bluuebunny/crossref_metadata_2025 huggingface dataset:
Old and Cold: Older People and Policies Failing to Address Fuel Poverty
Authors: Wright Fay
Published: August 2004

Research, funded by the British Gas Help the Aged Partnership and carried out by the Institute of Gerontology, King's College London, explored the multidimensional issues of fuel poverty. A sample of older homeowners and private renters living in England, Scotland and Wales were interviewed in the Spring of 2003 to explore their experiences of keeping their homes warm in the preceding winter. It was found that almost half of the sample for whom full information was available were in fuel poverty. Government schemes failed to address some important issues. Grants were only available to those with “passport benefits”, excluding those who had minimal occupational pensions. Although most respondents had central heating, it was often old and ineffective, yet grants were not available to modernize them. Government schemes did not extend to paying for external and internal insulation for solid wall properties yet many older people live in such property. Several older people lived in rural areas not connected to mains gas. As mains gas currently provides the cheapest fuel, they faced high bills, yet government policies do not address the differential fuel costs in these areas. The culture of many older people in the study contributed to their living in cold homes. They lived frugally and usually turned heating off in daylight hours during winter. It was also a common practice to sleep in an unheated bedroom during winter and to keep the window open at night. Such practices are acknowledged to be unhealthy.
Changing Welfare Regimes in East and Southeast Asia: Crisis, Change and Challenge
Authors: Croissant Aurel
Published: August 2004

The Asia‐Pacific region is a latecomer to the development of the welfare state. However, in some countries, governments have implemented ambitious programmes to extend social security systems and to enlarge the institutional structure of their welfare states. Comparative study of the welfare systems in East and Southeast Asia is, however, underdeveloped and there still is a relative lack of accurate knowledge about welfare systems in the region. Since the Asian financial crisis, more attention has been paid to the social policies of the countries. This paper examines features of welfare regimes in Indonesia, Malaysia, the Philippines, Singapore, South Korea, Taiwan and Thailand, and undertakes a systematic review of the development, levels and patterns of welfare regimes in the region. Two core questions are answered: can the existing welfare systems help mitigate the social impact of the financial and economic crisis? What are the needs, challenges and developmental perspectives that inform the future of welfare regimes in this region?
“So Many Tiers, So Many Agendas, So Many Pots of Money”: The Challenge of English Regionalization for Voluntary and Community Organizations
Authors: Harris Margaret , Cairns Ben , Hutchinson Romayne
Published: August 2004

This paper looks at the challenges facing voluntary and community organizations (VCOs) within the new policy context of English “regionalism”, drawing primarily on an empirical study in one of the emerging Regions. Barriers to voluntary and community sector (VCS) engagement with the new regional governmental organizations and the new regional policy agenda are identified. The role of VCS “infrastructure” organizations in facilitating relationships with regional levels of government is also considered. The concepts of exchange, ownership, trust and legitimacy are then employed to analyse and explain the implications for English VCOs of working with a new tier of government at regional level. The paper concludes by reconsidering the nature of the relationship between VCOs and “government” in the light of the new policy context presented by English regionalism combined with central government interest in building the capacity and infrastructure of the voluntary sector.
Effectiveness of LPG® treatment in morphea
Authors: Worret W‐I , Jessberger B
Published: August 2004

Background  The LPG® technique, also known as Endermology® treatment, is a noninvasive technique consisting of a tissue mobilization process in which a skin fold is created between two rollers, stretching the underlying tissue and mobilizing the fold. The LPG® technique is very effective in treating scars. Because the lesions of morphea or circumscribed scleroderma are similar to atrophic scars, it seemed reasonable to treat them with a method proven helpful for scars.

Materials and methods  We treated 17 lesions of 10 patients (four males and six females) with the diagnosis of morphea ranging in age from 17 to 78 years (mean age 55 years) and investigated and documented the evolution of their lesions and changes in their quality of life.

Results  In all patients there was a large improvement in the clinical appearance of the lesions, the induration and the pain. Elasticity was particularly increased, not only based on clinical findings but also as documented with objective assessment. The acceptability of the treatment was good and the patients reported an improved quality of life.

Conclusion  The LPG® technique (Endermology®) is an adjunctive treatment for morphea. It cannot eliminate the disease but can relieve the pain, soften the skin and improve the quality of life for these patients.
Increased risk of squamous cell carcinoma in junctional epidermolysis bullosa
Authors: Mallipeddi R , Keane FM , McGrath JA , Mayou BJ , Eady RAJ
Published: August 2004

Non‐Herlitz junctional epidermolysis bullosa (JEB) is an autosomal recessive genodermatosis characterized by skin fragility and blistering. It is usually caused by mutations in the genes encoding the basement membrane proteins laminin 5 or type XVII collagen. Clinically, impaired wound healing and chronic erosions cause major morbidity in affected patients. Previously it was thought that these individuals, unlike patients with dystrophic EB, did not have an increased risk of developing skin cancer. However, we describe three patients with non‐Herlitz JEB (aged 42, 56 and 75 years) who developed cutaneous squamous cell carcinomas (SCCs). The tumours were well‐differentiated in two cases, but one patient had multiple primary SCCs that were either well‐ or moderately differentiated. Most cases of SCC in non‐Herlitz JEB described have occurred in those with laminin 5 defects and on the lower limbs. These clinicopathological observations have important implications for the management of patients with this mechanobullous disorder as well as providing further insight into the biology of skin cancer associated with chronic inflammation and scarring.
Cutaneous adverse reaction to 2‐chlorodeoxyadenosine with histological flame figures in patients with chronic lymphocytic leukaemia
Authors: Rossini MS , De Souza EM , Cintra ML , Pagnano KB , Chiari AC , Lorand‐Metze I
Published: August 2004

Introduction  2‐Chlorodeoxyadenosine (cladribine or 2‐CdA) is a purine analogue that has been used successfully in hairy cell leukaemia (HCL). Moreover, it has been increasingly used to treat chronic lymphoproliferative syndromes and paediatric acute myeloid leukaemia. Cutaneous side‐effects associated with this drug have seldom been described in cases of HCL.

Patients and methods  We describe three patients with chronic lymphocytic leukaemia that presented generalized skin eruptions after treatment with 2‐CdA.

Results  All patients had advanced disease, receiving 2‐CdA as a second or third line chemotherapy. Skin lesions were severe and chemotherapy had to be discontinued. Histological examination of skin biopsies showed an eosinophil‐rich infiltrate with flame figures, similar to what is observed in Wells’ syndrome (eosinophilic cellulitis). Corticosteroids were effective to control the eruptions.

Conclusions  Cutaneous adverse reactions associated with 2‐CdA have seldom been observed in the treatment of HCL. However, as this purine analogue has been used in more advanced cases these may be more frequent and severe. The pathophysiology of these lesions is unclear, but it is probably related to drug‐induced change in T‐cell imbalance in severely immunosuppressed patients.
Eyelid discoid lupus erythematosus and contact dermatitis: a case report
Authors: MAB Trindade , AOA Alchorne , Da Costa EB , Enokihara MMSS
Published: August 2004

We report a patient with discoid lupus erythematosus (DLE) and associated allergic contact dermatitis (ACD) in the eyelids. In women, ACD caused by nail varnish is frequent and often seen in the eyelids. ACD caused by drugs (e.g. neomycin) is also frequent in this region. However, DLE with periorbital presentation without evidence of systemic or other cutaneous involvement is rare.
Reactive perforating collagenosis associated with scabies in a diabetic
Authors: Brinkmeier T , Herbst RA , Frosch PJ
Published: August 2004

Reactive perforating collagenosis (RPC) in adults commonly manifests in patients with diabetes mellitus. Pruritus and consequent induced scratching have been identified as the bases for the evolution of this skin disease. We present the unusual case of a 55‐year‐old female diabetic with characteristic umbilicated skin lesions and a long history of scabies. Histology from a crusty nodule revealed transepidermal elimination of collagen. Following antiscabietic treatment, two courses of oral doxycycline demonstrated beneficial effects in controlling the perforating skin disorder.
Leukaemia‐associated eosinophilic folliculitis (Ofuji's disease)
Authors: Patrizi A , Chieregato C , Visani G , Morrone P , Patrone P
Published: August 2004

Background  Ofuji's disease is an eosinophilic dermatosis mostly affecting male subjects. It is characterized by the appearance of follicular papulopustolosis, at times on an erythematous base, which tend to form an annular configuration.

Patients and methods  Two cases are described: the first is a 45‐year‐old man affected by acute myeloid leukaemia and Ofuji's disease; the second is a 61‐year‐old man affected by chronic lymphatic leukaemia and Ofuji's disease. Culture tests were negative in both cases. In both patients no hypereosinophilia was found.

Conclusions  The simultaneous presence of the two pathologies in these patients can only give rise to hypothesis. In the first case it could be attributed to interleukin (IL)‐5, which causes both eosinophilic hyperproduction and blast differentiation. In the second case the hypersecretion of intercellular adhesion molecule type 1 (ICAM‐1) in Ofuji's disease could be attributed to a modified transcriptional gene belonging to the class of immunoglobulin codifying genes located on the altered chromosomes in a certain percentage of leukaemic patients.
Leishmaniasis of the lip in a patient with Down's syndrome
Authors: Ferreli C , Atzori L , Zucca M , Pistis P , Aste N
Published: August 2004

Cutaneous leishmaniasis is an endemic protozoan infection in Sardinia, one of the major islands of the Mediterranean Basin. The main causative strain in this country is Leishmania infantum, which rarely involves mucocutaneous areas, but has the potential to cause visceral leishmaniasis. An atypical leishmaniasis involving the inferior lip of a 57‐year‐old female with Down's syndrome was observed at the Dermatology Department of Cagliari (italy). The diagnosis was mainly based upon histopathological examination, revealing intra‐ and extra‐cellular leishmania amastigotes. The leishmania infantum zymodeme MON‐111 was identified by isoenzymatic characterization. Laboratory investigations revealed a normal complete blood count and biochemistry profile, except for an inverted CD4/CD8 ratio. Treatment with meglumine antimoniate 60 mg/kg/day (Glucantime®) intramuscularly for 15 days, followed by intralesional administration 1 ml weekly for 4 weeks led to complete recovery. No relapses were observed at 6‐month follow‐up. The unusual localization is likely to be a reflection of the uncommon site of inoculation of the protozoa, transmitted by bites from flying vectors. Nevertheless, the presence of Down's syndrome in our patient may have contributed to the atypical presentation by traumatic exacerbation of the lesion, due to repeated auto‐induced microtraumas of the inferior lip accompanied by subclinical immunodeficiency. In fact, the specific immune response to Leishmania infection depends on a host‐cell‐mediated immune response, reported as defective in Down's syndrome patients. Differential diagnosis and early detection of the infection are necessary in order to start effective treatment and prevent more serious complications.
Multiple perforating and non perforating pilomatricomas in a patient with Churg–Strauss syndrome and Rubinstein−Taybi syndrome
Authors: Bayle P , Bazex J , Lamant L , Lauque D , Durieu C , Albes B
Published: August 2004

We report an unusual association of multiple perforating and non‐perforating pilomatricomas with Churg–Strauss syndrome, and a dysmorphic syndrome evocative of Rubinstein‐Taybi syndrome. These syndromes may be independent, but these rare diseases and genetic abnormalities may be linked together.
Awareness, knowledge and attitudes to basal cell carcinoma and actinic keratoses among the general public within Europe
Authors: MacKie RM
Published: August 2004

Objective  As the incidence of non‐melanoma skin cancer (NMSC) is reported to be increasing in Europe, the objective of this survey was to establish the general population's awareness and knowledge of basal cell carcinoma (BCC) and actinic keratoses (AK) within five European countries.

Methods  A total of 1500 individuals from the United Kingdom, France, Italy, Germany and Spain were randomly selected to participate in the study. In a 10‐minute structured telephone interview respondents answered questions on skin cancer and BCC and AK.

Results  Overall, 46% of respondents were concerned about skin cancer. Even though the majority of respondents believed there was a correlation between skin cancer and the sun or overexposure to sunlight, nearly a third of the surveyed population rarely or never used sunscreen when outdoors. In general there was a low level of awareness about BCC and AK, with only 22% and 6% of respondents, respectively, being aware of the conditions.

Conclusion  There is a need to increase the awareness of skin cancer and safe sun practices among the European population.
Increased endothelemia as an indirect marker of changes in the blood vessel endothelium in psoriasis
Authors: Sochorova R , Svecova D , Sinka L , Rybarova L
Published: August 2004

Background  Endothelial cells have a pivotal role in the initiation and development of inflammation. The dermal microvasculature undergoes distinctive morphological changes. Central to the angiogenetic process are endothelial cell division and migration controlled by local expression of the mitogenic factor. There is considerable evidence for the development of angiogenesis in psoriatic skin. Quantitative assessment of the endothelium in psoriasis demonstrated a fourfold increase in surface area of the superficial vascular plexus in lesional skin. The rate of vascular proliferation in active psoriasis is similar to that in other angiogenic pathologies. To identify vasoproliferation in the skin adds a useful tool in the assessment of psoriasis activity in future studies of its pathogenesis. The basal level of endothelemia reflects a continuous replacement of cells. The hyperproliferation in psoriasis stimulates physiological cell replacement. The higher replacement of blood vessel endothelial cells causes an increase in circulating cell levels in the bloodstream. Endothelemia might serve as an indicator of changes in the blood vessel endothelium in psoriatics.

Objective  The aim of the present study was to assess the changes in the amount of endothelial cells in the blood of psoriatic patients by comparing them with healthy controls.

Material and methods  Fifty‐six patients suffering from psoriasis (PASI score 35.05 ± 5.61) and 20 healthy subjects were estimated for quantitative endothelemia using the counting of endothelial cells in Burker's chamber after their isolation together with platelets and the removal of the latter by addition of adenosine diphosphate. The cells were confirmed as endothelial in origin by positive staining for von Willebrand factor. The significance of the differences was estimated by Student's t‐test.

Results  There were 2.02 ± 0.21 (female) and 2.3 ± 0.25 (male) endothelial cells in the control group and 4.6 ± 0.59 (female) and 5.15 ± 0.67 (male) in the psoriatic patients. The difference was statistically significant (P < 0.001).

Conclusion  Expansion of the dermal microvasculature is a prominent feature in psoriasis. Endothelemia might be an indirect marker of changes in the blood vessel endothelium in psoriatic patients. No differences were found in endothelemia in psoriatics according to the gender.
Dermoscopic observation of Bowen's disease
Authors: Bugatti L , Filosa G , De Angelis R
Published: August 2004

Background  In the literature no specific dermoscopic criteria have been described for the diagnosis of Bowen's disease (BD).

Objective/aim  To assess the morphological findings of BD seen under dermoscopic observation.

Methods  Clinical and dermoscopic images of 14 patients affected by BD with various amount of pigmentation were obtained by means of Heine Dermaphot. Dermoscopic images were analysed by experienced observers applying the modified pattern analysis.

Results  The most frequently occurring dermoscopic features were found to be: multicomponent pattern (100%); atypical vascular structures (86.6%); absence of pigmented network (64.3%) or presence of pseudo‐network (35.7%); irregular diffuse pigmentation or blotches of pigment (64.2%); irregularly distributed dots and globules (64.2%); focal/multifocal hypopigmentation (78.5%), scaly surface (64.2%) and haemorrages (26.6%).

Conclusions  Dermoscopically, BD is mainly characterized by a multicomponent global pattern associated with a prominent vascular pattern (mainly dotted vessels) and a scaly surface. Although no specific dermoscopic criteria can be given for BD, epiluminescence can be a valuable aid in the diagnosis of such a mimicker lesion.
Naxos disease in Saudi Arabia
Authors: Bukhari I , Juma’a N
Published: August 2004

Naxos disease is an autosomal recessive genodermatosis characterized by palmoplantar keratoderma, woolly hair and cardiomyopathy. In this report we describe an early case of Naxos disease and we briefly review the literature of this disorder.
Nickel allergy and orthodontic treatment
Authors: Kalimo K , Mattila L , Kautiainen H
Published: August 2004

Objectives  Tolerance induction to prevent development of nickel allergy has been suggested with permanent dental braces. We wanted to find out which effect orthodontic treatments had had on the development of nickel allergy in university students.

Study design  We examined and patch tested 153 students, of whom 113 had a history of pierced skin, and 70 a history of orthodontic treatment roughly 10 years earlier.

Results  All except one student with pierced skin were females. Development of nickel allergy was significantly associated with skin piercing (54% compared with 12%). At the time of the study, there was a slight but non‐significant difference in the prevalence of nickel allergy between students who had been subjects for orthodontic treatment (49%) compared with non‐treated ones (58%) if they had pierced skin. There were no significant differences in the development of nickel allergy among students who had had permanent dental braces before (50%) or after skin piercing (48%). However, from 40 students without skin piercing four of 11 (three males) with a history of permanent braces had developed nickel allergy, as compared with none of 22 (P = 0.008) without orthodontic treatment suggesting possibility of sensitization through dental devices.

Conclusions  Orthodontic treatment may not lead to tolerance induction on all occasions, and sensitization through permanent devices seems to be possible.
Superficial white onychomycosis revisited
Authors: Baran R , Hay R , Perrin C
Published: August 2004

Background  Superficial white onychomycosis (SWO) is a distinct pattern of fungal nail invasion, which is usually treated with topical antifungals.

Objective  This paper presents a case of SWO with deep penetration and records other similar cases.

Methods  The clues to deep invasion of the nail plate are twofold: an inability to clear the discoloration by scraping the nail and a clinical involvement of the nail plate in the proximal nailfold area. Histology of the nail keratin will confirm deep penetration beyond the superficial layers of the nail plate.

Results  In the light of this finding the authors propose a further subdivision of SWO to reflect previously unrecognized variants with therapeutic implications into: (i) the classical SWO type; (ii) the dual invasion of the nail plate, superficial and ventral; and (iii) the pseudo‐SWO with deep fungal invasion of the nail plate.

Conclusions  This subdivision of SWO allows the clinician to treat the patient appropriately using topical antifungals when the disease is restricted to the dorsum of the nail. Systemic drugs either in isolation or in combination with topical treatment are mandatory when deep penetration or ventral fungal invasion are observed.
Onychomycosis in a premature infant caused by Candida tropicalis
Authors: Chun DK , Lee UH , Park HS , Choi JC
Published: August 2004

We report a case of onychomycosis caused by Candida tropicalis in a 107‐day‐old infant.
A case of porokeratotic eccrine ostial and dermal duct naevus of late onset
Authors: Birol A , Erkek E , Bozdoðan Ö , Koçak M , Atasoy P
Published: August 2004

We describe the case of a 21‐year‐old man with an 8‐year history of porokeratotic eccrine ostial and dermal duct naevus (PEODDN) of late onset. The patient had pruritic, keratotic papules on the dorsal surface of his left hand, bilaterally on his palms and multiple yellowish lesions on the plantar surface of his feet. On histopathological examination cornoid lamella‐like parakeratotic columns above eccrine sweat ducts were observed. The acrosyringium was also dilated. The lesions were refractory to treatment with salicylic acid in petrolatum and acitretin for 2 months. This entity should be taken into consideration in the differential diagnosis of linear keratotic cutaneous eruptions.
Skin abnormalities in the National Portrait Gallery
Authors: Strauss RM , Marzo‐Ortega H , Goulden V
Published: August 2004

Pathological changes in the human body have long been recognised in painting. To assess the frequency of potential physical abnormalities reflected in paintings, we reviewed portraits on display at one visit in the National Portrait Gallery in London. We identified a number of possible abnormalities, most of them dermatological, with the commonest finding being small facial papular lesions, most likely representing either common warts or dermal naevi. This exercise however, reflects a subjective interpretation of the different artists's perceptions of their models’ physical appearances.
Spontaneous regression of keratoacanthoma can be promoted by topical treatment with imiquimod cream
Authors: Di Lernia V , Ricci C , Albertini G
Published: August 2004

Imiquimod, the first member of a new class of immune response modifiers, is approved for the treatment of external genital and perianal warts. Recently, many clinical trials highlighted the potential of imiquimod as a treatment for other viral infections and cutaneous neoplasms. We report two cases of facial keratoacanthomas (KA) treated with topical 5% imiquimod cream. Patients were successfully cleared of KAs after treatment for 8 weeks. No recurrence occurred after a 1‐year follow‐up. Despite the fact that KAs are characterized by the potential for spontaneous regression, it is possible that a faster activation of CD4+ lymphocytes, via interferon release and cytokine secretion takes place after imiquimod application leading to KA regression.
Oral lichen planus: an unusual cause of facial and abducens nerve paralysis associated with conjunctival and oesophageal involvement
Authors: Tunca A , Çalikoǧlu E , Aktaş D , Şafak N , Üstün H
Published: August 2004

Lichen planus (LP) is a T‐cell‐mediated disorder that may involve the skin, nails and mucosal surfaces. Conjunctival, laryngeal and oesophageal involvement were reported to be extremely rare manifestations of the disease. In this report, we present an oral LP case who complained of severe burning pain on his tongue and oral mucosa caused by ulcerative lesions and associated with conjunctival, laryngeal and oesophageal involvement. In addition, neurological examination revealed facial and abducens nerve palsy. To the best of our knowledge, we are presenting the first case of erosive oral LP associated with facial and abducens nerve paralysis. Although this association may be coincidental, according to an immunological concept proposed to explain the pathogenesis of Bell's palsy, degranulation of mast cells activated by complement or specific allergens with the release of histamine and other substances were to be presented responsible from nerve oedema, ischaemia and paralysis. As mast cell mediators are likely to be involved in the immunopathogenesis of OLP, we think that the cause of facial and bilateral abducens nerve palsy could be explained by the same mechanism. This case is a good example of the need for team work in lichen planus patients undergoing interdisciplinary consultations.
The Scottish Path to Capitalist Agriculture 2: The Capitalist Offensive (1747–1815)
Authors: DAVIDSON NEIL
Published: August 2004

The first in this series of articles left Scotland on the verge of agrarian transformation. Although the nation geographically nearest to England, it remained in 1745 considerably more distant in social structure. England was the first state unambiguously to complete the transition from feudal to capitalist agriculture. Unlike England, however, those that followed did not have a period of several centuries in which to undertake the process. Lenin identified the alternatives that they faced as the Prussian ‘reformist’ and American ‘revolutionary’ paths. Scotland was to prefigure the Prussian path, where the feudal landowners themselves instigated the transition to capitalism in the countryside. After the final defeat of Jacobitism at Culloden in 1746, the Scottish feudal landowners were juridically stripped of the powers (military tenures, local jurisdictions) with which a section of them had threatened the British state. They were, however, allowed to retain most of their power over their tenants. With no remaining alternative but to adapt to the capitalist mode of production, they systematically used these powers to reorganize their estates along existing English lines. The speed and extent of the transformation that followed remains unprecedented in Western European history.
Restructuring and Redundancy: The Impacts and Illogic of Neoliberal Agricultural Reforms in Jamaica
Authors: WEIS TONY
Published: August 2004

Since the onset of IMF lending in the late 1970s, Washington‐based planners have progressively compelled the Jamaican state to abandon its role in agriculture. Jamaica's agricultural adjustment occurred in two stages: first, agricultural development programmes were rolled back in the 1980s; second, liberalizing pressures in the 1990s threatened both the uncompetitive plantation sector (imperilling preferential markets) and domestically oriented small farmers (initiating a flood of cheap food imports). Today, agriculture in Jamaica is on the brink of irrelevance, with serious social and economic consequences in the balance. In critically assessing the process, impacts and illogic of agricultural restructuring in Jamaica, this paper highlights the uneven outcomes of global market integration and points to the urgent need for a reassertion of local sovereignty.
Continuity and Change: Some Observations on the Landscape of Agricultural Labourers in North Bihar, India
Authors: JHA PRAVEEN
Published: August 2004

This paper is an attempt to catalogue and analyse the changes over two decades in the world of agricultural labourers in a backward region in India. It is primarily based on a series of field visits to two villages in Purnia district, located in the north‐eastern part of Bihar. Changes in the living conditions of labourers are obviously connected to developments in the rural economy of the region and there are important linkages with developments elsewhere, including changes in the overall macro‐economic policy regime. An attempt is made to trace these. Agricultural wage workers in the surveyed region are extremely poor by any reckoning, although a few of them have made some progress through state‐sponsored programmes and migration. These developments have also contributed significantly to altering the relations of dominance and subordination, thus creating greater elbow‐room for labourers. However, it is important not to overstate these small gains and there are serious doubts as to whether they can be sustained. It appears that some of the material correlates of labourers’ well‐being in the surveyed region are being affected adversely by the currently ascendant neoliberal policy regime. There are no signs of the emergence of mechanisms that might imply sustained significant improvements in the very fragile life and work conditions of these labourers.
Agricultural Wage Rates Under Forced and Free Labour: Pre‐1944 and Post‐1954 Guatemala
Authors: SCHWEIGERT THOMAS E.
Published: August 2004

From 1871 to 1944 liberal trade and foreign investment policies were combined with illiberal labour coercion to create a classic export economy based on coffee plantations. The substantial reallocation of labour from the subsistence‐oriented peasant economy to the coffee sector is associated with a sustained reduction in the agricultural wage rate. Throughout the forced labour period the wage was below a subsistence level, made possible by rural workers’ access to land for their own subsistence production. The post‐1954 free labour period is associated with a once‐and‐for‐all doubling of the real wage to a subsistence level, consistent with the emergence in this period of a sizeable landless rural labour force. In the free labour era, the commercial agricultural sector has grown in ‘classical’ fashion, drawing on labour at a virtually constant, subsistence wage.
Rural Adaptation in Russia: Who Responds and How Do We Measure It?
Authors: WEGREN STEPHEN K.
Published: August 2004

Utilizing survey data from 800 households in five regions of Russia, this article attempts to measure adaptation to reform stimuli according to socio‐economic strata. While the orthodox literature has emphasized rural resistance to reform, in fact one of the main analytical obstacles is differentiating between adaptive and survival strategies. Time horizon is used as the primary criterion to distinguish between adaptive and survival behaviour. The article analyses adaptive responses by examining the use of rural credit, the operation of a household business, the enlargement of household land plots and a set of attitudes that taken together comprise an ‘entrepreneurial spirit’.
Book Reviews
Authors: BYRES TERENCE J. , PHIMISTER IAN , FARRER JAMES , FIELD DONALD R. , CLENDENNING GREG
Published: August 2004

Book Reviews

Neil Davidson, Discovering the Scottish Revolution 1692–1746.

Benno Teschke, The Myth of 1648. Class, Politics and the Making of Modern International Relations.

Amanda Hammar, Zimbabwe's Unfinished Business: Rethinking Land, State and Nation in the Context of Crisis.

Yunxiang Yan, Private Life Under Socialism: Love, Intimacy and Family Change in a Chinese Village, 1949–1999.

A. E. Luloff and R. S. Krannich (eds), Persistence and Change in Rural Communities: A 50 Year Follow Up to Six Classic Studies.
Defining endometrial growth during the menstrual cycle with three‐dimensional ultrasound
Authors: Raine‐Fenning Nicholas J. , Campbell Bruce K. , Clewes Jeanette S. , Kendall Nigel R. , Johnson Ian R.
Published: August 2004

Objective  To define the changes in endometrial morphometry that occur during the normal menstrual cycle and to examine the discriminatory power of volumetric analysis over conventional two‐dimensional measurements in quantifying the effect of compounding factors on endometrial growth.

Design  The design was that of a longitudinal observational study. Subjects were seen on an alternate‐day basis until ovulation and then every four days until the next menstrual period.

Setting  A University teaching hospital.

Population  Thirty women with regular cycles and acceptable ‘normal’, menstrual patterns.

Methods  Three‐dimensional ultrasound data were acquired and subsequently analysed by a single observer.

Main outcome measures  Endometrial thickness and volume.

Results  Both endometrial volume and thickness increased significantly during the follicular phase (P < 0.001), reaching a plateau around the time of ovulation and remaining relatively stable throughout the luteal phase. These changes in endometrial thickness and volume were highly correlated (R2= 0.767; P < 0.001). Parity was associated with a significantly greater endometrial volume than nulliparity (4.159 vs 2.234 cm3; P < 0.05).

Conclusions  This study has defined the relative and absolute changes in endometrial growth, both in terms of thickness and volume, throughout the normal menstrual cycle. These data provide a reference for future three‐dimensional studies investigating menstrual disorders, pathophysiological change and subfertility.
Misoprostol in the treatment of postpartum haemorrhage in addition to routine management: a placebo randomised controlled trial
Authors: Walraven Gijs , Dampha Yusupha , Bittaye Bubacarr , Sowe Maimuna , Hofmeyr Justus
Published: August 2004

Postpartum haemorrhage remains a leading cause of maternal mortality, despite treatment with conventional methods. In this randomised controlled trial, we compared misoprostol 600 μg (200 μg orally and 400 μg sublingually) with placebo in the treatment of postpartum haemorrhage in addition to routine treatment. One hundred and sixty consenting women who delivered vaginally with measured blood loss ≥500 mL and for whom inadequate uterine contraction was thought to be a possible factor were given either misoprostol or placebo in addition to normal treatment and after routine active management with uterotonics. Blood loss was measured by collection in a special plastic bedpan and side effects of treatment were recorded. Measured average additional blood loss was 325 mL (95% confidence interval [CI] 265 to 384 mL) with misoprostol and 410 mL (95% CI 323 to 498 mL) with placebo. No severe side effects were noted in the use of misoprostol.
Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial
Authors: Morales Michel , Ceysens Gilles , Jastrow Nicole , Viardot Caroline , Faron Gilles , Vial Yvan , Kirkpatrick Christine , Irion Olivier , Boulvain Michel
Published: August 2004

Objective  To compare blood loss with spontaneous delivery and manual removal of the placenta during caesarean section.

Design  A randomised controlled trial.

Setting  Four university hospitals between September 1999 and June 2002.

Population  A total of 472 women delivering by caesarean section at term were randomised to spontaneous placental delivery (n= 235) or manual removal (n= 237).

Methods  The allocation was made by opening the next available of a series of sealed opaque envelopes and derived from a computer‐generated list of numbers.

Main outcome measures  Significant blood loss, defined as either a drop in haemoglobin of greater than 2.5 g/dL, or the need for blood transfusion.

Results  The mean interval between delivery of the newborn and the placenta was longer in the spontaneous delivery group (3.4 vs 1.9 minutes), but the mean duration of the operation was similar. Significant blood loss occurred in 30 women (13%) in the spontaneous delivery group and 49 women (21%) in the manual removal one (RR 0.62; 95% CI 0.41–0.94). Post‐operative fever affected 6 and 5 cases, respectively, and antibiotics were used in 14 and 12 cases, respectively.

Conclusions  Allowing spontaneous delivery of the placenta reduces significant blood loss without increasing operating time.
Obstetric risk factors and persistent increases in brain parenchymal echogenicity in preterm infants
Authors: Spinillo Arsenio , Chiara Alberto , Bergante Carola , Biancheri Danila , Fabiana DePaoli , Fazzi Elisa
Published: August 2004

Objective  To assess the risk of persistent (>7 days) increases in brain parenchymal echogenicity in preterm infants and their association with known obstetric risk factors.

Design  Case–control study of prospectively collected data.

Setting  A University hospital in Northern Italy.

Population  Eighty‐five singleton infants between 24 and 34 weeks of gestation with a cranial ultrasonographic diagnosis of persistently increased parenchymal echogenicity without development of cystic degeneration, and 170 control infants with negative cranial ultrasonographic findings.

Methods  A comparison of the prevalence of selected obstetric risk factors between infants with persistent echo‐dense lesions and negative controls.

Main outcome measures  Odds ratios of persistent echo‐dense lesions including first‐degree interactions between variables.

Results  After adjusting for birthweight, logistic regression analysis showed that the only factor associated with an increased risk of persistent brain echo‐dense lesions in infants was multiple courses of antenatal steroids (OR = 2.14, 95% CI = 1.11–4.15, P= 0.024). In this group, the risk of persistent echo‐dense lesions was particularly high in: (i) mothers receiving dexamethasone rather than betamethasone (P value for interaction = 0.015) and (ii) after expectant management of pre‐eclampsia or intrauterine growth retardation (P value for interaction = 0.03).

Conclusions  Multiple doses of antenatal steroids, especially dexamethasone, could influence the prevalence of persistent increases in brain parenchymal echogenicity in preterm infants.
The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study
Authors: Einarson Adrienne , Maltepe Caroline , Navioz Yvette , Kennedy Deborah , Tan Michael Paul , Koren Gideon
Published: August 2004

Objective  Ondansetron (Zofran) is a drug used for the treatment of nausea and vomiting caused by cancer chemotherapy. Despite the fact that it is not indicated, women are being prescribed this drug for the treatment of nausea and vomiting of pregnancy (NVP). There is a paucity of information on fetal safety for this indication. The objective of this study is to determine whether this drug increases the baseline rate of major malformations.

Design  A prospective comparative observational study.

Setting  Teratogen Information Services (TIS).

Population  Pregnant women.

Methods  Our three groups included women who were exposed to ondansetron and women exposed to (1) other anti‐emetics and (2) non‐teratogen exposures. All of the women called either our NVP Helpline or TIS at The Motherisk Program in Toronto, Canada, or The Mothersafe Program in Sydney, Australia.

Main outcome measure  Rates of major malformation.

Results  We have completed 176 pregnancy outcomes in each group. In the ondansetron cohort, there were 169 live births, 5 miscarriages, 2 therapeutic abortions, 6 (3.6%) major malformations and the mean birthweight was 3362 g [SD 525]. There were no statistical differences in any of the study endpoints between the ondansetron and the comparison groups.

Conclusions  This drug does not appear (although the sample size is limited) to be associated with an increased risk for major malformations above baseline.
State of the Science of Translational Research: From Demonstration Projects to Intervention Testing
Authors: Kirchhoff Karin T.
Published: August 2004

An overview of the effort of nursing in translation research begins with studies in research utilization. Delineation of issues in the uptake of evidence using guidelines and systematic reviews is discussed next. The federal initiatives in translation research are described with a focus on the Translating Research Into Practice (TRIP) studies. The article closes with future directions.
Qualitative Perspectives in Translational Research
Authors: Tripp‐Reimer Toni , Doebbeling Bradley
Published: August 2004

The rapid uptake of qualitative approaches in translational research can be best understood in the context of recent innovations in health services research, as well as an overarching concern with improving the quality of health care. Qualitative approaches highlight the human dimension in health care by foregrounding the perceptions, experiences, and behaviors of both consumers and providers of care. As such, these methods are particularly useful for addressing the complex issues related to improving health care quality and implementing system change. This overview traces a brief history of the factors contributing to the recent and rapid growth of qualitative methods in health research in general and translational research in particular; describes the varieties of qualitative approaches employed in this research; and illustrates the utility of these approaches for variable identification, instrument development, description/explanation of patient/provider perceptions and behaviors, individual/organizational change, and theory refinement.
Organizational Research with Impact: Working Backwards
Authors: Fraser Irene
Published: August 2004

Background or Rationale: To improve health care, we need to improve the organization of care, along with the payment systems that shape organizational priorities and behavior. The opportunity and challenge for research are to find a way to work with health care leadership so that future management decisions can make use of strong evidence.

Aims and Methods: This article uses findings from research on nursing to illustrate the potential for organizational research and management research to improve health care. It then distills recommendations from six focused stakeholder meetings to identify five ways in which we might improve organizational, management, and policy research to maximize its use.

Results and Discussion: Hospital, health plan, and other system leaders have five recommendations for research: (1) Design studies that answer user questions, with a focus on the “why” and “what if” rather than just the “what.” (2) Present findings in leaders' time and space, defining evidence as they do and identifying generalizability of findings. (3) Change the incentive system for researchers so that they are rewarded for the activities that maximize impact on decision making. (4) Build user‐researcher collaborations and dialogue. (5) Change the way we disseminate evidence, with dissemination through “early adopters,” trade association meetings, consultants, etc.

Implications for Research, Practice, and Policy: System and policy leaders control important levers for improving health care, since they shape organizational structure, processes and culture, payment strategies, program design, and regulation. Just as evidence‐based medicine can improve clinical practice, evidence‐based management and policymaking can change how these powerful levers are used. But for evidence to inform the decisions of system and policy leaders, we will need to rethink and restructure the research enterprise itself, bringing the potential users of evidence into the production process.
Translation Research in Long‐Term Care: Improving Pain Management in Nursing Homes
Authors: Jones Katherine R. , Fink Regina , Vojir Carol , Pepper Ginny , Hutt Evelyn , Clark Lauren , Scott Jill , Martinez Ruby , Vincent Deborah , Mellis B. Karen
Published: August 2004

Background: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement.

Aims: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain.

Methods: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed.

Findings: The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain.

Discussion: Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices.

Implications: Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership.

Conclusions: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.
Outcomes of Adoption: Measuring Evidence Uptake by Individuals and Organizations
Authors: Donaldson Nancy E. , Rutledge Dana N. , Ashley Jeffrey
Published: August 2004

Background: The translation and diffusion of findings into health care validate the potential of evidence‐based innovation to improve clinical practice and affirm the benefits of society's investment in advancing science.

Aims: This article briefly reviews key concepts in the knowledge use process, considers theoretical implications for measuring outcomes and uptake of innovation, discusses issues to consider in planning for measurement of adoption, and provides an example of confronting those challenges from a project now in progress.

Theoretical Perspectives and Translation Outcomes: Four principal conceptual frameworks related to translational science, Lewin, Rogers, Havelock, and Promoting Action on Research Implementation in Health Services (PARIHS), explicate a process that catalyzes new knowledge adoption and use by individuals and systems to solve problems. Each conceptual perspective suggests that translation is not complete until the extent and impact of use is examined and understood. Most perspectives support evaluation of impact of evidence‐based practice using process measures that integrate clinician knowledge, actual performance of the practice, and patient/clinician outcomes. Based on the Agency for Healthcare Research and Quality (AHRQ) framework, additional measures might include changes in patterns of care and changes in policies, procedures, or protocols.

Case Example: A description of process and outcome measures used in an in‐progress quality improvement demonstration project, California Nursing Outcomes Coalition (CalNOC) Partners in Quality Translating Research into Practice to Reduce Patient Falls Project, is presented.

Implication(s) for Practice, Research, and Policy: Since the adoption of evidence‐based innovation is a process that is often described along a continuum, investigators seeking to measure the impact of an evidence‐based innovation must gather evidence that uptake of the innovation has occurred. The theoretical perspective and practical measurement issues of a given project will drive selection of process and outcome measures.

Conclusions: Efforts to change practice in order to enhance evidence‐based patient care must integrate monitoring and evaluation of specific target outcomes of adoption as the basis for validating the impact of the change.