bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of the use of patient‐based measures of health in routine practice in improving the process and outcomes of patient care: a literature review
Authors: Greenhalgh Joanne , Meadows Keith
Published: March 2003

Despite a number of potential benefits to both the clinician and the patient, patient‐based measures of health have not been routinely or systematically used within routine practice by clinicians in the care of individual patients. There are a number of practical, methodological and attitudinal barriers which have so far limited the use of patient‐based measures of health within routine practice. The extent to which these barriers are overcome is likely to influence the effectiveness of such instruments in improving the process and outcomes of patient care. This study reviewed the evidence for the effectiveness of this intervention and identified some of the factors that may influence its effectiveness. Thirteen relevant studies were located using search strategies on three computerized databases for 1987–97. The study found that clinicians see information from patient‐based measures of health as valuable in the overall assessment of the patient and that its feedback to clinicians increases the detection of psychological and, to a lesser extent, functional problems. However, there was little evidence to suggest their use substantially changed patient management or improved patient outcomes. Our findings suggest that the ways in which patient based measures of health are implemented in routine practice may have an impact on their effectiveness. It is recommended that implementation strategies that are guided by theories of individual and organizational change might allow the barriers to using patient‐based measures of health in routine practice to be identified and overcome more effectively.
Individual patient data meta‐analysis of randomized anti‐epileptic drug monotherapy trials
Authors: Williamson Paula R. , Marson Anthony G. , Tudur Catrin , Hutton Jane L. , Chadwick David
Published: March 2003

Meta‐analysis may be based on either aggregate data or individual patient data (IPD). Three reasons why IPD are desirable for the meta‐analysis of anti‐epileptic drug (AED) monotherapy trials are: (1) to undertake a more complete analysis of time‐to‐event outcomes; (2) to investigate the interaction between AED and type of epilepsy; and (3) to undertake re‐analysis of the trial to obtain results for all relevant outcomes. We demonstrate that IPD meta‐analysis is possible in AED research. Problems arose from missing data at four levels: (1) unknown trials; (2) known trials but no IPD supplied; (3) known trials but missing outcome data for some individuals within trials; and (4) known trials but missing covariate data for some individuals within trials. Empirical evidence of the reliability of meta‐analyses based on aggregate rather than individual patient data is still lacking. Examples of other benefits such projects may bring include improvements to the design of a new trial in the area, in terms of the sample size considerations, the definition of outcomes and data collection.
Identifying meaningful intra‐individual change standards for health‐related quality of life measures
Authors: Wyrwich Kathleen W. , Wolinsky Fredric D.
Published: March 2003

Abstract

Although numerous measures have been developed for the evaluation of health‐related quality of life (HRQoL), strategies for identifying meaningful intra‐individual change in these measures have not kept pace with instrument development. As a result, clinical trial researchers, quality assurance assessment teams and practising clinicians are without established standards to evaluate individual patient change in HRQoL measures as improved, stable or declined. This article reviews and critiques the methods that have been applied to establish intra‐individual HRQoL change standards. These methods include within‐person and between‐persons anchor‐based studies, as well as distribution‐based techniques using the effect size, the standard error of measurement, the mean squared error or individual slope coefficients derived from hierarchical linear modelling. Practical approaches to improving and advancing HRQoL change evaluations that enhance the interpretation of intra‐individual change are provided. Two future methodological challenges in this area of HRQoL research are examined: (1) the development of individual change standards for generic HRQoL measures; and (2) the incorporation of individual clinical assessments into the process for establishing significant intra‐individual change standards.
Choosing a doctor: an exploratory study of factors influencing patients’ choice of a primary care doctor
Authors: Bornstein Brian H. , Marcus David , Cassidy William
Published: March 2003

We assessed the relative importance healthcare consumers attach to various factors in choosing a primary care doctor (PCD) in a cross‐sectional, in‐person survey. Three survey locations were used: doctors’ offices, a public shopping area, and meetings of a women’s organization. A total of 636 community residents, varying across major demographic categories, participated. Participants completed a 23‐item survey, designed to assess which factors consumers perceive as most relevant in choosing a PCD. Participants perceived professionally relevant factors (e.g. whether the doctor is board certified, office appearance) and management practices (e.g. time to get an appointment, evening and weekend hours) as more important than the doctor’s personal characteristics (race, age, gender, etc.). Participants’ own characteristics bore little relationship to the perceived importance of doctor characteristics. Factors patients perceive as most important to their choice of a PCD are also those that have the greatest effect on the quality of healthcare they will receive. However, they do not always have access to this information. A better understanding of the factors that influence people’s choice of a PCD can contribute to efforts to provide them with the resources to make well‐informed decisions in selecting among healthcare options.
The effect of a hepatitis serology testing algorithm on laboratory utilization
Authors: Walraven Carl van , Goel Vivek
Published: March 2003

Rationale, aims and objectives Laboratory testing algorithms use patient and laboratory data to identify the optimal testing strategy for patients. Studies have shown that these algorithms can decrease test utilization. Since over‐utilization of hepatitis serological tests was suspected, a hepatitis serology testing algorithm was initiated in Ontario, Canada. This study determined the effects of this algorithm on utilization. Methods  Population‐based retrospective observational study, involving all patients having viral hepatitis serological testing at private laboratories in Ontario, Canada, between July 1991 and December 1999. Prior to the testing algorithm, physicians listed the required specific antigens and antibodies on the test requisition form. In September 1996, the form was changed so that physicians identified the clinical indication – acute hepatitis, chronic hepatitis or immune status testing – for hepatitis serology testing. Therefore, the algorithm introduced a new ‘tick‐box’ to the requisition form. Tests conducted by the laboratory depended upon which indication was chosen. Rates for hepatitis serological testing were calculated using population‐based claims data. Results Time‐series modelling showed that the testing algorithm was associated with a slight but significant increase in the use of hepatitis serology (P < 0.05). The algorithm was associated with an increase of 30 serological tests per 100 000 population per month. Conclusions Introducing a testing algorithm for hepatic viral serology in Ontario did not significantly decrease hepatitis serology utilization and may be associated with a slight, but significant, increase in serology utilization rates.
Can safety assurance procedures in the food industry be used to evaluate a medical screening programme? The application of the Hazard Analysis and Critical Control Point system to an antenatal serum screening programme for Down's syndrome. Stage 2: overcoming the hazards in programme delivery
Authors: Derrington M. Clare , Draper Elizabeth S. , Hsu Ronald T. , Kurinczuk Jennifer J.
Published: March 2003

Rationale, aims and objectives An adaptation of the first stage of the systematic qualitative tool, the Hazard Analysis and Critical Control Point (HACCP) system from the food industry, was used to identify problems in the delivery of a district‐wide antenatal screening programme for Down's syndrome. The aim of the second stage, described here, was to develop specific solutions (termed controls) for these problems.

Methods The views of staff delivering the programme and of members of the Down's screening steering group were used to identify control measures. The steering group members were also asked to identify which controls were critical to a risk management strategy, i.e. whether a control was essential to eliminate the hazard or if other control measures operating further down‐line would be sufficient. The control measures were piloted both to determine if they were operationally feasible and whether they were practical in the context of staff workload and attitude. Two main control measures were the development of a rolling education programme for staff and of a written protocol with a checklist to verify stepwise delivery of the Down's screening programme. The checklist was designed to be included in the notes of every pregnant woman to enable audit of the offer of screening and delivery of each step of the screening programme. The control measures were all tailored specifically to overcome the problems reported by staff during the first stage of the work, the hazard analysis.

Results and conclusions The HACCP system proved useful in confirming the existence of problems in delivery of a Down's serum screening programme and in determining solutions tailored to overcome those problems. Future work is required to monitor and evaluate the usefulness of the control measures implemented.
Are health states ‘timeless’? A case study of an acute condition: post‐chemotherapy nausea and vomiting1
Authors: Franic Duska M. , Pathak Dev S. , Gafni Amiram
Published: March 2003

Rationale, aims and objectivesThe objective was to test whether individuals’ responses to standard gamble (SG) and visual analogue scale (VAS) questions do not depend on the time horizon of the health scenario presented.

MethodsFace‐to‐face interviews were conducted in a convenience sample of 18 women aged 22–50 years with no history of breast cancer or cancer requiring chemotherapy. Data were collected from March 2000 to June 2000 at a university in the Midwest of the United States of America. Preference weights were estimated using SG top‐down titration method and VAS scaled from zero (death) to one (perfect health). Subjects were asked to rate their preferences if faced with two scenarios: post‐chemotherapy nausea and vomiting (PCNV) occurring for 3 days (scenario 1), and PCNV lasting for the rest of their lives (scenario 2). Three PCNV health states of varying severity were tested: complete alleviation, partial alleviation, and no alleviation.

ResultsPaired‐t‐test analysis showed statistically significantly lower preference weights (P< 0.05) when the health state was for the rest of the respondent's life vs. 3 days. Mean SG weights for scenario 1 vs. scenario 2 were: 0.968 vs. 0.927 (complete alleviation), 0.942 vs. 0.810 (partial alleviation) and 0.866 vs. 0.644 (no alleviation). Mean VAS weights for scenario 1 vs. scenario 2 were: 0.741 vs. 0.676 (complete alleviation), 0.490 vs. 0.307 (partial alleviation) and 0.276 vs. 0.136 (no alleviation).

Discussion and conclusionsFor the majority of respondents the utility independence assumption for SG and VAS did not hold. Similar to Balaet al., the results of this study indicated that preference weights as measured by SG and VAS techniques were not ‘timeless’. Regardless of the preference measure used, both SG and VAS yielded higher scores when PCNV lasted for a shorter period of time.
Vibrio spp. isolated from salmonids with shallow skin lesions and reared at low temperature
Authors: Benediktsdóttir  , Helgason  , Sigurjónsdóttir
Published: March 2003

In Iceland the rearing temperature of salmonid fish, mostly Atlantic salmon, is generally below 10°C. Infections most often characterized by shallow skin lesions that may cause considerable mortality have been endemic in the country since rearing in salt water started. A variety of Vibrio spp. has been isolated from the diseased fish. In the present study, a total of 58 strains isolated from salmonid fish and 21 reference strains were subjected to a numerical taxonomy study. The results show that two phena are most common in the diseased fish; one of them includes V. marinus, whereas the other does not include a reference strain but has similarities to V. logei. Challenge tests showed that a representative strain of the phenon that included V. marinus is pathogenic for Atlantic salmon with an LD50 lower than 3.5 × 103.
Further studies on acquired resistance to amoebic gill disease (AGD) in Atlantic salmon, Salmo salar L.
Authors: Findlay  , Munday
Published: March 2003

Trials were designed to test the efficacy of freshwater treatments for amoebic gill disease (AGD) of Atlantic salmon, Salmo salar L., and the effect they had on the acquisition of resistance to reinfection with AGD. The first trial involved fish being given an industry‐simulated freshwater bath of 2–3 h duration which simulated treatments given on farms. These fish did not display appreciable resistance to reinfection. The second trial involved four groups of fish which had been infected with and treated for AGD in a number of different ways. Once again the fish that had been infected for the first time and given a single 2–3 h freshwater bath and then re‐exposed did not exhibit appreciable resistance to reinfection. In contrast, those fish that had been given a second 2–3 h freshwater bath and those that had been maintained in freshwater for 4 weeks displayed high levels of resistance. There is preliminary evidence to suggest that this resistance could be related to stimulation of the non‐specific immune system.
Loma salmonae‐associated growth rate suppression in rainbow trout, Oncorhynchus mykiss (Walbaum), occurs during early onset xenoma dissolution as determined by in situ hybridization and immunohistochemistry
Authors: Speare D. J. , Daley J. , Markham R. J. F. , Sheppard J. , Beaman H. J. , Sanchez J. G.
Published: March 2003

Experimental infection of rainbow trout, Oncorhynchus mykiss (Walbaum), juveniles with Loma salmonae at a water temperature of 15 °C yielded detectable parasite DNA within the gills by week 2 post‐exposure (PE) and detectable spore‐wall antigen within developing xenomas by week 3 PE, as determined by in situ hybridization and monoclonal antibody (Mab) based immunohistochemistry, respectively. The microsporidian was most commonly located within endothelial cells of lamellar basal channels. Whereas the onset of xenoma formation appeared to be relatively synchronous, as expected from previous studies, xenoma dissolution followed an unexpected biphasic pattern with peaks at weeks 4 and 9 PE. The onset of significant growth rate suppression, at week 4 PE in exposed fish, was temporally associated with the appearance of gill lesions which, in turn, were centred about sites of premature xenoma dissolution. The latter was determined by the detection of spore‐wall antigen within lesions. Co‐habitant control fish began developing xenomas by week 10, indicating the infective potential of those spores released from the principal fish during early xenoma dissolution. Although infection with L. salmonae significantly affects fish growth rates, the time‐course of this suppression is limited, and as an unexpected finding, growth rate recovery commences prior to the infection’s resolution.
Detection of channel catfish virus DNA in acutely infected channel catfish,Ictalurus punctatus(Rafinesque), using the polymerase chain reaction
Authors: Gray W. L. , Williams R. J. , Griffin B. R.
Published: March 2003

Channel catfish virus (CCV) causes an acute haemorrhagic disease in channel catfish,Ictalurus punctatus(Rafinesque), fry and fingerlings. The present study describes a polymerase chain reaction (PCR)‐based assay for detection of CCV DNA in the tissues of acutely infected juvenile catfish. The assay is rapid, sensitive and specifically detects CCV DNA derived from epidemiologically distinct viral isolates. The use of two independent PCR primers sets, each specific for particular CCV genes (open reading frames 8 and 59), provides a means to confirm the results and minimize false‐positive results. The method identifies CCV DNA in several tissues of acutely infected fish, including the brain, blood, intestine, kidney and liver. The CCV PCR assay is useful for the diagnosis of acute CCV disease and for studies to investigate the molecular basis of CCV pathogenesis.
Effect of water temperature manipulation on a thermal unit predictive model for Loma salmonae
Authors: Speare D. J. , Beaman H. J. , Daley J.
Published: March 2003

Loma salmonae is an important microsporidian pathogen affecting the mariculture of Pacific salmon, Oncorhynchus tshawytscha (Walbaum). Clinical signs associated with infection arise when the parasite enters sporogony and forms xenoparasitic complexes (xenomas) within the gill. The present study tested a thermal unit (TU) model, which was devised to predict the timing of xenoma formation, under conditions in which water temperature changed during the course of infection. In vivo trials with juvenile trout showed that the model [TU for xenoma onset = (days post exposure) × ( °C above 7 °C)] accurately predicted the onset time for xenomas when fish were moved from either 11 or 5 °C to 15 °C at various intervals after exposure. These findings suggest that the TU model may allow aquaculturists to predict disease onset. However, the model failed when fish were moved from 15 to 5 °C at intervals after exposure. This finding suggests that the temperature‐constrained phase of the life‐cycle of L. salmonae occurs early on after the spore is ingested by the fish.
The immunomodulatory effects of levamisole on the nonspecific immune system of Atlantic salmon, Salmo salar L.
Authors: Findlay V L , Munday B L
Published: March 2003

Sea water‐adapted Atlantic salmon, Salmo salar L., were given a 2‐h bath in a 2.5 mg L−1 levamisole (as levamisole hydrochloride) solution in fresh‐water. Following bathing, the fish were held in full salinity sea water for 2 weeks before being subjected to a number of immunological assays. Heightened activity of the nonspecific defence system was demonstrated by increases in phagocytic index, phagocytic capacity and phagocytic activity, increased levels of the reactive oxygen intermediate, superoxide anion, and an increased lytic activity of both the mucus and the serum. These results indicate that levamisole is effective in augmenting parts of the nonspecific defence system of Atlantic salmon. This is the first record of the use and efficacy of levamisole as an immunomodulator in Atlantic salmon.
Cardiac disorders in farmed adult brown trout, Salmo trutta L.
Authors: Mercier C , Aubin J , Lefrançois C , Claireaux G
Published: March 2003

During summer in Brittany, France, sea farmed brown trout, Salmo trutta L., regularly experience a high mortality rate which is associated, at least in part, with cardiac disorders (aneurysms and infarcts). The present study is preliminary to a more extensive research programme, the objective of which is to determine to what extent the physiological performance of the cardiovascular system of brown trout is affected by the environmental conditions the fish experience in farm cages. We conducted a 2‐week in situ experiment during which the heart rate of eight sea water acclimatized individuals was telemetered using acoustic tags. During the experimental period, water temperature ranged from 16.0 to 17.6 °C. Water oxygen saturation was above 80% at all times and salinity was very high (35.5‰) but stable. Although they were unfed and not active, seven of out the eight tagged animals displayed near maximum heart beat frequencies, which ranged between 83 and 98 beats per minute (bpm). On the other hand, the eighth animal exhibited medium‐range heart rates (50–70 bpm). Using phase delay maps, we established that the maximum heart rate of brown trout at 17 °C was in the range of 96–100 bpm. This result suggests that in our experimental conditions, the heart rate of most of our inactive fish was between 85 and 100% of maximum myocardial performance. We hypothesize that the cardiac failures observed in brown trout during summer are most likely a result of strenuous workloads imposed on the cardiovascular system by a combination of elevated temperature, high salinity and possibly season‐related decreased hypo‐osmoregulatory abilities.
Trichodina murmanica (Ciliophora) and Gyrodactylus pleuronecti (Monogenea) parasitizing hatchery‐reared winter flounder, Pseudopleuronectes americanus (Walbaum): effects on host growth and assessment of parasite interaction
Authors: Barker D E , Cone D K , Burt M D B
Published: March 2003

Winter flounder, Pseudopleuronectes americanus, caught in Passamaquoddy Bay, New Brunswick, Canada, and held captive under crowded conditions, developed mixed infections of Trichodina murmanica Polyanski, 1955 (Ciliophora) and Gyrodactylus pleuronecti Cone, 1981 (Monogenea). A protocol involving sequential sieving was used to separate the two species of parasites and produce viable experimental baths. Replicate groups of juvenile, hatchery‐reared flounder received one of the following treatments: mixed bath of G. pleuronecti and T. murmanica, bath of G. pleuronecti, bath of T. murmanica or parasite‐free (controls). The abundance of both parasites correlated negatively with condition factor of the flounder (r=−0.354, P < 0.001 for Trichodina; r=–0.205, P < 0.05 for Gyrodactylus). During the periods of peak parasite abundance (1–2 weeks postinfection), the effect of the two parasite species was additive, as mean condition factor and the percentage change in weight were significantly lower (ANOVA, P < 0.05) among fish with mixed infections compared to single infections or controls. The most common signs of tissue pathology were increased density of epidermal mucous cells on the fins and macrovesicular lipidosis of the hepatocytes. After a significant decline in parasite infrapopulations (3 weeks postinfection), infected fish resumed normal growth, indicating the observed effects were somewhat reversible.
Epizootiology of Parvicapsulaminibicornis in Fraser River sockeye salmon, Oncorhynchusnerka (Walbaum)
Authors: St‐Hilaire S , Boichuk M , Barnes D , Higgins M , Devlin R , Withler R , Khattra J , Jones S , Kieser D
Published: March 2003

Late‐spawning Fraser River sockeye salmon, Oncorhynchus nerka, stocks have suffered significant prespawn mortality associated with an unusually early freshwater migration pattern and the myxosporean parasite Parvicapsula minibicornis. Surveys of migrating adult salmon from several spawning populations were conducted in 1999 and 2000 to determine the extent of infection with P. minibicornis, when and where the parasite first becomes detectable during migration, and whether early migrating stocks might be used as sentinels to assess risk of infection in late‐spawning stocks. Posterior kidney, preserved in 95% ethanol, was examined for P. minibicornis in stained histological sections and using a polymerase chain reaction (PCR) test. The prevalence of this parasite in all Fraser River sockeye salmon stocks examined was high (range 47–100% infected). In contrast, P. minibicornis was not detected in the fish tested from the two sockeye salmon stocks outside the Fraser River drainage in either 1999 or 2000. The parasite was also not detected histologically or by PCR in the kidney tissue of the fish from the Fraser River that were sampled in salt water or early during their freshwater migration up the river. These findings and the progression in the prevalence and intensity of infection as the fish from three stocks (early Stuart, Weaver Creek and Cultus Lake) were monitored over time, suggest salmon acquired the parasite either in the lower Strait of Georgia or in the lower Fraser River before the confluence of the Harrison River. In both 1999 and 2000 the parasite was present in all Fraser River sockeye salmon stocks sampled, which suggests that early Stuart salmon may be valuable as a sentinel stock for the presence of the parasite in later‐spawning stocks.
Detection of koi herpesvirus DNA in tissues of infected fish
Authors: Gray W L , Mullis L , LaPatra S E , Groff J M , Goodwin A
Published: March 2003

A newly recognized herpesvirus, koi herpesvirus or KHV, causes a lethal disease in common carp, Cyprinus carpio, and its colourful strain known as koi or fancy carp. In this study, we report new outbreaks of the disease, present initial characterization of the KHV genome, and describe assays for detection of KHV DNA in infected cells and tissues of infected fish. Restriction endonuclease (RE) profiles of viral DNA derived from two epidemiologically distinct KHV isolates were identical to each other. Cloned KHV BamHI and SphI DNA probes specifically hybridized to KHV DNA, but not to DNAs derived from a variety of other fish herpesviruses. The KHV DNA probes detected KHV DNA in tissues of experimentally infected koi fish by DNA hybridization. The KHV specific polymerase chain assays (PCR) were developed for rapid detection and confirmation of KHV DNA in tissues of infected fish.
Ichthyophonus hoferi Plehn & Mulsow in British Columbia stocks of Pacific herring, Clupea pallasi Valenciennes, and its infectivity to chinook salmon, Oncorhynchus tshawytscha (Walbaum)
Authors: Jones S R M , Dawe S C
Published: March 2003

Pacific herring, Clupea pallasi Valenciennes, collected from three areas of coastal British Columbia were screened for Ichthyophonus by histological examination. The infectivity of Ichthyophonus to juvenile chinook salmon, Oncorhynchus tshawytscha (Walbaum), was examined in laboratory studies. Ichthyophonus was detected in a total of 82 of 356 herring from all three areas. Prevalence in 2000 and 2001 ranged from 10.5 to 52.5% and was significantly lower in more northern (Hecate Strait) samples. Ichthyophonus was detected by histological examination in chinook salmon following oral or intraperitoneal (i.p.) exposure to homogenates of infected herring tissue. Infections in Yukon stock chinook salmon were occasionally associated with mortality and with inflammation in all tissues examined. Infections were detected significantly more frequently in the caecal mesenteries of i.p.‐infected compared with oral‐infected chinook salmon. The distribution and prevalence of Ichthyophonus isolates among diverse host species may assist in stock identification and in an improved understanding of trophic interactions.
A sandwich enzyme linked immunosorbent assay (S‐ELISA) for detection of MrNV in the giant freshwater prawn, Macrobrachium rosenbergii (de Man)
Authors: Romestand B , Bonami J‐R
Published: March 2003

A sandwich enzyme‐linked immunosorbent assay (S‐ELISA) was developed to improve diagnosis of white tail disease of the giant freshwater prawn, Macrobrachium rosenbergii, caused by the nodavirus, Mr NV. Polyclonal antibodies were produced by immunization of Balb/C mice using a purified suspension of the virus and IgG anti‐MrNV were purified from ascitic fluid. A sandwich method was successfully developed, coating first with unlabelled antibody and detecting trapped antigens with a second biotinylated antibody. Reaction was demonstrated using an avidin–peroxidase conjugate. Tissue extracts from M. rosenbergii infected with MrNV or purified viral extracts (control) were successfully identified in an individual ELISA, thus confirming the validity of the method. This S‐ELISA should be the technique of choice for epidemiological studies of this disease and is a rapid and inexpensive assay with high specificity and sensitivity.
A survey of viral diseases in farmed and feral salmonids in Switzerland
Authors: Knuesel R , Segner H , Wahli T
Published: March 2003

A field survey was carried out to study the occurrence and distribution of viruses causing diseases of major impact in fish farming, namely viral haemorrhagic septicaemia (VHS), infectious haematopoietic necrosis (IHN) and infectious pancreatic necrosis (IPN) in farmed and wild fish in Switzerland. The presence of VHS virus (VHSV), IHN virus (IHNV) and IPN virus (IPNV) in the tissue samples was tested by virus isolation in cell cultures, and subsequent virus identification by immunofluorescence. The sera were screened for anti‐VHSV antibodies (VHSV‐AB) using a serum plaque neutralization test with complement addition. These data were then compared with results of a similar survey performed in 1984/85, and with data from routine diagnostic work completed at the Centre for Fish and Wildlife Health (FIWI) of the University of Bern from 1978 to 2001. Sampling sites included private and government fish farms as well as natural habitats from all major river catchments in Switzerland. In 2000/01, 522 tissue samples and 1910 sera were collected from 3400 fish. In 1984/85 1239 tissue samples and 694 sera were collected from 1628 fish. During the last 24 years of routine diagnostics at the FIWI, 1776 tissue samples were examined for presence of viruses. The results of the tissue analysis from the surveys in 1984/85 and 2000/01 showed low numbers of sites with virus‐positive fish (five VHSV, three IPNV and three VHSV, one IPNV, respectively) in Swiss fish farms and rivers. The sites with virus‐positive fish were located throughout the country. The decline in virus‐positive cases observed between the two surveys agrees with data from the routine diagnostic work of the FIWI which show a decrease in total virus isolations from approximately 35 cases per year in the late 1970s, to approximately 10 cases per year during the last 10 years. However, in 1984/85 8.3% (58 of 694 serum samples) and in 2000/01 6.3% (121 of 1910 serum samples) proved to be positive for VHSV‐AB. The 58 positive samples in 1984/85 originated from 40 of 175 sites (23%) and the 121 positive samples in 2000/01 were from 84 of 217 (29%) sites. These results are indicative of a wider distribution of VHSV than expected from the results of the virus isolations.
Can clinically significant weight loss be achieved and sustained? An evaluation of a general practice based weight control clinic
Authors: Sleath
Published: March 2003

Background and aims: An evaluation was carried out of a general practice based weight control advice clinic to determine if clinically significant weight loss can be achieved and maintained in patients by this means. The weekly clinic was run by a health visitor for 8 years during which time 198 patients attended. Patients were seen individually by appointment on average between 1 and 4 weeks following referral by the GP, nurse or health visitor. The intervention was based on dietary and lifestyle advice.

Methods: Short‐term outcomes were determined from retrospective inspection of clinic data for all 198 patients. One hundred and five patients were followed‐up at least 1 year after completion of the programme of clinic attendance and weighed to determine the long‐term outcome.

Results: One hundred and ninety‐three (97%) patients achieved some weight loss during the programme, 33% achieved a 10% reduction in weight and 52% of patients achieved a reduction of BMI from above to below 30 kg/m2. Long‐term follow‐up showed that 6% patients maintained a 10% weight loss and 18% maintained a reduction of BMI from above to below 30 kg/m2.

Conclusion: The results of this evaluation suggest that research on appropriate follow‐up to enable patients to maintain weight loss is needed.
Evaluation of an Asian women’s healthy eating and exercise group
Authors: Williams  , Sultan
Published: March 2003

Background: A healthy eating and exercise group for Asian women was established in April 1996. A community dietitian, fitness instructor and link worker took part in running the group and funding was provided by Trafford Healthcare NHS Trust and Trafford Metropolitan Borough Council. The group was run as a 14‐week pilot project, however, due to a positive response the group was continued.

Aims: To follow up participants in the programme and examine their perceptions of the programme and changes in weight.

Methods: Thirteen of the 15 overweight or obese women who attended the initial pilot group were followed up and qualitative evaluation was undertaken using a semistructured interview. Measurement of weight change was also made.

Results: Formal methods of recruiting participants appear to have had little impact. Verbal recommendation of the group by the Link Worker and participants appear to have been effective routes for recruiting. Respondents suggested that the group fulfilled social and weight loss functions, both functions being interrelated and affecting weight. Important reasons for no longer attending the group seem to include difficulty getting to the venue and prioritization of the needs of the family over the women’s own needs.

Conclusions: Some implications for the group are that women should be encouraged to walk to the group with others and it should be stressed that coming to the group and learning about healthy eating and exercise is important for the women’s health and also that of their families. Exercise was a popular aspect of the group and it is recommended that exercise sessions are held more frequently for a trial period. The resulting effects on attendance could then be assessed. All women could relate their weight change to diet and exercise in some way. The women who reported that they would definitely re‐attend the group were generally those with a higher BMI (body mass index).
Perception of body image as indicator of weight status in the European Union
Authors: Sánchez‐Villegas A. , Madrigal H. , Martínez‐González M. A. , Kearney J. , Gibney M. J. , De Irala J. , Martínez J. A.
Published: March 2003

Objective

To identify the factors associated with an adequate perception of body image in relation to body weight.

Material and methods

An observational, cross‐sectional study was conducted in a representative sample of the European Union (7155 men and 8077 women). Body Mass Index (BMI) was grouped into four categories, perceived body image was assessed using the nine silhouettes drawing scheme. A multivariable logistic regression model for each sex was used to adjust for potentially confounding variables.

Results

Underweight men and women classified themselves better than other groups (92.9% of correct answers among men and 79.3% among women). Overall, women classified themselves better than men (57.6% vs. 32.7%).

Discussion

Perceived body image as a method of assessment for body weight has different validity depending on sociodemographic or attitudinal categories. Perceived body image as an estimate of the nutritional status has a limited individualized application. Thus, perhaps it could be applied as a proxy measure of adiposity among slim males and among slim and overweight females, but not among the other groups.
Dietary intakes of elite female athletes in Greece
Authors: Hassapidou M. N. , Manstrantoni A.
Published: March 2003

Background

Although there is a great interest in sports in Greece, there are very few data regarding dietary intakes and habits of Greek elite female athletes. The present study assesses the dietary intakes and the energy balance of elite female athletes of four different sports (volleyball, middle distance running, ballet dancing, and swimming) and a non‐athletic control group.

Methods

Data were collected over two seasons, the training and the competitive, using 7‐day weighed dietary records. Energy expenditure was calculated from 7‐day activity records. Anthropometric measurements were also taken for all athletes.

Results

Athletes and controls had similar BMI values. Per cent body fat was lower for athletes compared with controls. Between sports, middle distance runners had the lowest per cent body fat. No significant differences were found between mean energy intake of athletes and controls. Mean energy intake was found lower than calculated energy expenditure, for all four teams.

Macronutrient and micronutrient intakes of the athletes were not statistically different from those of the non‐athletic control group. Mean micronutrient intakes were found above the recommended values with the exception of iron. Both athletes and controls had a high intake of vitamin C that is a characteristic of the population of the Mediterranean countries.

Conclusions

Energy intakes varied between sports and between athletes of the same sport. Calculated energy expenditure was higher from the reported energy intake for most athletes. Athletes with the lowest energy intakes reported menstrual abnormalities.
Dietary calcium in galactosaemia
Authors: Rutherford P. J. , Davidson D. C. , Matthai S. M.
Published: March 2003

The diets of 19 galactosaemic patients were assessed for calcium and phosphorous intake. Despite the use of infant soya formula or calcium‐supplemented soya milk the reference nutrient intake (RNI) for calcium was only met in 26% of the group; all patients met > 100% of the RNI for phosphorous. The regular assessment of the diets of galactosaemia patients is recommended as the milk‐free nature of the diet can lead to an inadequate calcium intake. Lactose‐free calcium supplements should be prescribed if the diet alone is inadequate.
The principles of dietary management of gestational diabetes: reflection on current evidence
Authors: Dornhorst A. , Frost G.
Published: March 2003

Background

Gestational diabetes (GDM) is the commonest metabolic disorder of pregnancy. Most women with GDM are treated with nutritional management alone. There are conflicting guidelines surrounding its dietary management and this has resulted in a lack of conformity to the dietary advice currently prescribed. There is also conflicting opinions to the effectiveness of dietary management of GDM on pregnancy outcomes. The aim of this review was to examine the scientific evidence for the optimal nutritional management of GDM.

Methods

A Medline search of all English papers published between 1995 and 2001 that cross‐referenced GDM with diet was under taken. Because of the poor quality of many of these papers, literature prior to 1995 known to the authors and considered relevant to the review were also included.

Results

The evidence base in this area is of poor quality. One systematic review based on randomized control trials failed to show any benefit from dietary intervention in GDM. However, that review did not include informative clinical and observational studies that are not classified as randomized controlled trials. Overall current evidence points to the effectiveness of dietary advice as a means of improving maternal hyperglycaemia and reducing the risk of accelerated foetal growth. The evidence surrounding energy restriction, carbohydrate and fat manipulation in GDM remains controversial.

Conclusions

Current but limited evidence supports dietary alterations to reduce rates of accelerated foetal growth. There is a clear need for good quality randomized control trials in this area.
A behavioural intervention in a child with feeding problems
Authors: Blissett J. , Harris G.
Published: March 2003

Aim  This case study aimed to describe an intervention with a 2‐year‐old child with growth problems and moderately severe feeding difficulties.

Method  The intervention was based on cognitive behavioural principles and psycho‐physiological techniques, and focused on reducing parental anxiety and returning the control of feeding to the child.

Results  The child's feeding behaviour considerably improved over a 6‐month period, and growth and weight were significantly increased. These positive changes have been maintained for a 3‐year subsequent period.

Conclusion  The principles described can be applied to children with a wide range of feeding problems with multivariate causes.
Changing from a mixed to self‐selected vegetarian diet – influence on blood lipids
Authors: Robinson F. , Hackett A. F. , Billington D. , Stratton G.
Published: March 2003

Objective  To observe any changes in serum concentrations of lipids, when UK meat‐eaters switch to a self selected vegetarian diet for 6 months.

Design  Observational study using capillary blood samples and 3‐day estimated dietary diary.

Setting  Free‐living subjects in the North‐West of England.

Subjects  Twelve male and 31 female adult volunteers aged between 18 and 42 years.

Outcome measures  Serum lipids; nutrient intake and anthropometric measurements at baseline and 6 months after switching to a self‐selected vegetarian diet.

Results  Total energy intake and amount of energy derived from saturated fatty acids decreased significantly after changing to a vegetarian diet (P < 0.05) whereas energy derived from carbohydrate, and intakes of nonstarch polysaccharide intake increased. On switching to a vegetarian diet, total cholesterol and triacylglycerol concentrations were not significantly changed, but HDL‐C was 21% higher than at baseline (1.21 mmol L−1 vs. 1.47 mmol L−1; P = 0.001).

Conclusions  These results suggest that beneficial changes to diet occurred on changing to a self‐selected vegetarian diet. Changing to a self‐selected vegetarian diet appears to be one way of achieving a better blood lipid profile.
An epidemiological and aetiological study of children with intellectual disability in Taiwan
Authors: Hou J.‐W. , Wang T.‐R. , Chuang S.‐M.
Published: March 2003

A large‐scale cytogenetic study of the causes of intellectual disability (ID) in children from special schools and institutions was made in Taiwan between 1991 and 1996. The screening methods and the identification of subjects with ID consisted of both clinical evaluation (i.e. photographs, questionnaires on family, pre‐, peri‐ and postnatal history, and hospital records, including IQ) and further laboratory studies for diagnosis (i.e. standard chromosome analysis, and if indicated, high‐resolution banding, cytogenetic fragile‐X study or molecular techniques). A total of 11 892 patients were enrolled in this study. After excluding the acquired causes of ID, such as infections and the sequelae of brain insults, or the well‐known single‐gene disorders and other multifactorial diseases, 4372 (36.8%) cumulative cases were recruited for karyotyping studies according to their phenotypes and medical records. Abnormal karyotypes were noted in 1889 children (43.2% of all selected children). Thus, the overall incidence of chromosomal aberrations in subjects with ID was estimated as 15.9%. Down's syndrome, the most common cause of ID, accounted for 82.4% of all patients with abnormal karyotypes. The causes of ID were considered to be prenatal in 55.2% (n= 6564) of cases, perinatal in 9.5% (n= 1130), postnatal in 3.3% (n= 392) and unknown in 32.0% (n= 3805) of cases. Two large groups were classified: (1) serious ID (37%), including profound, severe and moderate categories; and (2) mild ID (63%). The causes (pre‐, peri‐ and postnatal, and unknown) in these two populations were: 70%, 10.5%, 5.4% and 14.1%, and 46.5%, 8.9%, 2.1% and 42.5%, respectively. Genetic causes accounted for 38.5% (n= 4578) of all cases in this study, including 1557 with Down's syndrome, 233 with fragile‐X syndrome, 199 with other various chromosomal abnormalities (i.e. unbalanced translocation, supernumerary markers and structural rearrangements), 238 with a defined or presumed single‐gene defect, and 98 with a recognized contiguous gene syndrome (Prader‐Willi, 56; Angelman, 34; Williams, 5; and Kallmann, 3); 2120 cases had familial ID. Multiple anomalies of undefined pattern, but without chromosomal aberration, infantile autism, ID of normal phenotype or family history, were of the other categories. Patients with a single‐gene disorder or chromosomal aberration, especially those with unbalanced translocated or rearranged chromosomes, had genetic counselling and family studies. Pre‐screening with photographs and questionnaires may give a better costbenefit than blind mass cytogenetic studies for each individual with ID.
Swedish and English adolescents' attitudes toward the community presence of people with disabilities
Authors: Hastings R. P. , Sjöström K. E. , Stevenage S. V.
Published: March 2003

Predictions derived from North American formulations of normalization suggest that contemporary care policies for people with intellectual disabilities will have a positive impact on societal perceptions of this group. To test this, adolescents' attitudes towards the community presence of people with disabilities in a normalization‐advanced country (Sweden) and a relatively less normalization‐advanced country (England) were compared. It was expected that Swedish and English participants would hold equally positive views of people with a non‐intellectual disability, whereas English participants would hold less positive views than Swedish participants of people with an intellectual disability. The results gave limited support to this expectation when dimensions of participants' attitudes derived from a factor analysis were analysed. These results are discussed with reference to other factors that may influence attitudes in the two countries. In addition, implications for future research and practice are outlined.
Excess of non‐right handedness among individuals with intellectual disability: experimental evidence and possible explanations
Authors: Grouios G. , Sakadami N. , Poderi A. , Alevriadou A.
Published: March 2003

Seventy‐three subjects with mild and moderate intellectual disability (ID) of an unknown/idiopathic nature, who had no record of specific deficits in motor control, and 73 normal controls, matched for chronological age and sex, underwent evaluation of handedness. The results confirmed the previously reported excess of non‐right handedness among subjects with ID, and suggested that this finding might be indicative of a deviant cerebral organization or atypical lateralization of cerebral representation of function in this group. However, it was noted that further research is needed to clarify how far this is a function of level of motor skill and how far is a syndrome‐specific pathological phenomenon.
Observations on the use of the ICD‐10 Guide for Mental Retardation
Authors: Einfeld S. L. , Tonge B. J.
Published: March 2003

In acknowledgement of the challenges posed by the diagnosis of mental disorders in people with intellectual disability (ID), the World Health Organization (WHO) has recently published a multi‐axial guide to assist clinicians in applying the ICD‐10 to this group of people. The WHO has invited users to review of the ICD‐10 Guide for Mental Retardation. In order to review its usefulness in clinical practice, the present authors used the Guide together with the ICD‐10 in the psychiatric assessment of 106 young people with ID, and emotional and behavioural problems of varying severity. Strengths and weaknesses in the utility of the Guide were noted. As a result of the clinical audit process, the present authors identified a number of inconsistencies, significant gaps and assertions unsupported by the available literature in the Guide. They also noted aspects of the ICD‐10 itself which are problematic when applied to people with ID. Despite these limitations, the Guide is a valuable first attempt to establish a standardized structure for multi‐axial diagnosis in this population. A number of suggestions for major changes and refinements to future editions are made, and a strategy for development of research to establish validity and reliability is proposed.