bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer‐based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy
Authors: Kay‐Lambkin Frances J. , Baker Amanda L. , Lewin Terry J. , Carr Vaughan J.
Published: February 2009

Aims  To evaluate computer‐ versus therapist‐delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems.

Design  Randomized controlled trial.

Setting  Community‐based participants in the Hunter Region of New South Wales, Australia.

Participants  Ninety‐seven people with comorbid major depression and alcohol/cannabis misuse.

Intervention  All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ‘live’ (i.e. delivered by a psychologist) or via a computer‐based program (with brief weekly input from a psychologist).

Measurements  Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post‐baseline assessment.

Findings  (i) Depression responded better to intensive MI/CBT compared to BI alone, with ‘live’ treatment demonstrating a strong short‐term beneficial effect which was matched by computer‐based treatment at 12‐month follow‐up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer‐based therapy showing the largest treatment effect.

Conclusions  Computer‐based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12‐month outcomes relative to a ‘live’ intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer‐based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress.
School‐based alcohol education: results of a cluster‐randomized controlled trial
Authors: Morgenstern Matthis , Wiborg Gudrun , Isensee Barbara , Hanewinkel Reiner
Published: February 2009

Objective This study aimed to examine the effects of a school‐based alcohol education intervention.

Design Two‐arm three‐wave cluster‐randomized controlled trial, with schools as the unit for randomization. Surveys were conducted prior to intervention implementation, then 4 and 12 months after baseline.

Setting A total of 30 public schools in Schleswig‐Holstein, Germany.

Participants Baseline data were obtained from 1686 7th graders. The retention rate was 85% over 12 months.

Intervention The intervention consisted of four interactive lessons conducted by teachers, booklets for students and booklets for parents.

Measures Knowledge, attitudes, life‐time alcohol consumption (ever use alcohol without parental knowledge, ever been drunk and ever binge drinking) and past‐month alcohol use.

Results Intention‐to‐treat analyses revealed that intervention status was associated with more general knowledge about alcohol and lower levels of life‐time binge drinking. No effects were found with respect to students' self‐reported attitudes, intentions to drink, life‐time alcohol use and past‐month alcohol use.

Conclusions The results indicate that this brief school‐based intervention had a small short‐term preventive effect on alcohol misuse.
Changes in environmental tobacco smoke (ETS) exposure over a 20‐year period: cross‐sectional and longitudinal analyses
Authors: Jefferis Barbara J. , Thomson Andrew G. , Lennon Lucy T. , Feyerabend Colin , Doig Mira , McMeekin Laura , Wannamethee S. Goya , Cook Derek G. , Whincup Peter H.
Published: February 2009

Aims  To examine long‐term changes in environmental tobacco smoke (ETS) exposure in British men between 1978 and 2000, using serum cotinine.

Design  Prospective cohort: British Regional Heart Study.

Setting  General practices in 24 towns in England, Wales and Scotland.

Participants  Non‐smoking men: 2125 studied at baseline [questionnaire (Q1): 1978–80, aged 40–59 years], 3046 studied 20 years later (Q20: 1998–2000, aged 60–79 years) and 1208 studied at both times. Non‐smokers were men reporting no current smoking with cotinine < 15 ng/ml at Q1 and/or Q20.

Measurements  Serum cotinine to assess ETS exposure.

Findings  In cross‐sectional analysis, geometric mean cotinine level declined from 1.36 ng/ml [95% confidence interval (CI): 1.31, 1.42] at Q1 to 0.19 ng/ml (95% CI: 0.18, 0.19) at Q20. The prevalence of cotinine levels ≤ 0.7 ng/ml [associated with low coronary heart disease (CHD) risk] rose from 27.1% at Q1 to 83.3% at Q20. Manual social class and northern region of residence were associated with higher mean cotinine levels both at Q1 and Q20; older age was associated with lower cotinine level at Q20 only. Among 1208 persistent non‐smokers, cotinine fell by 1.47 ng/ml (95% CI: 1.37, 1.57), 86% decline. Absolute falls in cotinine were greater in manual occupational groups, in the Midlands and Scotland compared to southern England, although percentage decline was very similar across groups.

Conclusions  A marked decline in ETS exposure occurred in Britain between 1978 and 2000, which is likely to have reduced ETS‐related disease risks appreciably before the introduction of legislation banning smoking in public places.
Can invasion patches of Acacia mearnsii serve as colonizing sites for native plant species on Réunion (Mascarene archipelago)?
Authors: Tassin J. , Médoc J. M. , Kull C. A. , Rivière J. N. , Balent G.
Published: February 2009

There is need for documenting the long‐term effects of plant invasions at the landscape scale. We investigated the possible catalytic effect of invasive Acacia mearnsii De Wild. on the colonization of rural landscapes by native plant species on Réunion Island (Mascarene Archipelago, Indian Ocean). Data were recorded from 182 circular plots of 50 m2 within a set of 48 large invasion patches, aged from 1 to 48+ years. Only eighteen native plant species were present in the invaded patches and these in only 21 of the 48 patches. The Acacia invasion patches colonized by native flora were older and closer to the closest forest remnant. Most invasion patches colonized by native species were located <200 m from forest remnants. Results are consistent with studies on colonization rates of nonindigenous forest plantations, which increase with age and decrease with distance to seeds sources. Yet, the rate of Acacia invasion patches colonized by native flora remained very low compared to studies on the colonization of exotic plantations in other tropical countries. We conclude that invasion patches of Acacia mearnsii are poor colonizing sites for native plant species. Allelopathy is suspected as one of the strongest factors, which prevent this colonization.
Bacterial infection and neutropenia during peginterferon plus ribavirin combination therapy in patients with chronic hepatitis C with and without baseline neutropenia in clinical practice
Authors: YANG J.‐F. , HSIEH M.‐Y. , HOU N.‐J. , DAI C.‐Y. , HUANG J.‐F. , LIN Z.‐Y. , CHEN S.‐C. , HSIEH M.‐Y. , WANG L.‐Y. , CHUANG W.‐L. , YU M.‐L.
Published: February 2009

Background Peginterferon‐α–based therapy frequently leads to neutropenia. It remains unclear whether neutropenia is associated with bacterial infection in chronic hepatitis C (CHC).

Aim To evaluate the risk of bacterial infection and neutropenia in patients with CHC treated with peginterferon‐α/ribavirin.

Methods In all, 207 patients with CHC with (group A,n = 30) and without (group B,n = 177) baseline neutropenia were treated with peginterferon‐α/ribavirin.

Results Group A had significantly higher rates of moderate (<750 cells/μL) and severe (<500 cells/μL) neutropenia than group B (70.0% and 26.7% vs. 20.3% and 8.5% respectively, bothP < 0.0001). The sustained virological response rate was similar between patients with and without neutropenia, at baseline or during treatment. Bacterial infection occurred in 4.3% of patients. Group A and patients with lower baseline neutrophil counts had substantially higher rates of bacterial infection. Patients with cirrhosis had significantly higher rates of infection during combination therapy than those without cirrhosis (15%, 3 of 20 vs. 3.2%, 6 of 187,P = 0.045). Nadir neutrophil counts were not correlated to infection episodes.

Conclusions Bacterial infection during peginterferon‐based therapy for CHC was associated with comorbidity of cirrhosis, but not with neutropenia, whether at baseline or during treatment. Neutropenic CHC patients might be treated safely with close monitoring.
Intestinal decontamination improves liver haemodynamics in patients with alcohol‐related decompensated cirrhosis
Authors: VLACHOGIANNAKOS J. , SAVERIADIS A. S. , VIAZIS N. , THEODOROPOULOS I. , FOUDOULIS K. , MANOLAKOPOULOS S. , RAPTIS S. , KARAMANOLIS D. G.
Published: February 2009

Background  Endotoxaemia is commonly seen in cirrhotic patients with ascites and this may be associated with increased portal pressure.

Aim  To investigate the effect of intestinal decontamination on liver haemodynamics in alcohol‐related cirrhotic patients with ascites.

Methods  We included 30 patients. At day 0, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed. Patients received rifaximin (1200 mg/day) for 28 days. At day 29, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed again.

Results  Median (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45(0–3.1) vs. 0.7(0–2.7), P < 0.0001] and splanchnic circulation [1.8(0–3.4) vs. 0.8(0–2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137). HVPG measurement was possible in 28 patients. Median (range) HVPG values were 18 mmHg (12.7–26.3) on day 0 vs. 14.7 mmHg (7–20) on day 29 (P < 0.0001). HVPG decreased after rifaximin in 23, remained stable in two and increased in three patients.

Conclusion  Hepatic venous pressure gradient values decreased significantly after intestinal decontamination with rifaximin in patients with alcohol‐related decompensated cirrhosis and this might have been achieved through significant reduction of plasma endotoxin levels.
Patients with chemotherapy‐refractory mantle cell lymphoma experience high response rates and identical progression‐free survivals compared with patients with relapsed disease following treatment with single agent bortezomib: results of a multicentre phase 2 clinical trial
Authors: O’Connor Owen A. , Moskowitz Craig , Portlock Carol , Hamlin Paul , Straus David , Dumitrescu Otilia , Sarasohn Debra , Gonen Mithat , Butos John , Neylon Ellen , Hamelers Rachel , Mac‐Gregor Cortelli Barbara , Blumel Susan , Zelenetz Andrew D. , Gordon Leo , Wright John J. , Vose Julie , Cooper Brenda , Winter Jane
Published: February 2009

The recent approval of bortezomib for the treatment of mantle cell lymphoma (MCL) by the US Food and Drug Administration is based on the results of the multicentre PINNACLE study with supportive data from a number of single and multicentre Phase 2 studies. This multicentre Phase 2 study enroled 40 patients with heavily pretreated MCL. The overall response rate (ORR) was 47%, including 5 complete remissions and 14 partial remissions. Overall, these remissions are relatively durable. The ORR in relapsed and refractory patients was 50% and 43% respectively (P = 0·74), while both populations of patients exhibited essentially similar progression‐free survival (PFS; 5·6 months vs. 3·9 months, P = 0·81). Responding patients experienced a PFS from bortezomib that was similar to their line of prior therapy (7·8 months vs. 8·4 months, respectively). The data showed similar responses in relapsed and refractory patients as well as remission durations similar to prior therapy, suggesting that there may be little cross‐resistance with other conventional cytotoxic agents. Importantly, these data suggest that MCL patients with refractory or poorly responsive disease may still derive meaningful clinical benefit from treatment with bortezomib.
Poleward shifts in breeding bird distributions in New York State
Authors: ZUCKERBERG BENJAMIN , WOODS ANNE M. , PORTER WILLIAM F.
Published: February 2009

Like other regions of the northern hemisphere, the northeastern United States has experienced a general increase in regional temperatures over the past 20 years. Quantifying the ecological implications of these changing temperatures has been severely constrained by a lack of multispecies distributional data by which to compare long‐term changes. We used the New York State Breeding Bird Atlas, a statewide survey of 5332 25 km2 blocks surveyed in 1980–1985 and 2000–2005, to test several predictions that the birds of New York State are responding to climate change. Our objective was to use an information‐theoretic approach to analyze changes in three geographic range characteristics, the center of occurrence, range boundaries, and states of occurrence to address several predictions that the birds of New York State are moving polewards and up in elevation. As expected, we found all bird species (n=129) included in this analysis showed an average northward range shift in their mean latitude of 3.58 km [Prob(Ha|data)=0.87)]. Past studies have found that northern range boundaries are more likely to be influenced by climatic factors than southern range boundaries. Consequently, we predicted that northward shifts would be more evident in northern as opposed to southern range boundaries. We found, however, that the southern range boundaries of northerly birds moved northward by 11.4 km [n=43, Prob(Ha|data)=0.92], but this pattern was less evident in northern range boundaries of southerly birds. In addition, we found that bird species demonstrated a general shift downhill in their mean elevation, but demonstrated little change in their elevational boundaries. The repeated pattern of a predicted northward shift in bird ranges in various geographic regions of the world provides compelling evidence that climate change is driving range shifts.
Interactive effects of warming and increased nitrogen deposition on 15N tracer retention in a temperate old field: seasonal trends
Authors: TURNER MICHELLE M. , HENRY HUGH A. L.
Published: February 2009

The extent to which increased atmospheric nitrogen (N) deposition will drive changes in plant productivity and species composition over the next century will depend on how other influential global change factors, such as climate warming, affect the N retention of ecosystems. We examined the interactive effects of simulated climate warming and N deposition on the recoveries of 15N‐labeled ammonium and 15N‐labeled nitrate tracers added as a pulse to grass‐dominated, temperate old‐field plots at spring thaw. In addition to the year‐round warming treatment, a winter‐only warming treatment was applied to a set of plots to explore the contribution of this component of climate warming to the overall warming effect. By the end of the plant growing season, there was approximately twice as much 15N enrichment in the plant roots and bulk soil from 15NH4+‐addition plots than from 15NO3−‐addition plots, but there were no effects of warming or N fertilization on 15N recovery. Over winter, approximately half of the excess 15N present in plant shoots was lost, which corresponded with large 15N losses from bulk soil in N fertilized plots and large 15N increases in bulk soil in nonfertilized plots. By the next spring, there was decreased 15N recovery in plants in response to N fertilization, which was largely offset by increases in plant 15N recovery in response to year‐round warming. However, 15N retention in bulk soil, where the major part of the 15N label was recovered, was approximately 40% higher in nonfertilized plots than in N fertilized plots. Overall, our results indicate that climate warming increases plant N sequestration in this system but this effect is overwhelmed by the overall effect of nitrogen deposition on ecosystem N losses.
Interaction between tool and talk: how instruction and tools support consensus building in collaborative inquiry‐learning environments
Authors: Gijlers H. , Saab N. , Van Joolingen W.R. , De Jong T. , Van Hout‐Wolters B.H.A.M.
Published: February 2009

The process of collaborative inquiry learning requires maintaining a mutual understanding of the task, along with reaching consensus on strategies, plans and domain knowledge. In this study, we explore how different supportive measures affect students' consensus‐building process, based on a re‐analysis of data from four studies. We distinguish between scaffolds that aim at supporting students' collaborative processes and scaffolds that aim primarily at supporting the inquiry learning process. The overall picture that emerges from the re‐analysis is that integration‐oriented consensus‐building activities are facilitated by scaffolds that provide explicit instruction in rules for effective collaboration and by scaffolds that encourage students to collaboratively construct a representation. Scaffolds that display inter‐individual differences between students' opinions resulted primarily in quick consensus‐building activities.
Octopus Gonadotrophin‐Releasing Hormone: A Multifunctional Peptide in the Endocrine and Nervous Systems of the Cephalopod
Authors: Minakata H. , Shigeno S. , Kano N. , Haraguchi S. , Osugi T. , Tsutsui K.
Published: February 2009

The optic gland, which is analogous to the anterior pituitary in the context of gonadal maturation, is found on the upper posterior edge of the optic tract of the octopus Octopus vulgaris. In mature octopus, the optic glands enlarge and secrete a gonadotrophic hormone. A peptide with structural features similar to that of vertebrate gonadotophin‐releasing hormone (GnRH) was isolated from the brain of octopus and was named oct‐GnRH. Oct‐GnRH showed luteinising hormone‐releasing activity in the anterior pituitary cells of the Japanese quail Coturnix coturnix. Oct‐GnRH immunoreactive signals were observed in the glandular cells of the mature optic gland. Oct‐GnRH stimulated the synthesis and release of sex steroids from the ovary and testis, and elicited contractions of the oviduct. Oct‐GnRH receptor was expressed in the gonads and accessory organs, such as the oviduct and oviducal gland. These results suggest that oct‐GnRH induces the gonadal maturation and oviposition by regulating sex steroidogenesis and a series of egg‐laying behaviours via the oct‐GnRH receptor. The distribution and expression of oct‐GnRH in the central and peripheral nervous systems suggest that oct‐GnRH acts as a multifunctional modulatory factor in feeding, memory processing, sensory, movement and autonomic functions.
Masticatory function in subacute TMD patients before and after treatment
Authors: PEREIRA L. J. , STEENKS M. H. , De WIJER A. , SPEKSNIJDER C. M. , Van Der BILT A.
Published: February 2009

Summary  Masticatory function can be impaired in temporomandibular disorders (TMDs) patients. We investigated whether treatment of subacute non‐specific TMD patients may influence oral function and clinical outcome measures. Fifteen patients with subacute TMD participated in the study. We quantified masticatory performance, maximum voluntary bite force, muscle activity and chewing cycle duration before and after treatment. Masticatory performance and bite force of patients were compared with the results obtained for an age‐ and gender‐matched group of subjects without TMD complaints. Furthermore, we determined possible changes in anamnestic and clinical scores from questionnaires (mandibular function impairment questionnaire; MFIQ), pain scores and clinical outcome measures. Maximum bite force significantly increased, although the values after treatment were still significantly lower than those of the subjects without TMD complaints. The corresponding electromyography values did not show significant change after treatment. The masticatory performance of the patients remained unaltered; patients chewed significantly less efficient than controls. The average duration of chewing cycles significantly decreased after treatment. We observed a significant improvement in MFIQ scores. During the clenching and chewing tasks, the visual analogue scale scores were significantly higher than before these tasks. We may conclude that subacute temporomandibular joint disorders negatively influence chewing behaviour. Bite force, chewing cycle duration and also perceived mandibular function significantly improved after treatment, although the masticatory performance remained unaltered.
Incidence of symptoms and signs of TMD following third molar surgery: a controlled, prospective study
Authors: JUHL G. I. , JENSEN T. S. , NORHOLT S. E. , SVENSSON P.
Published: February 2009

Summary  The purpose of this prospective study was to investigate if third molar surgery is associated with the development of symptoms and signs of temporomandibular disorders (TMD) during a 6‐month post‐operative observation period using the Research Diagnostic Criteria for TMD (RDC/TMD) instrument. Seventy‐two subjects eligible for third molar surgery under local anaesthesia (patients) were included. Patients were examined according to the RDC/TMD instrument at baseline, 1 week, 1 and 6 months after surgery. Twenty‐five age‐ and sex‐matched healthy non‐operative control subjects (controls) were included and examined at baseline and at 6 months. In the patient group, we found: (i) reduced range of maximum jaw opening at one week after surgery (P < 0·001), (ii) increased characteristic pain intensity 1 week after surgery (P < 0·05), (iii) increased disability up to 1 month after surgery (P < 0·05), (iv) increased incidence of muscle pain on palpation up to 6 months after surgery (P < 0·05), (v) increased incidence of pain on palpation of the temporomandibular joint up to 6 months after surgery (P < 0·05) and (vi) increased incidence of painful TMD 6 months after surgery. But, when compared with untreated controls, subjects undergoing third molar surgery have a statistically insignificant increased incidence of TMD 6 months post‐operatively.
Advocacy in mental health nursing: an integrative review of the literature
Authors: JUGESSUR T. , ILES I. K.
Published: February 2009

The term ‘advocacy’ has taken on a meaning beyond its legal origins and is now of importance as a concept in health and social care. Within nursing, the role of advocate has been accepted as an important one, although there are arguments against nurses taking on such a role. The majority of papers on this topic relate to nursing generically rather than being specifically mental health oriented. Nurses need to be made aware of the legal framework within which they practice, in terms of duty of care within their role of nurse advocate, maintaining standards of advocacy acceptable to their professional body, accountability relating to action and omission of actions, guidance on guarding against stepping beyond the boundaries of their professional practice of advocacy, and to have adequate knowledge of the law. This paper offers a critique of nursing advocacy models, raising a number of mental health nursing issues and identifying some areas for further research.
Use of a think‐aloud procedure to explore the relationship between clinical reasoning and solution‐focused training in self‐harm for emergency nurses
Authors: MCALLISTER M. , BILLETT S. , MOYLE W. , ZIMMER‐GEMBECK M.
Published: February 2009

Self‐harm is a risk factor for further episodes of self‐harm and suicide. The most common service used by self‐injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self‐harm. In a study that aimed to improve understanding and teach solution‐focused skills to emergency nurses so that they may be more helpful with patients who self‐harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think‐aloud procedure was used as a way of exploring and improving the solution‐focused nature of nurses' clinical reasoning in a range of self‐harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses' ability to consider the patients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change – acknowledgment and respect.
Resilience revisited
Authors: ATKINSON P. A. , MARTIN C. R. , RANKIN J.
Published: February 2009

Contemporary reports of individuals experiencing severe adversity have led to renewed debate regarding the processes that mediate a person's ability to withstand extremes of both psychological and physical abuse. The capacity to recover from extremes of trauma and stress is termed resilience. This important concept is of key relevance to health professionals as resilience and also defines a more general concept of responding to challenges that affect the individual in terms of their health behaviour. The evidence base in this area is noteworthy in that much research is based on historical case studies that, although rich in both content and appeal, also fall short of contemporary rigour in terms of validity. This review will describe the evidence for the salience of the concept of the resilience to health and mental health and the implications of the domain to the healthcare professional.
Epidemiology of absconding from an Iranian psychiatric centre
Authors: YASINI M. , SEDAGHAT M. , GHASEMI ESFE A. R. , TEHRANIDOOST M.
Published: February 2009

Absconding by psychiatric patients from acute psychiatric wards has been a significant problem for some time. This study was conducted to identify the incidence rate of absconding in a psychiatric hospital and some of the characteristics of patients who had escaped from hospital in year 2006. In this descriptive cross‐sectional study, all of absconds in our centre have been registered in the period of 9 months. We assessed patients' age, gender, marital status, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. A total of 43 cases of absconding have been registered in this period, attempted by 35 patients, with the incidence rate of 3% in our centre. The mean age of absconders was 31.7 years; 95.3% of absconds were made by men; 67.4% were single; 37.4% absconded through the main door; 62.8% of our absconders had bipolar mood disorder or schizophrenia; mean in hospital stay before absconding was 18.4 days; and 53.5% of absconds were attempted by substance users. Absconders utilize a significant portion of hospital resources and have an adverse effect on ward milieu. It seems that the patients who are more prone to abscond are male, young, single, addict, with the diagnosis of bipolar mood disorder or schizophrenia and patients who are admitted not long ago.
Community treatment orders: the ethical balancing act in community mental health
Authors: SNOW N. , AUSTIN W. J.
Published: February 2009

Community treatment orders (CTOs) are legal mechanisms by which an individual with a mental illness and a history of non‐compliance and potential for violence can be mandated (against their will) to undergo psychiatric treatment in an outpatient setting. Although CTOs are increasingly being adopted by governments as a means of protecting both mentally ill persons and society itself, their use continues to stimulate considerable debate. While there is some evidence of their potential benefits in promoting treatment compliance and reducing hospital stays, there is concern that they infringe on the mental health client's human rights and freedoms. Consideration of the ethical and practical implications of the use of CTOs must continue. In this paper, some of the most pressing issues are identified and discussed.
Cultural adaptation and validation of a questionnaire for use in hepatitis B patients
Authors: Ong S. C. , Lim S. G. , Li S. C.
Published: February 2009

Summary.  Health‐related quality of life (HRQoL) is an important aspect of the overall management of hepatitis B virus (HBV) infection. The major challenge is to find a valid and reliable disease‐specific HRQoL instrument designed specifically for measuring health status in hepatitis B patient. Consequently, this study was undertaken to adapt culturally the Hepatitis Quality of Life Questionnaire (HQLQ) and assess its suitability for use in English‐speaking hepatitis B virus‐infected (HBV) patients in Singapore. Two patient focus groups were conducted to facilitate the cultural adaptation of the HQLQ. Reliability was assessed using Cronbach’s alpha coefficients and intraclass correlation coefficients. Item‐to‐scale correlation was assessed using Spearman’s rank correlations (ρ) between scale scores and their constituent items. Convergent and divergent construct validities were tested in three and two a priori hypotheses, respectively, and the correlations were assessed using Spearman’s rank correlation coefficients (ρ). The culturally adapted questionnaire was tested in 298 HBV patients. The test‐retest reliability was supported with 10 of the 12 scales showing acceptable correlation coefficients (i.e. α > 0.7). Item‐to‐scale correlations were good with most items highly correlated with their hypothesized scales. Convergent and divergent construct validities were supported by the presence of hypothesized correlations between the HQLQ and the EQ‐5D domains (eight of 10 sub‐hypotheses for convergent construct validity and all hypotheses for divergent construct validity were fulfilled). In conclusion, our results showed that the culturally adapted HQLQ has good validity and reliability, making it a potentially useful outcome measure in the evaluation of HBV patients in Singapore.
Complete blood count reflects the degree of oesophageal varices and liver fibrosis in virus‐related chronic liver disease patients
Authors: Lee J.‐H. , Yoon J.‐H. , Lee C.‐H. , Myung S. J. , Keam B. , Kim B. H. , Chung G. E. , Kim W. , Kim Y. J. , Jang J. J. , Lee H‐S.
Published: February 2009

Summary.  To optimize management of chronic liver disease (CLD), a simple and noninvasive test to determine oesophageal varices (EV) and liver fibrosis is necessary. We performed a cohort study in a single tertiary care centre in order to devise a simple index reflecting EV and liver fibrosis. We derived an index reflecting EV which resulted from portal hypertension (the first part) and evaluated the index’s ability to detect liver fibrosis which resulted in portal hypertension (the second part). Five hundred fifty‐six patients (the first part, n = 409, mean age = 55.4 years, EV prevalence = 34.0%; the second part, n = 147, mean age = 48.8 years, cirrhosis prevalence = 12.9%) with virus‐related CLD were included. P2/MS [(platelet count [109/L])2/(monocyte fraction [%] × segmented neutrophil fraction [%])] was derived to detect EV. The area under the receiver‐operating characteristic curve (AUROC) of P2/MS was 0.916 (95% confidence interval, 0.879–0.954) for detecting EV, and 0.905 (0.862–0.947) for detecting high‐risk EV (grade ≥ II or with red colour signs). P2/MS had AUROCs of 0.952 (0.904–0.999) and 0.873 (0.792–0.955) for histological cirrhosis (METAVIR F4) and significant fibrosis (METAVIR F2–F4), respectively, which were significantly greater than those of AST‐to‐platelet count ratio index (0.658, P < 0.001; 0.644, P = 0.003) and FIB‐4 (0.776, P = 0.031; 0.707, P = 0.026). The predictive values of P2/MS were maintained at similar accuracy in subsequent validation sets. Our study suggests that P2/MS comprising only the complete blood count results is an efficient and noninvasive marker reflecting the presence of EV and the grade of liver fibrosis in patients with virus‐related CLD. An independent external validation of P2/MS is required.
Serum BLyS/BAFF predicts the outcome of acute hepatitis C virus infection
Authors: Tarantino G. , Marco V. D. , Petta S. , Almasio P. L. , Barbaria F. , Licata A. , Bosco G. L. , Tripodo C. , Stefano R. D. , Craxì A.
Published: February 2009

Summary.  B‐lymphocyte stimulator/B activating factor (BLyS/BAFF) is a tumour necrosis factor‐family cytokine that plays a key role in generating and maintaining the mature B‐cell pool. BLyS/BAFF expression by macrophages is stimulated by interferon‐γ and interleukin‐10, and its serum levels are increased in chronic hepatitis C (CHC). The aim of this study was to assess serum levels of BLyS/BAFF in patients with acute hepatitis C (AHC) and correlate them with disease outcome. We studied 28 patients with AHC (14 males, mean age 59.3 ± 15 years), followed for at least 7 months since onset, comparing them with 86 CHC patients and 25 healthy blood donors (HBD). BLyS/BAFF levels were assessed at baseline (within 4 weeks of onset) and during follow‐up. BLyS/BAFF median levels were significantly higher in AHC (1485 pg/mL) than in CHC (1058 pg/mL) and in HBD (980 pg/mL) (P < 0.001). BLyS/BAFF levels were higher in AHC patients evolving to chronicity (1980 pg/mL) than in those with a self‐limited course (1200 pg/mL), (P = 0.02). By logistic regression analysis, higher BLyS/BAFF levels were independently associated with persistence of HCV infection (OR 29.7; 95% CI: 1.73–508.20). High serum levels of BLyS/BAFF at onset of AHC can predict its evolution to chronic infection.
Hyaluronic acid, transforming growth factor‐β1 and hepatic fibrosis in patients with chronic hepatitis C virus and human immunodeficiency virus co‐infection
Authors: Sanvisens A. , Serra I. , Tural C. , Tor J. , Ojanguren I. , Barluenga E. , Rey‐Joly C. , Clotet B. , Muga R.
Published: February 2009

Summary.  Chronic hepatitis C virus (HCV) infection follows an accelerated course in patients co‐infected with human immunodeficiency virus (HIV); establishing the extent of liver fibrosis is crucial for disease staging and determining treatment strategy in these patients. The utility of noninvasive markers of fibrosis as alternatives to liver biopsy has not been well‐studied in these patients. We evaluated the predictive value of serum transforming growth factor‐beta1 (TGF‐β1) and hyaluronic acid (HA) levels for determining the extent of liver fibrosis. Liver biopsies and blood samples were collected from 69 consecutive patients (74% male; median age, 41 years) between May 2005 and November 2006. Serum TGF‐β1 and HA were analysed using commercial kits. Aspartate aminotransferase, alanine aminotransferase and gamma‐glutamyl transpeptidase levels were elevated in 81%, 70% and 60% of patients, respectively. Fifty‐three patients (90%) were on highly active antiretroviral therapy and the median CD4‐positive cell count was 422 cells/μL. The extent of fibrosis according to Scheuer’s scoring was 32% F0 (no fibrosis), 16.5% F1, 16.5% F2, 26% F3 and 7% F4 (cirrhosis). Mean serum TGF‐β1 was 36.1 ± 14.4 ng/mL; mean serum HA was 75.2 ± 85.0 μg/L. Serum HA was positively associated and significantly correlated with the stage of fibrosis (r = 0.56; P < 0.05). The area under the curve for discriminating mild (F0–F2) from significant (F3–F4) fibrosis in receiver operating analysis using HA was 0.83 (sensitivity, 87%; specificity, 70%). These data suggest that HA is clinically useful for predicting liver fibrosis and cirrhosis in patients co‐infected with HCV/HIV. However, serum TGF‐β1 was not predictive of histological damage in co‐infected individuals treated with HAART.
Sec6‐dependent sorting of fungal extracellular exosomes and laccase of Cryptococcus neoformans
Authors: Panepinto John , Komperda Kazimierz , Frases Susana , Park Yoon‐Dong , Djordjevic Julianne T. , Casadevall Arturo , Williamson Peter R.
Published: February 2009

The cell wall of pathogenic fungi such as Cryptococcus neoformans, provides a formidable barrier to secrete virulence factors that produce host cell damage. To study secretion of virulence factors to the cell periphery, sec6 RNAi mutant strains of C. neoformans were tested for virulence factor expression. The studies reported here show that SEC6 RNAi mutant strains were defective in a number of virulence factors including laccase, urease as well as soluble polysaccharide and demonstrated attenuated virulence in mice. Further analysis by transmission electron microscopy detected the production of abundant extracellular exosomes in wild‐type strains containing empty plasmid, but a complete absence in the iSEC6 strain. In addition, a green fluorescent protein–laccase fusion protein demonstrated aberrant localization within cytoplasmic vesicles in iSEC6 strains. In contrast, iSEC6 strains retained normal growth at 37°C, as well as substantially normal capsule formation, phospholipase activity and total secreted protein. These results provide the first molecular evidence for the existence of fungal exosomes and associate these vesicles with the virulence of C. neoformans.
Eosinophil Cationic Protein Stimulates Migration of Human Lung Fibroblasts In Vitro
Authors: Zagai U. , Lundahl J. , Klominek J. , Venge P. , Sköld C. M.
Published: February 2009

Asthma is characterized by eosinophilic inflammation and remodelling of the airways. Eosinophil cationic protein (ECP) is a protein released by activated eosinophils and the hypothesis that ECP contributes to the development of structural changes in the airways of asthmatics has been posed. Fibroblast recruitment is an important step in the remodelling process, and we therefore put the question whether ECP stimulates migration of human lung fibroblasts. Human peripheral eosinophils isolated from buffycoats from healthy individuals were cultured and conditioned media (CM) were collected. Native ECP was extracted from human peripheral eosinophils by gel filtration, ion‐exchange and chelating chromatography. The ability of eosinophil CM and ECP to stimulate fibroblast migration was determined using the 48‐well Boyden chamber. ECP concentrations in CM were assayed by ECP‐CAP‐FEIA. Both CM and ECP significantly stimulated fibroblast migration (48.4 ± cells/field versus 33 ± 2 and 36 ± 6 versus 25 ± 4; P < 0.001 and 0.05 respectively) in a time‐ and concentration‐dependent manner. Adding neutralizing ECP antibodies attenuated fibroblast migration induced by both ECP as well as CM. ECP stimulates migration of human lung fibroblasts, suggesting a potential mechanism for eosinophils in the fibrotic response. This may be an important mechanism by which ECP promotes remodelling of extracellular matrix leading to airway fibrosis in asthmatics.
Under‐report and underdiagnosis of chronic respiratory diseases in an African country
Authors: Martins P. , Rosado‐Pinto J. , Do Céu Teixeira M. , Neuparth N. , Silva O. , Tavares H. , Spencer J. L. , Mascarenhas D. , Papoila A. L. , Khaltaev N. , Annesi‐Maesano I.
Published: February 2009

Background:  Chronic respiratory diseases (CRD) are greatly underestimated. The aim of this study was to assess the burden associated with reported CRD and chronic obstructive pulmonary disease, as defined on the basis of various standardized criteria, by estimating their point prevalence in a sample of individuals attending the Primary Health Care (PHC) level and Emergency Room (ER) Departments in Cape Verde (CV) archipelago. The second aim of the study was to identify factors related to airways obstruction and reported CRD in this population.

Methods:  A cross‐sectional study was carried out in CV during 2 weeks. Outpatients aged more than 20 years seeking care at PHC level and ER answered a standardized questionnaire and were subjected to spirometry, independently of their complaint. Two criteria for airways obstruction were taken into account: forced expiratory volume (FEV1) <80% of the predicted value and FEV1/forced vital capacity (FVC) ratio <0.70.

Results:  A total of 274 individuals with a satisfactory spirometry were included. 22% of the individuals had a FEV1 < 80%. Individuals older than 46 years had a higher risk of having airways obstruction. Asthma diagnosis (11%) had a clear association with airways obstruction. Smoking was a risk factor for a lower FEV1. Working in a dust place and cooking using an open fire were both related to chronic bronchitis and asthma diagnosis.

Conclusion:  Under‐report and underdiagnosis of chronic respiratory conditions seem to be a reality in CV just as in other parts of the world. To improve diagnosis, our results reinforce the need of performing a spirometry.
Microbial exposure, interferon gamma gene demethylation in naïve T‐cells, and the risk of allergic disease
Authors: Vuillermin P. J. , Ponsonby A‐L. , Saffery R. , Tang M. L. , Ellis J. A. , Sly P. , Holt P.
Published: February 2009

The period of immune programming during early life presents a critical window of opportunity for the prevention of allergic diseases. There is mounting evidence that inappropriate immune programming may involve disruption of specific epigenetic modifications (switches) at immune‐related genes. This novel area of research has great potential, as epigenetic changes are known to be sensitive to environmental factors and may therefore provide a mechanistic link for the observed association between specific environmental cues, faulty immune development, and the risk of allergic disease. In addition, the dynamic and potentially reversible nature of epigenetic modifications offers potentially novel targets for therapeutic and/or preventative interventions. We review the evidence that (1) failure to up‐regulate the interferon gamma (IFNγ) response during infancy is an important determinant of the risk of allergic disease, (2) expression of the IFNγ gene in naïve T‐cells is regulated by epigenetic mechanisms, and (3) failure to up‐regulate IFNγ gene expression of naïve T‐cells associated with low early life microbial exposure. Taken together, these lines of evidence suggest that low microbial exposure during early life increases the risk of allergic disease by reducing demethylation (activation) of the IFNγ gene of naive T‐cells.
Relation between inflammation and symptoms in asthma
Authors: Tillie‐Leblond I. , Montani D. , Crestani B. , De Blic J. , Humbert M. , Tunon‐de‐Lara M. , Magnan A. , Roche N. , Ostinelli J. , Chanez P.
Published: February 2009

Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the induced sputum and an increased production of exhaled NO. Control by anti‐inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggest that there is a relationship between the perception of symptoms and eosinophilic inflammation and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow‐up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease‐modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti‐inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids.
Tomato atopy patch test in adult atopic dermatitis: diagnostic value and comparison among different methods
Authors: Di Leo E. , Nettis E. , Cardinale F. , Foti C. , Ferrannini A. , Vacca A.
Published: February 2009

Tomato atopy patch test in adult atopic dermatitis.
The economic impact of severe asthma to low‐income families
Authors: Franco R. , Nascimento H. F. , Cruz A. A. , Santos A. C. , Souza‐Machado C. , Ponte E. V. , Souza‐Machado A. , Rodrigues L. C. , Barreto M. L.
Published: February 2009

Background:  To estimate the direct and indirect costs of severe asthma and the economic impact of its management to low‐income families in Salvador, Brazil.

Methods:  One hundred and ninety‐seven patients with severe asthma and referred to a state‐funded asthma center providing free treatment were evaluated. At registration, they were asked about family cost‐events in the previous year and had a baseline assessment of lung function, symptoms and quality of life. During the subsequent year, they were reassessed prospectively.

Results:  One hundred‐eighty patients concluded a 12‐month follow‐up. Eighty‐four percent were female patients, and the median family income was US$ 2955/year. Forty‐seven percent of family members had lost their jobs because of asthma. Total cost of asthma management took 29% of family income. After proper treatment, asthma control scores improved by 50% and quality of life by 74%. The income of the families increased by US$ 711/year, as their members went back to work. The total cost of asthma to the families was reduced by a median US$ 789/family/year. Consequently, an annual surplus of US$ 1500/family became available.

Conclusions:  Family costs of severe asthma consumed over one‐fourth of the family income of the underprivileged population in a middle‐income country. Adequate management brings major economic benefit to individuals and families.
Being Sherlock Holmes: the Internet as a tool for assessing live organ donors
Authors: Bramstedt Katrina A. , Katznelson Steven
Published: February 2009

Abstract:  Donor advocacy is a critical feature of live donor transplantation. Donor Advocates and Donor Advocate Teams (DAT) are now routine to the practice of live donor evaluation in the USA. Multidisciplinary in nature, DATs gather both medical and psychosocial information about potential live organ donors and then render a decision as to whether or not these individuals are suitable to participate. Because of the critical ethical and psychosocial concerns about live donation, thorough donor evaluations are essential. Additionally, the information gathered must be accurate, and this requires honest disclosure by the donor candidate. In this paper, we describe how DATs can use various forms of free, public content available on the Internet to aid live donor assessments. In this way, the DAT assumes somewhat of an investigative role; however, this is ethically justified in light of the DAT duty to protect the donor. The protective effect can also spread to the transplant program, in general, when inappropriate donors are excluded from the donation process.