bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sudden infant death syndrome in South Australia 1968–97. Part I: Changes over time
Authors: Beal S M 
Published: March 2003

Objective: To compare the epidemiology of sudden infant death syndrome (SIDS) over three consecutive decades. Methodology: The birth history, infant’s developmental and health history, infant care practices for the infant, death scene investigation and autopsy findings for all infants dying suddenly and unexpectedly in South Australia (SA) between January 1968 and December 1997 were studied. Results: The incidence of SIDS in SA rose through the 1970s and early 1980s with the highest incidence being in infants born in 1986 at 2.4 per 1000 live births (LB). Two factors felt to be dangerous for some infants were identified – being left unobserved in the prone position and having the head covered by bed clothes. Publicity about the risk of prone sleeping has been accompanied by a fall in SIDS deaths, to an incidence of 0.5 per 1000 LB in 1997. The incidence in Aboriginal infants, and infants living in lower socio‐economic conditions has always been high, but the over‐representation of these groups has increased in the last 5 years. Conclusion: If no infant under 8 months of age was placed prone or was able to get to prone unobserved before the age when they can easily get back to supine, and no infant was able to get the head completely covered while unobserved, the incidence of SIDS in SA should fall below 0.2 per 1000 LB.
Controlled trial of cumulative behavioural effects of a common bread preservative*
Authors: Dengate S , Ruben A 
Published: March 2003

Objective:  Many anecdotes and one scientific report describe cumulative behavioural effects of bread preservative on children.Methodology:  Twenty‐seven children, whose behaviour improved significantly on the Royal Prince Alfred Hospital diet, which excludes food additives, natural salicylates, amines and glutamates, were challenged with calcium propionate (preservative code 282) or placebo through daily bread in a double‐blind placebo‐controlled crossover trial.Results:  Due to four placebo responders, there was no significant difference by anova of weighted placebo and challenge Rowe Behaviour Rating Inventory means, but a statistically significant difference existed in the proportion of children whose behaviours ‘worsened’ with challenge (52%), compared to the proportion whose behaviour ‘improved’ with challenge (19%), relative to placebo (95% confidence intervals 14−60%).Conclusions:  Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative in healthy foods consumed daily. Minimizing the concentrations added to processed foods would reduce adverse reactions. Testing for behavioural toxicity should be included in food additive safety evaluation.
Successful screening for neonatal hip instability in Australia
Authors: Goss PW 
Published: March 2003

Objective:  Australian screening programmes for congenital dislocation of the hip (CDH) are characterized by lower neonatal hip instability (NHI) detection rates than more successful international programmes. Through creating a quality, accountable clinical screening programme for NHI detection, the present study aimed to establish the true incidence of NHI in Australian babies and to eliminate ‘late diagnosed’ CDH.Methods:  Doctors responsible for routine neonatal care were made accountable for NHI detection and examined 5166 consecutive live births in the first days of life between 1989 and 2000. Techniques for clinical NHI detection were taught, and doctors practised with teaching‐mannequins. Paediatricians clinically determined true positive NHI cases and managed them for a 12‐month period. Peer review of NHI detection rates was introduced to encourage accountability. Surveillance for ‘late diagnosed’ CDH occurred regularly through a variety of methods.Results:  One hundred babies with NHI were detected (19.4 per 1000): 77% were female; 26% were breech presentation, 25% had a family history of hip instability; and all received some form of splinting. Follow up for 85% of these babies at 12 months revealed no significant complications. Extensive searching has revealed no baby with ‘late diagnosed’ CDH from the study population in 12 years. One baby commenced treatment late (at 4 months) because of a failure of process following early NHI detection.Conclusions:  The true incidence of NHI in Australia is ≥19 per 1000 births. Successful clinical CDH screening programmes using primary care doctors can be created and might eliminate ‘late diagnosed’ CDH.
Urine amino and organic acids analysis in developmental delay or intellectual disability
Authors: Poplawski NK , Harrison JR , Norton W , Wiltshire E , Fletcher JM 
Published: March 2003

Objectives:  To determine the proportion of urine amino and organic acids screening tests (UMS) undertaken for patients referred with developmental delay or intellectual disability (DD/ID), and within the group with DD/ID, to determine the diagnostic yield, the proportion of diagnoses with a therapy and the associated recurrence risks.Methods:  A retrospective review of request forms and results of UMS, in individuals older than 28 days, referred to the Women's and Children's Hospital, North Adelaide, between 1 January 1992 and 31 December 1998 was carried out. Urine was analysed by ion exchange chromatography (amino acids), gas chromatography/mass spectrometry (organic acids), colorimetric assay (orotic acid) and stable isotope−dilution mass spectrometry (trimethylamine).Results:  A total of 3316 samples were received, 1447 being from patients with DD/ID. A diagnosis was determined for 1.8% of all referrals. For patients with DD/ID, the diagnostic yield was 1.1%, with a similar yield for isolated DD/ID and DD/ID with other features (9/828 vs 7/619; χ2 = 0.006; P = 0.93). Specific therapies were available for 69% of diagnoses associated with DD/ID and 87.5% had known Mendelian or mitochondrial inheritance.Conclusion:  Urine metabolic screening is an important part of the evaluation of children with DD/ID as it can enable families to make reproductive decisions and children to receive appropriate therapy early.
Childhood invasive pneumococcal disease in Tasmania, 1994−2000
Authors: Christie DJF , Coleman DJ , Wan X , Jacobs MA , Carapetis JR 
Published: March 2003

Objective:  To describe the burden of invasive pneumococcal disease in Tasmanian children, including age‐specific incidence and antibiotic‐resistance pattern.Methods:  A population‐based retrospective study was carried out, examining cases of childhood disease associated with isolates of Streptococcus pneumoniae from normally sterile sites, identified via scrutiny of laboratory records at all major Tasmanian laboratories during a 7‐year period between January 1994 and December 2000. Medical records were sub­sequently examined for information describing the clinical syndrome and course of disease.Results:  Invasive pneumococcal disease was identified in 76 children during the 7‐year period. The incidence per 100 000 children was 28.5 (95% CI 22.0−36.3) in children under 5 years and 54.3 (95% CI 40.2−71.8) in children under 2 years. The incidence of meningitis in children younger than 2 years was 12.2 (95% CI 6.1−21.8). Penicillin resistance was observed in 2.6% of cases, with no high level resistance. Predisposing conditions were identified in 34% of children with invasive disease.Conclusions:  The incidence of invasive pneumococcal disease was comparable to many urban populations in Australia. The high rate of predisposing conditions supports the recommendations of the Australian Technical Advisory Group on Immunisation for targeted immunization in this group. The paucity of data describing Indigenous status is an argument for improved data collection in this area. The low level of penicillin resistance necessitates ongoing surveillance, and the lack of serotype information requires prospective data collection.
Persistent cough in children and the overuse of medications
Authors: Thomson F , Masters IB , Chang AB 
Published: March 2003

Objective:  Children referred for persistent cough were evaluated for the referring and final diagnosis, and the extent of the use of medications prior to referral and the side effects encountered.Methods:  Data on children seen by respiratory paediatricians for persistent cough (≥4 weeks) in a tertiary respiratory setting were collected prospectively over 12 months.Results:  Of the 49 children, 61.2% were diagnosed with asthma at referral, with similar referral rates from general practitioners and paediatricians. Children with isolated cough were just as likely to have been diagnosed with asthma as children with cough and wheeze. Medication use (asthma, gastro‐oesophageal reflux and antibiotics) prior to referral was high, asthma medications were most common, and of these 12.9% had significant steroid side effects. The most common abnormality found (46.9%) was a bronchoscopically defined airway lesion, and in 56.5% of these children, another diagnosis (aspiration, achalasia, gastro‐oesophageal reflux) existed. No children had a sole final diagnosis of asthma and pre‐referral medications were weaned in all children.Conclusion:  Over diagnosis of asthma and the overuse of asthma treatments with significant side effects is common in children with persistent cough referred to a tertiary respiratory clinic. Children with persistent cough deserve careful evaluation to minimize the use of unnecessary medications and, if medications are used, assessment of response to treatment is important.
Sudden infant death syndrome in Indigenous and non‐Indigenous infants in north Queensland, 1990–1998
Authors: Panaretto KS , Whitehall JF , McBride G , Patole S , Whitehall JS 
Published: March 2003

Objective: To compare the epidemiology of sudden infant death syndrome (SIDS) in Indigenous and non‐Indigenous infants in north Queensland, and to assess the quality of data recorded for SIDS deaths.Methods: Records were obtained for SIDS cases from all coronial courts in north Queensland from 1990 to 1998. Demographic characteristics, ethnicity, age at death, sleeping and feeding patterns, smoking incidences and autopsy findings were compared. Incidences, medians and univariate associations were generated where appropriate.Results: There were 83 248 live births for the 9‐year period; 71 389 non‐Indigenous and 11 859 Indigenous births. There were 69 SIDS deaths (0.83 per 1000 live births). Overall, recording of demographic and death scene data was poor. Thirty‐eight autopsies (55%) were performed by specialist pathologists. There were 22 (32%) non‐Indigenous and 22 (32%) Indigenous SIDS deaths (25 ethnicity unknown), giving an estimated relative risk of 2.82 (95% CI 2, 4). Median age at death was 13.1 weeks (range 1–83 weeks) with 14% of deaths occurring in the neonatal period for both groups. Sleeping position was not recorded in 42% of cases and co‐sleeping was not recorded in 27% of cases. Bed sharing was more common amongst Indigenous infants. Fifty‐two per cent of SIDS cases occurred in the wet season and 48% in the dry season.Conclusions: Data recorded for SIDS deaths in north Queensland are poor, preventing specific conclusions concerning SIDS risk factors. However, SIDS rates may be up to three‐fold higher in the Indigenous population. A uniform system of post‐mortem and death scene data reporting is needed urgently.
Four general principles for the management and conservation of wetlands in large lakes: The role of water levels, nutrients, competitive hierarchies and centrifugal organization
Authors: Keddy Paul , Fraser Lauchlan H. 
Published: March 2003

AbstractThe most important factor in shoreline wetlands is variation in water depth. Superimposed upon this are gradients of soil fertility, ranging from sandy, open shorelines to sheltered, fertile bays. The use of both transplant and pot experiments shows that competitive hierarchies rapidly arise in wetland vegetation and that species are sorted along exposure and depth gradients according to their relative competitive abilities. These patterns can be summarized in the centrifugal organization model, in which competitive dominants occupy preferred core habitats and where different species and vegetation types are then arrayed outward along different constraint gradients (Wisheu & Keddy 1992). Knowledge of these general patterns provides an essential tool for managing lakes and reservoirs in order to maintain and enhance biological diversity.
Lake Champlain Basin Program: Working together today for tomorrow
Authors: Stickney Michaela , Hickey Colleen , Hoerr Roland 
Published: March 2003

AbstractLake Champlain is the sixth largest freshwater lake in the USA. Lake Champlain’s watershed is shared by Vermont and New York in the USA, and Quebec in Canada. The lake’s remarkable drainage area to surface area ratio is 19:1. More than 600 000 people live in the Lake Champlain basin and millions visit each year. The lake’s relatively healthy natural resources sustain a thriving economy. The three most challenging environmental issues facing the Lake Champlain basin are reducing phosphorus pollution, preventing toxic contaminants from entering the lake and managing invasive aquatic species that are not native that threaten native flora and fauna. To effectively address these issues, the Lake Champlain Basin Program (LCBP) believes that all decisions about the lake must be based on accurate, ongoing scientific research and that citizen involvement and inter‐jurisdictional cooperation is vital. The programme has worked hard to identify all citizens and organizations that have a stake in Lake Champlain and draw them into a cooperative, sustainable management process. A 1990 Act of Congress (Public Law 101‐596) established a coordinated framework to study and understand the diverse systems of Lake Champlain and its basin in order to develop a comprehensive management plan to protect and restore lake and watershed resources. A 31‐member multi‐stakeholder board was established to develop the plan, a process that took 5 years and included numerous public meetings. Today, a Steering Committee oversees the implementation of the plan and the activities of the LCBP.
Neuropathological investigation of cerebral white matter lesions caused by closed head injury
Authors: Onaya Mitsumoto 
Published: March 2003

In order to ascertain whether there is widespread axonal disruption of cerebral white matter in the so‐called ‘diffuse axonal injury’ (DAI), a type of closed head injury, proposed by Adams et al. the author investigated his own cases clinicopathologically. Twenty‐six male autopsied cases of head injury, aged between 19 and 84, 15 of which had sustained road traffic accidents, were examined; the others were due to falling from heights and so on. The study group all belonged to non‐missile head injuries and included 12 cases of diffuse brain injury, as well as 14 cases of focal brain injury, according to the classification of Gennarelli et al. The survival time ranged from 2 h to 21 years. Formalin‐fixed brains were cut coronally so as to make paraffin‐embedded hemispheric sections. Then these sections were stained conventionally (HE, Bodian, Kluver‐Barrera and Holzer) and immunohistochemically (GFAP) to assess axonal decrease, myelin pallor and gliosis by the use of light microscopy. In the 13 chronic cases that died more than 1 month after the accidents, the intensities of gliosis, myelin pallor and axonal decrease tended to correlate with each other. In the 13 acute cases who died less than 1 month after their accident, the degree of axonal decrease in white matter seemed to correlate with the severity of myelin pallor. Regardless of types of trauma, however, axonal retraction balls, the so‐called hallmark of DAI, were found only with myelin pallor suggesting the presence of brain swelling after the injury. Therefore these findings indicate that it may be difficult to accept the notion of DAI, that is, the presence of axonal retraction balls without brain swelling. In addition, diffuse vascular injury (2 cases) as well as rarefaction of subcortical white matter (6 cases) were presented and their pathogenesis individually discussed based on a literature review.
Dosage requirement of erythropoietin can be reduced with more frequent administration
Authors: Wang Angela Yee Moon , Yu Alex Wai Yin , Lai Kar Neng , Lui Sui Fai 
Published: March 2003

SUMMARY:In short‐term studies, once weekly and twice weekly dosing regimens of erythropoietin (EPO) have both been shown to be effective in correcting anaemia in dialysis patients. However, the optimal dosing frequency has yet to be determined. The long‐term effects of EPO given by more frequent divided doses in 10 stable haemodialysis patients were studied. The patients achieved a stable haemoglobin level for at least 3 months prior to the study. The frequency of administration was altered from 4000 units once weekly to 2000 units twice weekly in seven patients, from 4000 units once every 10 days to 2000 units twice weekly alternating with 2000 units once weekly in two patients, and from 4000 units fortnightly to 2000 units once weekly in one patient. After the conversion, EPO dosage was adjusted in order to maintain the haemoglobin at the preconversion level. At the end of 28 weeks, the mean haemoglobin level remained unchanged. However, the mean dosage requirement of EPO reduced from 3400 units per week to 2500 units per week (P = 0.019). This represents a significant 26% reduction in dosage and cost. It was concluded that subcutaneous administration of frequent small doses of EPO is a more cost‐effective way of correcting anaemia in haemodialysis patients.
Dendritic cells, tolerance and transplantation
Authors: Coates Toby , Krishnan Ravi , Russ Graeme R. 
Published: March 2003

SUMMARY:Dendritic cells (CD) are professional antigen‐presenting cells of the immune system that play a central role in the initiation of the alloimmune response. Recently these cells have been found to also play a role in the maintenance of peripheral tolerance to antigens. Dendritic cells initiate alloimmunity by migrating from the graft to lymphoid sites within the host where they activate alloantigen‐specific T cells. They are therefore an ideal target for new biological therapies aiming to divert the response away from immunity and towards tolerance. Genetic modification of DC with immunosuppressive cytokines has already proven successful in modifying the alloimmune responsein vitroand in prolonging allograft survival in small animal transplantation studies. Manipulation of the DC subsets that maintain peripheral tolerance and targeting the mechanisms that control DC immunogenicity with somatic gene therapy is a promising and novel means of inducing immunosuppression for transplantation.
Maintaining clearance in peritoneal dialysis
Authors: Johnson David W 
Published: March 2003

SUMMARY:Numerous studies have now established that there is a strong association between small solute clearance and improved outcomes in peritoneal dialysis (PD) patients. Preservation of both renal and peritoneal clearances is therefore of paramount importance, although very few trials have satisfactorily addressed this critical issue. Observational studies have suggested that the groups most at risk of loss of residual renal function are women, non‐whites, diabetic patients, patients with congestive cardiac failure, patients who experience frequent episodes of peritonitis and, possibly, patients treated with automated PD (APD). There have been no controlled trials of renoprotective therapies in PD patients, but reasonable strategies for preventing renal functional decline include avoidance of nephrotoxins and infection, maintenance of adequate blood pressure, abstinence from smoking and possibly administration of angiotensin‐converting enzyme inhibitors and/or calcium channel blockers. In contrast, peritoneal small solute removal can be maximized by augmenting fill volume, increasing exchange frequency and using either long‐dwell continuous ambulatory PD (CAPD) or short‐dwell (APD) therapies to suit individual patients’ transport characteristics. Tidal PD may additionally increase solute clearance, although studies have reported conflicting findings. Preservation of membrane function may be achieved by minimizing episodes of peritonitis and avoiding hypertonic glucose exchanges. Newer peritoneal dialysates, such as icodextrin, amino acids, bicarbonate‐buffered solutions and aldehyde‐poor fluids, are more biocompatible in experimental models of PD, but their long‐term clinical safety and efficacy have not yet been established by clinical trials. Moreover, no trials have demonstrated an independent effect of peritoneal clearance on patient outcomes. Further studies determining the relative value of renal and peritoneal clearances are therefore urgently required in order to optimize dialytic adequacy for PD patients.
Angiotensin‐converting enzyme inhibition attenuates renal platelet‐derived growth factor gene expression and cell proliferation in subtotal nephrectomy
Authors: Jandeleit‐Dahm Karin , Wu Leonard L. , Johnson Richard J. , Cox Alison J. , Kelly Darren J. , Cooper Mark E. , Gilbert Richard E. 
Published: March 2003

SUMMARY:Cell proliferation, matrix accumulation and cell infiltration are characteristic features of progressive glomerulosclerosis and tubulointerstitial fibrosis. Platelet‐derived growth factor (PDGF), a cytokine which has proliferative, prosclerotic and chemokine properties, has been shown to be upregulated in the rat remnant kidney model. Inhibition of the renin–angiotensin system by angiotensin‐converting enzyme (ACE) inhibitors has a beneficial effect on renal function and morphology, but the effect of ACE inhibition on PDGF gene expression and PDGF‐mediated cellular proliferation in subtotal nephrectomy has not been studied in detail. Twelve rats were subtotally nephrectomized (STNx) and received either the ACE inhibitor perindopril or a placebo for 12 weeks. Five sham‐operated rats served as controls. Subtotal nephrectomy was associated with hypertension, proteinuria, elevated plasma creatinine and increased kidney weight. After 12 weeks, PDGF B‐chain mRNA was significantly upregulated in the glomeruli and tubulointerstitium of subtotally nephrectomized rats. ACE inhibition attenuated PDGF mRNA expression in association with a reduction in tubular and glomerular proliferation, as assessed by staining for proliferating cell nuclear antigen. In the context of the known in vitro and in vivo effects of PDGF, it is postulated that the renoprotective action of ACE inhibitors may be partially related to PDGF‐mediated antiproliferative mechanisms.
The required role of the psychiatric‐ mental health nurse in primary health‐ care: an augmented Delphi study
Authors: Walker Louise , Barker Phil , Pearson Pauline 
Published: March 2003

The required role of the psychiatric‐mental health nurse in primary health‐care: an augmented Delphi study An augmented Delphi study was employed to elicit the perceptions of CPNs, GPs, social workers, managers of psychiatric nursing services and health service purchasers in England, on the role required of a psychiatric (mental health) nurse in primary health care. In the final stage of the study, users of mental health service were enlisted in a verification study of the emergent findings. A broad consensus emerged that a gap existed in mental health services in primary care. This was perceived as placing a large burden on GPs, which might be reduced by the appropriate development of community psychiatric‐mental health nursing. The study suggested the possibilities for development of a ‘mental health nurse consultant’ role, which might augment the current CPN role, within which the nurse might offer not only direct patient care, but also support to members of the primary care team.