bluuebunny/crossref_metadata_2025_split huggingface dataset:
The form and function of challenging behaviours
Authors: Emerson E. , Bromley J. 
Published: August 2009

AbstractAspects of the topography and behavioural function underlying the challenging behaviours of all people with learning disabilities and challenging behaviour (n =70) in a defined geographical area were investigated. Results indicated that: (1) more severe challenging behaviours were shown by people with more severe disabilities; (2) a significant minority (44%) of people showed more than one form of challenging behaviour, this rising to 79% among people with more severe challenging behaviours; and (3) cross‐sectional analyses revealed specific clusters of problematic, aggressive and self‐injurious behaviours. Analysis of information derived from the Motivation Assessment Scale (MAS) indicated that (5) the most common funaions of challenging behaviours appeared to be ‘self‐stimulation’(for self‐injury, destructiveness and ‘other’ challenging behaviours) and securing the attention of carers (for aggressive behaviours). However, (6) parametric analyses failed to identify any consistent relationships between the form and function of an individual's challenging behaviour for aggressive, destructiveness and ‘other’ challenging behaviours, but (7) clients with self‐injurious behaviour were significantly more likely to score highly on the ‘self‐stimulation’ sub‐scale than other sub‐scales of the MAS. Finally, (8) significant consistency of behavioural functions across different forms of challenging behaviours shown by the same individual were found for the two combinations of aggressive‐destructive behaviours and self‐injury‐'other’ behaviours.
Cross‐national comparisons of ageing mothers of adults with intellectual disabilities
Authors: Seltzer M. M. , Krauss M. W. , Walsh P. , Conliffe C. , Larson B. , Birkbeck G. , Hong J. , Cchoi S. 
Published: August 2009

AbstractAgeing (55 + years) mothers of adults with intellectual disabilities in the Republic of Ireland, Northern Ireland and the United States were compared with respect to three general issues. Firstly, to what extent do the adults in these three countries differ in their level of reliance on their mothers? Secondly, do the mothers differ in the extent to which they have made plans for the future care of their son or daughter with intellectual disabilities? Thirdly, do the mothers differ in physical, social and psychological well‐being? These cross‐national comparisons were undertaken to examine the extent to which lifelong caregiving has either a common influence on mothers across national boundaries, or, alternatively, whether the cultural context exerts a unique influence on mothers In each country. Findings suppxarted the latter explanation, even when background characteristics were statistically controlled.
Overweight and obesity amongst Down's syndrome adults
Authors: Prasher V. P. 
Published: August 2009

AbstractTwo hundred and one individuals with Down's syndrome were assessed for evidence of overweight and obesity. Thirty‐one per cent of males and 22% of females were overweight, while 48% males and 47% females were obese. Overweight and obesity was significantly associated with living in the family home compared to supervised community units or in hospital. No association with the degree of learning disability vras found.
Mortality in a hospitalized mentally handicapped population: a 10‐year survey
Authors: Puri B. K. , Lekh S. K. , Langa A. , Zaman R. , Singh I. 
Published: August 2009

AbstractThe mortality experiences of a hospitalized mentally handicapped population between 1981 and 1990 (inclusive) were examined. A continued trend for increasing longevity in both males and females was found, with mean ages at death now approaching those in the general population. The commonest cause of death was non‐tubercular respiratory infection, from which patients were particularly at risk during the months of December to February (inclusive). Patients diagnosed as suffering from psychoses other than schizophrenia and mood disorder had an increased mortality and should be thoroughly investigated for the presence of organic pathology. Epilepsy and Down's syndrome were associated with increased risk of earlier death, although in the case of Down's syndrome there has been a marked increase in longevity.
A lethal case of atlantoaxial dislocation in a 56‐year‐old woman with Down's syndrome
Authors: Saad K. F. G. 
Published: August 2009

AbstractA case of fatal atlantoaxial dislocation is reported in a 56‐year‐old woman with Down's syndrome. The literature indicates such a case to be a rarity; however, this may be a result of the predominance of younger age samples. The implications of this are discussed.
Exercise‐provoked ST‐segment depression and prognosis in patients recovering from acute myocardial infarction. Significance and pitfalls
Authors: JESPERSEN C. M. , HAGERUP L. , HOLLÄNDER N. , LAUNBJERG J. , LINDE N. C. , STEINMETZ E. 
Published: August 2009

Abstract. The importance of maximal versus submaximal exercise testing and the significance of heart failure on the prognostic value of exercise‐provoked ST‐segment depression ≥ 0.1 mV was studied in 143 patients recovering from acute myocardial infarction. Patients were exercise tested prior to discharge and follow up lasted for up to 18 months (mean 17 months). End‐point was first major event (i.e. first non‐fatal reinfarction or death). A symptom‐limited exercise test was superior to a heart‐rate‐limited test in detecting ST‐segment depressions (27% vs. 20%; P < 0.5), and patients with ST‐segment depression at lower heart rates did not have an increased risk of subsequent events compared with patients with ST‐segment depression at higher heart rates (14% vs. 27%; NS). Heart failure surpassed ST‐segment depression as a risk predictor (34% vs. 18%).Based on a meta‐analysis including 13 studies (1987 patients) exercise‐provoked ST‐segment depression possessed an increased risk of subsequent major events (P < 0.0001; risk ratio = 1.90: 95% confidence limits 1.43.2.51).Thus, ST‐segment depression provoked by a symptom‐limited test selects patients with an increased risk of subsequent major events. In patients with a history of heart failure exercise‐provoked ST‐segment depression is of limited value.
Hepatic cytosolic oestrogen receptors in patients with liver disease
Authors: BECKER U. , ANDERSEN J. , POULSEN H. SKOVGAARD , HORN T. 
Published: August 2009

Abstract.Patients with liver disease present many of the features of ‘feminized’ hepatic metabolism. Oestrogens exert their effects through interaction with specific cellular high‐affinity receptors (ER). We measured hepatic ER in 102 needle biopsies from patients with chronic alcoholic and non‐alcoholic liver disease using an enzyme immunoassay. Fifteen patients with no or minimal changes in liver histology served as controls.The hepatic ER concentrations were significantly (P= 0.05) lower in the 44 men (median 13 fmol mg−1protein, interquartile range 7–17 fmol mg−1protein) compared to the 58 women (median 15 fmol mg−1protein, interquartile range 10–21 fmol mg−1protein). Patients with alcoholic liver disease (n= 63) had significantly (P< 0.05) lower ER concentrations than controls (n= 15) (median 13 fmol mg−1protein, interquartile range 7–17 fmol mg−1proteinvs. median 16 fmol mg−1protein, interquartile range 10–26 fmol mg−1protein), and compared with patients with non‐alcoholic liver disease (n= 24) (P< 0.05, median 20 fmol mg−1protein, interquartile range 11–24 fmol mg−1protein).ER concentrations were significantly lower (P< 0.05) in patients with alcoholic liver disease and alcoholic hepatitis (n= 21) compared to those without alcoholic hepatitis (n= 42) (medians 10vs. 14 fmol mg−1protein, interquartile ranges 6–15 fmol mg−1proteinvs. 9–18 fmol mg−1protein), while ER concentrations did not differ significantly (P> 0.05) between actively drinking (median 13 fmol mg−1protein, interquartile range 7–17 fmol mg−1protein) and abstaining alcoholic patients (median 13 fmol mg−1protein, interquartile range 7–18 fmol mg−1protein).In summary, the small but significant variation in hepatic ER concentrations reflects variation in liver function rather than an effect of ethanol.
Diacylglycerol/protein kinase C signalling: a mechanism for insulin resistance?
Authors: SHMUELI E. , ALBERTI K. G. M. M. , RECORD C. O. 
Published: August 2009

Abstract. It is proposed that an intracellular cycle exists to limit or terminate the insulin signal. The cycle involves increased synthesis of sn‐1,2‐diacylglycerol (DAG) in response to insulin. The DAG activates protein kinase C (PKC) which phosphorylates glycogen synthase either directly or through other protein kinases to render it inactive. Protein kinase C may also inhibit the insulin receptor by phosphorylation of receptor serine residues.Insulin resistance could then arise as a consequence of a persistent increase in DAG levels. Such an increase could occur in three different ways. Chronic hyperinsulinaemia could increase DAG levels by de‐novo synthesis from phosphatidic acid, by hydrolysis of phosphatidylcholine, or by hydrolysis of glycosyl‐phosphatidylinositol; DAG is also formed by hydrolysis of phosphatidylinositol 4,5‐biphosphate (PIP2). This reaction, known as the ‘PI response,’ may be the connection between hypertension and insulin resistance. A third mechanism for an increase in DAG involves neural abnormalities. Thus, muscle denervation in the rat is characterized both by a profound insulin resistance and a large increase in DAG. It is possible that a similar increase occurs in humans and may explain the association between denervation, inactivity, and insulin resistance.
Hyperlipidaemia—management and views amongst physicians in general practice, in occupational health care and in internal medicine
Authors: DANIELSSON B. , ÅBERG H. 
Published: August 2009

Abstract. Objectives. To study aspects of management and views about hyperlipidaemia and its treatment amongst different categories of physicians.Design. A postal questionnaire was sent to selected physicians. Reminders were used.Setting. The study included physicians in primary health care (PHCPs), occupational health care (OHCPs), and in departments of internal medicine in hospitals (IMPHs).Subjects. All 146 PHCPs in the south‐western region of Stockholm, 147 OHCPs, randomly selected from the directory of occupational health care offices, and all 157 IMPHs in six hospitals, in the greater Stockholm area, were offered the questionnaire.Main outcome measures. Differences in views, attitudes and treatment policy amongst different categories of physicians.Results. Response rate was 70% (61–81%). Intervention was initiated by the OHCPs at lower levels of cholesterol than by the other two groups, with diet (P < 0.001) and with drug intervention as primary (P < 0.01) and secondary prevention (P < 0.005). When other cardiovascular risk factors were present, intervention was started earlier by the OHCPs only in comparison with the PHCPs (P < 0.01). Knowledge of one's own cholesterol level was more common amongst the OHCPs than in the other two groups (P < 0.001). Patient follow‐up was the same in all groups.Conclusions. Disagreement amongst physicians about hyperlipidaemia leads to conflicting information being given to patients. It is important to be aware of these differences when trying to reach a consensus on this topic. Corresponding knowledge and attitudes amongst members of the public should also be studied.
Follow‐up study of patients with clinically suspected deep venous thrombosis and a normal venogram
Authors: PEDERSEN L. M. , LERCHE A. , JØRGENSEN M. , URHAMMER S. , STEENBERG P. , JENSEN R. 
Published: August 2009

Abstract. Objectives. To evaluate the clinical course in patients with clinically suspected deep venous thrombosis (DVT) of the leg and a normal venogram.Design. Prospective study over 15 months with a follow‐up of 4–12 (median 8.6) months after a normal venogram. A questionnaire survey was performed at follow‐up. Information from general practitioners and medical records was reviewed. An alternative diagnosis was established at presentation and at the time of follow‐up.Setting. The Department of Internal Medicine in a Danish university hospital.Subjects. A total of 133 consecutive out‐patients referred with clinical suspicion of DVT and a normal venogram.Main outcome measures. The state of symptoms at follow‐up. The frequency of referrals to hospitals and contacts with general practitioners or medical specialists in the follow‐up period. Clinical diagnoses provided at presentation and at follow‐up.Results. The follow‐up response rate was 78% (n = 104). The symptoms were still present at follow‐up in 53 (51%) patients. More than half of the patients had been referred to medical facilities for the same disorder. Diagnoses could be established in 93 (70%) of the 133 patients at presentation and in 119 (89%) at follow‐up.Conclusions. The majority of patients with clinical signs and symptoms of a DVT and a normal venogram may require a follow‐up surveillance programme to ensure correct diagnosis and adequate treatment. Further studies are recommended to confirm our results and to assess the cost‐effectiveness.
Diabetic lipohypertrophy treated with suction‐assisted lipectomy
Authors: SAMDAL F. , AMLAND P. F. , SANDSMARK M. , BIRKELAND K. I. 
Published: August 2009

Abstract. Objectives. To investigate the effectiveness of liposuction as treatment for lipohypertrophy in insulin‐treated diabetic patients.Design. Open clinical study.Setting. Norwegian National Hospital, Oslo.Subjects. Five consecutive diabetic patients operated on for insulin‐induced lipohypertrophy.Interventions. Syringe‐assisted liposuction under local anaesthesia.Main outcome measures. Change in contours assessed by pre‐ and postoperative photographs, and by the patients' and surgeon's evaluations according to a four‐point graded scale.Results. Good or excellent results were obtained in all patients. Small surface irregularities were seen in two patients who had large volumes of fat removed from the proximal anterior thighs. Apart from this no side‐effects or complications occurred.Conclusions. Insulin‐induced lipohypertrophy (‘insulin tumours’) can be treated successfully with liposuction.
The risk of hip fractures in patients with primary hyperparathyroidism: a population‐based cohort study with a follow‐up of 19 years
Authors: Larsson Karin , LJUNGHALL S. , KRUSEMO U. B. , NÆSSÉN T. , LINDH E. , PERSSON I. 
Published: August 2009

Abstract. Objective. To evaluate primary hyperparathyroidism (HPT) as a risk factor for hip fractures.Design. A population‐based, record‐linked, prospective study with a mean observation time of 17 years (women) and 16.5 years (men).Setting. A cohort obtained from a register of hospital admissions in the Uppsala Health Care Region, Sweden, 1965–1983.Participants. All patients (1373 women and 551 men) who were admitted to hospital with the diagnosis of HPT during the period. Comparisons were made with the entire background population.Measurements. Cohort subjects were followed with regard to a first instance of hip fracture prior to or after the diagnosis of HPT. The observed number of cases was compared with that expected on the basis of person‐years of observation and incidence rates in the background population. Analyses were made for cervical and trochanteric fractures, and for patients operated and not operated for HPT.Main results. (i) Women. During 23 341 person‐years of observation, 67 cases of first hip fractures occurred, yielding a relative risk (RR) of 0.93 (95% confidence interval [CI] 0.72–1.19). The RR for cervical fractures was 0.77 (CI 0.54–1.06), and for trochanteric fractures 1.33 (CI 0.88–1.93). Operation for HPT did not influence the risk of hip fracture. (ii) Men. The total person‐years was 9091. Eleven fractures were observed—compared with the expected 7.90 (RR 1.39; CI 0.69–2.50). Men operated for HPT had an increased risk for cervical hip fractures (RR 2.73; CI 1.18–5.39). Owing to the few fractures in this group (n = 8) the relevance of this is uncertain.Conclusions. This study indicates that HPT is not a risk factor for hip fractures in women.
Response of hypertension to conventional antihypertensive treatment and/or steroidogenesis inhibitors in Cushing's syndrome
Authors: FALLO F. , PAOLETTA A. , TONA F. , BOSCARO M. , Sonino Nicoletta 
Published: August 2009

Abstract. Objectives. To evaluate the effect of conventional antihypertensive drugs and/or inhibitors of steroid production in the management of hypertension in Cushing's syndrome.Design. A retrospective open clinical study with pre‐and post‐treatment assessment.Setting. A university hospital, where patients were initially admitted and then followed‐up in an ambulatory clinic over a period of 6 years.Subjects. Forty consecutive hypertensive patients with Cushing's syndrome.Interventions. Patients were divided into two groups according to the different management of hypertension. The first group (group 1) of 28 patients included those treated with antihypertensive drugs at full dose (diuretics, calcium antagonists, angiotensin converting enzyme [ACE] inhibitors, as single agents or in combination). The second group (group 2) of 12 patients received ketoconazole alone.Main outcome measures. Blood pressure variations compared to pre‐treatment levels.Results. Blood pressure normalization was obtained in four of the 28 patients of group 1. In 12 of the remaining patients, ketoconazole, an inhibitor of steroid production, was subsequently added and this normalized blood pressure in all but the one in whom Cortisol was not decreased. In the 12 patients of group 2, ketoconazole alone lowered blood pressure within normal limits in all but one who had longstanding hypertension.Conclusions. In hypertensive patients with Cushing's syndrome, conventional antihypertensive therapy is mostly ineffective. Blood pressure response is satisfactory only after the restoration of normal Cortisol levels, indicating the need for a specific treatment for hypertension in this disorder.
Polycythaemia vera and cerebral blood flow: a preliminary study with transcranial Doppler
Authors: FIERMONTE GIANCARLO , SPIRITI M. A. ALOE , LATAGLIATA R. , PETTI M. C. , GIACOMINI P. 
Published: August 2009

Abstract. Objectives. The purpose of this study has been to investigate by ultrasonographic methods the flow velocities of cerebral arteries because increased blood viscosity due to haematocrit elevation can cause neurological symptoms in polycythaemia vera patients, because of the resulting decrease in cerebral flow.Subjects and design. Twenty newly diagnosed patients, with haemoglobin values of > 18 g dl−1 and/or an haematocrit of > 50%, were examined by transcranial Doppler. Recordings were performed in basal conditions and after pharmacological and/or phlebotomic treatment, when haematocrit values were ≤ 50%. Blood velocities were evaluated in middle (MCA), anterior (ACA), posterior (PCA) cerebral arteries and in the basilar (BA) artery.Results. Basal recordings showed decreased velocities (MCA: 39.40 ± 9.34 cm s−1; ACA: 34.05 ± 10.25 cm s−1; PCA: 31.46 ± 5.97 cm s−1; and BA: 27.47 ± 7.42 cm s−1); pre‐ and post‐treatment value differences observed in MCA, ACA and BA were highly significant (P < 0.001).Conclusions. A decrease in cerebral flow could be a risk for multifocal micro‐ischaemic cerebral infarctions leading, after several years, to a multi‐infarct dementia; an early reduction in erythrocyte burden should be very useful in polycythaemic patients in preventing lacunar lesions.
Serum cholesterol concentration before and after streptokinase in acute myocardial infarction
Authors: Chua T. P. , FRY I. D. R. , FRANKEL R. J. , LIM R. 
Published: August 2009

Abstract. Objective. To determine if serum cholesterol concentration should be measured before or after streptokinase therapy within the first 24 h of myocardial infarction.Design. Prospective study of patients receiving streptokinase therapy for acute myocardial infarction (AMI).Setting. Coronary care unit of a district general hospital.Subjects. Thirty‐one patients (26 men aged 38–74 years, mean 60 years) admitted with a definite diagnosis of myocardial infarction.Intervention. Streptokinase therapy given intravenously at a mean of 5 h (range 1.5–15 h) after the onset of chest pain.Main outcome measures. Serum cholesterol concentration just prior to, and 11.5 h (range 4–20.5 h) after streptokinase administration.Results. There was a significant mean fall of 0.4 mmol l−1 (P = 0.002, 95% CI = 0.2–0.6) in serum cholesterol concentration from a pre‐streptokinase concentration of 7.0 (range 5.3–9.9) to a post‐streptokinase concentration of 6.6 (range 4.9–9.9). In the patients who showed a fall in cholesterol concentration, the magnitude of fall correlated with the baseline cholesterol concentration (r = 0.66, P < 0.01) but not with peak cardiac enzyme activities (r = 0.05, P > 0.2 for aspartate aminotransferase; r = 0.10, P > 0.2 for lactate dehydrogenase), time from onset of chest pain to post‐streptokinase measurement (r = 0.27, P > 0.2) or time from streptokinase administration to post‐streptokinase measurement (r = 0.01, P > 0.2).Conclusion. Serum cholesterol concentration may be underestimated when measured after streptokinase therapy, particularly when the true basal value is high. Further management of this risk factor may be based more accurately on its measurement before than after streptokinase therapy within the first 24 h of AMI.
The Helsinki Heart Study: an 8.5‐year safety and mortality follow‐up
Authors: Huttunen Jussi K. , Heinonen O. P. , Manninen V. , Koskinen P. , Hakulinen T. , Teppo L. , Mänttäri M. , Frick M. H. 
Published: August 2009

Abstract. Objectives. Earlier monitoring of all symptoms, hospital admissions, cancer diagnoses and causes of death during gemfibrozil treatment had raised some suspicions which called for further follow‐up.Design. Close monitoring of selected, potentially adverse events amongst treated subjects after a placebo‐controlled trial and comparing occurrences to those in various untreated groups.Setting. All participants of the Helsinki Heart Study (a controlled, 5‐year, multi‐clinic coronary heart disease (CHD) primary prevention trial with gemfibrozil and placebo) were offered gemfibrozil treatment and twice yearly follow‐up for 3.5 years. Untreated groups in the source population and national cancer statistics were utilized in comparisons.Subjects. Of the 2046 dyslipidaemic men initially randomized to gemfibrozil, 2002 survivors entered the 3.5‐year follow‐up; of the 2035 initial placebo men, 1992 continued to be monitored.Interventions. Gemfibrozil was chosen for the follow‐up by 66.3% of the gemfibrozil‐treated and 68.5% of the placebo‐treated men.Main outcome measures. Gastrointestinal symptoms, surgery, strokes, cancer incidence, mortality by cause.Results. Gastrointestinal symptoms remained more common in the original gemfibrozil group. After 8.5 years strokes numbered 32 (gemfibrozil) vs. 37 (placebo), violent deaths 16 vs. 14, and cancers 51 in both groups. Total mortality was equal during the original 5 years, but higher in the gemfibrozil group post‐trial, leading to an 8.5 year mortality of 101 vs. placebo 83 (P = 0.19). This was mainly a result of higher cancer mortality in the gemfibrozil (30) than the placebo group (18, P = 0.08). An additional 18‐month post‐study registry follow‐up disclosed 13 placebo and five gemfibrozil cancer deaths, altering the cancer mortality to gemfibrozil 35 vs. placebo 31 at 10 years.Conclusions. The most plausible explanation for the discrepancy between cancer incidence and cancer‐specific mortality, based mainly on comparison with untreated groups, is delayed diagnosis. The increased cancer and total mortality is most probably due to chance, based on the later reversal of trends.