bluuebunny/crossref_metadata_2025_split huggingface dataset:
Failure to Thrive and the Risk of Child Abuse: A Prospective Population Survey
Authors: Skuse David H , Gill Dorothy , Reilly Sheena , Wolke Dieter , Lynch Margaret A 
Published: January 2017

Objective — To identify the relative importance of failure to thrive during infancy as a risk factor for later abuse or neglect. Design — Whole population birth cohort (1 January to 31 December 1986) studied prospectively over a four year period. Setting — An inner city health district in London, England. Subjects — 2609 births, of whom 47 were identified as having non-organic failure to thrive by first birthday. Main outcome measures — Registration on Child Protection Register, or subject to investigation of suspected abuse or neglect without registration. Results — 2·5% (64) of birth cohort had been placed on the Child Protection Register during the period 1986–1990, and a further 1·2% (32) had been a cause for concern. The relative risk attributable to nonorganic failure to thrive was 4·3 (95% CI 1·65 to 11·94) and exceeded other measured risk factors, including birth weight <2500g, 1·96 (95% CI 1·01 to 3·82); gestation <35 weeks, 3·26 (95% CI 1·32 to 3·75); ordinal position >4, 1·53 (95% CI 0·72 to 3·23). A multiple logistic regression confirmed the independent contribution of non-organic failure to thrive to subsequent poor parenting warranting professional intervention. Conclusions — Early postnatal non-organic failure to thrive is a risk factor for later serious parenting deficiencies, but previous research has overstated its importance. Within the community studied the nature of subsequent risk was (non-nutritional) neglect, rather than non-accidental injury. More than eight out of 10 cases do not give further cause for concern.
The Oxford Growth Study: A District Growth Surveillance Programme 1988–1994
Authors: Ahmed Marion L , Allen Alison D , Dunger David B , Macfarlane Aidan 
Published: January 2017

Objectives — To develop a method of community based growth assessment. Setting — Oxford District, United Kingdom. Methods — A system of growth surveillance involving a community consultant paediatrician, a paediatric endocrinologist, a clinical auxologist, a project coordinator, and the many primary health care teams was started. Letters and meetings were arranged to introduce the programme to general practitioners and health visitors, emphasising the importance of growth assessment in normal child development. They were asked to measure all children as part of their routine developmental checks at 3 and 4·5 years of age. Community growth assessment clinics staffed by an experienced auxologist were established. Children whose heights were more than two standard deviation (SD) scores below the mean or whose height SD score decreased between the two ages were referred to the clinic. Any child whose height was more than 3 SD scores below the mean was referred directly to the paediatric endocrinologist. Those seen in the community clinics were followed up for a year and if their velocity was >25th centile, karyotype normal, and bone age appropriately delayed, they were discharged to the general practitioner for further follow up. Any child with an annual velocity <25th centile was referred to the endocrinologist. Results — Of 20 338 children monitored, 260 (1·3%) had heights >−2 SD scores. Seventy six were lost to follow up, 35 were measuring errors, 69 were already seeing a paediatrician, leaving 80 children to be evaluated. Of these, 69 were “short normals” and 11 were newly identified diagnoses. Conclusions — This system of secondary referral keeps normal healthy children out of hospital, avoids unnecessary over-investigation, reduces travel and anxiety for families, avoids filling specialist clinics with normal children, and provides an inexpensive system of growth surveillance.
An Overview of the Swedish Randomised Mammography Trials: Total Mortality Pattern and the Representivity of the Study Cohorts
Authors: Nyström Lennarth , Larsson Lars-Gunnar , Wall Stig , Rutqvist Lars Erik , Andersson Ingvar , Bjurstam Nils , Fagerberg Gunnar , Frisell Jan , Tabár Laszlo 
Published: January 2017

Objectives –To analyse the cause of death pattern in the cohorts of women included in the Swedish randomised mammography screening trials by comparing the groups of invited and control women both with each other and with the general population of Swedish women. Setting –Since 1977 four randomised trials of mammography screening have been performed in Sweden: Malmö, Kopparberg and ÖOstergötland (the two county trial), Stockholm, and Gothenburg. Design –Overview of four randomised mammography screening trials. Results –The total numbers of deaths in the invited and control groups respectively were 15 695 and 11 887 corresponding to a relative risk (RR) of 1.00. There were no significant differences between the invited and control groups for cause-specific mortality, except for breast cancer. When the total mortality in the invited and the control groups was compared with that for Swedish women in general the standardised mortality ratio was close to 100. Conclusions –The cause of death pattern in the invited group was, except for breast cancer, very similar to that in the control group, showing that the groups were comparable. Similarly, the total mortality including breast cancer mortality in the control group was almost identical to that in Swedish women in general. The same was true, with the exception of breast cancer, for the invited group. These observations confirm that the trial cohorts are representative of Swedish women and indicate that the quantitative results from these trials may safely be generalised to the Swedish population.
Population Screening for Haemochromatosis: Expectations Based on a Study of Relatives of Symptomatic Probands
Authors: Bradley Linda A , Haddow James E , Palomaki Glenn E 
Published: January 2017

Objectives— The frequency of symptomatic haemochromatosis in the general population and the potential efficacy of population screening is uncertain. Data from family members of clinically diagnosed index cases were used to estimate the frequency of the haemochromatosis genotype, the proportion of homozygous individuals with clinical manifestations, and the efficacy of transferrin saturation and serum ferritin measurements as screening tests. Setting— English language studies from Europe, North America, and Australia. Methods— Haemochromatosis zygosity was classified only by HLA haplotyping, the most reliable available method. All subsequent analyses were based on family members classified in this way. Results— An estimated 53 individuals per 10 000 are homozygous for haemochromatosis. Overall, 67% of male and 41% of female family members display at least one clinical manifestation; for men, the frequency increases with age. Transferrin saturation levels are 70% or above in an estimated 72% of homozygous men, along with three per 1000 heterozygous or unaffected men. Transferrin saturation levels are 60% or above in an estimated 67% of homozygous women, along with six per 1000 heterozygous or unaffected women. Serum ferritin levels, but not transferrin saturation levels, are associated with clinical manifestations. Conclusions— This information can be used to compare expected versus actual screening performance for intervention trials aimed at detecting haemochromatosis in the general population.
Career satisfaction and work stressors in psychiatrists and psychiatry trainees in Australia and New Zealand
Authors: Rotstein Sarah , Jenkins Kym 
Published: January 2017

Objective: To assess the level of career satisfaction and factors associated with work stress in members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Methods: In 2014 an online survey was distributed to members of the RANZCP (including psychiatrists and psychiatry trainees). Results: A total of 1051 members responded to the survey. Almost 85% of respondents indicated that they were satisfied with the work they were doing at the current stage of their career. ‘Too much work to do in too little time’ emerged as a key stressor and was ranked as the number one stressor in last 12 months by over one third of respondents. Where applicable, examinations, prospect of revalidation and training hurdles were all noted to be moderately/extremely stressful by over 50% of respondents. Conclusions: The majority of psychiatrists and trainees appear to be satisfied with their current work. However, there are many factors creating increased work stress and affecting welfare. The role of the college in protecting the welfare of its members should be further considered.
Access to healthcare by psychiatrists, psychiatric trainees and overseas trained psychiatrists: findings from the RANZCP welfare study
Authors: Jenkins Kym 
Published: January 2017

Objective: To understand the challenges faced by psychiatrists and psychiatry trainees in accessing healthcare. Methods: An online survey was distributed to all members (fellows, associates and affiliates) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and a number of focus groups were held across Australia and New Zealand. Results: A total of 1051 members responded to the survey and nine focus groups were held. Almost all respondents indicated they had a personal general practitioner. However, there were varying factors affecting access to healthcare and the ability to take leave when unwell. Conclusion: There are numerous barriers facing RANZCP members in looking after their own health. Addressing these barriers will require action at multiple points in the system.
Crossover Design in Pharmacy Research
Authors: Cody Rebecca L. , Slack Marion K. 
Published: January 2017

OBJECTIVE: Reports of pharmacy research using crossover designs were reviewed to determine if the studies adequately consider interaction effects and use appropriate statistical analyses. DATA SOURCES: All crossover studies published in DICP, The Annals of Pharmacotherapy during 1988 and 1989 were analyzed. STUDY SELECTION: Reports of crossover studies were included only if at least two treatments were applied in a different order to two or more groups of subjects. DATA EXTRACTION: The principal characteristics of crossover studies and the critical design variables were listed and each study analyzed according to these variables. The critical design variables included consideration of period, sequence, and carryover effects as well as the presentation of data by groups and the use of multivariate statistical analysis. The analysis was conducted independently by each author and conflicts were discussed until consensus was obtained. RESULTS: A total of 11 crossover studies were identified: 6 were bioavailability trials, 3 were treatment comparisons, and 2 had multiple objectives. The possibility of period, sequence, or carryover effects was less with bioavailability studies than with treatment comparisons. Only 1 study presented data by group and only 4 studies used multivariate analysis. CONCLUSIONS: The crossover design appears more appropriate for bioavailability trials than for treatment trials in pharmacy research. Analysis of data from crossover designs could be improved by presenting the data for each treatment group and using multivariate statistical analysis.
The Effects of Impaired Liver Function on the Elimination of Antineoplastic Agents
Authors: Koren Gideon , Beatty Kim , Seto Arnold , Einarson Thomas R. , Lishner Michael 
Published: January 2017

OBJECTIVE: To critically review available data on the disposition of cancer chemotherapy in patients with hepatic dysfunction, and to derive at dose recommendation. DATA SOURCES: All published studies in English. STUDY SELECTION: Both human and animal studies. DATA SYNTHESIS: The available studies were sequentially qualitatively described and critically discussed. CONCLUSIONS: The liver is responsible for the metabolism and elimination of many anticancer agents. Their accumulation during hepatic insufficiency may expose the patient to increased risk of drug toxicity. A variety of clinical methods have been described to estimate the need to decrease doxorubicin dose according to degree of hepatic failure to avoid serious toxicity. In some studies prospective ascertainment of clinical indices such as hepatic enzymes and bilirubin was successful in preventing doxorubicininduced hepatotoxicity. Liver dysfunction has a major impact on cyclophosphamide pharmacokinetics. However, because such impairment leads to less production of the active aldophosphamide, fewer adverse effects were observed in hepatically impaired patients. Vinca alkaloids are extensively metabolized by the liver and excreted in the bile. Systemic exposure to these drugs is inversely correlated to the degree of hepatic failure measured by serum alkaline phosphatase. Although hepatic metabolism is a major route of elimination of fluorouracil, the kidney also plays an important role in its elimination. It has been suggested to reduce its dose in cirrhotic patients. Available pharmacokinetic data and their clinical implications are also discussed for azathioprine, mercaptopurine, etoposide, epirubicin, amsacrine, cytarabine, and other less-studied drugs. Recommendations for dose adjustments are presented and discussed.
Closed Ankle Fractures in the Diabetic Patient
Authors: Flynn John M. , Rio Felix Rodriguez-del , Pizá Pedro A. 
Published: January 2017

Systemic and local manifestations of diabetes mellitus may complicate the treatment of ankle fractures in the diabetic population. We studied 98 patients (73 non-diabetics and 25 diabetics) who were treated for closed ankle fractures by either surgical or non-surgical methods. We found that overall, the risk of infection in the diabetic population (32%) was 4 times higher than in the non-diabetic population (8%). The infection rate in the diabetic group treated surgically more than doubled that in the non-diabetic group. Four out of six diabetic patients treated with cast became infected compared to no infections in the five non-diabetics treated with a cast. Even though the diabetic foot and ankle are well studied, the medical literature is not conclusive regarding the management of ankle fractures in the diabetic patient. Diabetic patients treated conservatively had a tendency to become infected over those treated surgically. Peripherovascular disease, peripheral neuropathy and swelling and/or echymosis increased the risk of infection in the diabetic population. Diabetic patients with poor compliance had a tendency to become infected more than those who were compliant. We concluded that the diabetic patient who is poorly compliant with evidence of neuropathic disease, peripherovascular disease and severe swelling and echymosis presents the most difficult group to manage. Although these patients are poor surgical candidates, they are also the most difficult to manage and also most prone to infection and complications if treated conservatively. When faced with this difficult scenario a multidisciplinary team approach would probably yield the best possible results by early identification and intervention in these patients.
The MABAL Shoe, an Alternative Method in Contact Casting for the Treatment of Neuropathic Diabetic Foot Ulcers
Authors: Hissink Rutger Jan , Manning Hendrik Anton , van Baal Jeff G. 
Published: January 2017

INTRODUCTION: Total Contact Casting (TCC) is considered the gold standard in the treatment of neuropathic diabetic foot ulcers. To overcome some disadvantages of TCC we developed a removable fiberglass combicast shoe - the MABAL shoe. PATIENTS AND METHODS: The MABAL shoe was used to treat 23 plantar ulcers. RESULTS: Before treatment the mean surface area was 2.0 cm 2 (0.5–7.1 cm 2 ). Twenty-one of 23 ulcers healed, with a mean healing time of 34 days (7–75 days). CONCLUSION: The MABAL shoe provides healing of neuropathic diabetic foot ulcers comparable to existing methods of treatment, while offering some potential advantages. The main advantages are mobilization of the ankle, removability of the cast and a less time consuming form of treatment.
The Effect on Ankle Dorsiflexion of Gastrocnemius Recession
Authors: Pinney Stephen J. , Hansen Sigvard T. , Sangeorzan Bruce J. 
Published: January 2017

Gastrocnemius equinus contracture has been suggested as an etiologic factor in mechanical diseases of the foot and ankle and in ulcer formation in the foot. The purpose of this study is to assess the correction in ankle dorsiflexion that can be achieved with a gastrocnemius recession. An isolated gastrocnemius release (Strayer procedure) was performed on 26 legs, in 20 consecutive patients, for clinically significant gastrocnemius equinus contracture. Ankle dorsiflexion was assessed using a validated electrogoniometer. Ankle dorsiflexion was recorded with the knee straight and with the knee bent. Measurements were recorded preoperatively, and immediately postoperatively. Measurements at an average of 55.0 days post-surgery (range, 37 to 128 days) were performed on 20 legs (15 patients). Results: Average preoperative ankle dorsiflexion with the knee straight was 5.1°. Average preoperative ankle dorsiflexion with the knee bent was 22.8°. Immediately following surgery the average ankle dorsiflexion with the knee straight was 23.2°. The average correction was 18.1° and this increase was significant (p < 0.0001.) In the 15 patients (20 legs) available for follow-up, the increase in ankle dorsiflexion with the knee straight was maintained (average: 24.9°). Patients with gastrocnemius contracture who underwent an isolated gastrocnemius release increased their ankle dorsiflexion (knee straight) by an average of 18.1° with postoperative ankle dorsiflexion (knee straight) being equivalent (23.2 and 22.8°) to preoperative ankle dorsiflexion (knee bent). This correction appears to be maintained (23.2 vs. 24.9°) at short-term follow-up.
Erythropoietic Protoporphyria: Spectrum of Three Cases
Authors: Bertrand Janie , Clarke Joe T.R. , Hanna Dominique 
Published: January 2017

Background: Erythropoietic protoporphyria is a rare photodermatosis of childhood, and the diagnosis can be delayed. A deficient ferrochelatase enzyme leads to accumulation of protoporphyrins in the dermis, causing phototoxic burning. Objective: To report three cases with great variability in severity of symptoms and age at diagnosis. We discuss clinical and biochemical findings, mutation analysis, and therapeutic options. Methods: We report three cases with different degrees of photosensitivity, laboratory results, psychosocial impact, and preventive and therapeutic treatments. Results: The diagnosis of erythropoietic protoporphyria was confirmed by both typical elevation of plasma porphyrins and the discovery of a mutated FECH gene. Conclusion: Erythropoietic protoporphyria should be suspected in any cases of childhood photosensitivity. Systemic complications are unusual. Mutation analysis confirms the diagnosis. Photoprotection is the cornerstone of treatment. Renseignements de base: La protoporphyrie érythropoïétique est une photodermatose infantile rare, et le diagnostic peut être retardé. Une déficience de l'enzyme ferrochélatase produit une accumulation de protoporphyrines dans le derme ce qui provoque une réaction phototoxique. Objectif: Présenter trois cas qui illustrent une grande variabilité de la gravité des symptômes et de l'âge au moment du diagnostic. Nous discutons des résultats cliniques et biochimiques, de l'analyse des mutations, et des options thérapeutiques. Méthodes: Nous exposons trois cas qui présentent différents degrés de photosensibilité, les résultats d'examen de laboratoire, l'impact psychosocial, et les traitements préventifs et thérapeutiques. Résultats: Le diagnostic de la protoporphyrie érythropoïétique a été confirmé à la fois par l'élévation caractéristique des porphyrines plasmatiques et par la mise en évidence d'une mutation du gène FECH. Conclusion: La protoporphyrie érythropoïétique doit être soupçonnée dans tous les cas de photosensibilité infantile. Les complications systémiques sont inhabituelles. L'analyse des mutations confirme le diagnostic. La photoprotection est la pierre angulaire du traitement.
In the Queue for Coronary Artery Bypass Grafting: Patients' Perceptions of Risk and ‘Maximal Acceptable Waiting Time’
Authors: Llewellyn-Thomas Hilary , Thiel Elaine , Paterson Michael , Naylor David 
Published: January 2017

Objectives: To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Methods: Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Results: Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, ≥ 1.45%) or 6 (upper quartile, ≥ 10%) months. However, MAWT scores were related only to expected waiting time ( r= 0.47; P < 0.0001). Conclusions: Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.