bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Classification of Soiling and Encopresis and a Possible Treatment Protocol
Authors: Murphy Shona , Carney Terri 
Published: July 2004

Background:  It is proposed that the classification of paediatric bowel elimination disorders is central to their effective treatment.Method:  By separating the terms soiling and encopresis and clearly defining the aetiologies behind both, a treatment pathway begins to emerge.Results:  The theoretical model described suggests that encopresis may require only psychological management, whereas soiling (caused by constipation) is more complex, and although it needs medical management, it may or may not require psychological input.Conclusions:  By using such a functional classification to define a treatment protocol, the roles of both medical and psychological services could be more clearly understood from the outset.
School‐Based Open Access Parenting Programmes: Factors Relating to Uptake
Authors: Rooke Oliver , Thompson Margaret , Day Crispin 
Published: July 2004

Background:  Many parents of children with conduct problems do not seek professional help.Method:  A new questionnaire examining the beliefs about the problem behaviour, together with the Strengths and Difficulties Questionnaire, was administered to all parents of five reception year classes. They were then invited to attend school based group parent training.Results:  Attendance was associated with the beliefs that there was potential for change and the child's behaviour adversely affecting the parent, but not with the child's behaviour adversely affecting the child.Conclusions:  These findings may be of use when devising promotion for parent training.
Induction of oral immune regulation towards liver‐extracted proteins for treatment of chronic HBV and HCV hepatitis: results of a phase I clinical trial
Authors: Israeli Eran , Safadi Rifaat , Melhem Alaa , Pappo Orit , Shibolet Oren , Klein Athalia , Hemed Nilla , Thalenfeld Barbara , Engelhardt Dean , Rabbani Elazar , Ilan Yaron 
Published: July 2004

Abstract:  Background: Anti‐viral immunity can be modulated via oral feeding of viral proteins. Hepatitis B and C viral (HBV, HCV)‐associated hepatocellular injury is mediated by a defective host anti‐viral immune response.Aims: To determine the effect of oral administration of a mixture of liver‐extracted proteins with HBV/HCV proteins, on viral load, liver injury, and the anti‐viral T‐cell response of chronic HBV/HCV patients.Methods: Fourteen patients with chronic HBV and 15 patients with chronic HCV were treated orally with hepatocyte‐extracted proteins and HBV or HCV viral proteins for 24 weeks, and followed for an additional 26 weeks. Patients were monitored for HBV‐DNA or HCV‐RNA levels, liver enzymes and liver histology. Viral‐directed T‐cell immunity was assessed by IFNγ and IL10 ELISPOT, viral‐specific T‐cell proliferation, cytotoxicity, and cytokines assays, and followed for peripheral natural killer T‐cell (NKT) number.Results: In both chronic HBV and HCV patients, oral administration of a mixture of selected liver‐extracted proteins and viral proteins induced a favorable increase in viral‐specific T‐cell proliferation, and IFNγ‐secreting clones, along with a significant decrease in the anti‐viral IL10‐secreting T‐cell clones. However, the effects of modulation of the anti‐viral immunity differed between the HBV and HCV patients. In both groups, no major adverse events were noted. In chronic HBV patients, a significant decrease in viral load was observed in 5/14 (35.7%) of patients. HB surface antigen/HB nucleocapsid antigen scores on liver biopsy improved in 46.1% and 50%, respectively, and the histological necroinflammatory score improved in 4/13 (30.7%). Forty percent of the patients with elevated liver enzymes showed a favorable biochemical response. In contrast, an improvement in the histological necroinflammatory score was observed in only 2/12 (17%) of the chronic HCV patients. No significant decrease in HCV RNA was noted in any of these patients.Conclusions: Immune regulation of the anti‐HBV/HCV immune response via oral administration of a mixture of liver‐extracted and viral proteins significantly altered the viral‐specific immunity. This effect was associated with clinical and virological improvements in chronic HBV patients.
Efficacy and Tolerability of Oral Zolmitriptan in Menstrually Associated Migraine: A Randomized, Prospective, Parallel‐Group, Double‐blind, Placebo‐Controlled Study
Authors: Loder Elizabeth , Silberstein Stephen D. , Abu‐Shakra Susan , Mueller Loretta , Smith Timothy 
Published: July 2004

Background.—Approximately 60% of female migraineurs report experiencing migraine in association with menstruation, while 7% to 25% experience attacks almost exclusively with menstruation.Objective.—To examine the efficacy and tolerability of oral zolmitriptan in the acute treatment of menstrually associated migraine. In this study, menstrually associated migraine was defined as migraine that consistently occurred from 72 hours before to 5 days after onset of menses.Methods.—Participants were women with regular menstrual cycles, aged 18 to 55 years, who had experienced migraine with at least two thirds of prior menstrual cycles. Subjects were randomized to treat one attack per menstrual cycle for 3 months with either zolmitriptan or placebo. Treatment was intensity based: mild migraines were treated with half of a 2.5‐mg zolmitriptan tablet, moderate migraines were treated with zolmitriptan 2.5 mg, and severe migraines were treated with 5 mg (two 2.5‐mg tablets) of zolmitriptan, or placebo.Results.—Of the 579 women enrolled in the study, 260 were treated with zolmitriptan and 251 were assigned placebo. Twelve hundred thirty‐two attacks were treated, and a 2‐hour headache response was achieved in 48% of zolmitriptan‐treated attacks as compared with 27% of placebo‐assigned attacks (P < .0001). Zolmitriptan was superior to placebo in achieving a headache response as early as 30 minutes (18% versus 14%, P= .03) and at 1 hour (33% versus 23%, P < .001). Drug‐related adverse events were reported in 16% of subjects receiving zolmitriptan and 9% of subjects receiving placebo.Conclusion.—Oral zolmitriptan exhibits efficacy and good tolerability in the treatment of menstrually associated migraine. Improvement over placebo was observed as early as 30 minutes following treatment.
Consecutive Transcranial Magnetic Stimulation: Phosphene Thresholds in Migraineurs and Controls
Authors: Young William B. , Oshinsky Michael L. , Shechter Aaron L. , Gebeline‐Myers Cheryl , Bradley Kathleen C. , Wassermann Eric M. 
Published: July 2004

Objective.—To characterize the temporal course of transcranial magnetic stimulation‐induced phosphene thresholds in subjects with migraine and in controls.Methods.—Eleven subjects with migraine with aura, 10 subjects with migraine without aura, 9 subjects with menstrual migraine, and 15 controls (no history of migraine and without migraine during the study) were studied. Subjects were not on preventive medication. Transcranial magnetic stimulation was performed, and a phosphene threshold was measured 3 times a week over 3 weeks in a manner timed to incorporate the menstrual period in females. A headache calendar was kept during the study.Results.—Mean transcranial magnetic stimulation thresholds were lower for each migraine group compared with controls (P < .001) for each comparison. There was a trend for lower thresholds among subjects with migraine with aura compared with subjects with migraine without aura (P < .10), but not subjects with menstrual migraine. There was consistent lowering of thresholds from the first to the last stimulation in all migraine groups and in the controls. Maximum and minimum thresholds did not predict headache occurrence, nor did the occurrence of headache predict an ensuing maximum or minimum phosphene threshold.Conclusions.—Transcranial magnetic stimulation thresholds are lower in subjects with migraine compared with controls. The reported phosphene threshold is lowered with repeated measurement. Neither high nor low phosphene thresholds predict a subsequent headache, nor do migraines predict a subsequent high or low threshold.
Efficacy of Diclofenac Sodium Softgel 100 mg With or Without Caffeine 100 mg in Migraine Without Aura: A Randomized, Double‐blind, Crossover Study
Authors: Peroutka Stephen J. , Lyon James A. , Swarbrick James , Lipton Richard B. , Kolodner Ken , Goldstein Jerome 
Published: July 2004

Objective.—A phase II, randomized, double‐blind, crossover study was designed to evaluate the efficacy of 100‐mg diclofenac sodium softgel (formulated using ProSorb technology) with or without 100‐mg caffeine versus placebo in migraineurs during migraine attacks.Background.—Diclofenac has been demonstrated to be an effective migraine treatment in several placebo‐controlled studies. A rapidly absorbed softgel of diclofenac has been shown to be effective in the rapid relief of acute pain, and may have advantages in migraine treatment. In addition, caffeine has consistently been shown to increase both the efficacy and speed of onset of concurrently administered analgesics. The ability of caffeine to both enhance and accelerate analgesic effects has been documented with a variety of different medications (ie, aspirin, acetaminophen, ibuprofen, and ergotamine).Methods.—The 3‐period crossover study was designed to compare diclofenac softgel 100 mg, diclofenac softgel 100 mg plus caffeine 100 mg, and placebo in the acute treatment of migraine. Subjects treated one moderate or severe attack with each study medication. The primary efficacy parameter was the percentage of subjects with headache relief at 60 minutes as defined by a reduction of headache severity from moderate or severe at baseline to absent or mild compared with placebo. Though the sample size estimate required that 72 subjects treat 3 separate attacks, 51 subjects treated 1 migraine attack, 44 treated 2 attacks, and 39 treated 3 attacks.Results.—In the placebo group, 6 (14%) of 43 subjects reported headache relief at 60 minutes versus 12 (27%) of 45 subjects in the diclofenac softgel group, and 19 (41%) of 46 subjects in the diclofenac softgel plus caffeine group. Differences were statistically significant for the diclofenac softgel plus caffeine group versus placebo (odds ratio, 4.2; 95% confidence interval, 1.3 to 13.7). Rescue medication was used by 27 (63%) of 43 subjects treated with placebo, 15 (33%) of 45 subjects treated with diclofenac softgel, and 14 (30%) of 46 subjects treated with diclofenac softgel plus caffeine. This result is highly statistically significant (χ22= 11.56, P= .003). Both the diclofenac plus caffeine (P < .03) and diclofenac only (P < .03) groups were significantly different from the placebo group in terms of the visual analog scale score at 60 minutes.Conclusions.—The major finding of the present study is that diclofenac softgel plus caffeine produces statistically significant benefits relative to placebo at 60 minutes. Diclofenac softgel alone did not differ significantly from placebo, perhaps due to limits in sample size. Nonsignificant trends support the analgesic adjuvant benefit of caffeine when added to diclofenac softgels.
Onset of Effect of 5‐HT1B/1D Agonists: A Model With Pharmacokinetic Validation
Authors: Fox Anthony W. 
Published: July 2004

Objective.—To quantitate onset of effect of all formulations of sumatriptan, and to investigate whether this is related to rate, not extent, of drug absorption.Methods.—From published literature, for 4 formulations of sumatriptan and matching placebos, response rates were modeled using a simple logarithmic equation, with a being a parameter of curve convexity and B, a location parameter (equal to response rate at 2 hours [the standard regulatory parameter]). The average rate of drug absorption (A) was estimated by dividing the maximal drug concentration by the time needed to achieve it (Cmax/Tmax). Least mean square correlation was then performed between the therapeutic gains and therapeutic ratios of curve convexity and rate of drug absorption.Results.—Models closely fitted observed response rates (2 hours or less). Curve convexity correlated with rate of drug absorption. Sumatriptan response rates (0 to 2 hours) for formulations correlated with rate, not extent, of drug absorption. The range of rates of onset of effect among different routes of administration was greater than that for tablets with 4‐fold differences in dose size.Conclusion.—Onset of effect is related to rate of absorption of sumatriptan. There is greater scope for improving onset of effect using an alternative route of administration than by increasing the oral dose.
Headache Induced by Chronic Substance Use: Analysis of Medication Overused and Minimum Dose Required to Induce Headache
Authors: Relja Giuliano , Granato Antonio , Maria Antonello Rodolfo , Zorzon Marino 
Published: July 2004

Background.—The International Headache Society has defined the diagnostic criteria for headache induced by substance use. Recently, a revision to these criteria has been proposed.Objective.—To consider whether the International Headache Society criteria for headache induced by substance use and the proposed revisions for the classification of daily and near‐daily headache with medication abuse permit classification of patients commonly seen in a headache center.Methods.—One hundred fourteen consecutive patients (96 women [84.2%] and 18 men [15.8%]; mean age, 54.2 years [SD, 14]) with headache and chronic overuse of medications, admitted for detoxification to the inpatient unit of a headache center, participated in the study. The initial headache, medications and doses used, duration of daily medication use, and means of medication administration were studied.Results.—Eighty‐one patients (71%) had an initial headache of migraine without aura, 13 patients (11.4%) had migraine without aura and coexistent tension‐type headache, 11 (9.7%) patients had migraine with and without aura, and 9 patients (7.9%) had episodic tension‐type headache. Medications overused by patients included analgesics combined with barbiturates or other nonnarcotic substances in 39.5%, simple analgesics in 38.6%, triptans in 11.4%, and ergotamine in 10.5%. Using the International Headache Society diagnostic criteria, we were able to classify only 28.1% of our patients; the proposed revised criteria for daily and near‐daily headaches with medication abuse permitted the classification of 46.4% of patients.Conclusion.—The minimum dose of medication required to induce chronic headache should be revised because a high proportion of patients are not classifiable using either the International Headache Society diagnostic criteria or the revised criteria recently proposed. A more comprehensive definition for the required minimum dose might be used. Triptan abuse can cause chronic headache and should be included in the International Headache Society classification.
Relationship Between Chronic Tension‐type Headache, Cranial Hemodynamics, and Cerebrospinal Pressure: Study Involving Provocation With Sumatriptan
Authors: Hannerz Jan , Jogestrand Tomas 
Published: July 2004

Objective.—To study the relationship between chronic tension‐type headache, cranial hemodynamics, and cerebrospinal pressure.Background.—Cerebrospinal pressure has been found to be above 200 mm in about 50% of patients with chronic tension‐type headache.Methods.—Heart rate, blood pressure, common carotid artery diameter and blood flow, and craniovascular resistance and pain at regular intervals before, during, and after head‐down tilt—a procedure which increases cerebrospinal pressure, were recorded. After head‐down tilt, subcutaneous injections of either placebo or 6 mg of sumatriptan were administered. Chronic tension‐type headache intensity before and after withdrawal of 20 mL of cerebrospinal fluid was documented. Cerebrospinal pressure and chronic tension‐type headache intensity were measured after subcutaneous injection of 6 mg of sumatriptan.Results.—Head‐down tilt provoked an increase of headache compared with baseline. Common carotid artery blood flow decreased and craniovascular resistance increased after sumatriptan injection, but not after placebo injection. The pain decreased after head‐down tilt and placebo injection, but not after sumatriptan injection. Chronic tension‐type headache intensity decreased in all 4 patients studied after withdrawal of 20 mL of cerebrospinal fluid. Cerebrospinal pressure increased in 5 patients with chronic tension‐type headache after subcutaneous injection of 6 mg of sumatriptan with slight or no increase of pain.Conclusion.—The results indicated that cerebrospinal pressure or intracranial venous pressure (or both) are related to chronic tension‐type headache.
Rofecoxib in the Prevention of Perimenstrual Migraine: An Open‐Label Pilot Trial
Authors: Von Seggern Randal L. , Mannix Lisa K. , Adelman James U. 
Published: July 2004

Objective.—To investigate the effectiveness of rofecoxib in the prevention of perimenstrual migraine.Background.—Nonsteroidal anti‐inflammatory drugs have demonstrated benefit in reducing the frequency and intensity of menstrual migraine when administered perimenstrually. Anti‐inflammatory drugs, however, may not be well tolerated and can produce gastrointestinal irritation. Rofecoxib, a selective cyclooxygenase‐2 inhibitor, has anti‐inflammatory and analgesic properties, and a significantly improved gastrointestinal tolerability profile.Methods.—A pilot study was conducted in which patients with a history of menstrually associated migraine and experiencing at least one migraine monthly during the perimenstrual period were enrolled. Patients who completed a baseline diary for the first month were randomized to receive either rofecoxib 25 mg or 50 mg daily for 10 days, starting 5 days before menstrual flow. Headaches experienced during this 10‐day period were recorded in the patient's diary. Patients continued rofecoxib for 2 consecutive menstrual cycles. Mean migraine frequency, intensity, and duration as well as patient's level of functioning during the 2 cycles were compared with baseline.Results.—Fourteen patients completed baseline and rofecoxib dosing for 2 menstrual cycles. Mean migraine frequency decreased from 5.6 to 2.6 migraines per menstrual cycle (P= .005). Eight (57%) of 14 patients had a ≥50% reduction in headache frequency. No significant improvement in headache intensity, duration, and functional impairment were observed. Both doses of rofecoxib were well tolerated with no statistical difference in patient response between the doses.Conclusion.—Rofecoxib at a perimenstrual daily dose of 25 or 50 mg demonstrated a significant reduction in frequency of perimenstrual migraine. A double‐blind, placebo‐controlled trial of rofecoxib in the prevention of perimenstrual migraine is warranted.
Cranial Magnetic Resonance Imaging Findings in Patients With Migraine
Authors: Gozke Eren , Ore Ozgul , Dortcan Nimet , Unal Zeynep , Cetinkaya Mehmet 
Published: July 2004

Objective.—To investigate the frequency of cranial magnetic resonance imaging abnormalities in patients with migraine and their relationship to type, duration, and frequency of migraine attacks.Methods.—Forty‐five patients (43 women, 2 men) with migraine whose ages ranged between 19 and 53 years (mean, 40.91 [SD, 7.69]) were evaluated. Of the 45 patients, 20 had migraine with aura and 25 had migraine without aura, according to the diagnostic criteria of the International Headache Society.Results.—In 13 (28.8%) of 45 patients, white matter foci were present on magnetic resonance imaging. Eight of these patients (61.5%) had migraine with aura, and 5 patients (38.4%) had migraine without aura. The presence of white matter foci was significantly higher in the patients with aura (8 [40%] of 20) than in those without aura (5 [20%] of 25). It was found that as the frequency of attacks per month increased, the number of patients with white matter foci also increased. Although the mean duration of migraine was longer in patients with white matter foci (149.5 months [SD, 87.9]) than in those without white matter foci (134.1 months [SD, 88.3]), there was no significant difference (P > .05).Conclusion.—Although there are no specific magnetic resonance imaging findings peculiar to migraine, detection of white matter foci should be taken into consideration in patients with migraine (especially migraine with aura). Frequency of attacks is an important indicator of existence of white matter foci.
Efficacy of Topiramate in Migraine Aura Prophylaxis: Preliminary Results of 12 Patients
Authors: Lampl Christian , Bonelli Silvia , Ransmayr Gerhard 
Published: July 2004

Objective.—To evaluate the efficacy of topiramate in the treatment of migraine aura. Antiepileptic drugs may be useful in migraine prevention through such mechanisms as acting directly on the nociceptive system or by modulating the biochemical phenomena of aura. Topiramate acts directly on N‐methyl‐d‐aspartate and amino‐3‐hydroxy‐5‐methylisoxazole‐4‐propionic acid/kainate glutamate receptors and modulates calcium ion channel activity by inhibiting high‐voltage–activated L‐type calcium ion channels.Methods.—Twelve patients with migraine with aura were enrolled in an open‐label study and treated with topiramate for 6 months. The dose of topiramate was increased weekly by 25 mg up to a daily dose of 100 mg after 4 weeks.Results.—In all 12 patients after 6 months of treatment, topiramate did not statistically influence aura frequency (P= .317) or duration (P= .480) compared with baseline. Mild to moderate side effects were observed, but they did not interfere with treatment. Consistent with previous observations, migraine frequency as well as headache intensity and duration improved statistically significantly.Conclusion.—Topiramate is not effective in preventing migraine aura.
Frequent Triptan Use: Observations on Safety Issues
Authors: Robbins L. 
Published: July 2004

Objective.—To examine the safety of frequent triptan use over extended periods. For a small group of patients with refractory migraine plus chronic daily headache, triptans are effective.Methods.—This retrospective study primarily evaluated the cardiac safety of daily triptan use in 118 patients and, in addition, hematologic tests were assessed. Each patient had utilized a triptan for a minimum of 4 days per week for at least 6 months. Patients with rebound headache had been withdrawn from the triptans. Most patients (97 of 118) averaged 1 tablet daily; most would occasionally go for several days without a triptan. Forty patients had taken a triptan for 6 months to 2 years, 37 patients from 2 to 4 years, and 41 for 4 or more years.Results.—Routine hematologic tests were performed periodically on all patients, and no abnormalities were attributable to triptans. Almost all patients had an electrocardiogram, and no abnormal electrocardiograms were felt to be related to triptans. Cardiac echocardiography was performed in 57 patients. The 10 abnormal echocardiograms were not due to triptans. All 20 cardiac stress tests revealed normal findings. Adverse events were minimal; 9 patients described fatigue due to triptans, and 5 had mild chest tightness.Conclusion.—This long‐term study of 118 patients indicates that frequent triptan use may be relatively safe.