bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency and determinants of formal respite service use among caregivers of children with cerebral palsy in Ontario
Authors: Damiani G. , Rosenbaum P. , Swinton M. , Russell D. 
Published: December 2003

AbstractObjective  To describe the use of formal respite services among caregivers of children with cerebral palsy in Ontario and discuss the factors that may contribute to respite use and non‐use.Methods  A total of 468 caregivers were interviewed about their experience with formal respite services. Interviews were part of a larger cross‐sectional study on caregiver health. Caregivers were asked about their knowledge of formal respite services; their use of formal respite services in the past year; financial implications relating to formal respite use; perceived barriers to formal respite service use; and reasons for not using formal respite services (if applicable).Results  Nearly half (46%) of caregivers in the sample reported using respite services in the past year. Most of the caregivers who used respite services used more than one source of respite, had services provided in their home, often for less than 1 day, and reported using them more than six times. The most commonly cited reason for using formal respite services was for a planned break. Many factors influenced caregivers’ use of formal respite services. Caregivers who had a child with a lower level of function, with multiple additional conditions, or who was male, were more likely to use formal respite services. Although over 90% of caregivers indicated that respite use is beneficial for both their family and child, over 60% reported facing many barriers while attempting to access respite services.Conclusion  Results from this cross‐sectional study indicate that caregivers who used respite services used them frequently for breaks from caregiving. Caregivers described facing many barriers while attempting to access respite services therefore to improve caregiver's experience with respite services, strategies are suggested.
Health‐related quality of life of severely obese children and adolescents
Authors: Maher Elise 
Published: December 2003

Context  One in seven US children and adolescents is obese, yet little is known about their health‐related quality of life (QOL).Objective  To examine the health‐related QOL of obese children and adolescents compared with children and adolescents who are healthy or those diagnosed as having cancer.Design, setting and participants  Cross‐sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years [mean (SD) 12.1 (3) years], who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002. Children and adolescents had a mean (SD) body mass index (BMI) of 34.7 (9.3) and BMI z‐score of 2.6 (0.5).Main outcome measures  Child self‐report and parent‐proxy report using a paediatric QOL inventory generic core scale (range 0–100). The inventory was administered by an interviewer for children aged 5 through 7 years. Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer.Results  Compared with healthy children and adolescents, obese children and adolescents reported significantly (P < 0.001) lower health‐related QOL in all domains [mean (SD) total score, 67 (16.3) for obese children and adolescents; 83 (14.8) for healthy children and adolescents]. Obese children and adolescents were more likely to have impaired health‐related QOL than healthy children and adolescents [odds ratio (OR) 5.5; 95% confidence interval (CI) 3.4–8.7] and were similar to children and adolescents diagnosed as having cancer (OR 1.3; 95% CI 0.8–2.3). Children and adolescents with obstructive sleep apnoea reported a significantly lower health‐related QOL total score [mean (SD), 53.8 (13.3)] than obese children and adolescents without obstructive sleep apnoea [mean (SD), 67.9 (16.2)]. For parent‐proxy report, the child or adolescent's BMI z‐score was significantly inversely correlated with total score (r = −0.246; P = 0.01), physical functioning (r = −0.263; P < 0.01), social functioning (r = −0.347; P < 0.001), and psychosocial functioning (r = −0.209; P = 0.03).Conclusions  Severely obese children and adolescents have lower health‐related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents and teachers need to be informed of the risk for impaired health‐related QOL among obese children and adolescents to target interventions that could enhance health outcomes.
Bicycle helmet campaigns and head injuries among children. Does poverty matter?
Authors: Reading Richard 
Published: December 2003

Objectives  To assess the impact of a community‐based bicycle helmet programme aimed at children aged 5–12 years (about 140 000) from poor and well‐off municipalities.Methods  A quasi‐experimental design, including a control group, was used. Changes in the risk of bicycle‐related head injuries leading to hospitalization were measured, using rates ratios.Results  Reductions in bicycle‐related head injuries were registered in both categories of municipalities. Compared with the pre‐programme period, the protective effect of the programme during the post‐programme period was as significant among children from poor municipalities (RR 0.45; 95% CI 0.26–0.78) as among those from richer municipalities (RR 0.55; 95% CI 0.41–0.75).Conclusion  Population‐based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.
The ‘lids For kids’ Project Team. Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham
Authors: Reading Richard 
Published: December 2003

Aims  To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation.Methods  Cross‐sectional survey in 28 primary schools in deprived areas of Nottingham; 1061 year 5 schoolchildren were studied.Results  All year 5 children attending school on the day of the survey completed the questionnaire (87% of children registered at participating schools). Children residing in a deprived area were less likely to own a bike and more likely to ride it 4 days a week or more. Half the children owned a helmet (52%), but only 29% of these always wore their helmet. Children in deprived areas were less likely to own a helmet, but those that owned a helmet were not less likely to always wear one. Family encouragement and parental warning of dangers of not wearing a helmet were associated with increased helmet ownership rates. Family encouragement and best friends wearing a helmet were associated with higher rates of helmet wearing.Conclusions  Programmes aimed at preventing head injury among child cyclists will need to address the inequality in helmet ownership that exists between children residing in deprived and non‐deprived areas. Strategies to increase family encouragement to wear a helmet may be useful, as may those recognizing the importance of the attitudes and behaviours of peers, such as peer education programmes. Further work is required to assess how exposure to risk of cycling injury varies with deprivation.
Thimerosal and the occurrence of autism: negative ecological evidence from Danish population‐based data
Authors: Reading Richard 
Published: December 2003

Objective  It has been suggested that thimerosal, a mercury‐containing preservative in vaccines, is a risk factor for the development of autism. We examined whether discontinuing the use of thimerosal‐containing vaccines in Denmark led to a decrease in the incidence of autism.Design  Analysis of data from the Danish Psychiatric Central Research Register recording all psychiatric admissions since 1971, and all outpatient contacts in psychiatric departments in Denmark since 1995.Patients  All children between 2 and 10 years old who were diagnosed with autism during the period from 1971 to 2000.Outcome measures  Annual and age‐specific incidence for first day of first recorded admission with a diagnosis of autism in children between 2 and 10 years old.Results  A total of 956 children with a male‐to‐female ratio of 3.5 : 1 had been diagnosed with autism during the period from 1971 to 2000. There was no trend towards an increase in the incidence of autism during that period when thimerosal was used in Denmark, up through 1990. From 1991 until 2000, the incidence increased and continued to rise after the removal of thimerosal from vaccines, including increases among children born after the discontinuation of thimerosal.Conclusions  The discontinuation of thimerosal‐containing vaccines in Denmark in 1992 was followed by an increase in the incidence of autism. Our ecological data do not support a correlation between thimerosal‐containing vaccines and the incidence of autism.
Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine – A systematic review of current epidemiological evidence
Authors: Jacobson Robert M. 
Published: December 2003

The authors conducted a systematic review of the evidence for and against the existence of an association between autistic spectrum disorder and the measles, mumps and rubella (MMR) vaccine. Specifically, they tested four hypotheses: (1) that the rates of autistic spectrum disorder is higher in individuals who have received MMR than those who did not, (2) that an increase in autistic spectrum disorder may be occurring as a result of MMR, (3) that the development of autistic spectrum disorder is temporally associated with receiving the MMR, and (4) that a new variant form of autistic spectrum disorder may be associated with the MMR vaccine. The authors sought to identify all controlled epidemiological articles examining for an association between autistic spectrum disorder and the MMR vaccine. They extracted data from the articles on the characteristics and objectives of the study as well as evidence of an association.Twelve articles met the inclusion criteria. One study found no difference in the rates of autistic spectrum disorder and the MMR vaccine in children who were vaccinated and those who were not. Six studies examined for evidence of an increase in autistic spectrum disorder associated with an increase in the MMR vaccine coverage; none of the six showed evidence of an association. Four studies examined if a variant form of autistic spectrum disorder was associated with the MMR vaccine; none of the four showed evidence of an association. Eight studies attempted to determine if there was a temporal association between developing autistic spectrum disorder and receiving the MMR vaccine. Of these, one study identified an increase in parental concern in the 6‐month period following vaccination with MMR in one of its analyses. The results of all other studies showed no association between autistic spectrum disorder and the MMR vaccine. The authors concluded that the current literature does not suggest an association between autistic spectrum disorder and the MMR vaccine. The authors did note that the studies were not large enough even in aggregate to rule out a link between a rare variant form of autistic spectrum disorder and the MMR vaccine; they held, however, that given the real risks of not vaccinating and that the risks and existence of variant autistic spectrum disorder remain theoretical, current policies should continue to advocate the use of the MMR vaccine.
Parents’ beliefs and expectations when presenting with a febrile child at an out‐of‐hours general practice clinic
Authors: Bhrolchain Cliona Ni 
Published: December 2003

Background  A qualitative study in a central out‐of‐hours consultation room in Aarhus, Denmark, a city of about 250 000 people.Aim  To describe why parents of children with fever and/or respiratory symptoms used the service, what parents did before seeking medical advice and what they expected from their consultation.Method  All parents with a child under 12 attending the centre on 17 weekdays (except Fridays) in September and October 1998 were invited for a structured interview before seeing the GP.Results  Of 153 parents, 152 agreed to an interview, but six were later excluded as it became apparent their main reason for consultation was not fever or respiratory symptoms. The only refusal was because a mother did not wish to delay her consultation with the doctor.Fifty‐two per cent of parents had sought advice from family, friends, day‐care staff and others before seeking medical help. Twenty‐one per cent had tried over‐the‐counter remedies. Forty‐six per cent did not consider the illness serious, but 1/3 did not know how serious it was and 12% thought their child was very ill.They were asked an open‐ended question about their expectation of the consultation. Nearly all expected their child to be examined, 79% expected a diagnosis or an explanation but only 13% said they expected a prescription. To the more specific question ‘Do you expect a prescription of an antibiotic?’, 71% said no, 19% said yes and 10% didn’t know.Conclusions  The study confirms previous findings in relation to parents’ seeking informal advice prior to seeking a medical opinion. However, the study shows different parental expectations in relation to the likelihood of a prescription after the consultation. The authors stress the importance of exploring parents’ expectations during emergency consultations. Concentrating on clinical examination and communicating with parents about the child's condition may be better than a prescription.
The paradox of Prader–Willi syndrome: a genetic model of starvation
Authors: Cundall David 
Published: December 2003

People with Prader–Willi syndrome have many other problems in addition to their insatiable appetites, and Tony Holland and his colleagues from Cambridge have done much to advance our understanding of this condition. In this article, which appears under the ‘Hypothesis’ banner in the Lancet, he makes the striking assertion that all of the many problems experienced by people with Prader–Willi syndrome can be explained by considering the syndrome as a syndrome of starvation, which manifests as obesity in a food‐rich environment.They postulate that, in this syndrome, the body incorrectly interprets the absence of satiation as starvation. It had been assumed that other aspects of the phenotype, like growth hormone deficiency, central hypogonadism, low metabolic rate, lower IQ, ritualistic behaviours were all somehow related to genes on the long arm of chromosome 15. However, the authors assert that all the various aspects of the phenotype can be attributed to their starvation hypothesis and put forward two main supporting arguments. The first is all about energy balance and they present some strong evidence that the low metabolic rate and hypogonadism is centrally mediated and what one might expect with abnormal hypothalamic responsiveness.The second is about imprinted genes in the placenta. This might explain the neonatal hypotonia, failure to thrive and arrested brain development. There is little experimental evidence to support this part of the argument yet, but like all good hypotheses, it should be a stimulus to more research.
Research on the quality of parent‐provider communication in paediatric care: implications and recommendations
Authors: Glascoe Francis Page 
Published: December 2003

This narrative review of the correlates of effective parent‐provider communication and relevant interventions indicates that effective parent‐provider communication is associated with parental satisfaction with care, adherence to treatment recommendations, and enhanced discussion of psychosocial concerns. Moreover, interventions designed to improve parent‐provider communication resulted in more discussion of psychosocial concerns, better recall of information from the visit, and improved parent‐provider communication. Recommendations for the development of more effective studies of parent‐provider communication and relevant interventions in paediatric primary care include the need for theoretical models to help guide research, the development of reliable and valid self‐report measures of communication, the assessment of clinically relevant correlates of parent‐provider communication, and the study of children's roles in communication with their paediatricians.Read and do likewise!
Rhesus macaque antibody molecules: sequences and heterogeneity of alpha and gamma constant regions
Authors: Scinicariello Franco , Engleman Carrie N. , Jayashankar Lakshmi , McClure Harold M. , Attanasio Roberta 
Published: December 2003

SummaryRhesus macaques (Macaca mulatta) are extensively used in vaccine development. Macaques infected with simian immunodeficiency viruses (SIV) or simian‐human immunodeficiency viruses (SHIV) are the best animal model currently available for acquired‐immune‐deficiency‐syndrome‐related studies. Recent results emphasize the importance of antibody responses in controlling HIV and SIV infection. Despite the increasing attention placed on humoral immunity in these models, very limited information is available on rhesus macaque antibody molecules. Therefore, we sequenced, cloned and characterized immunoglobulin gamma (IGHG) and alpha (IGHA) chain constant region genes from rhesus macaques of Indian and Chinese origin. Although it is currently thought that rhesus macaques express three IgG subclasses, we identified four IGHG genes, which were designated IGHG1, IGHG2, IGHG3 and IGHG4 on the basis of sequence similarities with the four human genes encoding the IgG1, IgG2, IgG3 and IgG4 subclasses. The four genes were expressed at least at the messenger RNA level, as demonstrated by real‐time reverse transcription polymerase chain reaction (RT‐PCR). The level of intraspecies heterogeneity was very high for IGHA genes, whereas IGHG genes were remarkably similar in all animals examined. However, single amino acid substitutions were present in IGHG2 and IGHG4 genes, indicating the presence of IgG polymorphism possibly resulting in the expression of different allotypes. Two IgA alleles were identified in several animals and RT‐PCR showed that both alleles may be expressed. Presence of immunoglobulin gene polymorphism appears to reflect the unusually high levels of intraspecies heterogeneity already demonstrated for major histocompatibility complex genes in this non‐human primate species.
Impact of cAMP on the T‐cell response to type II collagen
Authors: Ozegbe Patricia , Foey Andrew D. , Ahmed Salman , Williams Richard O. 
Published: December 2003

SummaryThere is considerable interest in the possible use of cAMP‐elevating agents in the treatment of autoimmune diseases such as rheumatoid arthritis. The objective of this study was to evaluate the impact of different cAMP‐elevating agents on the T‐cell response to type II collagen within the context of collagen‐induced arthritis, a murine model of rheumatoid arthritis. Spleen cells or lymph node cells from type‐II‐collagen‐immunized DBA/1 mice were cultured in the presence of type II collagen plus one of five different cAMP‐elevating agents: rolipram, forskolin, prostaglandin E2, 8‐bromo‐cAMP, or cholera toxin. Levels of interferon‐γ (IFN‐γ), interleukin‐4 (IL‐4) and IL‐5 were measured in culture supernatants by enzyme‐linked immunosorbent assay. All of the cAMP‐elevating agents tested were found to profoundly suppress IFN‐γ production in a dose‐dependent manner. IL‐4 and IL‐5 production was slightly up‐regulated at low concentrations of the cAMP‐elevating agents and was modestly suppressed at the highest concentrations of cAMP‐elevating agents. Experiments were then carried out to determine whether T cells were directly affected by cAMP‐elevating agents or whether the immunomodulatory effects were mediated via antigen‐presenting cells. Pulsing T cells alone for a brief period with cholera toxin produced an almost identical effect to pulsing antigen‐presenting cells alone, i.e. down‐regulation of proliferation, down‐regulation of IFN‐γ production with little effect on IL‐5 production. It was concluded that cAMP‐elevating agents suppressed T helper type 1 responses to type II collagen to a greater extent than T helper type 2 responses. The cAMP‐elevating agents could directly influence the activity of T cells but, in addition, influenced the ability of antigen‐presenting cells to support T helper type 1 responses.
Highly up‐regulated CXCR3 expression on eosinophils in mice infected with Schistosoma japonicum
Authors: Li He , Chunsong Hu , Guobin Cai , Qiuping Zhang , Qun Li , Xiaolian Zhang , Baojun Huang , Linjie Zhang , Junyan Liu , Mingshen Jiang , Jinquan Tan 
Published: December 2003

SummaryCXCR3, predominately expressed on memory/activated T cells, is a receptor for both interferon‐γ inducible protein‐10/CXC ligand 10 (CXCL10) and monokine induced by interferon‐γ/CXCL9. We reported here that CXCR3 was highly up‐regulated on infiltrating eosinophils in Schistosoma japonicum egg‐induced granuloma in the mouse liver. It was also highly and functionally up‐regulated on peritoneal exudate eosinophils in mice infected with S. japonicum. The phenomena were demonstrated at protein and mRNA levels using immunohisto‐ and immunocytochemistry evaluation of biopsy, flow cytometry and real‐time quantitative reverse transcriptase–polymerase chain reaction technique, and verified by Northern blotting and chemotaxis assay in vitro. We also found that CCR3 expression on the infiltrating and peritoneal exudate cells was significantly decreased, CXCR4 expression was unchanged during the 42‐day period of infection. We screened mRNA expression levels of the all known chemokine receptors in purified peritoneal exudate eosinophils and liver granuloma dominated by eosinophils. CXCR3 was highly and functionally up‐regulated on peritoneal exudate eosinophils in mice infected with S. japonicum, meanwhile CCR3 was significantly and functionally down‐regulated in these cells. The findings could lead to a better understanding of the chemokine receptor expression pattern of eosinophils at inflamed tissue sites caused by parasites. These could be also crucial for establishing a therapeutic strategy for eosinophilic inflammation via intervention in chemokine actions.
Nuclear factor‐κB contributes to interleukin‐4‐ and interferon‐dependent polymeric immunoglobulin receptor expression in human intestinal epithelial cells
Authors: Ackermann Laynez W. , Denning Gerene M. 
Published: December 2003

SummaryPolymeric immunoglobulins (pIgs) that are present at mucosal surfaces play key roles in both the innate and adaptive immune responses. These pIgs are delivered to the mucosal surface via transcytosis across the epithelium, a process mediated by the polymeric immunoglobulin receptor (pIgR). Previous studies demonstrate that expression of the pIgR is regulated by multiple immunomodulatory factors including interleukin‐4 (IL‐4) and interferon‐γ (IFN‐γ). In studies using human intestinal epithelial cells (HT29), multiple inhibitors of the transcription factor nuclear factor‐κB (NF‐κB), including a dominant negative IκBα‐serine mutant, inhibited both IL‐4‐ and IFN‐dependent increases in pIgR expression. Under identical conditions, NF‐κB inhibitors had no effect on cytokine‐dependent increases in expression of the transcription factor interferon regulatory factor‐1. Over‐expression of the IκBα‐serine mutant also inhibited reporter gene expression in response to IL‐4, TNF‐α, IL‐1β, and in some cases IFN‐γ using constructs with sequences from the pIgR promoter. Reduced levels of pIgR were observed even when inhibitors were added ≥24 hr after cytokines suggesting that prolonged activation of NF‐κB is required. Finally, reporter gene studies with NF‐κB enhancer elements indicated that IFN‐γ alone and IL‐4 in combination with other cytokines activated NF‐κB in HT29 cells. Together, these studies provide additional insight into the signalling pathways that contribute to expression of the pIgR, a critical player in mucosal immunity.