bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health beliefs of rural Canadians: Implications for practice
Authors: Thomlinson Elizabeth , McDonagh Meg Kathleen , Crooks Kathryn Baird , Lees Margaret 
Published: December 2004

AbstractObjective:  The objective of the present study was to examine the health beliefs, values and practices of rural residents living in two geographically diverse regions of western Canada. Design:  An ethnographic study with semistructured interviews of 55 persons was conducted with participants ranging in age from 19 to 84 years. Results:  Being healthy was described as having balance in one's life, taking into consideration the relationship between the physical, mental, social, and spiritual aspects of the person. Health‐seeking behaviours spanned the gamut of diet, exercise, sleep, home remedies, a belief in a spiritual being, to consulting health professionals. Resources that participants valued included professionals who listened, friends, neighbours, church, music, elders, ambulance service and the internet. Conclusions:  It is important that professionals view the person beyond the disease and take into account more than the physical manifestations of an illness. A key component is the demonstration of respect for all persons regardless of age. It is essential that health professionals develop websites providing accurate health‐care information. Participants noted the need to recruit and retain professionals in rural regions. What this paper adds:  Canadian rural research, to date, has largely focused on the recruitment of rural health‐care providers. Nurse researchers from Montana discovered that rural dwellers have a tendency to define health from a role performance perspective that meant being able to work and meet family obligations; in contrast to urban dwellers, who tend to focus upon the comfort, cosmetic and life prolonging aspects of health. Because of the paucity of Canadian published literature on this topic, the health benefits, values and practices of rural Canadians are entirely speculative. Data analysis revealed several themes with implications relevant to health‐care professionals. Being healthy was described as involving the physical, mental, social and spiritual aspects of a person. Health‐seeking behaviours engaged in included diet, exercise, sleep, home remedies, spiritual beliefs and consulting health professionals. Accessing accurate health information was identified as a significant resource. The development of websites by health‐care professionals to facilitate the acquisition of information that are understandable and pertinent was seen as one way of meeting this need. Those health professionals who truly listen to their patients and view them as whole persons rather than disease entities are highly valued. Health professionals need to be retained once recruited if trusting relationships are to be developed and maintained. To maintain these relationships over the long term, resources that support the elderly and infirm must be secured and further developed, such as day programs, respite care for family members and palliative care services.
Changes in seroprevalence of hepatitis A in children and adolescents in Manisa, Turkey
Authors: Tosun Selma , Ertan Pelin , Kasirga Erhun , Atman Ümit 
Published: December 2004

Abstract
Background
: Hepatitis A virus (HAV), being an enteric transmitting virus wide world, occurs mostly in children of developing countries. However, the virus has recently been seen in adolescents and young adults worldwide. The aim of the present study was to evaluate the seroprevalence of the HAV infection in children and adolescents in Manisa, Turkey, and to verify whether the increased incidence of HAV infection in other parts of the world and Turkey generally is also true for the area of Manisa.
Methods
: The authors studied blood samples of 1395 adolescents and children aged between 6 months and 17 years from the Manisa area in order to evaluate the existence of anti‐HAV antibodies using micro‐ELISA test.
Results
: Total seropositivity was 44.6% while age related values were as followed: 6–23 months, 47.8%; 2–6 years, 23.7%; 7–10 years, 43.4%; 11–14 years, 52.4%; and 15–17 years, 76.6%. These results suggest that the seropositivity increases significantly among children at school age and also increases parallel to age.
Conclusions
: According to these results, the authors concluded that there has been a shift of seropositivity from children to adolescents especially in families with an average or high socio‐economical level.
Intestinal parasitic infection in children in post‐disaster situations years after earthquake
Authors: Öztürk C. Elif , Şahin İdris , Yavuz Taner , Öztürk Ayhan , AkgünoĞlu Mustafa , Kaya Demet 
Published: December 2004

Abstract
Backround
: Two earthquakes in the north‐west region of Turkey destroyed 80% of the houses and schools in Düzce in 1999. This study was conducted to determine the parasitic infection rate associated with the post‐earthquake unhealty living conditions and related epidemiological risk factors.
Methods
: Two populations living and studying in different socioeconomic conditions as a result of the earthquake were compared: Group 1 (study group) consisted of 326 children living and studying in transitory houses and classes. Group 2 (control) consisted of 127 children living in normal houses and studying in normal school classes. Fecal samples were obtained from both groups and examined for intestinal parasites’ eggs and trofozoid forms. In addition, selotype procedure was applied to both populations. Epidemiological data determining the socioeconomic status of the populations were collected by questionnaire.
Results
: In group 1, Giardia lamblia (G. lamblia) cysts were observed in 10.4% of the fecal samples and Enterobius vermicularis (E. vermicularis) eggs were observed in 13.5% of selotype samples. In group 2, Giardia cysts were observed in 3.1% of the samples and E. vermicularis eggs were observed in 5.5% of selotype samples. The rate of Giardiasis and Enterobiasis was found to be significantly higher in children still living and studying in temporary houses and schools years after the earthquakes (P < 0.05). The following pidemiological and social factors arising after the earthquakes were associated with increased rate of G. lamblia and E. Vermicularis infections: number of communal toilets per child at school, socioeconomic level of the children, dimensions of the classrooms where the children are studying and living and frequency of hand‐washing at school. These parameters are significantly different between the groups (P < 0.05).
Conclusion
: Giardiasis should be considered as an emerging disease in postdisaster situations and adequate prevention measures should be implemented in these circumstances. It should also be known that the rate of Enterobiasis is increased in populations living in crowded unhealthy conditions.
Primary ureteroscopic treatment for obstructive ureteral stone‐causing fornix rupture
Authors: KALAFATIS PANAGIOTIS , ZOUGKAS KONSTANTINOS , PETAS ANASTASIOS 
Published: December 2004

Abstract  Background:  Management of fornix rupture (FR) by obstructive stone is comprised of extravasation control and the elimination of the obstruction. For all patients, management initially remains conservative under close follow up.Endoscopic management of FR involved with an obstructive stone of the ureter or the pelvi‐ureteric junction (UPJ) consists mainly of stenting the ureter. Our endoscopic approach to this pathological entity comprises of the sole stenting of the ureter, as well as primary ureteroscopic lithotripsy followed by ureter stenting.Patients and methods:  In the Department of Urology at the General Hospital of Rhodos Island, Rhodos, Greece, over the last 15 years, 51 of 86 patients with FR due to an obstructive stone, were treated endoscopically. Twenty‐two patients underwent sole stenting of the ureter (option A) and 29 patients underwent primary ureteroscopic lithotripsy and stenting (option B).Results:  The overall primary ‘successful outcome’ was achieved in nine of the 22 patients (40.9%) in the group treated with sole stenting, while the remaining 59.1% required secondary interventions. However, 27 of the 29 patients (93.1%) treated with primary ureteroscopic lithotripsy and stenting required no auxiliary treatment.The primary successful outcome results for obstructive middle and lower ureteral stones with FR were eight out of 12 (66.6%) and 26 out of 27 (96.3%) for therapeutic options A and B, respectively. Upper obstructive ureteral stones with FR required secondary intervention in most cases, regardless of the therapeutic option chosen. (In nine out of 10 and one out of two cases for options A and B, respectively).The mean duration of hospitalization for options A and B were 7.6 and 5.3 days, respectively. The mean duration that the ureter stent remained in situ for A and B treatment options was 30.9 and 10.2 days, respectively.Conclusions:  Sole stenting of the ureter is reserved for infected FR or for stones of the upper ureter or the UPJ. Ureteroscopic lithotripsy followed by double‐J stenting of the ureter may offer a quick and safe therapeutic alternative for distal and middle obstructive ureteral stones with FR.
Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux
Authors: MATSUMOTO FUMI , TOHDA AKIRA , SHIMADA KENJI 
Published: December 2004

Abstract  Aim:  We retrospectively reviewed the results of ureteral reimplantation in infants with primary vesicoureteral reflux (VUR) to evaluate the effect on prevention of urinary tract infection (UTI) and renal growth.Materials and methods:  From July 1991 to December 2001, a total of 205 infants (180 boys and 25 girls) with primary VUR underwent ureteral reimplantation at the Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Indications for surgery were high‐grade reflux (grade IV–V), breakthrough UTI and non‐compliance of medical treatment. Age at surgery raged from 1 to 11 months (mean, 6.4 months). Ureteral reimplantation was performed according to Cohen's method. Only two of 336 refluxing ureters required ureteral tailoring. Follow‐up ranged from 12 to 110 months (mean, 64 months). Surgical outcome, frequency of UTI and individual renal growth measured by 99mTc‐dimercaptosuccinic acid (DMSA) scintigraphy was evaluated.Results:   Postoperative ultrasound and voiding cystourethrography showed neither residual reflux nor ureterovesical obstruction. Contralateral low grade reflux occurred in six of 74 patients (8.1%) who had unilateral reflux preoperatively. After reimplantation, 10 patients documented 13 febrile UTI. Eleven of the 13 episodes occurred early in the postoperative period (<6 months). Frequency of febrile UTI reduced from 0.23538 before surgery to 0.00894 and 0.00081 per patient per month at 6 and 12 months after surgery, respectively. No development of renal scarring was seen in postoperative DMSA scan. Changes of differential renal function was <0.05 in all patients.Conclusion:  The present results show ureteral reimplantation in infants is safe and very effective for the prevention of UTI. After surgical treatment in infancy, individual renal growth of children with primary VUR is stable.
Insulin detemir used in basal‐bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin
Authors: De Leeuw I. , Vague P. , Selam J.‐L. , Skeie S. , Lang H. , Draeger E. , Elte J. W. F. 
Published: December 2004

Aim:  The aim of this study was to compare the long‐term safety and efficacy of twice‐daily insulin detemir or NPH insulin as the basal component of basal‐bolus therapy in people with type 1 diabetes.Methods:  A multicentre, open‐label, parallel‐group study was conducted over 12 months and completed by 308 people (from an original randomized cohort of 428). Patients were randomized in a 2 : 1 ratio to receive insulin detemir or NPH insulin before breakfast and dinner, with insulin aspart at mealtimes.Results:  Glycaemic control improved in both groups with HbA1c decreasing by 0.64 and 0.56% point in the insulin detemir and NPH insulin groups, reaching baseline‐adjusted final values of 7.53 ± 0.10% and 7.59 ± 0.13%, respectively. No significant difference was apparent between treatments in terms of HbA1c, fasting plasma glucose or 9‐point blood glucose profiles. Fewer hypoglycaemic events (major and minor) occurred in association with insulin detemir compared with NPH insulin, but the overall hypoglycaemic risk did not differ statistically significantly (RR for detemir, 0.78 [0.56–1.08]). However, the risk of nocturnal hypoglycaemia during the maintenance phase (month 2–12) was 32% lower in the detemir group (p = 0.02) and lower in every month. This risk reduction remained statistically significant after correction for HbA1c. After 12 months, baseline‐adjusted mean body weight was significantly lower in the insulin detemir group than in the NPH insulin group (p < 0.001).Conclusions:  In long‐term basal‐bolus therapy, insulin detemir with insulin aspart as mealtime insulin is well tolerated and reduces the risks of nocturnal hypoglycaemia and weight gain compared to NPH insulin.
Lower within‐subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes
Authors: Haak T. , Tiengo A. , Draeger E. , Suntum M. , Waldhäusl W. 
Published: December 2004

Aim:  The aim of this study was to compare the efficacy and safety of a basal‐bolus insulin regimen comprising either insulin detemir or neural protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 2 diabetes.Methods:  This was a 26‐week, multinational, open‐label, parallel group trial with 505 patients with type 2 diabetes (mean age, 60.4 ± 8.6 years; mean BMI, 30.4 ± 5.3 kg/m2; mean HbA1c, 7.9 ± 1.3%). Patients, randomized 2 : 1 to insulin detemir or NPH insulin, received basal insulin either once or twice daily according to their pretrial insulin treatment and insulin aspart at mealtimes.Results:  After 26 weeks of treatment, significant reductions in HbA1c were observed for insulin detemir (0.2%‐points, p = 0.004) and NPH insulin (0.4%‐points; p = 0.0001); HbA1c levels were comparable at study end (insulin detemir, 7.6%; NPH insulin, 7.5%). The number of basal insulin injections administered per day had no effect on HbA1c levels (p = 0.50). Nine‐point self‐measured blood glucose (SMBG) profiles were similar for the two treatment groups (p = 0.58), as were reductions in fasting plasma glucose (FPG) (insulin detemir, 0.5 mmol/l; NPH insulin, 0.6 mmol/l). At study end, FPG concentrations were similar for the two treatment groups (p = 0.66). By contrast, within‐subject day‐to‐day variation in fasting SMBG was significantly lower with insulin detemir (p = 0.021). Moreover, patients receiving insulin detemir gained significantly less body weight than those who were administered NPH insulin (1.0 and 1.8 kg, respectively, p = 0.017). The frequency of adverse events and the risk of hypoglycaemia were comparable for the two treatment groups.Conclusions:  Patients with type 2 diabetes, treated for 26 weeks with insulin detemir plus insulin aspart at mealtimes, experienced comparable glycaemic control but significantly lower within‐subject variability and less weight gain compared to patients treated with NPH insulin and insulin aspart. Insulin detemir was well tolerated and had a similar safety profile to NPH insulin.
Efficacy and safety of ezetimibe co‐administered with simvastatin in thiazolidinedione‐treated type 2 diabetic patients
Authors: Gaudiani L. M. , Lewin A. , Meneghini L. , Perevozskaya I. , Plotkin D. , Mitchel Y. , Shah S. 
Published: December 2004

Aim:  In patients with type 2 diabetes mellitus (T2DM), combination therapy is usually required to optimize glucose metabolism as well as to help patients achieve aggressive targets for low‐density lipoprotein cholesterol (LDL‐C) and other lipid parameters associated with cardiovascular risk. The thiazolidinediones (TZDs) are increasingly being used for both their blood glucose‐lowering properties and their modest beneficial effects on triglycerides (TG) and high‐density lipoprotein cholesterol (HDL‐C). Ezetimibe, an intestinal cholesterol absorption inhibitor, has a mechanism of action that differs from that of statins, which inhibit hepatic cholesterol synthesis. We compared the lipid‐modifying efficacy and safety of adding ezetimibe to simvastatin, vs. doubling the dose of simvastatin, in TZD‐treated T2DM patients.Methods:  This was a randomized, double‐blind, parallel group, multicentre study in T2DM patients, 30–75 years of age, who had been on a stable dose of a TZD for at least 3 months and had LDL‐C > 2.6 mmol/l (100 mg/dl) prior to study entry. Other antidiabetic medications were also allowed. Following 6 weeks of open‐label simvastatin 20 mg/day, patients were randomized to the addition of either blinded ezetimibe 10 mg/day (n = 104) or an additional blinded simvastatin 20 mg/day (total simvastatin 40 mg/day; n = 110) for 24 weeks. Patients were stratified according to TZD type and dose (pioglitazone 15–30 vs. 45 mg/day; rosiglitazone 2–4 vs. 8 mg/day).Results:  LDL‐C was reduced more (p < 0.001) by adding ezetimibe 10 mg to simvastatin 20 mg (−20.8%) than by doubling the dose of simvastatin to 40 mg (−0.3%). Ezetimibe plus simvastatin 20 mg also produced significant incremental reductions in non‐HDL‐C (p < 0.001), very low‐density lipoprotein cholesterol (p < 0.05) and apolipoprotein B (p < 0.001) relative to simvastatin 40 mg. There were no differences between the groups with respect to changes in TG and HDL‐C levels, and both treatments were well tolerated.Conclusions:  Co‐administration of ezetimibe with simvastatin, a dual inhibition treatment strategy targeting both cholesterol synthesis and absorption, is well tolerated and provides greater LDL‐C‐lowering efficacy than increasing the dose of simvastatin in T2DM patients taking TZDs.
Reduction of body weight and co‐morbidities by orlistat: The XXL – Primary Health Care Trial
Authors: Wirth A. 
Published: December 2004

Aim:  The aim of this postmarketing surveillance (PMS) study was to investigate the effect of an orlistat therapy under the everyday conditions of our health care system.Methods:  11 131 women and 4418 men from Germany [mean age 48 years, mean body mass index (BMI) 34.7 kg/m2 and mean duration of obesity 13.7 years] were included. The patients were predominantly cared for by general practitioners. Four fifths of the patients reported having obesity‐associated co‐morbidities. All patients were advised to take orlistat 120 mg three times daily.Results:  After a mean treatment duration of 7.1 months, both women and men lost 10.7% of their baseline weight (87% lost > 5% weight and 51% lost > 10% weight). All cardiovascular risk factors improved markedly, and the intake of concomitant medications was either reduced or discontinued. Compared with baseline, 65% of the patients assessed their general state of health to have improved. For more than 90% of their patients, physicians described the success of the treatment as satisfactory, and most patients (62%) were willing to continue with the treatment.Conclusions:  The results obtained in this naturalistic PMS study were comparable with the results of randomised and placebo‐controlled studies, which were performed predominantly in special care centres. Therefore, without any risk of adversely affecting the quality of treatment provided, the treatment of obese patients with orlistat may be transferred to general practitioners.
Increased adiposity and reduced adipose tissue mRNA expression of uncoupling protein‐2 in first‐degree relatives of type 2 diabetic patients: evidence for insulin stimulation of UCP‐2 and UCP‐3 gene expression in adipose tissue
Authors: Pedersen S. B. , Nyholm B. , Kristensen K. , Nielsen M. F. , Schmitz O. , Richelsen B. 
Published: December 2004

The mitochondrial uncoupling proteins (UCP‐2 and UCP‐3), which have been suggested to be involved in the development of obesity by controlling the energy expenditure (EE), were studied in 22 healthy first‐degree relatives (FDRs) of patients with type 2 diabetes and 13 body mass index (BMI)‐ and age‐matched healthy control subjects. Abdominal subcutaneous adipose tissue biopsies were obtained before and after 150‐min hyperinsulinaemic clamp (average serum insulin 250 pm). Basal adipose tissue UCP‐2 mRNA levels in the FDR group were significantly lower than that in the control group. After the hyperinsulinaemic clamp, adipose tissue UCP‐2 mRNA levels were increased by 32% in the control group (p < 0.05) and 32% in the FDR group (p < 0.05). The basal adipose tissue UCP‐3 mRNA level was similar in the two groups and increased in both the groups during hyperinsulinaemia (p < 0.001). Dual energy X‐ray absorptiometry showed that despite similar BMI the FDR group had significantly higher fat mass (FM) per cent compared to that of the control group (p < 0.01). The UCP‐2 mRNA expression was inversely correlated with the amount of adipose tissue (r = −0.53, p < 0.001), and multiple regression analysis revealed that only the amount of FM was independently correlated with basal UCP‐2 mRNA levels, whereas age, gender nor family history of type 2 diabetes contributed independently to the variation in UCP‐2 mRNA levels. No differences in EE were observed between the two groups, and no association between EE and UCP mRNA expression was found.In conclusion, we have demonstrated that adipose tissue UCP‐2 and UCP‐3 mRNA levels are significantly increased during a 150‐min hyperinsulinaemic clamp. The UCP‐2 mRNA levels were expressed at a significantly lower level FDR to type 2 diabetes compared to control subjects. However, in multiple regression analysis controlling for amount of adipose tissue, the difference between the two groups disappeared. Thus, only the amount of adipose tissue contributed independently to the variation in UCP‐2 mRNA expression.
Grading and disease management in national screening for diabetic retinopathy in England and Wales
Authors: Harding S. , Greenwood R. , Aldington S. , Gibson J. , Owens D. , Taylor R. , Kohner E. , Scanlon P. , Leese G. ,   The Diabetic Retinopathy Grading and Disease Management Working Party
Published: December 2004

AbstractAims  A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight‐threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false‐positive referral to the hospital eye service.Methods  Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications.Proposals  Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no ‘questionable’ lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight‐threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight‐threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1).Discussion  The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality‐assured screening for people with diabetes.