However, the causes for dyspepsia have changed markedly in recent decades. In contrast to gastro‐oesophageal reflux ­disease, both gastro‐oesophageal malignancy and peptic ulcer disease have become uncommon causes for ­dyspepsia. Concurrent with these changes, management strategies for dyspepsia have changed. Once aware of these changes the non‐gastroenterologist can effectively manage the majority of patients with dyspepsia. The present paper reviews these key changes in dyspepsia management. (Intern Med J 2003; 33: 604−609)