bluuebunny/crossref_metadata_2025_split huggingface dataset:
A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis
Authors: Al-Smadi J , Warke K , Wilson I , Cramp A F L , Noble G , Walsh D M , Lowe-Strong A S 
Published: November 2003

Objective: To investigate the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) upon low back pain (LBP) in people with multiple sclerosis (MS). Design: A randomized double-blind placebo controlled clinical pilot study. Subjects and setting: Fifteen people with MS were recruited and randomly allocated to one of the following groups under double blind conditions ( n = 5 per group): TENS 1 (4 Hz, 200 µs), TENS 2 (110 Hz, 200 µs), placebo TENS. Interventions: Treatment was applied for 45 minutes three times a week for six weeks with a four-week follow-up. Outcome measures: The following outcome measures were taken at weeks 1, 6, and 10: visual analogue scale (VAS) (for current LBP, right leg pain, left leg pain); Leeds Multiple Sclerosis Quality of Life Questionnaire; Roland Morris Disability Questionnaire; Short Form-36 (SF-36) Version 1; and the McGill Pain Questionnaire (MPQ). VAS for current LBP, right and left leg pain were also taken before and after treatment, and once a week during the follow-up period. Results: Analysis showed no statistically significant effects for any of the data. However, both active treatment groups showed a trend of improvement in the majority of the outcome measures. Conclusion: Active TENS was more effective than placebo TENS in decreasing VAS scores following each treatment although results were not statistically significant. Further work in this area is warranted and should include a larger number of participants in the form of a randomized controlled clinical trial to determine the efficacy of this modality.
A study of five cervicocephalic relocation tests in three different subject groups
Authors: Kristjansson Eythor , Dall'Alba Paul , Jull Gwendolen 
Published: November 2003

Objective: To compare head relocation accuracy in traumatic (whiplash), insidious onset neck pain patients and asymptomatic subjects when targeting a natural head posture (NHP) and complex predetermined positions. Design: A case–control study. Setting: University-based musculoskeletal research clinic. Participants: Sixty-three volunteers divided into three groups of similar gender and age: Group 1 ( n = 21) an asymptomatic group; group 2 ( n = 20) insidious onset neck pain; group 3 ( n = 22) a history of whiplash injury. Intervention: Five randomly ordered tests designed to detect relocation accuracy of the head. Outcome measures: A 3-Space Fastrak system measured the mean absolute relocation error of three trials of each relocation test. Results: A significant difference was found between groups in one of the tests targeting the NHP ( p = 0.001). Post-hoc pairwise comparisons revealed a significant difference ( p £ 0.05) between the asymptomatic group and each symptomatic group. The difference between the symptomatic groups just failed to reach significance ( p = 0.07). None of the other four tests revealed significant differences. Conclusion: The test of targeting the NHP indicates that relocation inaccuracy exists in patients with neck pain with a trend to suggest that the deficit may be greater in whiplash patients. Tests employing unfamiliar postures or more complex movement were not successful in differentiating subject groups.
Effects of prosthesis alignment on pressure distribution at the stump/socket interface in transtibial amputees during unsupported stance and gait
Authors: Seelen H A M , Anemaat S , Janssen H M H , Deckers J H M 
Published: November 2003

Objective: To assess the effects of antero-posterior realignment of the prosthesis on pressure distribution at the stump/socket interface in unilateral transtibial amputees during unsupported stance and gait. Design: Cross-sectional group study. Setting: Outpatient rehabilitation clinic. Subjects: Seventeen unilateral transtibial amputees. Intervention: Antero-posterior prosthesis realignment using 0.5 cm heel or forefoot wedging. Measures: Pressure distribution changes at several sites at the stump/socket interface, expressed as peak pressure, peak pressure time, sustained submaximal load (MP80+) and time period of MP80+ (TP80+). Results: During stance, heel wedging led to a 30.4% decrease in mean pressure near the patella tendon and a 40.0% increase near the distal tibia site, whereas forefoot wedging led to a 30.0% decrease in pressure in the tibial end region. Antero-posterior ankle realignment did not lead to significant changes near the fibular head. During gait only heel wedging led to a 11.5% increase in peak pressure in the tibia end region. Mean peak pressure time increased 22.7% using heel wedging and decreased 8.8% using forefoot wedging. MP80+ increased 23.8% in the tibia end region during heel wedging and 17.0% in the subpatellar region during forefoot wedging. Conclusions: Antero-posterior realignment of the ankle joint led to an inverse loading and unloading of the subpatellar region versus tibial end region. However, results indicate that stump/socket interface pressure during stance seems not to be highly predictive as to pressure behaviour during gait. Ankle joint realignment led to significant differences in temporal sequences of tissue (un-)loading in the subpatellar area during gait.
A randomized controlled trial of an education and counselling intervention for families after stroke
Authors: Clark Michael S , Rubenach Sally , Winsor Adrian 
Published: November 2003

Objectives: To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses, and better functional and social outcomes for patients. Design: Two-group randomized controlled trial. Data were collected on admission to and discharge from rehabilitation, and again six months later. Setting: Rehabilitation units at Repatriation General Hospital and Griffith Hospital, in Adelaide, South Australia. Participants: Sixty-two stroke patients and their spouses, 32 in the intervention group and 30 in the control group. Intervention: Stroke information package and three visits from a social worker trained in family counselling. Outcome measures: Family functioning: McMaster Family Assessment Device (FAD); functional status: Barthel Index (BI); social recovery: Adelaide Activities Profile (AAP); depression: Geriatric Depression Scale (GDS); anxiety: Hospital Anxiety and Depression Scale (HADS); mastery: Mastery Scale (MS); health status: SF-36. Results: At six months the intervention group had better family functioning for both patients (mean FAD difference 0.19) and spouses (mean difference 0.09). A modest benefit in functional status for intervention patients (mean BI difference 1.3) was related to improved family functioning. Intervention patients reported better social recovery (mean AAP differences: domestic chores 5.7, household maintenance 4.6, social activities 11.5), but there were no significant effects on depression, anxiety, mastery or health status. Conclusions: An education and counselling intervention maintained family functioning, and in turn led to improved functional and social patient outcomes. This approach helps patients and their spouses to make the optimal adjustment to living with stroke.
Palliative day care: what does it cost to run a centre and does attendance affect use of other services?
Authors: Douglas H-R , Normand C E , Higginson I J , Goodwin D M , Myers K 
Published: November 2003

Aim: To describe the cost of palliative day care (PDC), assessing the value of all resources whether paid for or not. To examine different patterns of resource use resulting from attending PDC. Methods: Five PDC centres in southern England provided detailed cost and resource use data, both paid and unpaid for. The PDC group were consecutive new referrals to a PDC centre who were well enough to be interviewed. The comparison group were recruited from home care teams. Data were collected at baseline, six to eight weeks and 12–15 weeks, on health and social care utilization in the month prior to interview. Data were divided into cohorts based on time from first interview to death and analysed separately. Main outcomes: Annual cost of running a day care centre, and cost per patient per day. Use of all health and social care resources over time, stratified by time from death. Comparison of health and social care by stage of illness, and by PDC attendance. Results: PDC cost around £54 per person per day in 1999, rising to £75 including unpaid resources. 145 patients had data on health and social care use. The patterns of care showed that, overall, patients accessed few services other than PDC. Comparison group patients did not access similar services elsewhere. PDC might substitute home nursing and GP care for patients who attend PDC at least three months before death but this data is not conclusive. Inpatient care was negligible for both groups. Conclusions: A full economic evaluation could not be undertaken without robust evidence of the effectiveness of PDC. PDC centres made use of resources that were not paid for and shared resources with inpatient units, reducing costs. Service use was different for patients who attended compared with patients who did not. Similar services were not accessed elsewhere in the community; PDC does not appear to replicate other services for this group of patients.
Psychosocial morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Focused Grief Therapy controlled trial
Authors: Kissane David W , McKenzie Maria , McKenzie Dean P , Forbes Andrew , O'Neill Imogen , Bloch Sidney 
Published: November 2003

Family Focused Grief Therapy (FFGT) is a new model of brief intervention, which is commenced during palliative care for those families shown to be at high risk of poor adaptation, and continued preventively into bereavement with the aim of improving family functioning and reducing the morbid consequences of grief. In this paper, baseline data on 81 families (363 individuals) selected by screening from a palliative care population are explored to confirm our previously reported observation that high levels of psychosocial morbidity are positively associated with worsening family dysfunction. The Family Relationships Index (FRI) was used for screening and the Family Assessment Device (FAD) as an independent family outcome measure. The Beck Depression Inventory (BDI), Brief Symptom Inventory (BSI) and Social Adjustment Scale (SAS) were the psychosocial measures. Families were classified according to their functioning based on the FRI. To allow for correlated family data, statistical analyses employed the generalized estimating equation (GEE) method, controlling for gender and depression (BDI). Screening of 257 families (701 individuals) revealed 74 (29%) well-functioning families and 183 (71%) at some risk of morbid outcome. Of the latter, 81 (44%) gave informed consent to enter a randomized controlled trial of FFGT. Patients had a mean age of 57 years, 51% were male and they suffered from cancer, with a median length of illness from diagnosis to death of 25 months. In accordance with the FFGT model, their family types were identified as Intermediate 51%, Sullen 26% and Hostile 23%. These were significantly associated with steadily increasing levels of distress (BSI) and poor social adjustment (SAS). The FAD confirmed the concurrent accuracy of the FRI. As significantly greater levels of psychosocial morbidity were present in families whose functioning as a group was poorer, support was generated for a clinical approach that screens for families rather than individuals at high risk. The predictive validity of the FRI as a screening measure was confirmed. Overall, these baseline data point to the importance of a family-centred model of care.
Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional
Authors: Meyer H A Martine , Sinnott Claire , Seed Paul T 
Published: November 2003

Objective: To survey changes in depressive symptoms over time in patients with advanced cancer using the Mood Evaluation Questionnaire (MEQ), and explore how effective Palliative Care Professionals (PCPs) are at assessing this. Method: Forty-five advanced cancer patients were followed monthly for up to six interviews (108 interviews in total). Selected clinical variables were recorded. Results: At first interview, 26 (58%) patients were depressed using MEQ, seven (16%) severely. Attrition rates were high, with 28, 13, nine, seven and six patients available for subsequent interviews. A > 12-point increase in MEQ over sequential interviews was associated with reduced survival (Hazard ratio 3.2, CI 1.2–8.4). PCPs recognized depressed mood, but underdiagnosed severe depression in 9% of patients (CI 3–16%, P = 0.002). A past history of depression was a strong indicator of current depressed mood on the MEQ. Conclusion: Change in depressive symptoms over time is related to mortality in this patient cohort, patients with marked deterioration in mood dying earlier. PCPs usually recognize patients' depression but underestimate the severity of depressed mood.
Community care and disability: the limits to justice
Authors: Gleeson Brendan 
Published: November 2003

This article considers the distinctive injustices experienced by disabled people and assesses recent institutional strategies which have sought to reduce these inequities and exclusions. A principle of ‘enabling justice’ is proposed. This is to emphasize that the attainment of a just society which respects social difference is dependent upon the creation of human environments which satisfy the material and cultural needs of all who occupy them. The article reviews a critical area of state policy practice in capitalist societies – the establishment of community care networks for socially dependent persons. While the policy of community care cannot alone produce enabling environments, it may well lessen one dynamic of oppression which disabled people experience: their sociospatial exclusion in remote, often dehumanizing, institutional settings. However, an examination of the practice of community care in particular national contexts reveals several problems which may frustrate the realization of its policy aims, including opposition to care facilities from nearby residents and structural changes to social policy by neoliberal governments. The article considers these challenges to community care using recent research which has examined the relationship between deinstitutionalization, urban regulation and social policy.
Predictors of survival after acute paraquat poisoning
Authors: Lee Eun-Young , Hwang Kyu-Yoon , Yang Jong-Oh , Hong Sae-Yong 
Published: November 2003

Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning. Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1′-dimethyl-4,4′-bipyridium dichloride) ingested was 45.69 / 74.1 mL (mean9 / SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.
Determination of hemoglobin adducts formed in rats exposed orally with 3,3′-dichlorobenzidine by GC/MS-SIM
Authors: Lee Jin Heon , Shin Ho-Sang 
Published: November 2003

3,3?-dichlorobenzidine (DCB) can be metabolically N-acetylated and/or N-oxidized, and can form hemoglobin adducts. Gas chromatography/mass spectrometry-selected ion monitoring detection mode (GC/MS-SIM) could be a good analytical method to detect them. 4-Aminobiphenyl and phenanthrene-d10 were used as internal standards, and standard metabolites of DCB were synthesized from DCB. Pyridine is a promoter and acetic acid is a controller in the acetylation of DCB during titrating with acetyl chloride. After washing with acetone, the purity of N-acetyl DCB and N, N?-diacetyl DCB were 98.72% and 98.82%, respectively. The maximum detection limits (MDLs) by GC/MS-SIM were 0.5 mg/L in DNA adduct and 1.0 ng/g in hemoglobin for DCB and N-acetyl DCB. The base peaks of their fragmentation pattern were 252 m/z at the peak of DCB, 252 m/z and 294 m/z at the peak of N-acetyl DCB, and 252 m/z, 294 m/z, and 336 m/z at the peak of N, N?-diacetyl DCB. This analytical method was applied to determine hemoglobin adducts formed in young female Sprague -Dawley rats orally exposed with 20, 30, and 40 mg DCB/kg/day for three weeks. Two adducts were detectable by GC/MS-SIM after alkaline hydrolysis of hemoglobin samples and extraction. The structure of these adducts could be assigned to DCB and N-acetyl DCB by co-chromatography with the synthetic standards. After the first week of treatment, the total amount of hemoglobin adducts determined was 837.5∼2501 ng/g hemoglobin. The adduct levels were increased up to 1203.3∼2605.4 ng/g after the second week, and slightly decreased after the third week. The ratio of DCB and N-acetyl DCB was nearly similar in all treatment groups at the third week, such as 4.28∼4.78. Three different treatments (20, 30, and 40 mg DCB/kg) of rats resulted in dose-proportional increases in the total and DCB amount of hemoglobin adducted formed for three weeks. The relative contribution of DCB and N-acetyl DCB to the total hemoglobin adduct level was strongly dose dependent. The results show that GC/MS-SIM is suitable for the biological monitoring of humans exposed to DCB or DCB-containing products
Ecotoxicology and sustainable use of the planet
Authors: Cairns John 
Published: November 2003

The goal of sustainable use is indefinite use of the planet by humankind. This objective, in turn, requires that the planet’s ecological life support system, consisting of natural capital and ecosystem services, remains healthy for an indefinite period. Achieving sustainability will require a new view of the responsibilities of professionals, such as ecotoxicologists, to ensure a healthy ecological life support system. Because both human society and natural systems are complex and multivariate, a high degree of uncertainty will remain. Therefore, sound judgment will be needed in determining what, if any, precautionary measures should be taken until more robust information has been gathered. The role of ecotoxicologists in the quest for sustainable use of the planet is quite varied: 1) shifting goals and endpoints from an absence of harm to persuasive evidence of health; 2) increasing both temporal and spatial scales of ecotoxicological studies; 3) achieving a critical mass of qualified personnel; 4) including demographic change in ecotoxicological analysis and judgment; 5) developing new ecological thresholds; 6) being prepared for environmental surprises; 7) focusing on design for a quality environment; 8) developing ecosystem services as endpoints in ecotoxicological studies, and 9) being prepared for climate change and other events that might destabilize the biosphere and require major adjustments in the process of ecotoxicological testing. Both sustainable use of the planet and the field of ecotoxicology are rapidly developing fields that are mostly evolving in isolation from each other. To be successful, they must co-evolve.
Pycnogenol® in cigarette filters scavenges free radicals and reduces mutagenicity and toxicity of tobacco smoke in vivo
Authors: Zhang Deliang , Tao Yi , Gao Juntao , Zhang Chunai , Wan Sujun , Chen Yuxia , Huang Xiazhen , Sun Xiayou , Duan Shaojin , Schönlau Frank , Rohdewald Peter , Zhao Baolu 
Published: November 2003

Despite large-scale anti-smoking campaigns throughout the world, the number of smokers remains high and cigarette smoking continues to represent a life-threatening health risk. Until a smoke-free society is achieved, reduction of cigarette smoke toxins may reduce the health burden. Current cigarette filter techniques are limited to the reduction of volatile tar constituents by dilution and by condensation on the filter surface. Vast quantities of harmful constituents, such as polycyclic aromatic hydrocarbons, heterocyclic (aromatic) amines, free radicals and reactive oxygen species, are inefficiently retained in the filter. We investigated whether neutralisation of free radicals in cigarette filters is feasible and accompanied by a reduction in smoke toxicity. Addition of the bioflavonoid pine bark extract Pycnogenolfi to cigarette filters depleted free radicals in a dose dependent manner. This was paralleled by a reduction of toxicity and mutagenicity in rodent test models. In this model system, the acute toxicity of cigarette smoke was markedly reduced by up to 70% in rodents with 0.4 mg Pycnogenolfi in filters. Chronic exposure to cigarette smoke for 75 days revealed that Pycnogenolfifilters significantly reduced mutagenicity by up to 48% and decreased pathological changes in lung tissue.
Validation of a Chinese version of the Medical Outcomes Study Family and Marital Functioning Measures in patients with SLE
Authors: Thumboo J , Feng P-H , Soh C-H , Boey M-L , Thio S-t , Fong K-Y 
Published: November 2003

The objective was to validate a Chinese translation of the Medical Outcomes Study Family and Marital Functioning Measures (FFM and MFM) in patients with systemic lupus erythematosus (SLE). Chinese-speaking SLE patients (n ‘ 69) completed a self-administered questionnaire containing the FFM and MFM and assessing demographic and socio-economic status twice within a 2 week period. SLE activity, disease-related damage and quality of life were assessed using the BILAG, SLICC/ACR Damage Index and SF-36 Health Survey, respectively. Scale psychometric properties were assessed through factor analysis, Cronbach's alpha, quantifying test ± retest differences and known-groups construct validity. Factor analysis identified 1 factor corresponding to the FFM and 2 factors corresponding to the MFM. Internal consistency for the FFM was excellent (a ‘ 0.92) while that for the MFM was acceptable (a ‘ 0.62). Mean (s.d.) test ± retest differences were 0.06 (1.54) points for the FFM and 0.03 (2.08) points for the MFM. 11 and 10 of 13 a priori hypotheses relating the FFM and MFM, respectively, to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales. The Chinese FFM and MFM are valid and reliable measures of family and marital functioning in Chinese-speaking SLE patients, with psychometric properties very similar to the source English version.