bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal antibodies against cytomegalovirus in pregnancy and the risk of fetal death and low birth weight
Authors: Eskild Anne , Jenum Pål A. , Bruu Anne‐Lise
Published: October 2005

Background.  The aim of this study was to assess the impact of maternal cytomegalovirus (CMV) antibody status in pregnancy on the risk of fetal death and of low birth weight.

Methods.  The study of fetal death risk was a nested case–control study. Cases were all women within a cohort of 35 940 pregnant women in Norway 1992–94, who experienced fetal death after 16th week of gestation (n = 281). Controls were 957 randomly selected women with live born children. Both groups were identified through linkage to the Norwegian Medical Birth Registry. The risk of low birth weight was studied in the live born children

Results.  Seventy‐two percent (203/281) of the cases and 69% (662/957) of the controls had CMV immunoglobulin G (IgG) antibodies in the first trimester (P = 0.3). 0.4% (1/281) of the cases and 0.7% (7/957) had CMV IgM antibodies in the first trimester (P = 0.7). Among 322 initially CMV antibody‐negative women, 11% (6/55) of the cases and 9% (24/267) of the controls had occurrence of CMV IgG and/or IgM antibodies (P = 0.7) during pregnancy. Also, after control for maternal age, parity, and follow‐up time, no association between CMV antibodies and fetal death was found. CMV antibody status was not associated with low birth weight.

Conclusions.  This study does not support a causal relation between CMV infection in pregnancy and fetal death or low birth weight.
Interobserver agreements in assessing 549 labor admission tests after a standardized training program
Authors: Blix Ellen , Øian Pål
Published: October 2005

Background.   The labor admission test is a short cardiotocography (CTG) performed upon admission to the maternity ward. The aim of the present study is to examine interobserver agreements when the labor admission tests were assessed by midwives and obstetricians who had received training in interpreting CTG.

Methods.   Five hundred forty‐nine high‐ and low‐risk women who delivered at Hammer‐fest Hospital were included. The tests were assessed by three midwives and three obstetricians who had completed a standardized training program. The traces were assessed as normal, intermediary, or abnormal. Weighted kappa (κw), proportion of agreement (Pa), and predictive values were calculated.

Results.   Between the pairs of observers, κw varied between 0.57 and 0.75; Pa for a normal test between 0.78 and 0.88, and Pa for an intermediary/abnormal test between 0.56 and 0.69. At a cutoff intermediary test, mean sensitivity was 0.43 (range = 0.39 – 0.48), specificity 0.75 (range = 0.69 – 0.81, positive predictive value 0.13 (range = 0.12 – 0.15), negative predictive value 0.94 (range = 0.94 – 0.94), likelihood ratio (LR) for a positive test result 1.73 (range = 1.53 – 1.99), and LR for a negative test result 0.76 (range = 0.75 – 0.77).

Conclusions.   Midwives and obstetricians who had completed the training program achieved good levels of agreements in assessing labor admission tests. The agreements in normal tests were better than those in intermediary/abnormal tests. Obstetric staff should be aware that there are disagreements in assessing labor admission tests; especially in tests assessed as intermediary/abnormal.
An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 µg for first‐trimester legal medical abortion
Authors: Ravn Pernille , Rasmussen Åse , Knudsen Ulla Breth , Kristiansen Frank Vous
Published: October 2005

Aim.  To evaluate the success rate of medical abortion using an outpatient regimen of oral mifepristone 400 mg and oral misoprostol 400 µg for legal abortion in women < 56 days pregnant.

Methods.  Successful abortion was defined as an endometrial thickness < 20 mm evaluated by transvaginal ultrasound and minimal vaginal bleeding at a control examination performed 14 days after administration of misoprostol. Over a 6‐month period in 2003, a questionnaire (completion rate 70%) was used for a spot check of the patients' evaluation of the method.

Results.  Six hundred and sixty women underwent the procedure over a 3‐year period and 606 (92%) experienced successful medical abortion. The remaining 8% had vacuum aspiration performed mainly due to uterine retention (70%). Other reasons were vaginal bleeding (25%), vomiting (2%), or pelvic infection (4%). Most women reported no days with severe pain (67%), 0–1 days with moderate pain (82%), and 0–1 days with light pain (62%). In terms of gastrointestinal side effects, 68% reported nausea, 33% vomiting, and 27% diarrhea. Most women (90%) felt that the information given at the hospital prior to the abortion was sufficient, 74% would prefer medical abortion again in case of a future unwanted pregnancy, and 85% would prefer to abort at home again.

Conclusion.  A high acceptance and success rate was seen using this outpatient oral regimen of mifepristone and misoprostol.
Laminin‐5γ2 chain expression in cervical intraepithelial neoplasia and invasive cervical carcinoma
Authors: Noel J.‐C. , Fernandez‐Aguilar S. , Fayt I. , Buxant F. , Ansion M.‐H. , Simon P. , Anaf V.
Published: October 2005

Background.  To analyze the expression of laminin‐5γ2 chain, a protein which plays a major role in keratinocyte migration, in cervical intraepithelial neoplasia (CIN), and invasive cervical carcinoma associated with high‐risk oncogenic human papillomaviruses (HR‐HPVs).

Material and methods.  The expression of laminin‐5γ2 chain protein has been analyzed by immunohistochemistry in 17 cases of low‐grade squamous intraepithelial lesions (LSIL‐CIN1), 35 high‐grade squamous intraepithelial lesions (HSIL‐CIN2/3), 18 microinvasive or invasive carcinomas, and three metastatic lymph nodes. All these lesions have been proved to contain HR‐HPVs and were also positive for p16 protein which classically is overexpressed at all stages of cervical neoplasia and dysplasia linked with HR‐HPVs. 20 cases of normal cervix served as controls.

Results.  The expression of laminin‐5γ2 chain protein was observed in 100% of invasive or microinvasive carcinoma and in their related lymph node metastasis with an immunoreactivity located preferentially at the invasive front of the lesions. All the HSILs (100%) associated with invasive carcinoma were also positive. In contrast, in HSILs without associated invasive component, the expression of the protein has been found in only 34% of cases. In positive HSILs, laminin‐5γ2 protein was expressed in basal layers. In LSILs and normal epithelium, no expression of the protein was noted.

Conclusions.  We conclude the following: (i) the expression of laminin‐5γ2 is a late event in cervical carcinogenesis increasing with the grade of dysplastic lesions; (ii) laminin‐5γ2 expression facilitates the identification of invasive and microinvasive lesions which could be difficult to diagnose on the basis of routine stains; (iii) laminin‐5γ2 expression in HSILs could potentially identify those lesions with a more increased risk of tumor progression.
Variables that predict the success of labor induction
Authors: Bueno Beatriz , San‐Frutos Luis , Salazar Francisco , Pérez‐Medina Tirso , Engels Virginia , Archilla Beatriz , Izquierdo Fernando , Bajo José
Published: October 2005

Background.  To analyze the clinical and sonographic variables that affect the success of labor induction.

Methods.  Bishop score, cervical length, and parity were studied in 196 pregnant women in the prediction of successful vaginal delivery within 24 hr of induction. Logistic regression and segmentation analysis were performed.

Results.  Cervical length [odds ratio (OR) 1.089, P < 0.001], Bishop score (OR 0.751, P = 0.001), and parity (OR 6.85, P < 0.001) predict the success of labor induction. The best cut‐off points for cervical length were <16.5, 16.5–27, and >27 mm (P = 0.0016). In the analysis of the Bishop score, we also obtained three discriminatory points, 0, 1–4, and >4 (P = 0.0006), that best predict the labor induction. Finally, in a global analysis of the variables studied, the best statistic sequence that predicts the labor induction was found when we introduced parity in the first place. The success of labor induction in nulliparous was 50.77 and 83.33% in multiparous (P = 0.0001).

Conclusions.  Cervical length, Bishop score, and parity predict the success of labor induction.
Chromosomal anomalies in first‐trimester miscarriages
Authors: Ljunger Elisabeth , Cnattingius Sven , Lundin Catarina , Annerén Göran
Published: October 2005

Background.  It is well known that a large proportion of first‐trimester spontaneous abortions is caused by chromosomal disorders. The present study represents a unique material and the success rate of the karyotyping was high.

Methods.  Chromosomal analysis from chorionic villus sampling of 259 of 304 consecutive first‐trimester miscarriages in the Uppsala County, Sweden is presented.

Results and conclusions.  An abnormal karyotype was found in 61% of the cases. Autosomal trisomies were most frequently detected (in 37% of the karyotyped samples), followed by polyploidies (9%) and monosomy X (6%). Cases with an extra sex chromosome constituted approximately 5% of the karyotyped abortions, with a remarkable high frequency of 47,XXY (3.4%), that is approximately 40 times greater the prevalence of Klinefelter syndrome among live birth. Similar to autosomal chromosome abnormalities, present finding indicates that the majority of sex chromosome abnormalities do not survive to term. Autosomal trisomies and an extra X‐chromosome in males (47,XXY) were associated with an advanced maternal age, whereas monosomy X as well as polyploidy changes seems to be inversely related to the age of the mother. The single most common aberration was trisomy 16, which was found in 14% of the chromosomally abnormal abortions.
The Age of Environmental Impasse? Globalization and Enviromental Transformation of Metropolitan Cities
Authors: Melchert Luciana
Published: October 2005

Metropolitan cities are undergoing a major spatial and environmental transformation. The proliferation of business districts, corporate headquarters and international hotels is prompting a massive verticalization and densification of land use, which is affecting the urban environment and infrastructure in a number of ways. Nowhere are urban environmental pressures so accentuated as in Third World metropolitan cities. Here the rush to gain a competitive edge in the global economy, in order to attract multinational firms and become a ‘global city’, is leading to an inconsistent urban policy framework in which development policies frequently clash with environmental policies. This article explores the environmental complexity of Third World metropolitan cities, focusing on the cases of Beijing and São Paulo. After a conceptual review of the relationship between globalization, cities and urban environmental problems, it examines how globalization is prompting spatial and environmental transformations in both cities; looks at the dichotomy between development policies and environmental policies by analysing the instruments in place; and investigates the role of globalization vis‐à‐vis urban sustainability issues.
Land Tenure Insecurity and Inequality in Nicaragua
Authors: Broegaard Rikke J.
Published: October 2005

This article uses empirical data from a case study in rural Nicaragua to demonstrate the need for a conceptualization of tenure security as seen from the perspective of the landholder. A large group of farmers in the case study area perceive their tenure situation as being insecure despite the fact that they possess a legal title to their land. The article argues that more attention must be paid to aspects such as inequalities of wealth and power, lack of enforcement and lack of impartiality on the part of the formal institutions when addressing tenure security in an institutionally unstable setting, such as that found in Nicaragua. The article contributes to the ongoing discussion by arguing that future research on how to increase rural land tenure security should explore the concept of tenure security as experienced by farmers.
Law, Culture and Access to Justice under the Palestinian National Authority
Authors: Kelly Tobias
Published: October 2005

It has been widely claimed that the Palestinian National Authority has failed to provide adequate access to the law for many Palestinians. Whilst impediments to legal access are often treated as a technical questions of procedure, or as an issue of the cultural appropriateness of legal regimes, this article takes a third approach, which stresses political and historical factors. In order to understand obstacles to legal access it is necessary to discover the ways in which legal practices are understood, used and abandoned in particular contexts. Through an examination of labour disputes, the article argues that in the context of the West Bank, legal claims have no absolute moral value, but are attractive for the substantive claims that can be made through them, opening up legal avenues for political manipulation. In this context, legal entitlements are distributed according to political resources, rather than legal procedures. The article concludes by arguing that promotion of effective access to legal processes in the West Bank should not be seen as a short‐cut to a stable political regime, since accountable legal processes require a centralized, strong and stable coercive support, based in a measure of organizational cohesion and territorial sovereignty.
Orphans’ Land Rights in Post‐War Rwanda: The Problem of Guardianship
Authors: Rose Laurel L.
Published: October 2005

In 1994, the Rwandan civil war and genocide produced thousands of orphans. Alongside the war, the growing HIV/AIDS crisis in Rwanda has produced a current population of about 300,000 orphans — many of whom are compelled to head households. These orphans urgently require land use rights, but many find that their rights to their deceased parents’ customary land holdings are denied or restricted by their guardians and others. Despite the legal protections for children that are guaranteed within Rwanda's laws, the reality is that many guardians do not respect orphans’ land rights and few orphans have sufficient access to administrative and legal forums to assert and defend these rights. In contrast to most accounts in the literature that discuss more generally the issue of African orphans’ land rights in the context of adults’ land rights, this article focuses on specific cases in which Rwandan orphans independently pursued their land rights. Ultimately, the article concludes that in Rwanda — and elsewhere in Africa — government officials should re‐examine their ideas about guardianship and grant orphans urgent attention as individuals and as a special interest group.
Witchcraft, Social Cohesion and Participation in a South African Village
Authors: Golooba‐Mutebi Frederick
Published: October 2005

The past thirty years have seen development agencies, non‐governmental organizations and their funders embrace ‘participatory’ development strategies. These strategies require the poor to take part in decision‐making about, and the implementation of, development projects and programmes. Underlying enthusiasm for participation is the recognition that centralized, top‐down systems and methods have not delivered development, and the assumption that the poor are eager and able to ‘participate’. Using ethnographic research on witch beliefs and their impact on social relations in a South African village, this article argues that such assumptions are not always justified. It shows that witch beliefs and related conflicts have long‐term negative consequences for intra‐community relations and examines what this implies for development policy and practice.
The nuclear power industry as an alternative analogy for safety in anaesthesia and a novel approach for the conceptualisation of safety goals
Authors: Webster C. S.
Published: October 2005

Safety practices in health care have not kept pace with the increasing complexity of medical technology. Although anaesthesia is generally considered to be a leader in the improvement of patient safety, more powerful safety strategies must be found and employed. From an analysis of system characteristics, the nuclear power industry is proposed as an alternative analogy for safety in anaesthesia, and a novel diagrammatic approach is developed for the conceptualisation of safety goals. The nuclear power industry has spent vastly more time and money than has health care on the development of safety, and has progressed through significant safety milestones approximately three times more quickly than has anaesthesia. The greatest scope for the improvement of safety in anaesthesia lies in the appropriate re‐design of medical systems and the lowering of the threshold for the reporting of incidents to include accident precursors, thus allowing the identification of dangerous systems before accidents occur.
The effects of ambient music on simulated anaesthesia monitoring
Authors: Sanderson P. M. , Tosh N. , Philp S. , Rudie J. , Watson M. O. , Russell W. J.
Published: October 2005

We examined the effect of no music, classical music or rock music on simulated patient monitoring. Twenty‐four non‐anaesthetist participants with high or low levels of musical training were trained to monitor visual and auditory displays of patients' vital signs. In nine anaesthesia test scenarios, participants were asked every 50–70 s whether one of five vital signs was abnormal and the trend of its direction. Abnormality judgements were unaffected by music or musical training. Trend judgements were more accurate when music was playing (p = 0.0004). Musical participants reported trends more accurately (p = 0.004), and non‐musical participants tended to benefit more from music than did the musical participants (p = 0.063). Music may provide a pitch and rhythm standard from which participants can judge changes in vital signs from auditory displays. Nonetheless, both groups reported that it was easier to monitor the patient with no music (p = 0.0001), and easier to rely upon the auditory displays with no music (p = 0.014).
Statin therapy: a potentially useful peri‐operative intervention in patients with cardiovascular disease
Authors: Biccard B. M. , Sear J. W. , Foëx P.
Published: October 2005

Statin cardiovascular protection is mediated by lipid lowering and pleiotropic effects. The efficacy of statins has been established in non‐surgical patients with cardiovascular disease and also more recently in non‐surgical patients who sustain an acute coronary event. Peri‐operative statin administration has been shown to improve both short‐term and long‐term cardiac outcome following non‐cardiac and coronary bypass graft surgery. This cardioprotection may be independent of peri‐operative haemodynamics due to a positive effect on plaque stability. Recommendations for the peri‐operative statin administration are suggested. These include indications for peri‐operative statin therapy, timing of administration, therapeutic targets, duration of administration, the adverse implications of peri‐operative statin withdrawal, safety and cost‐effectiveness.
Continuous prednisoloneversusconventional prednisolone with VMCP–interferon‐α2b as first‐line chemotherapy in elderly patients with multiple myeloma
Authors: Ludwig Heinz , Spicka Ivan , Klener Pavel , Greil Richard , Adam Zdenek , Gisslinger Heinz , Tarkovács Gábor , Linkesch Werner , Maniatis Alice , Morant Rudolf , Drach Johannes , Kuhn Ingrid , Schuster Judith , Hinke Axel
Published: October 2005

We report on a randomised trial that aimed to compare the efficacy of continued daily prednisolone treatment during the entire induction phase, with prednisolone given for 2 weeks of each cycle in combination with VMCP (vincristine, melphalan, cyclophosphamide, prednisolone)–interferon‐α2b (IFN‐α2b) treatment in 299 previously untreated elderly patients (median age: 67 years) with multiple myeloma. After completion of induction treatment patients were randomised to IFN‐α2b with or without prednisolone, thrice weekly. Response rate was 62% in the continuous and 60% in the control arm (intent to treat analysis,P = 0·81). Progression‐free survival [median: 20 months vs. 19 months; hazard ratio (HR): 0·99, 95% confidence interval (CI): 0·74–1·33,P = 0·97] and overall survival (median: 34 months vs. 37 months; HR: 1·16, 95% CI: 0·85–1·59,P = 0·35) were similar in both groups. Reduced performance status (Eastern Cooperative Oncology Group, grades 2–4) was the predominant risk factor for poor survival followed by age >65 years, highβ2‐microglobulin, and impaired renal function. There was more grades 3–4 dyspnoea and cardiac impairment and grades 1–2 hyperglycaemia, but less nausea, emesis and anaemia in patients on continuous prednisolone therapy. In conclusion, continuing prednisolone treatment during the entire duration of the induction phase with VMCP–IFN‐α2b did not improve outcome.
The frequency of double‐positive thymocytes expressing an αβ TCR clonotype regulates peripheral CD4 T cell compartment homeostasis
Authors: Reed Amy J. , Zarrabi Yasaman , Perate Alison L. , Jeganathan Arjun , Naji Ali , Noorchashm Hooman
Published: October 2005

The present study aimed to determine whether the frequency of double positive (DP) thymocytes expressing αβ T‐cell receptor (TCR) clonotypes at the time of selection regulates peripheral CD4 T‐cell compartment size. Scid recipients were inoculated with various ratios of TCR Cα0/0 and wild‐type bone marrow (BM) stem cells. Increasing the frequency of TCR Cα0/0 thymocytes at steady‐state introduced a graded decrease in the maturation probability of the total DP thymocyte pool. At 12–14 weeks following BM inoculation, the frequency of TCR Cα0/0 DP thymocytes was inversely correlated with that of CD4 single positive (SP) thymocytes. Notwithstanding, a decreased frequency of wild‐type DP thymocytes led to a marked increase in their transit efficiency from the DP to SP compartments. The frequency‐dependent increase in thymocyte transit efficiency was associated with a CD4 SP cell surface phenotype indicative of increased antigenic experience. Importantly, the frequency of DP thymocytes capable of expressing TCR clonotypes dictated the steady‐state size of the peripheral CD4 T cell compartment and its potential for homeostatic proliferation. Collectively, these results indicate that the efficiency of DP to CD4 SP transit is a frequency dependent process, which determines (1) the steady‐state size of the peripheral T cell compartment and (2) the threshold for homeostatic expansion of peripheral CD4 T cells.
Overwinter mass loss of snowshoe hares in the Yukon: starvation, stress, adaptation or artefact?
Authors: HODGES KAREN E. , BOONSTRA RUDY , KREBS CHARLES J.
Published: October 2005

Overwinter mass loss can reduce energetic requirements in mammals (Dehnel's phenomenon). Alternatively, mass loss can result from food limitation or high predation risk.

We use data from fertilizer, food‐supplementation and predator‐exclusion experiments in the Yukon during a population cycle from 1986 to 1996 to test the causes of overwinter mass loss by snowshoe hares (Lepus americanus). In all years, some hares on control sites gained mass overwinter. During the increase phase the majority gained mass, but in all other phases the majority lost mass.

Snowshoe hares weighing < 1000 g in autumn always gained mass overwinter, as did the majority that weighed 1000–1400 g. Hares weighing > 1800 g in autumn usually lost mass.

Snowshoe hares on the predator‐exclosure + food site gained mass overwinter in all years. Hares on the food‐supplementation sites lost mass during the decline but gained mass in all other phases. Fertilization had little effect on mass dynamics.

Snowshoe hares were more likely to lose mass during winters with low survival rates. Snowshoe hares on the predator‐exclosure treatments were more likely to gain mass than were hares on control sites.

Overwinter mass loss was correlated with maximum snow depth. At equivalent snow depths, hares on food‐supplemented areas lost 98 g (± 14·6 SE) less on average than hares on the controls and predator‐exclosure treatment.

Bone‐marrow fat was related to body mass and cause of death. Small hares had the lowest marrow fat. Hares killed by humans had higher marrow fat than those killed by predators; hares that simply died had the lowest marrow fat. Hares on food‐supplemented sites had the highest kidney and marrow fat.

Overwinter‐mass loss for snowshoe hares is explained interactively by winter conditions, food supply, predation risk and autumn mass. Some snowshoe hares lost mass overwinter in all years and on all treatments, suggesting that reducing body mass may facilitate survival, especially in cases where foraging costs are high energetically or increase predation risk.
Sexually transmitted disease epidemics in a natural insect population
Authors: WEBBERLEY K. MARY , BUSZKO JAROSŁAW , ISHAM VALERIE , HURST GREGORY D. D.
Published: October 2005

The epidemiology of sexually transmitted diseases (STDs) in human and domesticated populations is well documented. However, there has been less study of STDs in natural populations.

We investigated STD dynamics in the model system involving a host from the most speciose group of animals: the insects. We investigated temporal variation in the prevalence of the sexually transmitted miteCoccipolipus hippodamiaeon its ladybird host,Adalia bipunctata.

Field surveys over two seasons showed a repeated pattern of a profound epidemic in the overwintered cohort and a later prevalence decline.

In order to understand the key factors in the dynamics of this system we studied the phenology of the host and simulated parasite dynamics in the overwintered cohort using a model with within‐sex homogeneity in mating rate and field‐measured parameter values. The similarity of natural and simulation prevalence levels allowed us to carry out sensitivity analysis and hence to identify the key determinants of the dynamics.

The observed pattern of periodic extreme prevalence combined with system persistence probably results from time lags in host recruitment and widespread promiscuity.

Our findings improve our understanding of STDs in natural populations and illustrate the importance of examining seasonality and time delays in population dynamics in order to fully understand the characteristics of natural populations and their parasites.
Periodic habitat loss alters the competitive coexistence between brown trout and bullheads in a small stream over 34 years
Authors: ELLIOTT J. M.
Published: October 2005

Changes in the population density of juvenile sea troutSalmo truttaL. and bullheadsCottus gobioL. were compared in a small stream over 34 years. Both species have a similar diet and obviously live in the same general habitat. Habitat loss was most marked in seven summer droughts: severest in 1976, 1983, 1984, 1995, and less severe but followed by autumn droughts in 1969, 1989 and 1993. The contrasting effects of habitat loss on the two species were examined.

For both species, the Ricker curvilinear model significantly fit (P < 0·001) the relationship between initial egg density and survivor density for successive life stages, even though egg densities were much lower for bullheads than trout. These analyses provided evidence for density‐dependent population regulation and also identified extreme outliers, most being for year‐classes affected by summer droughts.

The variable effects of changes in habitable area (= % wettable area in sampling section) were quantified by using the residuals, each residual being the absolute value expressed as a percentage of the expected value from the Ricker curve. Significant relationships between the residuals and habitable area showed that habitat loss had a marked effect on survivor density, this being negative for 0+ and 1+ trout, and positive for 0+, 1+ and 2+/3+ bullheads.

Therefore, during periods of habitat loss in the summer months, bullhead density increased at the expense of trout density. Low flows and a decrease in wettable area were associated with a marked reduction in habitat quality for drift‐feeding trout and an increase in habitat quality, and perhaps also quantity, for benthic‐feeding bullheads. This case study shows that, during a major perturbation, the relationship between the densities of two species can change markedly in favour of the less numerous species. The competitive coexistence between the two species is therefore a dynamic process that changes through time with periodic changes in the environment.
Depressive symptomatology among Turkish older adults with low incomes in a rural community sample
Authors: Nahcivan Nursen O , Demirezen Esma
Published: October 2005

Aims and objectives.  To identify the characteristics that are associated with depressive symptomatology among Turkish older adults with low income.

Background.  Depression is a major threat to mental health in older people, but little is known about older adults with low income at risk for depressive symptomatology in Turkey.

Design.  This was a cross‐sectional study, based in one area of Istanbul.

Methods.  The sample included 132 older adults in a rural setting living in Istanbul, Turkey. The participants were 55 years of age or older and chosen from among older adults with low income. Data were collected through a structured interview conducted in the homes of the participants.

Results.  High depressive symptoms (Geriatric Depression Scale ≥11) were reported by 50% of the participants. Compared with non‐depressed individuals, those with depressive symptomatology were more likely to be women, widowed, lack health insurance and to live alone. Depressed participants significantly more often reported chronic health conditions compared to non‐depressed participants (OR = 4·11, 95% CI = 1·35, 12·57). Overall well‐being scores were significantly higher in men and in the non‐depressed group. The result of the Pearson correlation provided support for the association between depression scores and overall well‐being scores (r = −0·60).

Conclusions.  Depressive symptomatology is prevalent within Turkish older adults with low income. Further research is needed to examine potential risk factors associated with depressive symptomatology for this population.

Relevance to clinical practice.  Findings may assist health care professionals in assessing high‐risk older people who could benefit from interventions aimed at minimizing depressive symptoms.
An evaluation of a community aged care nurse practitioner service
Authors: Allen Jacqueline , Fabri Anne Marie
Published: October 2005

Evaluation aims.  An evaluation is presented that aimed to augment current understandings of the nurse practitioner role by investigating potential outcomes of a community aged care nurse practitioner (ACNP) service on clients and the health care team.

Background.  In Australia, the nurse practitioner role is being implemented in a variety of health care settings and is characterized by extended practice: prescribing of medications, requests for diagnostic investigations, referral to medical specialists and admitting clients to inpatient facilities.

Design.  An exploratory qualitative evaluation method through data collection by interview and thematic analysis was undertaken.

Method.  All clients referred to the ACNP service between June and August 2003, and a convenience sample of health professionals, were invited to participate in individual semi‐structured interviews.

Results.  Findings suggested that an ACNP could provide a high quality of holistic nursing care and positively affect clients’ physical and psychological symptom management, enhance clients’ quality of life, assist with supplies, provide health education and assist with advocacy. Health professionals commented on effective collaboration with the ACNP service during their partnerships in client care provision.

Conclusions.  Overall, the positive effects of the ACNP service on clients and the health care team support the full implementation of the role within the community setting.

Relevance to clinical practice.  Funding support for the nurse practitioner role is a vital addition to consideration in the development of international policy on advanced practice nursing. Without adequate funding, the full benefits of the nurse practitioner role in clinical practice, as suggested by the findings presented in this evaluation, will be compromised.
Reliability and validity of the Greek version of Kogan's Old People Scale
Authors: Lambrinou Ekaterini , Sourtzi Panayota , Kalokerinou Athena , Lemonidou Chrysoula
Published: October 2005

Aims and objectives.  The aim of this study was to test the psychometric properties – validity and reliability – of the Greek version of Kogan's Old People scale.

Background.  The ageing of the population in most of the developed world and in Greece, challenge‐nursing care, therefore, nursing education needs to be updated accordingly. Until today there have been no studies in Greece in relation to student nurses’ attitudes towards older people. To have a reliable questionnaire for measuring a Greek population's attitudes towards older people the Kogan's Old People Scale was translated into Greek.

Design.  The study was designed as a cross‐sectional survey. The main reason for choosing a cross‐sectional survey was the time limits for the study. A sample of 390 nursing students in Athens participated in the study.

Methods.  A questionnaire was given to the students, which included the Kogan's Old People Scale.

Results.  Results showed Cronbach's alpha coefficient 0·73 for the OP− scale and 0·65 for the OP+ scale, which are comparable to published studies until today. The six‐factor solution explains the 41·5% of the variance in the sample. The scale was also found to differentiate between first and final year students on how their education in nursing is influencing their attitudes towards the older people.

Conclusions.  Reliability and validity supported the Greek version of the Kogan's Old People Scale as a reliable instrument. Its use in evaluating Greek nursing education programmes could help in preparing nurses capable of meeting the needs of older people.

Relevance to clinical practice.  Nursing education – basic and lifelong – needs to be updated in order to respond to the needs of older people and a reliable instrument can help to evaluate it.
Ethical challenges in the care of older people and risk of being burned out among male nurses
Authors: Nordam Ann , Torjuul Kirsti , Sørlie Venke
Published: October 2005

Aim. The aim of this study was to illuminate the meaning of being in ethically difficult situations when caring for older people, as experienced by male nurses.

Background. Nurses and physicians are frequently faced with ethical issues and challenges in their work with older people in hospitals. Male nurses are a minority group in the nursing profession, thus it is important to listen to their lived experiences of the ethical challenges they are faced with in their work.

Method. The study is part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experiences of being in ethically difficult care situations in the care of older people. Five male nurses working at gerontology wards at a university hospital in Norway participated in the study. A phenomenological hermeneutical method was applied.

Results. The narratives revealed that the nurses were focusing on good nursing, emphasizing what meeting the patient entails. They highlighted what they perceived as barriers to good nursing. A third theme was ethical challenges, which lead to emotional and moral strain and a fear of becoming burned out.

Conclusions. Continuous stress, little degree of autonomy and high expectations of oneself are causing the male nurses much moral strain. These factors place them at risk of being burned out. The nurses emphasized that burn out can be counteracted by clinical supervision.

Relevance to clinical practice. It is suggested that the male nurses feeling of doing an important and rewarding job may be essential for protection against becoming burned out and why they can endure being in ethically difficult care situations. Other institutional support structures like ethics education and ethics rounds are suggested to reduce the level of moral strain.
Patients’ informational needs and information received do not correspond in hospital
Authors: Suhonen Riitta , Nenonen Heljä , Laukka Arja , Välimäki Maritta
Published: October 2005

Aims and objectives.  This study describes and compares the information patients want with the information they receive and examines whether this varies between patients.

Background.  Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view.

Design.  Descriptive, survey design with questionnaires.

Methods.  The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non‐parametric tests (Mann–Whitney U, Kruskal–Wallis, McNemar and Wilcoxon Signed Ranks tests).

Results.  Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients’ rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas.

Conclusions.  Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses’ roles in assessing patients’ informational needs to tailor and provide explicit and relevant information to satisfy patients’ informational needs.

Relevance to clinical practice.  More emphasis should be put on developing methods to ascertain patients’ informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web‐based information systems.
A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling
Authors: Huang Tzu‐Ting , Liang Su‐Hwa
Published: October 2005

Aim.  The objective of this study was to examine the effectiveness of a discharge plan in hospitalized elderly patients with hip fracture due to falling.

Background.  Hip fractures are an important cause of morbidity and mortality among older people. Hip fracture patients require ongoing medical and long‐term care services. Discharge plan services can play a very important role for these patients, since the services improved their outcome conditions.

Methods.  Hip fracture patients aged 65 years and older (n = 126), hospitalized due to falling and discharged from a medical centre in northern Taiwan, were randomly assigned to either a comparison group (the routine care) or experimental group (the discharge planning intervention). The outcomes used to determine the effectiveness of the intervention were: length of hospitalized stay, rate of readmission, repeat falls and survival, and activities of daily living.

Results.  The discharge planning intervention decreased length of stay, rate of readmission and rate of survival and improved activities of daily living for intervention group compared with those of control group. Mean total SF‐36 scores of patients in the experimental group were higher than for the control group and both groups had improved quality of life.

Conclusion.  The discharge planning benefited older people with hip fractures. Relevance to clinical practice. A discharge planning intervention by a nurse can improve physical outcomes and quality of life in hip fracture patients.
Plasma homocysteine and microvascular and macrovascular complications in type 1 diabetes: a cross‐sectional nested case–control study
Authors: SOEDAMAH‐MUTHU S. S. , CHATURVEDI N. , TEERLINK T. , IDZIOR‐WALUS B. , FULLER J. H. , STEHOUWER C. D. A. ,   THE EURODIAB PROSPECTIVE COMPLICATIONS STUDY GROUP
Published: October 2005

Objectives.  To examine the independent relationship between plasma total homocysteine (tHcy) and microvascular and macrovascular complications.

Design.  We performed a cross‐sectional nested case–control study from the EURODIAB Prospective Complications Study.

Setting.  A hospital‐based multicentre study at 24 centres in 13 European countries.

Subjects.  A total of 533 type 1 diabetic patients, diagnosed at <36 years of age. Cases (n = 359) were defined as those with one or more complications of diabetes and control subjects (n = 174) were all those with no evidence of any complication.

Main outcome measures.  Retinopathy, albumin excretion rate (AER), glomerular filtration rate (GFR) estimated by Cockcroft–Gault formula, hypertension and cardiovascular disease (CVD) were assessed.

Results.  In unadjusted models, tHcy (per 5 μmol L−1) was significantly associated with nonproliferative retinopathy (OR = 1.45, 95% CI: 1.10–1.91), proliferative retinopathy (OR = 1.74, 95% CI: 1.34–2.27), macroalbuminuria (OR = 1.90, 95% CI: 1.49–2.42), hypertension (OR = 2.23, 95% CI: 1.69–2.93) and CVD (OR = 1.59, 95% CI: 1.18–2.14). In multivariate models, tHcy was significantly related to macroalbuminuria (OR = 1.66, 95% CI: 1.24–2.24) and hypertension (OR = 1.57, 95% CI: 1.19–2.07), independent of age, sex, diabetes duration, GFR, microvascular and macrovascular complications and cardiovascular risk factors. There was a significant relationship between tHcy and decreased GFR, independent of established risk factors. The relationship between tHcy and retinopathy was not independent of albuminuria or GFR. The initial positive relationship with CVD was explained by cardiovascular risk factors.

Conclusion.  In this large study of European type 1 diabetic subjects, increased concentrations of tHcy were independently related to macroalbuminuria, renal function and hypertension, which suggests that tHcy might play an important role in the pathogenesis of vascular complications in type 1 diabetes.
Role of nucleic acid testing in cadaver organ donor screening: detection of hepatitis C virus RNA in seropositive and seronegative donors
Authors: Aswad S. , Khan N. S. , Comanor L. , Chinchilla C. , Corado L. , Mone T. , Mendez R. , Mendez R.
Published: October 2005

Summary.  Hepatitis C virus (HCV) transmission by both seropositive and seronegative cadaver organ donors has been documented, yet nucleic acid testing is not routinely used to identify active infection in these donors prior to transplantation. Between November 2001 and February 2004, we screened 1445 cadaver organ donors for anti‐HCV antibodies with either HCV EIA‐2.0 (Abbott Diagnostics, Chicago, IL, USA) and/or Ortho® HCV Version 3.0 ELISA (Ortho‐Clinical Diagnostics, Raritan, NJ, USA) and confirmed seropositive samples with Chiron RIBA®3.0 SIA (Chiron Corporation, Emeryville, CA, USA). Samples with sufficient volume (n = 726) were tested by the VERSANT® HCV [transcription‐mediated amplification (TMA)] Qualitative assay (Bayer Healthcare LLC, Tarrytown, NY, USA) which can be performed in approximately 5 h. Those with detectable HCV RNA and sufficient volume were quantified by the VERSANT® HCV 3.0 (bDNA) Assay (Bayer Healthcare LLC) and/or the HCV RNA TMA Quantitative Assay (n = 23) and genotyped (n = 57). Seventy‐seven of 1445 (5.3%) donors were seropositive, reactive by either one or both anti‐HCV assays. Fifty‐two of 63 (82.5%) of the seropositive samples had detectable HCV RNA and were genotyped. Seventeen of these samples had quantifications ranging from 128,123 to >7,692,307 IU/mL. Six of 663 (0.9%) seronegative samples had detectable HCV RNA. Their quantifications ranged from <9.3 to 1,464,799 IU/mL, and five of these six were successfully genotyped. As HCV RNA was demonstrated in samples from both our seropositive and seronegative cadaver organ donors, we are now incorporating nucleic acid testing into our donor screening/diagnostic algorithm.
Silymarin treatment of viral hepatitis: a systematic review
Authors: Mayer K. É. , Myers R. P. , Lee S. S.
Published: October 2005

Summary. Silymarin from the milk thistle herb (Silybum marianum) is used by many patients with chronic viral hepatitis, but its efficacy remains unknown. We performed a systematic review of silymarin for the treatment of chronic viral hepatitis B and C. An exhaustive search strategy identified 148 papers that studied silymarin compounds in liver disease. Of these, four trials included patients with hepatitis C, one included hepatitis B patients, and two, unspecified chronic viral hepatitis. However, only one trial exclusively studied patients with hepatitis C, and none involved patients with only hepatitis B. Silymarin treatment resulted in a decrease in serum transaminases compared with baseline in four studies, and compared with placebo in only one study. There is no evidence that silymarin affects viral load or improves liver histology in hepatitis B or C. No studies were found that investigated the use of silymarin concomitantly with interferon, nucleoside analogues, or other conventional treatments for hepatitis B or C. In conclusion, silymarin compounds likely decrease serum transaminases in patients with chronic viral hepatitis, but do not appear to affect viral load or liver histology. Nevertheless it may be worthwhile to determine its effects in conjunction with standard antiviral treatment.
Viral evolution of hepatitis C in injection drug users
Authors: Dove L. , Phung Y. , Bzowej N. , Kim M. , Monto A. , Wright T. L.
Published: October 2005

Summary.  Injection drug users represent the largest cohort of patients with established hepatitis C virus (HCV) infection as well as the group that is at highest risk for new infections. Most published studies have focused on the clinical consequences of established HCV infection and have not examined the consequences of new infection. The aim of the current study was to measure the virological consequences of HCV in patients with ongoing injection drug use that might pose a risk for new and/or for superinfection with additional strains of HCV. We examined the following groups: (a) those with resolved HCV infection with ongoing injection drug use, (b) those with chronic infection who continued to inject and (c) those with chronic infection who no longer injected. Our study demonstrated a spectrum of responses. The majority of patients appeared to be ‘protected’ from new infection. None of six patients with resolved infection had detectable HCV RNA by quantitative or qualitative PCR when followed for 1 year. Similarly, despite ongoing injection drug use, no patient with persistent infection had a ‘switch’ in HCV genotype indicative of possible superinfection. Virological analysis of HCV quasispecies to detect possible infection with new variants of HCV in patients with apparently ‘stable’ infection, indicated divergence of virus over time, divergence that was unrelated to injection drug behaviour. Thus, patients with ongoing or prior HCV infection appear to develop immunity that protects against further infection with HCV despite repeated exposure.