bluuebunny/crossref_metadata_2025_split huggingface dataset:
Service evaluation and development: experience of a paediatric disability team
Authors: Cass H. , Kugler B. 
Published: March 2003

Classical audit frameworks encourage the use of audit cycles, with performance being evaluated against predefined quality targets and modified accordingly. This approach has obvious validity in clinical settings where treatments have very clear endpoints and outcome measures can be prioritized with ease. The situation becomes more complex in disability service settings, where the impact of clinical intervention is often qualitative rather than quantitative, and where management strategies are dependent on working in partnership with families, purchasers and other professional colleagues. There is thus a danger of neglecting aspects of service delivery which are of major importance to one sector of this extensive network.To ensure that service goals and standards comprehensively reflect the specific concerns of all parties, it is proposed that measures of service quality should be defined within the context of a dynamic multi‐user framework. Development of such a framework is dependent on collating information on specific needs from parents, referrers, purchasers and other involved professionals, and determining areas of overlap, as well as areas of potential conflict. Audit techniques for key Issues can then be devised, alongside a timetable to revisit these issues at appropriate intervals.Application of this approach is illustrated by reference to our own paediatric disability service.
Clumsiness, Dyspraxia and Developmental Co‐ordination Disorder: how do health and educational professionals in the UK define the terms?
Authors: Peters JM , Barnett AL , Henderson SE 
Published: March 2003

SummaryAt the turn of the century, the idea that there might be a discrete childhood syndrome, which had ‘clumsiness’ of movement as its defining symptom, began to emerge. Since then numerous labels have been applied to the syndrome. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter‐professional communication and interpretation of research. The aim of this study was to determine how the three terms ‘Clumsy’, ‘Dyspraxia’ and ‘Developmental Co‐ordination Disorder (DCD)’ are viewed by health and educational professionals in the UK. Two hundred and thirty‐four adults (57% from the health professions and 43% from education) provided a written definition of each term. Content analysis of the 702 definitions was used to determine: (1) the extent to which the terms were familiar/acceptable to the respondents; and (2) to capture differences in the meaning of the term being defined. The results indicated that the terms ‘DCD’ and ‘Dyspraxia’ were less familiar than the term ‘clumsy’ which was, however, least acceptable. Amongst those professionals who were familiar with all three terms, there was general agreement that all were used to describe some sort of overall movement difficulty. Beyond that point, divergence of understanding and inter‐professional differences in emphasis emerged. The implications of these differences for clinical and educational practice, research and policy making are discussed.
Children with sialorrhoea in the absence of neurological abnormalities
Authors: Johnson Hilary , King Jane , Reddihough Dinah S. 
Published: March 2003

AbstractObjective To study the outcome of 21 typically developing children who had been referred to the Saliva Control Clinic at the Royal Children’s Hospital, Melbourne.Method Information was collected on various aspects of the child’s health, oromotor function and severity of drooling. A follow‐up telephone survey was completed by the parents of these children after a mean period of 3.4 years. Information was gathered regarding their child’s drooling, current health, oromotor status and the usefulness of the clinic.Results There was a statistically significant improvement (P< 0.01) in the saliva control measures analysed on follow‐up. Thirteen children ceased to drool, three still drooled occasionally, and five continued to drool. The recommendations, mainly advice and referrals to other health professionals, were generally reported to be helpful by the parents.Conclusions This cohort of children was established retrospectively, and the study is therefore limited in both numbers and design. The results indicate that some typically developing children may be delayed in the development of saliva control. Parents and professionals can be reassured that this problem is likely to resolve.
Early rehabilitation service utilization patterns in young children with developmental delays
Authors: Majnemer A. , Shevell M.I. , Rosenbaum P. , Abrahamowicz M. 
Published: March 2003

Abstract
Objective
There is a growing demand for interdisciplinary rehabilitation services for children with developmental disabilities, however, information is lacking on service utilization patterns. This study describes the type, frequency and location of initial rehabilitation services provided to young children recently diagnosed with a developmental delay.
Methods
A telephone survey was conducted on a consecutive cohort of children referred to subspecialists for the first investigation of their delay.
Results
Out of 129 respondents, only 30 (23%) did not receive any rehabilitation services within the first 6 months following medical evaluation, and 61 (47%) received two or more services. Services were provided most frequently in the hospital setting, especially for occupational or physical therapy (73–80%). Services were less often rendered in a rehabilitation centre (5–13%) or in the community (< 10%). Services were provided privately for a subset, particularly for speech language pathology and psychology (34% and 30% respectively). Interventions were typically given weekly or bi‐weekly. Children receiving physical therapy were significantly younger whereas children referred to speech language pathology were older than the age of our cohort at intake. Overall, parents’ educational level did not influence services received with the exception of private services, which were more likely to occur in children of fathers with university education.
Conclusions
The findings would suggest that long waiting times and lack of resources may limit access to comprehensive services, particularly in community settings. Service utilization patterns were not consistent within types of developmental disability, suggesting that formal and co‐ordinated interdisciplinary programmes are not in place for this population of interest.
Disability in children from different ethnic populations
Authors: Morton R. , Sharma V. , Nicholson J. , Broderick M. , Poyser J. 
Published: March 2003

AbstractWe report on the prevalence of severe neurodisability in children in the Southern Derbyshire Health Authority from different ethnic groups. Information was obtained from the health records of children at the Child Development Centre (CDC), and analysed according to ethnic group. There were 53 in the Pakistani group, 20 in the Indian group and 764 in a mixed group, of which 95% were of European origin. It was estimated that all children with severe disability in the area of the Health Authority had notes at the CDC, except for 10% of the mixed group living on the periphery. The numbers of children with different disabling conditions were recorded, together with a measure of the level of individual disability; the ‘Disability Scores’. We also noted if the condition was genetic or chromosomal in origin. Pakistani children showed a higher prevalence than the other groups of severe learning disorder, severe and profound hearing loss and severe visual problems. They also had a slightly increased prevalence of autism and cerebral palsy. Conversely, they showed a lower prevalence of language disorder. Disability scores for Pakistani children attending the CDC were higher than for other groups. Genetic disease causing disability was 10 times more common in the Pakistani children than other ethnic groups. Disability is more common in Pakistani children probably as a result of the cultural practice of consanguineous marriages. This community needs special help for disabled children, and their families, for general support and appropriate genetic counselling.
The recruitment and training crisis in community paediatrics: what do registrars think?
Authors: Reading R. , Surridge H. , Steel S. , Sansome A. 
Published: March 2003

AbstractObjective There is currently a crisis in the recruitment of trainees into community paediatrics. Focus groups were conducted to explore the views of paediatric specialist registrars about this crisis.Design A total of 18 registrars participated in two focus groups. Data were analysed qualitatively by content analysis.Results The overriding theme was the poor status and image of community compared with acute paediatrics. This existed at five levels, which could be arranged from a ‘macro’ structural level down to a ‘micro’ individual level. These were: the hospital/community divide, issues related to training, practical experience, the influence of role models, and personal factors.Conclusions We identified several specific implications for community paediatric training. However, the deep divide between acute and community paediatrics, as perceived by registrars, is unlikely to change unless training programmes are designed to produce paediatricians suited to the needs of future child health services rather than existing models of acute and community paediatricians.
Dissimilarity in adolescent and maternal representations of Type 1 diabetes: exploration of relations to adolescent well‐being
Authors: Law G. Urquhart 
Published: March 2003

AbstractPurposeTo compare the illness representations of adolescents with Type 1 diabetes and their mothers, and to explore how congruence and incongruence influences adolescent psychological adjustment.MethodsA total of 30 adolescents (13–19 years) with Type 1 diabetes completed self‐report questionnaires of illness representations and psychological well‐being; 26 mothers completed the illness representation questionnaire.Resultst‐Test and correlation analyses showed convergence on the majority of the illness representation dimensions with maternal representations differing significantly on only two dimensions: perceiving their adolescent's diabetes to have more serious consequences and to have a greater emotional impact. Computation of dissimilarity scores between mothers and adolescents, showed mothers to maximize the seriousness of diabetes across several dimensions, but no significant associations were found with adolescent psychological well‐being.ConclusionsChronic illness in children and young people exists in a social context and the management of diabetes requires an ongoing supportive relationship between parent and child. The results show a high degree of consistency in the beliefs adolescents and their mothers hold, and such congruence is presumed to benefit psychological well‐being. However, the mediators and moderators for family belief processes are unclear and several possibilities are discussed.
Immune‐reactivity of recombinant isoforms of the major house dust mite allergen Der p 2
Authors: Hakkaart G. A. J. , Chapman M. D. , Aalberse R. C. , Van Ree R. 
Published: March 2003

BackgroundRecombinant Der p 2, expressed in yeast, lacked reactivity with 5 monoclonal antibodies against natural Der p 2.ObjectiveThe aim of this study was to investigate whether the lack of reactivity with recombinant Der p 2 can be explained by the existence of isoforms.MethodsBy site‐directed mutagenesis three recombinant isoforms of Der p 2 were produced. Reactivity with monoclonal antibodies and human IgE was analysed by means of RAST and RAST‐inhibition.ResultsAll five monoclonals that lacked reactivity with the originally selected isoform, showed reactivity upon replacement of aspartic acid by asparagine at position 114. The other two substitutions (at position 26 and 47) had no effect. Binding of human IgE (n = 10) was not significantly influenced by the isogenetic variation at position 114.ConclusionsMonoclonal antibodies raised against natural Der p 2 can sometimes discriminate between different isoforms, allowing the study of the natural occurrence of isoforms. For application in allergen‐measurement assays, non‐discriminating monoclonal antibodies should be selected.
Changes in CD23 expression of blood and skin in atopic eczema after Chinese herbal therapy
Authors: Banerjee  , XU X.‐J. , Poulter  , Rustin  
Published: March 2003

BackgroundAberrant expression of CD23 (low affinity IgE receptor) on cells of the monocyte/macrophage series in peripheral blood and lesional skin of patients with atopic eczema has been demonstrated. It is not known whether this abnormality results from a fundamental systemic problem of the monocytes of these patients or reflects local changes to cell populations within the skin tissues.ObjectivesThis study was designed to determine whether this aberrant expression was caused by local cutaneous influences on mature cells or fundamental changes in monocyte differentiation. The possible relationship between these aberrations and clinical severity was also investigated by repeating these immunopathological studies after a course of efficacious treatment with Chinese herbal therapy (CHT).MethodsPeripheral blood mononuclear cells were obtained from patients with atopic eczema before, and after 8 weeks of treatment. Efficacy of CHT was quantified on clinical grounds. Monocytes were isolated by adherence to plastic and cultured for up to 7 days. Samples were harvested at 2, 5 and 7 days of culture and cytospins prepared. Immunocytochemical staining to identify phenotypic subsets was performed on the monocytes at time 0 and on maturing cells from culture. This immunocytology was quantified using computerized image analysis equipment to determine the emergence of macrophage subsets and their level of CD23 expression. Biopsies were taken from lesional skin before and after treatment and immunohistology was performed on cryostat sections to determine the number of antigen presenting cells expressing CD23 as well as the level of expression of these molecules.ResultsThe results showed that increased numbers of monocytes from patients with atopic eczema express CD23 at day 0 and that cultured monocytes from these patients differentiate faster during the 7 day culture period as compared to normal controls. Efficacious treatment did not affect the number of peripheral blood monocytes expressing CD23. However, treatment did lead to a significant decrease in the number of CD23+ mature macrophages in the skin as well as a reduction in the level of expression of this moiety. These results demonstrate that changes in clinical severity are more closely related to the expression of CD23 on mature antigen presenting cells in lesional skin rather than to differentiating peripheral blood monocyte CD23 expression.ConclusionsThese results suggests that local factors within lesional skin govern the accumulation and the expression of CD23 on mature macrophages and that these factors may be more relevant to the pathogenesis of the disease than aberrations in CD23 expression that may occur systemically.
Neutrophil infiltration and release of IL‐8 in airway mucosa from subjects with grain dust‐induced occupational asthma
Authors: Park  , Jung  , Hwang  , Nahm  , Yim  
Published: March 2003

BackgroundThe immuno‐pathological mechanism for occupational asthma induced by grain dust (GD) remains to be clarified. There have been few reports suggesting the involvement of neutrophils inducing bronchoconstriction after inhalation of GD.ObjectiveTo further understand the role of neutrophil in the pathogenesis of GD‐induced asthma.Materials and methodsWe studied the phenotype of leucocytes of the bronchial mucosa in patients with GD‐induced asthma. Bronchial biopsy specimens were obtained by fibreoptic bronchoscopy from six subjects with GD‐induced asthma. Six allergic asthma patients sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistochemistry with a panel of monoclonal antibodies to tryptase‐containing mast cell (AA1), activated eosinophil (EG2), pan T‐lymphocyte (CD3) and neutrophil elastase (NE). Induced sputum was collected before and after the GD‐bronchoprovocation test. The IL‐8 level in the sputum was measured using ELISA.ResultsThere was a significant increase in the number of AA1+ and NE+ cells in bronchial mucosa of GD‐induced asthma, compared with those of allergic asthma (P = 0.01, P = 0.01, respectively). No significant differences were observed in the number of EG2+ and CD3+ cells (P = 0.13, P = 0.15, respectively). IL‐8 was abundant in the sputum of all GD‐induced asthma patients and significantly increased after the bronchial challenges compared with the baseline value (P = 0.03).ConclusionThese findings support the view that neutrophil recruitment together with mast cells may contribute to the bronchoconstriction induced by GD. A possible involvement of IL‐8 was suggested.
Determinants of dust mite allergen concentrations in infant bedrooms in Tasmania
Authors: Couper  , Ponsonby  , Dwyer  
Published: March 2003

BackgroundHigh exposure to house dust mite allergen during the first year of life has been found to increase the risk of subsequent asthma and mite sensitization. Environmental factors, home construction and cleaning methods used are associated with levels of dust mites in the home.ObjectiveTo investigate determinants of levels of Der p 1 and Der f 1 mite allergens in homes of infants in southern Tasmania.MethodsDust samples were collected from 72 homes of infants participating in the Tasmanian Infant Health Survey (TIHS). The Der p 1 and Der f 1 allergen concentrations in these samples were measured. The TIHS interviewers obtained information from the mothers of the infants via a questionnaire, observed specified aspects of the home environment, and took readings of bedroom temperature and humidity. The effect of each item on allergen concentration in dust from bedroom floors was examined in a variety of ways. Those items which in this study appeared to be significantly related to allergen concentrations plus items which in other studies have been found to be related to allergen concentrations were then investigated further in multivariate models.ResultsDer p 1 allergen concentration (μg/g) and density (μg/m2) in dust from bedroom floors were found to be related to several home environment factors. In the univariate analyses, indoor humidity, 24 h maximum temperature, number of residents and a combination of floor covering and cleaning methods appeared to have a significant effect on allergen levels. These factors remained important in the multivariate model except that indicators for mould in the bathroom and drying washing on an outside line replaced indoor humidity.ConclusionFeatures related to home dampness, the number of residents and floor covering and cleaning were major determinants of Der p 1 levels in the bedrooms studied.
A new collection method for the evaluation of nasal mucus proteins
Authors: Ruocco  , Fattori  , Romanelli  , Martelloni  , Casani  , Samolewska  , Rezzonico  
Published: March 2003

BackgroundDifferent sampling techniques for collecting nasal mucus have been used. The eosinophil and its granule toxin proteins, especially the eosinophil cationic protein (ECP), is an important inflammatory cell.ObjectiveIn the healthy subjects (with no acute or chronic disease of the respiratory tract), no detailed quantitative data on mucus nasal proteins have been reported, so the aim of the study is to demonstrate a simple and reliable method for the collection of nasal mucus and for measuring nasal ECP.MethodsOur method consists in collecting two specimens of mucus from each nasal fossa, using a square of sterile pre‐humidified gauze, centrifuged at 2000
g for 20 min and stored at −20°C until tested. To evaluate the reproducibility of the technique, 30 healthy subjects were retested after 24 h.ResultsThe amounts of secretion gathered in the 89 collections did not show any statistical difference between the sexes. In the pooled subjects (n = 59), the mean levels of ECP were 108 ng/mL and 325 ng/g and total protein (TP) levels were 701 mg/dL and 2.5 mg/g (expressed in absolute concentration and concentration related to the weight in grams). In the classes, according to age, no statistical differences were found on analysis of the groups by: sex, recovery rate, and ECP and TP concentrations. The Reproducibility Index was very good for the recovery rate (0.78), ECP (ng/mL = 0.95, ng/g = 0.83) and TP (mg/dL = 0.89, mg/g = 0.76).ConclusionWith our method, the sample collections were taken with minimal stimulation of the mucosa and it was well tolerated by the subjects; the low known dilution factor is also adequate for analysing small quantities of mucus recovered, and the protein concentration can be measured as an absolute value.
Anaphylactic reaction to ingestion of Quercus ilex acorn nut
Authors: Vega  , DomÍnguez  , Cosmes  , MartÍnez  , BartolomÉ  , MartÍnez  , Palacios  
Published: March 2003

BackgroundA patient experienced an anaphylactic reaction after eating acorn nuts, fruit of the holm oak (Quercus ilex), one of the most abundant trees in Spain. Several urticaria episodes upon ingestion of peanuts were also referred.ObjectiveTo assess the hypersensitivity reaction to acorn and to characterize the allergenic proteins involved.MethodsCutaneous tests were performed using the skin‐prick technique, using a large variety of grass, tree and weed pollens as well as fresh nuts and nut extracts. Specific IgE determination was assessed by RAST. IgE binding bands were determined by SDS‐PAGE immunoblotting.ResultsSkin‐prick tests were strongly positive with acorn and peanut. Olea europaea, Quercus alba, Quercus ilex and grass pollens also elicited a weal higher than negative control. Patient serum had measurable levels of IgE antibodies especially to acorn, peanut and grass pollens. Only one protein band, of 17.9 kDa molecular mass, showed IgE‐binding properties in the acorn extract. The possible homology of this strong allergenic protein with the group 1 tree pollen allergens was evidenced by the partial inhibition of the western blot with Bet v 1.ConclusionsWe present a case of anaphylaxis to acorn ingestion as demonstrated by in vivo and in vitro results. A 17.9 kDa IgE‐binding band, showing some homology to group 1 pollen tree allergens, was recognized by patient serum.
Circulating cat allergen and immune complexes in cat‐ allergic children
Authors: Casas  , Djerf  , HÄggstrÖM  , FerrÁndiz  , BJÖrkstÉN  
Published: March 2003

BackgroundThe first encounters with allergens seem to influence the development of allergy. Food antigens have been detected in sera as free antigens and in complexes with IgG but less is known about the presence of inhalant allergens.ObjectiveTo investigate the presence of the major cat allergen Fel d 1, either as free allergen and/or in complexes with IgG and IgE antibodies in sera from atopic children.MethodsSerum samples from 33 cat allergic asthmatic children, 7–17 years old, and 15 non‐allergic controls were investigated for the presence of Fel d 1 by ELISA (detection limit 0.13 μg/L). To detect immune complexes (IC), the IgG fraction from Fel d 1 positive sera was purified by affinity chromatography. Purified and non‐absorbed material was then analysed for allergen content and specific IgG antibody levels. Immune complexes with Fel d 1 IgE were detected by coupling anti‐Fel d 1 MoAb to paramagnetic particles.ResultsFel d 1 was detected (0.15–1.8 μg/L) in 23 of the 33 patients (70%) but not from any of the controls. Eighteen samples contained IgE‐Fel d 1 IC and two of four tested samples contained Fel d 1 in the IgG fraction. Electrophoresis and Western blotting of IgG purified material using anti‐Fel d 1 MoAb corroborated the presence of IgG‐Fel d 1 IC.ConclusionFree‐circulating inhalant allergen and IC with allergens may contribute to maintaining immune responsiveness and sensitivity.