bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information sessions for outpatients referred to a hospital Nutrition and Dietetic Service for cholesterol lowering advice
Authors: Reid V. , Barnes E. , Daly L. 
Published: March 2003

AbstractAim  To assess the feasibility of recruiting outpatients referred for cholesterol lowering advice to attend a 1‐h evening information session provided by a hospital dietitian and to evaluate the service.Method  A Cholesterol Information Session was held on one evening each month between April and September 2000. Patients referred to the Nutrition and Dietetic Service for cholesterol lowering advice were sent appointments for these sessions by post instead of a one‐to‐one daytime appointment with the dietitian. At the session, the dietitian explained what cholesterol is and gave advice about the healthy eating and lifestyle changes needed to control it. Video material and literature were used to support verbal information. Questions were encouraged throughout the session.Results  Thirty‐four patients were sent appointments. Twenty‐seven (79%) attended, 10 of whom were accompanied by a spouse/partner/carer/family member. All patients who attended completed evaluation forms. There was a high level of satisfaction with the sessions. Twenty‐six patients (96%) said they liked the way the session was runand found the advice and videos helpful. Twenty‐five patients (93%) preferred the evening appointment to a day time one. Patients who attended with a spouse/partner/carer/family member indicated it was helpful to them and the accompanying person. Feedback through patient comments was positive. The seven patients (21%) who did not attend the sessions made contact with the dietetic service.Conclusion  As a result of the positive outcome of the evaluation, the Cholesterol Information Session is continuing as a service to patients. It provides a facility outside the usual hours of outpatient services and can readily accommodate accompanying people. The information session uses the group format, which may be applicable to other specialist areas of the Nutrition and Dietetic service in the future, such as diabetes management.
Developing a model for quality evaluation in residential care for people with intellectual disability
Authors: Maes B. , Geeraert L. , Bruel B. Van den 
Published: March 2003

AbstractThe present article describes the development of a general model for the evaluation, enhancement and assurance of quality of care processes in residential facilities for children and adults with intellectual disability. The framework is based on current theories regarding quality of life and quality evaluation, on a consensus between several participants in Delphi discussion‐rounds, and on a questionnaire for care providers and clients in all Flemish residential facilities. The model describes 13 quality standards and a list of indicators concerning organization and support interventions. Facilities may use this set of criteria and indicators in several ways within a continuous and dynamic system of internal quality assurance. Finally, the prospects of and conditions for the implementation of this model are discussed.
Challenging behaviour in community services
Authors: Joyce T. , Ditchfield H. , Harris P. 
Published: March 2003

AbstractThe implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty‐eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self‐injury as well as a range of behaviours of the ‘hard to engage’ type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty‐five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out‐of‐borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.
Transfer and interference of motor skills in people with intellectual disability
Authors: Mohan A. , Singh A. P. , Mandal M. K. 
Published: March 2003

AbstractAtypical laterality (i.e. the lack of a clear pattern of lateralization) has been found to be a characteristic feature of individuals with intellectual disability (ID). The evidence for this has been based on ‘handedness’ studies which have contained little information about the ability of people with ID to carry out interhemispheric tasks reflecting bilateral transfer or interference. The present study examined this capacity in individuals with ID by utilizing bilateral transfer and interference paradigms. Right‐handed subjects with ID (IQ = 55–76) and controls matched for age and sex were tested for bilateral transfer of motor skill in contralateral hands with a mirror‐drawing task. The subjects were also tested for their ability to perform a finger‐tapping task while processing verbal and non‐verbal stimuli. The findings indicated that people with ID are significantly deficient relative to matched controls in bilateral transfer of motor skills from their non‐preferred (left) hand to their preferred (right) one. The effect of interference during performance of the dual task was significantly greater in individuals with ID. Subjects with ID were found to perform better with their non‐preferred than with their preferred hand. A within‐group comparison revealed that right‐handed performance was more affected by interference than left in these subjects.
Prader–Willi syndrome: new insights in the behavioural and psychiatric spectrum
Authors: Descheemaeker M. J , Vogels A , Govers V , Borghgraef M , Willekens D , Swillen A , Verhoeven W , Fryns J. P 
Published: March 2003

AbstractPrader–Willi syndrome (PWS) is a genetic disorder caused by the loss of the paternal contribution of the proximal part (15q11–q13) of the long arm of chromosome 15 (i.e. deletion, disomy and imprinting mutation). The syndrome is associated with distinct physical dysmorphism, as well as with specific behavioural and psychopathological characteristics. Psychiatric symptoms in adolescence and adulthood have been described, including acute cycloid psychosis, and obsessive compulsive, bipolar and pervasive developmental disorders. At the Centre for Human Genetics in Leuven, Belgium, 53 individuals (31 children and adolescents, and 22 adults) have been followed up for 15 years by a special multidisciplinary team. Attention was given to their medical, cognitive, behavioural and emotional development, and the evolution of psychiatric disorders in adolescence and adulthood. This study describes the psychiatric problems in four patients diagnosed with acute cycloid psychosis and traces their development from infancy to adolescence. Four other individuals needed psychiatric evaluation and treatment, and could be diagnosed as having unspecified bipolar disorder, also termed unstable mood disorder. Both groups were compared, and significant differences in early development and later evolution into adulthood were noted. The individuals with PWS who later developed psychotic episodes were described as active and extrovert toddlers, and showed autistic behaviour during their primary school education. Their intellectual functioning was in the moderate to severely retarded range. The individuals with PWS who later developed an unstable mood disorder were described as rather passive and introvert toddlers, and they presented less disturbed behaviour during their primary school education. The intellectual functioning of these subjects was in the normal to borderline range.
Getting personal: an exploratory study of intimate and personal care provision for people with profound and multiple intellectual disabilities
Authors: Carnaby S. , Cambridge P. 
Published: March 2003

AbstractBackground Intimate and personal care is a major area of support and provision for people with intellectual disability (ID), particularly those with profound and multiple ID. However, its management and practice has largely been neglected outside the use of individual guidelines and same‐gender intimate care policies, with little research evidence or theoretical literature to inform the planning, conduct and organization of associated care tasks.Results The present paper reports on the methodology and findings of an exploratory study designed to map the key management and practice issues, and suggest ways forward for the providers of services for people with ID in relation to the quality and outcomes of intimate and personal care.
Involvement with peers: comparisons between young children with and without Down’s syndrome
Authors: Guralnick M. J. 
Published: March 2003

AbstractBackgroundIt has been well established that heterogeneous groups of young children with mild intellectual disability are at considerable risk of becoming socially isolated from their peers in school, home and community settings.MethodMatched groups of young children with and without Down’s syndrome (DS) were compared in terms of the children’s involvement with peers, maternal arranging and monitoring of peer play, and maternal beliefs about inclusion.ResultsDespite aetiology‐specific expectations for children with DS, no differences were found for a variety of measures of peer involvement focusing on the frequency of contacts and the characteristics of children’s peer social networks. Maternal arranging of activities with peers was similarly related to peer involvement for both groups of children. Higher ratings of the benefits of inclusion were obtained from mothers of children with DS, but these maternal beliefs were unrelated to maternal arranging or peer involvement.ConclusionsParental adaptations to the aetiology‐specific behavioural patterns of children and the general influence of children’s experiences within a developmental framework are discussed in the context of interpreting aetiology‐specific findings.
Self‐concept and adaptive behaviour of people with intellectual disability in integrated and segregated recreation activities
Authors: Duvdevany I. 
Published: March 2003

AbstractBackgroundLeisure and recreation are areas in which the inclusion of people with intellectual disability (ID) in the community is required. In Israel, leisure activities have been developed over the past decade as part of the services provided to individuals with ID in the regular programmes of the community. However, even within those frameworks, people with ID are typically segregated from the whole population.MethodsThe purpose of the present study was to examine whether individuals with ID who participate in recreation activities with normal people as equals are different in their self‐concept and adaptive behaviour from their counterparts who participate in segregated recreation programmes. Two hypotheses were examined: (1) whether people with ID who participate in integrated recreation programmes have a higher self‐concept than those who participate in segregate programmes; and (2) whether individuals with ID who have better adaptive behaviour have a higher self‐concept than people with ID who have lower adaptive behaviour.ResultsThe hypotheses were partially confirmed. Differences were found in two subscales of self‐concept. First, the physical self‐concept of individuals with ID who participated in integrated programmes was found to be higher than that of their counterparts who participated in segregated programmes. Secondly, satisfaction with the whole self‐concept of people with ID who participated in integrated programmes was found to be higher than of those who participated in segregated programmes.ConclusionsThe implications of the research findings are discussed and future planning is recommended.
Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case–control study from northern Sweden
Authors: Weinehall  , Johnson  , Jansson  , Boman  , Huhtasaari  , Hallmans  , Dahlen  , Wall  
Published: March 2003

ObjectivesTo assess the importance of biomedical risk factors, social factors and self‐reported health in the prediction of the first event of acute myocardial infarction (AMI) in an apparently healthy middle‐aged population.DesignAn incident case–control study.SettingThe study was nested within the Västerbotten Intervention Program and the Northern Sweden MONICA cohorts.SubjectsThe study consists of 78 AMI cases with two randomly selected controls per case from the same study cohorts.ResultsSignificant odds ratios were found for history of diabetes, daily smoking, cholesterol, body–mass index, hypertension, lower education and perceived ill health. In multivariate logistic regression smoking, hypertension and cholesterol of ≥7.8 mmol L−1 remained significant. An interaction was observed between number of biomedical risk factors and perceived health.ConclusionsSmoking, hypertension and hypercholesterolaemia explain a major share of incident AMI events in a Swedish middle‐aged population. The study further illustrates that perceived ill health negatively modifies the impact of these risk factors.
Intravenous nitroglycerin reduces ischaemia in unstable angina pectoris: a double‐blind placebo‐controlled study
Authors: Karlberg  , Saldeen  , Wallin  , Henriksson  , Nyquist  
Published: March 2003

Karlberg K‐E, Saldeen T, Wallin R, Henriksson P, Nyquist O, Sylvén C (Huddinge Hospital, Huddinge; University of Uppsala, Uppsala; and Södertälje; Sweden). Intravenous nitroglycerin reduces ischaemia in unstable angina pectoris: a double‐blind placebo‐controlled study. J Intern Med 1998; 243: 25–31ObjectivesTo study whether intravenous nitroglycerin (NTG) reduces the incidence of ischaemic events and leucocyte activation, as well as inhibiting platelet aggregation in patients with unstable angina pectoris.DesignRandomized double‐blind placebo‐controlled study.SubjectsOne hundred and sixty‐two patients with a history and electrocardiographic changes suggesting unstable angina pectoris.InterventionsA 48‐hour titrated intravenous infusion of NTG or placebo.ResultsOf the 162 randomized patients, 19 were excluded because of an acute myocardial infarction on randomization (11 patients) or proven presence of a non‐ischaemic cause of the pain (6 patients). Other causes (2 patients). No differences in the clinical findings were detected between the groups on randomization. In the comparison of NTG and placebo, fewer patients in the former group had more than two new attacks of chest pain lasting for <20 min or one new attack of chest pain lasting >20 min, despite sublingual NTG (13/25, P < 0.03). In addition, the attacks of pain lasting >20 min in the NTG group were delayed compared to those in the placebo group (P < 0.05), suggesting a beneficial effect on these more servere episodes. Fewer patients in the NTG group required more than two sublingual NTG tablets (P < 0.005). NTG also reduced the rate‐pressure product (P < 0.05), compared to placebo after 2 h but not after 24 h. Compared to baseline, platelet aggregation was inhibited in the patients who had received an NTG infusion for 2 h (P < 0.05). In both groups, leucocytes were activated at baseline, but remained unchanged thereafter.ConclusionsIntravenous NTG seems to reduce myocardial ischaemia in patients with unstable angina pectoris more than the placebo.
Pharmacological treatment of diabetic patients with cardiovascular complications
Authors: Sawicki  , Berger  
Published: March 2003

Sawicki PT, Berger M (Heinrich‐Heine University of Düsseldorf, Germany). Pharmacological treatment of diabetic patients with cardiovascular complications (Review). J Intern Med 1998; 243: 181–89.Cardiovascular complications are frequently present in insulin‐dependent (IDDM) and non‐insulin dependent diabetes mellitus (NIDDM) patients and confer a very poor prognosis. In this overview we critically analyse the current literature with regard to the benefits and also the possible harms of the available pharmacological treatment strategies in these patients. To date, insulin is the only hypoglycaemic agent which has been proven both effective and safe in NIDDM patients with cardiovascular complications. Also, several trials indicate that treatment with oral hypoglycaemic agents may confer a substantial risk in such patients. Conventional antihypertensive treatment, including betablockers and diuretics, has been convincingly shown to reduce mortality and morbidity in diabetic nephropathy and in NIDDM patients. However, this may not be the case with newer antihypertensive agents, such as angiotensin‐converting enzyme (ACE) inhibitors and calcium channel blockers. Likewise, convincing evidence is lacking that these newer antihypertensive agents provide meaningful clinical benefit when compared to the conventional treatment regarding slower progression of diabetic nephropathy or their impact on lipid and glucose metabolism. Cholesterol lowering therapy with statins and aspirin treatment have also been repeatedly shown to improve the prognosis of diabetic patients with coronary heart disease.
Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow‐up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study (HDDRISC‐1)
Authors: Godsland  , Leyva  , Walton  , Worthington  , Stevenson  
Published: March 2003

AbstractGodsland IF, Levya F, Walton C, Worthington M, Stevenson JC (Imperial College School of Medicine, London, UK). Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow‐up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study. J Intern Med 1998; 244: 33–41.ObjectivesTo investigate the associations between risk factors for cardiovascular disease and cigarette smoking, alcohol intake, and physical activity in a group of predominantly healthy men.DesignCohort study with baseline characterisation, clinical follow‐up, and identification of predictors of coronary artery disease and diabetes.SettingUniversity hospital metabolic day ward.SubjectsParticipants in a company health programme (n= 742).Main outcome measuresRoutine haematology and biochemistry, cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol (on a subset of 522 subjects), and glucose and insulin levels during a 3 h oral glucose tolerance test (OGTT).ResultsIndependent associations with previous cigarette smoking included high uric acid and low HDL cholesterol, and with current cigarette smoking, high haemoglobin and white cell count and low OGTT insulin. Increasing alcohol intake was associated with increasing blood pressure, uric acid, HDL cholesterol and fasting glucose. The moderate range of exercise intensity in this cohort was associated with decreasing systolic blood pressure, fasting insulin and OGTT glucose and insulin. Factor analysis distinguished principal factors comprising features of the metabolic syndrome with low physical activity, and high white cell count, high haemoglobin concentration and low HDL cholesterol with increasing previous and current cigarette smoking and alcohol intake.ConclusionsSome characteristics of the metabolic syndrome were seen with previous but not current smoking habit. Regular alcohol consumption was associated with mainly unfavourable metabolic characteristics, although there was an independent beneficial association with HDL cholesterol. The improved metabolic syndrome profile seen with increasing exercise is consistent with even moderate degrees of physical activity having beneficial effects on metabolism.
Recurrent hypoglycaemia in multiple myeloma: a case of Munchausen syndrome by proxy in an elderly patient
Authors: Ben‐Chetrit  , Melmed  
Published: March 2003

Ben‐Chetrit E, Melmed RN (Hadassah University Hospital, Jerusalem, Israel). Recurrent hypoglycaemia in multiple myeloma: a case of Munchausen syndrome by proxy in an elderly patient (Case Report). J Intern Med 1998; 244: 175–8.A 73‐year‐old woman with multiple myeloma experienced four episodes of loss of consciousness, convulsions and profuse sweating whilst she was in the hospital. A thorough investigation in the department of medicine disclosed that with each attack, she had a serum glucose <1.6 mm L−1, insulin level >1400 pMol L−1 (N – <150) and a normal level of serum C‐peptide. Since she had no anti‐insulin antibodies (which may rarely exist in multiple myeloma), a diagnosis of exogenous injection of insulin was made. A search for a possible perpetrator discovered that the patient had a daughter who was a surgical nurse and who was genuinely concerned whenever she was told that her mother was about to be discharged from the hospital. If she was the perpetrator in the present case, then it is possible that the motive for such an action was to postpone the mother's discharge from hospital. This case is an example of a ‘factitious disease by proxy’ in an elderly patient. The aim of the present report is to alert the medical personnel to the possibility that Munchausen's syndrome by proxy may also occur in the elderly.