bluuebunny/crossref_metadata_2025 huggingface dataset:
Updated Review of the Coronary Artery Bypass Grafting Option in Octogenarians: Good Tidings
Authors: Shapira Itzhak , Pines Amos , Mohr Rephael
Published: June 2007

This review of the literature is presented in an attempt to keep pace with the constantly changing statistics in postsurgical outcomes, which reflect the considerable strides in technology and technical skills that have been made during the past decade in cardiovascular surgery. Although there is still much to be done in terms of improving surgical techniques and managing emergency cases, the reported results of coronary artery bypass grafting in octogenarians are similar to or even better than those obtained with medical or angioplastic approaches, and the life expectancy and quality of life are similar to or better than those of age‐matched controls.
Clinical Manifestations of Acute Myocardial Infarction in Older Patients
Authors: Gregoratos Gabriel
Published: June 2007

Coronary artery disease is the major cause of morbidity and mortality in the elderly in the United States. In this age group, the clinical presentation of coronary heart disease can be quite atypical. In general, the incidence of typical precordial chest pressure/pain denoting myocardial ischemia is less common, whereas dyspnea as an anginal‐equivalent symptom is frequent. The diagnosis of ischemic cardiac pain is frequently confused by the many comorbid conditions present in the elderly. Even when classic ischemic precordial discomfort is present, it tends to be less severe and less well defined. The elderly appear to have reduced pain perception; as a result, silent myocardial ischemia is more common and carries a somewhat worse prognosis in the elderly than in younger age groups. Similarly, the presenting symptoms of acute myocardial infarction in the elderly can be nonspecific. The classic crushing substernal chest pain decreases with age, whereas the symptom of dyspnea gradually increases. Neurologic symptoms, confusional states, weakness, and worsening heart failure are common clinical presentations of an acute infarction in elderly patients. Silent (unrecognized) myocardial infarctions are common in the elderly and carry serious prognostic implications.
Treatment of Acute Myocardial Infarction
Authors: Rich Michael W.
Published: June 2007

Persons 75 years of age or older constitute 6.1% of the US population but account for 36% of acute myocardial infarctions (MI) and 60% of deaths. Unfortunately, despite the fact that patients over age 75 represent a large subgroup with an exceptionally high case‐fatality rate, most randomized clinical trials have enrolled few patients in this group. As a result, therapeutic recommendations for managing acute MI in the very elderly are often extrapolated from studies conducted in younger patients. This article reviews current evidence‐based guidelines for early treatment of acute MI in the elderly. As in younger patients, aspirin, β blockers, and angiotensin‐converting enzyme inhibitors should be considered standard therapy in appropriately selected elderly patients. Although the benefits of reperfusion therapy (i.e., thrombolysis and primary angioplasty) are less well established, advanced age per se should not be considered a contraindication to the use of these interventions. Given the relative paucity of data in the very elderly, additional studies are needed to define optimal pharmacologic and nonpharmacologic treatment of acute MI in this rapidly growing, high‐risk population.
Treatment of the Elderly Post‐Myocardial Infarction Patient
Authors: Aronow Wilbert S.
Published: June 2007

Coronary risk factors should be modified in older persons after myocardial infarction (MI). Aspirin 160–325 mg daily and β blockers should be administered indefinitely. Anticoagulants should be administered post‐MI to patients unable to tolerate daily aspirin, to those with persistent atrial fibrillation, and to those with left ventricular thrombus. Nitrates, along with βblockers, should be used to treat angina pectoris. Angiotensin‐converting enzyme inhibitors should be administered after MI to patients who have congestive heart failure, an anterior MI, or a left ventricular ejection fraction of =40%. There are no class I indications for the use of calcium channel blockers after MI. Complex ventricular arrhythmias should be treated with βblockers. Persons with life‐threatening ventricular tachycardia or ventricular fibrillation or who are at very high risk for sudden cardiac death after MI should receive an automatic implantable cardioverter‐defibrillator. There are no class I indications for the use of hormonal therapy in postmenopausal women after MI. Indications for coronary revascularization after MI in older individuals are prolongation of life and relief of unacceptable symptoms despite optimal medical management.
Exercise in Patients With Hypertension
Authors: Ehsani Ali A.
Published: June 2007

A progressive increase in arterial stiffness with aging contributes to systolic hypertension that results in left ventricular hypertrophy and concentric remodeling in the elderly. Lowering of blood pressure in older adults reduces cardiovascular risks. Endurance exercise training can lower blood pressure in older adults with mild (grade I) hypertension. However, the blood pressure‐lowering effect of exercise training, compared with antihypertensive medications, is generally modest for both systolic and diastolic blood pressure. Exercise training alone is likely to be ineffective in lowering blood pressure sufficiently in older adults with moderate to severe (grade II and higher) hypertension. However, exercise and weight loss may potentiate the effects of antihypertensive medications in these subjects. Low‐intensity endurance exercise training appears to be most effective in reducing blood pressure in older hypertensive adults. Metabolic adaptations to exercise training can significantly reduce other risk factors for coronary artery disease and atherosclerosis, in addition to reducing blood pressure. Endurance exercise training improves exercise capacity and quality of life, and can induce a modest but significant regression of left ventricular hypertrophy and remodeling in older adults with hypertension.
Exercise in the Geriatric Patient With Congestive Heart Failure
Authors: Gottlieb Stephen S.
Published: June 2007

The benefits of exercise in the elderly patient with heart failure have been well documented, but the studies have been limited by restrictive inclusion criteria. Most studies have involved patients who are younger and healthier than those normally seen in clinical practice. Improvements in neurohormonal, metabolic, and vascular status have been well documented in the relatively young patients who have been evaluated. Consequently, peak exercise time, oxygen consumption, submaximal exercise, and quality of life have also improved. Studies suggest that older, more severely limited patients may also benefit from exercise. However, they are less likely to tolerate an exercise program and may not improve their quality of life if the exercise is excessive. Caution is warranted when exercise is prescribed to elderly patients with heart failure.
Exercise in the Healthy Older Adult
Authors: Karani Reena , McLaughlin Mary Ann , Cassel Christine K.
Published: June 2007

Habitual exercise provides numerous health benefits to the older adult. While dynamic aerobic activities increase stamina and lung capacity, isometric or resistance training improves muscle strength and endurance. Long‐term benefits of continued exercise include a decreased risk of death from heart disease, enhanced balance and mobility, a decreased risk of diabetes, and an improvement in depressive symptoms. While the hazards of exercise relate predominantly to extremes of intensity and duration, all older adults should consult with a physician before beginning a new activity program. A prescription for exercise should include both aerobic and resistance training components, and frequent follow‐up to improve adherence is highly recommended.
The Benefits of Exercise in Geriatric Women
Authors: George Barbara J. , Goldberg Nieca
Published: June 2007

Women 65 years of age and older are the fastest growing segment of the population. As women age, physical inactivity is the leading cause of morbidity and mortality due to coronary heart disease, diabetes mellitus, and hypertension. There is also a loss of both physiologic and psychological capabilities that contributes to an overall reduction in function and independent living. Regular physical activity in geriatric women has been shown to reduce cardiovascular morbidity and all‐cause mortality. Further research needs to be done to evaluate the role of regular physical activity in the management of diabetes and hyperlipidemia.
Smoking and Obesity Are Associated with the Progression of Aortic Stenosis
Authors: Ngo Minh Van , Gottdiener John S. , Fletcher Ross D. , Fernicola Dan J. , Gersh Bernard J.
Published: June 2007

Objective. The purpose of the study was to identify clinical predictors of progression of aortic stenosis. Background. The natural history of valvular aortic stenosis includes a latency period followed by an unpredictable progression. Recent investigations have shown an association between risk factors for atherosclerosis and the presence of aortic stenosis. The authors hypothesized that atherosclerosis risk factors are also associated with the progression of aortic stenosis. Methods. In a retrospective study, patients with a diagnosis of aortic stenosis were identified by continuous wave Doppler and a follow‐up study of at least 6 months. Clinical data at the time of the index echocardiogram were obtained from review of patients' medical records. Independent risk factors for the progression of aortic stenosis were identified by stepwise logistic regression analysis. Results. One hundred twenty‐three patients were identified, and complete data were obtained for 87 patients (mean age, 70.7±10 years; men, 81%; mean follow‐up, 2.54±1.6 years). The initial gradient was mild in 61% of patients and moderate in 31%. The mean rate of progression was 6.3±13 mm Hg/year. Mild aortic stenosis in 36% of patients at the time of the index echocardiogram progressed to moderate or severe over an average of 2.9±2.0 years. Independent clinical factors associated with a progression of 5 mm Hg/year or greater included a history of smoking (relative risk [RR]=3.06; 95% confidence interval [CI]=1.09–8.61; p=0.034) and body mass index (RR=1.16; 95% CI=1.03–1.30; p=0.013). Hypertension, diabetes, cholesterol, age, gender, and coronary artery disease were not independently associated with progression. Conclusions. Body mass index and a history of smoking are independent predictors of significant progression of aortic stenosis, defined as >5 mm Hg/year. The rate of progression of aortic stenosis is variable. However, a substantial number of patients have progression of even initially mild aortic stenosis within a relatively short period of time. The effect of controlling atherosclerosis risk factors on the rate of progression of aortic stenosis remains to be determined.
Ethical Issues in the Management of Geriatric Cardiac Patients
Authors: O'Neal Michael L. , Basta Lofty
Published: June 2007

Ethical Issue: The patient's pneumonia required assisted ventilation. After weaning, a second intubation is necessary. The patient's “living will” asks for no artificial life support
Ethical Issues in the Management of Geriatric Cardiac Patients
Authors: Morrow Michael F. , Plunkitt Kenneth , Basta Lofty
Published: June 2007

The Ethical Issue: A patient with multiple health problems and a clear advance directive succumbs to pleadings from her daughter to undergo heart surgery, with disastrous consequences.
Left Ventricular Diastolic Function in the Elderly
Authors: Tokushima Takashi , Reid Cheryl L. , Gardin Julius M.
Published: June 2007

Previous studies using pulsed Doppler echocardiography have demonstrated a pattern of abnormal left ventricular relaxation associated with increasing age. Specifically, aging is associated with decreased peak velocity of early diastolic mitral inflow, increased peak velocity of late diastolic inflow, increased isovolumic relaxation time, and early diastolic deceleration time. Abnormal relaxation can progress to significantly elevated left atrial pressure—characterized by increased early peak velocity and shortened isovolumic relaxation time and deceleration time—as part of the disease processes. Left ventricular diastolic dysfunction is highly prevalent, occurring in one half to two thirds of elderly patients with congestive heart failure, in association with normal systolic function. Left ventricular hypertrophy, which is commonly related to systemic arterial hypertension, and ischemic heart disease are the two major causes of abnormal left ventricular diastolic function in the elderly. Recently, newer echocardiographic techniques have been described that allow more accurate evaluation of left ventricular diastolic function. Treatments for left ventricular diastolic dysfunction should focus on the underlying disease etiology as well as on the derangement in left ventricular diastolic function. Although calcium channel blockers and angiotensin—converting enzyme inhibitors have been used clinically to treat diastolic dysfunction, their effects on prognosis remain unproven.
Transesophageal Echocardiographic Evaluation of Coronary Arteries for Stenosis in the Elderly Patient
Authors: Sorrell Vincent L. , Nanda Navin C.
Published: June 2007

This article documents the ability of transesophageal echocardiography to provide adequate images and clinically relevant information about the coronary anatomy of the elderly patient. Transesophageal echocardiography is commonly used to assess elderly patients who suffer cerebral vascular accidents. It is important to evaluate not only for the usually suspected causes of a cardiac source of emboli but also for direct and indirect evidence of coronary artery disease—the leading cause of death in the elderly stroke patient. Because atherosclerotic cardiovascular diseases identified in one vascular bed are prone to universally involve the other vascular territories to some degree, it is not surprising that the coronary arteries are often stenotic. As a sudden event with catastrophic symptoms, a stroke is commonly the first vascular event the elderly patient experiences. Depending on the degree of recovery, physical limitations may contribute to the lack of symptoms from coexistent peripheral or coronary artery disease. Transesophageal echocardiography may be the first, or only, coronary evaluation for high‐risk elderly patients.
Ethical Issues in the Management of Geriatric Cardiac Patients
Authors: Holtey Blair J. , Basta Lofty L.
Published: June 2007

Ethical Issue: No participating physician wanted to unilaterally make a decision to terminate the life‐support of a mentally incompetent and terminally ill patient.
Assessing whether to receive funding support from tobacco, alcohol, gambling and other dangerous consumption industries
Authors: Adams Peter J.
Published: June 2007

Aim  To examine the risks taken by health, research and community organizations when they opt to receive funding from dangerous consumption industries and to identify ways in which they might generate their own assessment of these risks.

Methods  Common risks associated with industry involvements are examined, along with potential barriers to self‐reflection.

Results  Funds derived from tobacco, alcohol, gambling and other dangerous consumptions are accessed increasingly by public good organizations. The variety of risks these involvements incur place individuals and organizations somewhere along a continuum of moral jeopardy, stretching from those with minor involvements to those with unmanageable conflicts of interest. The concept of a ‘continuum’ is preferable to a ‘binary’ interpretation in that the latter tends to lock understandings into all‐or‐nothing positions, thereby discouraging reflection and discussion regarding ethical and moral issues. Active scrutiny of these risks can be assisted through strategies that promote ongoing self‐assessment. This is illustrated in the application of criteria that help breakdown risks and provide guidance in deciding on the extent of involvement with industry funding.

Conclusion  The paper finishes with practical examples of educational and assessment strategies that could assist in reducing moral jeopardy.
The predictors and consequences of adolescent amphetamine use: findings from the Victoria Adolescent Health Cohort Study
Authors: Degenhardt Louisa , Coffey Carolyn , Moran Paul , Carlin John B. , Patton George C.
Published: June 2007

Objectives  Previous work has highlighted the adverse consequences of early‐onset cannabis use. However, little is known about the predictors and effects of early‐onset amphetamine use. We set out to examine these issues using a representative cohort of young people followed‐up over 11 years in Victoria, Australia.

Methods  A stratified, random sample of 1943 adolescents was recruited from secondary schools across Victoria at age 14–15 years. This cohort was interviewed on eight occasions until the age of 24–25 years (78% follow‐up at that age). Cross‐sectional associations were assessed using logistic regression with allowance for repeated measures. Both proportional hazards models and logistic regression models were used to assess prospective associations.

Results  Approximately 7% of the sample had used amphetamines by the age of 17 years. Amphetamine use by this age was associated with poorer mental health and other drug use. The incidence of amphetamine use during the teenage years was predicted by heavier drug use and by mental health problems. By young adulthood (age 24–25 years), adolescent amphetamine users were more likely to meet criteria for dependence upon a range of drugs, to have greater psychological morbidity and to have some limitations in educational attainment. Most of these associations were not sustained after adjustment for early‐onset cannabis use.

Conclusion  Young people in Australia who begin amphetamine use by age 17 years are at increased risk for a range of mental health, substance use and psychosocial problems in young adulthood. However, these problems are largely accounted for by their even earlier‐onset cannabis use.
Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys, 1980–2005
Authors: Bray Robert M. , Hourani Laurel L.
Published: June 2007

Aims  This study was designed to assess trends in cigarette, illicit drug, and heavy alcohol use among active‐duty military personnel from 1980 to 2005 and to examine the influence of socio‐demographic changes within the military on patterns of substance use.

Design  Substance use prevalence rates were estimated from cross‐sectional data obtained from nine self‐report surveys administered to more than 150 000 active‐duty service members world‐wide over a 25‐year period. Direct standardization was used to adjust for socio‐demographic changes.

Measurements  Measures included self‐reported cigarette use, illicit drug use and heavy alcohol use in the 30 days prior to the survey. Heavy alcohol use was defined as drinking five or more drinks per typical drinking occasion at least once a week in the past 30 days.

Findings  Cigarette and illicit drug use among military personnel declined sharply and significantly from 1980 to 1998. Heavy alcohol use decreased in the mid‐1980s but was stable from 1988 to 1998. Both cigarette smoking and heavy alcohol use increased significantly between 1998 and 2002 and remained at those levels in 2005. Illicit drug use remained low. Logistic regression analyses indicated that trends were influenced by other factors besides socio‐demographic changes across survey years.

Conclusions  The military has made notable progress in decreasing cigarette smoking and illicit drug use, but has made less progress in reducing heavy alcohol use. Additional emphasis should be placed on understanding recent increases in substance use and on planning effective interventions and prevention programs to reduce use in this high‐risk population.
Crystal methamphetamine use among young adults in the USA
Authors: Iritani Bonita J. , Hallfors Denise Dion , Bauer Daniel J.
Published: June 2007

Aims  To examine the prevalence and correlates of crystal methamphetamine use among young adults in the USA.

Design  Cross‐sectional analyses of nationally representative data of young adults from the National Longitudinal Study of Adolescent Health (Add Health).

Setting  In‐home interviews conducted in 2001–02.

Participants  A total of 14 322 respondents aged 18–26 years.

Measurements  Past year and 30‐day crystal methamphetamine use; crime/violence (ever arrested, past year drug selling, past year violent behavior) and sexual risk behaviors (multiple partners, poor condom use, regretted sex, sex for money).

Findings  Prevalence of past year crystal methamphetamine use was 2.8%; past month was 1.3%. White or Native American race, residence in the west or south, having an ever‐incarcerated father, marijuana, cocaine, intravenous drug use and high novelty seeking were associated with greater likelihood of past year use in multivariate analyses. Compared to marijuana and cocaine users, crystal methamphetamine users were more likely to be male, unemployed, reside in the west or south, have an ever‐incarcerated father and less likely to be black or Hispanic. Frequent users were no different from occasional users, except being more likely to have dropped out of school. Although crystal methamphetamine use was associated with crime and risky sex, controlling for covariates greatly diminished this relationship.

Conclusions  Most users are occasional users, but any past year use is associated with risky and antisocial behaviors, including other illicit drug use. Further research is needed to examine how other drug addiction is associated with methamphetamine use, and to identify longitudinal antecedents for prevention.
Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia*
Authors: Aceijas Carmen , Hickman Matthew , Donoghoe Martin C. , Burrows Dave , Stuikyte Raminta
Published: June 2007

Objective  To estimate access, activity and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia.

Methods  Two data sets (‘regional’ and ‘high‐coverage sites’) were used to estimate NSP provision (availability/number of sites), NSP utilization (syringes distributed/year), needle and syringe distribution (needles/syringes distributed/IDU/year), IDU reached (number/percentage of IDU contacted/year), regular reach (five or more contacts/month) and syringe coverage (percentage of injections/IDU/year administrable with new injecting equipment).

Results  Regional data set: results from 213 sites in 25 countries suggested that Czech Republic, Poland, Russia and Ukraine had > 10 NSP during 2001/2. Czech Republic, Kazakhstan, Latvia, Russia, Slovakia and Ukraine had ≥ 10 000 IDU in contact with NSP. Ten countries reached ≥ 10% of the estimated IDU population. The 25 countries distributed ∼ 17 million syringes/needles. Eight countries distributed > 0.5 million syringes/year. Syringe coverage (assuming 400 injections/IDU/year) was < 5% in 19 countries, 5–15% in five and > 15% in Macedonia. Overall syringe coverage was 1.2% and when assuming 700 injections/IDU/year it decreased to 0.7%. Syringe coverage for the IDU population in contact with NSP was ≤ 15% in 10 countries, 15–60% in 11 and > 60% in Croatia, Macedonia, Moldova and Tajikistan. Overall syringe coverage for the population in contact with NSP was 9.8%. High‐coverage data set: Soligorsk, Pskov and Sumy's NSP reached 92.3%, 92.2% and 73.3% of their estimated IDU population, respectively (regular reach: 0.2%, 1.8% and 22.7%). The distribution levels were 47.2, 51.7 and 94.2 syringes/IDU/year, respectively.

Conclusion  The evidence suggests suboptimal levels of NSP implementation, programme activity and coverage. This paper provides a baseline for development of indicators that could be used to monitor NSP. Strategies to increase coverage that may go beyond NSP are urgently required, as is research into understanding how NSP can contribute to better syringe coverage among IDU.
Is attention‐deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community‐based case–control study
Authors: Szobot Claudia M. , Rohde Luis A. , Bukstein Oscar , Molina Brooke S. G. , Martins Caroline , Ruaro Pauline , Pechansky Flávio
Published: June 2007

Aims  This study aims at evaluating the association between attention‐deficit/hyperactivity disorder (ADHD) and illicit substance use disorders (SUD) (marijuana, cocaine and inhalants), controlling for the association with conduct disorder (CD), in a community‐based sample of adolescents.

Design  Case–control, community‐based study.

Setting  A delimited geographical area in the South of Brazil, served by four public health clinics.

Participants  A total of 968 male adolescents (15–20 years of age) were screened for SUD in their households. Of the subjects who were screened positive, we selected 61 cases with illicit SUD. For each case we selected, from the group which was screened negative, three controls without illicit or alcohol SUD, matched by age and proximity with the case's household.

Measurements  The screening instrument was the Alcohol Smoking and Substance Screening Test (ASSIST). SUD diagnoses were assessed by the drug section of the Mini International Neuropsychiatry Interview (MINI). Other psychiatric diagnoses were based on semistructured (Schedule for Affective Disorders and Schizophrenia for School‐Age Children—epidemiological version; MINI) and clinical interviews.

Findings  Adolescents with ADHD presented a significantly higher odds ratio (OR) for illicit SUD than youths without ADHD, even after adjusting for potential confounders (CD, ethnicity, religion and estimated IQ) (OR = 9.12; 95% CI = 2.84–29.31, P < 0.01).

Conclusions  Our results suggest an association between ADHD and illicit SUD in Brazilian adolescents that is not mediated by CD. These findings are potentially important from a prevention perspective because treatments are available for ADHD.
Getting it right: designing adolescent‐centred smoking cessation services
Authors: MacDonald Sarah , Rothwell Heather , Moore Laurence
Published: June 2007

Aims  To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services.

Design  Structured qualitative interviews drawing on means‐end theory.

Setting  Three youth‐clubs and two secondary schools in south‐east Wales.

Participants  Twenty‐five male and female 13–18‐year‐olds, mainly daily smokers.

Findings  Interviewees did not assume immediately that a smoking cessation service is something that will be available to them, and therefore they initially encountered difficulties in identifying attributes of such support. With further prompting interviewees were able to express a preference for support attributes, but these were not attributes that traditionally form part of cessation provision. Their main preference was for support from friends and family, access to nicotine replacement therapy and non‐school‐based, flexible support and guidance.

Conclusion  The results re‐emphasize the inadequacies of existing cessation provision for meeting adolescent preferences and suggest that developing more adolescent‐appropriate support requires a reconceptualization of existing interventions, with service users situated at the core of intervention design. The study highlights a number of service development points for intervention planners including: rethinking the timing and location of provision; placing more emphasis on the selection of facilitators; harnessing support from friends and family; and rooting these developments in broader tobacco control strategies.
Alcohol‐specific rules, personality and adolescents' alcohol use: a longitudinal person–environment study
Authors: Van Der Vorst Haske , Engels Rutger C. M. E. , Deković Maja , Meeus Wim , Vermulst Ad A.
Published: June 2007

Aims  To examine the bi‐directional associations between providing alcohol‐specific rules and adolescents' alcohol use. Further, to explore person–environment interactions, we tested whether Big Five personality traits moderate the assumed association between providing alcohol‐specific rules and adolescents' alcohol use.

Design  Longitudinal data (three waves in 2 years) from 428 families, consisting of both parents and two adolescents (aged 13–16 years) were used for the analyses. Analyses were conducted on four samples: a group of older adolescents and a group of younger adolescents who already consumed alcohol, and a group of older and younger adolescents who were not drinking at baseline measurement.

Findings  In general, results of structural equation modelling showed that providing clear alcohol‐specific rules lowers the likelihood of drinking initiation, regardless of the age of the youngsters. Once adolescents have established a drinking pattern, the impact of parental alcohol‐specific rules declined or even disappeared. Finally, the Big Five personality traits did not moderate the association between providing alcohol‐specific rules and adolescents' alcohol involvement.

Conclusions  In sum, in particular during the initiation phase of drinking, parents could prevent the drinking of their offspring, regardless of the age or personality of their youngsters, by providing clear alcohol‐specific rules.
Physical activity in adolescence and smoking in young adulthood: a prospective twin cohort study
Authors: Kujala Urho M. , Kaprio Jaakko , Rose Richard J.
Published: June 2007

Aims  To control for familial confounds, we studied the association between adolescent physical activity and later smoking in twin siblings discordant for their baseline physical activity.

Design and measurements  In this prospective population‐based twin study, we asked whether persistent physical activity/inactivity in adolescence (assessed at 16, 17 and 18.5 years) predicted questionnaire‐reported daily smoking at ages 22–27. Twins who, on the three baseline questionnaires, consistently reported frequent leisure physical activity (more than three times weekly) were classified as persistent exercisers, those who exercised less than three times monthly were called persistently inactive, others were occasional exercisers.

Setting  Finland.

Participants  A total of 4240 individuals, including 1870 twin pairs.

Findings  In analyses of individual twins, compared to persistent activity, persistent physical inactivity predicted increased risk of daily smoking (age‐ and sex‐adjusted odds ratio 5.53, 95% confidence interval 3.88–7.88, P < 0.001). The risk remained elevated even after excluding all those who had smoked 50 cigarettes or more life‐time at baseline and adjusted for educational level in adolescence. In within‐pair analyses compared to the active members of discordant twin pairs, the physically inactive co‐twins had increased risk of future daily smoking (sex‐adjusted odds ratio 3.39, 95% confidence interval 1.56–7.39, P = 0.002).

Conclusions  Persistent physical inactivity in adolescence relates to adult smoking, even after familial factors are taken into account.
Enhancing the validity and utility of randomized clinical trials in addictions treatment research: I. Treatment implementation and research design
Authors: Del Boca Frances K. , Darkes Jack
Published: June 2007

Purpose  This paper is the first in a series that examines methods for improving the validity and utility of randomized clinical trials (RCTs) in addictions treatment research. The specific foci of this article are treatment implementation and research design.

Scope  We begin by considering the conditions under which the RCT provides an appropriate design choice. Sections that follow discuss methodological issues with respect to RCT structure and collaborative arrangements; treatment specification, delivery and cost; experimental design; and randomization/blinding procedures. We emphasize the importance of advance planning; treatment integrity and discriminability; treatment standardization; staff training and supervision; client compliance; maintenance of between‐group equivalence across study conditions; and inclusion of appropriate comparison groups in study designs.

Conclusions  Investigators are encouraged to maximize the internal validity of RCTs, but also to consider methods for enhancing external validity. The utility of addictions RCTs for advancing theory and improving clinical practice can be enhanced by investigating underlying mechanisms of action.
Goals indicate motivation to quit smoking
Authors: Peters Erica N. , Hughes John R. , Callas Peter W. , Solomon Laura J.
Published: June 2007

Aims  To test if goals indicate motivation to quit smoking and predict which smokers will make a quit attempt.

Design  A 28‐day natural history feasibility study of smoking cessation and reduction.

Setting  The study was conducted via telephone calls and mailings.

Participants  A total of 186 cigarette smokers.

Measurements  At baseline participants reported one of the following goals for the next 30 days: to quit abruptly, quit gradually, reduce but not quit, or not change their smoking. They also reported motivation to quit smoking on an Intention to Quit Ladder. Throughout the study they reported their cigarette consumption via daily telephone messages.

Findings  Self‐reported motivation to quit differed among goals (F = 286.6, df = 3, P < 0.01). Goals significantly predicted the likelihood of making a quit attempt in the 28 days of the study. In comparison to smokers with the goal of not changing, smokers with a goal of quitting abruptly were more likely to make a quit attempt [relative risk (RR) = 9.6, P < 0.01], as were those with a goal of quitting gradually (RR = 4.5, P = 0.01). Those with a goal of reducing only appeared to be more likely to make a quit attempt than those with a goal of not changing, but the difference was not statistically significant (RR = 3.1, P = 0.15). Smokers with a goal of quitting abruptly were more likely to make a quit attempt than those with a goal of quitting gradually (RR = 2.1, P < 0.05).

Conclusions  Goals indicate not only preferred method of change but also motivation. Differences in gradual versus abrupt cessation outcomes may be due to motivational rather than methodological differences. Those who plan to quit gradually or reduce only may need additional motivational interventions.
Population drinking and liver cirrhosis mortality: is there a link in eastern Europe?
Authors: Ramstedt Mats
Published: June 2007

Aims  To analyse the relationship between population drinking and liver cirrhosis mortality in eastern European countries and compare it with similar findings from western Europe.

Design and measurements  Yearly data, from the approximate period 1960–2002, on liver cirrhosis mortality in total and by gender were analysed in relation to per capita alcohol consumption in nine eastern European countries divided into ‘spirits countries’ and ‘non‐spirits countries’. The Box–Jenkins technique for time–series analysis was used to estimate the impact on liver cirrhosis resulting from a 1‐litre increase in per capita consumption in terms of relative (%) and absolute effects (number of cirrhosis deaths).

Findings  Cirrhosis mortality rates were related significantly to population drinking in eight of nine eastern European countries and both relative and absolute alcohol effects laid within the range of previous western European estimates. A 1‐litre increase in per capita consumption was on average estimated to cause three to four additional cirrhosis deaths per 100 000 for men and one additional death for women. The absolute effects for men were relatively high in a European perspective: stronger than in mid‐ and northern Europe and only marginally weaker in comparison with southern Europe.

Conclusions  A reduction in per capita alcohol consumption would prevent many cirrhosis deaths in eastern Europe, particularly for men. It is suggested that further studies of the extent other forms of alcohol‐related mortality respond to changes in population drinking in eastern Europe would be valuable.
Borderline personality disorder and persistently elevated levels of risk in 36‐month outcomes for the treatment of heroin dependence
Authors: Darke Shane , Ross Joanne , Williamson Anna , Mills Katherine L. , Havard Alys , Teesson Maree
Published: June 2007

Aims  To determine the effects of borderline personality disorder (BPD) on 36‐month outcomes for the treatment of heroin dependence.

Design  Longitudinal cohort study.

Setting  Sydney, Australia.

Participants  A total of 429 heroin users enrolled in the Australian Treatment Outcome Study, interviewed at 36‐month follow‐up.

Findings  The BPD group enrolled in significantly more different treatment episodes across follow‐up, but there was no difference in the cumulative number of treatment days received. At 36 months, there were no group differences in sustained or current heroin abstinence, daily heroin use or level of polydrug use. BPD patients maintained significantly higher levels of crime, injection‐related health problems, heroin overdose, major depression and poorer global mental health. In contrast to 12‐month follow‐up, at 36 months there were no group differences in the proportions who attempted suicide over the preceding 12 months or had recently borrowed used injection equipment.

Conclusions  The clinical picture provided some cause for optimism since 12‐month follow‐up. Despite this, BPD patients maintained elevated risk levels across a number of domains. The fact that these risks were maintained indicates that this is a group that requires specific clinical attention for BPD‐related risks.
Caudal anaesthesia as a treatment for penile ischaemia following circumcision
Authors: Kaplanian S. , Chambers N. A. , Forsyth I.
Published: June 2007

We report an ischaemic penile glans following circumcision and a dorsal penile nerve block in a 9‐year‐old boy. Ischaemia of the glans penis is a rare complication associated independently with both circumcision and dorsal penile nerve blocks. There are a number of pathophysiological mechanisms of this ischaemia and its management is varied and not well recorded. We report the successful management of this complication using a caudal epidural block and also discuss technical aspects of penile nerve blocks.
A comparison of the disposable Ambu® AuraOnce™ Laryngeal Mask with the reusable LMA Classic™ laryngeal mask airway*
Authors: Sudhir G. , Redfern D. , Hall J. E. , Wilkes A. R. , Cann C.
Published: June 2007

Single‐use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA Classic™ laryngeal mask airway. We performed a randomised cross‐over study comparing the Ambu® AuraOnce™ Laryngeal Mask with the LMA Classic. Fifty patients participated in the trial. Success rates for insertion at the first attempt were similar (92% with the Ambu and 84% with the LMA Classic; p = 0.22). The volumes of air required to inflate the cuff to produce a seal were similar, but the cuff pressure was lower for the Ambu Laryngeal Mask (median (IQR [range]) 18 (10–31 [0–100] cmH2O) than the LMA Classic 27 (17–50 [4–90] cmH2O; p = 0.007). Visual analogue scores for ease of insertion were 87 (73–93 [26–97]) mm for the Ambu and 84 (60–89 [18–96]) for the LMA Classic (p = 0.017). Complications were similar in both groups. We suggest that the disposable Ambu Laryngeal Mask is an acceptable alternative to the reusable LMA Classic.
Evaluation of four manikins as simulators for teaching airway management procedures specified in the Difficult Airway Society guidelines, and other advanced airway skills*
Authors: Jordan G. M. , Silsby J. , Bayley G. , Cook T. M.
Published: June 2007

Ten volunteers evaluated the performance of four currently available manikins: Airway Management TrainerTM, Airway TrainerTM, Airsim™ and Bill 1™ as simulators for the 16 procedures described in the Difficult Airway Society Guidelines (DAS techniques) and eight other advanced airway techniques (non‐DAS techniques), by scoring and ranking each manikin and procedure. Manikin performance was unequal (p < 0.0001 for both SCORE and RANK data for both DAS and non‐DAS techniques). Post hoc analysis ranked the manikins for DAS techniques as: 1st Laerdal, 2nd Trucorp, 3rd equal VBM and Ambu. For non‐DAS techniques, the ranking was: 1st equal Laerdal and Trucorp, 3rd equal VBM and Ambu. The power to discriminate for individual procedures was considerably lower but for 15 of 16 DAS techniques and 6 of 8 non‐DAS techniques, manikin performance differed significantly. Post hoc tests showed significant performance differences between individual manikins for 10 DAS procedures, with the Laerdal manikin performing best.
Systematic reviews: how they work and how to use them
Authors: Carlisle J. B.
Published: June 2007

At their best, systematic reviews should be the least biased summaries of the effect of healthcare interventions. However, authors can introduce both intended and unintended biases into systematic reviews. Results presented as odds ratios are often misinterpreted by readers as relative risks, meaning that the effect of the intervention is overestimated. Authors may analyse trials separately having mistaken differences in baseline risk for differences in the effect of an intervention and differences in effect between trials that have been analysed together may go undetected. In this article I discuss how a systematic review should work and how it can go wrong.
Extending low‐dose epidural analgesia in labour for emergency Caesarean section – a comparison of levobupivacaine with or without fentanyl*
Authors: Malhotra S. , Yentis S. M.
Published: June 2007

Women in labour receiving epidural analgesia with 15 ml bupivacaine 0.1% and 2 μg.ml−1 fentanyl followed by 10–15‐ml top‐ups as required, who needed Caesarean section, were randomly allocated to receive 20 ml levobupivacaine 0.5% over 3 min with either 75 μg fentanyl (1.5 ml) or 1.5 ml saline. Further top‐ups or inhaled or intravenous supplementation were given for breakthrough pain. Time to onset (loss of cold sensation to T4 and touch sensation to T5 bilaterally), quality of analgesia and side‐effects were recorded. The study was stopped after 112 patients had been randomly assigned, due to a unit protocol change, from midwife‐administered top‐ups to patient‐controlled epidural analgesia. Data from 51 patients given fentanyl and 54 given saline were available for analysis. There were no significant differences in onset times or supplementation between the groups, but there was more intra‐operative nausea/vomiting with fentanyl (53%) than with saline (18%; p = 0.004). We found no advantage of adding fentanyl to epidural levobupivacaine when extending epidural analgesia in women already receiving epidural fentanyl during labour and there was an increased incidence of intra‐operative nausea and vomiting. Power analysis suggested the same conclusion even had the study proceeded to completion.
What do service users think of evaluation? Evidence from family support
Authors: Cortis Natasha
Published: June 2007

Programme evaluators increasingly strive to capture how service users experience child and family welfare programmes. Yet user involvement is rare in a more routine form of evaluation: performance measurement. This paper considers how service users' perspectives can help improve the performance indicators that inform child and family service funding, management and planning. Qualitative research, conducted in family support contexts in New South Wales, Australia, identifies five user‐defined domains upon which indicators can be based. As well as showing how parents judge service quality and outcomes, the findings also show how they experience data collection, and how they prefer to participate in the routine performance measurement and monitoring that informs child and family welfare provision.
Children's understanding of psychological problems displayed by their peers: a review of the literature
Authors: Hennessy E. , Swords L. , Heary C.
Published: June 2007

Background  There is a widespread consensus in the literature that children who have psychological problems are more likely than other children to be excluded or rejected by their peers. The existence of this phenomenon has been established, primarily with the use of research on their sociometric status within groups of peers. Much less research has been performed on the way in which children develop attitudes and behavioural intentions towards peers with problems.

Aims  The primary aim of this article is to introduce readers to research on children's understanding of the nature of common childhood psychological problems, with a view to exploring the factors that might contribute to the development of negative attitudes and behaviour.

Method  Relevant publications were identified through searches of electronic databases and articles in print.

Results  From the early years of primary school, children are able to identify peers whose behaviour deviates from the norm and to suggest causes for the behaviour of peers with psychological problems. Furthermore, their beliefs about peers' personal responsibility for these problems appear to be a significant determinant of attitudes and behavioural intentions. The article identifies the need for more research on the role of factors such as gender and personal contact in determining children's understanding of, and attitudes towards, peers with psychological problems. In addition, the article calls for more research on mental health education programmes and the extension of these programmes to younger children, given the fact that even young primary school children appear to have beliefs about the causes of psychological problems and negative attitudes to peers who display such problems.

Conclusions  Research on children's understanding of mental health can make an important contribution to our understanding of why children with problems are so much more likely to be excluded from their peer group.
Evergreen leaf respiration acclimates to long‐term nocturnal warming under field conditions
Authors: BRUHN DAN , EGERTON JOHN J. G. , LOVEYS BETH R. , BALL MARILYN C.
Published: June 2007

Acclimation of plant respiration rates (R) to climate warming is highly variable and many results appear contradictory. We tested the recently suggested hypotheses that pre‐existing, long‐lived leaves should exhibit a relatively limited ability for R to acclimate to climate warming, and that acclimation would occur via changes in the short‐term temperature sensitivity of respiration. Seedlings of a subalpine, evergreen tree species (Eucalyptus pauciflora) were grown under naturally fluctuating conditions within its natural distribution. We used a free air temperature increase (FATI) system of infra‐red ceramic lamps to raise night‐time leaf temperatures by 0.3±0.1, 1.3±0.1, and 2.2±0.1 °C above ambient for 1 year. Light‐saturated assimilation rates and plant growth did not change with nocturnal FATI treatments. Leaf R measured at prevailing temperatures did not differ between FATI treatments. Within each FATI treatment, nocturnal leaf R was highly sensitive to artificial temperature changes within minutes, and also correlated strongly with natural nocturnal and seasonal temperature variation. The corresponding values of Q10 of R varied according to time scale of measurements, but did not vary between FATI treatments. Instead, acclimation of R to nocturnal FATI occurred through changes in the base rate of respiration.