bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term results of antireflux surgery indicate the need for a randomized clinical trial
Authors: Sandbu R , Khamis H , Gustavsson S , Haglund U 
Published: December 2004

Abstract

Background
Well conducted, comparative trials of laparoscopic versus open antireflux surgery with an adequate patient enrolment are few and they do not demonstrate obvious advantages for the laparoscopic approach except for a marginal gain in shorter hospital stay. The aim of this study was to compare the effectiveness of laparoscopic and open procedures.

Methods
Two unselected groups of 230 patients were identified through a register of all inpatient public care in Sweden. Outcomes of laparoscopic and open antireflux surgery were compared using a disease-specific questionnaire 4 years after operation.

Results
Failure and dissatisfaction were significantly more common in the laparoscopy group than among patients having conventional open surgery. Treatment failure rates were 29·0 and 14·6 per cent respectively (P = 0·004). Dissatisfaction rates were 15·0 and 7·0 per cent respectively (P = 0·005). There was no other questionnaire item for which the proportion of failures differed significantly between the two groups.

Conclusion
This study does not support the presumption that laparoscopic antireflux surgery is to be preferred to the open procedure. It is strongly recommended that a randomized controlled trial be conducted.
Endoscopic ultrasonography in the diagnosis and management of suspected upper gastrointestinal submucosal tumours
Authors: Shen E F , Arnott I D R , Plevris J , Penman I D 
Published: December 2004

AbstractBackground‘Submucosal’ lesions in the upper gastrointestinal tract are often difficult to evaluate. Endoscopic ultrasonography (EUS) provides high-quality information about the nature of these lesions and may assist management. This study assessed the use of EUS in the evaluation and management of upper gastrointestinal submucosal tumours.MethodsForty-four consecutive patients were referred with suspected upper gastrointestinal submucosal lesions for EUS. All examinations were performed by one of two experienced endosonographers.ResultsMost patients were referred for EUS with a suspected gastrointestinal stromal tumour. The pre-EUS diagnosis did not correlate with the EUS diagnosis in 25 of 44 patients. Pathological correlation was possible in 16 patients, and the EUS diagnosis was confirmed in each case. Based on the findings at EUS, 12 patients underwent resection. Pathology confirmed the ultrasonographic findings in these patients. Follow-up EUS to monitor lesions was recommended in a further three patients.ConclusionEUS is safe and provides useful information in many patients with suspected submucosal tumours. EUS may reveal unsuspected findings and can increase physician certainty, allowing accurate diagnosis and facilitation of the management process.
Systematic review of dynamic graciloplasty in the treatment of faecal incontinence
Authors: Chapman A E , Geerdes B , Hewett P , Young J , Eyers T , Kiroff G , Maddern G J 
Published: December 2004

Abstract

Background
The aim of this systematic review was to compare the safety and efficacy of dynamic graciloplasty with colostomy for the treatment of faecal incontinence.

Methods
Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase and Cochrane Library databases up until November 1999. Inclusion of papers depended on a predetermined protocol, independent assessments by two reviewers and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials and case series. Forty papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance.

Results
No high-level evidence was available and there were no comparative studies. Mortality rates were around 2 per cent for both graciloplasty and colostomy. Morbidity rates reported for graciloplasty appear to be higher than those for colostomy. Dynamic graciloplasty was clearly effective at restoring continence in between 42 and 85 per cent of patients, whereas colostomy is, by its design, incapable of restoring continence. However, dynamic graciloplasty is associated with a significant risk of reoperation.

Conclusion
While dynamic graciloplasty appears to be associated with a higher rate of complications than colostomy, it is clearly a superior intervention for restoring continence in some patients. It is recommended that a comparative, but non-randomized, study be undertaken to evaluate the safety of dynamic graciloplasty in comparison to colostomy, and that the procedure should be performed only in centres where it is carried out routinely.
Managing sexually abused and/or abusing children in substitute care
Authors: Farmer Elaine , Pollock Sue 
Published: December 2004

ABSTRACTThis paper reports on research on the characteristics, management and therapeutic treatment of sexually abused and/or abusing children in substitute care. Of the 40 sexually abused and/or abusing young people aged 10 or over in the interview sample, two‐thirds showed sexual behaviours in the placement studied but one‐third did not. The range of sexual behaviours shown by the young people is described. Analysis of the findings shows that four key components of effective management are supervision, adequate sex education, modification of inappropriate sexual behaviour and therapeutic attention to the needs that underlie such behaviour. Supervision includes planning for safe care before placement, preparing other children in the setting, teaching young people how to keep themselves safe when out on their own, and careful monitoring of contact with birth family members. The need for a proactive approach to sex education is stressed. Effective management approaches to masturbation, sexualized behaviour and sexually abusing behaviour are discussed but the processes of denial and minimization of sexual abuse and the development of high thresholds for action when looked after children are abused or at risk are shown to present obstacles to effective care. Finally, the importance of addressing children's deeper needs is emphasized, including the importance of regular review of their need for counselling. At the end of the article two case examples from the study are given.
Positive Connections: a programme for children who have a parent with a mental illness
Authors: Orel Nancy A. , Groves Patricia A. , Shannon Leona 
Published: December 2004

ABSTRACTMental health professionals working with parents who suffer from a mental illness often overlook the children within the family. Children whose parents are mentally ill face numerous obstacles to their own emotional development and these children are at higher risk for developing mental illnesses than other children. These risks can be decreased if protective or positive interventions are available for the children. This article will describe the development and implementation of Positive Connections, an effective intervention programme specifically designed for children whose parents have been diagnosed with a mental disorder. The effectiveness of this programme has been evaluated using both qualitative and quantitative research strategies, and the results are presented.
A personal reflective account: The impact of the collation and sharing of information during the course of a child protection investigation
Authors: Richardson M. 
Published: December 2004

ABSTRACTThis paper provides a subjective, personal account of the impact and effect which the collation and sharing of information had and continues to have on my family during the course of a child protection investigation. By sharing my story I hope to preserve my unique, subjective experience in the midst of an impersonal and highly invasive bureaucratic process in an attempt to bridge the power divide between the professional and parent. I do not attempt to analyse theory but rather feelings, and identify the differing perceptions of those involved. The importance of the professional maintaining an open mind and challenging any preconceived assumptions or judgements about a family is also stressed. Child protection work must ensure that policies and practice comply with the rights laid down in the Human Rights Act (1998) and the professionals involved must be seen to promote and protect the rights of all vulnerable individuals.
Infant–mother interaction as a predictor of child's chronic health problems
Authors: Mäntymaa M. , Puura K. , Luoma I. , Salmelin R. , Davis H. , Tsiantis J. , Ispanovic‐Radojkovic V. , Paradisiotou A. , Tamminen T. 
Published: December 2004

AbstractBackground   Psychological stress is associated with physical illnesses like asthma or infections. For an infant, situations perceived as stressful are highly dependent on the relationship with the caregiver. Constantly poor mother–infant interaction increases the child's vulnerability to stressful conditions and experiences. The aim of the study was to investigate the impact of the quality of early mother–infant interaction on the subsequent physical health of the child. Poor mother–infant interaction was hypothesized to be associated with chronic or recurrent health problems in the child.Participants   Fifty‐seven mother‐infant dyads from families at risk of psychosocial problems and 63 from non‐risk families, altogether 120 dyads, participated in the study. Families were drawn from normal population, from well‐baby clinics in the city of Tampere, Finland. Infants were full‐term and healthy, families with severe risks like psychotic illnesses of the parents or a history of child protection concerns were excluded from the study.Methods   After the initial interview with the mother, the mother–infant interaction was videotaped when the infants were 8–11 weeks of age and the interaction was assessed using the Global Rating Scale for Mother–Infant Interaction (Murray et al. 1996a). After the 2‐year follow‐up mothers were interviewed again and the health problems of the child were elicited.Results   Poor dyadic mother–infant interaction and infant's poor interactive behaviour assessed at two months were separately associated with the physical health of the child during the two‐year follow‐up. After adjusting for other factors in the logistic regression analysis infant's poor interactive behaviour remained as a significant predictor of chronic or recurrent health problems in the child. Infant's health problems at the time of the initial interview and day care centre attendance were also significant predictors.Conclusions   The results suggest that interactional issues between a mother and her infant are related to the child's subsequent physical health. Children with recurrent or chronic health problems may have relationship difficulties with which they need help. Also, early avoidant behaviour of the infant should be regarded as an indicator of the infant's distress with possibly adverse outcomes in the child's physical health, among other consequences.
When adolescents disagree with their mothers: CBCL‐YSR discrepancies related to maternal depression and adolescent self‐esteem
Authors: Berg‐Nielsen T. S. , Vika A. , Dahl A. A. 
Published: December 2004

AbstractObjective  To facilitate understanding of disagreement between mothers and adolescents when they report on adolescents’ mental symptoms, discrepancy of reports were studied in relation to depressive symptoms of mothers and self‐esteem of adolescents.Participants  Sixty‐eight mother–adolescent pairs participated. All the adolescents (11–17 years) were referred to child and adolescent psychiatric outpatient clinics in Norway for emotional or behavioural disorders.Methods  The adolescents completed the questionnaire Youth Self Report (YSR), and mothers completed the corresponding Child Behaviour Checklist (CBCL). Maternal depression was measured with the Hospital Anxiety and Depression Scales and adolescent self‐esteem was measured with Self‐Perception Profile for Adolescents.Results  Mothers’ level of depression emerged as a significant variable (P < 0.001) predicting CBCL‐YSR discrepancy on internalizing disorders, explaining 41% of the variance. With increased levels of depression mothers tended to report more internalizing problems compared to the adolescents. For mother–adolescent discrepancy on externalizing problems, adolescents’ age was the most significant variable. With increasing age the adolescents were more in agreement with their mothers when reporting their externalizing problems. But also self‐esteem problems concerning their looks made adolescents inclined to admit more externalizing problems, thus being more in agreement with their mothers.Conclusions  Subjective, psychological variables such as mothers’ level of depression and self‐esteem of adolescents may be useful to consider when interpreting informant discrepancy concerning the mental problems of adolescents.
Current Literature: 4
Authors: Ni Bhrolchain Cliona 
Published: December 2004

Background  The Clifton area of Nottingham with a total population of nearly 20 000 and a child population of 4500.Aim  To track the changes in clinical services provided by community paediatricians in Clifton from 1983 to 1999.Methods  The paper tracks changes through a series of reports produced over time by the paediatricians working in the Clifton area. The 5 reports are dated 1983, 1985, 1989–91, 1995, 1999–2000.Results  The child population in Clifton dropped somewhat from 4700 to 3900 during the study period. A child health clinic (CHC) with no appointment system and providing Child Health Surveillance was staffed by a senior community paediatric trainee in 1983. This had transformed into a referral clinic with an appointment system by 1995 (still staffed by the trainee). By 2000, the clinic had added a consultation element for GPs, HVs, school nurses and school support teachers for a session a week and added a clinical psychologist to its staff. Trainees staff the clinics still (a lecturer and an SHO) but an Associate Specialist session has been added to provide better continuity of care.In 1983, each infant was seen 26.7 times (range 9–51): 61% at the CHC (mostly for weighing), 31% at the GP surgery. By 1991, GPs had taken on CHS and the clinic had a formal appointment system but with a ‘drop in’ period when necessary. Total attendances dropped by almost a half between 1989 and 1991, as did those attending for immunizations. Primary care referrals accounted for 15.5% of those seen in 1991. Major diagnostic categories included weight and feeding, development, behaviour and ‘minor problems’. By 2000, there were 3 referral clinics a week with the additional consultation clinic. No CHS was provided. Developmental difficulties (61) and behaviour difficulties (60) now top the list of referral categories and the latter include self‐harm, anorexia, Tourette’s, ADHD and conduct disorder, with 8 of these excluded from school. Medical diagnoses (49) such as short stature, epilepsy and various syndromes come next with child protection referrals (28) and weight and feeding (26) following on behind. Hospital consultants had referred some children to be managed by the community paediatricians.Conclusions  The authors point out the invisibility of the changes in community paediatric services compared with the more apparent hospital changes. The lack of regular reporting of community data reinforces this invisibility. However they also sound a hopeful note that the community services have shown a constant ability to innovate and respond to changing demand and that this should stand us in good stead in the future.
Current Literature: 5
Authors: Ni Bhrolchain Cliona 
Published: December 2004

Background  A tertiary neurodisability centre at a major London teaching hospital (Guy's and Thomas’).Aim  To review the outcome after 4 years of a cohort of children with severe language delay/disorder and some features of autism, but not sufficient at the time to confirm a diagnosis of autism.Methods  The notes of 227 children assessed at the centre between the age of 2 and 5 were examined to select cases. This resulted in 40 children with severe receptive language delay as the primary diagnosis and a nonverbal IQ above 70. One hundred and eight children were excluded as another diagnosis, including autism, had been made and in 79 cases original clinical notes were insufficient for re‐analysis. However further exclusions due to lack of formal IQ scores, changed addresses, refusals and re‐assessment delays left a total of 18 children who participated in the study.Standard measures of performance were used to assess intellectual and language functioning, in addition to clinical evaluation.Results   Follow‐up at a mean age of 8 years and 7 months showed that five children now showed sufficient language and social impairments for a diagnosis of childhood autism and the other 13 met criteria for atypical autism although nine of these showed some recovery in their language skills. The severity of social communication impairments and repetitive behaviours in the original notes were associated with the severity of autism when re‐assessed.From parental questionnaires, none of the children was considered to have developed ‘true friendships’ with reciprocal interaction, sharing and coinitiation of activities. Some tried but didn’t succeed while others were ‘loners’ who preferred their own company. All 18 children had a statement. Ten children attended specialist educational provision (six in a language unit, two in an MLD school and two in an autism unit) and the others had help in mainstream.Conclusions   The authors thought they would find two groups of children at follow‐up: one with ‘true autism’ and one where improvement had occurred; ‘true language delay’. Instead, they found that all could be given a diagnosis of autism when re‐assessed. They discuss the continuing difficulties of defining childhood developmental disorders at an early age and the difficulties of separating autism from ‘a receptive language disorder with secondary socio‐emotional problems’ as required by ICD‐10.They comment on the apparent importance of repetitive behaviours and the prognosis of children who show impairments in all three ASD areas in the preschool years, even if they are not sufficient to diagnose an ASD at the time. They also comment on the risk to effective education and health support if a diagnosis of autism is not given.
Current Literature: 6
Authors: Reading Richard 
Published: December 2004

Aims  To evaluate the effect of site specific advice from a school travel coordinator on school travel patterns.Methods  Cluster randomised controlled trial of children attending 21 primary schools in the London boroughs of Camden and Islington. A post‐intervention survey measured the proportion of children walking, cycling, or using public transport for travel to school, and the proportion of parents/carers very or quite worried about traffic and abduction. The proportion of schools that developed and implemented travel plans was assessed.Results  One year post intervention, nine of 11 intervention schools and none of 10 control schools had travel plans. Proportions of children walking, cycling, or using public transport on the school journey were similar in intervention and control schools. The proportion of parents who were very or quite worried about traffic danger was similar in the intervention (85%) and control groups (87%). However, after adjusting for baseline and other potential confounding factors we could not exclude the possibility of a modest reduction in parental concern about traffic danger as a result of the intervention.Conclusions  Having a school travel coordinator increased the production of school travel plans but there was no evidence that this changed travel patterns or reduced parental fears. Given the uncertainty about effectiveness, the policy of providing school travel coordinators should only be implemented within the context of a randomised controlled trial.
Expression of the neutrophil‐activating CXC chemokine ENA‐78/CXCL5 by human eosinophils
Authors: Persson T. , Monsef N. , Andersson P. , Bjartell A. , Malm J. , Calafat J. , Egesten A. 
Published: December 2004

SummaryBackground Eosinophils are seen at sites of inflammation in diseases such as helminthic infestation, asthma, ulcerative colitis and some neoplastic diseases. They are also associated with connective tissue remodelling, for example in longstanding asthma. In the present study, we investigated whether eosinophils express the CXC chemokine epithelial cell‐derived neutrophil activating peptide (ENA‐78/CXCL5), a chemokine that can activate neutrophils and in addition possesses angiogenic properties.Immunocytochemistry detected CXCL5 in eosinophils and the peptide was localized in the specific granules by immunoelectron microscopy.Methods and Results In eosinophil lysates, 12 ± 2 pg (mean ± SEM) of CXCL5 was detected per 106 cells by enzyme‐linked immunosorbent assay (ELISA). Weak constitutive expression of CXCL5, as well as the related CXC chemokine IL−8/CXCL8, could be detected in freshly isolated eosinophils by RT–PCR. However, during prolonged incubation of eosinophils, a strong increase in both CXCL5 and IL‐8/CXCL8 expression was seen, as detected by RT‐PCR, and increasing amounts of CXCL5 peptide with time were detected in the incubation medium by ELISA. Addition of TNF‐α neutralizing antibodies during prolonged incubation significantly inhibited CXCL5 production, demonstrating involvement of auto‐ and paracrine effects from TNF‐α produced by eosinophils themselves. Addition of IFN‐γ showed a strong inhibitory effect on CXCL5 synthesis.Conclusion These findings suggest that, through expression of CXCL5, eosinophils can recruit and activate CXC receptor 2 (CXCR2)‐bearing cells such as neutrophils at sites of inflammation. Eosinophils may also promote connective tissue remodelling through release of this peptide.