bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of ‘criminal offending’ by men and women with intellectual disability and the characteristics of ‘offenders’: implications for research and service development
Authors: Holland T. , Clare I. C. H. , Mukhopadhyay T. 
Published: March 2003

AbstractThe investigation of the relationship between criminal offending and the presence of an intellectual disability (ID) is problematic for two main reasons. First, because of problems associated with the definition of ‘ID’, and secondly, because much criminal offending goes undetected or unreported, and studies can only investigate those already involved with the criminal justice process. Studies using IQ as a continuous variable indicate that significantly below‐average intellectual ability is an independent predictor of future offending. Whilst people with ID may be over‐represented in parts of the criminal justice system, given the intellectual and other psychosocial disadvantages which they experience, the level of offending behaviour in this particularly vulnerable group is strikingly low. The present authors propose that two broad groups of people can be identified. The first, broader, group is one of people for whom social disadvantage and mental ill health (particularly substance abuse), coupled with a significant intellectual impairment, are the main characteristics. Secondly, there is a smaller group of people, usually already known to ID services as service users, but for whom the process whereby what might have been conceptualized as ‘challenging behaviour’ becomes ‘offending’ is far from clear. The distinction the present authors make between challenging behaviour and offending is important for understanding how ‘difficult’ behaviour becomes identified as ‘antisocial/criminal behaviour’. They argue that research needs to move from prevalence and descriptive studies to investigating the processes which determine movement in and out the criminal justice system. The present political emphasis on public protection and proposals for significantly broader mental health legislation raise the danger of a re‐expansion of institutional models of care, rather than the development of multi‐agency support networks. The present paper underscores a note of caution, particularly where choices have to be made between expanding institutional models on the one hand and providing more integrated services on the other. Over and above policy decisions, these are social and political choices.
The Edinburgh Principles with accompanying guidelines and recommendations
Authors: Wilkinson H. , Janicki M. P. 
Published: March 2003

AbstractA panel of experts attending a 3‐day meeting held in Edinburgh, UK, in February 2001 was charged with producing a set of principles outlining the rights and needs of people with intellectual disability (ID) and dementia, and defining service practices which would enhance the supports available to them. The Edinburgh Principles, seven statements identifying a foundation for the design and support of services to people with ID affected by dementia, and their carers, were the outcome of this meeting. The accompanying guidelines and recommendations document provides an elaboration of the key points associated with the Principles and is structured toward a four‐point approach: (1) adopting a workable philosophy of care; (2) adapting practices at the point of service delivery; (3) working out the coordination of diverse systems; and (4) promoting relevant research. It is expected that the Principles will be adopted by service organizations world‐wide, and that the accompanying document will provide a useful and detailed baseline from which further discussions, research efforts and practice development can progress.
Bone mineral density in patients with Crohn's disease during long‐term treatment with azathioprine
Authors: Florén  , Ahrén  , Bengtsson  , Bartosik  , Obrant  
Published: March 2003

Florén C‐H, Ahrén B, Bengtsson M, Bartosik J, Obrant K (Lund University, Malmö, Sweden). Bone mineral density in patients with Crohn's disease during long‐term treatment with azathioprine. J Intern Med 1998; 243: 123–26.ObjectivesTo ascertain whether patients with Crohn's disease treated with azathioprine maintained bone mineral mass better than patients treated with steroids alone.DesignRetrospective study.SettingUniversity Hospital of Malmö, Sweden.SubjectsA total of 59 patients with ileocolonic, ileocaecal or colonic Crohn's disease.MethodsBone mass was assessed by dual photon X‐ray absorptiometry at the level of L2 – L4.ResultsPatients treated with a high lifetime dose of steroids (> 5 g prednisolone) had significantly (P= 0.011) lower Z‐score of L2–L4 (−0.87 ± 1.11; 11 SD) than steroid‐treated patients, who had received a low dose of prednisolone (< 5 g) (0.08 ± 1.16 SD). Azathioprine did not negatively influence the steroid effect on bone mineral density.ConclusionsAzathioprine does not seem to affect bone mineral density by itself. However, by being steroid‐saving, it seems to conserve bone mineral mass in patients with Crohn's disease.
Survival in breast cancer patients after the first episode of hypercalcaemia
Authors: Kristensen  , Ejlertsen  , Mouridsen  , Loft  
Published: March 2003

Kristensen B, Ejlertsen B, Mouridsen HT, Loft H (Copenhagen University Hospital, Copenhagen, Denmark). Survival in breast cancer patients after the first episode of hypercalcaemia. J Intern Med 1998; 244: 189–98.Objectives.To investigate hypercalcaemia (serum ionized calcium (S‐Ca2+) > 1.35 mmol L−1) in breast cancer patients before and after the introduction of bisphosphonates and the effect of disease‐ and treatment‐related factors on survival.Design.Prospective and retrospective registration of covariates.Setting.A department of oncology in a university hospital.Subjects.A consecutive cohort of 212 hypercalcaemic patients never treated with bisphosphonate was identified prospectively (period 1) and 193 patients with metastases were classified into three groups: mild (S‐Ca2+ < 1.48; n= 102), moderate (1.48 ≤ S‐Ca2+≤ 1.60; n= 41), and severe hypercalcaemia (S‐Ca2+ > 1.60 mmol L−1; n= 50). Fifty‐one patients with severe hypercalcaemia all treated with bisphosphonate except one were identified retrospectively (period 2).Results.For period 1 median survival was 6.7 months. Survival was significantly decreased in the two groups with the highest initial S‐Ca2+ (P < 0.0001). Median survival times in severely hypercalcaemic patients from periods 1 and 2 were 1.4 (95% confidence interval 0.8–2.1) and 2.2 (95% confidence interval 1.3–3.1) months, respectively. In a Cox model for period 1 significant covariates were: WHO performance, extent of metastases, whether systemic anticancer treatment could be given, and haemoglobin, but not S‐Ca2+.Conclusion.Prognosis is poor in hypercalcaemic breast cancer patients with WHO performance 3–4 and advanced metastatic disease when effective systemic treatment can no longer be offered. Bisphosphonate treatment does not seem to improve survival in severe hypercalcaemia. Antihypercalcaemic treatment of mild malignancy‐associated hypercalcaemia appears not to be vital. Therapeutic efforts should be aiming at patients with moderate hypercalcaemia.
Disease spectrum of patients with antineutrophil cytoplasmic autoantibodies of defined specificity: distinct differences between patients with anti‐proteinase 3 and anti‐myeloperoxidase autoantibodies
Authors: Franssen  , Gans  , Kallenberg  , Hageluken  , Hoorntje  
Published: March 2003

Franssen C, Gans R, Kallenberg C, Hageluken C, Hoorntje S (University Hospital, Groningen; Free University Hospital, Amsterdam; and Catharina Hospital, Eindhoven; the Netherlands). Disease spectrum of patients with antineutrophil cytoplasmic autoantibodies of defined specificity: distinct differences between patients with antiproteinase 3 and antimyeloperoxidase autoantibodies. J Intern Med 1998; 244: 209–16.ObjectiveTo compare the disease spectrum of consecutive patients with antineutrophil cytoplasmic autoantibodies directed against proteinase 3 (anti‐PR3) or myeloperoxidase (anti‐MPO).DesignRetrospective analysis.SettingThree teaching hospitals in the Netherlands.Main outcome measuresClinical features at presentation, histopathological characteristics and outcome.SubjectsAll consecutive patients who tested positive for anti‐PR3 (n= 46) or anti‐MPO (n= 46) over an 8‐year‐period.ResultsAt diagnosis, patients with anti‐PR3 had a higher vasculitis activity index than patients with anti‐MPO (P < 0.001). The mean (SD) number of affected organs in the anti‐PR3 group exceeded that of the anti‐MPO group (3.9 (1.4) and 2.2 (1.1), respectively; P < 0.01). The combination of renal and respiratory tract involvement was present in as many as 78.3% of patients with anti‐PR3 and in only 23.9% of patients with anti‐MPO (P < 0.01). Renal‐limited disease exclusively occurred in patients with anti‐MPO. Granulomas were found in 41.3% of anti‐PR3‐ but in only 4.3% of anti‐MPO‐positive patients (P < 0.01). All anti‐PR3‐positive patients had Wegener's granulomatosis or microscopic polyangiitis. By contrast, diagnoses in the anti‐MPO group were more diverse: idiopathic necrotizing crescentic glomerulonephritis (26.1%), microscopic polyangiitis (26.1%), Churg–Strauss syndrome (4.3%), Wegener's granulomatosis (2.2%), giant cell arteritis (2.2%), clinically suspected vasculitis (19.6%), as well as miscellaneous nonvasculitic disorders (19.6%). During follow‐up, 10 anti‐PR3‐positive patients had 11 relapses whereas only 3 patients with anti‐MPO relapsed (P= 0.04).ConclusionA large divergence was seen in the disease spectrum between patients with anti‐PR3 and those with anti‐MPO. In particular, extra‐renal disease manifestations, granuloma formation and relapses were more prominent in anti‐PR3‐ than in anti‐MPO‐positive patients.
Extrahepatic manifestations of chronic hepatitis C infection and the interrelationship between primary Sjögren's syndrome and hepatitis C in Swedish patients
Authors: Verbaan H. , Carlson J. , Eriksson S. , Larsson Å. , Liedholm R. , Manthorpe R. , Tabery H. , Widell A. , Lindgren S. 
Published: March 2003

Objective. To analyse the frequency of some extrahepatic manifestations of chronic hepatitis C virus (HCV) infection in northern European patients, including a postulated association between HCV and primary Sjögren's syndrome (SS).Design. Cohort study.Setting. Department of Medicine, Malmö University Hospital, Sweden.Patients. Twenty‐one patients with HCV infection and 53 with primary SS (according to the Copenhagen criteria).Main outcome measures. Cryoglobulins were analysed in all patients, while patients with primary SS were investigated with regard to markers of HCV infection, and HCV patients with objective tests of SS (Schirmer‐1 test, break‐up time, van Bijsterveld score, sialometry, labial salivary gland biopsy) and antibodies against nuclear antigens, smooth muscle (SMA) and mitochondria (AMA). HCV antigens in small salivary glands from lower lip biopsies were detected by immunohistochemical analysis.Results. Only one of the SS patients had detectable cryoprecipitates, while another was HCV‐positive. None of the 21 HCV patients had cryoprecipitates. A total of 14/21 (67%) patients with HCV infection had at least one abnormal objective test suggestive of xerostomia or keratoconjunctivitis sicca, while eight (38%) had objective evidence of both eye and salivary gland involvement. HCV antigens were not detected in affected glands. Only two patients had clinical symptoms of SS, and two fulfilled the Copenhagen criteria for SS. None of the HCV‐positive patients had detectable antibodies against SS‐A, SS‐B, RNP, Jo‐1, PCNA or Scl‐70, and the frequency of ANA/SMA/AMA was low.Conclusions. While involvement of salivary and lacrimal glands was common in Swedish patients with HCV infection, cryoglobulinaemia was not observed. The pathogenetic mechanism responsible for glandular inflammation appears to be different from that in primary SS. HCV infection does not seem to be an aetiological factor for primary SS in this population. These observations suggest that viral, genetic or possibly environmental factors may be responsible for the reported high frequencies of systemic complications associated with chronic hepatitis C infection in southern Europe.
Low vitamin E status is a potential risk factor for insulin‐dependent diabetes mellitus
Authors: Knekt P. , Reunanen A. , Marniemi J. , Leino A. , Aromaa A. 
Published: March 2003

Abstract.Objectives. To study the association of vitamin E status with occurrence of insulin‐dependent diabetes mellitus (IDDM).Design. A case–control study nested within a 21‐year follow‐up study.Subjects. Nineteen incident IDDM patients with an average age of 28 years and three individually matched controls per patient.Main outcome measure. Serum concentrations of alpha‐tocopherol.Results. Serum alpha‐tocopherol concentration at the baseline examination was inversely associated with IDDM occurring 4–14 years later. The cholesterol‐adjusted relative risk of IDDM between the highest and lowest thirds of the vitamin concentration was 0.12 (95% confidence interval = 0.02– 0.85).Conclusions. The finding corroborates the hypothesis of a protective effect of vitamin E against development of IDDM. Because of the relatively old age of the patients in the present population, further epidemiological studies on the topic are warranted.
Prevalence of the metabolic syndrome in drug‐treated hypertensive patients and control subjects
Authors: Rantala A. O. , Kauma H. , Lilja M. , Savolainen M. J. , Reunanen A. , Kesäniemi Y. A. 
Published: March 2003

Objectives. To determine the prevalence of the metabolic abnormalities associated with hypertension and to define the predictors of the metabolic syndrome by different definitions in random population‐based samples.Design. A cross‐sectional epidemiological study of hypertensive patients and controls.Setting. The participating study subjects visited the research laboratory of the Department of Internal Medicine, University of Oulu, Oulu, Finland.Subjects. Six hundred treated male and female hypertensives aged 40–59 years and 600 age‐ and sex‐matched controls were randomly selected by age stratification from population registers.Main outcome measures. A wide range of laboratory analyses were conducted. After fasting blood had been drawn, the subjects were given a 75 g glucose load except previously known insulin‐treated diabetics. Both 1 h and 2 h glucose and insulin concentrations were determined. During the same visit, a standardized health questionnaire covering the past medical history, current and former medication use, physical activity, smoking habits, alcohol consumption and family history was completed. Ten different definitions of the metabolic syndrome were applied to achieve a wide perspective of the prevalence of the different combinations.Results. The prevalence of the metabolic syndrome in different samples varied depending on the definition from 0.8 to 35.3%, being lowest in the control men and women and highest in the hypertensive men. Three‐quarters of a random, middle‐aged, urban population show at least one cardiovascular risk factor and 91.3% of all the hypertensive subjects show at least one cardiovascular risk factor in addition to hypertension itself. The independent predictors of the metabolic syndrome were waist circumference, uric acid, total cholesterol and gamma‐glutamyl transpeptidase in logistic analysis after adjustment for age, measure of obesity and gender.Conclusions. This cross‐sectional, epidemiological study shows that the magnitude of the prevalence rates of the metabolic syndrome is at the same level in various populations, being less than one‐third in population‐based samples in spite of the different definitions. The cluster of several cardiovascular risk factors, especially in the hypertensives, leads to an increased relative risk of cardiovascular diseases.
Panic disorder in chest pain patients referred for cardiological outpatient investigation
Authors: Dammen T. , Arnesen H. , Ekeberg Ø. , Husebye T. , Friis S. 
Published: March 2003

Abstract.Objectives. The aims of the study were to: (i) determine the prevalence of panic disorder (PD) in patients referred to cardiological outpatient clinics for evaluation of chest pain; (ii) compare psychiatric comorbidity, psychological distress, pain characteristics and suicidal ideation in PD and non‐PD patients; (iii) compare the prevalence of coronary risk factors and medical comorbidity in PD and non‐PD patients; and (iv) describe current PD treatment and need for PD treatment as expressed by PD patients.Design. A cross‐sectional study based on psychiatric and cardiological investigation.Setting. Four cardiological outpatient clinics in Oslo, Norway.Subjects. One‐hundred and ninety‐nine consecutive patients without known heart disease referred to outpatient clinics for investigation of chest pain.Main outcome measures. Psychiatric state diagnosis (axis I); scores on self‐assessment rating scales of psychological factors and pain modalities; cardiological diagnosis.Results. Thirty‐eight per cent of the patients met criteria for current panic disorder (PD). Panic disorder was associated with psychological distress, comorbid psychiatric disorders, medical disorders and significantly higher prevalence of coronary risk factors (P < 0.05). Furthermore, the results suggest that these patients were not identified and appropriately treated for panic disorder prior to cardiological investigation. The results indicate that the patients are positive to screening for psychiatric disorder and communicate a need for treatment early in the investigation process.Conclusion. PD commonly occurs in this chest pain population. Thus, there is a need to educate physicians caring for these patients about PD identification and treatment.
Clinical importance of coronary endothelial vasodilator dysfunction and therapeutic options
Authors: B. Britten M. , M. Zeiher A. , Schächinger V. 
Published: March 2003

Abstract.The vascular endothelium plays a key role in the control of vasomotor tone, local haemostasis and vascular wall proliferation processes. These responses are mediated by a variety of substances released from the endothelium in response to physiological stimuli, including prostacyclin, endothelin, and most importantly nitric oxide (NO). NO mediates vasodilation and furthermore inhibits platelet aggregation, expression of adhesion molecules for monocytes and adhesion of neutrophils, and it impairs growth of vascular smooth muscle cells. Risk factors for coronary atherosclerosis, such as hypercholesterolaemia, impair NO bioactivity, mainly due to an oxidative stress by superoxide radicals (O2−), which are able of rapidly inactivating endothelium‐derived NO. Impaired NO bioactivity leads to unopposed paradoxical vasoconstriction of epicardial conductance vessels in response to physiological stimuli such as sympathetic activation as well as impaired vasodilator function of coronary resistance vessels. Therefore, endothelial dysfunction contributes to ischaemic manifestation of coronary artery disease. In addition, enhanced paradoxical vasoconstriction and a loss of endothelial antithrombotic activities might unfavourably modulate the course of acute coronary syndromes. Thus, the aim of therapeutic interventions is to increase NO bioavailability by either increasing NO production or decreasing O2− production in the endothelium. This goal can be reached, for example by ACE inhibitors, lipid‐lowering drugs, increased shear‐stress by physical exercise, oestrogens, and l‐arginine, which have already been shown to improve endothelial vasodilator function. Nevertheless, it has to be determined whether ameliorated endothelial function will contribute to improved patients prognosis.
Oral anticoagulants are effective long term after acute myocardial infarction
Authors: Smith P. 
Published: March 2003

Abstract.Three long‐term studies on oral anticoagulation, the Sixty Plus trial, the WARIS study, and the ASPECT trial all meet the methodological requirements for modern stand alone clinical trials: large number of patients, double‐blinded, placebo‐controlled design, and intention to treat analysis. All demonstrate significant reduction in recurrent myocardial infarction, and all show reduction in the risk of total stroke. The WARIS study, however, is the only study demonstrating efficacy in terms of statistically significant reduction of all‐cause mortality. These findings are confirmed by a recent meta‐analysis. The overall benefit of oral anticoagulation after myocardial infarction suggests avoidance of 4–26 events per 100 patients treated for 2–3 years. Given the results from the trials applying the most adequate control of anticoagulation, avoidance of 10–14 events per 100 patients treated seems to be a realistic benefit. Provided there is sound management of the anticoagulant therapy, especially employment of suitable control methods, the incidence of bleeding may be kept at a low level.
Life‐threatening ventricular tachycardia due to liquorice‐induced hypokalaemia
Authors: Eriksson J. W. , Carlberg B. , Hillörn V. 
Published: March 2003

Abstract. Eriksson JW, Carlberg B, Hillörn V (Umeå University Hospital, Umeå, Sweden). Life‐threatening ventricular tachycardia due to liquorice‐induced hypokalaemia (Case Report). J Intern Med 1999; 245: 307–10.We report on a patient with hypokalaemia and severe ventricular tachycardia of torsades de pointes type which turned out to be caused by an apparent mineralocorticoid excess syndrome associated with liquorice consumption. The patient, a 44‐year‐old woman, attended the hospital because of irregular heart rhythm and she displayed repeated episodes of life‐threatening torsades de pointes ventricular tachycardia. The initial serum potassium was low: 2.3 mmol L–1. The patient was treated with potassium and magnesium infusions, and the dysrhythmias eventually ceased. Endocrinological investigations showed no indication of Cushing’s syndrome or hyperaldosteronism. After some time it became clear that the patient had ingested moderately large amounts of liquorice every day for 4 months. After the patient stopped this habit the hypokalaemia and dysrhythmias did not recur and after more than 1 year there are no signs of cardiac illness.