bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder
Authors: Chisholm Dan , Van Ommeren Mark , Ayuso-Mateos Jose-Luis , Saxena Shekhar 
Published: November 2005

BackgroundBipolar disorder has been ranked seventh among the worldwide causes of non-fatal disease burden.AimsTo estimate the cost-effectiveness of interventions for reducing the global burden of bipolar disorder.MethodHospital-and community-based delivery of two generic mood stabilisers (lithium and valproic acid), alone and in combination with psychosocial treatment, were modelled for 14 global sub-regions. A population model was employed to estimate the impact of different strategies, relative to no intervention. Total costs (in international dollars (I$)) and effectiveness (disability-adjusted life years (DALYs) averted) were combined to form cost-effectiveness ratios.ResultsBaseline results showed lithium to be no more costly yet more effective than valproic acid, assuming an anti-suicidal effect for lithium but not for valproic acid. Community-based treatment with lithium and psychosocial care was most cost-effective (cost per DALY averted: I$2165–6475 in developing sub-regions; I$5487–21123 in developed sub-regions).ConclusionsCommunity-based interventions for bipolar disorder were estimated to be more efficient than hospital-based services, each DALY averted costing between one and three times average gross national income.
Measuring autistic traits: heritability, reliability and validity of the Social and Communication Disorders Checklist
Authors: Skuse David H. , Mandy William P. L. , Scourfield Jane 
Published: November 2005

BackgroundAutistic traits are widely distributed in the general population, but the boundaries of the autistic spectrum are unclear. Whole-population surveys of unselected samples of children are hampered by the lack of appropriate screening instruments.AimsTo assess whether the Social and Communication Disorders Checklist (SCDC) fulfils the need for a sensitive measure of autistic traits, which can be completed in a few minutes and which measures heritable characteristics in both males and females.MethodA 12-item scale, the SCDC, was completed by three independent samples drawn from a twin register, a group with Turner syndrome and children with a diagnosis of autistic-spectrum disorder attending clinics. The data were used to establish the heritability reliability and validity of the checklist.ResultsTraits measured by the SCDC were highly heritable in both genders (0.74). Internal consistency was excellent (0.93) and test–retest reliability high (0.81). Discriminant validity between pervasive developmental disorder and other clinical groups was good, discrimination from non-clinical samples was better; sensitivity (0.90), specificity (0.69).ConclusionsThe SCDC is a unique and efficient first-level screening questionnaire for autistic traits.
Instability of eating disorder diagnoses: prospective study
Authors: Milos Gabriella , Spindler Anja , Schnyder Ulrich , Fairburn Christopher G. 
Published: November 2005

BackgroundThe stability of eating disorder diagnoses has received little research attention.AimsTo examine the course of the full range of clinical eating disorders.MethodA sample of 192 women with a current DSM–IV eating disorder (55 with anorexia nervosa, 108 with bulimia nervosa and 29 with eating disorder not otherwise specified) were assessed three times over 30 months using a standardised interview.ResultsAlthough the overarching category of ‘eating disorder’ was relatively stable, the stability of the three specific eating disorder diagnoses was low, with just a third of participants retaining their original diagnosis. This was due only in part to remission since the remission rate was low across all three diagnoses.ConclusionsThere is considerable diagnostic flux within the eating disorders but a low overall remission rate. This suggests that underpinning their psychopathology may be common biological and psychological causal and maintaining processes.
Validity of the construct of post-traumatic stress disorder in a low-income country
Authors: Mehta Khyati , Vankar Ganpat , Patel Vikram 
Published: November 2005

SummaryThe validity of the clinical construct of post-traumatic stress disorder (PTSD) has been questioned in non-Western cultures. This report describes in-depth interviews exploring the experiences of women who were traumatised by the communal riots in Ahmedabad, India, in March 2002. Three specific narratives are presented which describe experiences that closely resemble re-experiencing, avoidance and hyperarousal. Thus, symptoms described as characteristic features of PTSD in biomedical classifications are clearly expressed by the women in our study, and are attributed by them to trauma and grief. We conclude that PTSD may be a relevant clinical construct in the Indian context.
Psychiatric in-patients receive fewer greetings cards than other in-patients
Authors: Lankappa Sudheer , Spence Sean A. 
Published: November 2005

Aims and MethodGreetings cards (wishing patients well) appear less abundant on psychiatric wards than other in-patient facilities. We tested this hypothesis in three cross-sectional surveys of teaching hospitals in Sheffield.ResultsOn each occasion, psychiatric wards contained significantly fewer card recipients (χ2 test, P<0.001). Individual recipients in psychiatric wards received significantly fewer cards than recipients in general hospitals (Kruskal–Wallis test, P<0.05).Clinical ImplicationsAlthough receiving a card might seem a trivial matter, it nevertheless denotes the outcome of an altruistic act, which may be appreciated by its recipient. Psychiatric in-patients receive fewer such acts of kindness than other in-patients. These data concur with other recent reports suggesting that the stigma of mental illness extends to expressions of altruism.
New long-stay patients in a psychiatric admission ward setting
Authors: Cowan Colin , Walker Philippa 
Published: November 2005

Aims and MethodThis is a descriptive study of the admissions of new long-stay patients and their outcome in a district with minimal access to longer-stay in-patient beds. Cases were identified through an ongoing in-patient census and information was gathered by retrospective case-note review.ResultsThirty-nine new long-stay admissions were identified. High rates of living alone, early readmission following previous discharge and use of the Mental Health Act 1983 were noted. The 39 admissions occupied 12% of the unit's capacity. Four patients returned to a family residence but 27 went into residential or in-patient care. Of those discharged to settings not providing patient care, 48% were readmitted in the year after discharge.Clinical ImplicationsNew long-stay admissions continue to absorb a high proportion of the bed resources of an in-patient unit for their numbers and these patients are at risk of unsuccessful discharge.
Service innovations: Is there a market for neuropsychiatry? A year in the life of a district-based neuropsychiatry service
Authors: Barrett K. , Sudharsan S. 
Published: November 2005

Aims and MethodThis paper describes the clinical activity of a district neuropsychiatry service over a 1-year period. The data presented are drawn from a clinical database with individuals classified according to the following diagnostic groups: acquired brain injury, early-onset dementia, Huntington's disease, epilepsy, other neurological disorders, developmental disorders and non-organic disorders. Information is presented on out-patient case-load, new out-patient referrals, general hospital referrals and in-patient admissions.ResultsThe total out-patient case-load was 451; 189 new out-patient and 99 liaison referrals were seen and 90 individuals were admitted. Acquired brain injury was the most common neurological diagnosis in all groups.Clinical ImplicationsThe demand for this service indicates that there is a market for neuropsychiatry, even at a district level, and particularly in the management of the sequelae of acquired brain injury.
Partners in Care: Staywell Support Group for patients. In the beginning was an idea
Authors: Burton Sandra , Blaj Adrian 
Published: November 2005

Motto: With perseverance a blade of glass splits rocks(Chinese proverb).Over 3 years ago a former in-patient of mine walked quietly into my clinic and asked my opinion in respect of her desire to put something back into the system which helped her to recover. I instantly thought that this was a brilliant idea; a support group run by the patients for the patients! People around me remained sceptical about this project and simply thought the project was doomed to failure from the start as there was no known long-term successful precedent. Then I thought of the idea behind the enormously successful Alcoholics Anonymous self-help organisation founded in the USA by two alcoholic men, a surgeon and stockbroker. The result was impressive – I only wish that this project would find deep resonance in a few dedicated hearts and spread nationally. For those who want to read further about this against-all-the-odds journey, I stop myself and let Sandra tell the story about the origin of the Staywell Support Group.
Postoperative care after varicose vein surgery: patient-based questionnaire
Authors: Tang T , Boyle J R , Gaunt M E , Varty K 
Published: November 2005

Objective: Practical advice given postoperatively to varicose vein patients remains subjective. They are encouraged to walk in their stockings or bandages as much as possible. The aim of this study was to investigate if this is a realistic request. Methods: A postal questionnaire was given to all patients undergoing varicose vein surgery from July 2003. The questionnaire referred to the following issues: pain scores, walking ability, stairs, driving, return to work, dressings and stockings. Results: A total of 93 patients replied, of which 55 (59%) were women and the mean age was 52 years (range 23–83). Of the patients who replied, 66 (71%) had a unilateral procedure and 13 (14%) had recurrent varicose veins. A total of 65 (70%) underwent a high tie, strip and avulsions, 16 (17%) underwent a short saphenous tie, nine (10%) underwent ligation of both saphenous systems and three (3%) underwent avulsions alone. Pain scores were low (3/10), resolving completely after nine days on average. Despite this, 89% of patients could only walk around the garden or block in the first week. After two weeks, normal activities were possible but most patients remained off work for three weeks. Stockings were a problem for 49 (53%) patients. Conclusions: Although we would like all our patients to mobilize early after varicose vein surgery, the traditional long walk is unrealistic. Support stockings cause difficulties in over half the patients. Postoperative care and advice for varicose vein surgery need re-thinking.
Temporary caval filter in the prevention of pulmonary embolism during delivery and postpartum
Authors: Pagliariccio G , Carbonari L , Grilli Cicilioni C , Angelini A , Gatta E , Curatola A , Alo′ F P 
Published: November 2005

Objectives: The treatment of deep vein thrombosis (DVT) of the lower limbs during pregnancy remains controversial. There are a lot of problems related to anticoagulant therapy for the safety of the fetus; the use of caval filters rarely appears in the literature and it is not yet codified. So the choice of the right treatment is often difficult. The authors review their experience with a prophylactic use of a temporary caval filter for patients with proximal DVT of the last period of pregnancy, in order to avoid the inherent risk of major pulmonary embolism during delivery and postpartum. Methods: Ten women with proximal DVT were treated. The diagnosis was performed by Doppler ultrasonography (DU) and magnetic resonance (MR). At the end of pregnancy, a temporary caval filter (eight Prolyser and two Tempofilter) was percutaneously inserted under X-ray control. The patients were then subjected to a planned caesarean section. After 15 days, all filters were removed after a phlebography to check the absence of clots. Results: The mean time of X-ray exposure was about 1 min and 30 s. None of the patients suffered a major pulmonary embolism. All fetuses were born without problems or malformations. There were no complications related to the filters. No caval thrombosis or filters clots were found at the phlebography. The follow-up registered no pulmonary embolism episodes. Conclusions: The use of a temporary caval filter in pregnancy is safe and does not introduce any additional risk. It could be suggested for pregnant patients with proximal DVT beginning in the last period of pregnancy.
Perforator of the popliteal fossa and short saphenous vein insufficiency
Authors: De Palma M , Carandina S , Mazza P , Fortini P , Legnaro A , Palazzo A , Liboni A , Zamboni P 
Published: November 2005

Objectives: To assess the preoperative frequency of reflux from the perforator of the popliteal fossa (PPF) in cases of short saphenous vein insufficiency. Methods: Short saphenous vein insufficiency cases were carefully investigated in 590 consecutive patients affected by primary chronic venous insufficiency. PPF was identified in accordance with anatomical criteria translated in ultrasonic anatomy. Reflux was elicited in standing both by squeezing and active manoeuvres. Results: Short saphenous vein insufficiency occurred in 77/590 cases (13%). In 15/77 cases (19%) short saphenous insufficiency was fed by reflux from the PPF, with a competent saphenopopliteal junction, and this finding was confirmed at surgical exploration. PPF superficial outlet was found on the inferior aspect of the short saphenous main trunk (type 1 presentation, 11 cases) and on a varicous tributary (type 2, four cases). Conclusions: PPF is a neglected entity, but often is the only source of the reflux in the short saphenous vein system. The lack of preoperative awareness of its presence could lead to an increased rate of saphenopopliteal recurrences, especially in case of type 1 presentation.
Informed consent: what do we tell patients about the risk of fatal pulmonary embolism after varicose vein surgery?
Authors: Srilekha A , Karunanithy N , Corbett C R R 
Published: November 2005

Objective: To obtain an estimate of the frequency of fatal pulmonary embolism (PE) after varicose vein surgery. Methods: Firstly by analysis of official statistics and secondly by a postal questionnaire to surgeons carrying out varicose vein surgery. The response rate from the questionnaire was 68% (391/576). Surgeons were asked if they had encountered PE after varicose vein surgery, whether the outcome was fatal and how many years they had spent in the specialty. Further calculations were based on data obtained from the Vascular Society of Great Britain and Ireland that suggest that on average about 120 cases are operated per year per consultant surgeon. Results: Analysis of the statistics available from official sources suggested that the risk of fatal PE after varicose vein surgery is about 1 in 15,000. Respondents to the questionnaire reported a total of 396 pulmonary emboli, of which 73 were fatal. From the questionnaire, we estimate that between one in three and one in four surgeons will encounter a fatality in the course of a full career. From knowledge of the length of time spent in the specialty by our respondents and using the figure of 120 operated cases per consultant per year, we obtained a higher estimate of the risk of fatal PE, around one in 10,000 cases. Conclusions: While the methods used to collect these figures are imperfect and open to criticism, they suggest a risk between one in 10,000 and one in 15,000. We think it is reasonable, when obtaining consent, to warn patients of the very small risk of fatal PE, using the more pessimistic figure of one in 10,000.
Determinants of the Differences in Ldl-Cholesterol After Initiation of Statin Treatment
Authors: Caspard Herve , Chan Arnold K , Walker Alexander M 
Published: November 2005

Background: Randomized clinical trials may not accurately predict drug benefit in clinical practice because the patients and conditions of therapy almost always differ between those settings. Objective: To determine whether differences in low-density lipoprotein cholesterol (LDL-C) time curves between clinical trial results and usual care experience after initiation of statin therapy could be explained fully in terms of observable characteristics of patients and practice in usual care. Methods: We compared LDL-C measurements for 3 years after initiation of statin treatment in individuals enrolled in a health maintenance organization (HMO), with enrollees in the active treatment arm of the CARE (Cholesterol and Recurrent Events) trial. Analysis of the determinants of variation in LDL-C in the HMO cohort was used to adjust the crude results to the distribution of patient and treatment characteristics in the trial. Results: The mean percent decrease in LDL-C was lower in the HMO cohort (n = 1245) than in the clinical trial at the end of each 6-month period, with the difference diminishing over time. Adjustment of the HMO time curve to the baseline characteristics of the clinical trial cohort did not significantly change the mean estimates at any time point. Assuming optimal adherence in the HMO cohort raised the curve over time, with 95% confidence intervals including the means observed in CARE after 18 months. Fixing treatment to pravastatin 40 mg/day, as in CARE, brought the estimates in the HMO cohort very close to those of the clinical trial, with 95% confidence intervals including the means observed in CARE at all time points. Conclusions: Treatment selection, dosing, and adherence under usual care were the primary reasons for which improvements in LDL-C in practice fell short of expectations that are based on clinical trial findings for statin therapy. Beginning with a low dose of statins and titrating to a satisfactory response can delay effective treatment by 18 months or more. Poor adherence accounts for a further substantial shortfall from maximal effect. Differences between trial populations and the general population of statin users with respect to age, gender, and baseline LDL-C have no measurable impact on discrepancies between predicted and observed LDL-C improvement in usual practice.
Influence of Landscape‐Scale Factors in Limiting Brook Trout Populations in Pennsylvania Streams
Authors: Kocovsky Patrick M. , Carline Robert F. 
Published: November 2005

AbstractLandscapes influence the capacity of streams to produce trout through their effect on water chemistry and other factors at the reach scale. Trout abundance also fluctuates over time; thus, to thoroughly understand how spatial factors at landscape scales affect trout populations, one must assess the changes in populations over time to provide a context for interpreting the importance of spatial factors. We used data from the Pennsylvania Fish and Boat Commission's fisheries management database to investigate spatial factors that affect the capacity of streams to support brook trout Salvelinus fontinalis and to provide models useful for their management. We assessed the relative importance of spatial and temporal variation by calculating variance components and comparing relative standard errors for spatial and temporal variation. We used binary logistic regression to predict the presence of harvestable‐length brook trout and multiple linear regression to assess the mechanistic links between landscapes and trout populations and to predict population density. The variance in trout density among streams was equal to or greater than the temporal variation for several streams, indicating that differences among sites affect population density. Logistic regression models correctly predicted the absence of harvestable‐length brook trout in 60% of validation samples. The r2‐value for the linear regression model predicting density was 0.3, indicating low predictive ability. Both logistic and linear regression models supported buffering capacity against acid episodes as an important mechanistic link between landscapes and trout populations. Although our models fail to predict trout densities precisely, their success at elucidating the mechanistic links between landscapes and trout populations, in concert with the importance of spatial variation, increases our understanding of factors affecting brook trout abundance and will help managers and private groups to protect and enhance populations of wild brook trout.
Growth of Larval to Juvenile Green Sturgeon in Elevated Temperature Regimes
Authors: Allen Peter J. , Nicholl Mary , Cole Stephanie , Vlazny Amy , Cech Joseph J. 
Published: November 2005

AbstractTo determine the effect of high river temperatures on post‐yolk‐sac larval to early juvenile green sturgeonAcipenser medirostris, growth rates at elevated and cycling temperature regimes were measured. Water temperatures were chosen based on temperature regimes in their highly altered natal rivers. Post‐yolk‐sac fish (15 d after hatching) were placed into twenty‐four 60‐L tanks. Fish were kept on a natural photoperiod, receiving continuous well water and aeration and ad libitum commercial rations. Significant differences were found between final wet weights, total lengths, and specific growth rates (at 24°C and at cycling 19–24°C > 19°C) because of increases in food consumption, despite increases in activity (both significantly greater at 24°C than at 19–24°C or 19°C). Elevated and cycling temperatures in the 19–24°C range do not adversely affect juveniles (body size range, ∼0.1–10 g), when abundant food and oxygen are available.
Structure and Functions of State Public Health Agencies
Authors: Beitsch Leslie M. , Brooks Robert G. , Grigg Meade , Menachemi Nir 
Published: November 2005

Objectives. We assessed the structure and functions of state health departments throughout the United States and compared our findings with those from a previous national assessment conducted in 1990.Methods. In 2001, we sent a survey to the state health officers of all 50 states. The survey asked about the structure and functions of the state health agency.Results. The survey was completed by state health officers from 47 states (a 94% response rate). More than half of the states responding had a freestanding state public health agency and a state board or council of health. Forty-four percent had a regional or district structure. Although some traditional public health functions have been curtailed, important new public health functions have emerged since 1990.Conclusions. Our current findings confirm core changes in the structure and functions of state public health systems over the past decade and emphasize the need for more research into these systems to maximize their organizational performance.
FIDELIS—Innovative Approaches to Increasing Global Case Detection of Tuberculosis
Authors: Rusen I. D. , Enarson Donald A. 
Published: November 2005

Tuberculosis was declared a global public health emergency in 1993. In 2003, only 45% of the world’s estimated new smear-positive tuberculosis cases were detected—well below the 70% global case detection target set by the World Health Organization. The FIDELIS (Fund for Innovative DOTS Expansion Through Local Initiatives to Stop TB) initiative is a new global disease control initiative that has been developed to rapidly assess and implement innovative approaches to increase tuberculosis case detection. To date, 32 projects have been approved—covering approximately 378 million people in 13 countries—24 (75%) of which are in the world’s 6 highest-burden countries. A wide range of target populations and interventions have been incorporated into successful FIDELIS projects. The FIDELIS initiative may serve as a model to discover best practices to address other urgent global public health problems.