bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of two PEG‐interferon alpha‐2b doses (1.0 or 1.5 μg/kg) combined with ribavirin in interferon‐naïve patients with chronic hepatitis C and up to moderate fibrosis
Authors: Meyer‐Wyss B. , Rich P. , Egger Hp , Helbling B. , Müllhaupt B. , Rammert C. , Gonvers J.‐J. , Oneta C. , Criblez D. , Rossi L. , Borovicka J. , Meyenberger C. , Arn M. , Renner E. L. ,   Swiss Association for the Study of the Liver (SASL)
Published: February 2006

Summary.  Health regulatory approval of the 1.5 μg/kg body weight dose of pegylated interferon (PEG‐I) alpha‐2b in combination with ribavirin for the treatment of chronic hepatitis C was based on a study using PEG‐I alpha‐2b at doses of only 0.5 and 1.5 μg/kg body weight (BW), in spite of the previously shown flat dose–response curve at doses of ≥1.0 μg/kg. Our aim was to compare PEG‐I alpha‐2b 1.0 μg/kg with 1.5 μg/kg, both in combination with ribavirin. Open‐label, randomized study in 227 patients with biopsy‐proven chronic hepatitis C (Metavir ≤F2), receiving oral ribavirin (400 mg, twice daily) in combination with subcutaneous PEG‐I alpha‐2b (1.0 or 1.5 μg/kg, once weekly) for 24 weeks (genotype 2 or 3), or 48 weeks (other genotypes), followed by a 24‐week drug‐free period. Virologic response rates did not differ between the two doses of PEG‐I alpha‐2b: in patients infected with hepatitis C virus (HCV) genotype 1 or 4 treated with PEG‐I 1.0 μg/kg BW, 38% (22/58) had a sustained virologic response compared with 39% (27/70) in the PEG‐I 1.5 μg/kg BW dose group (P = ns). The corresponding values in patients infected with HCV genotype 2 or 3 were 71% (39/55) and 81% (29/36) respectively (P = ns). Adverse events led to transient or permanent dose reductions in fewer patients in the 1.0 μg/kg BW dose group (48/113 patients; 42%) than in the 1.5 μg/kg BW dose group (63/106 patients; 59%, P = 0.015). Furthermore, 89% of patients treated for 24 weeks but only 58% of patients treated for 48 weeks (P < 0.001) tolerated the treatment without relevant dose reduction or premature termination. In combination with ribavirin, PEG‐I alpha‐2b 1.0 μg/kg was as effective as 1.5 μg/kg but was better tolerated in patients with chronic hepatitis C and up to moderate fibrosis.
A conceptual framework based on Activity Theory for mobile CSCL
Authors: Zurita Gustavo , Nussbaum Miguel
Published: February 2006

There is a need for collaborative group activities that promote student social interaction in the classroom. Handheld computers interconnected by a wireless network allow people who work on a common task to interact face to face while maintaining the mediation afforded by a technology‐based system. Wirelessly interconnected handhelds open up new opportunities for introducing collaboration and thereby changing classroom pedagogical practices. We present a conceptual framework and a method for the design of a mobile computer‐supported collaborative learning system based on Activity Theory. An instance of the framework for teaching basic mathematics skills was evaluated with 24 6‐ and 7‐year‐old children in a month‐long study. Positive effects were observed on student social interaction, motivation and learning.
A METAETHICAL OPTION FOR THEISTS
Authors: Swan Kyle
Published: February 2006

John Hare has proposed “prescriptive realism” in an attempt to stake out a middle‐ground position in the twentieth century Anglo‐American debates concerning metaethics between substantive moral realists and antirealist‐expressivists. The account is supposed to preserve both the normativity and objectivity of moral judgments. Hare defends a version of divine command theory. The proposal succeeds in establishing the middle‐ground position Hare intended. However, I argue that prescriptive realism can be strengthened in an interesting way.
ETHICS AND EPISTEMOLOGY  Ecclesial Existence in a Postmodern Era
Authors: O'Neil Michael
Published: February 2006

This essay endeavors to show that application of a universalist epistemic method in theological ethics results in a construal of God, which is, from a biblical perspective, reductionist, and is a form of ethics in which universality is achieved at the expense of plurality. It argues for the formal possibility of an ecclesial ethics grounded in a tradition‐centered rationality. It further argues that such an ethic need not result in a narrow and defensive sectarianism, a rigid and static orthodoxy, or an authoritarian dogmatism. The posture of an ecclesial ethic based on the kind of critical realism advocated here may retain an apologetic and dialogical relation with the broader society, as it seeks to embody the incarnational narrative in its particular context.
MAIMONIDES ON KINGSHIP  The Ethics of Imperial Humility
Authors: Diamond James A.
Published: February 2006

In his adoption of the Maimonidean guidelines for extreme humility, the king acts as the supreme existential model for imitatio dei. Imperial governance, when filtered through the prism of Maimonidean humility, results in a regime that most closely resembles a divine one. Using those who occupy the very bottom of the social and political hierarchy (slaves and orphans) as models, the king projects his own sense of “lowliness” to the people. The king thereby promotes their sense of autonomy, and inhibits any anthropocentrism that would be fostered if he were to be viewed as an autocrat. His administration of the royal office is limited by the ethical and philosophical dictates of humility, thereby offering a window into the distinction between its common (anivut) and extreme (shefal ruah) manifestations. Maimonides does in fact define the parameters of this extraordinary humility, but he chooses to do so within the context of a distinct and concrete personality—that of the king.
ON MEDICINE, CULTURE, AND CHILDREN'S BASIC INTERESTS: A REPLY TO THREE CRITICS
Authors: Miller Richard B.
Published: February 2006

Margaret Mohrmann, Paul Lauritzen, and Sumner Twiss raise questions about my account of basic interests, liberal theory, and the challenges of multiculturalism as developed in Children, Ethics, and Modern Medicine. Their questions point to foundational issues regarding the justification and limitation of parental authority to make decisions on behalf of children in medical and other contexts. One of the central questions in that regard is whether adults' decisions deserve to be respected, especially when they seem contrary to a child's or adolescent's basic interests. Questions about respect, in turn, focus attention on others' decisions about what seems good for families and children, decisions that may be paternalistic or utilitarian. Such decisions are further complicated by a child's or adolescent's budding autonomy and need for respect and recognition. Pediatric bioethics grounded in an account of a child's basic interests produces a theory of negative and positive rights for assessing adults' actions in relation to children, especially (but not only) when adults demand respect in their expressions of care.
RESPONSE TO RICHARD B. MILLER'S CHILDREN, ETHICS, AND MODERN MEDICINE
Authors: Lauritzen Paul
Published: February 2006

In this essay, Paul Lauritzen examines Richard B. Miller's liberal account of pediatric ethics by asking if the duty to promote a child's basic interests is substantial enough to secure the well‐being of children. This question is raised in light of two case studies: daytime TV talk shows that broadcast interviews with sexually active children, and a medical study conducted to test the effect of growth hormone treatment on adult height in peripubertal children. In both cases, Lauritzen argues, children are subjected to potential harms that are not easily explained, and therefore not easily prevented, by appeals to basic interests.
ON CROSS‐CULTURAL CONFLICT AND PEDIATRIC INTERVENTION
Authors: Twiss Sumner B.
Published: February 2006

A critical examination of Richard Miller's position in his recent Children, Ethics, and Modern Medicine on how to handle pediatric interventions in cases of cross‐cultural conflict between parents and doctors with respect to treating young children. Particular emphasis is placed on Miller's interpretation of and arguments about a Hmong case extensively researched by Anne Fadiman in her The Spirit Catches You and You Fall Down. The conclusion drawn is that Miller's position requires further nuance and development, and some recommendations are made toward that end.
Dilation of Virchow‐Robin spaces in CADASIL
Authors: Cumurciuc R. , Guichard J.‐P. , Reizine D. , Gray F. , Bousser M. G. , Chabriat H.
Published: February 2006

To precise the severity of dilated Virchow‐Robin spaces (VRS) in CADASIL patients and to determine their correlation with clinical presentation and other abnormalities on cerebral Magnetic Resonance Imaging (MRI). Dilated VRS were previously associated with aging, hypertension, dementia, epilepsy or migraine. We already reported increased frequency of enlarged VRS in CADASIL patients when compared with family members without the affected haplotype. We analysed clinical and MRI data from 50 CADASIL patients collected prospectively in our center. The presence of dilated VRS was assessed in the subcortical white matter of temporal lobes, the centrum semi‐ovale and the basal ganglia. Their severity in each region was evaluated according to the scale proposed by Heier. We compared the clinical data, the severity of white matter abnormalities and the presence of microbleeds in patients with and without dilated VRS. Seventy‐eight percent of patients in our series had dilated VRS, mostly located in the lentiform nuclei (94%) and subcortical white matter of the temporal lobes (66%). The severity of these lesions was variable but not correlated neither to the extent of white matter abnormalities nor to the clinical presentation in our patients. Only the age was found to be related to the extent of dilated VRS. Dilated VRS are frequent in CADASIL and mostly located in the temporal white matter and basal ganglia. The dilation of perivascular spaces does not seem to be directly related to the occurrence of ischemic or hemorrhagic lesions in CADASIL. In contrast, the relation with age suggests that either aging, progression of vascular wall alterations during the course of the disease, or both of these processes can favour the extension of VRS in CADASIL.
Is there any correlation between severity of epilepsy and cognitive abilities in patients with temporal lobe epilepsy?
Authors: Kramer U. , Kipervasser S. , Neufeld M.Y. , Fried I. , Nagar S. , Andelman F.
Published: February 2006

Frequent refractory seizures may cause cognitive deterioration when they present at an early age, especially in infants. The findings of previous studies designed to examine the impact of repetitive seizures on cognition in adolescents and adults, however, have shown wide variation. We analyzed the data of neuropsychological evaluations of patients before they underwent temporal lobe resection because of refractory seizure disorder in our institution from 1998 to 2001. Forty‐four consecutive patients aged 12–48 years underwent a comprehensive neuropsychological evaluation that included a battery of selected visual and verbal memory tests. Statistical analysis revealed no significant correlation between disease‐related parameters, such as age of onset, duration of active disease, estimated cumulative number of complex partial seizures and secondarily generalized seizures, and the results of neuropsychological tests. These findings support the hypothesis that factors other than repetitive seizures are responsible for cognitive dysfunction among adolescents and adults.
The relationship between neuropeptide Y expression and headache in pituitary tumours
Authors: Levy M.J. , Classey J.D. , Maneesri S. , Meeran K. , Powell M. , Goadsby P.J.
Published: February 2006

Patients with pituitary tumours often present with disabling headache but there is no clear relationship between tumour size and headache. Neuropeptide Y (NPY) has been identified in pituitary tumours and may serve as a biochemical marker of the propensity for headache. Using immunohistochemical techniques we examined 27 consecutive pituitary adenoma specimens for NPY (including one normal postmortem control anterior pituitary specimen). A separate observer divided the patients into two groups: headache and non‐headache. The association between the presence of NPY and headache was tested. NPY positive immunoreactivity was seen in 13 tumour specimens (50%, 13 of 26 pituitary tumour specimens), characterized by cytoplasmic and nuclear staining patterns. There was no significant association between the presence of NPY and headache (χ2 = 0.9, P = 0.34). We did not observe NPY in the normal anterior pituitary control specimen. NPY was present in four of five (80%) growth hormone‐secreting tumours and two of two (100%) prolactinomas, compared with four of 11 (36%) non‐functioning adenomas. The mechanism of many pituitary tumour‐associated headaches remains undetermined. The significance of NPY positivity in pituitary tumours is unknown, although the results of this study may implicate this peptide in the control of somatotroph and lactotroph activity. Our data do not support a clear role for NPY pituitary tumour‐associated headache.
Correlation between regional myasthenic weakness and mental aspects of quality of life
Authors: Rostedt A. , Padua L. , Stålberg E. V.
Published: February 2006

Here we report how the different types of regional muscle involvement, i.e. bulbar, ocular or generalized, in patients with myasthenia gravis (MG) influence the mental aspects of quality of life. Clinical examination according to Osserman was performed in 48 MG patients (45 women, three men; mean age 54, SD 12 years). Each patient was at the time for clinical evaluation asked to fill out the disease‐specific Myasthenia Gravis Questionnaire (MGQ) and the Short‐Form 36‐item questionnaire for health survey (SF‐36) as patient‐oriented tools. We related the regional domains (generalized domain, bulbar domain and ocular domain) of the MGQ and the clinical findings, respectively, with mental quality of life as assessed by SF‐36. Bulbar and generalized involvement results in impairment of mental aspects of quality of life, whereas ocular involvement does not.
A case series of young stroke in Rome
Authors: Rasura M. , Spalloni A. , Ferrari M. , De Castro S. , Patella R. , Di Lisi F. , Beccia M.
Published: February 2006

In this hospital case series study we enrolled 394 consecutive ischemic stroke patients aged 14–47 years, all of whom were submitted to a diagnostic protocol. We evaluated the incidence of cerebral ischemia in young adults, as well as the risk factors and the etiopathogenesis of this pathology. Modified diagnostic criteria adopted from the TOAST and Baltimore–Washington Cooperative Young Stroke Study were used for the etiologic classification. The crude annual incidence rate was 8.8/100 000 (95% CI 7.7–9.9), which is in keeping with the rates reported in comparable registries. Risk factors were distributed as follows: smoking in 56% of patients, hypertension in 23%, dyslipidemia in 15%, migraine in 26%, and diabetes mellitus in 2%. Oral contraceptives were being taken by 38% of the women enrolled. The etiology of stroke in the patients was as follows: cardioembolism in 34%, atherothrombosis in 12%, non‐atherosclerotic vasculopathies in 14% (including arterial dissection in 12%), other determined causes in 13%, lacunar stroke in 2.5%, migraine in 1%, and undetermined causes in 24%. Despite its biased sampling frame, this large hospital case series, in which risk factor distribution and etiopathogenesis were investigated, stresses the need for an adequate diagnostic approach in young ischemic patients.
Cerebral vasomotor reactivity of bilateral severe carotid stenosis: is stroke unavoidable?
Authors: Gur A. Y. , Bornstein N. M.
Published: February 2006

We evaluated the cerebral hemodynamic features of severe bilateral carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. VMR was evaluated by recording the percentage differences in peak systolic blood flow velocity in each MCA and VA at baseline and by the Diamox test. Twenty‐eight symptomatic (SCAS) and 31 asymptomatic (ACAS) patients with bilateral severe (>70%) internal carotid artery stenosis were studied. The mean MCA VMR% was 29 ± 26.9% in SCAS and 43.2 ± 26.8% in ACAS patients (P < 0.01). Their respective mean VA VMR% was 30.2 ± 36.5% and 39.6 ± 24.4% (P = NS). VMR% of the symptomatic MCA side in SCAS patients was significantly lower than the opposite side (20.5 ± 31.1% and 39.2 ± 37.9% respectively; P < 0.03). In contrast, the VA VMR% of both sides in SCAS patients remained similar (28.1 ± 39.3% and 34.6 ± 47.9% respectively; P = NS). VMR% of the MCA and VA in ACAS patients was also similar for both sides of bilateral carotid stenosis. The cerebral hemodynamic features differ between SCAS and ACAS patients with bilateral carotid occlusive disease in the anterior part of the circle of Willis. An independent cerebral vascular reserve capacity of the posterior circulation is proposed.
Anti‐ganglioside antibodies and elevated CSF IgG levels in Guillain‐Barré syndrome
Authors: Matà S. , Galli E. , Amantini A. , Pinto F. , Sorbi S. , Lolli F.
Published: February 2006

Anti‐ganglioside antibody production and dysfunction of blood‐cerebrospinal fluid (CSF) barrier (BCB) are frequent findings in dysimmune neuropathy patients, whereas intrathecal synthesis of immunoglobulins is still a matter of debate. We examined the CSF, immunological and electrophysiological characteristics from a cohort of patients with Guillain‐Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), and from patients with other neurological diseases as control. Thirty‐eight percent of GBS patients and 28% of CIDP patients had detectable serum titers of anti‐ganglioside antibodies, which were associated with a high incidence of motor conduction block and increased F wave latencies. In GBS patients, but not in CIDP or control patients, there was an association between anti‐ganglioside antibodies and increased CSF immunoglobulin‐G (IgG) levels as determined by the IgG index. However, none of the GBS patients had CSF oligoclonal bands (OBs) or indications of intrathecal anti‐ganglioside antibody synthesis. The possibility of an abnormal CSF concentration of immunoglobulins from serum through dysfunctional BCB or damaged nerve roots, and the role of serum anti‐ganglioside reactivity in this process are discussed.
Juvenile myoclonic epilepsy: non‐classic electroencephalographical presentation in adult patients*
Authors: Baise‐Zung C. , Guilhoto L. M. F. F. , Grossmann R. M.
Published: February 2006

Although diagnosis of juvenile myoclonic epilepsy (JME), a common form of idiopathic generalized epilepsy, is based on clinical and electroencephalogram (EEG) criteria, at times clinical symptoms may be misleading, like the occurrence of asymmetric myoclonic jerks. Thus EEG assumes an important role in these cases, it can fail to show the classical polyspike and slow wave (PSW) discharges of JME, specially in a routine evaluation in older patients. We analyzed retrospectively EEG results of 35 patients with JME [Commission on Classification and Terminology of the International League Against Epilepsy (ILAE) Epilepsia 1989; 30: 389] aged 12–44 years. (mean 22.7 years) at first medical evaluation. EEG findings of 35 patients (19 females, 16 males) with JME consisted of normal tracings in 22.9 and 54.3% had at least one normal exam. EEG abnormalities present in 27 patients (77.1%) consisted of isolated generalized slowing in two and generalized discharges in 25: irregular spike and wave complexes (SWC) in 76%; PSW in 48%; SWC faster than 3 Hz in 20%; spikes, sharp waves, and irregular slow waves in 24%; asymmetric generalized epileptiform discharges in 40%; and associated focal paroxysms in 12%. Thus JME is classically associated to PSW on EEG, the most frequent abnormality was irregular SWC. Generalized paroxysms could occur in an asymmetric fashion and rarely associated to focal activity.
Delusion symptoms are associated with ApoE ε4 allelic variant at the early stage of Alzheimer's disease with late onset
Authors: Spalletta G. , Bernardini S. , Bellincampi L. , Federici G. , Trequattrini A. , Caltagirone C.
Published: February 2006

Alzheimer's disease (AD) is a neurodegenerative disorder with mixed cognitive and behavioural clinical manifestations. The possession of apolipoprotein‐E (ApoE) ε4 allelic variant is one of the most important risk factors for developing late‐onset AD (LOAD). In this study we analysed the relationship between the entire range of behavioural symptoms, cognitive deficit, and sociodemographic characteristics and ApoE ε4 allele possession with multivariate logistic regression models in LOAD patients. Patients included (n = 171) were consecutively admitted in a memory clinic for the first diagnostic visit. Levels of behaviour and cognition within the last month were assessed by the Neuropsychiatric Inventory and Mini Mental State Examination. Presence of clinically significant psychosis, delusions and hallucinations at the early stage of the illness, from the onset to the first visit, was measured with diagnostic criteria. ApoE ε4 allele possession was associated with increased levels of delusions within the last month from the first visit (OR 1.23; 95% CI 1.01–1.50; P < 0.05) and with the presence of categorical delusions at the early stage until the first visit (OR 3.11; 95% CI 1.21–8.01; P < 0.02). In this study, which considers the entire range of behavioural expressions in LOAD patients at the early stage of the illness, the relationship between behaviour and ApoE ε4 allele is confirmed for delusions only.
Varied electrophysiologic patterns in spinocerebellar ataxia type 2
Authors: Crum B. A. , Josephs K. A.
Published: February 2006

The autosomal dominant ataxias are a heterogenous group of disorders. Almost 30 different genetic loci have been identified. Spinocerebellar ataxia type 2 (SCA2) is one of many autosomal dominant cerebellar ataxias. Electrophysiologic studies in SCA2 have shown mainly a sensory neuropathy or neuronopathy. To determine if electrophysiologic testing reveals concomitant or isolated involvement of motor nerves in SCA2 we reviewed historic and electrophysiologic data on all cases of genetically confirmed SCA2 who underwent nerve conduction studies and needle electromyographic during initial evaluation at our institution. We performed electrophysiologic studies in six genetically confirmed, unrelated, cases of SCA2 and discovered that in three patients, there were findings consistent with motor neuronopathy or neuropathy without sensory involvement. One patient had normal results and only one had a pure sensory neuropathy or neuronopathy. The sixth patients had mixed sensorimotor neuropathy. This is the first study that demonstrates isolated involvement of motor neurons and/or axons occur in SCA2. Therefore, electrophysiologic findings in SCA2 are not limited to mainly a sensory neuropathy but are varied and can even mimic slowly progressive motor neuron disease.
Stroke and treatment with nasal CPAP
Authors: Palombini L. , Guilleminault C.
Published: February 2006

Stroke patients present a high prevalence of obstructive sleep apnea (OSA) and those with OSA have a higher mortality after 1 year and poorer functional outcome compared with others. The aim of this study was to prospectively evaluate the acceptance of nasal continuous positive airway pressure (CPAP) by recent stroke patients with OSA. Recruitment of non‐comatose stroke patients with sufficient consciousness for diagnostic evaluation of OSA was performed and they were treated at home with nasal CPAP after hospital calibration and training on the usage of CPAP. Initial evaluation and regular follow‐up of the home trial of auto‐CPAP was carried out for a duration of 8 weeks. Of 50 initially recruited patients, 32 (100%) responded to the minimum cognitive criteria but seven patients (22%) only used nasal CPAP for 8 weeks. Subject dropout was related to difficulties with CPAP usage as perceived by patient and family members, facial weakness, motor impairment and increase difficulties and discomfort with usage of full‐face mask. The majority of OSA stroke patients rejected CPAP treatment. Better education and support of patients and families, and special training sessions in rehabilitation services, will be needed to improve compliance.
Mycoplasma pneumoniae‐associated myelitis: a comprehensive review
Authors: Tsiodras S. , Kelesidis Th. , Kelesidis I. , Voumbourakis K. , Giamarellou H.
Published: February 2006

Myelitis is one of the most severe central nervous system complications seen in association with Mycoplasma pneumoniae infections and both acute transverse myelitis (ATM) as well as acute disseminated encephalomyelitis (ADEM) have been observed. We reviewed all available literature on cases of Mycoplasma spp. associated ATM as well as ADEM with dominant spinal cord pathology and classified those cases according to the strength of evidence implicating M. pneumoniae as the cause. A wide range of data on diagnosis, epidemiology, immunopathogenesis, clinical picture, laboratory diagnosis, neuroimaging and treatment for this rare entity is presented. The use of highly sensitive and specific molecular diagnostic techniques may assist in clearly elucidating the role of M. pneumoniae in ATM/ADEM syndromes in the near future. Immunomodulating therapies may have a role in treating such cases.
Mini‐Mental State Examination: standardization and validation for the elderly Slovenian population
Authors: Rakuša M. , Granda G. , Kogoj A. , Mlakar J. , Vodušek D. B.
Published: February 2006

For more than two decades Mini‐Mental State Examination (MMSE) has been adapted to the Slovenian language as ‘Kratek preizkus spoznavnih sposobnosti’ (KPSS). In this study, we evaluated the influences of age and education on the KPSS score, looking for the cut‐off point with the optimal ratio of sensitivity (SE) and specificity (SP) to support the use of the KPSS as a screening tool. During the years 2000–03 we examined 258 Slovenian volunteers. Volunteers were divided in two groups based on clinical criteria. A total of 189 were healthy, aged from 45 to 96 years, 69 were demented patients aged from 46 to 91 years, of both sexes, all different levels of education and different degrees of dementia. Median value, SE, SP, positive predictive power and negative predictive power were calculated at cut‐off points 23/24, 24/25, 25/26 and 26/27. Younger age and higher education (at least 10 years of education) were each associated with higher KPSS scores. The Slovenian modification of the MMSE demonstrates an optimal cut‐off score at 25/26 points for screening dementia in the Slovenian population, due to the best SP (75%)/SE (73%) ratio. The cut‐off level 26/27 is recommended for screening highly educated persons.
Intraepidermal nerve fibre density, quantitative sensory testing and nerve conduction studies in a patient material with symptoms and signs of sensory polyneuropathy
Authors: Løseth S. , Lindal S. , Stålberg E. , Mellgren S. I.
Published: February 2006

Small diameter nerve fibre (SDNF) neuropathy is an axonal sensory neuropathy affecting unmyelinated (C) and thin myelinated (A‐delta) fibres. We have evaluated 75 patients with symptoms and signs suggesting SDNF dysfunction with or without symptoms and signs of co‐existing large diameter nerve fibre involvement. The patients were examined clinically and underwent skin biopsy, quantitative sensory testing (QST) and nerve conduction studies (NCS). The purpose of this study was to compare the relationship between the different methods and in particular measurements of thermal thresholds and intraepidermal nerve fibre (IENF) density in the same site of the distal leg. The main subdivision of the patient material was made according to the overall NCS pattern. Patients with normal NCS (38) had 6.4 ± 3.8 and patients with abnormal NCS (37) had 4.4 ± 3.4 IENF per mm (P = 0.02). Limen (difference between warm and cold perception thresholds) was significantly higher (more abnormal) in those with abnormal than in those with normal NCS (22.1 ± 9.1 vs. 13.4 ± 5.6, P < 0.0001). Cold perception threshold was more abnormal (P < 0.0001) than warm perception threshold (P = 0.002). Correlation between IENF and QST was statistically significant only when NCS was abnormal, and thus dependent of a more severe neuropathic process in SDNFs.
Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study
Authors: Price J , Farmer G , Harris J , Hope T , Kennedy S , Mayou R
Published: February 2006

Objective  To describe the attitudes that women with chronic pelvic pain (CPP) attending gynaecology clinics have to their consultations and to determine the ways in which their health care can be improved.

Design  Qualitative study using semistructured individual interviews.

Setting  UK gynaecology outpatient clinics in district general and teaching hospitals.

Sample  Twenty‐six women with CPP.

Methods  Semistructured individual interviews were conducted. Data gathering and analysis followed a grounded theory approach.

Main outcome measures  Women's wishes regarding their care and their actual experiences of care.

Results  Four main themes emerged. The women wanted (a) personal care, which they often did not receive; (b) to feel understood and to be taken seriously, although they often felt dismissed, which applied both to women with and without an explanation for their pain; (c) explanation as much as cure, but an adequate explanation was often not provided; and (d) to be reassured, which often they were not. Effective reassurance was complex as it included general reassurance and specific reassurance about cause and treatment.

Conclusions  Improvements are needed in the outpatient care of women presenting with CPP. Changes should focus on providing more personal care, so that presenting problems are seen to be taken seriously, findings and management are appropriately explained, and women are more effectively reassured. Interventions need to be developed that meet these needs and tested to determine if they are feasible, acceptable, and improve outcomes.
Mode of delivery is associated with maternal and fetal endocrine stress response
Authors: Vogl SE , Worda C , Egarter C , Bieglmayer C , Szekeres T , Huber J , Husslein P
Published: February 2006

Objective  To determine whether mode of delivery is associated with the endocrine stress response in mother and child.

Design  Prospective observational study.

Setting  Tertiary care centre, University hospital.

Population  A total of 103 nulliparous women with uncomplicated singleton pregnancies at term undergoing either spontaneous labour for vaginal delivery or delivering by caesarean section without labour. Thirty women delivered vaginally without any pain relief, 21 women delivered vaginally with epidural anaesthesia, 23 women had ventouse extraction and 29 women underwent caesarean section with epidural analgesia.

Methods  After delivery, maternal and umbilical cord blood was collected for determination of different stress‐associated hormones.

Main outcome measures  Concentrations of epinephrine (EP), norepinephrine (NOR), adrenocorticotropic hormone (ACTH), cortisol (CORT), prolactin (PRL), corticotropin‐releasing factor and beta‐endorphin (BE).

Results  Caesarean section was associated with significantly lower maternal concentrations of EP, NOR, ACTH, CORT, PRL and BE and lower newborn levels of EP, NOR and CORT compared with all other modes of delivery. Concentrations of EP, ACTH and BE differed significantly in newborns delivered by normal vaginal delivery, vaginal delivery with epidural anaesthesia and ventouse extraction.

Conclusions  The mode of delivery and analgesia used during birth are associated with maternal and fetal endocrine stress responses.
The effect of image size on screen‐positive rates for nuchal translucency screening
Authors: Teoh M , Meagher SE , Choong S , Shekleton P , Wallace EM
Published: February 2006

It has been shown previously that the absolute measurement of nuchal translucency (NT) thickness, one of the most effective screening tests for fetal Down syndrome, significantly decreases with increasing image size. We undertook a prospective study to assess whether this effect materially alters the NT‐derived risk estimation for fetal Down syndrome. In 350 women, NT was measured at both 100 and 200% image sizes. The median NT measurement at 200% was 8% smaller than at 100%. The screen‐positive rates at 100 and 200% image sizes were 5.1% (18/350) and 2.3% (8/350), respectively (P= 0.048). Altering the image magnification settings is likely to decrease the sensitivity of NT‐derived Down syndrome risk estimation. Further study is required to test the effect of our finding on the sensitivity of NT screening and to assess whether adjustments in gain settings mitigate the effect.
Risk factors for developing residual urinary incontinence after obstetric fistula repair
Authors: Browning A
Published: February 2006

Obstetric vesicovaginal fistula is a devastating cause of urinary incontinence worldwide. More attention is being focused on treating these patients by various philanthropic societies but very little is known about the complications of surgery. One of the most common complications is that the woman is left with residual urinary incontinence despite the defect being successfully closed. If risk factors for this could be identified, then perhaps more appropriate surgical techniques could be developed with the aim of remedying the incontinence.
End‐of‐life in a Swedish population: demographics, social conditions and characteristics of places of death
Authors: Jakobsson Eva , Johnsson Tommy , Persson Lars‐Olof , Gaston‐Johansson Fannie
Published: February 2006

The objectives of this study were to identify and describe the demographics and social conditions as well as characteristics of the places of death in a randomly selected sample that died in a county in Sweden during 2001. The present study reports part of the findings from a larger study undertaken during 2003 using a survey design of retrospective reviews of death certificates, medical records, and nursing records. Among several noteworthy findings are: first, an examination of these individuals' living arrangements reveal not only a large and vulnerable group that lives alone at the end‐of‐life but also a group living separated from their partners near end‐of‐life; second, individuals differ with respect to residence prior to death, that is private homes versus residential care facilities, imparting highly different contexts of care at the end‐of‐life; and third, a high prevalence of institutionalized deaths demonstrates that places of death other than hospitals and residential care facilities are uncommon, if not rare. It is concluded that increased attention to the social circumstances of the time period surrounding individuals' at the end‐of‐life is essential.

There is need to develop more integrated models of care for dying people. Contemporary services available are not designed to meet a wide range of peoples' needs at the end‐of‐life. Home‐based care, residential care and hospital care must be adapted to the changing patterns of dying. The services available should be organized to the benefit of the users rather than around the providers. This is the first study of its kind of a Swedish sample and while the data are limited to one county in Sweden its findings may contribute to a deeper understanding of demographic and social patterns at the end‐of‐life in general.
Technological dependency – the experience of using home ventilators and long‐term oxygen therapy: patients’ and families’ perspective
Authors: Ingadóttir Thorbjorg Sóley , Jonsdottir Helga
Published: February 2006

Technological dependency is defined as a short or long‐term reliance on machines and techniques to evaluate, satisfy or resolve health problems. In nursing technological dependency has been explored in the context of caring. Hitherto it has been maintained that technology and caring are contradictory, but a more prominent view is that technology and caring can and must be reconciled to provide high‐quality care. This study describes patients’ and families’ experience of long‐term home treatment with noninvasive ventilation during sleep with or without additional oxygen therapy. Considering the potential burden of undergoing this treatment the research question is: What is patients’ and families’ experience of being dependent on technical breathing assistance during sleep? The methodological approach draws from interpretive phenomenology and narrative analysis. Participants were six patients aged 45–70, five spouses and one daughter. Data, generated through two 1‐hour semi‐structured interviews with each pair of participants, were analysed into themes. Results are presented by the following narratives: (i) mixed blessing: life‐saving treatment – meaningless exertion; (ii) compassion and understanding central amid use of complex machines; (iii) listening to the body; (iv) wanting to be seen as healthy; (v) dominance of technological thinking; and (vi) sustained work in maintaining the treatment. It is concluded that being dependent on technical breathing assistance during sleep, with or without oxygen, was a major life event for participants. The treatment was experienced as constraining and intrusive, particularly at the beginning, but concurrently it dramatically relieved difficulties for most participants. Regardless of its usefulness it provoked questions on purpose, indicating that the way to implement the treatment is crucial. Professionals need to pay close attention to how they introduce noninvasive ventilation technique, putting caring concern and respect for unique needs of patients and their families at the forefront.
Psychosocial work stress is associated with poor self‐rated health in Danish nurses: a test of the effort–reward imbalance model
Authors: Weyers Simone , Peter Richard , Boggild Henrik , Jeppesen Hans Jeppe , Siegrist Johannes
Published: February 2006

Nursing staff are exposed to stressful work load which in turn is associated with poor physical and psychological health, sickness absence and job exit. The effort–reward imbalance (ERI) model is a validated approach to measure chronic psychosocial work stress by identifying nonreciprocity between occupational efforts spent and rewards received, and has been found to predict poor health. The aim of this cross‐sectional study (n = 367 nurses and nurses aides) was first to test the psychometric properties of the Danish questionnaire measuring ERI, and secondly to analyse whether psychosocial work stress is associated with six indicators of poor self‐rated health. Results derived from confirmatory factor analysis indicate satisfying psychometric properties. Elevated risks of poor self‐rated health (odds ratios varying from 1.92 to 4.76) are observed in nursing staff characterized by high effort in combination with low reward. Effects are enhanced in those respondents who additionally exhibit a high level of work‐related overcommitment. In conclusion, despite methodological limitations, this study contributes to the validation of the ERI questionnaire in Danish language. Furthermore, by documenting associations with poor self‐rated health, it supports efforts of theory‐guided prevention of work stress in health care professions.
Mothers’ experiences of having their newborn child in a neonatal intensive care unit
Authors: Wigert Helena , Johansson Renée , Berg Marie , Hellström Anna Lena
Published: February 2006

Background:  From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU.

Aim:  The aim of this study was to describe mothers’ experiences when their full‐term newborn child was cared for in a NICU during the postpartum maternity care period.

Method:  A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience.

Results:  The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers’ experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU.
Health resources and health strategies among older Swedish‐speaking Finns – a hermeneutic study
Authors: Kulla Gunilla , Sarvimäki Anneli , Fagerström Lisbeth
Published: February 2006

Research has shown that the Swedish‐speaking Finns have better health than the Finnish‐speaking majority. The aim of this paper was to explore the health resources and health strategies among home‐dwelling Swedish‐speaking Finns aged 75 or older. The objective was to develop health‐promotive nursing care for this group. Data was collected through recorded semistructured conversations with 22 older persons. The conversations were transcribed and interpreted through a hermeneutic approach. The material was read through several times and compiled into 22 narratives with relevant quotations. The narratives were subsequently summarised into one core narrative under each major category, to present the health resources and health strategies. Six categories were found: the Positive, the Social, the Active, the Adaptable, the Stubborn and the Passive. Within the Positive category, morale played an important role as a health resource and health strategy. Within the Social category, social activities were regarded as both health resources and health strategies, whereas their absence was a health obstacle. Within the Active category, a wide range of physical activities played an important role. Within the Adaptable category, contentment was a health resource. Within the Stubborn category, stubbornness itself was a health resource, whereas strong belief was a health strategy. Within the Passive category, although health obstacles permeated the life context, contentment and caution were seen as health resources. The vision of the future varied from the confidence found in the Positive category to the uncertainty prevalent in the Passive category. The main health resources and strategies used by the elderly Swedish‐speaking Finns were related to social and other activities as well as to personality. Transforming health obstacles into resources could be an important health‐promotive nursing strategy.
Mental health professional support in families with a member suffering from severe mental illness: a grounded theory model
Authors: Gavois Helena , Paulsson Gun , Fridlund Bengt
Published: February 2006

The aim of this study was to develop a model of mental health professional (MHP) support based on the needs of families with a member suffering from severe mental illness (SMI). Twelve family members were interviewed with the focus on their needs of support by MHP, then the interviews were analyzed according to the grounded theory method. The generated model of MHP support had two core categories: the family members’ process from crisis to recovery and their interaction with the MHP about mental health/illness and daily living of the person with SMI. Interaction based on ongoing contact between MHP and family members influenced the family members’ process from crisis towards recovery. Four MHP strategies – being present, listening, sharing and empowering – met the family members’ needs of support in the different stages of the crisis. Being present includes early contact, early information and protection by MHP at onset of illness or relapse. Listening includes assessing burden, maintaining contact and confirmation in daily living for the person with SMI. Sharing between MHP and family members includes co‐ordination, open communication and security in daily living for the person with SMI. Finally, the MHP strategy empowering includes creating a context, counselling and encouraging development for the family members. The present model has a holistic approach and can be used as an overall guide for MHP support in clinical care of families of persons with SMI. For future studies, it is important to study the interaction of the family with SMI and the connection between hope, coping and empowerment.
Hyperarousal, depression and quality of life – validity and reliability of the Swedish version of the Hyperarousal Scale
Authors: Edéll‐Gustafsson Ulla , Carstensen John , Regestein Quentin , Swahn Eva , Svanborg Eva
Published: February 2006

Aim:  Research focusing on hyperarousability in association with general sensitivity to stress has increased. This study aimed to: (i) describe values for self‐reported hyperarousal behaviour traits, depression, sleeplessness behaviour and health‐related quality of life [The Short Form 36 Health Survey Questionnaire (SF‐36)] in a gender‐stratified random sample from the Swedish population; and (ii) test the validity and reliability of the Swedish version of the Hyperarousal Behavioural Trait Scale (H‐scale).

Methods:  In this study, 402 women and 391 men from Sweden were included. A test–retest study was performed on 297 subjects.

Results:  The total mean score on the H‐scale was 29.5 (SD 10.0, 95% CI 28.8–30.2). Compared to men, women scored higher on the H‐scale (total score, sub‐scales and many items), whereas no evidence of an age trend was seen. The H‐scale has proven to be a valid and reliable scale. Pearson's correlation coefficient showed similar magnitude and direction between the H‐scale and the Zung's Self‐rating Depression Scale, as between the H‐scale and the Vicious Cycle of Sleeplessness Behaviour Scale, Vitality, Mental Health and the Mental Component Summary index on the SF‐36 respectively. The Cronbach's alpha for the H‐scale was 0.84 and estimated stability test–retest point of time varies between 0.73 and 0.80.

Conclusions:  This study indicates gender differences in response style in association with altered health‐related quality of life. The H‐scale is a valid and reliable self‐reported scale for measuring hyperarousal behavioural trait research outcome in clinical practice.