bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biochemical markers of bone turnover do not decline after menopause in healthy women
Authors: Takahashi Masaaki , Kushida Kazuhiro , Hoshino Hironobu , Ohishi Tsuyoshi , Inoue Tetsuo 
Published: August 2005

Objectives
To investigate the duration of high bone turnover after menopause in normal healthy women.Design
Study recruited from three screening studies for health care in the elderly held in the area of Hamamatsu city.Setting
Department of Orthopaedic Surgery, Hospital at Hamamatsu University School of Medicine, Hamamatsu.Participants
Ninety‐two healthy postmenopausal women aged 47–81 years and 18 premenopausal women.Main outcome measures
Bone mass was determined by densitometry of the spine and the os calcis, or by ultrasound of the os calcis. Biochemical markers of bone turnover were measured including total and bone‐specific alkaline phosphatase, osteocalcin, C‐terminal propeptide of type I procollagen, free deoxypyridinoline and urinary degredation products of type I collagen.Results
All markers except the C‐terminal propeptide of type I procollagen were significantly higher in early postmenopausal women than in premenopausal women. Postmenopausal women were divided into four groups according to years since menopause. There was no difference in biochemical markers among those women in whom years since menopause were 1 to 5, 6 to 15, 16 to 25 and >26. There were no correlations between biochemical markers and age in postmenopausal women. When the postmenopausal women were divided into three groups according to t‐scores of bone mass, there was no significant difference in the biochemical markers among the groups.Conclusions
High bone turnover occuring after menopause lasts for >25 years during the postmenopausal period.
Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study
Authors: MacKenzie I. Z. , Bowell Peter , Gregory Helen , Pratt Geoff , Guest Claire , Entwistle C. C. 
Published: August 2005

Objective
To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae.Design
A retrospective (1980–1986) and prospective (1987–1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time.Setting
Obstetric units in two counties (three health districts) with similar annual numbers of matemities and the Regional Blood Transfusion Service antenatal serology laboratory.Participants
Non‐sentisitised Rhesus D negative pregnant nulliparae.Interventions
Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county.Main outcome measures
1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme.Results
Prophylaxis significantly reduced iso‐immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0.14–0.53; P < 0.0001) and contemporary controls (OR 0.43, CI 0.22–0.86; P= 0.02). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty‐two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill‐health that result from very preterm birth should be considerable.Conclusion
Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.
31P magnetic resonance spectroscopy of the liver in HELLP syndrome
Authors: Magee Laura A. , Dixon Ruth M. , Kemp Graham J. , Redman Christopher W. G. , Styles Peter 
Published: August 2005

Objectives
Using magnetic resonance spectroscopy (MRS) to measure phosphorus‐containing metabolites in the liver, this study aimed to investigate non‐invasively whether or not women with haemolysis, elevated liver enzymes and low platelets (HELLP) have detectable abnormalities of hepatic energetics.Setting
John Radcliffe Hospital, Oxford.Design
Prospective study.Methods
After giving informed consent, patients with HELLP syndrome (n= 7) and controls with severe Pre‐eclampsia (n= 3), were studied by 31P MRS of the liver as soon as possible after delivery (range 2–4 days) and compared with normal nonpregnant controls (n= 6). Haematological and biochemical tests were performed serially and on the day of the MRS in all pregnant patients.Results
The severity of HELLP varied as follows: peak aspartate aminotransferase (range 129–2574), peak gamma glutamyl transferase (range 28–96), peak lactate dehydrogenase (range 305–2820), nadir platelets (range 25–1 14), peak international normalised ratio for prothrombin time (before fresh frozen plasma) (range 0.9–1.9). One pregnancy was terminated but all others resulted in live births and all mothers made uneventful, rapid recoveries. MRS‐determined relative hepatic concentrations of phosphorus–containing metabolites and absolute concentrations of adenosine triphosphate did not differ significantly between groups. One patient with the most clinically severe HELLP syndrome (by laboratory criteria) exhibited magnetic resonance spectra which showed a relative increase in phomonoester and an absolute decrease in hepatic adenosine triphosphate (to 62% of control).Conclusions
Enthusiasm for the conservative management of HELLP syndrome that develops remote from term has been tempered by the inability to identify patients at risk for progression to hepatic necrosis. We found that most patients with HELLP syndrome had normal liver metabolism as assessed by MRS. However, clinically severe HELLP syndrome can be associated with disturbed hepatic metabolism consistent with that seen in hepatic ischaemia and or granulocytic infiltration of the liver.
Information Technology for postgraduate education: survey of facilities and skills in the South West Deanery
Authors: Draycott Tim , Cook Julian , Fox Robert , Jenkins Julian 
Published: August 2005

Objective
To determine the Information Technology (IT) infrastructure available to, and IT skills of, obstetric specialiast registrars across the South West Denery.Design
Open prospective study.Setting
NHS Hospitals in the South West Deanery.Methods
two separate surveys. Firstly, the computer equipment available to trainees was determined at each hospital in the deanery on site using a software programme. Secondly, IT skills of a sample of 22 specialist registrars were assessed using a checklist at a series of four workshops.Main outcome measures
Computers with sufficient specification to use CD‐ROMs, to access the Inter‐ net, and to support data‐, audio‐ and video‐conferencing. The number of trainees with IT skills to use a computer‐aided learning package and the Internet.Results
Sixty‐six percent of trainees have access to a computer with a CD‐ROM drive. Sixty‐six percent also have access to the Internet at their place of work. Thirteen percent have access to data‐conferencing but there were no computers in the Deanery able to support audio‐ or video‐conferencing. lbenty‐five percent of trainees have no IT skills and require basic training in the use of computers. Thirty‐six percent of our sample would require training to be able to use computer‐based tutorials programs. Seventy‐ seven percent of trainees require training to be able to use the Internet without assistance.Conclusion
A significant minority of trainees do not have access to computers with sufficient specification to run basic tutorial programmes or access the Internet. Similarly, a large minority of trainees do not even have a basic knowledge of computer technology and IT training is required for the majority of trainees for them to reap the potential benefits which computer‐based tutorials systems and the Internet can give.
Misoprostol for induction of labour at term: a more effective agent than dinoprostone vaginal gel
Authors: Danielian Peter , Porter Belinda , Ferri Natalia , Summers Jenny , Templeton Allan 
Published: August 2005

Objective
To compare the efficacy of vaginal misoprostol and dinoprostone vaginal gel for induction of labour at term.Design
A single‐blind randomised comparative trial.Setting
Induction and labour wards of a UK teaching hospital.Participants
Two hundred and eleven pregnant women at term in whom induction of labour was indicated, and with no contra‐indication to the use of prostaglandins for the induction of labour.Intervention
The women were randomly assigned to receive vaginal administration of either misoprostol 50 pg four hourly (to a maximum of four doses) or dinoprostone gel 1 mg six hourly (to a maximum of three doses).Main outcome measures
Time from induction to delivery, oxytocin requirement in labour, analgesic requirement, mode of delivery, neonatal outcome.Results
The misoprostol group had a highly significant reduction in median induction‐delivery interval compared with the dinoprostone group (14.4 hours vs 22.9 hours; P < 0.00001). In addition, more women delivered after only one dose (77% w 49%; P < 0.0001, OR 3.51, 95% CI 1.94–6.35), and within 12 and 24 hours. There was a reduced need for oxytocin augmentation in labour (21 %vs 47%; P < 0–0001, OR 0.30,95% CI 0.16–0.54). There was no difference in analgesia requirement in labour, or in mode of delivery. There were no adverse neonatal outcomes associated with the use of misoprostol. Women in the misoprostol group experienced more pain in the interval between induction and being given analgesia in labour, but this did not reach statistical significance.Conclusions
Misoprostol 50 μg vaginally is a more effective induction agent than 1 mg dinoprostone vaginal gel, with no apparent adverse effects on mode of delivery, or on the fetus. The higher pain scores in the misoprostol group must be balanced against the reduction in time spent having labour induced, and the reduction in need for intravenous oxytocin augmentation. Further randomised studies must continue to exclude the possibility of rare adverse side effects.
Withholding consent to participate in clinical trials: decisions of pregnant women
Authors: Mohanna Kay , Tuna Kate 
Published: August 2005

Objective
To identify factors affecting the decision of pregnant women to withhold their consent to Design A qualitative, cross‐sectional, retrospective study using semi‐structured interviews withSetting
Patients' homes.Participants
Eighteen women who had been invited previously to participate in a clinical trial in pregnancy, but who had declined.Results
The invitation to participate in a clinical trial when pregnant has different implications for different women, and the meanings they ascribe to the invitation to participate will affect the likelihood of them participating. A pregnant woman may feel the pressure of conflicting duties: a protective duty to the fetus and to be a ‘good citizen’ when asked to participate in research. The sharing of information during the recruitment phase has a crucial bearing on how the invitation will be received. The design of the trial, the type and style of information available, the manner in which it is conveyed, the timing and process of the invitation and by whom it is made all affect the likelihood of a woman agreeing to take part.Conclusion
By asking for the contribution of these women, this study identified factors that can influence the chances of an individual entering a trial or not. Contextualising and personalising risk is important in the consent process as recruiting women when pregnant can be difficult and hinder research. From these comments recommendations for future research involving pregnant women have been drawn up.
A Model for Management of Delirious Postacute Care Patients
Authors: Bergmann Margaret A. , Murphy Katharine M. , Kiely Dan K. , Jones Richard N. , Marcantonio Edward R. 
Published: August 2005

Although delirium has been shown to be a common, morbid, and costly problem for hospitalized older people, evidence has mounted that it may persist for weeks or months. Therefore, concern about delirium can no longer be confined to acute care. After an acute hospitalization, many older people are discharged to postacute care (PAC) facilities—rehabilitation hospitals and skilled nursing facilities. Although several models designed to prevent delirium in the hospital setting have been described, there have been few such efforts in the PAC setting.This article describes the development of a multifactorial delirium abatement program (DAP), a new model of care for older patients admitted to the postacute skilled nursing facility with delirium. The DAP is a nurse‐led, unit‐based intervention. The program consists of four modules based on best practices as defined by the peer‐reviewed literature: standardized screening for symptoms and signs of delirium upon admission to the PAC unit, assessment and treatment of possible causes of and contributors to delirium, prevention and management of common delirium complications, and restoration of patient cognitive and self‐care function.This article also presents the process of facility introduction, staff education on DAP content, and multidisciplinary outreach. Key strategies for DAP implementation are reviewed. Program adoption challenges and corresponding model refinements to enhance adherence and overall care quality are highlighted. Last, clinical adaptation of this research‐derived program is discussed.
Predictors of Overall Quality of Care Provided to Vulnerable Older People
Authors: Min Lillian C. , Reuben David B. , MacLean Catherine H. , Shekelle Paul G. , Solomon David H. , Higashi Takahiro , Chang John T. , Roth Carol P. , Kamberg Caren J. , Adams John , Young Roy T. , Wenger Neil S. 
Published: August 2005

Objectives: Prior research shows that the quality of care provided to vulnerable older persons is suboptimal, but little is known about the factors associated with care quality for this group. In this study, the influences of clinical conditions, types of care processes, and sociodemographic characteristics on the quality of care received by vulnerable older people were evaluated.Design: Observational cohort study.Setting: Two senior managed care plans.Participants: Three hundred sixty‐two community‐dwelling patients aged 65 and older identified as vulnerable by the Vulnerable Elder Survey (VES‐13).Measurements: Outcome variable: patients' observed‐minus‐expected overall quality score. Predictor variables: types of care processes, types and number of clinical conditions, sex, age, VES‐13 score (composite score of function and self‐rated health), income, education, mental health status, and number of quality indicators triggered.Results: Patients whose conditions required more history‐taking, counseling, and medication‐prescribing care processes and patients with diabetes mellitus received lower‐than‐expected quality of care. A greater number of comorbid conditions was associated with higher‐than‐expected quality of care. Age, sex, VES‐13 score, and other sociodemographic variables were not associated with quality of care.Conclusion: Complexity, vulnerability, and age do not predispose older persons to receive poorer‐quality care. In contrast, older patients whose care requires time‐consuming processes such as history taking and counseling are at risk for worse quality of care and should be a target for intervention to improve care.
Weight Change and Lower Body Disability in Older Mexican Americans
Authors: Snih Soham Al , Raji Mukaila A. , Markides Kyriakos S. , Ottenbacher Kenneth J. , Goodwin James S. 
Published: August 2005

Objectives: To examine the association between 2‐year weight change and onset of lower body disability over time in older Mexican Americans.Design: Data were from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993–2001). Weight change was examined by comparing baseline weight to weight at 2‐year follow‐up. Incidence of lower body disability was studied from the end of this period through an additional 5 years.Setting: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California.Participants: One thousand seven hundred thirty‐seven noninstitutionalized Mexican‐American men and women aged 65 and older who reported no limitation in activities of daily living (ADLs) and were able to perform the walk test at 2‐year follow‐up.Measurements: In‐home interviews assessed sociodemographic factors, self‐reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), self‐reported ADLs, depressive symptoms, and number of hospitalizations. Cognitive function, handgrip muscle strength, and body mass index (BMI) were obtained. The outcomes were any limitation of lower body ADL (walking across a small room, bathing, transferring from a bed to a chair, and using the toilet) and limitation on the walk test over subsequent 5‐year follow‐up period. General Estimation Equation (GEE) was used to estimate lower body disability over time.Results: Weight change of 5% or more occurred in 42.3% of the participants; 21.7% lost weight, 20.6% gained weight, and 57.7% had stable weight. Using GEE analysis, with stable weight as the reference, weight loss of 5% or more was associated with greater risk of any lower body ADL limitation (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.06–1.95) and walking limitation (OR=1.35, 95% CI=1.03–1.76) after controlling for sociodemographic variables and BMI at baseline. Weight gain of 5% or more was associated with greater risk of any lower body ADL limitation (OR=1.39, 95% CI=1.02–1.89), after controlling for sociodemographic variables and BMI at baseline. When medical conditions, handgrip muscle strength, high depressive symptomatology, cognitive function, and hospitalization were added to the equation, the relationship between 2‐year weight change (>5% loss or >5% gain) and lower body disability decreased.Conclusion: Health conditions and muscle strength partially mediate the association between weight loss or gain and future loss of ability to walk and independently perform ADLs.
Symptom Interactions as Mechanisms Underlying Symptom Pairs and Clusters
Authors: Parker Kathy P. , Kimble Laura P. , Dunbar Sandra B. , Clark Patricia C. 
Published: August 2005

Purpose:

To present a summary of the potential shared or interactive mechanisms underlying an exemplar symptom pair: sleep disturbances and pain.
Organizing Construct:

Understanding of the multidimensional shared and interactive mechanisms underlying symptoms pairs and clusters has the potential to enhance symptom management.
Methods:

Reviews of the literature were conducted to search for information on shared or interactive mechanisms underlying sleep disturbances and pain; minimal data were available. Relevant information about individual symptoms was outlined and categorized in areas often used to describe the multidimensional nature of symptoms, including the physiological, psychological, behavioral, and sociocultural domains. This information was examined for relationships and commonalities.
Conclusions:

Many potential shared and interactive mechanisms underlying the symptom pair of sleep disturbances and pain were identified. These results indicate the need for further work and theory development in this area. The symptom interactional framework is a beginning conceptual perspective designed to facilitate this work. Implications for interdisciplinary translational research designed to optimize symptom management are discussed.
Photoschädigung und Photoalterung – Prävention und Behandlung
Authors: Grether‐Beck Susanne , Wlaschek Meinhard , Krutmann Jean , Scharffetter‐Kochanek Karin 
Published: August 2005

ZusammenfassungDie Belastung der Haut mit natürlicher und künstlicher UV‐Strahlung hat in den letzten Jahren nicht nur durch die verstärkte solare Strahlung als Folge der Ozonabnahme in der Stratosphäre, sondern auch durch ein Freizeitverhalten mit dem Wunsch nach gebräunter Haut deutlich zugenommen. Dieser Wunsch wird nicht nur durch Reisen in die sonnigen Gebiete der Erde, sondern auch durch den häufigen Besuch von Solarien umgesetzt. Hinzu kommt die gestiegene Lebenserwartung in den Industrienationen, die mit einer gesteigerten kumulativen UV‐Belastung korreliert. Konsequenz daraus ist zusätzlich zu Immunsuppression und Hautkarzinogenese auch die Photo‐ oder Lichtalterung der Haut durch den photooxidativen Schaden an Zellen, subzellulären Kompartimenten und Makromolekülen, der durch die Absorption von Photonen in einer sauerstoffreichen Umgebung entsteht. Klinisch manifestiert sich die Photoalterung der Haut in Faltenbildung, Gewebeschlaffheit, ledrigem Erscheinungsbild mit Fragilität, Verletzbarkeit und eingeschränkter Wundheilung. Strategien zur Vermeidung oder Minimierung dieser photooxidativen Langzeitschäden umfassen effektiven UV‐Schutz und das Aufrechterhalten eines oxidativ‐antioxidativen Gleichgewichtes in Zellen und Geweben. Neuere Therapieentwicklungen wie der Einsatz von DNA‐Reparaturenzymen werden ebenfalls diskutiert.
Epidemiologie von chronischen Lichtschäden
Authors: Diepgen Thomas L. 
Published: August 2005

ZusammenfassungWährend insbesondere in Australien die hohe Inzidenz von UV‐Licht‐induzierten Hautkrebserkrankungen und chronischen Lichtschäden epidemiologisch gut belegt ist, fehlen vergleichbare Zahlen aus Europa und insbesondere auch aus Deutschland. Vermutlich werden die Prävalenz und Inzidenz von aktinischen Keratosen, Basaliomen und Plattenepithelkarzinomen deutlich unterschätzt. Der hohe Stellenwert chronischer Hautschäden wird anhand neuerer international publizierter epidemiologischer Studien diskutiert. Mit einem in Deutschland zunehmenden Anteil der älteren Bevölkerung wird auch die therapeutische und präventivmedizinische Bedeutung chronischer Lichtschäden in den nächsten Jahren weiter an Bedeutung gewinnen.
Cell Surface Heparan Sulfate Promotes Replication of
Toxoplasma gondii
Authors: Bishop Joseph R. , Crawford Brett E. , Esko Jeffrey D. 
Published: August 2005

ABSTRACT

Previous work suggests that cell surface heparan sulfate acts as a receptor for the Apicomplexan parasite
Toxoplasma gondii
. Using Chinese hamster ovary cell mutants defective in heparan sulfate biosynthesis, we show that heparan sulfate is necessary and sufficient for infectivity. Further, we demonstrate that the parasite requires N sulfation of heparan sulfate initiated by
N
-deacetylase/
N
-sulfotransferase-1, but 2-O sulfation and 6-O sulfation appear to be dispensable. In order to study the role of heparan sulfate in other cell types, we created a conditional allele for
N
-deacetylase/
N
-sulfotransferase-1 by using Cre-loxP technology. Mammary tumor cells lacking
N
-deacetylase/
N
-sulfotransferase-1 exhibited reduced toxoplasma infectivity like Chinese hamster ovary cell mutants. Surprisingly, heparin, chemically modified heparinoids, and monoclonal antibodies to heparan sulfate had no effect on toxoplasma infection.
T. gondii
attachment and invasion were unchanged in
N
-deacetylase/
N
-sulfotransferase-1-inactivated cells as well, but replication was reduced. Thus, heparan sulfate does not appear to function as a receptor for
T. gondii
but instead facilitates parasite replication postinvasion.