bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased risk of myocardial infarction as first manifestation of ischaemic heart disease and nonselective nonsteroidal anti‐inflammatory drugs
Authors: Hawkey C. J. , Hawkey G. M. , Everitt S. , Skelly M. M. , Stack W. A. , Gray D. 
Published: April 2006

AimsSelective cyclooxygenase (COX)‐2 inhibitors have recently been implicated as enhancing risk of myocardial infarction (MI). Nonselective nonsteroidal anti‐inflammatory drugs (NSAIDs) are also effective COX‐2 inhibitors, so we investigated the hypothesis that they too increase risk of MI.MethodsWe conducted a case–control study with direct structured interview of cases and controls. Cases were all subjects (N = 205) with a first nonfatal MI who had no previously recognized cardiovascular disease. Community controls (N = 258) were randomly selected from the same practice as the index case. Hospital controls (N = 205) were those admitted at the same time as index cases for nonmyocardial conditions not influenced by NSAID use. The effects of aspirin, NSAIDs and previously recognized influences on MI were investigated by unconditional logistic regression analysis.ResultsNSAID use was associated with an increase risk of MI with an odds ratio of 1.77 (1.03, 3.03) vs. community controls and 2.61 (1.38, 4.95) vs. hospital controls. These values were 5.00 (1.18, 21.28) and 7.66 (0.87, 67.48), respectively, in aspirin users. Results were similar when naproxen was grouped with aspirin. Odds ratios for smoking and for use of antidiabetic medication were 3.91 (2.52, 6.04) and 3.92 (1.25, 12,33), respectively, vs. community controls.ConclusionsLike nonselective NSAIDs, selective COX‐2 inhibitors are associated with an increased risk of MI. The extent to which this reflects interference with aspirin warrants further investigation.
Transfer of escitalopram and its metabolite demethylescitalopram into breastmilk
Authors: Rampono Jonathan , Hackett L. Peter , Kristensen Judith H. , Kohan Rolland , Page‐Sharp Madhu , Ilett Kenneth F. 
Published: April 2006

AimsTo investigate the transfer of escitalopram and its demethyl metabolite into milk, the absolute and relative infant doses via milk and to assess any unwanted effects in the breastfed infant.MethodsMultiple samples of blood and milk were obtained over a dose interval at steady state from eight women who were taking escitalopram for postnatal depression. Drug concentrations in plasma and milk were measured by high‐performance liquid chromatography and milk/plasma ratio (M/PAUC), absolute infant dose and relative infant dose were estimated by standard methods. Their breastfed infants were also examined clinically and in five infants a blood sample was taken for drug analysis.ResultsThe median dose taken by the women was 10 mg day−1. The mean (95% confidence interval) M/PAUC was 2.2 (2.0, 2.4) for escitalopram and 2.2 (1.9, 2.5) for demethylescitalopram. Absolute infant doses were 7.6 µg kg−1 day−1 (5.2, 10.0) for escitalopram and 3.0 µg kg−1 day−1 (2.4, 3.6) for demethylescitalopram. The total relative infant dose for escitalopram plus its demethyl metabolite was 5.3% (4.2, 6.4) as escitalopram equivalents. All of the infants had met normal developmental milestones and no adverse effects were seen. Compared with average maternal plasma concentrations (24 µg l−1), the concentrations of the parent drug and its metabolite in plasma from five infants were most commonly below the limit of detection (≤3 µg l−1).ConclusionThe study shows that escitalopram is safe for use during breastfeeding. Because its absolute infant dose is lower than that for an equivalent antidepressant dose of rac‐citalopram, it may be preferred over rac‐citalopram in treating depression in lactating women. Nevertheless, each decision to breastfeed should always be made on the basis of an individual risk:benefit analysis.
Activated γδ T cells express the natural cytotoxicity receptor natural killer p44 and show cytotoxic activity against myeloma cells
Authors: Von Lilienfeld-Toal M , Nattermann J , Feldmann G , Sievers E , Frank S , Strehl J , Schmidt-Wolf I G H 
Published: April 2006

Summaryγδ T cells account for up to 10% of T lymphocytes in the peripheral blood of healthy donors. They can be activated by cytokines such as interleukin (IL)-2, IL-12 and IL-15, express natural killer (NK) cell markers such as NKG2D and show cytotoxic activity against several tumour cells, including multiple myeloma. Here, we present activated polyclonal γδ T cells from healthy donors with an NK T cell-like phenotype expressing the natural cytotoxicity receptor NKp44. Natural cytotoxicity receptors NKp30, NKp44 and NKp46 have been regarded as specific NK receptors; only two γδ T cell clones described so far expressed NKp44. Isolated polyclonal γδ T cells cultured for 7 days according to the cytokine-induced killer cell (CIK) protocol with additional IL-15 revealed a surface expression of NKp44 of 8 ± 7% (n = 22). This could be confirmed by detection of NKp44 mRNA by reverse transcription–polymerase chain reaction (RT–PCR). γδ T cells exhibited a marked cytotoxic activity against myeloma cells, which could be reduced by inhibition of NKp44. To our knowledge, this is the first description of the expression of NKp44 on polyclonal γδ T cells.
The PPAR‐gamma activator rosiglitazone fails to lower plasma ACTH levels in patients with Nelson's syndrome
Authors: Mullan Karen R. , Leslie Hilary , McCance David R. , Sheridan Brian , Atkinson A. Brew 
Published: April 2006

SummaryBackround  Peroxisomal proliferator‐activated receptors (PPAR)‐ γ are expressed abundantly in ACTH‐secreting pituitary tumours. The PPAR‐gamma activator rosiglitazone has been shown to suppress ACTH secretion in human adrenocorticotroph tumour cells in vitro, and prevent and reduce adrenocorticotroph tumour development in mouse models in vivo.Objective  To evaluate the effect of rosiglitazone in patients with persistently elevated plasma ACTH levels postbilateral adrenalectomy for Cushing's disease.Patients  Seven patients were treated with rosiglitazone 8 mg orally per day for 12 weeks.Measurements  Plasma ACTH was measured at two hourly intervals from 09:00 h to 17:00 h before and after 6 and 12 weeks of treatment.Results  Plasma ACTH at 09:00 hours immediately before the usual morning hydrocortisone dose was 2599·0 ± 899·7 ng/l (mean ± SEM) basally and 1547·6 ± 515·7 ng/l after 12 weeks of rosiglitazone, whereas levels at 17:00 h were 1433·4 ± 506·2 ng/l (mean ± SEM) basally and 1122·3 ± 460·9 ng/l at 12 weeks (all nonsignificant).Conclusion  This study showed no effect of rosiglitazone treatment at maximum approved doses in lowering plasma ACTH levels in patients post bilateral adrenalectomy for Cushing's disease.
Coping with breast cancer in newly diagnosed Iranian women
Authors: Taleghani Fariba , Yekta Zohreh Parsa , Nasrabadi Alireza Nikbakht 
Published: April 2006

Aim.  This paper reports a study exploring how Iranian women coped with newly diagnosed breast cancer and provides a foundation for cultural‐based care.Background.  Although research has indicated that coping strategies are associated with adaptation to breast cancer, and despite the number of women with newly diagnosed breast cancer increasing each year, there is no information on how Iranian women cope with breast cancer when compared with women of other cultures.Method.  In this qualitative study, 19 women with newly diagnosed breast cancer were interviewed during the period May–September 2004 about coping with their disease. Interviews were analysed using a content analysis method.Findings.  The main themes emerging from this qualitative study included coping using a religious approach (acceptance of disease as God's will; spiritual fighting), thinking about the disease (positive thinking: positive suggestion, hope, intentional forgetfulness; negative thinking: hopelessness, fear, impaired body image), accepting the fact of the disease (active acceptance; passive acceptance), social and cultural factors and finally finding support from significant others.Conclusion.  Understanding how Iranian women cope with diagnosis of breast cancer is important to nurses involved in the process of healing. The majority of strategies used by Iranian women were positive, and religious faith played a major role in this. The findings of the study can be used to design a nursing approach to improve successful coping in Iranian women suffering from breast cancer, and can provide nurses and other healthcare professionals with deeper understanding of these women as they face this diagnosis.
Change in perceived psychosocial status following a 12‐week Tai Chi exercise programme
Authors: Taylor‐Piliae Ruth E. , Haskell William L. , Waters Catherine M. , Froelicher Erika Sivarajan 
Published: April 2006

Aim.  This paper reports a study to examine change in psychosocial status following a 12‐week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America.Background.  Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind–body exercise, such as Tai Chi, are related to improvements in mental health, emotional well‐being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors.Methods.  This was a quasi‐experimental study. Participants attended a 60‐minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self‐efficacy.Results.  A total of 39 participants, on average 66‐year‐old (±8·3), married (85%), Cantonese‐speaking (97%), immigrants participated. The majority were women (69%), with ≤12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P ≤ 0·05) following the intervention. Improvement in mood state (η2 = 0·12), and reduction in perceived stress (η2 = 0·13) were found. In addition, Tai Chi exercise statistically significantly increased self‐efficacy to overcome barriers to Tai Chi (η2 = 0·19), confidence to perform Tai Chi (η2 = 0·27), and perceived social support (η2 = 0·12).Conclusions.  Tai Chi was a culturally appropriate mind–body exercise for these older adults, with statistically significant psychosocial benefits observed over 12‐weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention‐control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind–body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved.
Effectiveness of intermediate‐fidelity simulation training technology in undergraduate nursing education
Authors: Alinier Guillaume , Hunt Barry , Gordon Ray , Harwood Colin 
Published: April 2006

Aim.  The aim of this paper is to present the results of a study designed to determine the effect of scenario‐based simulation training on nursing students’ clinical skills and competence.Background.  Using full‐scale, realistic, medical simulation for training healthcare professionals is becoming more and more common. Access to this technology is easier than ever before with the opening of several simulation centres throughout the world and the availability on the market of more sophisticated and affordable patient simulators. However, there is little scientific evidence proving that such technology is better than more traditional techniques in the education of, for example, undergraduate nursing students.Methods.  A pretest/post‐test design was employed with volunteer undergraduate students (n = 99) from second year Diploma of Higher Education in Nursing programme in United Kingdom using a 15‐station Objective Structured Clinical Examination. Students were randomly allocated to either a control or an experimental group. The experimental group, as well as following their normal curriculum, were exposed to simulation training. Subsequently, all students were re‐tested and completed a questionnaire. The data were collected between 2001 and 2003.Results.  The control and experimental groups improved their performance on the second Objective Structured Clinical Examination. Mean test scores, respectively, increased by 7·18 and 14·18 percentage points. The difference between the means was statistically significant (P < 0·001). However, students’ perceptions of stress and confidence, measured on a 5‐point Likert scale, was very similar between groups at 2·9 (1, not stressful; 5, very stressful) and 3·5 (1, very confident; 5, not confident) for the control group, and 3·0 and 3·4 for the experimental group.Conclusions.  Intermediate‐fidelity simulation is a useful training technique. It enables small groups of students to practise in a safe and controlled environment how to react adequately in a critical patient care situation. This type of training is very valuable to equip students with a minimum of technical and non‐technical skills before they use them in practice settings.
Nursing and midwifery students’ approaches to study and learning
Authors: Mansouri Parisa , Soltani Fahimeh , Rahemi Shamsi , Nasab Masood Moosavi , Ayatollahi Ali Reza , Nekooeian Ali Akbar 
Published: April 2006

Aim.  This paper reports an investigation of the approaches to study and learning of nursing and midwifery students at a school of nursing and midwifery in Iran.Background.  Current knowledge suggests that students approach their studies in surface, deep or strategic manners. Students’ approaches to study have an important impact on their academic success. Awareness of their approaches to study and factors that affect their choices is important for curriculum planners as well as nurse and midwife educators.Methods.  A cross‐sectional design was used with a convenience sample of nursing and midwifery students in all 3 years of study at one university in Iran. The validated Persian translation of Entwistle and Ramsden's Approaches and Study Skills Inventory was administered in a classroom context in 2003.Results.  Sixty‐four per cent (95% CI; 57–72%) of nursing and 63% (95%; CI 50–75%) of midwifery students adopted a deep approach. The use of a surface approach was negatively correlated to the stage of study for midwifery but not nursing students. There was also a statistically significant positive correlation between level of interest in the field of study and use of strategic approach for both nursing and midwifery students. Grade point average for the nursing students adopting the strategic approach was statistically significantly higher than for those adopting deep or surface approach. The grade point average for midwifery students adopting strategic approach was statistically significantly higher than that for those adopting deep approach, but not different from the grade point average of those adopting surface approach.Conclusion.  Our findings suggest that adoption of strategic or deep approaches to learning was associated with better educational outcome, as indicated by higher grade point averages. Moreover, the findings emphasize the impact of students’ interest in their field on their academic success. Therefore, the adoption of factors which foster deep or strategic approaches and activities which increase students’ interest should lead to improved academic outcomes.
Health promotion for frail older home care clients
Authors: Markle‐Reid Maureen , Weir Robin , Browne Gina , Roberts Jacqueline , Gafni Amiram , Henderson Sandra 
Published: April 2006

Aim. This paper reports a study evaluating the comparative effects and costs of a proactive nursing health promotion intervention in addition to usual home care for older people compared with usual home care services alone.Background. An ageing population, budget constraints and technological advances in many countries have increased the pressure on home care resources. The result is a shift in nursing services from health promotion to meet the more pressing need for postacute care. For frail older people with long‐term needs, these changes combine to create a fragmented system of health service delivery, characterized by providing nursing on demand rather than proactively.Methods. A two‐armed, single‐blind, randomized controlled trial was carried out with older people ≥75 years and eligible for personal support services through a home care programme in Ontario, Canada. Participants were randomly allocated either to usual home care (control) or to a nursing (experimental) group. In addition to usual home care, the nursing group received a health assessment combined with regular home visits or telephone contacts, health education about management of illness, coordination of community services, and use of empowerment strategies to enhance independence. The data were collected in 2001–2002.Results. Of the 288 older people who were randomly allocated at baseline, 242 (84%) completed the study (120 nursing group; 122 control group). Proactively providing older people with nursing health promotion, compared with providing nursing services on‐demand, resulted in better mental health functioning (P = 0·009), a reduction in depression (P = 0·009), and enhanced perceptions of social support (P = 0·009) at no additional cost from a societal perspective.Conclusions. Home based nursing health promotion, proactively provided to frail older people with chronic health needs, enhances quality of life while not increasing the overall costs of health care. The results underscore the need to re‐invest in nursing services for health promotion for older clients receiving home care.
Exploring the experience of weight loss in people with advanced cancer
Authors: Hopkinson Jane , Wright David , Corner Jessica 
Published: April 2006

Aim. This paper reports a study of the experience of and concerns about weight loss described by patients with advanced cancer, their caregivers and nurse specialists.Background. Weight loss is reported to be one of the commonest symptoms experienced by patients with advanced cancer. There is evidence that it can be of concern to patients and their caregivers. However, little is known about why this is the case or how people might be helped to live with the symptom.Method. An exploratory study with a purposive sample of 30 patients, 23 caregivers, and 14 specialist nurses from the South of England was conducted in 2003. The in‐depth interviews focused on the experience of weight loss and its management. Interviews were transcribed verbatim, then analysed using an approach informed by Wolcott's framework for qualitative data analysis and Miles and Huberman's ‘mixed strategy for cross‐case analysis’.Findings. Concern was experienced when advanced cancer became visible through weight loss. Visible weight loss symbolized proximity to death, loss of control and both physical and emotional weakness. Despite this, weight loss was not routinely assessed by palliative care nurse specialists, who, like others in the patient's social network, respected a weight loss taboo in the belief that little could be done to help people live with the symptom.Conclusion. Weight loss‐related concern might be mitigated if clinicians adopted a systematic and proactive approach to the management of the symptom that breaks through the weight loss taboo.
Serum lipid levels in relation to serum thyroid‐stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the Tromsø Study
Authors: IQBAL A. , JORDE R. , FIGENSCHAU Y. 
Published: April 2006

Abstract.Objective.  To evaluate the relation between serum thyroid‐stimulating hormone (TSH) and lipids.Design.  Cross‐sectional epidemiological study, nested case–control study, and a placebo‐controlled double‐blind intervention study.Methods.  In the 5th Tromsø study serum TSH, total cholesterol (TC), triglycerides (TG), high‐density lipoprotein cholesterol (HDL‐C), and low‐density lipoprotein cholesterol (LDL‐C) were measured. Subjects with subclinical hypothyroidism (SHT) and a matching control group were re‐examined and apolipoprotein A1 (Apo A1) and apolipoprotein B (Apo B) were also measured. Subjects with SHT were included in an intervention study with thyroxine supplementation for 1 year.Results.  A total of 5143 subjects from the 5th Tromsø study were included. A significant and positive correlation between serum TSH levels and serum TC and LDL‐C levels were found in both genders. However, in the females this did not reach statistical significance after adjusting for age and BMI. The serum LDL‐C were significantly higher and the Apo A1 levels significantly lower in 84 SHT subjects compared with 145 controls, and in the SHT females the TC levels were also significantly elevated. In the intervention study (32 subjects given thyroxine and 32 subjects given placebo), we observed a significant reduction in the Apo B levels after thyroxine medication. In those that at the end of the study had serum TSH levels in the range 0.2–2.0 mIU L−1, the serum TC and LDL‐C levels were also significantly reduced.Conclusions.  There is a positive association between serum TSH levels and TC and LDL‐C levels. These lipid levels are reduced with thyroxine treatment in subjects with SHT.
Role of the methylcitrate cycle in Mycobacterium tuberculosis metabolism, intracellular growth, and virulence
Authors: Muñoz‐Elías Ernesto J. , Upton Anna M. , Cherian Joseph , McKinney John D. 
Published: April 2006

SummaryGrowth of bacteria and fungi on fatty acid substrates requires the catabolic β‐oxidation cycle and the anaplerotic glyoxylate cycle. Propionyl‐CoA generated by β‐oxidation of odd‐chain fatty acids is metabolized via the methylcitrate cycle. Mycobacterium tuberculosis possesses homologues of methylcitrate synthase (MCS) and methylcitrate dehydratase (MCD) but not 2‐methylisocitrate lyase (MCL). Although MCLs share limited homology with isocitrate lyases (ICLs) of the glyoxylate cycle, these enzymes are thought to be functionally non‐overlapping. Previously we reported that the M. tuberculosis ICL isoforms 1 and 2 are jointly required for growth on fatty acids, in macrophages, and in mice. ICL‐deficient bacteria could not grow on propionate, suggesting that in M. tuberculosis ICL1 and ICL2 might function as ICLs in the glyoxylate cycle and as MCLs in the methylcitrate cycle. Here we provide biochemical and genetic evidence supporting this interpretation. The role of the methylcitrate cycle in M. tuberculosis metabolism was further evaluated by constructing a mutant strain in which prpC (encoding MCS) and prpD (encoding MCD) were deleted. The ΔprpDC strain could not grow on propionate media in vitro or in murine bone marrow‐derived macrophages infected ex vivo; growth under these conditions was restored by complementation with a plasmid containing prpDC. Paradoxically, bacterial growth and persistence, and tissue pathology, were indistinguishable in mice infected with wild‐type or ΔprpDC bacteria.