bluuebunny/crossref_metadata_2025 huggingface dataset:
Training physicians to increase patient trust
Authors: H. Thom David
Published: March 2003

Patient trust in the physician is an important aspect of the patient–physician relationship that has recently become a focus of interest, in part due to the rise of managed care in the US healthcare system. In a previous study, we identified physician behaviours reported by patients as important to establishing their trust in the physician. The current study attempted to modify these behaviours via a short training programme and thereby to increase patient trust and improve associated outcomes. After baseline measurements, 10 physicians were randomized to the intervention group and 10 remained as a control group. While intervention physicians showed a net improvement in 16 of 19 specific patient‐reported behaviours when compared to control physicians, these differences were not statistically significant. There was also no significant difference in patient trust, patient satisfaction, continuity, self‐reported adherence, number of referrals or number of diagnostic tests ordered. This short training course in a group of self‐selected physicians was not a sufficiently strong intervention to achieve the desired effect. Suggestions are given for designing a stronger training intervention.
Induction of infectious pancreatic necrosis (IPN) in covertly infected Atlantic salmon, Salmo salar L., post‐smolts by stress exposure, by injection of IPN virus (IPNV) and by cohabitation
Authors: Taksdal T , Ramstad A , Stangeland K , Dannevig B H
Published: March 2003

Atlantic salmon post‐smolts were given an intraperitoneal (ip) injection of tissue homogenate of Atlantic salmon fry from an outbreak of infectious pancreatic necrosis (IPN), and cohabitants were given an ip injection of Earle's balanced salt solution (EBSS). Parallel treatment groups were exposed to recurrent episodes of environmental stress by water drainage twice a week. Fish injected with EBSS and non‐injected fish were exposed to water drainage. The control fish were left untreated. Mortality due to IPN started 3 weeks after challenge in non‐injected and EBSS‐injected fish that had been exposed to water drainage. This showed that the fish used in the experiment were covertly infected with IPN virus (IPNV) prior to challenge, although no virus was detected in the fish sampled before the experiment. In fish that received an injection of IPNV, mortality started 5–6 days after challenge, regardless of the presence or absence of stress exposure. The EBSS‐injected cohabitants started to die after an additional 5–6 days, also regardless of the presence or absence of stress exposure. The final cumulative mortality in the IPNV‐injected fish was significantly lower than in the EBSS‐injected cohabitants, thus suggesting that the secondary immune response after injection of IPNV provided more protection than the response after a water‐borne infection. No disease outbreak was observed in the control fish.
TNP‐470, the analogue of fumagillin‐DCH, controls PKX in naturally infected sockeye salmon, Oncorhynchus nerka (Walbaum), underyearlings
Authors: Higgins M. J. , Kent M. L.
Published: March 2003

The use of fumagillin‐DCH, a natural product of Aspergillus fumigatus, has proven successful for the control of microsporidian infections, including Nucleospora salmonis Hedrick, Groff & Baxa (Hedrick, Groff & Baxa 1991) and Loma salmonae (Putz, Hoffmann & Dunbar) (Kent & Dawe 1994). Fumagillin has also been used to treat various myxosporean diseases of fishes, including proliferative kidney disease (PKD), which is caused by the PKX organism (Molnár, Baska & Székely 1987; Hedrick, Groff, Foley & McDowell 1988; Székely, Molnár & Baska 1988; Wishkovsky, Groff, Laurén, Toth & Hedrick 1990; Yokoyama, Ogawa & Wakabayashi 1990; El‐Matbouli & Hoffmann 1991; Sitjá‐Bobadilla & Alvarez‐Pellitero 1992; Higgins & Kent 1996). An analogue of fumagillin, TNP‐470, has been shown to be effective in in vitro studies against the mammalian microsporidian pathogens Encephalitozoon intestinalis (Cali, Kotler & Orenstein), Vittaforma corneae (Shadduck, Meccoli, Davis & Font) (Didier 1997), E. cuniculi Levaditi, Nicolau & Schoen and E. hellem Didier, Didier, Freidberg, Stenson, Orenstein, Yee, Tio, Davis, Vossbrinck, Millichamp & Shadduck (Coyle, Kent, Tanowitz, Wittner & Weiss 1998). Higgins, Kent, Moran, Weiss & Dawe (1998) tested TNP‐470 against two microsporidian diseases of salmonids, N. salmonis and L. salmonae, and showed a significant reduction in parasitism after oral treatment with 0.1 or 1.0 mg kg‐1 fish day‐1 for 5 weeks. Therefore, the present authors investigated the efficacy of TNP‐470 against the PKX myxosporean in naturally exposed sockeye salmon, Oncorhynchus nerka (Walbaum). This host was chosen as it has been found to be particularly susceptible to the infection.
A single‐dose pharmacokinetic study of oxolinic acid and vetoquinol, an oxolinic acid ester, in Atlantic halibut, Hippoglossus hippoglossus L., held in sea water at 9 °C
Authors: Samuelsen O. B. , Ervik A.
Published: March 2003

The pharmacokinetic properties of the antibacterial agent oxolinic acid were studied after intravenous, intraperitoneal and oral administration to 1.5–3.0 kg Atlantic halibut, Hippoglossus hippoglossus L., held in sea water at 9 °C. Following intravenous injection, the plasma drug concentration‐time profile showed two distinct phases. The terminal elimination half‐life was estimated to be 52 h, whereas total body clearance (ClT) was determined to be 0.044 L kg–1 h–1. The volume of distribution at steady state, Vd(ss), was calculated to be 3.0 L kg–1, indicating good tissue penetration of oxolinic acid in Atlantic halibut. The peak plasma concentration (Cmax) and the time to peak plasma concentration (Tmax) were estimated to be 1.2 and 2.7 μg mL–1, and 21.5 and 80 h, respectively, following oral administration of medicated feed or intraperitoneal injection. The corresponding bioavailabilities were calculated to be 15% and 92%, respectively. Oral administration of vetoquinol, the carbitol ester of oxolinic acid, increased the bioavailability of oxolinic acid to 64% and the total bioavailability (oxolinic acid + vetoquinol) to 82%, whereas Cmax and Tmax values of 6.7 μg mL–1 and 14.5 h, respectively, for oxolinic acid, and 1.0 μg mL–1 and 6.3 h, respectively, for vetoquinol were obtained. Based on a minimum inhibitory concentration (MIC) of 0.0625 μg mL–1 for susceptible strains, a single intraperitoneal injection of 25 mg kg–1 of oxolinic acid maintains plasma levels in excess of 0.25 μg mL–1, corresponding to four times the MIC value, for ≈12 days. The corresponding values for a single oral dose of 25 mg kg–1 of oxolinic acid and vetoquinol were 5 and 10 days, respectively. For resistant strains with a MIC of 1 μg mL–1, a single oral dose of vetoquinol (25 mg kg–1) maintained plasma levels in excess of 4 μg mL–1 for 34 h.
Enhancement of protective immunity in blue gourami, Trichogaster trichopterus (Pallas), against Aeromonas hydrophila and Vibrioanguillarum by A. hydrophila major adhesin
Authors: Fang H M , Ling K C , Ge R , Sin Y M
Published: March 2003

Blue gourami, Trichogaster trichopterus (Pallas), were intraperitoneally immunized with major adhesin, a 43 kDa OMP protein isolated from fish Aeromonas hydrophila, in the presence of Freund's complete adjuvant (FCA). Three weeks later, a booster injection of adhesin without FCA was administered. Control group fish were similarly treated with phosphate‐buffered saline (PBS) and FCA. Results showed that anti‐adhesin serum obtained from fish after booster immunization exhibited very strong ability in agglutinating bacterial cells. Although this antiserum had no bactericidal effect, it could significantly inhibit serologically different strains of A. hydrophila from invading EPC (Epithelioma papillosum of carp) cells in vitro. In addition, the proliferative response of head kidney leucocytes of these immune fish was significantly increased as compared to that of the control. The results also showed that the major adhesin could provide significant protective immunity to fish against the challenge by homologous and heterologous strains of A. hydrophila and one virulent strain of Vibrio anguillarum.
Pathology of shell disease in the blue crab, Callinectes sapidus Rathbun, (Decapoda: Portunidae)
Authors: Noga E J , Smolowitz R , Khoo L H
Published: March 2003

Blue crabs affected with shell disease displayed a wide array of pathologies in response to this very common affliction. Grossly, shell disease lesions most commonly presented as variably sized brown to black foci. Such lesions ranged from very small (1 mm2) to locally extensive (up to 200 mm2 in area). The larger of the melanized lesions sometimes appeared ulcerated. The most severe lesions observed (Pamlico River shell disease‐PRSD) resulted in loss of up to 25% of the entire carapace. A diverse bacterial flora consisting of aeromonads, vibrios and five other genera were isolated as the predominant organisms from shell disease lesions. Fungi were rarely observed in larger lesions. Protozoa and algae were also rarely observed on the surface of some lesions. Histologically, lesions ranged from mild erosion of the epicuticle and outermost layers of the calcified endocuticle to more extensive endocuticle erosion with accompanying inflammation. In the most severe cases, there was total loss of the endocuticle and epidermis, with pseudomembrane formation, intense haemocyte infiltration, and involvement of adjacent viscera. There was no apparent relationship between the size of gross lesions and their histological severity (as defined by the extent of tissue damage), suggesting that gross examination of shell disease lesions is not a reliable method for assessing the damage to affected blue crabs.
Hepatic coccidiosis of the blue whiting, Micromesistius poutassou (Risso), and horse mackerel, Trachurus trachurus (L.), from Galician waters
Authors: Abollo E , Calvo M , Pascual S
Published: March 2003

The aetiology, epidemiology and pathology of coccidiosis in commercially‐exploited populations of Micromesistius poutassou and Trachurus trachurus from Galician waters were investigated. Sporogonic stages of Goussia clupearum and G. cruciata were found in the liver. Although the descriptive statistics of Goussia infrapopulations and demographic infection values were always higher in M. poutassou than in T. trachurus, parasite distribution was highly skewed for both coccidian species. In both fish species, the number of oöcysts showed a similar cumulative effect as parasite counts increased with increasing length and weight of fish, but did not change with host sex or sexual maturity. Pathological changes in infected liver parenchyma of both species were moderate (in T. trachurus) to severe (in M. poutassou), with greatly reduced livers in the most heavily infected fish. Large areas of liver tissue were replaced with oöcysts. Host response to infection included the formation of a fibrous capsule prior to infiltration by melanin and lymphocytes. Although post‐recruit individuals of both fish species apparently tolerate a severe infection, there was statistical evidence of a serious contribution by the parasite to poor body condition in M. poutassou shown by changes in the hepatosomatic and K‐Fulton indices and in the length‐ to‐weight relationship.
Betanodavirus infections of teleost fish: a review
Authors: Munday B L , Kwang J , Moody N
Published: March 2003

In the last decade betanodavirus infections have emerged as major constraints on the culture of marine fish in all parts of the world with the exception of the African continent. The occurrence of these infections appears to be a function of the number of species cultured and the intensity of culture. This has been further complicated by the promiscuous translocation of stock within and between countries. Great strides have been made in defining these agents and producing diagnostic techniques but much more remains to be done. Lack of knowledge of the epidemiology of the diseases caused by nodaviruses, except for vertical transmission of the pathogen in some species, has impeded the development of control measures but, even so, the measures identified to date have not been adequately implemented by producers with the result that catastrophic losses still occur on a regular basis.
A multivariate study on the effects of dietary vitamin K, vitamin D3 and calcium, and dissolved carbon dioxide on growth, bone minerals, vitamin status and health performance in smolting Atlantic salmon Salmo salar L.
Authors: Graff I E , Waagbø R , Fivelstad S , Vermeer C , Lie Ø , Lundebye A K
Published: March 2003

Bone deformities represent an increasing, unsolved problem for intensive farming of Atlantic salmon, Salmo salar L. To increase insight into nutritional and environmental impacts on bone mineralization, 16 groups of Atlantic salmon parr were fed diets with different levels of menadione sodium bisulphite (MSB), vitamin D3, and calcium (Ca), and exposed to different levels of dissolved carbon dioxide (CO2) based on a multivariate factorial design (24). The composition of the experimental diets was either a high or low level of each of the design variables. In addition, four groups (centre points) were fed a diet with intermediate levels of all dietary parameters and exposed to an intermediate level of dissolved CO2 to record the variation among tanks. After 6 weeks in fresh water, fish were marked according to group, transferred to a common net pen in sea water and fed commercial feed for another 11 weeks. High levels of CO2 decreased fish growth both in fresh water and sea water. No visible bone deformities were recorded at any time. Dry matter, protein and ash compositions of bone and concentrations of Ca, phosphorus (P) and magnesium (Mg) in bone were not significantly affected by any of the design variables. Minor effects were observed in clinical parameters recording health performance, stress and plasma Ca homeostasis. The mean level of vitamin D3 measured as cholecalciferol in fish organs increased significantly during the freshwater period and reflected dietary vitamin D3, whereas the level decreased when fish were fed commercial feed in sea water. The level of menaquinone in liver increased significantly in response to high dietary levels of MSB, indicating that dietary MSB was converted to menaquinone in salmon.
Oily fish and fish oil supplements in the prevention of coronary heart disease
Authors: Minnis R. , Haq I. , Jackson P. , Yeo W. , Ramsay L.
Published: March 2003

Dietary advice for the reduction of coronary heart disease events emphasizes the importance of a low‐fat diet and advice on the consumption of oily fish may also be given. This report reviews the evidence linking fish consumption with coronary risk. On the basis of available evidence, a target of two to three portions of oily fish per week (200–400 g, 7–14 oz) is considered reasonable, particularly for secondary prevention. For those who cannot achieve the suggested dietary intake of oily fish, the partial or complete substitution of fish oil supplements may be appropriate. A range of suitable types of fish oil supplements is given, but an awareness of the potential adverse effects of fish oil supplementation is considered important. Further studies are needed to define the role of fish intake in coronary heart disease.
Socioeconomic differences in food preference and their influence on healthy food purchasing choices
Authors: Turrell
Published: March 2003

Background: Studies have shown that socioeconomic groups differ in their dietary behaviours, and it has been suggested that these differences partly account for health inequalities between social groups. To‐date, however, we have a limited understanding of why socioeconomic groups differ in their dietary behaviours. This paper addresses this issue by examining the relationship between socioeconomic status, food preference (likes and dislikes) and the purchase of ‘healthy’ food (i.e. food consistent with dietary guideline recommendations).
Methods: This study was based on a dual‐sample, dual‐method research design. One sample was systematically selected from the Australian Commonwealth electoral roll and the data collected using a mail‐survey methodology (81% response rate,
n=403). The second consisted of a convenience sample of economically disadvantaged people recruited via welfare agencies (response rate unknown,
n=70). A mail survey methodology was deemed inappropriate for this sample, so the data were collected by personally delivering the questionnaire to each respondent.
Results: Socioeconomic groups differed significantly in their food purchasing choices and preferences. The food choices of respondents in the welfare sample were the least consistent with dietary guideline recommendations, and they reported liking fewer healthy foods (all results were independent of age and sex). Notably, socioeconomic differences in preference explained approximately 10% of the socioeconomic variability in healthy food purchasing behaviour.
Conclusion: Whilst it is not clear why socioeconomic groups differ in their food preferences, possible reasons include: reporting bias, differential exposure to healthy food as a consequence of the variable impact of health promotion campaigns, structural and economic barriers to the procurement of these foods, and subculturally specific beliefs, values, meanings, etc.
Evaluation of a multimodality treatment programme for weight management at the Luton and Dunstable Hospital NHS Trust
Authors: Barrett  , Finer  , Fisher  , Boyle
Published: March 2003

Background: The evaluation concerns a 12‐week group treatment programme providing formalized behaviour and cognitive modification combined with an initial low calorie liquid diet offered through a specialist NHS Obesity Clinic.

Aims: The aims of this evaluation were to: (1) determine the success of the programme in terms of: (a) producing medically significant weight loss for up to 18 months after the programme; (b) psychological and social benefits for patients; (2) identify factors predictive of weight loss and the likelihood of completing the programme.

Methods: A retrospective evaluation was undertaken of 12 groups of patients (115 patients), referred by their General Practitioners to the Obesity Clinic for advice and treatment of obesity. Data were obtained from initial assessment questionnaires, clinical notes and a follow‐up questionnaire.

Results: The evaluation showed that the programme was successful in helping patients achieve medically significant weight loss (on average 12% of initial body weight) and to partially maintain some weight loss for up to 18 months after. In addition, there were measurable psychological and social benefits from their adherence to the programme. Only the mental state of the patients at the start of the programme was predictive of the likelihood of their managing to complete it.

Conclusion: The progamme can be effective in achieving and maintaining weight loss. Patients may benefit psychologically. Patients may have an improved likelihood of completing the programme if depression is treated first.
Study to evaluate the effect of dietary advice and the role of exercise in obese women who are trying to lose weight
Authors: Reed  , Jackson  , Harborne  , Roberts
Published: March 2003

Background: Exercise should play an important part in any weight control programme and swimming/exercise in water has particular advantages for the obese individual. Since 1996 aquafit sessions for the obese have been available in Coventry as an optional adjunct to dietary intervention.

Aim: The study aimed to compare outcomes in two groups; one group had received individual dietary advice (GpDO) and the other group had received individual dietary advice and also attended aquafit sessions regularly (GpDAq). Characteristics of groups members were compared and perceived barriers to successful weight loss were considered.

Method: The study looked retrospectively at a sample of obese women, aged 18–70 years, with a BMI (kg/m2) of over 35, referred by their general practitioners or consultants, for dietary advice for weight reduction. Participants were interviewed by a dietitian and researcher to gain data on long‐term changes in weight, activity, and factors they felt had affected their weight changes. 76 women (54 in GpDO and 22 in GpDAq) were invited to participate in the study. Thirty attended for interview (25 in GpDO and five in GpDAq). The average time since first contact with dietitian to the review for this study (the study period) was 19 months (range 7–39 months).

Results: The mean weight loss was 3.8 kg, SD = 5.5 (GpDO mean = 3.3 kg, SD = 4.9, and GpDAq mean = 6.2 kg, SD = 8.2). Two (7%) women (one in GpDO and one in GpDAq) reduced their weight by > 10% over the study period. Twenty‐one (70%) participants (68% of GpDO and 80% of GpDAq) did not gain weight over the study period (initial weight > study weight). Nine (30%) participants increased their physical activity by one episode of 30 min per week and maintained this over the study period.

Conclusions: The desire of many clients for long‐term support and continuity of care from a dietitian was highlighted, as were the perceived difficulties in increasing physical activity. This study demonstrates that weight management interventions that provide dietary advice with and without exercise can help some women to achieve moderate weight loss and maintain this, highlighting areas for further consideration.
Estimating food and nutrient intake from food frequency questionnaire data by reference to a standard weighed diet survey
Authors: Tefft M. E. , Boniface D. R.
Published: March 2003

Introduction The food frequency questionnaire is widely regarded as more appropriate for ranking and grouping individuals according to levels of nutrient intake than for estimating absolute nutrient amounts.

Aims To develop a method for estimation of amount of nutrient intake from food frequency questionnaires by reference to an independent weighed dietary survey.

Method Six stages of the method are described and illustrated in the estimation of total dietary fat from the 1984–85 Health and Lifestyle Survey using the 1986–87 Dietary and Nutritional Survey of British Adults as the reference standard.

Results Several points support the validity of the approach although limitations are identified.
The effect of weekly iron supplementation on anaemia and on iron deficiency among female tea pluckers in Bangladesh
Authors: Gilgen D. , Mascie‐Taylor C. G. N.
Published: March 2003

Aim

To investigate the effect of weekly iron supplementation on anaemia and iron deficiency among adult, female tea pluckers.

Method

A randomized double‐blind intervention trial was conducted in a tea estate in Bangladesh where a total of 280 women received either weekly iron supplementation (200 mg ferrous fumarate and 200 mg folic acid) for 24 weeks or a matching placebo. Capillary blood samples were drawn at baseline and post‐trial to determine haemoglobin, haematocrit and ferritin concentration. Mean corpuscular haemoglobin concentration (MCHC) was calculated using the haemoglobin and haematocrit values.

Results

The mean haemoglobin concentration in the supplemented group increased by 5.52 g L−1 over the study period, on average, while ferritin values decreased by 0.33 μg L−1. The control group showed a decrease in both mean haemoglobin (−0.24 g L−1) and ferritin (−5.32 μg L−1). Those individuals in the supplemented group with the lowest pretrial haemoglobin and ferritin values experienced the greatest improvements post‐trial, whereas nonanaemic individuals showed a decrease in both haemoglobin and ferritin concentrations. A total of 62.2% of women in the supplemented group reported feeling better and more energetic compared to 51.1% in the placebo group; 14.4% of the supplemented group and 22.7% of the control group complained about side‐effects.

Conclusion

Weekly iron supplementation was logistically simpler and cheaper than daily supplementation but would have to be continued on a longer term basis in order to combat both anaemia and iron deficiency.
Riboflavin deficiency in cystic fibrosis: three case reports
Authors: McCabe H.
Published: March 2003

Three cases of clinical riboflavin deficiency are reported in children aged 2–10 years attending a regional Cystic Fibrosis clinic. Riboflavin deficiency presented as angular stomatitis in all three patients. Patients were confirmed to be riboflavin deficient by assaying the activity of erythrocyte glutathione reductase. Patients were not on routine supplements of water‐soluble vitamins before presentation and were treated with riboflavin supplements as part of a water‐soluble vitamin complex. At presentation, one patient had poor nutritional status, but two patients were adequately nourished, receiving overnight Gastrostomy feeds. Data on these two patients indicate an adequate dietary intake of riboflavin, suggesting a mechanism for increased requirements, inadequate absorption or utilization. Additional deficiencies of thiamin, pyridoxine and iron were also observed. This paper reports the occurrence of a vitamin deficiency not previously reported in the cystic fibrosis population.
The methodology of nutritional screening and assessment tools
Authors: Jones J. M.
Published: March 2003

Background

The aim of this paper was to give a critical appraisal of the methodology of nutritional screening and assessment tools.

Methods

A literature search identified 44 tools. Each tool was assessed in relation to details of its application, method of derivation and evaluation of its performance.

Results

The findings indicate that tools were published with insufficient details regarding their intended use and method of derivation, and with an inadequate assessment of their effectiveness. An appraisal of these features judged that no one tool satisfied a set of criteria regarding scientific merit.

Conclusion

There is thus a need to ensure that nutritional screening and assessment tools are developed using procedures based on good design and sound statistical practice. This paper suggests that a unified approach using multivariate techniques could make a significant contribution to this process.
An audit of nutritional care delivered to elderly inpatients in community hospitals
Authors: Hamilton K. , Spalding D. , Steele C. , Waldron S.
Published: March 2003

Background

There is continuing concern over the lack of attention to the nutritional needs of older people in hospitals. A 2‐year audit project was undertaken to examine the nutritional care of inpatients in Leicestershire Community Hospitals.

Method

The methods used included analysis of menu cycles; observation of meal and drink provision, wastage, supplement usage and portion sizes; and patient satisfaction questionnaire examination.

Results

Patient menus were nutritionally inadequate for energy, fibre and vitamin D, and protein levels were variable. The percentage of meal wastage and inadequate portion sizes were of concern. Patient satisfaction results were overall positive.

Conclusion

Patient energy intakes are a major concern with low calorie provision from menus exacerbated by a deficit in recommended portion sizes and a high percentage of meal wastage. Routine audits need to be implemented to monitor both portion size and meal wastage, and to address patient satisfaction issues to improve the overall intakes of patients. Multidisciplinary team input is required to address the above issues and additional recommendations to promote nutrition as a key component in clinical care.
Infant feeding practices of Pakistani mothers in England and Pakistan
Authors: Sarwar T.
Published: March 2003

Objectives  To investigate infant feeding practices followed by Pakistani mothers in Pakistan and in England. To establish if practices conform to current guidelines and to investigate reasons for adherence and nonadherence.

Methods  Ninety mothers of weaning age children were interviewed; 45 were in England and 45 in Pakistan. A questionnaire available in English and Urdu sought to find out about the methods of milk feeding and weaning used and the advice received, together with general beliefs about weaning.

Results  Characteristics of the infants in terms of current age, gender distribution, birth order of baby and age of weaning showed no significant differences between the two groups. Thus, differences between the two groups could be attributed to cultural differences rather than any of these factors. Chi‐square analysis showed that the initial method of feeding chosen was significantly different (P < 0.001, d.f. = 2) with 73% of mothers in Pakistan breast‐feeding compared with 24% in England. Similar proportions of mothers in both groups commenced weaning between 3 and 4 months. Common weaning foods included rice, cereals and eggs with progression to fruit and vegetables and family food in Pakistan, and fruit, vegetables, meat and convenience foods (especially sweet options) in England. Both groups of mothers wanted more information about infant feeding practices.

Conclusion  Mothers in Pakistan demonstrated more confidence in weaning practices than in England because of experiences with other siblings and advice from relatives. More advice from health professionals was requested and is needed by all mothers in order to improve weaning practices of the infants.
Psychological services utilization: relationship to severity of behaviour problems in intellectual disability services
Authors: Jacobson J. W.
Published: March 2003

Using the Developmental Disabilities Profile, a population service registry, the present study gives an analysis of the relationship between the rated frequency of contact with psychology specialists and a composite rating of 13 behaviour problems in intellectual disability services. An analysis of information on 45 810 adults with intellectual disability indicated that, when the population was divided into quintile groups based on behaviour severity, distinctively different distributions of rated contacts with psychologists were discernible. The people rated in the highest quintile for severity of maladaptive behaviour constituted especially high utilizers of psychology services. About 37% of participants had had no contact with psychologists during the past year, whereas 26% had such contact weekly or more frequently. The findings are introduced and discussed in the context of psychological practice in intellectual disability services and trends toward managed health and behavioural health care in the USA.
A case of mosaic trisomy 21 with Down's syndrome signs and normal intellectual development
Authors: De A. Moreira L. M. , San Juan A. , Pereira P. S. , De Souza C. S.
Published: March 2003

The present case study describes an adult male with clinical signs of mild Down's syndrome (DS), who performed well at school and reached university level. A karyotype was done on a lymphocyte culture and mosaic trisomy 21 was found in 3% of the 437 cells analysed. Eleven signs from Jackson's checklist were found in the clinical evaluation, which along with the analysis of the subject's dermatoglyphic traits, confirmed the DS diagnosis . Cognitive evaluation was done with several psychological tests and the results were within the average range. This rare phenotypic association shows that normal intellectual development may be possible in DS. This finding could be explained by the low trisomic cell frequency, which may have little effect on the critical tissues for intellectual development, and it might also reflect the wide phenotypic variation in mosaic trisomy 21. Other factors, such as strong family support, early and continued intervention programmes for both physical and speech therapy, and a thorough educational process, also provided opportunities for the development of the cognitive potential of the subject.
Results of barbiturate antiepileptic drug discontinuation on antipsychotic medication dose in individuals with intellectual disability
Authors: Hanzel T. E. , Bauernfeind J. D. , Kalachnik J. E. , Harder S. R.
Published: March 2003

Five individuals with intellectual disability prescribed both a barbiturate antiepileptic drug (AED) and an antipsychotic medication were identified in a public residential facility. It was hypothesized that antipsychotic medication was prescribed at doses higher than necessary as a result of inadvertent barbiturate AED behavioural side‐effects thought to be part of the underlying psychiatric or behavioural condition. To test this hypothesis, barbiturate AEDs were gradually reduced, and replaced with either carbamazepine or valproic acid, and antipsychotic medication was gradually reduced as well. Challenging behaviours, such as physical aggression, self‐injurious behaviour and property destruction, were measured with a frequency count or partial interval recording, and retrospectively analysed for time periods of ≈60 days before phenobarbital reduction, after phenobarbital discontinuation and after the lowest antipsychotic medication dose. Challenging behaviour collectively decreased by 81.5% after barbiturate discontinuation, mean antipsychotic medication dose significantly decreased from 146 mg day–1 (SD = 98) to 106 mg day–1 (SD = 88) chlorpromazine equivalence, and antipsychotic medication was discontinued in the cases of two individuals. Compared to the prebarbiturate AED reduction period, challenging behaviour collectively decreased by 96.3% after the lowest antipsychotic medication dose, which confirmed that reduced antipsychotic medication was not achieved at the expense of behaviour deterioration. The data supported the hypothesis that discontinuation of barbiturate AEDs results in decreased challenging behaviour and less antipsychotic medication.
Working memory structure and intellectual disability
Authors: Numminen H. , Service E. , Ahonen T. , Korhonen T. , Tolvanen A. , Patja K. , Ruoppila I.
Published: March 2003

The working memory of people with intellectual disability has been found to generally lag behind their mental age. However, studies concerning the structure of working memory or its connections to other cognitive functions are rare. The present study employs a versatile battery of tests for the evaluation of working memory structure in adults with intellectual disability of unknown aetiology. In addition, connections between working memory and cognitive skills valid for everyday functioning are evaluated. Working memory performance in the study participants was found to stem from two distinct components which could be regarded to represent phonological and general working memory. General working memory was closely related to intelligence, whereas phonological working memory was not. The subjects in the study group differed in their working memory profiles. These distinct profiles were significantly related to academic skills (e.g. reading, writing and mathematics) and sentence comprehension because the profile of the working memory predicted these abilities even when the intelligence and educational background of the participants was taken into consideration.
Sensory impairments, intellectual disability and psychiatry
Authors: Carvill S.
Published: March 2003

The present review looks at: (1) prevalence studies of sensory impairments in people with intellectual disability (ID); (2) studies looking at psychological and psychiatric disorders in people with sensory impairments; and (3) studies that have examined the association of sensory impairments with autism. Research has indicated that sensory impairments are more common in people with ID. Psychiatric disorders are believed to be more common in children with visual impairment (VI) when associated with other handicaps. Some authors believe that hearing impairment (HI) can result in personality disorders. Studies have also shown a higher prevalence of psychiatric disorders in children with HI and a higher incidence of deaf people in psychiatric hospitals than in the general population. Psychiatric disorders in children with HI are particularly associated with low IQ and low communication ability, especially in those with multiple handicaps. There is little evidence for a higher incidence of schizophrenia in people with HI. Blind people demonstrate many autistic‐like features and there has been discussion in the literature as to their cause. Deaf people also demonstrate some similar features to those in autism, but an association with autism has not been conclusively made. Deaf‐blind people commonly demonstrate problem behaviour (e.g. self‐injury). Usher syndrome, which is the most common cause of deaf‐blindness, is associated with psychiatric disorders, particularly psychosis. The need for assessment of sensory functioning in people with ID, the difficulties inherent in this and the need for specialist services is stressed.
Sleep problems and daytime problem behaviours in children with intellectual disability
Authors: Didden R. , Korzilius H. , Aperlo B. van , Overloop C. van , Vries M. de
Published: March 2003

Background

Sleep problems are common among children with intellectual disability (ID).

Method

The present study assessed the prevalence of severe sleep problems in a sample of children (n=286) with mild to profound ID who lived at home with their parents(s) in the Netherlands. It also explored relationships between severe sleep problems, and family and child variables. Demographic information, data on children's sleep behaviours and parent variables were collected using questionnaires.

Results

Severe settling problems, night waking and early waking were present in 4.2%, 10.8% and 4.2% of cases, respectively; 16.1% of children had at least one type of sleep problem. Children with a severe sleep problem had more severe levels of ID, used medication more often, had a greater frequency of epilepsy, were younger, had a greater frequency of cerebral palsy, and showed more daytime drowsiness and daytime napping than children without a severe sleep problem. Furthermore, children with a severe sleep problem showed more severe levels of daytime problem behaviours; for example, aggression, non‐compliance and hyperactivity.

Conclusion

The results of the present study are discussed with regard to the assessment and treatment of sleep problems in children with ID.
Identifying bipolar disorders in individuals with intellectual disability
Authors: Cain N. N. , Davidson P. W. , Burhan A. M. , Andolsek M. E. , Baxter J. T. , Sullivan L. , Florescue H. , List A. , Deutsch L.
Published: March 2003

Objective  The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM‐IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses.

Methods  A retrospective chart review was done of a convenience sample of adult patients seen over a 3‐year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM‐IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups.

Results  Subjects with clinical symptoms of BPD had significantly more DSM‐IV mood‐related and non‐mood‐related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups.

Conclusions  Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM‐IV criteria can be useful in the diagnosis of BPD.
Surgical management of patients with persistent or recurrent medullary thyroid cancer
Authors: Moley  , DeBenedetti  , Dilley  , Tisell  , Wells
Published: March 2003

Moley JF, DeBenedetti MK, Dilley WG, Tisell LE, Wells SA (Washington University School of Medicine, St Louis, MO, USA). Surgical management of patients with persistent or recurrent medullary thyroid cancer (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 521–6.

Residual or recurrent medullary thyroid carcinoma (MTC), manifested by elevated calcitonin levels, occurs commonly following primary treatment of MTC. Re‐operation in appropriately selected patients is the only treatment modality which consistently and reliably reduces stimulated calcitonin levels, and results in excellent local disease control. We report improved results of surgical management of recurrent MTC in two consecutive series of patients. In our most recent series (1992–96), 38% of patients (17 out of 45) had normal postoperative stimulated calcitonin levels, compared to 28% (nine of 32) in our first series (1990–92). In the most recent series, only 13% (six of 45) of patients had no decrease in calcitonin levels following re‐operation, compared to 31% (10 of 32) in our first series (P= 0.07, Fisher's exact test). This improvement has mainly occurred through better preoperative selection of patients, and the institution of routine laparoscopic liver examination preoperatively, which identified metastases in 10 patients, nine of whom had normal CT or MRI imaging.
The eye in von Hippel–Lindau disease. Long‐term follow‐up of screening and treatment: recommendations
Authors: Wittebol‐Post  , Hes  , Lips
Published: March 2003

Wittebol‐Post D, Hes FJ, Lips CJM (University Hospital Utrecht, Utrecht, The Netherlands). The eye in von Hippel–Lindau disease. Long‐term follow‐up of screening and treatment: recommendations (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 555–561.

Von Hippel–Lindau disease (VHL) is an autosomal dominant tumour syndrome caused by germline mutations of the VHL tumour suppressor gene located on chromosome 3p25–26. In VHL tumours may occur in 14 different target organs, including the eye. Retinal angiomas are considered the first manifestation of VHL disease in 43% of cases, and the cumulative probability of developing a retinal angioma in one or both eyes rises during each decade of life, reaching 80% for patients over 80 years old. Since 1976 patients with VHL at the University Hospital of Utrecht and their at‐risk relatives have been screened periodically by a multidisciplinary team. Long‐term follow‐up ophthalmological data were analysed with special attention to natural course and results of treatment. In addition, we looked for a genotype‐phenotype correlation. Retinal angiomas were found in all families. In one large family with a missense mutation (V170D) of the VHL gene, in which the complete spectrum of visceral‐ and central nervous system (CNS) features of VHL is present, macular, parapapillary, optic disc and ora serrata angiomas were also found. In general, however, a clear‐cut genotype‐phenotype correlation could not be found. Only early detection and treatment of peripheral retinal angiomas can be expected to decrease the percentage of patients with decreased visual acuity. Therefore, early detection and treatment of these tumours is of paramount importance. Ophthalmological screening of patients and persons at risk should start as early as possible.

In patients with apparently sporadic retinal angiomas it is advisable to perform germline DNA analysis, since the risk of developing VHL is high, especially if the angiomas are bilateral, or unilateral and multifocal, if the patient is young, or if there is a family history suggestive of VHL.
Coronary heart disease mortality amongst non‐insulin‐dependent diabetic subjects in Iceland: the independent effect of diabetes. The Reykjavik Study 17‐year follow up
Authors: Vilbergsson S. , Vilbergsson S. , Sigurdsson G. , Sigurdsson G. , Sigvaldason H. , Sigfusson N.
Published: March 2003

Vilbergsson S, Sigurdsson G, Sigvaldason H, Sigfusson N, (Icelandic Heart Association, University of Iceland, Department of Medicine and Reykjavik Hospital, Reykjavik, Iceland). Coronary heart disease mortality among non‐insulin‐dependent diabetic subjects in Iceland the independent effect of diabetes. The Reykjavik Study 17‐year follow up. J Intern Med 1998; 244: 309–316.

Objectives

The main aim of this study was to estimate the independent risk for coronary heart disease (CHD) death associated with non‐insulin dependent (Type 2) diabetes (NIDDM) and effect on life expectancy.

Design

and setting. The Reykjavik Study is a prospective cardiovascular population study which started in 1967. A randomized selection procedure identified individuals for invitation to participate, based on their year and date of birth. Participants were examined in the years 1967–91 in one research clinic in Reykjavik.

Subjects

and methods. The population in this survey were Icelandic Caucasian males and females, born 1907–35 and therefore 34–79 years old when their examination was performed. Altogether 9139 males and 9773 females attended, and of those 267 males and 210 female were NIDDM as defined by a questionnaire or an oral glucose tolerance test. Other factors measured in the study included systolic and diastolic blood pressure, fasting total cholesterol, triglycerides, uric acid, smoking habits, height, and weight. The causes of death were determined by a review of all death certificates.

Results

The relative risk of death from CHD (95% confidence limits), independently associated with NIDDM, was 2.0 (1.5–2.6) for males and 2.4 (1.6–3.6) for females. The relative risk of death from all causes was 1.9 (1.6–2.3) and 1.7 (1.3–2.1), respectively, for male and female diabetic patients.

Conclusions. N

on‐insulin dependent diabetes mellitus carried twice the risk of CHD death in both sexes, independently of other risk factors. The diagnosis of NIDDM at the age 55 years reduced an individual's life expectancy by about five years, mostly because of increased CHD death rate.
Breast cellulitis complicating breast conservation therapy
Authors: Wilhelmsen Lars , Baddour L. M.
Published: March 2003

Breast conservation therapy has gained acceptance as treatment for limited disease due to breast cancer. Unfortunately, a minority of patients who undergo this therapy will develop cellulitis of the breast, often recurrently, months to years later. A definitive pathogen has not been identified in the large majority of cases reported to date. Whilst some patients develop systemic toxicity with local skin changes of cellulitis, others manifest no fever, chills or leukocytosis. Local breast findings gradually clear with antibiotic treatment; when breast changes persist, non‐inflammatory causes, including tumour recurrence, of the breast should be considered. More study is needed to define risk factors for the development of breast cellulitis complicating breast conservation therapy.