bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare needs of people with intellectual disability in institutions in Taiwan: outpatient care utilization and implications
Authors: Lin J.‐D. , Wu J.‐L. , Lee P.‐N. 
Published: March 2003

AbstractBackground  The present study assessed the outpatient care use of people with intellectual disability (ID) in order to identify patterns of healthcare needs and the factors affecting this utilization.Methods  The primary method used in this study was a cross‐sectional survey of 1390 subjects with ID in Taiwan. Data were obtained from questionnaires completed at 30 registered institutions caring for people with ID.Results  The findings show that people with ID in Taiwan are likely to make more outpatient visits per year than members of the general population. The prevalence of illness in people with ID was 41%, with epilepsy being the most frequently reported disease. A total of 39.5% of individuals with ID took medicine regularly, and 38.9% had used alternative forms of medication besides Western medicine. In terms of the use of outpatient facilities by people with ID, paediatric clinics were the most frequently utilized. The average monthly number of outpatient visits per person with ID was 2.18 (around 26 visits per year). This study found that the need for outpatient care is determined by a variety of factors relating to: the age of people with ID, the type of handicap, the place of medical treatment, having a family physician, the accessibility of medical care, the time‐consuming nature of the medical visits, having an illness, ID accompanied with other disabilities, and finally, a need for rehabilitative care.Conclusions  From the examination of the expressed needs of people with ID, it was found that these individuals have a heightened need for healthcare and the treatment of special diseases/disorders in comparison to members of the general population in Taiwan. Within the context of ordinary services, it is particularly important to have a precise view of the ways in which the health needs of people with ID are different from the general population as a whole. This will enable healthcare services to respond to these needs, either through support systems within generic care or, in some cases, through the delivery of specific healthcare through specialized services which are kept separate from generic care.
The activated immune system and the renin–angiotensin–aldosterone system in congestive heart failure
Authors: Samsonov  , Lopatin  , Tilz  , Artner‐Dworzak  , Nassonov  , Mareev  , Belenkov  , Wachter  , Fuchs  
Published: March 2003

Samsonov M, Lopatin J, Tilz G, Artner‐Dworzak E, Nassonov E, Mareev V, Belenkov J, Wachter H, Fuchs D, (Cardiology Research Centre, Moscow, Russia; University of Graz, and the University of Innsbruck, Austria). Activated immune system and the renin–angiotensin–aldosterone system in congestive heart failure. J Intern Med 1998; 243: 93–98.ObjectsThe aim of the study was to investigate a possible relationship between plasma renin activity, angiotensin II, serum levels of angiotensin‐converting enzyme, aldosterone and markers of immune activation in congestive heart failure (CHF).Patients and MethodsFifty‐three patients (50 male, three female, mean age 46 ± 16 years) with congestive heart failure were studied. Twenty‐eight patients had I or II NYHA class of CHF and 25 patients had III or IV NYHA class (NYHA class, mean ± SD : 2.3 ± 0.9). Serum neopterin concentration and hormones were measured by commercial radioimmunoassays. Serum soluble receptors of tumour necrosis factor and interleukin‐2 were determined by ELISA.ResultsAll analytes significantly correlated with NYHA classes (P < 0.05). There existed correlations between neopterin and angiotensin‐converting enzyme or aldosterone (rs= 0.35 and rs= 0.36, P < 0.05). The soluble tumour necrosis factor receptor concentrations correlated with plasma renin activity (rs= 0.38, P < 0.05).ConclusionThe result of our study suggest that there exists some relationship between the renin–angiotensin–aldosterone system and immune activation in severe congestive heart failure, however, the associations found are rather weak.
Metabolic features of inflammatory bowel disease in a remission phase of the disease activity
Authors: Capristo  , Mingrone  , Addolorato  , Greco  , Gasbarrini  
Published: March 2003

Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G (Sacred Heart Catholic University, Rome, Italy). Metabolic features of inflammatory bowel disease in a remission phase of the disease activity. J Intern Med 1998; 243: 339–47.ObjectivesTo evaluate the anthropometric and metabolic characteristics of patients with Crohn's disease (CD) and ulcerative colitis (UC), comparing both groups with healthy volunteers.DesignA cross‐sectional study.SettingThe Department of Internal Medicine, Catholic University Hospital, Rome, Italy.SubjectsThirty‐four patients with biopsy‐proven inflammatory bowel disease (18 CD; 16 UC) in clinical remission (SCDAI <3 and Powell–Tuck index <4) not receiving steroid therapy.InterventionsAll patients had a clinical examination.Main outcome measuresBlood indicators of inflammation and nutritional status. Body composition was assessed by both anthropometry and bioimpedance and metabolic variables were measured by indirect calorimetry over a 60–90 min period.ResultsCD had a lower body weight than both controls (58.1 kg, range 41.5–71.0 vs. 66.4 kg, range 57.0–76.0; P < 0.001) and UC) 58.1 kg, range 41.5–71.0 vs. 69.6 kg, range 50.5–94.0; P < 0.001). Fat‐free mass (FFM) did not differ between the groups, whilst fat mass was significantly lower in CD than in UC (P < 0.05) and controls (P < 0.001). Normalizing the basal metabolic rate by FFM, a higher value was found in CD compared with UC (143 kJ kg−1 d–−1, range 97.5–179 vs. 133 kJ kg−1 d−1, range 123–148; P < 0.05) and control subject 143 kJ kg−1 d−1, range 97.5–179 vs. 134 kJ kg−1 d−1, range 122–162; P < 0.05). The nonprotein respiratory quotient was significantly lower in CD compared to UC 0.80, range 0.73–0.84 vs. 0.84, range 0.79–0.91; P < 0.01) and controls (0.80, range 0.73–0.84 vs. 0.83, range 0.81–0.87; P < 0.001), with a consequently higher lipid oxidation rate in CD.ConclusionsCD subjects showed a decreased fat mass and enhanced utilization of lipids compared with UC and controls. These data could be explained by the larger intestinal involvement and considered as a contribution to lipid tissue wasting in CD.
Imported rickettsioses: think of murine typhus
Authors: Van Der Kleij  , Gansevoort  , Kreeftenberg  , Reitsma  
Published: March 2003

van der Kleij FGH, Gansevoort RT, Kreeftenberg HG, Reitsma WD (University Hospital Groningen, the Netherlands). Imported Rickettsioses: think of murine typhus (case report). J Intern Med 1998; 243:177–79.Murine typhus is a disease still prevalent in many parts of the world. Because the incidence in the US and Europe has declined rapidly, physicians in these continents have become unfamiliar with the clinical picture. Murine typhus is associated with significant morbidity and fatalities do occur, especially in the elderly and when late recognized. We present a patient with murine typhus that illustrates the wide variety of symptoms in this disease, which makes diagnosis difficult. However, if one keeps the possibility of murine typhus in mind, it is easily diagnosed and treated.
Sleep and cardiac symptoms amongst women aged 40–64 years
Authors: Asplund  , Åberg  
Published: March 2003

Abstract. Asplund R, Åberg H (County Hospital, Strömsund; and Karolinska Institute, Huddinge; Sweden). Sleep and cardiac symptoms amongst women aged 40–64 years.J Intern Med1998;243: 209–13.Objectives.To determine whether the occurrence of cardiac symptoms is related to sleep disturbances.DesignAn epidemiological survey by means of a questionnaire.SettingThe county of Jämtland in northern Sweden.SubjectsRandomly selected women (6000) aged 40–64 years, with a similar number of women in each 5‐year age group. A total of 3669 responded.Main outcome measuresSleep disturbances and cardiac symptoms.ResultsIn total, 81.9% of the women reported a good night's sleep. Amongst them, 0.4% stated that they were troubled by both spasmodic chest pain and a sensation of irregular heart beat, 0.8% spasmodic chest pain alone, 5.8% irregular heart beat and 93.0% neither of these conditions. The corresponding frequencies amongst the women who slept poorly were 1.5, 1.8, 15.0 and 81.7%, respectively (P&lt; 0.0001).Amongst the subjects with reported sleep complaints, there was an increase in heart symptoms, both in those with trouble falling asleep, frequent awakenings and difficulty in getting to sleep again, and in those who awoke too early in the morning. Spasmodic chest pain was 8.8 (1.9–40.3) times and irregular heart beat 7.7 (3.3–18.1) times more common in women with nightmares almost every night than in those who never experienced nightmares. Daytime sleepiness was also associated with increased heart symptoms.ConclusionPoor sleep was associated with an increase in spasmodic chest pain and irregular heart beat.
Effects of Simvastatin and omega‐3 fatty acids on plasma lipoproteins and lipid peroxidation in patients with combined hyperlipidaemia
Authors: Nordøy  , Bønaa  , Nilsen  , Berge  , Hansen  , Ingebretsen  
Published: March 2003

Nordøy A, Bønaa KH, Nilsen H, Berge R, Hansen JB, Ingebretsen OC (University of Tromsø, Tromsø, Norway). Effects of Simvastatin and omega‐3 fatty acids on plasma lipoproteins and lipid peroxidation in patients with combined hyperlipidemia. J Intern Med 1998; 243: 163–70.Objectives.Patients with combined hyperlipidemia are at increased risk for development of coronary heart disease. The purpose of this study was to evaluate the efficiency and the safety of treatment with Simvastatin and omega‐3 fatty acids in patients with this lipid disorder.Design.A double‐blind placebo controlled, randomized study evaluating the effects of Simvastatin separately and in combination with omega‐3 fatty acids in 41 healthy patients with defined hyperlipidemia. After a 16 weeks dietary run‐in period the patients were treated in periods of 5 weeks.Results.As expected Simvastatin (20 mg day−1) reduced serum total cholesterol, triacylglycerols, apolipoproteins B and E and increased HDL‐cholesterol and apolipoprotein A1. Addition of omega‐3 fatty acids (4 g day−1) further decreased serum triacylglycerols (P= 0.007), total cholesterol (P= 0.052) and apolipoprotein E (P= 0.035). No significant changes attributable to supplementation of polyunsaturated fatty acids on the content of lipid peroxides in plasma and in the various lipoprotein fractions were observed.Conclusions.The combined treatment of Simvastatin and omega‐3 fatty acids seems to be an efficient and safe alternative for patients with combined hyperlipidemia.
Use of dobutamine echocardiography for cardiac risk stratification of patients with chronic renal failure
Authors: Marwick  , Lauer  , Lobo  , Nally  , Braun  
Published: March 2003

Marwick TH, Lauer MS, Lobo A, Nally J, Braun W (Cleveland Clinic Foundation, Cleveland, USA). Use of dobutamine echocardiography for cardiac risk stratification of patients with chronic renal failure. J Intern Med 1998; 244: 155–61.ObjectivesThis study sought to define the value of dobutamine echocardiography (DbE) for cardiac risk stratification in patients with chronic renal failure (CRF).DesignOutcome study correlating results of DbE with late cardiac events in patients with CRF.SettingAcademic medical centre.SubjectsAll patients with CRF (serum creatinine > 2.5 mg dL−1) undergoing DbE were studied; we analysed 193 consecutive patients (aged 63 ± 13 years, 73 men).InterventionsA standard dobutamine–atropine stress was administered until attainment of peak dose, or the development of severe ischaemia or side‐effects. The electrocardiogram (ECG) and echocardiogram were obtained before, during and after stress. Ischaemia was identified by new or worsening wall‐motion abnormalities with stress.Outcome measuresPatients were followed up after 38 ± 14 months for cardiac death, myocardial infarction or coronary disease progression requiring revascularization.ResultsDbE demonstrated ischaemia in 36 patients (19%), scar in 36 (19%) and a normal study in 121 patients. The heart‐rate response to dobutamine was submaximal (< 85% age‐predicted heart rate) in the absence of wall‐motion abnormalities in 69 patients (36%), 54 of whom completed the protocol. Follow‐up data were complete in 191 patients (99%); cardiac events occurred in 33 patients (17%), including 17 with cardiac death, 7 with infarction, and 9 requiring late revascularization. Spontaneous events occurred in 7 patients with ischaemia, 3 with scar (8%), 11 with a nondiagnostic study (16%) and 3 patients with a normal study (6%). Over the entire follow‐up, the event‐free survival in patients with ischaemia (66%) was markedly lower than those without ischaemia (84%, P= 0.006). However, the event rate in patients with nonischaemic responses increased from 8% to 16% between 24 and 40 months, and whilst ischaemia was an independent predictor of outcome at 24 months, it was not at 40 months.ConclusionsIn patients with CRF, the identification of ischaemia at DbE is associated with a significant risk of adverse cardiac events. Patients with nonischaemic scans have a low frequency of events over short‐term follow‐up, but this increases at later follow‐up. These later events may reflect progressive coronary disease, attributable to the atherogenic milieu of these patients, and imply that repeated testing may be required to maintain cardiac risk stratification in patients with CRF.
Clinical management of the multiple endocrine neoplasia syndromes: results of a computerized opinion poll at the Sixth International Workshop on Multiple Endocrine Neoplasia and von Hippel–Lindau disease
Authors: Lips  
Published: March 2003

Lips CJM (University Hospital, Utrecht, The Netherlands). Clinical management of the multiple endocrine neoplasia syndromes: results of a computerized opinion poll at the Sixth International Workshop on Multiple Endocrine Neoplasia and von Hippel–Lindau disease (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 589–94.Objectives and designIn order to provide all participants of the Sixth International Workshop on Multiple Endocrine Neoplasia and von Hippel–Lindau Disease with the opportunity to express their opinion on medical, ethical and social issues on clinical management of these hereditary cancer syndromes, a meeting employing an interactive voting system was organized.ResultsIn many aspects, the majority of the participants shared the same opinion. The following percentages of participants felt that, if a specific germline mutation is present in a definitely affected family member, DNA diagnosis should be performed in the offspring of this patient before the age of 10: 78% for MEN‐1, 93% for MEN‐2, and 71% for VHL. About 71% felt the clinical specialist should provide information about the consequences of DNA analysis and be responsible for disclosing the DNA test results and performing genetic counselling. If possible, selective surgery is preferred to maintain organ function. To make a complete diagnosis in a patient with an apparently sporadic tumour, 89% believed that mutation analysis of germline DNA is mandatory in order to investigate the possibility of inherited disease. In several areas, controversial opinions exist, depending on diversity in discipline, specific research area, experience in the field, and cultural and religious backgrounds. In particular, in vitro fertilization combined with pre‐implantation genetic diagnosis is an area which attracts considerable emotion.ConclusionsIn order to avoid confusion in the families, explicit and common guidelines are needed for the identification, treatment and follow‐up of individuals who have predisposing MEN or VHL mutations. Close collaboration between endocrinologists, oncologists, surgeons, pathologists, psychologists and geneticists is required in order to establish and verify such guidelines.
The hypothalamus–pituitary–gonad axis and testicular function in male patients after treatment for haematological malignancies
Authors: Kauppila  , Viikari  , Irjala  , Koskinen  , Remes  
Published: March 2003

Abstract. Kauppila M, Viikari J, Irjala K, Koskinen P, Remes K (Turku University Central Hospital, Turku, Finland). The hypothalamus–pituitary–gonad axis and testicular function in male patients after treatment for haematological malignancies. J Intern Med 1998; 244: 411–6.ObjectiveThe effect of aggressive chemotherapy on the hypothalamus–pituitary–gonad axis and on testicular function was assessed in nine male patients who had received chemotherapy only (CT, group I) and in 10 males after allogeneic bone marrow transplantation (BMT, group II). The mean time from CT or BMT to the assessment was 3.7 (range, 1.0–11.7) years.DesignThe responses of follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) were assessed by the gonadotropin‐releasing hormone (GnRH) test and, in addition, serum basal values for testosterone and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. In 13/19 patients the human chorionic gonadotropin (hCG) test was performed.ResultsIn group I, only one patient had an abnormal basal FSH value, but all (100%) had pathologically poor responses to the GnRH test. In contrast, all baseline FSH values were raised in group II (mean, 18; range, 11–30 U L−1), indicating toxic injury to the seminiferous tubules. Also in group II the responses to GnRH were low throughout the test (90%) and there were no clear peak values. In group II, the basal FSH and its maximum response to GnRH were significantly more affected than in group I (P < 0.001). The difference may be due to the effect of the conditioning regimen. Serum basal LH was raised in three of the patients in group I and they also had abnormal releasing test responses. In group II, baseline LH was abnormal in four patients, but the responses to GnRH were normal. However, the maximum response to the releasing test was significantly more affected in group II (P = 0.024). Serum testosterone levels were normal in all test subjects in both study groups. However, in two patients in both groups, the serum free androgen index was below the low reference limit, and an impaired response of serum testosterone to hCG stimulation was common (60%).ConclusionsA toxic injury in the testis is common in haematological patients, especially after high‐dose chemoradiotherapy. Serum basal testosterone usually remains normal, but even then subnormal serum free androgen index, impaired testosterone response to hCG injection and abnormal response in LH may indicate a deficient androgen status. It may well be that testosterone replacement therapy should be considered in these cases.
Factors predicting clinical remission in adult patients with type 1 diabetes
Authors: Schölin A. , Berne C. , Schvarcz E. , Karlsson F. A. , Björk E. 
Published: March 2003

Objectives. To describe the course of clinical remission in adult patients (16–50 years of age) with type 1 diabetes and to identify factors predictive of the occurrence and length of remission.Design. A retrospective cohort study.Subjects. Sixty‐two consecutive patients (43 men and 19 women) with new onset IDDM, 27 ± 8 years at diagnosis and treated with multiple insulin injections from the beginning.Setting. Department of Medicine, Uppsala University Hospital and Örebro Medical Centre, Sweden.Main outcome measures. Length and occurrence of remission (defined as maintenance of HbA1C <6.5% and an insulin dosage of <0.4 U kg−1 day−1 for a minimum of 1 month) in relation to nine biochemical and clinical factors at diagnosis.Results. Sixty‐one per cent of the patients entered remission. The duration of remission was longer in males than females (10 ± 12 vs. 2 ± 3 months; P < 0.01). Male gender, normal serum bicarbonate at onset and a short time of classic symptoms before onset were predictive markers (P < 0.01; P < 0.05 and P < 0.01, respectively) for longer duration of remission. Low serum bicarbonate levels at onset were associated with lower occurrence of remission. Blood glucose, body mass index (BMI), and age at diagnosis did not influence the occurrence or the duration of remission.Conclusions. In most adult patients with new onset of type 1 diabetes remission is induced when using multiple insulin injection therapy. Male patients seem particularly prone to remission, and the length and extent of β‐cell strain prior to diagnosis strongly influences its course.
Long‐term effects of LDL apheresis on carotid arterial atherosclerosis in familial hypercholesterolaemic patients
Authors: Koga N. , Watanabe K. , Kurashige Y. , Sato T. , Hiroki T. 
Published: March 2003

Objectives. To assess the long‐term effect of LDL apheresis on carotid arterial atherosclerosis in severe familial hypercholesterolaemic (FH) patients.Design. Changes in existing plaque, new plaque formation and annual progression rate of carotid early plaque were evaluated by B‐mode ultrasonography.Subjects. LDL apheresis group: two homozygous FH and nine heterozygous FH patients received a combination of LDL apheresis and cholesterol‐lowering drug therapy for a mean of 7.8 years. Control group: 10 heterozygous FH patients were maintained by medication only for a mean of 5.5 years.Results. As a result of LDL apheresis treatment, LDL cholesterol levels reduced from 16.0 ± 3.60 to 6.43 ± 0.07 mmol L–1 in homozygous FH patients and from 11.5 ± 2.46 to 4.32 ± 1.2 mmol L–1 in heterozygous FH patients. During the long‐term treatment period, the existing plaque tended to progress and new plaque formation in carotid arteries was also observed in both groups. The annual progression rate of mean maximum intima–media thickness in the common carotid artery was a mean of –0.0023 ± 0.0246 mm year–1 in heterozygous FH patients in the LDL apheresis group, suggesting regression. This was significantly lower when compared with the control group, which had a mean of 0.0251 ± 0.0265 mm year–1.Conclusion. The results suggest that the long‐term treatment with combined LDL apheresis and drugs may delay the progression of the atherosclerotic process and prompt the stabilization of atheromatous plaque in severe FH patients.
The role of TNFα and TNF receptors in obesity and insulin resistance
Authors: Hotamisligil G. S. 
Published: March 2003

Abstract. Hotamisligil GS (Harvard University, Boston, Massachusetts, USA). The role of TNFα and TNF receptors in obesity and insulin resistance. (Minisymposium: Genes & Obesity). J Intern Med 1999; 245: 621–625.Insulin resistance, a smaller than expected response to a given dose of insulin, is associated with many common diseases including, ageing, polycystic ovarian disease, syndrome X, cancer, infections, trauma and, most significantly, obesity and type 2 diabetes mellitus. The biochemical basis of insulin resistance in type 2 diabetes has been the subject of many studies. Earlier studies have indicated that quantitative regulation of the insulin sensitive glucose transporters (Glut‐4) and insulin receptors themselves may contribute to this disorder, however, these two factors are probably inadequate to explain the extent of insulin resistance. This point also became apparent by the development of only mild hyperinsulinaemia in mice with a targeted mutation in the Glut‐4 gene. Studies on postreceptor defects in type 2 diabetes has recently focused on the intrinsic catalytic activity of the insulin receptor and downstream signalling events. A reduction in tyrosine phosphorylation of both the insulin receptor (IR) and the insulin receptor substrate‐1 (IRS‐1) has been noted in both animal and human type 2 diabetes. Importantly, this appears to occur in all of the major insulin‐sensitive tissues, namely the muscle, fat and liver. It is now clear that decreased signalling capacity of the insulin receptor is an important component of this disease. I will review some of the potential mechanisms underlying this deficiency.