bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of intentional self-poisoning in rural Sri Lanka
Authors: Eddleston Michael , Gunnell David , Karunaratne Ayanthi , De Silva Dhammika , Sheriff M. H. Rezvi , Buckley Nick A. 
Published: November 2005

SummaryWe investigated the epidemiology of intentional self-poisoning in rural Sri Lanka by prospectively recording 2189 admissions to two secondary hospitals. Many patients were young (median age 25 years), male (57%) and used pesticides (49%). Of the 198 who died, 156 were men (case fatality 12.4%) and 42 were women (4.5%). Over half of female deaths were in those under 25 years old; male deaths were spread more evenly across age groups. Oleander and paraquat caused 74% of deaths in people under 25 years old; thereafter organophosphorous pesticides caused many deaths. Although the age pattern of self-poisoning was similar to that of industrialised countries, case fatality was more than 15 times higher and the pattern of fatal self-poisoning different.
Psychiatric disorders in HIV-positive individuals in urban Uganda
Authors: Petrushkin Harry , Boardman Jed , Ovuga Emilio 
Published: November 2005

Aims and MethodThe study examined the prevalence of psychiatric disorders in people with HIV/AIDS attending the AIDS Support Organisation (TASO) clinic at Mulago Hospital, Kampala, Uganda and the preparedness of AIDS counsellors to deal with mental disorders. Forty-six patients were interviewed using the Mini International Psychiatric Interview to ascertain DSM–IV diagnoses. All 15 counsellors working at the clinic were interviewed.ResultsThe total prevalence of psychiatric disorder was 82.6 (38 out of 46 patients). Depressive and anxiety disorders were common. Non-affective psychoses were present in eight patients (17.4%), bipolar affective disorder in eight (17.4%) and major depression with melancholic features in five (10.9%); 8 (13%) had current suicidal thoughts. None of the people with psychiatric disorders were receiving mental health treatment. The prevalence of disorder as estimated by the counsellors ranged from 0 to 33%. Only one counsellor had received any formal training in mental disorders and only two thought that they could deal with these if they arose. The attitudes of counsellors towards people with mental disorders were mixed, but most believed that they should be trained to provide care.Clinical ImplicationsThere is a need to provide additional mental health services to the TASO clinic through appropriate training of TASO counsellors to improve their awareness of psychiatric disorders, delivery of some psychological therapies and liaison with the psychiatric services at Mulago Hospital, in addition to public mental health education. The psychiatric disorders experienced by those attending the clinic might put them at greater risk of contracting HIV/AIDS.
National survey of methadone prescribing for maintenance treatment: ‘opiophobia’ among substance misuse services?
Authors: Joseph Renju , Foselpy Hamdy F. 
Published: November 2005

Aims and MethodThe aims of this study were to describe the characteristics of substance misuse services prescribing methadone for maintenance treatment of opioid dependence and to determine the average daily doses of methadone prescribed across England. A postal questionnaire survey of all substance misuse treatment centres in England was carried out.ResultsA total of 298 treatment centres were identified and contacted, 212 of which responded to the survey (response rate of 71%). Of these, 157 were prescribing methadone for maintenance treatment; the majority (71%) were community-based and 125 centres had doctors attached. The most common formulation of methadone prescription was oral methadone mixture (152 centres, 97%). The mean daily dose of methadone prescribed was 47 mg. Surprisingly, 37 (24%) of the respondents felt that methadone maintenance treatment should be time-limited and 21 teams (13%) stated that patients should receive only drug substitution and no psychosocial interventions.Clinical ImplicationsThere is currently a move among substance misuse services towards community-based treatment. In our survey, the mean daily dose of methadone prescribed was less than the dosage recommended by the Department of Health. This suggests that specialist addiction services are continuing to underprescribe heroin substitutes. The inadequate understanding of some of the respondents of the basic principles of methadone maintenance treatment also raises concerns, and highlights the need for further training and education.
Ordered thoughts on thought disorder
Authors: Rule Ashley 
Published: November 2005

Aims and MethodTo review and clarify the large number of psychophenomenological terms used to describe thought disorder. The most recent editions of the major psychiatric textbooks and medical dictionaries in the library of a London teaching hospital were used to compile a list of such terms. The various, often conflicting definitions were compared.ResultsThere were 68 terms identified. There was significant redundancy in these terms (i.e. more terms than significantly different concepts described). Different sources gave different definitions for the same terms.Clinical ImplicationsThe understanding of many of the terms used to describe thought disorder is poor. This is confusing for clinicians, trainees and patients.
Ultrasound-guided foam sclerotherapy in the treatment of varicose veins: tips and tricks
Authors: de Zeeuw R , Toonder I M , Wittens C H A , Loots M A M 
Published: November 2005

Objective: Ultrasound-guided foam sclerotherapy has become an accepted technique in the treatment of varicose veins. Compared with liquid sclerotherapy, foam is a much more powerful tool in the hands of an experienced practitioner. The introduction of consensus statements on foam sclerotherapy enhances its efficacy. This report will provide clinical tips and tricks during ultrasound-guided foam sclerotherapy. Methods: In general, consensus statements do not include practical tips and tricks to facilitate ultrasound-guided foam sclerotherapy itself. Experiences acquired during ultrasound-guided foam sclerotherapy sessions in our clinical practice can enhance the power of this treatment, which may be useful for colleagues in their everyday clinical practice. Conclusion: This report presents useful tips and tricks, which may contribute to effective ultrasound-guided foam sclerotherapy.
Audit of varicose vein surgery: the patients' perspective
Authors: Sains P S , Reddy K M , Jones H J S , Derodra J K 
Published: November 2005

Objectives: Varicose veins cause varying symptoms and post-surgical patient dissatisfaction is not uncommon. We aimed to identify patients' reasons for having surgery and sought to identify measures for improvement. Methods: A postal questionnaire was sent to patients. The patients' preoperative symptoms and postoperative satisfaction were enquired upon. Replies were cross-referenced to the operation notes. Results: Three hundred and thirty-five patients completed the questionnaire. The consultant carried out 73% of operations, with 27% being carried out by trainees. In all, 41% of patients were very satisfied with surgery, 39% were satisfied, 17% were dissatisfied and 4% were very dissatisfied. In those whose operation was carried out by a consultant, 18% were dissatisfied as compared with 31% of those operated on by a trainee. Conclusion: The vast majority of patients are satisfied with varicose vein surgery and there are modifiable factors such as grade of surgeon and supervision, which can influence the outcome and satisfaction.
Endoscope-assisted management of primary varicose veins below the knee
Authors: Lin S-D , Lin T-M , Lee S-S , Yang Y-L , Sun I-F , Lai C-S 
Published: November 2005

Objective: Primary varicose veins below the knee were managed with the assistance of endoscopic surgery in 240 limbs (235 cases). Methods: Patients were classified into five clinico-anatomic types according to associated normal veins involved in the varicosities. All procedures were limited to below the knee. With the superior illumination and magnified monitor view offered by the endoscope, all the varicosities and the incompetent perforating veins were dissected, clipped, divided and removed through one or more access incisions (2.5–3.0 cm in length). However, the normal veins were preserved, including the long saphenous vein. Results: The mean number of incisions in each limb of all patients was 1.86. As there were no residual varicosities or incompetent perforating veins, there was little possibility of recurrence. In the follow-up of 218 limbs, recurrence occurred in only two limbs. Conclusion: Endoscope-assisted surgery is a good alternative for management of primary varicose veins below the knee, resulting in low recurrence and aesthetically acceptable surgical scarring.
Retrospective study of radiologically confirmed hospital-acquired venous thromboembolic disease
Authors: Carrim Z I , Ruckley C V , Boyd J , Sutherland M , Murchison J T 
Published: November 2005

Objective: To study hospital-acquired venous thromboembolic disease (HAVTED) and the relationship between its incidence and compliance with thromboprophylaxis protocols. Methods: For the past eight years, specialty-specific protocols for VTE prophylaxis have been in operation throughout this hospital. Patients developing radiologically proven VTE either as inpatients or within 12 weeks of discharge were identified from a register. Patients were categorized according to risk as per the Scottish Intercollegiate Guidelines Network (SIGN) guidelines. The use of pharmacological prophylaxis for VTE was recorded. Results: Over a period of 24 months, 98 patients had radiologically proven HAVTED. Of 44 categorized as high risk, 17 (39%) had received prophylaxis. Corresponding figures for 50 at medium risk and four at low risk were 16 (32%) and three (75%), respectively. The overall incidence of HAVTED averaged two per 1000 inpatient discharges varying between 0.2 in General Medicine and 6.6 in Trauma Orthopaedics. The mean additional cost of treating a case of HAVTED was estimated at £3,000. Conclusion:Audit of radiological investigations of VTE showed that 18% of all cases were hospital acquired. A hospital policy of thromboprophylaxis may reduce but does not eliminate HAVTED. A substantial proportion of patients with HAVTED had not received prophylaxis. The possibility of a further reduction in incidence of HAVTED with potential saving in morbidity, mortality and cost is highlighted. The implementation and efficacy of thromboprophylaxis protocols should be monitored.
Hepatotoxicity Associated with Acarbose Therapy
Authors: Hsiao Shu-Hwa , Liao Li-Hsiang , Cheng Pin-Nan , Wu Ta-Jen 
Published: November 2005

Objective: To report a case of acarbose-induced hepatotoxicity and compare other reported cases from the literature. Case Summary: A 57-year-old woman with type 2 diabetes mellitus for about 10 years had been treated with insulin glargine 20 units/day since December 19, 2002. Acarbose 100 mg 3-times-daily add-on therapy for inadequate glycemic control was started on June 5, 2003. Six months later, the woman complained of gastrointestinal discomfort; the acarbose dose was decreased to 50 mg 3 times daily thereafter. Laboratory examination later revealed alanine aminotransferase (ALT) 640 U/L (upper reference value 55). To elucidate the possibilities of adverse reactions caused by concurrent use of nutritional supplements and medication, we discontinued propolis extract, Ginkgo biloba, placeta extract, and estrogen. Although no remarkable symptoms were noted thereafter, the abnormal ALT values persisted, and no definite viral or autoimmune etiologies were identified. Acarbose was discontinued in August 2004; aspartate aminotransferase and ALT values returned to normal in October 2004. Discussion: In addition to ruling out other possible etiologic factors, we assessed the probability of acarbose-induced hepatotoxicity by observing the close time relationship between drug administration and the development of signs and symptoms, as well as the close time relationship between drug withdrawal and the normalization of abnormal liver function test values. An objective causality assessment revealed that an adverse drug reaction was probable as determined by both the Naranjo probability scale and the Roussel Uclaf Causality Assessment Method score. Conclusions: Although acarbose-induced hepatotoxicity appears to be uncommon, diabetic patients receiving long-term acarbose therapy should be closely monitored for this adverse effect.
Blood Pressure and Heart Rate Effects Following a Single Dose of Bitter Orange
Authors: Bui Linda T , Nguyen DiemThuy T , Ambrose Peter J 
Published: November 2005

Background: The ingredients of numerous “ephedra-free” dietary supplements used for weight loss include bitter orange, which contains sympathomimetic alkaloids such as synephrine. Due to the similarity in chemical structure to ephedrine and the potential sympathomimetic effects of synephrine, it is hypothesized that bitter orange may increase blood pressure (BP) and heart rate (HR). Objective: To determine the effects on BP and HR after a single dose of bitter orange in healthy adults. Methods: In a prospective, randomized, double-blind, placebo-controlled, crossover study, 15 young, healthy, adult subjects received either a single dose of Nature's Way Bitter Orange—a 900 mg dietary supplement extract standardized to 6% synephrine—or matching placebo, with a one week washout period. Systolic BP (SBP), diastolic BP (DBP), and HR were measured at baseline and every hour for 6 hours after administration. Results: SBP after bitter orange was significantly increased versus placebo at hours 1–5 (p < 0.0001); the peak difference was 7.3 ± 4.6 mm Hg. Although the baseline DBP was higher than after administration of both placebo and bitter orange, DBP after bitter orange was significantly increased versus placebo at hours 4 and 5 (p ≤ 0.02); the peak difference was 2.6 ± 3.8 mm Hg. HR was significantly increased after bitter orange versus placebo for hours 2–5 (p < 0.01); the peak difference was 4.2 ± 4.5 beats/min. Conclusions: SBP, DBP, and HR were higher for up to 5 hours after a single dose of bitter orange versus placebo in young, healthy adults.
Environmental–Structural Interventions to Reduce HIV/STI Risk Among Female Sex Workers in the Dominican Republic
Authors: Kerrigan Deanna , Moreno Luis , Rosario Santo , Gomez Bayardo , Jerez Hector , Barrington Clare , Weiss Ellen , Sweat Michael 
Published: November 2005

Objectives. We assessed the effectiveness of 2 environmental–structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic. Methods. Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention–postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings. Results. Significant increases in condom use with new clients (75.3%–93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%–28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%–16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers’ verbal rejections of unsafe sex (50.0%–79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments’ ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22). Conclusions. Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers.
Integrating Behavioral and Social Science Research Into Microbicide Clinical Trials: Challenges and Opportunities
Authors: Tolley Elizabeth E. , Severy Lawrence J. 
Published: November 2005

It has been argued that rigid thinking about the types and progression of research needed to evaluate health promotion interventions has stymied the process by which research is translated to action. This argument is particularly salient in the field of HIV/AIDS prevention. We examined microbicide research and identified challenges that obstruct the integration of clinical trial and behavioral and social science research, thereby reinforcing linear programs of research. We found that behavioral and social science research can both support microbicide clinical trial performance and anticipate the information most needed for a rapid and successful introduction of future microbicide products.
Urban–Rural Inequalities in Ischemic Heart Disease in Scotland, 1981–1999
Authors: Levin Kate A. , Leyland Alastair H. 
Published: November 2005

Objectives. We sought to describe the pattern and magnitude of urban–rural variation in ischemic heart disease (IHD) in Scotland and to examine the associations among IHD health indicators, level of rurality, and degree of socioeconomic deprivation. Methods. We used routine population and health data on the population aged 40–74 years between 1981 and 1999 and living in 826 small areas (average population=5600) in Scotland. Three IHD health indicators—mortality rates (deaths per 100000 population), rates of continuous hospital stays (discharges per 100000 population), and rates of mortality in the hospital or within 28 days of discharge (MH+) were analyzed with multilevel Poisson models. A 4-level rurality classification was used: urban areas, remote small towns, accessible rural areas, and remote rural areas. Results. Rates of mortality, continuous hospital stays, and MH+ increased with area socioeconomic deprivation. After adjustment for population age, gender, and deprivation, the relative risk of IHD mortality in remote rural areas was similar to that of urban areas in 1981; the relative risk of a continuous hospital stay was significantly lower (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.64, 0.76) and the relative risk of MH+ was higher (RR=1.18; 95% CI=1.04, 1.35) in remote rural areas. Mortality and MH+ declined for all ruralities over time. However, MH+ remains highest in remote rural areas and remote towns. Conclusions. Low standardized ratios of IHD continuous hospital stays and mortality in remote rural areas mask health problems among rural populations. Although absolute and relative differences between urban and rural rates of MH+ have diminished, the relative risk of MH+ remains high in remote rural areas.
Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control
Authors: Cooper Richard S. , Orduñez Pedro , Iraola Ferrer Marcos D. , Munoz Jose Luis Bernal , Espinosa-Brito Alfredo 
Published: November 2005

Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there. Methods. We reviewed Cuban public health statistics, surveys, and reports of health services. Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors. Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD.
The Roles of Teaching Hospitals, Insurance Status, and Race/Ethnicity in Receipt of Adjuvant Therapy for Regional-Stage Breast Cancer in Florida
Authors: Richardson Lisa C. , Tian Lili , Voti Lydia , Hartzema Abraham G. , Reis Isildinha , Fleming Lora E. , MacKinnon Jill 
Published: November 2005

Objectives. We examined the roles of teaching hospitals, insurance status, and race/ ethnicity in women’s receipt of adjuvant therapy for regional-stage breast cancer. Methods. Data were taken from the Florida Cancer Data System for cases diagnosed from July 1997 to December 2000. We evaluated the impact of health insurance status and hospital type on use of adjuvant therapy (after adjustment for age, race/ethnicity, and marital status). Interaction terms for hospital type, insurance status, and race/ethnicity were entered in each model. Results. Teaching facilities diagnosed 12.5% of the cases; however, they cared for a disproportionate percentage (21.3%) of uninsured and Medicaid-insured women. Among women who received adjuvant chemotherapy only, those diagnosed in teaching hospitals were more likely than those diagnosed in nonteaching hospitals to receive therapy regardless of insurance status or race/ethnicity. Among women who received chemotherapy with or without hormonal therapy, Hispanics were more likely than White non-Hispanic women to receive therapy, whereas women with private insurance or Medicare were less likely than uninsured and Medicaid-insured women to receive this type of therapy. Conclusions. Teaching facilities play an important role in the diagnosis and treatment of regional-stage breast cancer among Hispanics, uninsured women, and women insured by Medicaid.
Decreasing Socioeconomic Inequalities and Increasing Health Inequalities in Spain: A Case Study
Authors: Regidor Enrique , Ronda Elena , Pascual Cruz , Martínez David , Calle María Elisa , Domínguez Vicente 
Published: November 2005

Objectives. We examined the evolution of income inequalities and health inequalities in Spain from the time of the country’s entry into the European Union. Methods. We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984–1986 and 1999–2001. Results. Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. Conclusions. Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.