bluuebunny/crossref_metadata_2025 huggingface dataset:
In situ hybridization of connective tissue growth factor mRNA in IgA nephropathy
Authors: Toyoda M , Suzuki D , Umezono T , Zhang S‐Y , Endoh M , Kurokawa K , Sakai H
Published: March 2003

Connective tissue growth factor (CTGF) is a member of the new family of growth regulators. It plays an important role of the pathogenesis of mesangial matrix accumulation and progressive glomerulosclerosis in IgA nephropathy (IgAN).

We investigated the expression and localization of CTGF mRNA in renal tissues of patients with IgAN and normal human kidneys (NHK), using in situ hybridization with digoxigenin‐labelled oligonucleotide. Open renal biopsy tissues were obtained from 16 patients with IgAN. The renal pathology was categorized into four grades by light microscopic findings. The expression level of CTGF mRNA was quantified by counting all nuclei, as well as nuclei surrounded by CTGF mRNA‐positive cytoplasm in randomly selected non‐sclerotic glomeruli and expressing the results as the percentage of total cells.

Connective tissue growth factor mRNA was mainly expressed in glomerular mesangial and epithelial cells in both IgAN and NHK, and cells of Bowman’s capsule. In IgAN, CTGF mRNA‐positive cells were increased in tubulointerstitial fibrotic areas. The percentage of positive cells for CTGF mRNA was significantly higher in IgAN than in NHK. The percentage of positive cells for CTGF mRNA in each IgAN grade was significantly higher than that in NHK. Furthermore, the percentage of positive cells for CTGF mRNA was significantly greater in IgAN with moderate mesangial proliferative lesions (grade 2, grade 3) than in IgAN with mild mesangial proliferative lesions.

Our study suggests that CTGF may play an important role in the development and progression of glomerulosclerosis and tubulointerstitial fibrosis in IgAN.
Vasculitic renal disease*
Authors: MACKINNON M W Bruce , NELSON Craig L , PUSSELL Bruce A , CHARLESWORTH John A
Published: March 2003

SUMMARY:The kidney may be involved in several forms of systemic vasculitis, particularly those affecting small‐calibre blood vessels. Hence, the majority of cases involve patients with Wegener's granulomatosis, Churg‐Strauss syndrome or microscopic polyangiitis. Anti‐neutrophil cytoplasmic antibodies (ANCA) are found in the majority of these patients and their detection has increased the sensitivity and specificity of diagnosis. However, the role of ANCA in the pathogenesis of these lesions remains uncertain. Moreover, the approach to treatment, both in terms of induction and maintenance of remission, remains problematic. This brief review discusses aspects of ANCA and current approaches to management.
Cytomegalovirus disease among renal transplant recipients in India
Authors: SAKHUJA Vinay , JHA Vivekanand , JOSHI Kusum , NADA Ritambra , SUD Kamal , KOHLI Harbir S , GUPTA Krishan L , SEHGAL Shobha
Published: March 2003

SUMMARY: There is a paucity of data on cytomegalovirus (CMV) disease in renal transplant recipients from India. We have encountered this problem with increasing frequency at our centre, and document our experience in this paper. Case records of 514 recipients of renal transplants performed between 1980 and 1997, including 96 autopsies, were reviewed. Diagnosis was made by demonstration of classic cytomegaly and intranuclear inclusions on histology, and/or detection of CMV pp‐65 antigen in the peripheral blood leucocytes. Cytomegalovirus disease was documented in 21 cases (11 at autopsy, six by antigen detection, and four by a combination of histological demonstration and antigenemia detection). the incidence of this infection rose from 0.6% in 1980–1991 (pre‐cyclosporin era) to 5.5% (4.4% lethal) during 1992–1997 (postcyclosporin era). At autopsy, the lung was the most frequently involved organ followed by the gastrointestinal tract. Ninety‐five per cent of patients had co‐infection with other organisms, and fungi were isolated in 80% of all patients with co‐infection. Graft dysfunction was present in 17 cases (81%). We conclude that there has been a four fold increase in the incidence of lethal CMV disease in renal transplant recipients after the introduction of cyclosporin immunosuppression. There is a high incidence of co‐infection with other organisms, with fungi being the commonest offenders in tropical environment. This, along with allograft dysfunction, could account for the high mortality seen with CMV disease.
Peritoneal mesothelial cell biology in peritoneal dialysis
Authors: HA Hunjoo , LEE Hi Bahl
Published: March 2003

SUMMARY: Progressive peritoneal membrane hyperpermeability, ultrafiltration failure, and peritoneal fibrosis have been observed in long‐term peritoneal dialysis (PD) patients, and these alterations in peritoneal structure and function may be responsible for the poor technique survival in PD. While frequent and/or severe peritonitis can result in alterations of the peritoneum, continuous exposure of the peritoneum to PD solutions may also adversely affect peritoneal structure and function. Peritoneal mesothelial cells (PMC) are directly and continuously exposed to unphysiological components of PD solution. Low pH, lactate, hyperosmolality, and glucose degradation products (GDP) reduce PMC viability and proliferation. High glucose, GDP, and advanced glycation end products (AGE) upregulate vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)‐1, transforming growth factor (TGF)‐β1, plasminogen activator inhibitor (PAI)‐1, and extracellular matrix protein expression by PMC, and may thus lead to peritoneal hyperpermeability, ultrafiltration failure, and peritoneal fibrosis, as observed in long‐term PD. Activation of diacylglycerol (DAG)‐protein kinase C (PKC) and generation of reactive oxygen species (ROS) are important upstream signalling events in high glucose‐induced PMC activation. Thus, strategies to inhibit high glucose‐induced PKC activation and ROS generation and the use of new PD solutions with non‐glucose osmotic agents, pH neutral solutions, or solutions containing low GDP may allow better preservation of the structural and functional integrity of the peritoneal membrane during long‐term PD.
An introduction to the KidneyCheck Australia Taskforce
Authors: Knight JF
Published: March 2003

SUMMARY: The KidneyCheck Australia program has been launched with the aim of reducing the incidence of end‐stage renal disease (ESRD) in Australia by an early detection and prevention program aimed at high risk groups. A multidisciplinary taskforce has been established to guide the process. The target groups for the program are the general public (particularly those in high risk groups), general practitioners, nephrologists, renal nurses, students, government and industry. Six risk factors have been identified: hypertension, diabetes, a family history of renal disease, smoking, age (over 50 years) and an Aboriginal or Torres Strait Islander heritage. This new public health awareness campaign will deliver several key messages. These include the message that kidney failure can be prevented, that urine protein is a useful early indicator of renal disease and general vascular risk, that early treatment with ACE inhibitors can be renal protective, and that general practitioners should think in terms of glomerular filtration rate (GFR) rather than creatinine levels when assessing renal function.
IgA nephropathy: effects of clinical indices, ACEI/ATRA therapy and ACE gene polymorphism on disease progression
Authors: Woo Keng‐Thye , Lau Yeow‐Kok , Choong Lina H‐L , Zhao Yi , Tan Hwee‐Boon , Cheung Wilson W , Yap Hui‐Kim , Chiang Gilbert SC
Published: March 2003

SUMMARY:
In 1985 the authors studied 151 patients with biopsy‐proven IgA nephropathy (IgAN). After a mean follow‐up period of 5 years, 84% had stable renal function, 5% had renal impairment and 11% progressed to end‐stage renal failure (ESRF). The unfavourable prognostic indices were proteinuria > 1 g/day, hypertension, crescents on renal biopsy, glomerulosclerosis and medial hyperplasia of blood vessels. The cumulative renal survival was 89% at 5 years. Fifteen years later, in 2000, with data from the Singapore Renal Registry it was ascertained that 53 patients (35%) had developed ESRF. Using multivariate analysis by the regression model of Cox it was found that serum creatinine, protein selectivity, segmental glomerulosclerosis, crescents and medial hyperplasia were significant predictors of progression. It is also shown that the presence of low‐molecular‐weight (LMW) proteinuria is another index of poor prognosis. Cumulative renal survival of the 151 patients was 65% at 20 years. In a recent study, the response of patients with IgAN to angiotensin‐converting enzyme inhibitor/angiotensin receptor antagonist (ACEI/ATRA) therapy was examined. There were 21 patients in the treatment group and 20 as controls. After 13 ± 5 months of treatment, 10 responders had improved selectivity index (SI; from 0.26 ± 0.07 to 0.18 ± 0.07, P < 0.001), indicating a shift towards selective proteinuria. This was associated with improvement in serum creatinine from a mean of 1.7 ± 0.6 to 1.5  0.6 mg/dL (P < 0.02) and a decrease in proteinuria from a mean of 2.3 ± 1.1 g/day to 0.7 ± 0.5 g/day (P < 0.001). Eight out of 21 patients in the treatment group who had documented renal impairment had improvement in their renal function, three of whom had normalized renal function. The angiotensin‐converting enzyme insertion/deletion (ACE I/D) polymorphism gene was also genotyped in 100 patients with IgAN (32 of whom were in ESRF) and in 90 normal adult subjects. All DD cases were subjected to confirmation with a second polymerase chain reaction (PCR), performed with the insert‐specific forward primer. Similar genotype frequencies were obtained for the 90 normal control subjects (II: 47%, ID: 44%, DD: 9%); for the 68 patients not in ESRF (II: 47%, ID: 46%, DD: 7%) and for the 32 patients with ESRF (II: 53%, ID: 38%, DD: 9%). The genotype frequencies in all three series are in Hardy–Weinberg equilibrium. These results suggest that ACE I/D polymorphism is not a risk factor for IgAN and is not a predictor for its progression. In conclusion the predictors in the progression of IgAN include abnormal renal function at presentation, segmental glomerulosclerosis, crescents, medial hyperplasia of blood vessels, non‐selective proteinuria, LMW proteinuria and failure to respond to antiproteinuria therapy with ACEI/ATRA. However, the D‐allele of ACE gene polymorphism is not a risk factor.
The human dimension of nosocomial wound infection: a study in liminality
Authors: Gardner Glenn
Published: March 2003

The human dimension of nosocomial wound infection: a study in liminality

Nosocomial wound infection is a disease that has to date been primarily understood through the language of science and biomedicine. This paper reports on findings from a sociological, interpretive study that focused on the experiential dimension of this phenomenon. The illness experience of a nosocomial wound infection is examined within a cultural milieu that values the smooth, untroubled body and alternatively ascribes cultural meaning to a body that has a definable illness. Within this context the person with a chronic wound from nosocomial infection defies normative categorisation and is thus situated outside the patterning of society. The human dimension of nosocomial wound infection includes the private, existential and embodied aspects of living with a chronic, infected wound. This report indicates that the experiential dimension is characterised by an embodied state of liminality. People with this illness live an indeterminate existence that is in‐between health and illness, cure and disease. As such they have no recognised place in the medical or social world.
Reform in public health: where does it take nursing?
Authors: Gibb Heather
Published: March 2003

Reform in public health: where does it take nursing?

The Australian healthcare system is undergoing changes that are impacting tangibly on professional nursing practice. While the evidence is clear that the changes pose a challenge to maintaining standards amidst resource cuts and restructuring, the processes through which these changes occur and the decisions which drive the reforms remain complex and largely obscure. This paper intends to stimulate further thinking and debate among nurses about the effects of these reforms on the conduct of practice, both in terms of our emerging discipline and our ability to conduct clinical nursing practice. It offers a way of understanding the policy ‘reform’ process through an application of policy analysis grounded in critical social theory. The discussion sets out to apply these analytical propositions to specific events that constitute examples of change in the nursing workplace, and to focus on the implications for nurses and health service clientele.
Idealised versus tainted femininity: discourses of the menstrual experience in Australian magazines that target young women
Authors: Raftos Maree , Jackson Debra , Mannix Judy
Published: March 2003

Information and messages concerning health‐related issues are not confined to material provided by official figures or sources. Much information exists in the community and comes from a variety of sources. One such source is the media. This paper reports the findings of a study conducted over a 12‐month period of advertisements for menstrual products in a selection of four monthly Australian magazines (n= 48) directed towards young women. The study examined the way in which menstruation and the menstrual experience were depicted in terms of page space, textual content and visual images. Findings revealed that advertisements for menstrual products provided confusing, conflicting and paradoxical messages. These included stressing the normality of menstruation while also emphasising the importance of keeping it hidden and secret. Menstruation was depicted as being as state of tainted (idealised) femininity because of the potential for the menstrual silence to be shattered by people finding out. Protection failure was depicted as being the ultimate in tainted femininity and a result of a woman's incorrect choice of product. Choosing menstrual‐care products was depicted as simple but, paradoxically, complex and confusing. Women were depicted as liberated and sophisticated but images and language related to infancy were used. Freedom and liberation were conferred by the use of the advertised product. Overall, in common with previous studies, menstruation was depicted as a crisis of hygiene that is a risk to femininity. Advertisements for pantyliners suggest that femininity itself poses a threat to (idealised) femininity. This study demonstrates the crucial role of the media as a source of health information for young women.
Keeping the lid on infection: infection control practices of a regional Queensland hospital 1930–50
Authors: Madsen Wendy
Published: March 2003

Keeping the lid on infection: infection control practices of a regional Queensland hospital 1930–50

Nurses have played an important role in infection control practices throughout the past century. However, the desire for minimisation of cross infection has not always been the basis for many of the activities undertaken by nurses within the general ward. This paper is a historical analysis of those practices that formed the basis of infection control within the medical and surgical wards of the Rockhampton Hospital between 1930 and 1950. In particular, those activities dealing with the disposal of body fluids, ward cleaning, aseptic techniques and associated sterilisation of instruments and articles, the nurses’ personal cleanliness and isolation nursing have been addressed. This study has identified economic factors, professional image and local traditions as being influential in the origins and persistence of many activities which may be loosely grouped as infection control measures.
The culture of ‘culture’ in National Health Service policy implementation
Authors: Savage Jan
Published: March 2003

The culture of ‘culture’ in National Health Service policy implementation

The widespread reference to ‘culture’ in UK NHS policy and organisational literature suggests that culture has, in itself, become a cultural phenomenon. This article draws on anthropological thought to explore this trend, and finds it stems from the way that the term ‘culture’ has become analytically empty. Lack of rigour in the way that culture is conceptualised allows it to be used both to suggest an evolved consensus among the workforce, and to validate the imposition of values and beliefs by management. Such manipulation of ‘culture’ is evident in recent NHS policy demanding cultural change to ensure a flexible, empowered and self‐regulating workforce — the type of workforce not only valued by health services, but pivotal to a post‐Fordist economy. The findings from an ethnographic study are drawn upon to consider the relationship between nurses’ cultural practices, corporate culture shaped by NHS policy, and the requirements of the economic domain. It is suggested that a commitment to post‐Fordist priorities of flexibility, empowerment and self‐regulation is not necessarily matched by any shift in the traditional location of power. The article concludes that greater analytical rigour is necessary to challenge the way in which ‘culture’ is manipulated by policy makers.
A ‘good enough’ nurse: supporting patients in a fertility unit
Authors: Allan Helen
Published: March 2003

A ‘good enough’ nurse: supporting patients in a fertility unit

In this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as ‘emotional awareness’ and ‘non‐caring’ as ‘emotional distance’ may be forms of nursing akin to Fabricius’s (1991) arguments around the ‘good enough’ nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach to caring and do not expect an emotionally intimate relationship from nurses.
Procedure manuals and textually mediated death
Authors: Quested Beverleigh , Rudge Trudy
Published: March 2003

Procedure manuals and textually mediated death

The procedure manual as a document represents the practice of nursing care. Analysis of such manuals allows us to explore discourses of nursing and the ways in which they frame nursing practice. A critical analysis of a hospital procedure manual using discourse analysis was undertaken. A specific excerpt concerning ‘Last offices’ is used as an example of the institutionalisation of organisational values and beliefs as these influence nursing care. ‘Last offices’ directs nursing practices related to the death of a patient, and the laying out as preparation for the funeral director or coroner. The analysis shows that procedure manuals reproduce hegemonic ideologies of nursing. The analysis also shows how nursing practices are constituted by intersecting forces of differing locations such as the hospital as an organisation, the healthcare system and the wider society within which these function.
Using an interpreter in qualitative interviews: does it threaten validity?
Authors: Kapborg Inez , Berterö Carina
Published: March 2003

Using an interpreter in qualitative interviews: does it threaten validity?

There is an extensive literature on the problem of translating scales for use across cultures, but very little is published on the problems of conducting qualitative interviews in another language with assistance of an interpreter. The aim of this paper is to describe and discuss threats to validity that arise when conducting qualitative interviews using an interpreter. Ten female student nurses in two cities in Lithuania were interviewed about how they perceived their educational program. All interviews were conducted in English with an interpreter. When using an interpreter to conduct interviews, potential threats to validity arise at various points in the interview process. A threat arises when the researcher, whose first language is Swedish, addresses a question in English to the interpreter, another during the translation by the interpreter from English to Lithuanian, and again when the interpreter translates the interviewee’s Lithuanian responses to English. In the last situation, the researcher may not know whether the interpreter has summarized and/or modified the responses. To mitigate these problems, the interpreter should not only have the required linguistic abilities, but also be trained in the research field. The researcher has to be aware of these threats to validity and make efforts to meet and limit their effects.
Meta‐analysis: the glass eye of evidence‐based practice?
Authors: Gregson P. Rodger W. , Meal Andrew G. , Avis Mark
Published: March 2003

Meta‐analysis: the glass eye of evidence‐based practice?

Meta‐analysis was developed as a technique for combining the results of many different quantitative studies: it is often used to produce quantitative estimates of causal relations and/or association between variables. Meta‐analysis is sometimes regarded as a central component of evidence‐based practice. We draw attention to an incompatibility in the epistemology and methods of reasoning in quantitative meta‐analysis and the epistemology and reasoning implicit in expert practice. We argue that this may be because the common perception of meta‐analysis appeals to truth as correspondence; we suggest that rejecting the naïve realism that underpins truth as correspondence allows meta‐analysis to be understood in terms of truth as coherence. We can then develop an account of meta‐analysis that does not depend upon reduction to a mathematical procedure but is an attempt to maximise coherence in beliefs about what works that is consistent with clinical reasoning in expert practice.
Assessment of psychosocial stressors and maladjustment among foreign students of the University of the Ryukyus
Authors: Randall Maxine , Naka Koichi , Yamamoto Kazuyoshi , Nakamoto Haruo , Arakaki Hajime , Ogura Chikara
Published: March 2003

An extensive survey of problems encountered by foreign students of the University of the Ryukyus and the resulting levels of stress was carried out in order to determine the main stressors hindering academic progress and personal adjustment. Subjectively perceived stress levels after arrival in Japan were obtained from 134 subjects through a comprehensive questionnaire for reporting specific stressors. The 30‐item General Health Questionnaire (GHQ) was included to assess mental health state. Differences in scores by area of origin were also determined for the total GHQ scores and its sub‐scales. The GHQ results showed that regardless of length of time in Japan, more than 60% of the subjects scored within a range usually indicative of a mental health risk. Mean scores by area of origin showed a 50% reduction over time for non‐Chinese Asians and North American/Europeans, but only a reduction of 1.1% or less for Chinese, Latin American, Middle/Near Eastern and African subjects. Limitations in achievement of academic goals were reported by the greatest number of students as causing moderate to excessive stress (57.5%); most frequently reported causes were language inadequacy (55.2%), reference materials unavailable (34.3%), unfamiliarity with Japanese study methods (32.1%), and inadequate guidance from teachers/advisors (26.9%). Various social, personal and daily life problems in the non‐academic setting were also reported as causing high stress levels. Most of the stressors identified are not considered inevitable and point toward directions to pursue in preventive strategies in mitigating psychological distress and maladjustment of students.
Effects of phototherapy in patients with delayed sleep phase syndrome
Authors: Watanabe Tsuyoshi , Kajimura Naofumi , Kato Masaaki , Sekimoto Masanori , Takahashi Kiyohisa
Published: March 2003

Phototherapy was given to six patients with delayed sleep phase syndrome (DSPS). Polysomnography (PSG) and core body temperature were examined before and after phototherapy. Phototherapy was administered to each patient for 5 days, and this treatment not only advanced the delayed sleep phase but also delayed the time of minimum body temperature in all patients. On the PSG, decreases in total sleep time and amounts of stages 2 and REM were observed after phototherapy. These results suggest that phototherapy is effective even in the short term in advancing delays in sleep phase and time of minimum body temperature in DSPS patients.
Comparative studies on sleep disturbance in the elderly based on questionnaire assessments in 1983 and 1996
Authors: Yamaguchi Nariyoshi , Matsubara Saburo , Momonoi Fumio , Morikawa Keiichi , Takeyama Masashi , Maeda Yoshiki
Published: March 2003

We made an attempt to compare the complaints about sleep disturbance in the elderly based on the questionnaires using self‐rating scales carried out in 1983 and 1996. It was noted that the score of awakening frequency from the course of sleep was the highest of all the items in men and women in both the 1983 and 1996 inquiries. The scores of insomnia nights per week and the difficulty in falling asleep were slightly higher in women than in men in both inquiries.
Changes of amplitude and topographical characteristics of event‐related potentials during the hypnagogic period
Authors: Michida Nanae , Ebata Akiyuki , Tanaka Hideki , Hayashi Mitsuo , Hori Tadao
Published: March 2003

In the previous study, during the vertex sharp wave period (hypnagogic EEG stage 4), negative components (N300, N550) were dominant at Fz and Cz in contrast to the positive component (P400) being prominent at the other areas, Pz, Oz, T5 and T6. There is no agreement regarding P400 properties during the hypnagogic period. In this study, using topographic mapping, we found that two negative components (N300, N550) and P400 independently increased their amplitude at the different areas of the scalp as arousal level lowered. The anterior negative components may reflect the information processing related to the K‐complex. The P400 may reflect other activities different from the K‐complex mechanism or P300 attention mechanisms.
A polydiagnostic study of depressive disorders according to DSM‐IV and 23 classical diagnostic systems
Authors: Furukawa Toshi A , Anraku Kazutaka , Hiroe Takahiro , Takahashi Kiyoshi , Yoshimura Reiji , Hirai Toshiyuki , Kitamura Toshinori , Takahashi Kiyohisa
Published: March 2003

The classification of mood disorders is one of the most highly debated topics in modern psychiatry. The introduction of DSM‐III (and its followers) has set a new standard in this controversy but little empirical evidence is available as to how the various classical diagnostic categories of mood disorders by Kraepelin, Schneider, Leonhard, Hamilton, Kielholz, Winokur and others compare with this new standard. The Intensive Prospective Study arm of the Group for Longitudinal Affective Disorders Study has studied a broad spectrum of mood disorders in 23 participating centres from all over Japan with a polydiagnostic semistructured interview called Comprehensive Assessment List of Affective disorders. In this paper we examined how the various classical diagnostic systems of depressive disorders correspond to the DSM‐IV diagnoses, and found the following: (1) The classical ‘neurotic’ or ‘psychogenic’ depressions are diagnosed as major depression and not as dysthymia in DSM‐IV; although dysthymia was dubbed as ‘depressive neurosis’ in DSM‐III, its criteria were not true to the traditional usage of the term. Viewed from the other side of the coin, DSM‐IV can be said to stand in the unitary tradition. (2) Some of the classical diagnostic categories such as Schneider’s depressive psychopathy and Klein’s acute dysphoria as well as modern ones such as Akiskal’s subaffective dysthymia and Angst’s recurrent brief depression were rarely seen in traditional psychiatric treatment settings. (3) Comparisons of the unique diagnostic systems such as those by Leonhard, Winokur and Berner warrant further studies on their validity.
Dementia praecox to schizophrenia: The first 100 years
Authors: Adityanjee  , Aderibigbe Yekeen A. , Theodoridis D. , Vieweg W. Victor R.
Published: March 2003

The historical roots of dementia praecox and schizophrenia are described in the context of current nosology and continuing controversies surrounding this nosology. Relevant books and journal articles were reviewed. The information was obtained through computer searches and cross‐references from previously published papers. If English translations of foreign language articles were available, they were used; if not, the cross‐references were consulted. The psychoses have existed as diagnostic categories from ancient times although their names have changed. Initially, these disorders were considered diseases of the brain, a concept that was swept aside in the United States, influenced by European‐derived psychodynamic theories. American clinicians and investigators simply accepted these theories, showing little interest in testing their underlying principles. In contrast, a narrower Kraepelinian approach was adopted outside the United States, and attempts were made to refine its nosology. Because current data supports a central nervous system aetiology for schizophrenia, the concept of dementia praecox warrants resurrection. The authors suggest abandoning the term schizophrenia in favour of the more broad and generic term dementia praecox. Replacing ‘schizophrenia’ with ‘dementia praecox’ in the 21st century will facilitate further research and help clarify the nosology of various brain disorders currently included in the schizophrenias.
Hippocampus and amygdala volumes in elderly schizophrenic patients as assessed by magnetic resonance imaging
Authors: Sachdev Perminder , Brodaty Henry , Cheang David , Cathcart Stuart
Published: March 2003

Reduced size of the hippocampus and amygdala has been one of the more consistent morphological findings in schizophrenia, but the question of medial temporal abnormalities in elderly schizophrenia patients has been inadequately addressed. We examined 20 elderly subjects with a DSM‐III‐R diagnosis of schizophrenia, five of whom had a late‐onset schizophrenia (LOS), and compared them with 20 healthy volunteers on magnetic resonance imaging (MRI) and neuropsychological parameters. Hippocampus and amygdala volumes were obtained by manual tracing on T1‐weighted 1.5 mm thick contiguous coronal slices perpendicular to the long axis of the hippocampus. Patients had smaller left hippocampal and right amygdala volumes than comparison subjects, the mean differences being 9.7 and 11.1%, respectively, but the right amygdala volumes were not significantly different after Bonferroni correction. The hippocampus‐amygdala volumes together were smaller in the schizophrenia group bilaterally. In a pilot analysis, the LOS subjects had non‐significantly smaller hippocampus‐amygdala volumes than did the early‐onset schizophrenia (EOS) subjects. For the schizophrenia group, there were significant correlations between amygdala and hippocampus volumes and some neuropsychological performance indices. The findings are consistent with those reported in younger schizophrenics, and are of the same order of magnitude, suggesting that they are not likely to be progressive. This pilot analysis in LOS subjects argues against the condition being secondary to Alzheimer’s disease.
Typus melancholicus and the Temperament and Character Inventory personality dimensions in patients with major depression
Authors: Kimura Satoshi , Sato Tetsuya , Takahashi Toshihiko , Narita Tomohiro , Hirano Shigeki , Goto Miho
Published: March 2003

Although many clinical studies have been conducted to determine the etiological role and clinical implications of typus melancholicus for unipolar depression, maladaptive personality features in depressive patients have not been well described. This study explores typus melancholicus, as measured by the rigidity subscale of the Munich Personality Test, and maladaptive personality features, as measured by the Temperament and Character Inventory (TCI), in 131 remitted patients with DSM‐IV major depression and 154 normal controls. The patients reported significantly higher scores on rigidity and harm avoidance and significantly lower scores on self‐directedness and cooperativeness. Only 23.6% of the variance of the rigidity scale was explained by the variance of the seven TCI scales, in which only persistence was significantly correlated positively to rigidity. Cluster analysis identified four subgroups, two of which were characterized by a high rigidity score. One of these two subgroups showed no maladaptive personality features, as measured by the TCI, while the other showed high harm avoidance and low self‐directedness. These results indicate that the personality of depressive patients is characterized not only by typus melancholicus but also by maladaptive personality features, that typus melancholicus is not well represented by any TCI scale, and that typus melancholicus and maladaptive personality features can coexist in some depressive patients.
Factors associated with admission to a geriatric hospital in semisuburban southern Japan
Authors: Arai Yumiko , Washio Masakazu , Kudo Kei
Published: March 2003

A case‐control study was conducted to evaluate the factors associated with admission to a geriatric hospital. Case studied were 13 Japanese elderly who were admitted to a geriatric hospital because their female caregivers had found it impossible to look after them at home. We used 35 pairs of elderly and female caregivers, who were receiving domiciliary visits by nurses, in the catchment area of the hospital. The present study revealed that elderly with dementia (vs without; Odds ratio = 6.69) and with moderately limited activities of daily living (Barthel Index 61 +) (vs severely limited activities of daily living: Barthel Index 0–60; Odds ratio = 6.62), caregivers being a daughter‐in‐law (vs other kinship; Odds ratio = 6.30), were risk factors.
Affective communication of infants with autistic spectrum disorder and internal representation of their mothers
Authors: Kobayashi Ryuji
Published: March 2003

We have been examining the developmental process of affective communication in infants with autistic spectrum disorders from the viewpoint of relationship disturbance through our developmental and psychopathological studies on autism. In particular, the role of internal representation of the mother in the process of development of affective communication is discussed through the presentation of two cases diagnosed as autistic spectrum disorder in early infancy. In these cases, we postulate approach‐avoidance motivational conflict as the primary factor impeding development of affective communication, focusing therapeutic intervention on this perspective. As a result, attachment behavior was remarkably improved in the children, but affective communication with their mothers was not readily improved. Taking up the mothers’ own internal representation in mother–infant psychotherapy, in particular, the mothers’ problems in attachment behavior with their own mothers in infancy precipitated transition in the mothers’ internal representation of their children, leading to active evolution in mother–child interaction and development in affective communication between mother and child. In this context, the basis and significance of internal representation of both parties being determinants in the quality of mother–child communication are discussed.
Recognition of sleep paralysis among normal adults in Canada and in Japan
Authors: Fukuda Kazuhiko , Ogilvie Robert D. , Takeuchi Tomoka
Published: March 2003

Abstract There were no differences between Canada and Japan in the prevalence and symptoms of sleep paralysis (SP), but many more Canadians considered SP to be a dream. The difference was considered to be derived from the fact that there is a common expression for SP in Japan but there is not one in Canada. Then, we investigated why there are individuals who consider SP to be a dream and others who do not, and found that many Japanese who regarded it as a dream did not report the symptom of ‘unable to move’, while in Canada, self‐evaluation of spirituality was different between the two groups.
Research on psychosomatic complaints by senior high school students in Tokyo and their related factors
Authors: Takata Yuriko
Published: March 2003

Abstract The purpose of this study was to clarify the relationships between psychosomatic complaints of senior high school students in Tokyo and the cognition they receive from their fathers, mothers, friends, teachers, and schoolwork and between their complaints and lifestyle habits. The subjects were 168 first‐grade students (58 males and 110 females) at a Tokyo Metropolitan senior high school. In June 1996, a collective survey was carried out, using questionnaires. Moreover, I conducted a longitudinal study to investigate the variation of their complaints over the 3 years at the school. The females had more psychosomatic complaints than the males. There was the relationship between their psychosomatic complaints and the cognition they receive from their fathers, mothers and teachers, the relationship between their psychosomatic complaints and their schoolwork, the relationship between their psychosomatic complaints and their ingestion conditions at meals, or sleeping hours. As for the their complaints, they had more complaints at admission than at the completion of their first grade and at graduation.
A comparison of middle latency auditory‐evoked response in obstructive sleep apnea syndrome before and after treatment
Authors: Miyamoto Tomoyuki , Miyamoto Masayuki , Takekawa Hidehiro , Kubo Jin , Hirata Koichi , Katayama Soichi
Published: March 2003

The ascending reticular activating system seems to be affected by nocturnal hypoxia in obstructive sleep apnea syndrome (OSAS) patients so that their vigilance level is decreased. To evaluate the change in vigilance level in OSAS patients, polysomnography, the Epworth Sleepiness Scale and middle latency auditory‐evoked responses (MLR) were measured before and after treatment in seven men with OSAS (mean age 45.4 ± 12.9 years, mean body mass index 33.3 ± 7.6 kg/m2). After treatment there was significant improvement of nocturnal hypoxia in OSAS. Peak amplitude of P1 in MLR increased after treatment. There was also improvement of the electrical field distribution of MLR on the scalp. The results suggest that the decreased vigilance level in OSAS patients is reversible with treatment.
Amyotrophic lateral sclerosis associated with insomnia and the aggravation of sleep‐disordered breathing
Authors: Takekawa Hidehiro , Kubo Jin , Miyamoto Tomoyuki , Miyamoto Masayuki , Hirata Koichi
Published: March 2003

A case of amyotrophic lateral sclerosis (ALS) diagnosed by sleep‐disordered breathing is described. The patient’s chief complaints were insomnia and nocturnal dyspnea after taking a hypnotic drug. On examination, he showed restrictive ventilatory impairment, alveolar hypoventilation and hypoxia. Polysomnographic examination revealed marked hypoxia during REM sleep periods, decreased duration of REM sleep periods, and increased sleep disruption. Amyotrophic lateral sclerosis was diagnosed by the neurological finding of paraspinal muscle weakness and neurogenic changes revealed by needle electromyography and muscle biopsy. The daytime and nocturnal respiratory insufficiency improved after nasal bilevel positive airway pressure therapy. Amyotrophic lateral sclerosis should be suspected as a cause of insomnia and nocturnal dyspnea.
Effects of a one‐hour educational program on medical students' attitudes to mental illness
Authors: Mino Yoshio , Yasuda Nobufumi , Tsuda Toshihide , Shimodera Shinji
Published: March 2003

Abstract A new 1‐h educational program was developed to change attitudes towards mental illness, and was conducted on 95 first‐year medical students in order to investigate its effects on their attitudes towards mental illness, using a pre‐ and postquestionnaire study design. A similar study without the program was conducted on 94 first‐year medical students as controls. After the program, more students replied that they would accept former patients on relatively close social distance items. Favorable attitudinal changes were observed in terms of ‘psychiatric services’, ‘human rights of the mentally ill’, ‘patients’ independence in social life’, and ‘cause and characteristics of mental illness’. In contrast, no significant change was observed in the control group. These results suggest that attitudes towards mental illness could be changed favorably by this program.
Epidemiology of suicidal ideation and help‐seeking behaviors among the elderly in Japan
Authors: Ono Yutaka , Tanaka Eriko , Oyama Hiroshi , Toyokawa Keiko , Koizumi Takeshi , Shinohe Kiku , Satoh Kyoko , Nishizuka Emiko , Kominato Harue , Nakamura Kenji , Yoshimura Kimio
Published: March 2003

This study offers an analysis of the elderly (over 65 years of age) among a general community population in terms of the percentages of: (i) persons with recurring thoughts of death and/or of committing suicide, and (ii) people who have consulted others, including medical professionals, with regard to these problems. Among 433 elderly over the age of 65 in one community in a town in Aomori Prefecture, 358 agreed to participate in the project. Forty‐four participants (12.3%) responded that they had either ‘thoughts of death’ or ‘thoughts of suicide’, and these thoughts had continued for more than 2 weeks in 12 participants (3.4%). Only 15 of the 44 suicidal elderly responded that they had consulted someone about their problems. Although there are many elderly people exhibiting a subclinical depressive state with recurring thoughts of death or thoughts of suicide, the number of people who consult family members, professionals, or others is very low. This suggests the importance of community networking through educational activities so that people can more readily talk to and support one another.
Precedents of perceived social support: Personality, early life experiences and gender
Authors: Kitamura Toshinori , Watanabe Kyoko , Takara Nobue , Hiyama Kazutoshi , Yasumiya Rie , Fujihara Shigeki
Published: March 2003

Abstract The perception of social support may be a trait‐like construct stemming from the current personality and early environment as well as a summation of the actual support perceived. A total of 220 community individuals were examined for the effects of Eysenck Personality Questionnaire (EPQ) items and early life experience at home and outside on the number of sources of perceived social support and satisfaction with that support. High extraversion and low neuroticism scores of the EPQ were correlated with the availability of support only in women, while high maternal care and low maternal overprotection in childhood were correlated with the satisfaction with support only in men. Availability of support was also correlated with some types of early life events. The quantity and quality of perception of social support differ in their links to personality and early environment, and may be, to some extent, explainable in terms of them.
Effect of daytime light conditions on sleep habits and morningness–eveningness preference of Japanese students aged 12–15 years
Authors: HARADA TETSUO , MORISANE HIROMI , TAKEUCHI HITOMI
Published: March 2003

Abstract The effect of daytime light conditions on the sleep habits and morning–evening preference of Japanese junior high school students (415 girls and 411 boys; age range, 12–15 years old) was studied. Students who were outdoors during the short break between classes or their lunch‐time break were more morning‐type people than those who remained indoors. Students who shut out the light from outside showed longer subjective sleep latency and appealed more shallow sleep rather than those who did not. Sunlight can be an important factor for the timing of sleep based on the circadian system of Japanese young students.
Melatonin alleviates jet lag symptoms caused by an 11‐hour eastward flight
Authors: TAKAHASHI TOSHIHARU , SASAKI MITSUO , ITOH HIROSHI , YAMADERA WATARU , OZONE MOTOHIRO , OBUCHI KEITA , HAYASHIDA KEN‐ICHI , MATSUNAGA NAOKI , SANO HIDETAKA
Published: March 2003

Abstract The effect of 3 mg of melatonin on the rate of re‐entrainment of plasma melatonin rhythm after an 11‐h eastward flight was assessed. Eight subjects participated in the study, and underwent 24‐h blood samplings once before the flight and twice after the flight. Subjects were exposed to natural zeitgeber outdoors and took 3 mg of malatonin at 20:00 h local time on the days when no blood sampling was done. Antidromic re‐entrainment was dominant whereby melatonin administration in the evening promoted re‐entrainment. Melatonin accelerated the rate of re‐entrainment by 15 min per day and alleviated the jet lag symptoms.
Use of ambulatory skin conductance recording for monitoring psychophysiological arousal in the elderly staying in care facilities
Authors: SHIIHARA YASUFUMI , SAKAI YASUZIRO , TANNO YOSHIHIKO , UMEZAWA AKIO , KODAMA MASAHISA
Published: March 2003

Abstract To monitor the psychophysiological arousal level in the elderly, 24 h recordings

of skin conductance change (SCC) were done during their stay in care facilities.

The mean and maximum SCC levels in 17 awake elderly subjects were significantly lower

than those of levels in 20 healthy, young control subjects (P < 0.05 and

P < 0.001, respectively). The mean SCC levels during sleep did not differ between groups. The SCC trend graph reflected a degree of daily activity. The daytime SCC profile of elderly individuals who could walk independently was comparable to that of healthy young subjects. In contrast, the SCC profile of the bedridden elderly were generally flattened with poor SCC responses that were evoked only by nursing procedures.
Influence of κ‐rhythm when assessing drowsiness
Authors: SUENAGA KAZUE , ENDO TAKURO , OHKI NOBORU
Published: March 2003

Abstract κ‐Rhythm appears at the highest amplitude on a bipolar T3–T4 derivation and its frequency range is 7–10 Hz. When a contra‐lateral earlobe is used as a reference, the κ‐rhythm causes serious problems in assessing drowsiness. Assessment of drowsiness using contra‐ and ipsi‐lateral earlobes as references in 129 subjects who showed κ‐rhythm was compared. Drowsiness could be assessed properly in only 26% of subjects using the contra‐lateral earlobe and in 90% of subjects using the ipsi‐lateral earlobe. These results suggest that the ear on the ipsi‐lateral earlobe should be used as a reference in subjects who show κ‐rhythm.
Sleep patterns during 30‐m nitrox saturation dives and in a confined atmospheric environment
Authors: NAGASHIMA HIDETOSHI , MATSUMOTO KAZUYA , SEO YOOJIN , MOHRI MOTOHIKO , NARAKI NOBUO , MATSUOKA SHIGEAKI
Published: March 2003

Abstract Sleep patterns during saturation dives equivalent to a 30‐m depth (pressurized condition) and habitation in a confined environment at 1 atm absolute pressure (non‐pressurized condition) were studied to determine the effects of environmental pressure. Eight inexperienced divers experienced the pressurized condition of the saturation dives, and nine healthy subjects experienced the non‐pressurized condition. Standard polysomnographs were recorded for 262 nights. For both conditions, reductions in total sleep time accompanied by lengthening in sleep latency and reduction in sleep efficiency were observed from the latter part of the experiments through to the recovery periods. These findings suggest that changes were related to psychological and physiological stresses caused by long stays in a confined environment and not by the environmental pressure.