bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting secure attachment, maternal mood and child health in a vulnerable population: A randomized controlled trial
Authors: Armstrong K L , Morris J 
Published: March 2003

Objective: To evaluate the efficacy of an early home‐based intervention on the quality of maternal–infant attachment, maternal mood and child health parameters in a cohort of vulnerable families. Methodology: A total of 181 families were recruited to the study in the immediate postnatal period on the basis of a self report questionnaire relating to known family vulnerability factors. Families were assigned randomly to intervention (90), or control (91) groups. The intervention group received a series of home visits from a child health nurse (weekly to 6 weeks, fortnightly to 3 months), with a subgroup receiving home based short‐term dynamic therapy from a social worker. Parent/family function was assessed at inception and at 4 months by the Parenting Stress Index and the Edinburgh Post Natal Depression Scale. At 4 months the quality of the home environment was assessed, utilizing the Home Observation for Measurement of the Environment Inventory, as were child and family health parameters and satisfaction with the community child health service. Results: At 4 month follow‐up, 160 families (80 intervention, 80 control) were available for assessment. The intervention improved family functioning at 4 months. All aspects of the home environment, including the quality of maternal–infant attachment and mothers’ relationship with their child, were significantly enhanced. In particular, significant and positive differences were found in parenting with the intervention group feeling less restrictions imposed by the parenting role, greater sense of competence in parenting, greater acceptability of the child, and the child being more likely to provide positive reinforcement to the parent. Early differences in maternal mood were not maintained at 4 months. Various child health parameters were enhanced including immunization status, fewer parent‐reported injuries and bruising, and researcher confirmed lack of smoking in the house or around the infant. The families were consistently more satisfied with their community health service. Conclusions: This form of early home based intervention targeted to vulnerable families promotes an environment conducive for infant mental and general health and hence long‐term psychological and physical well‐being, and is highly valued by the families who receive it.
Paediatric walk‐out patients: Characteristics and outcomes
Authors: Browne GJ , McCaskill ME , Giles H , Lam LT , Fasher BJ , Exley B 
Published: March 2003

Objective: To investigate the characteristics and outcomes of patients who walked out from a tertiary children's hospital emergency department (ED) without seeing a medical officer. Methods: A prospective study of patients who walked‐out from the ED of a children's hospital, without seeing a medical officer. Information collected at triage included demographics, presenting problems, time of arrival, time of departure and reason for leaving. Charts were reviewed and those at high risk of serious illness or adverse outcome were contacted by telephone within 24 h. Further information collected during follow up included outcome, such as adverse events and admission to hospital. Data were analysed by comparing the walk‐out and non‐walk‐out groups with regard to demographic variables, presenting problems and outcomes. Results: Over a 29 week period, 1037 (5.5%) patients walked out from the ED of the hospital without seeing a medical officer. Comparisons between the walk‐out and non‐walk‐out patients indicated no differences in terms of demographics. However, significant differences were found between the triage categories, presenting problems and arrival time. Of these, 829 (79.9%) were followed up by telephone. This revealed the predominant presenting problem was non‐urgent and infectious in nature and no adverse events occurred. The admission rate for walk‐out patients (1.5%) was significantly lower in comparison with the non‐walk‐out group (6.9%; odds ratio 0.2; 95% confidence interval 0.1–0.3). Walk‐out patients who were eventually hospitalized had a shorter mean length of stay than non‐walk‐out patients (20.4 vs 34.8 h, respectively; t = 17.78, P < 0.0001). Conclusions: Medical resources are limited and, therefore, some extended waiting in the ED is necessary. Paediatric patients who walk‐out of the ED without seeing a medical officer have simple illnesses that resolve without medical intervention or adverse events.
Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department
Authors: Chin R , Browne GJ , Lam LT , McCaskill ME , Fasher B , Hort J 
Published: March 2003

Objective:  The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED).Methodology:  This before‐and‐after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6‐month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short‐stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re‐presentation, length of stay, and adverse clinical events. Children in the post‐intervention group were followed up by telephone within 48 h of discharge.Results:  There were 157 patients recruited in the pre‐intervention group and 110 in the post‐intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow‐up interviews of parents indicated that the new treatment strategy was well received.Conclusion:  The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events.
Sudden infant death syndrome risk factors in north Queensland: A survey of infant‐care practices in Indigenous and non‐Indigenous women
Authors: Panaretto KS , Smallwood VE , Cole P , Elston J , Whitehall JS 
Published: March 2003

Objective: To assess the prevalence of sudden infant death syndrome (SIDS) risk factors in the Indigenous and non‐Indigenous community of Townsville, a large remote urban centre in north Queensland, Australia. Methods: Thirty Indigenous and 30 non‐Indigenous women with young children were surveyed using sections of the West Australian Infancy and Pregnancy Survey 1997–1998. The prevalence of SIDS risk factors was compared between the two groups and medians and univariate associations were generated where appropriate. Results: The Indigenous women were significantly younger and more likely to be single. The median age of the infants was 8 months (range 0.3–26 months) with no difference between the two groups. Thirty‐seven per cent of Indigenous infants slept prone (cf. 17% of non‐Indigenous infants; P = 0.03), and 77% shared a bed (cf. 13% of non‐Indigenous infants; P < 0.001). The Indigenous households had significantly more members, with 57% including extended family members (cf. 20% non‐Indigenous group; P = 0.003). Fifty‐three per cent of the Indigenous women smoked during pregnancy (cf. 23% of non‐Indigenous women; P = 0.017), 60% were smokers at the time of the interview, and smoking occurred inside 40% of Indigenous houses (cf. 20% and 20% for non‐Indigenous women, respectively; P < 0.001, 0.09). Conclusion: This small survey suggests that the prevalence of SIDS risk factors is higher in the Indigenous population, and a new approach to education is needed urgently to promote SIDS awareness among Indigenous women.
Staphylococcus aureus bacteraemia in children: A 5‐year retrospective review
Authors: Suryati BA , Watson M 
Published: March 2003

Objective:
The clinical presentation of Staphyloccocus
aureus bacteraemia has been well described in adults, but there
is a paucity of published data on the presentation of S. aureus bacteraemia
in children. This review sought to compare the presentation of S.
aureus in children with that of adults. Methods:
We conducted a 5‐year retrospective
chart review of S. aureus bacteraemia at the Royal Alexandra Hospital for Children between 1994 and 1998. Results:
Of the 140 episodes of S. aureus bacteraemia,
53% were community acquired and 47% nosocomially
acquired. The clinical presentation of S. aureus bacteraemia in the children in the present study differed significantly from published studies of adult patients. Of children with community‐acquired bacteraemia without pre‐existing medical conditions, 59% had a bone or joint infection, which is higher than adult series. Endocarditis has been associated with up to 30% of community‐acquired bacteraemia in adults but was much less frequent (1.4%) in the present study. Despite the infrequent use of empiric antibiotic therapy (34% of episodes), the case fatality rate (1.4%) was significantly lower than the published literature relating to adults (11−32%). Conclusion:
The present study highlights the
differences between S. aureus bacteraemia in adults and children.
Symptomatic fracture incidence in those under 50 years of age in southern Tasmania
Authors: Jones G , Cooley HM 
Published: March 2003

Objective:  To document symptomatic fracture incidence in those aged under 50 years of age.Methods:  Fractures were ascertained from X‐ray reports containing the word ‘fracture’ from all radiology providers for the geographically defined population of southern Tasmania (n = 165 175) for the period 1 July 1997 to 30 June 1999.Results:  In the 2‐year study frame there were 2943 fractures in 164 730 person years in males and 1348 fractures in 165 620 person years in females. This represents a fracture incidence of 1787 per 100 000 person years in males and 819 per 100 000 person years in females. Peak fracture incidence was 10−14 years in females and 15−19 years in males although different fracture types had varying peak incidence suggesting different fracture‐specific causes. The most common fractures were those of the hand (24%), forearm (17%), wrist (10%) and foot (9%). All fractures (including vertebral) were more common in males with relative risks ranging from 1.34 to 4.50. The estimated probability of at least one fracture between birth and 50 years of age was 59% for males and 34% for females.Conclusion:  There are threefold as many fractures in this age group compared to those due to osteoporosis in the elderly in any given year. More research priority needs to be given to understanding the causes of these fractures so that preventive strategies can be formulated.
Congenital hypothyroidism in Western Australia 1981–1998
Authors: Kurinczuk JJ , Bower C , Lewis B , Byrne G 
Published: March 2003

Objective: Newborn screening for congenital hypothyroidism began in Western Australia in 1981. We describe the epidemiology, including trends over time. Methodology: Population‐based registers and databases were used to identify cases of congenital hypothyroidism in 1981–1998 (n = 126), a random sample of controls (n = 1260), and descriptive data on cases and controls. The prevalence of congenital hypothyroidism per 10 000 live births was calculated, and a case‐control analysis conducted. Results: The prevalence of congenital hypothyroidism was 1.74 per 10 000 in the period 1981–1987, compared with 3.54 per 10 000 between 1988 and 1998. Infants identified with congenital hypothyroidism were significantly more likely to have other birth defects (particularly heart defects), be female, have a birthweight heavier than 4500 g, and be born either preterm or after 41 weeks gestation. No cases had cerebral palsy or intellectual disability. Conclusions: Population‐based registers and linked databases can provide very useful information for evaluating screening programmes, and extending our knowledge of the epidemiology of congenital hypothyroidism.
Role of bottom sediments in the secondary pollution of aquatic environments by heavy‐metal compounds
Authors: Linnik Peter M. , Zubenko Irina B. 
Published: March 2003

AbstractThe results of long‐term investigations into the concentrations of some heavy metals (Fe, Mn, Cu, Zn, Pb, Cr, and Cd) in the bottom sediments of the Dnieper reservoirs and the Dnieper–Bug estuary are considered. Maximum quantities of the metals studied are characteristic of southern water bodies located within industrial zones (the Zaporozh’e and Kakhovka reservoirs as well as the Dnieper–Bug estuary). The highest concentrations of the metals studied occurred in the clay silts (Fe, 11 600–32 400; Mn, 1504–3450; Cu, 38.9–85.5; Zn, 89.8–186.5; Cr, 48.6–193.0; and Cd, 1.9–4.4 mg kg‐1 dry weight). Accumulation of heavy metals in the bottom sediments is an important factor in the self‐purification of aquatic environments. However, this process is reversible and therefore provides a constant threat of secondary water pollution. Secondary water pollution is observed in summer and autumn when water consumption increases. The concentrations of heavy metals increase by a factor of 1.5–3 after the drawdown of the water level. The main reason for the rise in the concentrations of metals is exchange between the bottom sediments and the water column. The rate of heavy metal migration is connected with the forms of occurrence in solid substrates and pore solutions in the bottom sediments, as well as with physico‐chemical conditions arising at the sediment/water boundary. Therefore, our investigations concentrated on the study of the fractional distribution of heavy metals among solid substrates and their forms of occurrence in interstitial solutions. This distribution depends, most of all, on the chemical properties of metals as well as the chemical and mineralogical composition of the sediments and the chemical properties of pore solutions. Most of the supply of Mn, Zn, Fe, and Cd is associated with oxides and hydroxides of iron and manganese (Mn, 74–93%; Zn, 43–70%; Fe, 27–59%; and Cd, 28–41%). Most copper and chromium is bound to organic matter and to scarcely soluble minerals. In the interstitial solutions studied, metals (except manganese) are found mainly as complex compounds with dissolved organic matter of a different molecular weight. Nevertheless, the fraction of complexes with a relatively low molecular weight (500–5000 Da) prevailed (40–70%). Dissolved manganese in the pore solutions consists chiefly of free (hydrated) ions Mn2+ (80–95%). The results obtained were used for a comparative evaluation of heavy metal mobility and the exchange ability of their associated compounds in the bottom sediment–water system.
Effects of river impoundment on body condition and reproductive performance of the Australian native fish, Macquarie perch (Macquaria australasica)
Authors: Gray Scott C. , De Silva Sena S. , Ingram Brett A. , Gooley Geoff J. 
Published: March 2003

AbstractThis study attempts to evaluate the influence of the impounding of Lake Dartmouth (36°35′S, 147°31′E; on Mitta Mitta River in Victoria) on the Macquarie perch (Macquaria australasica, Cuvier 1830), an Australian percichthyid fish of riverine origin. In this study the yearly changes in body condition and spawning performance of adult populations in the impoundment were evaluated in relation to lake features, in particular the water level. Body condition of the spawning population of Macquarie perch in Lake Dartmouth, in year n was related to mean annual storage volume of the lake, with a time lag of one year during the post‐filling phase of the lake (1991–1997). The influence of condition on the reproductive performance of captive female Macquarie perch from Lake Dartmouth using artificial propagation techniques was evaluated over the period 1991–1997. The mean relative fecundity (mrf), expressed as the number of eggs produced per kilogram of body weight of hypophysed fish, showed a decrease over the period, but the mean weight of hypophysed fish did not decrease over the same time period. The mrf (Ymrf) was positively correlated to yearly mean relative condition factor (XRc), the relationship being:The spawning variables, mean percentage fertilization (Yfn) (1991–1997) and mean larval production (Yln) (1992–1996) in each year (n) were also related to the mean relative condition factor (XRc) of female fish that spawned after hypophysation in each year. It is suggested that the declining success in the artificial propagation of this species is caused by a declining maternal condition of female fish collected from the impoundment, resulting from poor nutrition.
Heavy metal concentrations in fish of Lake Balaton
Authors: Farkas A. , Salánki J. , Varanka I. 
Published: March 2003

AbstractThe concentration of heavy metals (cadmium, copper, lead, mercury and zinc) found in muscle, gills and liver of eel, bream and pike‐perch living in Lake Balaton (Hungary) varied significantly between fish species and organs. The toxic metals in the muscle of fish, except for cadmium in bream, were below the maximum permissible level for human consumption. Cadmium concentrations above the maximum permissible level occurred in autumn in a few small individuals of bream, which, because they have poor culinary value and are seldom consumed, does not represent a risk for humans. Cadmium, copper, lead and zinc levels proved to be higher in eel and bream compared to pike‐perch, while high mercury concentrations were found in the predator fish, pike‐perch. Mercury accumulated most in the muscle in each species, while other metals were found in higher levels in the gills and liver. Seasonal differences were found for cadmium in each species and for lead in eel; the concentrations being elevated in autumn compared to spring. The fish species studied as bio‐monitors demonstrated that the overall heavy metal pollution of Lake Balaton is not significant, although, during summer an increase of cadmium and lead loading could occur at the catchment area and in the lake. Studies on the size (age) dependency of heavy metal concentrations showed that, in most cases, none or a negative relationship exists for each organ and metal in all species studied, and a positive regression coefficient was characteristic only on some occasions for mercury, cadmium and lead.
Trophic evolution of Lake Lugano related to external load reduction: Changes in phosphorus and nitrogen as well as oxygen balance and biological parameters
Authors: Barbieri Alberto , Simona Marco 
Published: March 2003

AbstractLake Lugano is located at the border between Italy and Switzerland and is divided into three basins by two narrowings. The geomorphologic characteristics of these basins are very different. The catchment area is characterized by calcareous rock, gneiss and porphyry; the population amounts to approximately 290 000 equivalent inhabitants. The external nutrient load derives from anthropogenic (85%), industrial (10%) and agricultural (5%) sources. The limnological studies carried out by Baldi et al. (1949) and EAWAG (1964) revealed early signs of eutrophication, with a phosphorous concentration of about 30–40 mg m–3 and an oxygen concentration of less than 4 g m–3 in the deepest hypolimnion. Subsequently Vollenweider et al. (1964) confirmed these data and was the first to point out the presence of a meromictic layer in the hypolimnion of the northern basin. From the 1960s, as a result of an increase in the population and internal migration, the lake became strongly eutrophic with the P concentration reaching 140 mg m–3 and the oxygen in the hypolimnion reduced to zero. Fifty‐five per cent of the P was from metabolic sources and 45% from detergents and cleaning products. In 1976, a partial diversion of waste water from the northern to the southern basin was begun, and gradually eight waste water treatment plants came into operation using mechanical, chemical and biological treatments. In 1986, Italy and Switzerland began to eliminate the P in detergents and cleaning products. Since 1995, the main sewage treatment plants have improved their efficiency by introducing P post‐precipitation, denitrification and filtration treatments. The recovery of the lake is due to be completed by the year 2005. Altogether, during the last 20 years recovery measures have reduced the external P load from about 250 to 70–80 tonnes year–1; the goal to be reached is 40 tonnes year–1. In‐lake phosphorous concentrations have decreased from 140 to 50–60 mg m–3, with the target at 30 mg m–3. Dissolved oxygen concentration is satisfactory only between the depths of 0 and 50 m, falling rapidly to zero in the deepest layers. Below a depth of 90 m, high CH4, HS–, NH4+, Fe2+ and Mn2+ concentrations exist. Primary production has decreased from 420 to 310 g Cass m–2 year–1, notwithstanding an increase in the thickness of the trophogenic layer. Structure and dynamic biomass show marked changes: phytoplankton dry weight has decreased from 16 to 7 g m–2, while zooplankton dry weight has increased from 3 to 4.5 g m–2. Chlorophyll concentration has fallen from 14 to 9 mg m–3 and Secchi disk transparency has increased from 3.5 to 5.5 m. The current sources of the external load are uncollected small urban conglomerations, storm‐water overflows from outfall sewers, and the residual load from sewage treatment plants, particularly those without P post‐precipitation.
Qualitative research from a feminist perspective in the postmodern era: methodological, ethical and reflexive concerns
Authors: Seibold Carmel 
Published: March 2003

Qualitative research from a feminist perspective in the postmodern era: methodological, ethical and reflexive concerns Developing methodology is an ongoing process in certain types of qualitative research. This paper describes the process in a study of single midlife women, detailing reflexive concerns on the ethics of data collection and dissemination of research findings from a feminist postmodern perspective, as well as the way in which modification of techniques of analysis occurred as the study progressed. Beginning research questions were concerned with identifying the impact of menopausal symptoms, and the debate surrounding HRT on the lives and decision‐making processes of single midlife women. Initial analysis of data, using grounded theory techniques, indicated a need to place greater emphasis on the way the women constructed or talked about the self, including the embodied self. This led to an exploration of the literature relating to reflexivity, identity construction and embodiment, including feminist poststructuralist interpretations of the discursive and embodied construction of self, and informed both the theoretical framework and the method. The way in which a type of analysis fitting under the broad rubric of discourse analysis, that is one that gave added emphasis to gendered subjectivity, directed further analysis is discussed, as well as the influence on the women of social and scientific discourses in circulation.