bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60–80 years
Authors: BING METTE H. , MOLLER LARS A. , JENNUM POUL , MORTENSEN SVEND , SKOVGAARD LENE T. , LOSE GUNNAR
Published: July 2006

OBJECTIVE

To study the prevalence and bother of nocturia, and sleep interruptions in an unselected population of Danish men and women aged 60–80 years.

SUBJECTS AND METHODS

A postal questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System, in which every person living in Denmark is identified. The Nocturia, Nocturnal Enuresis and Sleep‐interruption Questionnaire (NNES‐Q) was used to evaluate nocturia and bother, and sleep interruptions. Nocturia was defined as waking at night to void, according to the International Continence Society definition.

RESULTS

In all, 92% (3664) subjects returned the questionnaire; 71% completed the questionnaire satisfactorily and were included in the study. The prevalence of nocturia increased with age. The overall prevalence of nocturia was 77% and there was no difference between men and women (P = 0.11), but men had slightly more severe nocturia than women. The bother caused by nocturia in men and women increased with the severity of nocturia, and women were slightly more bothered than men when the degree of nocturia was >2 voids/night. Nocturia was the most frequent self‐reported reason for waking at night, followed by thirst.

CONCLUSION

The prevalence of nocturia increased with age. There was no difference between the genders in the overall prevalence of nocturia, but nocturia of ≥ 2 voids/night was more frequent in men. The degree of bother increased with the severity of nocturia, even after correcting for generic quality of life, and the younger groups were the most bothered. Nocturia was the major reason for waking at night, followed by thirst.
A Market for Time Fairness and Efficiency in Waiting Lines
Authors: Oberholzer‐Gee Felix
Published: July 2006

In situations of excess demand, many firms use waiting lists to allocate products and services among their customers. The resulting allocation is likely to be inefficient, creating opportunities for Pareto improving trades among those who are waiting in line. Yet, in the queuing context, the trading of places is rare and inefficiencies often persist over time. In this paper, I report the results of a field experiment which allows randomly selected customers to earn up to $10 for letting a stranger cut in line. The higher the offer, the more likely it is that individuals let someone cut in. But while a majority agrees to wait longer, only a small minority accepts the monetary reward. Trading in this market is constrained by multiple social concerns. The obligation not to exploit situations of excess demand and efficiency considerations influence the willingness to let a stranger jump the queue.
Guanxi networks and members’ effectiveness in Chinese work teams: Mediating effects of trust networks
Authors: Chou Li‐Fang , Cheng Bor‐Shiuan , Huang Min‐Ping , Cheng Hung‐Yueh
Published: July 2006

The present study examined 33 teams with a total of 206 team members (excluding team leaders) to explore the effects of intrateam guanxi and trust networks on individual effectiveness in Taiwan. Guanxi networks included non‐job, departmental and past team networks, while trust networks included affective and cognitive trust networks. Results showed that: (i) guanxi networks could better explain members’ effectiveness compared with relational demography, and different guanxi networks had different effects; (ii) the more central an individual’s position was in the cognitive trust network, the higher the individual’s effectiveness; (iii) the past team guanxi network of a team member displayed a positive effect on the centrality of cognitive trust network, while non‐job and departmental guanxi networks showed negative effects; and (iv) the effects of members’guanxi networks on individual effectiveness were mediated by the centrality of trust networks.
Social axioms in Iran and Canada: Intercultural contact, coping and adjustment
Authors: Safdar Saba , Lewis John Rees , Daneshpour Manijeh
Published: July 2006

A comparison was made between Iranian participants living in Iran, Iranian immigrants to Canada, and Canadian‐born participants on the Social Axioms Scale (SAS), including a sixth dimension, Harmony. The Iranian immigrants to Canada endorsed views that were intermediate between the other two groups. In the data from Iran, the relationships between social axioms on the one hand and measures of active coping and adjustment on the other were examined. Belief in Reward for Application predicted Active Coping; acknowledgment of Social Complexity predicted Life‐Satisfaction; and endorsement of belief in Harmony predicted Mastery. Those whose beliefs on Harmony and Social Complexity were closer to their country mean were higher on Mastery and Self‐Esteem, but those whose beliefs on Fate Control were closer to the country mean showed lower Life‐Satisfaction.
Chinese child‐rearing beliefs: Key dimensions and contributions to the development of culture‐appropriate assessment
Authors: Lieber Eli , Fung Heidi , Leung Patrick Wing‐Leung
Published: July 2006

Socio‐cultural perspectives explain inconsistency in Chinese child‐rearing research when imported methods and concepts are applied. We sought to elucidate child‐rearing belief constructs relevant to Chinese contexts. Exploratory factor analysis identified items representing child‐rearing concepts both imported and indigenous to Chinese culture and forming four dimensions: Training, Shame, Authoritative, and Autonomy. Data from parents of preschool‐aged children in Hong Kong (N = 228) and Taiwan (N = 213) were subject to confirmatory factor and scale internal consistency analyses. Results support the conceptual and psychometric coherence of each subscale. Discussion of findings focuses on the benefits of culturally responsive methodology and the potential utility of the scales in child‐rearing research with Chinese and other Confucian cultural populations.
Did Local Activism Really Matter? Liberal Democrat Campaigning and the 2001 British General Election
Authors: Cutts David , Shryane Nick
Published: July 2006

The importance of campaigning at British general elections seems to vary across the country's three main political parties, although it is of particular salience for the Liberal Democrats. Existing research suggests that the Liberal Democrats use the combination of local success and grass-roots activism as a stepping stone to achieve the prize aim of parliamentary representation. It could be argued that local factors are likely to account for more of the spatial variation in votes for the Liberal Democrats than is the case for the main parties. Using Seemingly Unrelated Regression (SUR) to model the parties’ relative vote shares, we find that intensive campaigning, not only what is spent but also the role of the local MP as a representative, particularly where there were first-time incumbents, was a significant influence on the Liberal Democrat vote in 2001 when compared against the Conservatives and Labour.
A Precautionary Approach to Foreign Policy? A Preliminary Analysis of Tony Blair's Speeches on Iraq
Authors: McLean Craig , Patterson Alan
Published: July 2006

This article examines the proposition put forward in a BBC documentary concerning ‘war on terror’ policies in recent decades that the British prime minister embraced the precautionary principle over his decision to go to war with Iraq. We argue that the conventional understandings of precaution that have been developed in the environmental arena do not translate well into the field of foreign policy. Our argument is buttressed by a content analysis of Tony Blair's speeches prior to the Iraq conflict of 2003. The analysis focuses on the ways the prime minister justified his decision to participate in the war in Iraq to the UK electorate. We conclude that, although understandings of precaution, particularly the ‘strong’ precautionary principle, do have problems when applied to this particular issue, and that the war was mainly based on a traditional ‘sound science’ foreign policy paradigm, the novel idea of using weaker forms of the precautionary principle in foreign policy is nevertheless intriguing, and warrants further research.
Global Governance, State Agency and Competitiveness: The Political Economy of the Commission for Africa
Authors: Cammack Paul
Published: July 2006

The Commission for Africa has been presented as a moral crusade, and linked by its proponents to the ‘anti-globalisation’ activism of such campaigns as ‘Make Poverty History’. But detailed analysis of the genesis and content of its report reveals direct continuity with EBRD and World Bank programmes from the 1990s onwards. It continues and extends a series of supranational initiatives aimed at endowing transitional and developing states with the capacity to pursue and legitimise capitalist development. Its principal focus is shown to be on the need to enhance the capacity of the state to impose and maintain the social relations of capitalist production. The emphasis on restoring rather than replacing state agency is identified as a constant feature of such projects, related to the promotion of competitiveness in the global capitalist economy. Finally, this is shown to be a feature shared with New Labour's programme for the ‘modernisation’ of Britain, and the broader theoretical implications are briefly explored.
Convergence in the Americas: Some Lessons from the DR‐CAFTA Process
Authors: Granados Jaime , Cornejo Rafael
Published: July 2006

The proliferation of trade agreements in the Americas is a major cause for concern as it might fragment or inhibit the emergence of a hemispheric trading system. In addition to establishing a free trade area between the US and six countries in Latin America, the DR‐CAFTA consolidates a set of trade arrangements among those six Latin American countries. The approaches and techniques employed to achieve this consolidation should be studied by policy analysts and negotiators of broader hemispheric‐wide negotiations since the DR‐CAFTA is in fact a microcosm of the spaghetti bowl of trade agreements now existing in the Americas. This paper points out the potential consequences of the proliferation of trade agreements in the Americas and provides an analysis of the convergence techniques and approaches used in the DR‐CAFTA, in particular in the areas of market access and rules of origin.
Reconstructing the past in medieval Iceland
Authors: Callow Chris
Published: July 2006

Locating and dating sagas is a difficult but still important task. This paper examines the relationship between the Sagas of Icelanders, which are concerned with tenth‐ and eleventh‐century events, and the contemporary sagas of the mid‐thirteenth century. Drawing upon models from anthropology, it looks at how contemporary ideas permeated these historicizing texts and how genealogy and geography act as structures around which the past is remembered. The many political relationships which occur in Laxdæla saga are analysed in relation to those from contemporary sagas from the same area of western Iceland. Since it appears that there is relatively little in common between the political situations depicted in Laxdæla saga and those portrayed in the contemporary sagas, it is likely that Laxdæla saga and the contemporary sagas were actually written down in different periods. It is possible, therefore, that the Sagas of Icelanders give us a view of the past which originates earlier than is usually suggested.
Myofascial Trigger Points, Neck Mobility and Forward Head Posture in Unilateral Migraine
Authors: Fernández-de-las-Peñas C , Cuadrado ML , Pareja JA
Published: July 2006

This paper describes the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles between unilateral migraine subjects and healthy controls, and the differences in the presence of TrPs between the symptomatic side and the nonsymptomatic side in migraine subjects. In addition, we assess the differences in the presence of both forward head posture (FHP) and active neck mobility between migraine subjects and healthy controls and the relationship between FHP and neck mobility. Twenty subjects with unilateral migraine without side-shift and 20 matched controls participated. TrPs were identified when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band and reproduction of the referred pain typical of each TrP. Side-view pictures were taken in both sitting and standing positions to measure the cranio-vertebral angle. A cervical goniometer was employed to measure neck mobility. Migraine subjects showed a significantly greater number of active TrPs ( P < 0.001), but not latent TrPs, than healthy controls. Active TrPs were mostly located ipsilateral to migraine headaches ( P < 0.01). Migraine subjects showed a smaller cranio-vertebral angle than controls ( P < 0.001), thus presenting a greater FHP. Neck mobility in migraine subjects was less than in controls only for extension ( P = 0.02) and the total range of motion in flexion/extension ( P = 0.01). However, there was a positive correlation between the cranio-vertebral angle and neck mobility. Nociceptive inputs from TrPs in head and neck muscles may produce continuous afferent bombardment of the trigeminal nerve nucleus caudalis and, thence, activation of the trigeminovascular system. Active TrPs located ipsilateral to migraine headaches might be a contributing factor in the initiation or perpetuation of migraine.
The Price Impacts of Open Market Repurchase Trades
Authors: McNally William J. , Smith Brian F. , Barnes Thomas
Published: July 2006

Abstract:  This paper analyzes a database of 60,000+ individual repurchase trades from the Toronto Stock Exchange. The average intraday price impact of repurchase trades is negative, since, because of execution rules, 60% are seller‐initiated. Prices fall less following repurchase than matched non‐repurchase trades—there is an abnormal price impact. We find evidence consistent with two hypotheses: repurchases provide price support, and the market learns that the shares are undervalued. Consistent with the latter, we find that repurchasing companies have superior timing. Share prices show abnormal losses (gains) before (after) the repurchase trades. We find no significant market reaction to the mandatory public disclosure of the trade details.
Prey preferences of the spotted hyaena (Crocuta crocuta) and degree of dietary overlap with the lion (Panthera leo)
Authors: Hayward M. W.
Published: July 2006

Spotted hyaenas Crocuta crocuta were once considered mere scavengers; however, detailed research revealed that they are very efficient predators. Information on what spotted hyaenas actually prefer to prey on and what they avoid is lacking, as well as the factors that influence prey selection. Data from 14 published and one unpublished study from six countries throughout the distribution of the spotted hyaena were used to determine which prey species were preferred and which were avoided using Jacobs' index. The mean of these values for each species was used as the dependent variable in multiple regression, with prey abundance and prey body mass as predictive variables. In stark contrast to the rest of Africa's large predator guild, spotted hyaenas do not preferentially prey on any species. Also surprisingly, only buffalo, giraffe and plains zebra are significantly avoided. Spotted hyaena most prefer prey within a body mass range of 56–182 kg, with a mode of 102 kg. The dietary niche breadth of the spotted hyaena is similar to that of the lion Panthera leo, and the two species have a 58.6% actual prey species overlap and a 68.8% preferred prey species overlap. These results highlight the flexible and unselective nature of spotted hyaena predation and are probably a reason for the species' success throughout its range, despite a large degree of dietary overlap with lions.
Prey preferences of the cheetah (Acinonyx jubatus) (Felidae: Carnivora): morphological limitations or the need to capture rapidly consumable prey before kleptoparasites arrive?
Authors: Hayward M. W. , Hofmeyr M. , O'Brien J. , Kerley G. I. H.
Published: July 2006

As a charismatic carnivore that is vulnerable to extinction, many studies have been conducted on predation by the cheetah Acinonyx jubatus. Cheetah are generally considered to capture medium‐sized prey; however, which species are actually preferred and why has yet to be addressed. We used data from 21 published and two unpublished studies from six countries throughout the distribution of the cheetah to determine which prey species were preferred and which were avoided using Jacobs' index. The mean Jacobs' index value for each prey species was used as the dependent variable in multiple regression, with prey abundance and prey body mass as predictive variables. Cheetah prefer to kill and actually kill the most available prey present at a site within a body mass range of 23–56 kg with a peak (mode) at 36 kg. Blesbok, impala, Thomson's and Grant's gazelles, and springbok are significantly preferred, whereas prey outside this range are generally avoided. The morphological adaptations of the cheetah appear to have evolved to capture medium‐sized prey that can be subdued with minimal risk of injury. Coincidentally, these species can be consumed rapidly before kleptoparasites arrive. These results are discussed through the premise of optimality theory whereby decisions made by the predator maximize the net energetic benefits of foraging. Information is also presented that allows conservation managers to determine which prey species should be in adequate numbers at cheetah reintroduction sites to support a cheetah population. Conversely, these results will illustrate which potential prey species of local conservation concern should be monitored for impact from cheetahs as several species are likely to be preyed upon more frequently than others.
Spontaneous pregnancy outcome after prenatal diagnosis of anencephaly
Authors: Jaquier M , Klein A , Boltshauser E
Published: July 2006

Parents are usually told that many anencephalic offspring die in utero or soon after delivery, and many obstetricians offer elective termination of the pregnancy. Following the personal experience of the first author, a personal website was created with the intention of providing information and exchanging views with other parents confronted with a prenatal diagnosis of anencephaly. Data were collected from 211 pregnancies where the parents opted not to terminate pregnancy. These data revealed that polyhydramnios was a feature in 56 (26%) pregnancies, death in utero in 15 (7%) pregnancies, 72 (34%) babies were born prematurely (<37 weeks of gestation), 113 (53%) at term and 21 (10%) after 42 weeks. Stillbirth, presumably resulting from intrapartum death, occurred in 43 (20%) deliveries. One hundred and fifty‐three (72%) of anencephalic offspring were liveborn, of those, 103 (67%) died within 24 hours but 6/211 survived 6 or more days (maximum 28 days). Continuation of pregnancy after a diagnosis of anencephaly is medically safe and should be considered as an option.
Glial cell‐line derived neurotrophic factor and neurturin regulate the expressions of distinct miRNA precursors through the activation of GFRα2
Authors: Yoong Li Foong , Wan Guoqiang , Too Heng‐Phon
Published: July 2006

Glial cell line‐derived neurotrophic factor (GDNF) and neurturin (NTN) are structurally related neurotrophic factors that have both been shown to prevent the degeneration of dopaminergic neurons in vitro and in vivo. NTN and GDNF are thought to bind with different affinities to the GDNF family receptor alpha‐2 (GFRα2), and can activate the same multi‐component receptor system consisting of GFRα2, receptor tyrosine kinase Ret (RET) and NCAM. MicroRNAs (miRNAs) are a class of short, non‐coding RNAs that regulate gene expression through translational repression or RNA degradation. miRNAs have diverse functions, including regulating differentiation, proliferation and apoptosis in several organisms. It is currently unknown whether GDNF and NTN regulate the expression of miRNAs through activation of the same multi‐component receptor system. Using quantitative real‐time PCR, we measured the expression of some miRNA precursors in human BE(2)‐C cells that express GFRα2 but not GFRα1. GDNF and NTN differentially regulate the expression of distinct miRNA precursors through the activation of mitogen‐activated protein kinase (extracellular signal‐regulated kinase 1/2). This study showed that the expression of distinct miRNA precursors is differentially regulated by specific ligands through the activation of GFRα2.
Linear patterns of Alzheimer's disease mutations along α‐helices of presenilins as a tool for PS‐1 model construction
Authors: Jozwiak Krzysztof , Zekanowski Cezary , Filipek Slawomir
Published: July 2006

We performed an analysis of mutation patterns in all 10 hydrophobic regions (HRs) of presenilin‐1 (PS‐1) and PS‐2 using a recent database of Alzheimer's disease (AD) mutations. The linear patterns were confirmed and extended to areas spanning as many as three faces of a given HR. The complementary areas of residues free of AD mutations were identified based on the location of non‐pathogenic polymorphisms and PS‐1 versus PS‐2 amino acid discordances. Taking into account the location of areas of AD mutations and mutation‐free areas/regions, we proposed a preliminary model of PS‐1 structure using a general stick‐out‐mutation rule. To build a molecular structure of PS‐1 and preserve features of the preliminary model, we used bacteriorhodopsin template in homology/comparative modelling. Two molecular models were built differing in the location of C‐terminal fragment helices. The models properly distinguish residues belonging to AD‐affected sites and non‐pathogenic areas, and may be used for classification purposes. They also comply with experimental results, such as differences in accessibility of the catalytic residues in uncleaved PS‐1, and binding of PEN‐2 by the PS‐1 NF motif.
Developmental expression of the SRF co‐activator MAL in brain: role in regulating dendritic morphology
Authors: Shiota Jun , Ishikawa Mitsuru , Sakagami Hiroyuki , Tsuda Masaaki , Baraban Jay M. , Tabuchi Akiko
Published: July 2006

The dynamic changes in dendritic morphology displayed by developing and mature neurons have stimulated interest in deciphering the signaling pathways involved. Recent studies have identified megakaryocytic acute leukemia (MAL), a serum response factor (SRF) co‐activator, as a key component of a signaling pathway linking changes in the actin cytoskeleton to SRF‐mediated transcription. To help define the role of this pathway in regulating dendritic morphology, we have characterized the pattern of MAL expression in the developing and adult brain, and have examined its role in regulating dendritic morphology in cultured cortical neurons. In histological studies of mouse brain, we found prominent expression of MAL in neurons in adult hippocampus and cerebral cortex. MAL immunostaining revealed localization of this protein in neuronal cell bodies and apical dendrites. During development, an increase in MAL expression occurs during the second post‐natal week. Expression of dominant negative MAL constructs or MAL siRNA in cortical neurons grown in primary culture reduces the number of dendritic processes and decreases the basal level of SRF‐mediated transcription. Taken together, these findings indicate that the MAL‐SRF signaling pathway plays a key role in regulating dendritic morphology.
Hypochlorous acid induces apoptosis of cultured cortical neurons through activation of calpains and rupture of lysosomes
Authors: Yap Yann Wan , Whiteman Matthew , Bay Boon Huat , Li Yuhong , Sheu Fwu‐Shan , Qi Robert Z. , Tan Chee Hong , Cheung Nam Sang
Published: July 2006

3‐Chlorotyrosine, a bio‐marker of hypochlorous acid (HOCl) in vivo, was reported to be substantially elevated in the Alzheimer's disease (AD) brains. Thus, HOCl might be implicated in the development of AD. However, its effect and mechanism on neuronal cell death have not been investigated. Here, we report for the first time that HOCl treatment induces an apoptotic‐necrotic continuum of concentration‐dependent cell death in cultured cortical neurons. Neurotoxicity caused by an intermediate concentration of HOCl (250 µm) exhibited several biochemical markers of apoptosis in the absence of caspase activation. However, the involvement of calpains was demonstrated by data showing that calpain inhibitors protect cortical neurons from apoptosis and the formation of 145/150 kDa α‐fodrin fragments. Moreover, an increase in cytosolic Ca2+ concentration was associated with HOCl neurotoxicity and Ca2+ channel antagonists, and Ca2+ chelators prevented cleavage of α‐fodrin and the induction of apoptosis. Finally, we found that calpain activation ruptured lysosomes. Stabilization of lysosomes by calpain inhibitors or imidazoline drugs, as well as inhibition of cathepsin protease activities, rescued cells from HOCl‐induced neurotoxicity. Our results showed for the first time that HOCl induces apoptosis in cortical neurons, and that the cell death process involves calpain activation and rupture of lysosomes.
Estimating the Effect of Smoking Cessation on Weight Gain: An Instrumental Variable Approach
Authors: Eisenberg Daniel , Quinn Brian C.
Published: July 2006

Objective. To propose and test a method that produces an unbiased estimate of the average effect of smoking cessation on weight gain. Previous estimates may be biased due to unobservable differences in attributes of quitters and continuing smokers. An accurate estimate of weight gain due to cessation is important for policymakers, health managers, clinicians, consumers, and developers of smoking cessation aids.

Study Setting. Our analysis consisted of an instrumental variables (IVs) approach in which treatment assignment in randomized smoking cessation trials served as a random source of variation in probability of quitting.

Data Collection. We searched the medical literature for previously conducted smoking cessation trials that contained data suitable for our reanalysis.

Principal Findings. We identified one trial for our reanalysis, the Lung Health Study, a randomized smoking cessation trial with 5,887 smokers aged 35–60 from 1986 to 1994 in several sites across the United States. In our IV reanalysis, we estimated a 9.7 kg weight gain over 5 years due to cessation, as compared with the conventional estimate of 5.3 kg.

Conclusions. The true effect of smoking cessation on weight gain may be larger than previously estimated. This result indicates the importance of fully understanding the possible weight effects of cessation and underscores the need to accompany cessation programs with weight management interventions. The result, however, does not overturn the conclusion that the net health benefits of quitting are positive and very large. The application of the IV technique we propose is likely to be useful in a variety of contexts in which one is interested in the effect of one health condition on another.
A study of women's knowledge regarding human papillomavirus infection, cervical cancer and human papillomavirus vaccines
Authors: GILES Michelle , GARLAND Suzanne
Published: July 2006

Aims:  Human papillomavirus (HPV) infection is a common sexually transmitted viral infection and is associated with the development of cervical cancer. HPV vaccines are now undergoing phase 3 clinical trials in Australia. It is likely that an HPV vaccine will become licensed for use in the near future.

Methods:  Ninety women aged 18–30 years from three different groups (those attending a dysplasia clinic, a local university health service and participants currently involved in a phase 3 HPV vaccine trial) completed a questionnaire assessing their knowledge base regarding HPV infection, cervical cancer, Pap tests and HPV vaccines.

Results:  Respondents demonstrated good understanding of the Pap test and interpretation of an abnormal result. Most respondents (89%) had heard of HPV and attributed a number of different clinical symptoms to infection. For women who had not heard of an HPV vaccine, 79% of respondents stated that the most common resource they would use to obtain further information is their general practitioner.

Discussion:  Many women do not understand the risk factors for HPV infection, the clinical problems it may cause and the potential long‐term complications of infection. Few women have heard of a HPV vaccine, but most women surveyed would approach their general practitioner for more information if one became available.

Conclusion:  This study highlights the need for further education regarding HPV infection and the potential long‐term complications such as cervical cancer. It also demonstrates that education of general practitioners regarding an HPV vaccine is essential, as this is the most likely resource women will use to obtain further information in the future.
The routine use of oxytocin after oral misoprostol for labour induction in women with an unfavourable cervix is not of benefit
Authors: DE Arunangsu , BAGGA Rashmi , GOPALAN Sarala
Published: July 2006

Background:  Induction of labour with misoprostol is often augmented with oxytocin with the possible consequence of uterine hypercontractility. It is important to determine whether the use of oxytocin in this circumstance has benefit as well as risk.

Aim:  To compare two regimens for labour induction in women with an unfavourable cervix: oral misoprostol vs. oral misoprostol routinely followed by oxytocin.

Methods:  A prospective randomised trial in which 200 women with an unfavourable cervix received either oral misoprostol 25 µg every 3 h (group 1, n = 100) or two such doses routinely followed by oxytocin (group 2, n = 100). Outcomes included change in Bishop score, induction delivery interval, oxytocin requirement, contraction abnormalities, mode of delivery and neonatal outcome.

Result:  The improvement in Bishop score with two misoprostol doses in all 200 women was highly significant (2.9 ± 1.5 to 6.6 ± 1.9, P < 0.0001). The induction delivery interval, Caesarean delivery rate, vaginal delivery rate within 24 h, contraction abnormalities and neonatal outcome were similar in both groups. Contraction abnormalities were remarkably low with either regimen (1%). Routine addition of oxytocin 3 h after the second misoprostol dose (group 2) resulted in the maximum oxytocin dose (64 mU/min) being given to more women (66% in group 2; 36% in group 1).

Conclusion:  There was no benefit of routine addition of oxytocin after two doses of misoprostol. Reduced oxytocin requirement was observed when it was added only if needed. Both regimens achieved 85–87% vaginal deliveries with low incidence of hypercontractility.
Hormones down under: Hormone therapy use after the Women's Health Initiative
Authors: TRAVERS Catherine , O’NEILL Sheila M. , KHOO Soo‐Keat , KING Robert
Published: July 2006

Aims:  The primary objective was to describe the usage pattern of hormone therapy (HT) in a sample of urban Australian women in 2001 and to assess the characteristics of users vs. non‐users. The second objective was to determine whether there had been any change in usage since the publication of the results of the combined oestrogen plus progestagen arm of the Women's Health Initiative (WHI) in 2002.

Methods:  A cohort of 374 postmenopausal women aged 50–80 years participated in this substudy of the LAW (Longitudinal Assessment of Ageing in Women) project: a 5‐year multidisciplinary, observational study. Participants completed an annual medical assessment including details of the use of HT and the reasons for use, as well as demographic and psychosocial data.

Results:  In December 2001, 30.8% of the participants were using HT, whereas 55.4% were ever users. The management of vasomotor symptoms and mood disturbance were the primary reasons for use. Of those who had been using HT in December 2001 (24.4%) women ceased using HT in the 3 months following publication of the WHI results. The percentage of women using HT in December 2003 (13.9%) was less than half of that of December 2001.

Conclusion:  The rate of HT use and the reasons for use, in 2001 in Brisbane was similar to that of other Australian regions. Usage of HT decreased since the publication of the WHI results in 2002 which may reflect changing attitudes by patients and practitioners regarding HT.
Predicting post‐operative delirium in elderly patients undergoing surgery for hip fracture
Authors: GOLDENBERG Gregory , KISELEV Pavel , BHARATHAN Thayylathil , BACCASH Emil , GILL Lovelyn , MADHAV Vinkatesh , DHILLON Perminder , THAKUR Chantrapal
Published: July 2006

Background:  Delirium in elderly patients with hip fracture has a significant negative influence on the disease course. Awareness of risk factors for postoperative delirium (POD) may lead to the development of effective preventive strategies. The aims of this study were: to find patients’ features that are predictors of POD, and; to develop a model predicting the risk for POD.

Patients and methods:  Seventy‐seven elderly patients (81.9 years of age, SD 7.5 years) were non‐delirious prior to surgery and enrolled in the study. Delirium was diagnosed by Confusion Assessment Method and Algorrhithm. Patients’ characteristics as potential predictors of POD were analyzed by logistic regression analysis on SAS software.

Results:  Postoperative delirium was diagnosed in 37 patients. Use of multiple (>3) medications, lower scores on cognitive tests (<20 on Set Test and <24 on Mini‐mental Status Exam), albumin level less than 3.5 g/dL, hematocrit level less than 33% and age over 81 years were predictors of POD. A logistic regression formula including these predictors weighed by their parameter estimates can be used to calculate the probability of POD. The model had a good fit and a good predictive power. A Delirium Predicting Scale was derived based on parameter estimates of these predictors. Patients can be classified as low‐, intermediate‐ or high‐risk for POD.

Conclusions:  A logistic regression model, which includes patients’ age, medication history, cognitive performance measured by Set Test and Mini‐Mental Status Exam, albumin and hematocrit levels, can be used to predict risk for POD after surgical repair of fractured hip in elderly patients.
Onset of schizophrenia in late eighties: very‐late‐onset schizophrenia‐like psychosis or late paraphrenia?
Authors: ARORA Manu , PRAHARAJ Samir Kumar
Published: July 2006

Late‐onset schizophrenia and very‐late‐onset schizophrenia‐like psychosis, although uncommon, have been described in the literature. We report a case of paranoid schizophrenia with onset of illness at 88 years, who fits well with the description of late paraphrenia as well. It is suggested that the term late paraphrenia would be more appropriate for such cases with late‐onset schizophrenia‐like psychosis, in order to remove the ambiguity in the terminology.
Physiological Parameters as Biomarkers of Migraine
Authors: Gantenbein Andreas R. , Sándor Peter S.
Published: July 2006

We review physical signs and measurements from neurophysiological research, which may be considered biomarkers of migraine. Most studies show that information processing is abnormal in migraineurs. Studies of trigeminal nociception are in line with a central sensitization during the attack. The best documented abnormality is an interictal lack of habituation in migraineurs, with a normalization during the headache state, which has been shown using evoked and event‐related potentials. Together with a diminished energy reserve found in MR‐spectroscopy studies, these results suggest a possible role of increased energy consumption in attack generation. Importantly, to date, no neurophysiological marker has a high enough sensitivity and specificity to point out the single migraine patient. Therefore, these biomarkers are to be understood as tools for research and are not to be used for diagnostic purposes.
Eletriptan in Migraine Patients Reporting Unsatisfactory Response to Rizatriptan
Authors: Goldstein Jerome , Tiseo Paul T. , Albert Kenneth S. , Li Chunming , Sikes Carolyn R.
Published: July 2006

Objective.—The objective of this open‐label study was to evaluate the efficacy of switching patients who had a previous unsatisfactory response to rizatriptan to eletriptan 40 mg.

Background.—The characteristics of individual migraine patients can vary tremendously and can have a significant impact on treatment outcomes. In addition, clinical experience has demonstrated that the triptans are not identical or interchangeable and that patients who respond poorly or who are dissatisfied with one agent can derive benefit by being switched to another agent within the triptan class.

Methods.—Patients were eligible if they met International Headache Society criteria for migraine, with a frequency of 1 to 6 migraine attacks per month, and had documented “unsatisfactory treatment response” to rizatriptan within the past year (54% on the melt formulation; 46% on tablets). Reasons for dissatisfaction with rizatriptan (>1 could be cited) included inadequate (84%) or slow onset (50%) of pain relief, high recurrence rate (69%), and lack of improvement in associated symptoms (60%). One hundred twenty‐three patients were eligible for treatment. Patients were instructed to take eletriptan 40 mg as soon as they were certain that their headache was a migraine, regardless of level of pain severity (8% treated headaches that were mild).

Results.—Headache response at 2 hours (first‐attack data) was 64%. Absence of nausea (from baseline to 2 hours) increased from 50% to 78%, absence of photophobia from 30% to 72%, and absence of phonophobia from 39% to 77%. Functional response at 2 hours was 63%, with 41% of patients reporting normal functioning. Treatment with eletriptan 40 mg was associated with a 27% to 40% reduction in migraine attack‐related functional impairment, as measured by the PQ‐7. Recurrence rates were 36.6%. Overall, 72% of patients rated eletriptan as a “good‐to‐excellent” treatment, and 78% reported overall satisfaction with the degree of headache relief.

Conclusion.—The results of this study suggest that eletriptan is an efficacious treatment option for patients who are dissatisfied with their response to rizatriptan.
Long‐Term Migraine Prevention With Topiramate: Open‐Label Extension of Pivotal Trials
Authors: Rapoport Alan , Mauskop Alexander , Diener Hans‐Christoph , Schwalen Susanne , Pfeil Joop
Published: July 2006

Objective.—To demonstrate that topiramate is an effective and generally well‐tolerated migraine preventive therapy when used for up to 14 months.

Background.—Topiramate 100 and 200 mg/d significantly reduced mean monthly migraine frequency during 2 large, 26‐week, randomized, placebo‐controlled trials. Only a small number of clinical trials have examined the long‐term (≥1 year) effectiveness and safety of migraine preventive therapies.

Methods.—Five hundred sixty‐seven patients with an established history of migraine with or without aura were enrolled in this 8‐month, open‐label extension of 2 large (49 US and 52 US and Canadian medical centers), randomized, double‐blind, placebo‐controlled, parallel group, 26‐week trials of identical design. To be eligible for the open‐label extension, patients were required to have either completed the double‐blind phase of the 2 pivotal migraine prevention trials or withdrew after 4 weeks due to lack of efficacy. All eligible patients, regardless of type or dose of study medication (topiramate or placebo) received in the double‐blind phase, were titrated to a clinically effective dose of open‐label topiramate based on physician judgment of patient response. Efficacy of topiramate was measured as the change in mean monthly migraine frequency.

Results.—The mean topiramate dose during the open‐label extension phase was 124.7 mg/d and 150.3 mg/d for patients on placebo (n = 159) or topiramate (n = 408), respectively, during the double‐blind phase (N = 567, 91% female, mean age 39.4 years). Patients on topiramate for up to 14 months had 2.2 ± 2.4 (mean ± SD) migraines per month after completion of the open‐label extension phase (3.4 ± 2.6 at double‐blind endpoint). Patients on topiramate during the open‐label extension phase only (placebo during the double‐blind phase) had 3.0 ± 2.9 migraines per month at open‐label extension endpoint (4.9 ± 3.0 migraines per month at double‐blind endpoint). Discontinuation rates due to adverse events during the double‐blind phase were 22.2% for patients on topiramate and 11.0% for patients on placebo. Discontinuation rates due to adverse events during the open‐label extension phase were 8.6% for those patients who had already received topiramate during the double‐blind phase and 20.9% for those patients who had previously received placebo.

Conclusions.—Patients receiving topiramate experienced a sustained reduction in migraine frequency for up to 14 months. The effectiveness and safety of topiramate was consistent with that observed during 2 26‐week pivotal trials.
Local Decrease of Pressure Pain Threshold in Nummular Headache
Authors: Fernández‐de‐las‐Peñas César , Cuadrado María Luz , Barriga Francisco J. , Pareja Juan A.
Published: July 2006

Background.—Nummular headache (NH) is a primary disorder presenting with localized pain that is circumscribed to a coin‐shaped area of the head surface.

Methods.—In 12 patients with NH (3 men and 9 women, 21 to 67 years old), we measured the pressure pain threshold (PPT) in several points while they were headache‐free. The following cephalic and extracephalic points were explored: the symptomatic cranial area, a symmetrical point on the nonsymptomatic side, and 3 standardized pairs of symmetrical points (anterior part of the temporal muscle, upper trapezius muscle, and distal dorsal part of the second finger). Three consecutive PPT readings were obtained with an algometer on each point, and the repeatability of these measurements was always high (ICC: 0.93 to 0.97).

Results.—Mean PPT was lower in the symptomatic cranial area than in the contra‐lateral symmetrical point (1.8 ± 0.6 kg/cm2 vs 2.4 ± 0.6 kg/cm2; P < .001), whereas in the remaining reference points PPT was almost equal on both sides.

Conclusions.—According to these data, NH seems to be associated with a local increase of pain sensitivity to mechanical stimulation.
Effects of Illness Duration on Memory Processing of Patients with Temporal Lobe Epilepsy
Authors: Cheung Mei‐chun , Chan Agnes S. , Chan Yu‐leung , Lam Joseph M. K. , Lam Wan
Published: July 2006

Summary:  Purpose: To examine the effects of illness duration on the neural processing of memory in patients with temporal lobe epilepsy (TLE) by using functional MRI.

Methods: Twenty‐three TLE patients (16 left, seven right) performed a complex visual scene‐encoding task during functional MRI. Region‐of‐interest (ROI) analyses were used to quantity functional activation in the mesial temporal and frontal lobes. The patients' verbal and visual memory performances were evaluated by standardized neuropsychological tests. Analyses included group comparison and correlations of duration of epilepsy with functional activation and memory performance.

Results: Compared with normal controls, TLE patients demonstrated reduced activation bilaterally in the mesial temporal lobe (p = 0.003), and the reduction was more pronounced on the ipsilateral side of the seizure focus. Moreover, a longer duration of illness was associated with fewer voxels activated in both the left (p = 0.038) and right (p = 0.017) mesial temporal lobe. Furthermore, the duration of illness was found to be significantly and negatively correlated with both verbal (p = 0.020) and visual (p = 0.000) memory functioning.

Conclusions: TLE seems to affect the memory processes in the mesial temporal lobes progressively (i.e., the longer the duration of illness, the lower the brain activation). In turn, the reduction of brain activation negatively affects memory functioning. Finally, the reduction is not limited to the side of seizure but also is observed in the contralateral hemisphere.
The shape of the socioeconomic–oral health gradient: implications for theoretical explanations
Authors: Sanders Anne E. , Slade Gary D. , Turrell Gavin , John Spencer A. , Marcenes Wagner
Published: July 2006

Abstract –  Objectives:  The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic ‐oral health relationship using a measure of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural).

Methods:  In 2003, cross‐sectional self‐report data were collected from 2,915 adults aged 43–57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) <24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14‐item Oral Health Impact Profile; (3) fair or poor self‐rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning.

Results:  There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0–5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self‐rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs.

Conclusion:  The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight‐line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution.