bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare Professionals' Awareness of Cancer Support Services
Authors: Matthews B. Alex , Baker Frank , Spillers Rachel L. 
Published: March 2003

purpose: This study was conducted to provide baseline information about the awareness, attitude, and willingness of oncology healthcare providers (HCPs) to recommend quality‐of‐life cancer education and support services to their patients.description of study: A brief survey questionnaire was mailed to a random sample of 2000 physicians, nurses, and social workers who were active members of their respective oncology associations.results: A total of 1241 questionnaires were returned (62% reply rate), resulting in a final sample of 1180 HCPs (61% response rate). Among HCPs who referred patients to cancer organizations, the American Cancer Society (ACS; 83%), the National Cancer Institute (NCI; 55%), and the Leukemia and Lymphoma Society ([formerly Leukemia Society of America] 42%) ranked at the top. More than 70% of HCPs indicated that they had heard about specific ACS programs and services or the NCI information hotline. Less than 60% of HCPs recommended or thought these same services were helpful to patients. Awareness, referrals, and attitudes toward cancer support services among HCPs were significantly related (P < .001). Qualitative comments qualified quantitative results.clinical implications: Although a surprising number of HCPs were aware of support services, fewer recommended or reported satisfaction with these services. HCPs' referrals and attitudes toward cancer psychosocial support services may be improved by assembling a concise directory of locally available resources, directing this information to HCPs who refer directly to cancer organizations, improving collaboration between agencies, increasing staff support, and targeting particular services in specific areas of the country for program monitoring and development.
Exploring Loss to Follow‐up
Authors: Hunt Linda M. , De Voogd Katherine B. , Soucy Mark D. , Longworth Judith C. 
Published: March 2003

purpose: The loss of patients to follow‐up for abnormal findings from Pap screenings is an important public health concern, particularly among poor and minority women. This study explores factors affecting incomplete follow‐up among a group of Hispanic women with low incomes.description of study: A qualitative descriptive study was conducted of 11 Hispanic patients with incomplete Pap smear follow‐up at a public clinic in a major city in south Texas. Patients were interviewed using a semistructured, open‐ended schedule of questions, and their medical records were abstracted. The clinic's five staff members also were interviewed. Comparative chronologies were constructed for each case, contrasting patient and staff accounts of the same set of events. All data were coded by at least two investigators.results: All study patients had mildly abnormal Pap smear results and had not met the follow‐up criteria, but all understood and were committed to Pap screening. Although viewed by staff as noncompliant, none of the patients viewed her behavior this way. This staff‐patient discrepancy was attributable to poor communication, mixed messages, clinic errors, and, perhaps most importantly, to a conflict between program policies and the specific circumstances of individual cases. Two case examples are presented to illustrate key points.clinical implications: Strategies that may help to reduce loss to follow‐up among similar patients include the following: allowing clinic staff more flexibility in follow‐up procedures for women who have consistently normal follow‐up tests, including Spanish translations of written messages; enlisting patients' agreement in setting appointments; and updating patient records to reflect follow‐up care that had been received in other clinics.
Embryonic development of mouse external genitalia: insights into a unique mode of organogenesis
Authors: Suzuki Kentaro , Ogino Yukiko , Murakami Ryutaro , Satoh Yoshihiko , Bachiller Daniel , Yamada Gen 
Published: March 2003

SUMMARY The mammalian external genitalia are specialized appendages for efficient copulation, internal fertilization and display marked morphological variation among species. In this paper, we described the embryonic development of mouse genital tubercle (GT), an anlage of the external genitalia utilizing the scanning electron microscope (SEM) analysis. It has been shown that the Distal Urethral Epithelium (DUE) may fulfill an essential role in the outgrowth control of the GT. Our present SEM analysis revealed a small distal protrusion at the tip of the GT of normal embryos as well as some morphological differences between male and female embryonic external genitalia. Previous analysis shows that the teratogenic dose of Retinoic Acid (RA) induces a drastic marformation of the urethral plate, but not gross abnormalities for GT outgrowth. Interestingly, a small distal protrusion at the tip of GT was clearly observed also after RA treatement. Furthermore, we showed that treatment with anti‐androgen flutamide resulted in the demasculinization of the GT in males. The unique character of GT development and the sexual dimorphism are discussed. Keyword: external genitalia; genital tubercle; urethral plate; outgrowth; morphogenesis; Fgf; retinoic acid; androgen
Starting from fins: parallelism in the evolution of limbs and genitalia: the fin‐to‐genitalia transition
Authors: Rosa‐Molinar Eduardo , Burke Anne Campbell 
Published: March 2003

SUMMARY Organizers of the symposium Starting from Fins: Parallelism in the Evolution of Limbs and Genitalia intended it 1) to begin debates and discussions about parallelism, serial homology and transitions in development, as well as evolution of gene function and theories of origins and 2) to examine closely the potential significance of serial homology in understanding the evolution of morphology. This issue of Evolution and Development focuses on unpaired fin to genitalia transitions; the July‐August issue will focus on paired fins to limbs, revisit the issues raised in the symposium, and point to future directions.Minelli's opening presentation introduced the central theme of the symposium by suggesting that body appendages such as arthropod and vertebrate limbs, chordate tails and external genitalia are evolutionarily divergent duplicates (paramorphs) of the main body axis. Suzuki's and Podlasek's presentations focused on the development of mammalian genitalia. Suzuki presented Suzuki et al investigations of the role of fibroblast growth factor (Fgf) and Sonic hedgehog (Shh) as signaling molecules during murine external genitalia formation, and Podlasek presented Podlasek et al investigations to elucidate a rudimentary pathway of essential developmental genes and transcriptional regulators such as Hox genes, Sonic hedgehog (Shh), and Bone morphogenetic proteins 2 and 4 (BMP‐2; BMP‐4), found in the limb.Discussions and questions emerging from the symposium point to the need to recognize that claims of phylogenetic cause must be based on something more than similarities; research must focus on the extent to which comparisons can be taken as well as on the evolutionary significance of similarities.
Looking for a Path to Sustainability in Eastern Siberia
Authors: Glazyrina Irina P. 
Published: March 2003

ABSTRACTThe purpose of this work is to describe a version of sustainable development strategy for the so‐called “resource dependent territories” (RDT) of Eastern Siberia, which is based on a paradigm of “the infinite value of the integrity of an ecosystem.”The main feature of RDTs is that the use of nature (natural resources) is practically the only source of economic growth for these regions. This is the result of a long history of previous economic development. RDTs have enormous possibilities both for the destructive and environmentally acceptable use of nature. However, incomes from the destructive use are far greater than those derived from renewable use. The differences often reach two‐to‐three orders of magnitude. We cannot expect market mechanisms in the economies of the RDTs to guarantee a sustainable use of the environment.It is declared a priori that the value of ecosystem integrity is much larger than any benefit from the use of its resources. This paradigm can be supported by a comprehensive system of institutional and legal tools. The main directions of this strategy should be defined as follows:
Teaching Headache Management to Medicine Residents
Authors: Kumar Kusum L. , Joos Sandra K. 
Published: March 2003

Background.—To evaluate the effect of teaching headache management to PG‐1 medicine residents.Design.—Observational study using prerotation and postrotation ratings by residents of improvement in their knowledge of etiology, diagnosis, appropriate use of narcotics, and treatment of headache.Setting.—Veterans Affairs Outpatient Clinic.Participants.—Twenty‐two medicine residents.Measurements and Results.—There was small but significant improvement in the total knowledge score (P=.03) and in areas of etiology of headache (P =.02) and appropriate use of narcotics (P =.001).Conclusion.—We found there were substantial increases in residents’ subjective levels of understanding, history‐talking and in the diagnosis and treatment of headache (P<.0001) in contrast to the objective knowledge test.
Headache Intensity and Quality of Life in Adolescents. How are Changes in Headache Intensity in Adolescents Related to Changes in Experienced Quality of Life?
Authors: Langeveld Johannes H. , Koot Hans M. , Passchier Jan 
Published: March 2003

Objective.‐To investigate the relationship between changes in actual presence of headache and the experience of different subdomains of quality of life (QoL) in adolescents.Design.‐Diary entered measurements of headache intensity and frequency were related to simultaneously recorded data on a QoL questionnaire for adolescents.Setting.‐Subjects completed both the QoL questionnaires and the headache diaries at home.Subjects.‐Subjects were selected by screening the total population of two secondary schools (N=1566) for headache and migraine symptoms. Sixty‐four students subject to chronic headache or migraine participated in the study. All subjects were diagnosed by a neurologist, following the IHS criteria for migraine.Conclusion.‐Changes in headache intensity and frequency were related to changes in self‐reported QoL within all QoL subdomains. More headache coincided with a lower self‐reported QoL.
Droperidol Treatment of Status Migrainosus and Refractory Migraine
Authors: Wang Shuu‐Jiun , Silberstein Stephen D. , Young William B. 
Published: March 2003

We conducted a pilot study of intravenous droperidol in 35 patients (32 women and 3 men; mean age 43 years) with status migrainosus (n=25) or refractory migraine (n=10) in an ambulatory infusion center. Headache was graded as severe in 21 patients and moderate in 14. An intravenous line was started and kept open. Droperidol (2.5 mg) was given intravenously every 30 minutes until either three doses were given or the patient was completely or almost headache‐free prior to the next dose.Seven patients received one dose, 12 received two doses, and 16, three doses (mean 5.6 mg). Our success rate (headache‐free or mild headache) was 88% (22 of 25) in patients with status migrainosus and 100% (10 of 10) in patients with refractory migraine. The average time to headache improvement was 40 minutes (n=35), to mild headache ‐ 60 minutes (n=32), and to headache‐free ‐ 105 minutes (n=28). Nausea, vomiting, and light and sound sensitivity resolved in all but 5 patients. Four patients had an asymptomatic systolic blood pressure drop ≤ 20 mm Hg. Most patients were sedated (34 of 35). Five patients developed akathisia and I dystonia. At follow‐up 24 hours after discharge, the recurrence rate (headache intensity from none or mild to moderate or severe) was 23% in status migrainosus and 10% in refractory migraine. Twenty‐one patients were sedated, while 19 had extrapyramidal symptoms, mainly restlessness.Droperidol is effective and safe in treating status migrainosus or refractory migraine. Hypotension was uncommon. Patients should be warned of sedation and akathisia.
Treatment of Migraine With Pulsing Electromagnetic Fields: A Double‐Blind, Placebo‐Controlled Study
Authors: Sherman Richard A. , Acosta Nancy M. , Robson Linda 
Published: March 2003

The effect of exposure to pulsing electromagnetic fields on migraine activity was evaluated by having 42 subjects (34 women and 8 men), who met the International Headache Society's criteria for migraine, participate in a double‐blind, placebo‐controlled study. Each subject kept a 1‐month, pretreatment, baseline log of headache activity prior to being randomized to having either actual or placebo pulsing electromagnetic fields applied to their inner thighs for 1 hour per day, 5 days per week, for 2 weeks.After exposure, all subjects kept the log for at least 1 follow‐up month. During the first month of follow‐up, 73% of those receiving actual exposure reported decreased headaches (45% good decrease, 14% excellent decrease) compared to half of those receiving the placebo (15% worse, 20% good, 0% excellent). Ten of the 22 subjects who had actual exposure received 2 additional weeks of actual exposure after their initial 1‐month follow‐up. All showed decreased headache activity (50% good, 38% excellent). Thirteen subjects from the actual exposure group elected not to receive additional exposure. Twelve of them showed decreased headache activity by the second month (29% good, 43% excellent). Eight of the subjects in the placebo group elected to receive 2 weeks of actual exposure after the initial 1‐month follow‐up with 75% showing decreased headache activity (38% good, 38% excellent).In conclusion, exposure of the inner thighs to pulsing electromagnetic fields for at least 3 weeks is an effective, short‐term intervention for migraine, but not tension headaches.
Estrogen Replacement and Migraine Aura
Authors: MacGregor Anne 
Published: March 2003

Objective.—To assess the association between estrogen replacement therapy and migraine aura.Background.—Estrogen replacement therapy is increasingly used by perimenopausal and postmenopausal women for management of menopausal symptoms and for long‐term protection against osteoporosis and arterial disease. There are few reports about the effects of estrogen replacement therapy on migraine.Method.—Case reports were collected from women developing migraine aura related to use of estrogen replacement therapy.Results.—Four patients who developed migraine aura associated with the use of estrogen replacement therapy are described. In all cases, reducing the dose of estrogen or changing the route of delivery was associated with loss of aura.Conclusion.—These findings suggest that high levels of estrogen in women using replacement therapy can trigger migraine aura.
Pregnancy Outcome Following Prescription for Sumatriptan
Authors: Olesen Charlotte , Steffensen Flemming Hald , Sørensen Henrik Toft , Nielsen Gunnar Lauge , Olsen Jørn 
Published: March 2003

Background.– Some 2.5% of fertile Danish women use sumatriptan, and the drug is also taken during pregnancy. Although sumatriptan reacts selectively in brain vessels, the possibility of reactions with placental blood flow and uterotonic activity cannot be ruled out. The aim of our study was to examine the association between sumatriptan exposure during pregnancy and the risk of preterm delivery and low birth weight.Methods.– Data from the Pharmaco‐Epidemiological Prescription Database of North Jutland county regarding all women who had given birth in the county of North Jutland from 1991 to 1996 were linked to the Danish Medical Birth Registry. Women who were exposed to sumatriptan during pregnancy were identified (
n=34), and using logistic regression models their pregnancy outcome was compared with two groups of pregnant women: (1) healthy women (
n=15  955) and (2) migraine controls (
n=89), defined as migraine patients who did not redeem prescriptions for migraine treatment during pregnancy.Results.– The risk of preterm delivery was elevated among women exposed to sumatriptan compared with migraine controls (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.2–32.0) and healthy women (OR 3.3, 95% CI 1.3–8.5). The odds ratio for having a newborn with a low birth weight was increased (OR 3.0, 95% CI 1.3–7.0) for all migraine patients who delivered at term (
n=115) compared with the outcome of healthy pregnancies.Conclusions.– We found that sumatriptan exposure during pregnancy was associated with an increased risk of preterm delivery and low birth weight. These findings may be due to drug exposure, but they may also reflect the impact of disease severity rather than the treatment itself, or confounding, or chance.
Acquired Transient Stuttering During a Migraine Attack
Authors: Perino Michele , Famularo Giuseppe , Tarroni Paolo 
Published: March 2003

Stuttering is an abnormality in the fluency of speech, which is characterized by interruption of the normal rhythm due to involuntary repetition and prolongation, or arrest, of uttered letters or syllables.The aphasic syndrome and dysarthria can be associated with classic migraine, but, to our knowledge, no study has so far described stuttering as the only neurological symptom accompanying an attack.
Amitriptyline Treatment in Chronic Drug‐Induced Headache: A Double‐Blind Comparative Pilot Study
Authors: Descombes S. , Brefel‐Courbon C. , Thalamas C. , Albucher J.F. , Rascol O. , Montastruc J.L. , Senard J.M. 
Published: March 2003

Objective.—To assess the effects of amitriptyline and sudden analgesic withdrawal on headache frequency and quality of life in patients suffering from chronic daily headache related to analgesics abuse.Methods.—Seventeen nondepressed patients with chronic drug‐induced headache were included in a 9‐week, parallel‐group, randomized, double‐blind, placebo‐controlled study. After abrupt analgesic withdrawal, amitriptyline or an active placebo (trihexyphenidyl) was started. The primary efficacy variable was headache frequency recorded on a headache diary in the last 4 weeks of each treatment. The secondary efficacy variable was quality of life (Nottingham Health Profile).Results.—Headache frequency decreased by 45% in the amitriptyline group and by 28% in the trihexyphenidyl group. Amitriptyline enhanced all the dimensions of quality of life and significantly improved emotional reaction and social isolation.Conclusion.—This pilot study suggests a beneficial effect of amitriptyline on headache frequency and quality of life for patients with chronic drug‐induced headache.
Quality of Life in Young Italian Patients With Primary Headache
Authors: Nodari E. , Battistella P.A. , Naccarella C. , Vidi M. 
Published: March 2003

Objective.—To compare the quality of life of young Italian patients with headache with that of the juvenile Italian population free of chronic disease.Methods.—The Quality of Life Headache in Youth (QLH‐Y) Questionnaire developed by Dutch investigators was translated into Italian and validated in a young Italian population. The forward/backward translation and, for psychometric testing, the factor analysis and Cronbach coefficient α were used. A new instrument (Questionnaire for Young Subjects Affected by Primary Headache) was developed to assess psychological, physical, and social functioning and functional status and was used to compare the quality of life of the patients with headache with that of headache‐free controls.For psychometric testing (via the questionnaire), we selected a sample of 394 subjects (178 males and 216 females, aged 10 to 18 years): 320 subjects from three schools of North Italy and 74 patients with headache from the Paediatric Headache Center of Padua. In the latter group, 48 patients had tension‐type headache and 26 had migraine without aura, according to the International Headache Society diagnostic criteria.Results.—The data derived from the comparison of 84 headache‐free subjects (control group) and the 74 young patients with headache confirmed that primary headache negatively influenced the latter's quality of life: patients scored significantly (P<.05) lower on psychological, physical, and social functioning than the headache‐free controls.Conclusions.—Quality of life is compromised significantly in young patients with primary headache disorders. The questionnaire used in this study is a valid and reliable self‐administered instrument that may facilitate clinical research in headache.
Borderline Personality Disorder and the Chronic Headache Patient: Review and Management Recommendations
Authors: Saper Joel R. , Lake Alvin E. 
Published: March 2003

Background.—Physicians and psychologists who treat headache not infrequently encounter patients with borderline personality disorder (BPD). BPD patients frequently suffer from headache, and often pose special problems in treatment. Few guidelines exist for the management of the BPD headache patient.Objectives.—To provide an overview of current concepts on BPD, including comorbidity, psychopathophysiology, and treatment. To provide an explicit framework for managing borderline behavior in patients with chronic headache.Methods.—A literature review combined with clinical observations from the tertiary treatment of intractable headache in outpatient and inpatient settings.Results.—BPD is found in almost 2% of the general population, with increased prevalence in patients with comorbid psychopathology and substance abuse. Severe headaches and migraine appear to be more prevalent in patients with BPD than the general population. A reported history of abuse is common, but must be interpreted with caution. Recent research has found reduced hippocampal volume in women patients with BPD; hypometabolism in the premotor, prefrontal, and anterior cingulate cortex, as well as the thalamic, caudate, and lenticular nuclei; and serotonergic dysfunction. Opioid medications may have an adverse influence on certain clinical features of BPD. Some patients show at least short‐term improvement in dissociative behavior when given opioid antagonists. Treatment should combine appropriate pharmacotherapy with ongoing psychotherapy. Early identification of BPD is likely to improve the course of treatment. Treatment often requires explicit contracts, consistent limit‐setting, confrontation, and communication between different treating professionals to avoid “splitting.” The recognition and management of the doctor's own countertransference is important to successful management. Noncompliant patients may need to be terminated from treatment.Conclusions.—Specific management guidelines and the use of explicit treatment contracts can help sustain patients in treatment, reduce the risk of medication abuse, and minimize distress in the treating professional. Headaches and other symptoms in patients with BPD can be successfully managed over the course of a long‐term relationship with clearly defined limits.