bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective professional practice: protocol for a systematic review of health professionals’ management of obesity
Authors: Harvey  , Glenny  , Kirk  , Summerbell  
Published: March 2003

While much attention has been paid to interventions to help overweight and obese people lose weight, relatively little is known about the contribution of health professionals to obesity reduction. As in other clinical areas, variations in the provision of health care for overweight and obese people may affect health outcomes. In this area in particular, there is reason to believe that practice may be adversely affected because of some providers’ negative attitudes towards the patient group.This work aims to identify strategies that are effective in improving health professionals’ management of obesity or the delivery of health care services for overweight and obese people. In contrast to recent systematic reviews of patient‐targeted approaches, this review focuses specifically on interventions designed to improve health professionals’ practice. It is undertaken in association with the Cochrane Effective Practice and Organisation of Care (EPOC) Group. The protocol for this review is described.
Assessment of body mass index for the residents of a long‐stay institution for people with learning disability
Authors: Lea A 
Published: March 2003

Summary Background: Body mass index (BMI) was used to assess the population of Royal Earlswood, a long‐stay institution for people with learning disability. Method: Height and weight measurements were taken for each resident. Where available, previous weight records were used to compare the study BMI measurement with that 3 years previously – the time at which the Dietetic Service was first set up. Results: This study indicated that 56.4% of the residents in Royal Earlswood had a BMI that was outside of the ideal range. The Dietetic Service knew of 60% of these residents, and the weight status of over three‐quarters of those receiving dietary advice had already been improved. The remaining 40% had not previously been identified as having an unhealthy weight. Conclusions: This paper supports previous research in demonstrating that people with learning disability are more likely than the general population to have a body weight that is outside the healthy range. In this study dietetic input is generally shown to have influenced BMI beneficially.
Intake of vitamins B1, B2, C, A and E estimated on the basis of analysis of weekly diets of 19 Finnish hospitals
Authors: Mattila P. , Kumpulainen J. 
Published: March 2003

SummaryContents of vitamins B1, B2, C, A and E were determined and intakes of these vitamins calculated in homogenized weekly diets collected from 19 central hospitals throughout Finland. In addition, the possibility of using the hospital diet data to estimate the level of average daily vitamin intake in Finland was evaluated. This was facilitated by comparing the daily food consumption in hospitals with the average daily food consumption in Finland and assessing the average vitamin intake of Finnish people accordingly. Intakes of vitamins A, B2;and C (1600 RE, 2.9 mg and 148.9 mg day−1, respectively) exceeded the recommendations for hospital diets. On the other hand, mean intakes of vitamins E and B1(8.9 and 1.0 mg day−1, respectively) were slightly below the recommendations. Comparison of daily food consumption from hospital diets with the average daily food consumption in Finland suggests that average Finnish intakes of vitamins B1and E are close to the intake values obtained from the hospital diets studied.
Sex differences in weight perception and nutritional behaviour in adults with cystic fibrosis
Authors: Walters S. 
Published: March 2003

IntroductionGood nutritional status in cystic fibrosis (CF) is associated with improved clinical status and survival. In some conditions where dietary and pharmacological treatment are important (e.g. diabetes), a combination of eating disorders and failure of treatment compliance has been reported. Cases of eating disorders have been reported in CF. Societal pressures on young women to remain slim may compromise optimum clinical management as women are content to remain underweight.ObjectiveTo determine whether women have different perception of their weight than men with CF and whether this manifests in different nutritional behaviour.MethodsConfidential postal questionnaire to 1870 adults with CF in 1994 known to the Association of Cystic Fibrosis Adults (UK). Participants were asked their own weight and height, and their perception of their weight. Very underweight was defined as < 85% ideal body weight, underweight as 85–94%, normal weight as 95–104%, overweight as 105–114% and very overweight as 115% and over.ResultsA significantly higher proportion of women than men who are very underweight (29% vs. 11%) or underweight (41% vs. 15%) saw themselves as being of normal weight or overweight. Conversely, a significantly higher proportion of men than women who were normal weight (42% vs. 19%) saw themselves as underweight. All P‐values < 0.01.A significantly higher proportion of people who perceived themselves to be underweight were taking oral or enteral food supplements compared with those who did not (77% vs. 30%, P < 0.05). Multiple logistic regression showed that perception of self as underweight was the strongest predictor of taking oral or enteral food supplements (adjusted odds ratio 2.42), even after adjustment for age, sex, overall severity score, body mass index, and seeing a dietitian in the last year.ConclusionYoung women with CF tend to overestimate their weight, and young men with CF underestimate their weight when compared with their actual body weight. Perception of self as underweight is reflected in nutritional behaviour, being a significant predictor of taking oral and enteral food supplements. People working with young patients with CF should be aware of these sex differences in weight perception, and work with young women and young men with CF to achieve a realistic perception of body weight and realistic nutritional goals. There is a need for further research into body image, weight perception, eating behaviour and adherence to pancreatic enzyme supplementation and oral and enteral food supplementation in young patients with CF.
Survey of UK dietetic departments: diet in secondary prevention of myocardial infarction
Authors: Hooper L. 
Published: March 2003

AimTo collate information on current British dietetic practice in the area of diet in secondary prevention of myocardial infarction, and to compare this with best evidence.MethodsA questionnaire was sent to all Chief Dietitians, to be completed by the whole department, asking about current dietary advice and practice, referrals and written dietary information for people following myocardial infarction.ResultsFifty‐seven per cent of questionnaires were returned. Dietary fat advice was prioritized by 84% of departments, fruit and vegetables by 49%, oily fish by 45% and fibre by 28%. Most dietitians (81%) felt that this advice would protect from further cardiovascular disease. Percentages of post‐myocardial infarction patients given advice by a dietitian varied (median 60%), reasons for non‐referral included patients having normal lipids or weight. More were given dietary advice by another health professional (median 90%); however, most dietitians were unsure about the quality of this advice. Diet sheets were felt to reflect advice priorities, but where sheets were sent they were much less likely than departments to prioritize oily fish or fruit and vegetable advice.ConclusionDietetic practice for people following myocardial infarction is out of line with current best evidence. Almost half of departments correctly prioritize oily fish advice, but often only see patients with raised lipids or weight. This is not the most effective strategy for preventing deaths.
Prader–Willi syndrome and psychotic symptoms: I. Case descriptions and genetic studies*
Authors: Bouras N. , Clarke D. , Boer H. , Webb T. , Scott P. , Frazer S. , Vogels A. , Borghgraef M. , Curfs L. M. G. 
Published: March 2003

AbstractSix people with Prader–Willi syndrome (PWS) who developed psychoses are described. Along with other literature reviewed in the present paper, the results imply an association between PWS and psychotic symptoms. Genetic studies were possible in five cases and SNRPN expression was examined in three cases. Maternal uniparental disomy and 15qllq13 deletions were found, demonstrating that psychotic symptoms are not associated with a single type of genetic abnormality.
People with intellectual disability, sensory impairments and behaviour disorder: a case series
Authors: Carvill S. , Marston G. 
Published: March 2003

AbstractBackgroundSensory impairments (SIs) are more prevalent in people with intellectual disability (ID). Both conditions lead to higher rates of emotional and behavioural problems than in the general population. The identification of psychiatric disorders in this group can be difficult, particularly in those with severe ID and limited communication skills.MethodThe present paper presents a series of 18 case reports of individuals with ID, SI and behavioural problems.ResultsThe majority of cases were young male caucasians with congenital rubella syndrome and autistic spectrum disorder, referred because of self‐injurious behaviour (SIB) or aggression. Nine cases were treated with autidepressants, five underwent environmental changes and two had medication reduced. All showed some improvement.ConclusionsThe benefits of comprehensive assessments, the use of standardized assessment tools and trials of treatments are discussed in the context of making psychiatric diagnoses.
Behaviour problems in adult women with Rett syndrome
Authors: Mount R. H. , Hastings R. P. , Reilly S. , Cass H. , Charman T. 
Published: March 2003

AbstractBackgroundDespite considerable interest in the genetic, physical and neurological aspects of Rett syndrome (RS), there have been few studies of associated behavioural and emotional features. Furthermore, few case studiesor surveys have included adult women with RS. The main aim of the present study was to compare behaviour problems in a sample of women with RS against data from normative samples.MethodsThe primary carers of 50 women with RS completed the community version of the Aberrant Behavior Checklist.ResultsWomen with RS were rated as having lower levels of irritability, hyperactivity and inappropriate speech behaviours than normative samples of adults with intellectual disability.ConclusionsA number of factors may affect the presentation of behaviour problems in women with RS (e.g. cognitive impairments or physical disabilities). Therefore, more research is needed in order to generate information about the behavioural phenotype of RS. The implications of the present data for future research are also discussed.
On the success, cost and efficiency of modern medicine: an international comparison
Authors: Kjellstrand  , Kovithavongs  , Szabo  
Published: March 2003

Kjellstrand CM, Kovithavongs C, Szabo E (University of Alberta, Edmonton, Canada). On the success, cost and efficiency of modern medicine: an international comparison. J Intern Med 1998; 243: 3–14.ObjectiveTo study the success and cost of modern medicine in industrialized, rich countries from 1980 to 1990.DesignCost per capita and per cent of gross domestic product (GDP) spent on health was related to: (i) mortality in six diseases amenable to treatment by modern medicine; (ii) the sum of those six diseases (avoidable disease); (iii) death due to other, unavoidable diseases; (iv) maternal and infant mortality; (v) life expectancy at birth; (vi) renal dialysis and transplantation rates. Efficiency was studied by comparing a country's avoidable mortality rates multiplied by expenses, to the mean for all countries.ResultsDuring the 10 years, avoidable death rate decreased 38% but unavoidable death rate only 10%. Life expectancy increased 3%. Cost per capita increased 107% but health expenditures, as per cent of GDP only 10%. There was a reasonable correlation between expenses and avoidable mortality but none between expenses and unavoidable death rate. In 1990 avoidable mortality was lowest in Canada, and highest in Japan. Cost was lowest in New Zealand, and highest in the USA. The efficiency index was highest for Australia, and lowest in the USA.ConclusionModern medicine as we have studied it is successful. Avoidable death rate shows a steep uninterrupted decline over the last 50 years while unavoidable death rate shows only small decreases. Cost as per cent of GDP has increased only moderately. There is a correlation between expenses and mortality from avoidable but not from unavoidable diseases, and a large variation in efficiency.
Muscle fibre composition and glycogen synthase activity in hypertension‐prone men
Authors: Endre  , Mattiasson  , Berglund  , HulthÉn  
Published: March 2003

Endre T, Mattiasson I, Berglund G, Hulthén UL (Malmö University Hospital, Lund University, Malmö; Sweden). Muscle fibre composition and glycogen synthase activity in hypertension‐prone men. J Intern Med 1998; 243: 141–147.ObjectivesTo study muscle fibre characteristics and glycogen synthase activity in relation to peripheral glucose disposal in skeletal muscle in hypertension‐prone men.DesignThe hyperinsuliemic euglycemic clamp method was used to calculate insulin sensitivity index (M/I). Muscle biopsies were performed for the analysis of slow‐twitch (ST) and fast twitch (FT, low insulin sensitivity and low capillarisation compared to ST fibres) muscle fibres, capillarisation (number of capillaries per fibre) and diffusional index (mean area per fibre divided by capillarisation) of muscle fibres, capillary density (capillaries mm−2 muscle fibre) and glycogen synthase activity.SubjectsThirty‐two young, healthy, normotensive men with a family history of hypertension (REL) were compared to 25 age‐matched men with no family history of hypertension (CON) and similar body mass index (BMI).ResultsREL had a lower M/I (P = 0.021), lower capillarisation (P = 0.04) and a tendency of a lower diffusional index of subgroup b of FT muscle fibres (P = 0.10) compared to CON. Glycogen synthase activity did not differ between the groups.ConclusionsMen with a family history of hypertension have less capillaries per FTb fibre and greater diffusion distance from the capillary to the muscle cell compared to controls, which may be a contributory factor to the lower insulin sensitivity in the former group. However, additional investigations are needed to study the casuality in this association.
Individuals with high total cholesterol/hdl cholesterol ratios are insulin resistant
Authors: Jeppesen  , Facchini  , Reaven  
Published: March 2003

Jeppesen J, Facchini FS, Reaven GM. (The Department of Medicine, Stanford University School of Medicine, Stanford, and Shaman Pharmaceuticals Inc., South San Francisco, CA, USA). Individuals with high total cholesterol/hdl cholesterol ratios are insulin resistant. Journal of Internal Medicine 1998; 243: 293–98.ObjectivesTo define the pathophysiologic characteristics of patients at high risk for coronary heart disease due to an increased ratio of total cholesterol (TC) to high density lipoprotein‐cholesterol (HDL‐C).DesignCross‐sectional.SettingClinical Research Center.SubjectsOne hundred‐20 healthy, non‐diabetic, normotensive, volunteers were screened for this study. From this pool, 40 individuals (20 females and 20 males) with the highest and the lowest TC/HDL‐C ratios were selected for comparison.Main Outcome MeasuresValues for body mass index (BMI), ratio of waist to hip girth (WHR), and blood pressure were obtained on all patients. In addition, measurements were made of fasting lipid and lipoprotein concentrations, plasma glucose and insulin responses to an oral glucose challenge, and insulin resistance as assessed by the insulin suppression test.ResultsAge, BMI, and WHR were the same in the two groups. However, the group with a high TC/HDL‐C ratio had higher (P < 0.05) systolic and diastolic blood pressures. In addition, patients with a high TC/HDL‐C ratio had significantly higher (P < 0.001) very low density (VLDL) and low density lipoprotein (LDL)‐cholesterol concentrations and lower HDL‐cholesterol concentrations, with significant (P < 0.001) correlations between the TC/HDL‐C ratio and VLDL (r= 0.60), LDL (r= 0.54), and HDL (r=− 0.73) cholesterol concentrations. Patients with a high TC/HDL‐C ratio were also significantly (P < 0.05–0.001) more insulin resistant, glucose intolerant with a greater plasma insulin response to oral glucose, and hypertriglyceridemic.ConclusionsThe results indicate that an increase in LDL‐cholesterol concentration is not necessarily the major contributor to a high ratio of TC/HDL‐C. Furthermore, individuals with this epidemiologic designation are insulin resistant, and liable to all the other abnormalities associated with this metaboic defect.
Nephron‐sparing surgery and renal transplantation in patients with renal cell carcinoma and von Hippel–Lindau disease
Authors: Goldfarb  
Published: March 2003

Goldfarb DA (Cleveland Clinic Foundation, Cleveland, Ohio, USA). Nephron‐sparing surgery and renal transplantation in patients with renal cell carcinoma and von Hippel–Lindau disease (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 563–7.Renal cell carcinoma is a common manifestation of von Hippel–Lindau disease and an important cause of mortality in these patients. A contemporary approach to the treatment of localized renal cell carcinoma is outlined based upon several recently conducted multicentre reviews. When technically feasible nephron‐sparing surgery can preserve renal function without compromising long‐term survival in most patients. For those who develop end‐stage renal failure as a result of treatment for renal cell carcinoma, excellent results with a limited risk for development of recurrence can be obtained with renal transplantation.
Does admission to a department of internal medicine improve patients' quality of life?
Authors: Eriksen  , Kristiansen  , Nord  , Pape  , Almdahl  , Hensrud  , Jæger  , Mürer  , Robertsen  , Thorsen  
Published: March 2003

Abstract. Eriksen BO, Kristiansen IS, Nord E, Pape JF, Almdahl SM, Hensrud A, Jæger S, Mürer FA, Robertsen R, Thorsen G (University Hospital of Tromsø; University of Tromsø; National Institute of Public Health, Oslo; Kommunelegekontoret i Bardu, Bardu; Nordland Central Hospital, Bodø; Rana Hospital, Mo; Åsgård Psychiatric Hospital, Tromsø; and Harstad sykehus, Harstad, Norway). Does admission to a department of internal medicine improve patients' quality of life?J Intern Med 1998; 244: 397–404.ObjectivesThe Tromsø Medical Department Health Benefit Study was designed to estimate health gains from admissions to a department of internal medicine. We have previously reported that the hospital stays had no effect on the life expectancy of 61% of the patients. However, it has been claimed that modern medicine has a greater effect on quality of life (QoL) than on life expectancy. The aim of the present study was to investigate this issue by estimating gains in QoL for patients admitted to a department of internal medicine.DesignThe time trade‐off method (TTO) was used for assessing QoL gain from consecutive admissions during a 6‐week period. The assessments were made by one of two expert panels, each consisting of an internist, a surgeon and a general practitioner, on the basis of summaries of all relevant clinical information about the patients. Short‐term improvements in QoL during the stay or shortly after discharge were scored on an ordinal scale.ResultsOf the admitted patients, 41% had gains in QoL measured with the TTO (mean gain = 0.06; 95% confidence interval = 0.05–0.07; n = 422), and eight of these had gains equal to or greater than 0.50. Another 40% had gains in health‐related short‐term QoL measured with the ordinal scale. In a multivariate linear regression analysis, emergency admissions, high age and the disease categories ‘endocrinological diseases’ and ‘pneumonia and influenza’, were associated with higher gain, and ‘undiagnosed symptoms’ and ‘cerebrovascular diseases’ with lower gain.ConclusionsAs judged by the expert panels, the investigated department of internal medicine was effective in improving the QoL of 81% of the admitted patients. Whilst most of the patients achieved small gains, a minority had gains in QoL corresponding to the treatment of life‐threatening diseases.
Hereditary haemorrhagic telangiectasia: a population‐based study of prevalence and mortality in Danish patients
Authors: Kjeldsen A. D. , Vase P. , Green A. 
Published: March 2003

Abstract.Introduction. Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease characterized by telangiectatic lesions. The disease manifestations are variable and include epistaxis, gastrointestinal bleeding, pulmonary arteriovenous malformations and cerebral arteriovenous malformations. Early death due to these complications has been described.Design. We report a study on the prevalence and mortality of HHT in a Danish population based on two cross‐sectional surveys in combination with a long‐term follow‐up study.Settings and subjects. Prevalent cases of HHT as of 1 January 1974 in the County of Fyn, Denmark, were identified. In 1995–97 a follow‐up study of mortality was performed of the initial patient sample, and a new point prevalence rate of HHT as of 1 January 1995 was calculated. All live patients and their families were invited to attend a detailed clinical examination.Results. The prevalence of HHT in the County of Fyn was 13.8 per 100 000 on 1 January 1974 and 15.6 per 100 000 on 1 January 1995. In the HHT group as a whole, we found a slightly increased mortality; however, amongst the HHT patients younger than 60 years at inclusion the mortality of HHT patients was twice the expected. The excess mortality could be fully explained by severe HHT symptoms.Conclusion. This study suggests that HHT is more prevalent than previously believed. In young patients the disease is associated with an excess mortality which is fully attributable to HHT. Future research should aim at the identification of HHT patients at particular risk of developing severe complications.
The snack is critical for the blood glucose profile during treatment with regular insulin preprandially
Authors: Orre‐Pettersson A.‐C. , Lindström T. , Bergmark V. , Arnqvist H. J. 
Published: March 2003

Abstract.Objectives. To evaluate how a snack influences the blood glucose profile during treatment with preprandial regular human insulin.Design. In a randomized study a mid‐morning snack either was or was not served. Insulin was given 30 min before the usual breakfast of the patients. Plasma free insulin and blood glucose were repeatedly determined for 5 h.Setting. Outpatient clinic at a university hospital.Subjects. Twenty patients with type 1 diabetes treated with multiple injections of regular insulin (Actrapid®) and eight non‐diabetic subjects.Interventions. A mid‐morning snack either was or was not served 2 h after the usual morning insulin injection.Main outcome measures. A difference in the blood glucose profile after a mid‐morning snack.Results. With a snack there was no difference in blood glucose fasting and at 12.30 h, whilst without a snack there was a decrease of almost 4 mmol L−1, several patients experienced low blood glucose and three had hypoglycaemia. An extended peak of free insulin was reached 30 min after the insulin injection with a slow decrease to the fasting level after 5 h. After the insulin injection a significant decrease in blood glucose occurred within 30–45 minConclusions. A snack 2 h after the insulin injection results in a smoother blood glucose profile and reduces the risk of hypoglycaemia in patients with type 1 diabetes treated with preprandial regular human insulin. Furthermore, the recommended interval of 30 min between insulin injection and a meal may be too long.