bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Social Networks of People with Intellectual Disability Living in the Community 12 Years after Resettlement from Long‐Stay Hospitals
Authors: Forrester‐Jones Rachel , Carpenter John , Coolen‐Schrijner Pauline , Cambridge Paul , Tate Alison , Beecham Jennifer , Hallam Angela , Knapp Martin , Wooff David 
Published: November 2006

Background  The social inclusion of people with intellectual disabilities presents a major challenge to services. As part of a 12‐year follow up of people resettled from long‐stay hospitals, the size of 213 individuals’ social networks and the types of social support they received were investigated, as viewed by people with intellectual disabilities themselves. The types of support received in four different kinds of community accommodation were compared.Method  Individuals were interviewed and their social support networks mapped using a Social Network Guide developed for the study. Descriptive statistics were generated and comparisons made using generalized linear modelling.Results  The sample comprised 117 men (average age 51 years) and 96 women (average age 56 years). All but seven were White British, 92% were single and they had in general, mild to moderate intellectual disabilities. The average network size was 22 members (range 3–51). The mean density was 0.5. A quarter of all network members were other service users with intellectual disabilities and a further 43% were staff. Only a third of the members were unrelated to learning disability services. In general, the main providers of both emotional and practical support were staff, although these relationships were less likely to be described as reciprocal. Other people with intellectual disabilities were the second most frequent providers of all types of support. People in small group homes, hostels and supported accommodation were significantly more likely to report close and companiable relationships than those in residential and nursing homes, but they also reported a greater proportion of critical behaviour.Conclusions  The social networks revealed in this study are considerably larger than those of previous studies which have relied on staff reports, but findings about the generally limited social integration of people with intellectual disabilities are similar. A clearer policy and practice focus on the desirability of a range of different social contexts from which to derive potentially supportive network members is required so that people do not remain segregated in one area of life.
The Camberwell Cohort 25 Years On: Characteristics and Changes in Skills Over Time
Authors: Beadle‐Brown Julie , Murphy Glynis , Wing Lorna 
Published: November 2006

Background  This study presents data on the characteristics of the Camberwell Cohort, 25 years after they were first assessed in the 1970s [Wing & Gould (1979) Journal of Autism and Childhood Schizophrenia vol. 9, pp. 11–29]. It also presents data on changes over time which adds to that presented in Beadle‐Brown et al. [Journal of Intellectual Disability Research (2000) vol. 32, pp. 195–206].Methods  Measures of level of skills, ability and behaviour, including self‐care, educational, social skills, cognitive ability and challenging behaviour, were conducted with as many of the cohort as possible. In addition, background information was collected on diagnosis, placement history, daytime activity and family contact.Results  The cohort (n = 91) now aged between 27 and 42 years were living mostly in the community (68%) or with their parents (27%). Sixty‐four per cent of the sample who could be tested (n = 36) had an IQ below 50, 73% were socially impaired and 72% had some form of autistic spectrum disorder. There were few changes over time between time 2 (1980s) and time 3 – as reported in Beadle‐Brown et al., most changes occurred during childhood and early adolescence. However, for those who had been in institutional care for more than 3 years, there were a number of self‐care skills which significantly increased between time 2 and time 3 (after a move into the community).
Menstrual Problems Experienced by Women with Learning Disabilities
Authors: Rodgers Jackie , Lipscombe Jo , Santer Miriam 
Published: November 2006

Background  Menstruation appears to be problematic for women with learning disabilities, yet there has been little quantitative research on their experiences, or comparisons with other groups of women. This paper considers the nature and extent of menstrual problems experienced by women with learning disabilities.Methods  The data reported here come from a cross‐sectional postal questionnaire survey conducted with carers of 452 women, aged 14–55 years, who had learning disabilities.Results  Women with learning disabilities appear to be as likely to experience menstrual problems as other women. However, such problems may be experienced differently and more negatively and may not always be recognized appropriately.Conclusions  More attention needs to be given to menstrual problems experienced by women with learning disabilities, both in research and in practice. It is particularly important that women with learning disabilities be supported to play a central role in recognizing and defining the problems they experience.
Obstetric‐induced incontinence: A black hole of preventable morbidity
Authors: THORNTON Michelle J. , LUBOWSKI David Z. 
Published: November 2006

AbstractThere is a detailed literature comprising clinical and anorectal physiological studies linking faecal incontinence to vaginal delivery. Specific risk factors are high infant birthweight, forceps delivery and prolonged second stage of labour. The onset of symptoms may be delayed for many years. Faecal incontinence occurs in more than 10% of adult females and urinary incontinence in about a third of multiparous women. This places a very large economic burden on the Australian health system. A conservative estimate for overall management of incontinence would be in excess of $A700 million but the actual amount is unknown. Preventative measures for avoiding pelvic floor injuries need to be established, and safe obstetric practice needs to be redefined in the light of current knowledge about incontinence. Outcome measures for safe birthing should not only include infant and maternal mortality and infant morbidity, but should also include the long‐term effects of vaginal delivery on the pelvic floor, particularly urinary and faecal incontinence. Several state reports and one federal senate report on safe birthing have been lacking in this area. The safety of birthing centres and home birthing needs to be examined to provide birthing mothers with complete and appropriate information about safety in order that they may consider their options. Appropriate Caesarean section rates for optimal birthing safety are unknown and need to be re‐examined. Calls for overall reduction in Caesarean section rates in Australia are inappropriate and cannot be justified until the effects of pelvic floor injury are added to the overall assessment.
Mapping uptake of prenatal diagnosis for Down syndrome and other chromosome abnormalities across Victoria, Australia
Authors: MUGGLI Evelyne Elvira , COLLINS Veronica Rose , HALLIDAY Jane Lavinia 
Published: November 2006

AbstractObjective:  To investigate geodemographic characteristics of women having prenatal diagnosis for Down syndrome and other fetal chromosome abnormalities in Victoria, Australia.Methods:  A descriptive analysis of population‐based data on all confinements, amniocenteses and chorionic villus sampling for 1998 and 2002 was undertaken. Multivariate logistic regression analysis of 2002 data investigated geographical differences, including selected maternal features and a socioeconomic status measure that may be associated with uptake of diagnostic testing.Results:  After adjusting for age, parity of three or more children was associated with a significantly decreased likelihood of testing (P < 0.001). Women from Africa were 61% less likely to have testing than women born in Australia (P < 0.01). While overall uptake of testing was lower than average in rural regions, only the Loddon Mallee had a significantly decreased likelihood of testing (OR 0.71 (0.53, 0.95), P = 0.02). A socioeconomic index of place of residence showed no association with uptake. Metropolitan and rural women giving birth in private hospitals were 31 and 60% more likely to have a test than women giving birth in public hospitals (P < 0.01).Conclusion:  Geographical differences influence uptake of prenatal diagnosis, probably related to access to services. However, other maternal demographic factors also play a role in uptake. To ensure equity in access and autonomy in women's reproductive choices, reasons for exceptionally low uptake in certain localities or within certain subgroups of pregnant women should be investigated further, followed by appropriate changes in service provision.
The psychosocial outcomes of antenatal day care for three medical complications of pregnancy: A randomised controlled trial of 395 women
Authors: TURNBULL Deborah A. , WILKINSON Chris , GRIFFITH Elizabeth C. , KRUZINS Gillian , GERARD Karen , SHANAHAN Marian , STAMP Georgina E. 
Published: November 2006

AbstractBackground:  Although antenatal day care is becoming increasingly common, there is little evidence as to the psychosocial efficacy of this model of care.Aim:  We aimed to assess the broader psychosocial impact of antenatal day care compared with admission to hospital.Methods:  We carried out a randomised trial of 395 women, randomly assigned in a 2 : 1 ratio between day care and antenatal ward, stratified for major diagnostic categories (proteinuric hypertension, non‐proteinuric hypertension and preterm premature rupture of membranes). Main outcome measures – self‐report questionnaires (response rates ranging from 80 to 90%) were sent to women's homes four days after randomisation and seven weeks after delivery.Results:  Overall, there were statistically significant differences favouring day care in 12 of 28 items at four days post‐randomisation, with no differences in the two groups for the other 16 items. At seven weeks postdelivery, we found differences in eight of 28 items favouring day care, with no differences in the two groups for the other 20 items. The types of items indicating a sustained difference covered a range of aspects of care and included satisfaction with staff, continuity of carer, information transfer, and social support. There were no differences in relation to infant feeding and relationship with the baby.Conclusions:  Day care has an effect on women's satisfaction with care but does not produce broader psychosocial outcomes.
Laparoscopic colposuspension versus vaginal suburethral slingplasty: A randomised prospective trial
Authors: FOOTE Andrew J. , MAUGHAN Vicky , CARNE Claire 
Published: November 2006

AbstractBackground:  This study aimed to determine if laparoscopic colposuspension (LC) was as effective as vaginal suburethral slingplasty (SPARC).Methods:  Ninety‐seven women with urodynamic stress incontinence were prospectively randomised to LC (n = 48) or SPARC (n = 49). Outcome measures were measured at, baseline, six months (n = 87) and two years (n = 58), and comprised leakage episodes per week and visual analogue scale (VAS) of incontinence severity. The LC and SPARC groups at baseline had similar leaks per week (8.8 vs 9.8) and VAS (5.6 vs 5.9).Results:  Laparoscopic colposuspension took longer to perform (48 vs 30 mins, P < 0.001), had a slightly higher blood loss (104 vs 82 mL, P < 0.01), had a longer hospitalisation (4.0 vs 1.5 days, P < 0.001) and had a longer time to resumption of normal activities (3.6 vs 2.8 week, P < 0.01). At six months there were no significant differences between LC and SPARC with regard to leaks per week (1.1 vs 2.6) and VAS (1.3 vs 0.7). The success rates were similar (88.3 vs 81.8%). These results again had no significant differences at two years (leaks per week 2.1 vs 3.5, and VAS 1.7 vs 2.2). At two years, the cure/improved rates again found no significant difference (81.5 vs 77.4%)Conclusions:  Laparoscopic colposuspension is as effective as vaginal suburethral slingplasty after two years’ follow‐up.
Risk factors for ectopic pregnancy: A case‐control study
Authors: KARAER Abdullah , AVSAR Filiz A. , BATIOGLU Sertac 
Published: November 2006

AbstractAim:  To identify the risk factors for ectopic pregnancy.Methods:  We conducted a prospective case‐control study for the role of several risk factors in the occurrence of ectopic pregnancy in Turkey. A total of 225 cases and 375 controls were compared for sociodemographic characteristics, cigarette smoking, obstetric, gynaecological, surgical histories, the presence or absence of assisted conception and contraceptive usage.Results:  The main risk factors for ectopic pregnancy were prior ectopic pregnancy (adjusted odds ratio (AOR): 13.1) and a history of infectious reproductive system (AOR for pelvic inflammatory disease: 6.8). Other risk factors found to be associated with an increased risk for ectopic pregnancy were multisexual partner (AOR: 3.5), history of infertility (AOR: 2.5), induced conception cycle (AOR: 3.4), current intrauterine device usage (AOR: 3.2), prior Caesarean section (AOR: 2.1) and cigarette smoking at the time of conception (AOR = 1.7). On the contrary, barrier methods were protective from ectopic pregnancy (AOR: 0.4).Conclusions:  The increased awareness and knowledge of risk factors have enabled an early and accurate diagnosis of ectopic pregnancy. This study has found prior pelvic infection to be a major aetiological factor for ectopic pregnancy. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy, infertility history and induced conception cycle, may be the result of a previous pelvic infection that may cause tubal sequelae. These factors are potential targets for intervention and modification.
Uterine rupture: Preventable obstetric tragedies?
Authors: MISHRA Sangeeta K. , MORRIS Norman , UPRETY Dhruba Kumar 
Published: November 2006

AbstractBackground:  Although ruptured uterus is nowadays a rare obstetric emergency in Western countries, it is still alarmingly common in developing countries, where it remains a major cause of maternal mortality and morbidity.Aims:  To review the recent experience of uterine rupture at a tertiary obstetric unit in eastern Nepal and to recommend improvements in the current management of labour, especially obstructed labour, in a poorly resourced country.Methods:  All cases of uterine rupture managed from March 2002 to March 2006 were identified retrospectively, and details were retrieved from medical records.Results:  Fifty‐two women suffered from uterine rupture during the four‐year period, approximately one woman per month. Most were unbooked multigravidae, with no antenatal care. They nearly all began labour at home in the absence of a skilled birth attendant. After prolonged labour, usually prolonged second stage, various interventions had often been attempted at home or in other health facilities before admission. Most were shocked and required urgent laparotomy and blood transfusion. Many required intensive care and ventilatory support. Forty‐six per cent required hysterectomy and 5.8% subsequently suffered from a urogenital fistula. The maternal mortality rate in this series was 13.5%, and the stillbirth rate was 94.2%.Conclusions:  Unsafe obstetric practices were identified, especially the injudicious use of oxytocic drugs and fundal pressure in prolonged second stage. Several achievable improvements in obstetric care are recommended, particularly aimed at reducing the delay in women reaching emergency obstetric care when labour is prolonged.
Stress Overload: A New Diagnosis
Authors: Lunney Margaret 
Published: November 2006

PURPOSE.  To describe the phenomenon of stress overload as a nursing diagnosis.METHODS.  A qualitative study using case study method was conducted with nine adults experiencing stress overload to fully describe the experience and identify possible defining characteristics. Current literature sources on stress and its related factors were examined to support stress overload as a nursing diagnosis for inclusion in the NANDA International classification. FINDINGS.  Stress overload, defined as excessive amounts and types of demands that require action, is a human response that is experienced as a problem and contributes to the development of other problems. The proposed defining characteristics are perceives situational stress as excessive, expresses a feeling of tension or pressure, expresses difficulty in functioning as usual, expresses problems with decision‐making, demonstrates increased feelings of anger and impatience, and reports negative effects from stress such as physical symptoms or psychological distress.PRACTICE IMPLICATIONS.  Nursing interventions such as active listening and decision‐making support are needed to help people reduce stress levels. Studies are needed to further validate the defining characteristics and related factors of this new diagnosis.
Pathophysiology and management of dengue hemorrhagic fever
Authors: CHUANSUMRIT AMPAIWAN , TANGNARARATCHAKIT KANCHANA 
Published: November 2006

SUMMARYDengue infection is caused by any of four dengue virus serotypes. The clinical manifestations range from asymptomatic infection to undifferentiated fever, dengue fever and dengue hemorrhagic fever (DHF). DHF is characterized by sustained high fever for 2–7 days; bleeding diathesis such as positive tourniquet test, petechiae, epistaxis and hematemesis; thrombocytopenia with platelet counts ≤ 100 × 109/L and plasma leakage due to increased vascular permeability evidenced by hemoconcentration, pleural effusion and ascites. Bleeding diathesis is caused by vasculopathy, thrombocytopenia, platelet dysfunction and coagulopathy. The three stages of clinical presentations are classified as febrile, toxic and convalescent. The toxic stage, which lasts 24–48 hours, is the most critical period, with rapid plasma leakage leading to circulatory disturbance. The severity of DHF varies from mild (World Health Organization grades I and II), with minimal and transient change in vital signs, to severe (World Health Organization grades III and IV), with threatened shock (e.g. blood pressure 100/90 mmHg) or profound shock. There is no specific treatment for DHF. Intensive supportive care is the most important aspect of management. Early recognition of the disease and careful monitoring for circulatory disturbance are essential. Optimal fluid therapy to maintain the functions of the vital organs during the critical period and effective control of bleeding episodes will lead to favorable outcomes. Administration of recombinant activated factor VII is suggested whenever massive bleeding does not respond to blood component therapy.
Effects of Age, Gender, and Race/Ethnicity on the Pharmacokinetics of Posaconazole in Healthy Volunteers
Authors: Sansone-Parsons Angela , Krishna Gopal , Simon Jason , Soni Peter , Kantesaria B. , Herron Jerry , Stoltz Randall 
Published: November 2006

ABSTRACT
Posaconazole is a triazole antifungal for prophylaxis of invasive fungal infection and treatment of oropharyngeal candidiasis. We evaluated the effects of gender, age, and race/ethnicity (black or white) on the steady-state pharmacokinetics of posaconazole in two studies on healthy adult subjects (≥18 years of age). Additionally, we explored the effect of P-glycoprotein expression and MDR1 genotype on posaconazole pharmacokinetics in black and white subjects. Age, gender, and race/ethnicity had no clinically relevant effects on posaconazole pharmacokinetics. No association was observed between any MDR1 single-nucleotide polymorphism and the area under the concentration-time curve for posaconazole. Posaconazole was safe and well tolerated regardless of age, gender, or race/ethnicity. In conclusion, age, gender, and race/ethnicity have no clinically relevant effects on the steady-state pharmacokinetics of posaconazole in healthy adults; therefore, dosage adjustments based on these covariates are unnecessary.
Association of Fluconazole Area under the Concentration-Time Curve/MIC and Dose/MIC Ratios with Mortality in Nonneutropenic Patients with Candidemia
Authors: Pai Manjunath P. , Turpin Robin S. , Garey Kevin W. 
Published: November 2006

ABSTRACT

The present study tested in vitro susceptibility of
Candida
bloodstream isolates to fluconazole to determine if the ratio of the fluconazole area under the concentration-time curve (AUC) or weight-normalized daily dose (dose
wn
) to MIC correlated with mortality. Fluconazole susceptibility and outcome data were determined for 77 patients with a positive
Candida
blood culture between 2002 and 2005. The most commonly isolated
Candida
species were
C. albicans
(64%),
C. glabrata
(14%),
C. parapsilosis
(8%),
C. tropicalis
(6%), and
C. lusitaniae
(4%). Only two isolates were classified as fluconazole resistant by the CLSI M27-A2 method. Fluconazole MICs were highest against
C. glabrata
relative to other
Candida
species. Overall the crude mortality assessed at hospital discharge was 19.4% (
n
= 15). Mortality rates by species were as follows:
C. albicans
, 16.3%;
C. glabrata
, 36.4%;
C. parapsilosis
, 0%;
C. tropicalis
, 0%;
C. lusitaniae
, 33.3%. A mortality rate of 50% was noted among patients infected with nonsusceptible isolates (MIC ≥ 16 μg/ml) compared to 18% for patients infected with susceptible (MIC ≤ 8 μg/ml) isolates (
P
= 0.17). The fluconazole dose
wn
/MIC (24-h) values were significantly higher for the 62 survivors (13.3 ± 10.5 [mean ± standard deviation]) compared to the 15 nonsurvivors (7.0 ± 8.0) (
P
= 0.03). The fluconazole AUC/MIC (24 h) values also trended higher for survivors (775 ± 739) compared to nonsurvivors (589 ± 715) (
P
= 0.09). These data support the dose-dependent properties of fluconazole. Underdosing fluconazole against less-susceptible
Candida
isolates has the potential to increase the risk of mortality associated with candidemia.
Identification and Structural Characterization of I84C and I84A Mutations That Are Associated with High-Level Resistance to Human Immunodeficiency Virus Protease Inhibitors and Impair Viral Replication
Authors: Mo Hongmei , Parkin Neil , Stewart Kent D. , Lu Liangjun , Dekhtyar Tatyana , Kempf Dale J. , Molla Akhteruzzaman 
Published: November 2006

ABSTRACT
Two novel human immunodeficiency virus protease mutations, I84C and I84A, were identified in patient isolates. The mutants with I84C displayed high-level resistance (median, at least 56-fold) to nelfinavir and saquinavir, but the majority remained susceptible to lopinavir. In contrast, isolates with the I84A mutation exhibited ≥33-fold median increased levels of resistance to nelfinavir, indinavir, amprenavir, ritonavir, lopinavir, saquinavir, and atazanavir. Isolates with the I84A or I84C mutation tended to be more resistant than the isolates with the I84V mutation. Modeling of the structure of the mutant proteases indicated that the I84V, I84C, and I84A mutations all create unoccupied volume in the active site, with I84A introducing the greatest change in the accessible surface area from that of the wild-type structure.