bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study
Authors: Andriesse G I , Gooszen H G , Schipper M E I , Akkermans L M A , van Vroonhoven T J M V , van Laarhoven C J H M 
Published: July 2002

INTRODUCTIONTo reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA.PATIENTS AND METHODSEleven patients underwent an INRA procedure with a temporary ileostomy. Anorectal function tests were performed two months prior to and six and 12 months after closure of the ileostomy and comprised: anal manometry, ultrasound examination, rectal balloon distension, and transmucosal electrical nerve stimulation (TENS). Function was subsequently related to the histopathology of rectal biopsy samples.RESULTSMedian stool frequency decreased from 15/24 hours (10–25) to 6/24 hours (4–11) at one year. All patients reported full continence. Anal sensibility, and resting and squeeze pressures did not change after INRA. Rectal compliance decreased (2.1 (0.7–2.8) v 1.5 (0.4–2.2) and 1.4 (0.8–3.7) ml/mm Hg (p=0.03)) but the maximum tolerated volume increased (70 (50–118) v96 (39–176) (NS) and 122 (56–185) ml (p=0.03)). Decreasing rectal sensitivity was found: the maximum tolerated pressure increased (14 (8–24) v 22 (8–34) (NS) and 26 (14–40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up.CONCLUSIONSThe technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence.
Quantitation ofHelicobacter pyloriin dental plaque samples by competitive polymerase chain reaction
Authors: Song Q , Haller B , Ulrich D , Wichelhaus A , Adler G , Bode G 
Published: July 2002

Aim—To establish a competitive PCR (cPCR) assay for quantitation ofH pyloriorganisms in dental plaque samples.Methods—The cPCR coamplified targetH pyloriDNA and a known amount of internal standard template in the same tube with the same primers directed to 0.86 kb DNA of H pylori. The internal standard was a synthesised DNA bearing the same primer recognition sites at two ends and a non-homologous core sequence as the target DNA fragment. Quantitation was based on determination of the relative, not absolute, amounts of the differently sized and [32P]-dCTP labelled products derived fromH pyloriDNA and the competitive internal standard after gel electrophoresis separation.Results—A significant correlation between known amounts ofH pyloriadded to dental plaque samples and the results of the cPCR was found, and a standard line was developed which allowed quantitation ofH pyloriin the plaque samples. cPCR was performed on supragingival plaque samples from 10 adult patients with H pylori infection in the stomach, and from five adults and six children withoutH pyloriinfection in the stomach. The ranges ofH pylorinumbers were 1–213 (median 25), 6–76 (10), and 4–94 (14) cells/mg of dental plaque in the three groups, respectively.Conclusions—cPCR is useful for quantitation ofH pyloriin supragingival dental plaque samples; however, the number of the organisms in dental plaque samples seems very low.
Aspergillus antigen testing in bone marrow transplant recipients
Authors: Williamson E C M , Oliver D A , Johnson E M , Foot A B M , Marks D I , Warnock D W 
Published: July 2002

Aims—To assess the clinical usefulness of a commercial aspergillus antigen enzyme linked immunosorbent assay (ELISA) in the diagnosis of invasive aspergillosis (IA) in bone marrow transplant recipients, and to compare it with a commercial latex agglutination (LA) test.Methods—In total, 2026 serum samples from 104 bone marrow transplant recipients were tested. These comprised 67 sera from seven patients who had died with confirmed IA, 268 sera from nine patients who had died with suspected IA, and 1691 sera from 88 patients with no clinical, radiological, or microbiological signs of IA.Results—The ELISA was more sensitive than the LA test. All patients who were ELISA positive were also LA positive, and a positive LA result never preceded a positive ELISA. Twelve of 16 patients with confirmed or suspected IA were ELISA positive on two or more occasions, compared with 10 of 15 who were LA positive. ELISA was positive before LA in five patients (range, 2–14 days), and became positive on the same day in the remainder. Aspergillus antigen was detected by ELISA a median of 15 days before death (range, 4–233). Clinical and/or radiological evidence of IA was noted in all patients, and a positive ELISA was never the sole criterion for introduction of antifungal treatment. Two samples (one from each of two patients without IA) gave false positive results.Conclusions—The aspergillus ELISA is a specific indicator of invasive aspergillosis if the criterion of two positive samples is required to confirm the diagnosis. However, the test is insufficiently sensitive to diagnose aspergillosis before other symptoms or signs are apparent, and hence is unlikely to lead to earlier initiation of antifungal treatment. It is therefore unsuitable for screening of asymptomatic patients at risk of invasive aspergillosis, but does have a useful role in confirming the diagnosis in symptomatic patients.
Ethical-legal problems of DNA databases in criminal investigation: Table 1
Authors: Guillén Margarita , Lareu María Victoria , Pestoni Carmela , Salas Antonio , Carracedo Angel 
Published: July 2002

Advances in DNA technology and the discovery of DNA polymorphisms have permitted the creation of DNA databases of individuals for the purpose of criminal investigation.Many ethical and legal problems arise in the preparation of a DNA database, and these problems are especially important when one analyses the legal regulations on the subject.In this paper three main groups of possibilities, three systems, are analysed in relation to databases. The first system is based on a general analysis of the population; the second one is based on the taking of samples for a particular list of crimes, and a third is based only on the specific analysis of each case. The advantages and disadvantages of each system are compared and controversial issues are then examined. We found the second system to be the best choice for Spain and other European countries with a similar tradition when we weighed the rights of an individual against the public's interest in the prosecution of a crime.
The Freiburg approach to ethics consultation: process, outcome and competencies
Authors: Reiter-Theil Stella 
Published: July 2002

The paper describes how ethics consultation can be valuable to health professionals, patients and their families in understanding and evaluating ethical values and their consequences in a particular situation. Ethics consultation as it is practised at the university hospital of Freiburg is a special professional service offered by members of an academic institution.The practical approach and the goals are illustrated by a case study showing the difficulties of deciding about the limitation of intensive care medicine after heart surgery in the setting of maximum treatment. Here, the ethics consultation was initiated by the relatives of the patient who wanted a decision to withhold further life-sustaining treatment.Following the experiences in Freiburg, it is concluded that clinical ethicists have to cover a variety of relevant fields of knowledge, need special analytical skills, and should have professional competence in counselling, including conflict mediation or crisis intervention.
The agony of agonal respiration: is the last gasp necessary?
Authors: Perkin R M , Resnik D B 
Published: July 2002

Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea.Gasping respiration is also referred to as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated.We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death.
Chlorination disinfection byproducts in water and their association with adverse reproductive outcomes: a review
Authors: Nieuwenhuijsen Mark J , Toledano Mireille B , Eaton Naomi E , Fawell John , Elliott Paul 
Published: July 2002

OBJECTIVES AND METHODSChlorination has been the major disinfectant process for domestic drinking water for many years. Concern about the potential health effects of the byproducts of chlorination has prompted the investigation of the possible association between exposure to these byproducts and incidence of human cancer, and more recently, with adverse reproductive outcomes. This paper evaluates both the toxicological and epidemiological data involving chlorination disinfection byproducts (DBPs) and adverse reproductive outcomes, and makes recommendations for future research.RESULTS AND CONCLUSIONSRelatively few toxicological and epidemiological studies have been carried out examining the effects of DBPs on reproductive health outcomes. The main outcomes of interest so far have been low birth weight, preterm delivery, spontaneous abortions, stillbirth, and birth defects— in particular central nervous system, major cardiac defects, oral cleft, and respiratory, and neural tube defects. Various toxicological and epidemiological studies point towards an association between trihalomethanes (THMs), one of the main DBPs and marker for total DBP load, and (low) birth weight, although the evidence is not conclusive. Administered doses in toxicological studies have been high and even though epidemiological studies have mostly shown excess risks, these were often not significant and the assessment of exposure was often limited. Some studies have shown associations for DBPs and other outcomes such as spontaneous abortions, stillbirth and birth defects, and although the evidence for these associations is weaker it is gaining weight. There is no evidence for an association between THMs and preterm delivery. The main limitation of most studies so far has been the relatively crude methodology, in particular for assessment of exposure.RECOMMENDATIONSLarge, well designed epidemiological studies focusing on well defined end points taking into account relevant confounders and with particular emphasis on exposure characterisation are ideally needed to confirm or refute these preliminary findings. In practice, these studies may be impracticable, partly due to the cost involved, but this is an issue that can be put right—for example, by use of subsets of the population in the design of exposure models. The studies should also reflect differences of culture and water treatment in different parts of the world. To identify the specific components that may be of aetiological concern and hence to fit the most appropriate exposure model with which to investigate human exposure to chlorinated DBPs, further detailed toxicological assessments of the mixture of byproducts commonly found in drinking water are also needed.
Longest held occupation in a lifetime and risk of disability in activities of daily living
Authors: Li Chung-Yi , Wu Shwu Chong , Wen Shi Wu 
Published: July 2002

OBJECTIVESTo examine the association between the longest held occupation in a lifetime and risk of disability in activities of daily living (ADL) among elderly people (65 years and older) in northern Taiwan.METHODSA case-control design was used nested within two cohorts of a total of 2198 elderly people who had been followed up either between 1993 and 1997 or between 1996 and 1997. Cases were 360 elderly people with ADL disability within the study period. For each case, two sex matched controls were randomly sampled from the pool of elderly people free from ADL disability. Occupational data were collected through interviews conducted in 1997. Performed job contents were classified into occupational categories and occupation based social classes. Unconditional logistic regression techniques were used to estimate relative risk and 95% confidence intervals (95% CIs) of ADL disability.RESULTSCompared with people who were former legislators, government administrators, or business executives and managers, workers in agriculture, animal husbandry, forestry, or fishing (odds ratio (OR) 1.9, 95% CI 1.1 to 3.5) and workers in craft and related trades (OR 1.9, 95% CI 1.1 to 3.4) had significantly increased risks of subsequent ADL disability. Differential risks of ADL disability were found across social classes, with a significant dose-response trend in which unskilled blue collar workers had an 1.8 times higher risk of ADL disability than higher social classes of white collar workers.CONCLUSIONSAfter adjustment for education, there was still an inverse relation between risk of ADL disability and social class. Although total control for all the known risk factors for ADL disability among elderly people was impossible, the results tend to suggest a potential for an effect of longest held occupation in a lifetime on risk of ADL disability.
Mortality experience among employees at a hydrometallurgical nickel refinery and fertiliser complex in Fort Saskatchewan, Alberta (1954–95)
Authors: Egedahl R , Carpenter M , Lundell D 
Published: July 2002

OBJECTIVETo study the mortality experience of workers at a hydrometallurgical nickel refinery and fertiliser complex in Fort Saskatchewan, Alberta, Canada.METHODSA total of 1649 male employees of Sherritt International who worked for at least 12 continuous months during the years 1954 to 1978 at the Fort Saskatchewan, Alberta hydrometallurgical nickel refinery and fertiliser complex were followed up for an additional 17 years. Mortality was ascertained from the Canadian mortality data base maintained by Statistics Canada and covered the years 1954–95. Statistics were analysed with Monson's computer program.RESULTSTotal mortality, when compared with the Canadian population, was significantly below expectation. Fewer deaths were found for circulatory disease, ischaemic heart disease, respiratory disease, neoplasms, digestive cancer, and accidents, poisonings, and violence. Among the 718 men in the group exposed to nickel, there were no deaths due to nasal cavity or paranasal sinus cancer. Fewer deaths were found for all causes, circulatory disease, ischaemic heart disease, neoplasms and digestive cancer. Lower death rates were observed than expected for respiratory malignancies and cancer of the bronchus and lung.CONCLUSIONNo association was found in this study between exposure to nickel concentrate or metallic nickel in the hydrometallurgical refining process and the subsequent development of respiratory cancer.
An epidemiological study of the respiratory health of workers in the European refractory ceramic fibre industry
Authors: Cowie H A , Wild P , Beck J , Auburtin G , Piekarski C , Massin N , Cherrie J W , Hurley J F , Miller B G , Groat S , Soutar C A 
Published: July 2002

OBJECTIVESTo investigate possible relations between respiratory health and past airborne exposure to refractory ceramic fibres (RCFs) and respirable dust in workers at six European factories, studied previously in 1987.METHODSThe target population comprised all current workers associated with RCF production, plus others who had participated in 1987 “leavers”. Information was collected on personal characteristics, chest radiographs, lung function, respiratory symptoms, smoking, and full occupational history. Regression analysis was used to study relations between indices of health of individual workers and of cumulative exposure to airborne dust and fibres, and likely past exposure to asbestos.RESULTS AND DISCUSSION774 workers participated (90% of current workers, 37% of leavers). Profusion of small opacities in exposed workers (51% 0/1+; 8% 1/0+) was similar to that among an unexposed control group but higher than in new readings of the 1987 study films (11% 0/1+, 2% 1/0+). The large difference between 1987 and recent films may be, at least in part, a reading artefact associated with film appearance. Small opacities of International Labour Organisation (ILO) category 1/0+ were not associated with exposure. An association of borderline significance overall between 0/1+ opacities and exposure to respirable fibres was found for some exposure periods only, the time related pattern being biologically implausible. Pleural changes were related to age and exposure to asbestos, and findings were consistent with an effect of time since first exposure to RCFs. Among men, forced expired volume in 1 second (FEV1) and forced vital capacity (FVC) were inversely related to exposure to fibres, in current smokers only. FEV1/ FVC ratio and transfer factor (TLCO) were not related to exposures. The estimated restrictive effect was on average mild. Prevalence of respiratory symptoms was low. Chronic bronchitis and its associated symptoms (cough, phlegm) showed some association with recent exposure to respirable fibres. This could be due to an irritant effect of RCFs.
OCCUPATIONAL EXPOSURE LIMITS FOR CHEMICALS
Authors: Topping M 
Published: July 2002

▸ Occupational exposure limits (OELs) are tools to help employers protect the health of those who may be exposed to chemicals in their workplace. Under the United Kingdom Control of Substances Hazardous to Health (COSHH) Regulations they define adequate control by inhalation.▸ OELs are set by the Health and Safety Commission (HSC) on advice from its Advisory Committee on Toxic Substances (ACTS) and after public consultation. Thus they are consensus limits which have the support of both sides of industry.▸ COSHH uses two types of occupational exposure limit—the occupational exposure standard (OES) and the maximum exposure limit (MEL).▸ OESs are set for substances for which it is possible to identify a concentration at which there is no significant risk to health. Employers are required to meet the limit, there is no requirement to go below it, and it can be exceeded provided steps are taken to meet it as soon as reasonably practicable.▸ MELs are set for substances which have serious health implications and for which an OES cannot be set. Most of the substances with MELs are either carcinogens or causes of occupational asthma. Employers must not exceed an MEL and must reduce exposure as far below it as is reasonably practicable.▸ MELs are set at concentrations achievable by good occupational hygiene practice such that risks to workers are judged to be reduced to a tolerable level. The HSC consider that this approach is preferable to the use of mathematical models to generate risk estimates, which inevitably gives a spurious appearance of accuracy.▸ The MEL/OES system is poorly understand by many employers who use chemicals, is not comprehensive as some substances meet neither the OES nor MEL criteria, and does not mesh well with indicative occupational exposure limit values which will increasingly be set under the European Union Chemical Agents Directive.▸ COSHH essentials: easy steps to control chemicalsprovides the practical help that firms need to control chemicals. It takes users straight from hazard and exposure considerations to benchmark standards of good practice.▸ The problems with the current system have prompted ACTS to set up a subgroup to review the OEL framework.
Nasal patency is related to dust exposure in woodworkers
Authors: Schlünssen V , Schaumburg I , Andersen N T , Sigsgaard T , Pedersen O F 
Published: July 2002

Objectives: A cross sectional study of 54 furniture factories and three control factories was conducted to investigate the relation between subjective and objective nasal obstruction and exposure to wood dust.Methods: Acoustic rhinometry was performed on 161 woodworkers and 19 controls. For each person, four measuring rounds were performed: before work, after 4 hours of work, and after 7 hours of work before and after decongestion. Before the first and third measuring round, each person rated the current feeling of nasal obstruction in the left and right nostril separately, using a visual analogue scale. Personal passive dust measurements were performed on 140 woodworkers.Results: The mean (SD) of equivalent inhalable dust was relatively low, 1.17 (0.62) mg/m3, range 0.17–3.44 mg/m3. The exposure was divided into four levels: controls, low exposure, medium exposure, and high exposure. For the two highest concentrations of exposure, a significant increase in congestion—decreased nasal cavity volume and cross sectional areas—was found after 4 and 7 hours of work, compared with before work. Multivariate linear regression analysis showed positive correlations between concentration of dust and change in mucosal swelling. A significant increase in self rated nasal obstruction was found after work compared with before work for the two highest exposure groups. No correlation between objective nasal variables and self rated nasal obstruction was found.Conclusion: Exposure to wood dust was related in a dose dependent manner to acute nasal obstruction measured by acoustic rhinometry and self reported obstruction, but no correlation was found between measured and self reported obstruction.
Ambient neighbourhood noise and children's mental health
Authors: Lercher P , Evans G W , Meis M , Kofler W W 
Published: July 2002

Objectives:To investigate the relation between typical ambient noise levels (highway, rail, road) and multiple mental health indices of school children considering psychosocial and biological risk factors as potential moderators.Methods:With a two stage design strategy (representative sample and extreme sample) two cross sectional samples (n=1280; n=123) of primary school children (age 8–11) were studied. Individual exposure to noise at home was linked with two indices of mental health (self reporting by the child on a standard scale and rating by the teacher of classroom adjustment on a standard scale). Noise exposure was modelled firstly according to Austrian guidelines with the aid of a geographical information system and then calibrated and corrected against measurements from 31 locations. Information on potential confounders and risk factors was collected by mothers and controlled in regression modelling through a hierarchical forward stepping procedure. Interaction terms were also analysed to examine subgroups of children at risk—for example, low birth weight and preterm birth.Results:Noise exposure was significantly associated in both samples with classroom adjustment ratings. Child self reported mental health was significantly linked to ambient noise only in children with a history of early biological risk (low birth weight and preterm birth).Conclusions:Exposure to ambient noise was associated with small decrements in children's mental health and poorer classroom behaviour. The correlation between mental health and ambient noise is larger in children with early biological risk.