bluuebunny/crossref_metadata_2025_split huggingface dataset:
The purchaser/provider separation in child and family social work: Implications for service delivery and for the role of the social worker
Authors: Hood Suzanne 
Published: November 2003

This paper discusses some of the findings from a research study that was carried out in 1995. The study aimed to examine the implications of the use of the purchaser/provider separation (and associated care management processes) in social work with children and families, focusing on the effects of separation on service delivery and on the role of the social worker. The research involved two stages: a telephone survey (to gather quantitative data about the prevalence of organizational separation in England and qualitative data about perceived advantages and disadvantages of separation) and a single exploratory case study in a Local Authority Social Services Department.The paper is concerned primarily with the case study findings. It begins by locating organizational separation within a social policy context. This is followed by an overview of the existing literature on the implications of the purchaser/provider separation and care management for service delivery and for the social work role. The methods and key findings for the telephone survey and the case study are then described. Analysis of the case study data suggested that separation in this setting could be understood along three dimensions: efficient processing versus delays; control of the work and work processes versus lack of control; and clarity of role and task versus duplication. The paper ends with a discussion of the study’s main conclusion – that the purchaser/provider separation in child and family work may introduce benefits of specialization whilst also bringing problems associated with fragmentation of the traditional social work role.
Ebastine inhibits T cell migration, production of Th2‐type cytokines and proinflammatory cytokines
Authors: Nori M. , Iwata S. , Munakata Y. , Kobayashi H. , Kobayashi S. , Umezawa Y. , Hosono O. , Kawasaki H. , Dang N. H. , Tanaka H. , Shiohara T. , Morimoto C. 
Published: November 2003

SummaryBackground  Cytokine imbalance and cellular migration to inflammatory sites are critical components of allergic diseases. Redirecting cytokine imbalance and inhibiting cell migration therefore represent important therapeutic strategies for the treatment of these disorders.Objectives  To study the in vitro effect of ebastine, a novel non‐sedating H1 receptor antagonist, on cytokine secretion and migration of activated T cells, as well as production of pro‐inflammatory cytokines by macrophages.Methods  Peripheral T cells obtained from healthy volunteers were cultured in wells coated with the combination of anti‐CD3 monoclonal antibody (mAb) and anti‐CD26 mAb, anti‐CD3 mAb and anti‐CD28 mAb, or anti‐CD3 mAb with PMA, in the presence or absence of ebastine. T cell proliferation and the production of cytokines were measured by [3H]thymidine incorporation assay and ELISA, respectively. In addition, transendothelial migration of T cells and production of pro‐inflammatory cytokines by macrophages were examined.Results  Ebastine inhibited T cell proliferation and the production of IL‐4, IL‐5, IL‐6, and TNF‐α by T cells under each co‐stimulatory condition tested, whereas it exhibited no effect on the production of IL‐2 or IFN‐γ. In addition, T cell migration and the production of such pro‐inflammatory cytokines as TNF‐α and IL‐6 by macrophages were inhibited by ebastine.Conclusions  These results indicate that ebastine has a specific inhibitory effect on Th2‐type cytokine production. Moreover, ebastine inhibited T cell migration and pro‐inflammatory cytokine production by T cells and macrophages, suggesting that ebastine might be useful for the treatment of T cell‐mediated allergic inflammatory disorders, including asthma, atopic dermatitis, and Th2‐type autoimmune diseases.
Effects of asthma on cell components in peripheral blood among smokers and non‐smokers
Authors: Sunyer J. , Springer G. , Jamieson B. , Conover C. , Detels R. , Rinaldo C. , Margolick J. , Muñoz A. 
Published: November 2003

SummaryBackground  Eosinophils play a central role in asthma, but the interplay of the effects of smoking, eosinophils and asthma remains unclear.Objective  The primary objective of our study was to investigate the extent to which smoking modifies the effect of asthma on circulating eosinophils, CD4+ and CD8+ T cell counts.Methods  Data were collected semiannually between 1987 and 1994 from HIV‐negative participants in the Multicenter AIDS Cohort Study. Asthma was defined by a questionnaire at baseline as a self‐report of diagnosed asthma. A total of 1420 blood samples from 197 asthmatics and 15 822 from 1997 non‐asthmatics were collected.Results  Eosinophil levels were higher in asthmatics (28% of asthmatics had eosinophils 4% and 16% of non‐asthmatics) regardless of smoking history, but smoking modified the association between eosinophils and asthma. Namely, the odds ratios for eosinophils being 4% in asthmatics to non‐asthmatics decreased from 2.7 (95% CI: 2.0, 3.6) in never, to 2.1 (1.4, 3.1) in former, and to 1.5 (0.9, 2.3) in current smokers. Cross‐sectional and longitudinal analyses coherently showed that smoking increased eosinophils in non‐asthmatics, but the converse was true for asthmatics. In contrast, no differences in peripheral blood T cell counts between asthmatics and non‐asthmatics were observed.Conclusion  Under the established link between increased eosinophils and asthma, these data indicate that smoking modified this relationship. This finding suggests that smoking plays a different immunological role in asthmatics and non‐asthmatics.
High interleukin‐13 production by phytohaemagglutinin‐ and Der p 1‐stimulated cord blood mononuclear cells is associated with the subsequent development of atopic dermatitis at the age of 3 years
Authors: Lange J. , Ngoumou G. , Berkenheide S. , Moseler M. , Mattes J. , Kuehr J. , Kopp M. V. 
Published: November 2003

SummaryObjective
The aim of our study was to conduct a prospective investigation into the potential association of cord blood proliferative response and cytokine production in response to various stimuli on the development of atopic dermatitis (AD) at the age of 3 years.Methods
Cord blood mononuclear cells (CBMC) from 40 healthy term neonates were isolated. The proliferative response of CBMC stimulated with IL‐2, betalactoglobulin (BLG) and house dust mite allergen (Der p 1) was assessed by liquid scintillation counting and the stimulation index (SI) was calculated. The cytokines interleukin (IL‐)13, interferon (IFN‐)γ, IL‐10 and IL‐18 in the cell culture supernatants in response to phytohaemagglutinin (PHA), Der p 1 and BLG were measured using the ELISA technique. After 3 years, symptoms of AD were obtained with a questionnaire completed by the parents.Results
We observed significantly higher IL‐13 levels in response to PHA in children who subsequently developed symptoms of AD (S: median, 291 pg/mL) compared with asymptomatic children (No‐S: 149 pg/mL; P=0.021, Wilcoxon test). Similarly, in response to Der p 1 significantly higher IL‐13 levels were observed in symptomatic children (S: 168.6; No‐S: 61.6 pg/mL; P=0.0084). In response to BLG, IL‐13 levels were 287.2 (S) and 123.6 pg/mL (No‐S; P=0.19). No significant differences were found when comparing the IFN‐γ levels in CBMC cultures stimulated with PHA (S: 10.2; No‐S: 17.6 IU/L; P=0.78), Der p 1 (S: 307.6; No‐S: 616.2 IU/L; P=0.2) or BLG (S: 18; No‐S: 28.5 IU/L; P=0.83; Fig. 2). The IL‐18 and IL‐10 levels and the stimulation index in response to IL‐2, BLG and Der p 1 showed no significant difference between children who subsequently developed symptoms of AD and asymptomatic children. Release of interferon‐gamma (IFN‐γ) in response to phytohaemagglutinin (PHA), house dust mite allergen (Der p 1) and betalactoglobulin (BLG) in children who developed symptoms of atopic dermatitis at the age of 3 years (‘symptomatic’) and asymptomatic children. The median value and the 5th and 95th percentile are presented. Differences between the groups were calculated with the Wilcoxon test and P‐values are reported.imageConclusion
Our data suggest that enhanced IL‐13 levels at birth are associated with the subsequent development of atopic symptoms at the age of 3 years.
Allergen‐mediated modulation of CD23 expression is interferon‐γ and interleukin‐10 dependent in allergic and non‐allergic individuals
Authors: Roever A. C. , Heine G. , Zuberbier T. , Worm M. 
Published: November 2003

SummaryBackground
CD23 plays an important role in IgE regulation. The modulation of CD23 expression during specific immunotherapy (SIT) has been described previously. In the present study, we investigated in detail the effects of complete birch pollen allergen extract (BPA) on CD23 expression of peripheral blood mononuclear cells (PBMCs) in vitro.Methods
PBMCs from 14 birch pollen‐allergic (bp‐allergic) patients and eight non‐bp‐allergic controls were stimulated with IL‐4 and increasing doses of BPA. CD23 expression on monocytes and B cells was measured by flow cytometry; sCD23 release and the levels of IFN‐γ and IL‐10 secretion were determined by ELISA. To analyse the mechanisms on CD23 expression in more detail, neutralizing anti‐IFN‐γ and anti‐IL‐10 antibodies were added to IL‐4 and BPA‐stimulated cultures.Results
IL‐4 induced CD23 expression on B cells and on monocytes and sCD23 release in the bp‐allergic and non‐bp‐allergic groups. The addition of BPA to IL‐4‐stimulated PBMC decreased CD23 expression significantly and dose‐dependently on B cells in both groups. CD23 expression on monocytes was also decreased in both groups after the addition of BPA, but higher doses were required in the non‐bp‐allergic population. IL‐4‐induced sCD23 release was also significantly decreased after the addition of BPA. IFN‐γ and IL‐10 were induced by BPA in both the bp‐allergic and non‐bp‐allergic groups. The addition of neutralizing anti‐IFN‐γ antibodies increased CD23 expression on B cells, which were stimulated with IL‐4 and BPA, but had no effect on monocytes, whereas the addition of anti‐IL‐10 antibodies increased CD23 expression on monocytes but not on B cells.Conclusion
These data indicate that early immunological effects like down‐regulation of CD23 on B cells and monocytes, which are observed during SIT are dose dependent, mediated by IFN‐γ and IL‐10 and seem not to depend per se on the sensitization state of an individual.
Interrelationships among asthma, atopy, rhinitis and exhaled nitric oxide in a population‐based sample of children
Authors: Jouaville L. F. , Annesi‐Maesano I. , Nguyen L. T. , Bocage A. S. , Bedu M. , Caillaud D. 
Published: November 2003

SummaryBackground
Exhaled nitric oxide (eNO) has attracted increasing interest as a non‐invasive marker of airway inflammation in asthma. However, little evidence exists on the influences exerted on eNO by the interrelations among atopic status, asthma and rhinitis.Methods
Among the 1156 children who participated in a large‐scale epidemiological survey on asthma and allergies (ISAAC II: International Study of Asthma and Allergies in Childhood Phase II) in the city of Clermont‐Ferrand, 53 asthmatics without corticosteroid treatment and 96 non‐asthmatics were invited to perform eNO and skin prick tests (SPTs) to 12 common allergens.Results
Atopic asthmatic children had higher eNO than non‐atopic asthmatic children (28.9±9.1 vs. 17.1±13.1 p.p.b.; P=0.0004) with a significant increase when one SPT or more are positive (26.5±7.8 vs. 17.1±13.1 p.p.b.; P=0.03). Similarly, non‐asthmatic, atopic subjects had higher eNO than non‐atopic subjects with a significant increase when two SPTs or more are positive (19.4±9.8 vs. 11.7 ±6.7 p.p.b.; P=0.003). In the case of equal levels of positive SPTs (0, 1, 2), asthmatic children always had higher eNO than non‐asthmatic ones. Furthermore, among non‐asthmatic children, the eNO level increased only in atopics who had rhinitis (20.7±13 vs. 12.5±6.4 p.p.b. in atopic controls (subjects without rhinitis and asthma) and 12.3±6.6 p.p.b. in non‐atopic controls; P=0.001), whereas among asthmatic children, eNO level increased in atopics independently of rhinitis (28.2±9.5 p.p.b. in those with rhinitis and 30.9±8.1 p.p.b. in those without) as well as in non‐atopics with rhinitis (22.5±17.2 p.p.b.).Conclusions
Our data suggest that besides atopy and asthma, allergic rhinitis should also be taken into account in the assessment of eNO.
Climatic variables are associated with seasonal acute asthma admissions to accident and emergency room facilities in Trinidad, West Indies
Authors: Ivey M. A. , Simeon D. T. , Monteil M. A. 
Published: November 2003

SummaryObjectives
To determine if there is seasonal variation in acute asthmatic visits to accident and emergency (A&E) facilities in Trinidad and to identify the climatic variables associated with such visits.Design and methods
A retrospective census of patients with asthma, defined as those who required emergency bronchodilator nebulization, was taken at two A&E facilities in Trinidad from 1 January 1997 to 31 December 1999. The study included patients aged 64 years and under. Patient demographic data were obtained from the A&E records. Climate variables were taken from the island's sole Meteorological Office. Multiple regression was used to identify climate variables that were independent predictors of A&E asthma visits.Results
There were a total of 45 842 asthma admissions to the two facilities during the study period. Visits exhibited a cyclic pattern over the 3 years that varied according to the island's dry (January–May) and wet (June–December) seasons. There were more visits during the wet season than the dry (40 [SD=2] vs. 32 [SD=2] visits/day; P<0.001). The results of multiple regression indicated that season (P<0.001), barometric pressure (P<0.001), temperature difference (P<0.001), minimum temperature2 (P<0.001) and wind speed2 (P=0.032) were predictors of paediatric visits. Independent predictors of adult visits were season (P<0.001), relative humidity (P<0.001), minimum temperature (P=0.01), temperature difference2 (P<0.001) and minimum temperature2 (P=0.004). Season and climatic variables explained 18% of the variance of the total A&E asthma admissions.Conclusion
There is seasonal variation in acute asthma visits to A&E facilities in Trinidad, which remains significant after controlling for climate variables. However, while climate has a role, there are other factors that may also be responsible for increased visits during the wet season. More research is needed to identify these factors.
Increased prevalence of colonic polyps and altered lymphocyte subset pattern in the colonic lamina propria in acromegaly
Authors: Colao Annamaria , Balzano Antonio , Ferone Diego , Panza Nicola , Grande Giovanni , Marzullo Paolo , Bove Antonio , Iodice Giovanni , Merola Bartolomeo , Lombardi Gaetano 
Published: November 2003

OBJECTIVEThe balance of evidence suggests that acromegaly is a risk factor for colonic neoplasia. We have evaluated the prevalence of colonic polyps in acromegalics from Southern Italy and characterized the lymphocyte subsets in the colonic lamina propria in order to analyze differences in the colonic immunological environment.DESIGNAll the patients and controls were submitted to pancolonoscopy. Ten per‐endoscopic biopsies of the intestinal mucosa surrounding polyps were carried out to evaluate lymphocyte subsets.PATIENTSFifty acromegalics and 318 sex‐ and age‐matched controls entered this study. Colonic lamina propria lymphocyte subsets were studied in 34 patients and 34 controls.RESULTSColonic polyps were resected in 23 acromegalics (46%) and 42 controls (13.2%; P < 0.0001); hyperplastic polyps were found in 24% and 6.3%, adenomatous polyps in 22 and 6.9%, (P < 0.01), adenocarcinoma in 2 and 1.2% while synchronous polyps occurred in 18% and 2.5% (P < 0.01), respectively. The number of polyps was significantly correlated with age both in acromegalics (r = 0.422, P < 0.005) and in controls (r = 0.865, P < 0.001). However, polyp prevalence was greater in patients aged below 40 yrs (r.r. = 1.9) and in patients with two or more skin tags (r.r. = 1.2). A significant decrease of CD20, CD19, CD16, γ/δ, CD4+/leu8− and increase of CD3 and CD4+/leu8+ was found in the lamina propria lymphocyte subsets.CONCLUSIONSThe results of this study confirm that acromegalics are at increased risk of colonic polyps compared to the healthy population. The increased prevalence of premalignant polyps, namely the adenomatous type, suggests that acromegalics should undergo a careful screening and follow‐up by pancolonoscopy. An impairment of mucosal immune surveillance seems to exist in acromegaly although a causal effect in the polyp formation cannot be ruled out.
The counterregulatory response to hypoglycaemia in women with the polycystic ovary syndrome
Authors: Gennarelli G. , Holte J. , Stridsberg M. , Niklasson F. , Berne C. , Bäckström T. 
Published: November 2003

OBJECTIVE The pathogenetic mechanisms behind insulin resistance in polycystic ovary syndrome (PCOS) are far from fully elucidated. Aberrant counterregulatory responses to hypoglycaemia have been reported in patients with insulin resistance, and recent reports suggest that plasma glucose may be regulated at lower levels in women with PCOS. In this study we investigated the complete hormonal counterregulatory response to hypoglycaemia in women with PCOS.DESIGN  Prospective cross‐sectional study.PATIENTS Eight obese (BMI  25) and 10 non‐obese (BMI < 25) women with PCOS, diagnosed by means of ultrasonography and clinical signs of chronic anovulation. Eight obese and 9 non‐obese controls.MEASUREMENTS Hypoglycaemia was induced by an intravenous bolus of soluble insulin (0.15 IU/kg body weight). The counterregulatory responses of cortisol, GH, catecholamines, glucagon, chromogranin A (CGA), and neuropeptide Y (NPY) were studied together with symptoms of hypoglycaemia.RESULTS The obese women with PCOS had a more pronounced truncal‐abdominal body fat distribution (waist hip ratio, WHR) and were hyperinsulinaemic, compared with the obese controls. All the women exhibited blood glucose levels (< 2 mmol/l) well below the threshold for the hormonal counterregulatory response and for the appearance of clinical symptoms. The non‐obese women with PCOS showed a greater increase in serum concentrations of GH than the lean controls. The obese women with PCOS exhibited blunted responses of noradrenaline and NPY, but similar increases of adrenaline and CGA, compared with the obese controls. They also showed a lower symptom score during hypoglycaemia. The response of noradrenaline to hypoglycaemia correlated inversely with fasting insulin levels in the women with PCOS. Among all the obese women (PCOS and controls pooled) basal levels of noradrenaline correlated inversely with the WHR.CONCLUSIONS All the women with PCOS, independent of BMI, body fat distribution and insulin levels, showed preserved counterregulatory responses to hypoglycaemia. The reduced plasma levels of noradrenaline and the lower perception of hypoglycaemic symptoms in the obese women with PCOS could both reflect a lower activation of the sympathetic nervous system. This aberration seems related to truncal‐abdominal obesity and hyperinsulinaemia. The finding of an increased response of GH in the lean women with PCOS could support previous suggestions of an altered activity of the GH/IGF‐I system in these women.
Pituitary tumours presenting in the elderly: management and outcome
Authors: Benbow Susan J. , Foy Patrick , Jones Bleddyn , Shaw Donald , MacFarlane Ian A. 
Published: November 2003

OBJECTIVEIn elderly patients there are few data on the efficacy and safety of pituitary surgery and radiotherapy (DXT). The aim of the present study was to assess the mode of presentation, treatment and outcome of patients >64 years with a pituitary tumour presenting to a regional neuroendocrine service.DESIGNA retrospective case note review of all patients with a pituitary tumour, from 1986 to 1993, was performed with DXT information from computerized records.PATIENTSForty‐four patients were identified: median age 70 (65–83) years; 25 males; followed for a mean of 34 (range 0–84) months.RESULTSThe commonest presenting symptom was with visual disturbance (24 patients) with a further 9 with asymptomatic visual field defects. Five patients had acromegaly and two prolactinoma. Thirty‐two patients underwent transsphenoidal surgery (TSS) (with post‐operative DXT in 14 cases) and 6 craniotomy. Two patients had DXT as the primary procedure and four were observed. Visual fields improved in 21 of 29 patients. Perioperative complications occurred significantly more often after craniotomy (5/6) than after TSS (6/32) (P<0.01). Eight patients died during the follow‐up period (three deaths tumour related; one death followed DXT).CONCLUSIONSPituitary adenoma is a remediable cause of visual disturbance in the elderly. Most tumours were non‐functioning. Age alone is not a contraindication to active treatment particularly with transsphenoidal surgery and radiotherapy.
Elevation of circulating proadrenomedullin‐N terminal 20‐peptide in thyrotoxicosis
Authors: Taniyama Matsuo , Kitamura Kazuo , Ban Yoshio , Sugita Eri , Ito Kunihiko , Katagiri Takashi 
Published: November 2003

BACKGROUND AND OBJECTIVE Adrenomedullin (AM) is a recently discovered peptide which has potent vasodilatory activity. We have found that the plasma adrenomedullin level is elevated in hyperthyroidism, suggesting a potential role of AM in the decrease of vascular resistance in thyrotoxicosis. Proadrenomedullin, a precursor of adrenomedullin, yields another peptide termed proadrenomedullin‐N terminal 20‐peptide (PAMP). PAMP also has potent vasodilatory activity. Although the regulation of secretion of AM and PAMP is not fully understood and the mechanism by which the plasma AM level is elevated in hyperthyroidism remains unknown, it is of interest to determine the plasma concentration of PAMP in thyrotoxicosis.DESIGN AND PATIENTS We measured the plasma concentration of immunoreactive AM and PAMP in newly recruited untreated thyrotoxic Graves’ patients using specific antibodies to each peptide.RESULTS Not only AM, but also the plasma concentration of PAMP in thyrotoxic patients was significantly (P >0.01) elevated (4.7 ±0.9 pmol/l), compared to that in control subjects (2.6 ±0.8 pmol/l). The correlation was marginally significant between the plasma AM concentration and serum free thyroid hormone levels. The plasma PAMP level tended to be more elevated when thyrotoxicosis was severe but the correlation was not statistically significant. Correlation was not demonstrated between the AM and PAMP levels in thyrotoxic patients.CONCLUSIONS Elevation of the plasma adrenomedullin and proadrenomedullin‐N terminal 20‐peptide levels raises the possibility of involvement of these vasodilatory peptides in the haemodynamic changes in thyrotoxicosis.