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Selected AbstractsWhat are the high risk periods for incident substance use and transitions to abuse and dependence?INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue S1 2008Implications for early intervention, prevention Abstract Background: For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females. Methods: A sample of (N = 3021) community subjects aged 14,24 at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results: Ages 10,16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition. Conclusion: Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence. Copyright © 2008 John Wiley & Sons, Ltd. [source] Interspecific variation in primary seed dispersal in a tropical forestJOURNAL OF ECOLOGY, Issue 4 2008Helene C. Muller-Landau Summary 1We investigated the relationships of seed size, dispersal mode and other species characteristics to interspecific variation in mean primary seed dispersal distances, mean annual seed production per unit basal area, and clumping of seed deposition among 41 tropical tree species on Barro Colorado Island, Panama. 2A hierarchical Bayesian model incorporating interannual variation in seed production was used to estimate seed dispersal, seed production, and clumping of seed rain for each species from 19 years of data for 188 seed traps on a 50-ha plot in which all adult trees were censused every 5 years. 3Seed dispersal was modelled as a two-dimensional Student's T distribution with the degrees of freedom parameter fixed at 3, interannual variation in seed production per basal area was modelled as a lognormal, and the clumping of seed rain around its expected value was modelled as a negative binomial distribution. 4There was wide variation in seed dispersal distances among species sharing the same mode of seed dispersal. Seed dispersal mode did not explain significant variation in seed dispersal distances, but did explain significant variation in clumping: animal-dispersed species showed higher clumping of seed deposition. 5Among nine wind-dispersed species, the combination of diaspore terminal velocity, tree height and wind speed in the season of peak dispersal explained 40% of variation in dispersal distances. Among 31 animal-dispersed species, 20% of interspecific variation in dispersal distances was explained by seed mass (a negative effect) and tree height (a positive effect). 6Among all species, seed mass, tree height and dispersal syndrome explained 28% of the variation in mean dispersal distance and seed mass alone explained 45% of the variation in estimated seed production per basal area. 7Synthesis. There is wide variation in patterns of primary seed rain among tropical tree species. Substantial proportions of interspecific variation in seed production, seed dispersal distances, and clumping of seed deposition are explained by relatively easily measured plant traits, especially dispersal mode, seed mass, and tree height. This provides hope for trait-based generalization and modelling of seed dispersal in tropical forests. [source] Parents' Beliefs About Condoms and Oral Contraceptives: Are They Medically Accurate?PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 2 2004Marla E. Eisenberg CONTEXT: Parents are encouraged to be the primary sex educators for their children; however, little is known about the accuracy of parents' views about condoms and oral contraceptives. METHODS: Telephone surveys using validated measures provided data on beliefs about the effectiveness, safety and usability of condoms and the pill among 1,069 parents of 13,17-year-olds in Minnesota and Wisconsin in 2002. Pearson chi-square tests and multivariate logistic regression models were used to compare beliefs according to sex, age, race, religion, education, income and political orientation. RESULTS: Substantial proportions of parents underestimated the effectiveness of condoms for preventing pregnancy and sexually transmitted diseases (STDs). Only 47% believed that condoms are very effective for STD prevention, and 40% for pregnancy prevention. Fifty-two percent thought that pill use prevents pregnancy almost all the time; 39% thought that the pill is very safe. Approximately one-quarter of parents thought that most teenagers are capable of using condoms correctly; almost four in 10 thought that most teenagers can use the pill correctly. Fathers tended to have more accurate views about condoms than mothers did; mothers' views of the pill were generally more accurate than fathers'. Whites were more likely than nonwhites to hold accurate beliefs about the pill's safety and effectiveness; conservatives were less likely than liberals to hold accurate views about the effectiveness of condoms. CONCLUSION: Campaigns encouraging parents to talk with their teenagers about sexuality should provide parents with medically accurate information on the effectiveness, safety and usability of condoms and the pill. [source] Redeeming Apartheid's Legacy: Collective Guilt, Political Ideology, and CompensationPOLITICAL PSYCHOLOGY, Issue 3 2008Bert Klandermans This paper reports two studies among white South African students on feelings of collective guilt about apartheid and attitudes to affirmative action. Study 1 reports on 21 in-depth interviews, Study 2 on results from 180 survey questionnaires. Substantial proportions of the participants in both studies displayed feelings of collective guilt. Among participants in both studies who identified strongly with white South Africans, some displayed strong feelings of collective guilt while others displayed no such feelings. Our survey data suggest that political ideology functions as a moderator. Strong feelings of guilt were found among students who identified strongly with white South Africans and defined themselves as liberals. If they defined themselves as conservatives then no feelings of collective guilt were observed. Strong feelings of collective guilt were accompanied by positive attitudes toward affirmative action. The influence of political ideology on attitudes toward affirmative action was mediated by collective guilt. [source] Quality of Care for Acute Myocardial Infarction in Rural and Urban US HospitalsTHE JOURNAL OF RURAL HEALTH, Issue 2 2004Laura-Mae Baldwin MD ABSTRACT: Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI. [source] MENTORS AND CRIMINAL ACHIEVEMENT,CRIMINOLOGY, Issue 1 2006CARLO MORSELLI Much of the research focusing on conventional occupations concludes that mentored individuals are more successful in their careers than those who are not mentored. Early research in criminology made a similar claim. Yet contemporary criminology has all but ignored mentors. We investigate this oversight, drawing on Sutherland's insights on tutelage and criminal maturation and incorporating ideas on human and social capital. We argue that mentors play a key role in their protégés' criminal achievements and examine this hypothesis with data from a recent survey of incarcerated adult male offenders in the Canadian province of Quebec. In this sample, a substantial proportion of respondents reported the presence of an influential individual in their lives who introduced them to a criminal milieu and whom they explicitly regarded as a mentor. After studying the attributes of offenders and their mentors, we develop a causal framework that positions criminal mentor presence within a pathway that leads to greater benefits and lower costs from crime. [source] Screening for Adolescent Depression in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 5 2006Emily Gale Scott MD Abstract Objectives: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. Methods: The Beck Depression Inventory,2nd edition (BDI-II) was used to screen all patients 13,19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). Results: Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. Conclusions: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression. [source] Non-alcoholic fatty liver disease, the metabolic syndrome and the risk of cardiovascular disease: the plot thickensDIABETIC MEDICINE, Issue 1 2007G. Targher Abstract Non-alcoholic fatty liver disease (NAFLD) affects a substantial proportion of the general population and is frequently associated with many features of the metabolic syndrome (MetS). Currently, the importance of NAFLD and its relationship with the MetS is being increasingly recognized, and this has stimulated an interest in the possible role of NAFLD in the development of atherosclerosis. Recent studies have reported the association of NAFLD with multiple classical and non-classical risk factors for cardiovascular disease (CVD). Moreover, there is a strong association between the severity of liver histopathology in NAFLD patients and greater carotid artery intima-media thickness and plaque, and lower endothelial flow-mediated vasodilation (as markers of subclinical atherosclerosis) independent of obesity and other MetS components. Finally, it has recently been demonstrated that NAFLD is associated with an increased risk of all-cause death and predicts future CVD events independently of other prognostic factors, including MetS components. Overall, therefore, the evidence from these recent studies strongly emphasizes the importance of assessing the global CVD risk in patients with NAFLD. Moreover, these novel findings suggest a more complex picture and raise the possibility that NAFLD, as a component of the MetS, might not only be a marker but also an early mediator of CVD. [source] Recent concepts in non-alcoholic fatty liver diseaseDIABETIC MEDICINE, Issue 9 2005L. A. Adams Abstract Non-alcoholic fatty liver disease (NAFLD) is present in up to one-third of the general population and in the majority of patients with metabolic risk factors such as obesity and diabetes. Insulin resistance is a key pathogenic factor resulting in hepatic fat accumulation. Recent evidence demonstrates NAFLD in turn exacerbates hepatic insulin resistance and often precedes glucose intolerance. Once hepatic steatosis is established, other factors, including oxidative stress, mitochondrial dysfunction, gut-derived lipopolysaccharide and adipocytokines, may promote hepatocellular damage, inflammation and progressive liver disease. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies, however, staging the disease requires a liver biopsy. NAFLD is associated with an increased risk of all-cause death, probably because of complications of insulin resistance such as vascular disease, as well as cirrhosis and hepatocellular carcinoma, which occur in a minority of patients. NAFLD is also now recognized to account for a substantial proportion of patients previously diagnosed with ,cryptogenic cirrhosis'. Diabetes, obesity and the necroinflammatory form of NAFLD known as non-alcoholic steatohepatitis, are risk factors for progressive liver disease. Current treatment relies on weight loss and exercise, although various insulin-sensitizing medications appear promising. Further research is needed to identify which patients will achieve the most benefit from therapy. [source] All-cause mortality and fatal alcohol poisoning in Belarus, 1970,2005DRUG AND ALCOHOL REVIEW, Issue 5 2008YURY E. RAZVODOVSKY Abstract Introduction and Aims. Although alcohol appears to be an important contributor to the burden of disease in the countries of eastern Europe, little systematic research has been undertaken on its impact on mortality in the former Soviet republic of Belarus. There may be a number of factors underlying the particularly negative effect of alcohol on mortality in Belarus, including the pattern of drinking and use of surrogates. A solid body of research and empirical evidence suggests that hazardous patterns of alcohol consumption (binge drinking) lead to quicker and deeper intoxication, increasing the propensity for alcohol-related mortality. Design and Method. To estimate the aggregate level effect of binge drinking on the all-cause mortality rate, trends in the all-cause mortality and fatal alcohol poisoning rates (as a proxy for binge drinking) in Belarus from 1970 to 2005 were analysed employing AutoRegressive Integrated Moving Average (ARIMA) time,series analysis in order to assess a bivariate relationship between the two time,series. Results. The results of time,series analysis suggest a close relationship between all-cause mortality and fatal alcohol poisoning rates at the population level. Conclusions. This study supports the hypothesis that alcohol and all-cause mortality are connected closely in countries where the drinking culture is characterised by heavy drinking episodes and adds to the growing body of evidence that a substantial proportion of total mortality in Belarus is due to acute effects of binge drinking. [source] Progress in the development of new treatments for combined Alzheimer's and Parkinson's diseasesDRUG DEVELOPMENT RESEARCH, Issue 3 2002Eliezer Masliah Abstract Misfolding of synaptic molecules such as amyloid , peptide and ,-synuclein has been proposed to play a key role in the mechanisms of neurodegeneration in Alzheimer's and Parkinson's disease, respectively. Notably, the majority of patients with Alzheimer's disease also have ,-synuclein-immunoreactive Lewy bodies, and a substantial proportion of them develop a form of parkinsonism also known as Lewy body disease, that defies conventional therapies. Thus, factors involved in the pathogenesis of Alzheimer's disease might promote the development of particularly recalcitrant forms of Lewy body disease. We have shown that the amyloid , peptide 1-42, of Alzheimer's disease, promotes the toxic conversion of ,-synuclein and accelerates ,-synuclein-dependent deficits in transgenic mice. Understanding the mechanisms promoting the toxic conversion of ,-synuclein is of critical importance for the design of rationale treatments for Lewy body disease and transgenic models hold the promise for the development of such novel therapies. In this context therapies aimed at: (1) reducing amyloid , peptide 1-42 production, (2) blocking toxic ,-synuclein oligomerization (e.g., ,-synuclein, antioxidants), (3) promoting ,-synuclein protofibril degradation, and (4) protecting neurons (e.g., anti-oxidants, neurotrophic agents) against toxic ,-synuclein aggregates might prove to be significantly useful in the treatment of Lewy body disease. We characterized ,-synuclein, the non-amyloidogenic homologue of ,-synuclein, as an inhibitor of aggregation of ,-synuclein. Our results raise the intriguing possibility that ,-synuclein might be a natural negative regulator of ,-synuclein aggregation, and that a similar class of endogenous factors might modulate the toxic conversion of other molecules involved in neurodegeneration. Such an anti-amyloidogenic property of ,-synuclein in combination with other treatments might also provide a novel strategy for the treatment of neurodegenerative disorders. Drug Dev. Res. 56:282,292, 2002. © 2002 Wiley-Liss, Inc. [source] Long-term reproductive behaviour of woody plants across seven Bornean forest types in the Gunung Palung National Park (Indonesia): suprannual synchrony, temporal productivity and fruiting diversityECOLOGY LETTERS, Issue 10 2007Charles H. Cannon Abstract For 68 months, we observed the reproductive behaviour of 7288 woody plants (172 figs, 1457 climbers and 5659 trees) spanning major soil and elevational gradients. Two 2,3 month community-wide supra-annual fruiting events were synchronized across five forest types, coinciding with ENSO events. At least 27 genera in 24 families restricted their reproduction to these events, which involved a substantial proportion of tree diversity (> 80% of phylogenetic diversity). During these events, mean reproductive levels (8.5%) represented an almost four-fold increase compared with other months. These patterns indicate a strong behavioural advantage to this unusual reproductive behaviour. Montane forest experienced a single, separate fruiting peak while the peat swamp forest did not participate. Excluding these events, no temporal reproductive pattern was detectible, at either the landscape or forest type. These phenological patterns have major implications for the conservation of frugivore communities, with montane and swamp forests acting as ,keystone' forests. [source] Comparison of three models of alcohol craving in young adults: a cross-validationADDICTION, Issue 4 2004Peter M. McEvoy ABSTRACT Aims The aim of study 1 was to develop a three-factor Approach and Avoidance of Alcohol Questionnaire (AAAQ), designed to assess mild and intense inclinations to drink, as well as inclinations to avoid drinking. The aims of study 2 were to cross-validate the AAAQ with an independent sample and to test the goodness-of-fit of three models of craving for alcohol: (a) the traditional unidimensional model; (b) a two-dimensional, approach,avoidance ambivalence model; and (c) an expanded two-dimensional neuroanatomical model that retains avoidance, while positing a threshold that partitions approach into two distinct levels and relates all three factors involved in craving to brain pathways associated with inhibitory processes, reward and obsessive,compulsive behaviour, respectively. Design, setting and participants The survey was administered to 589 Australian university students (69% women) in study 1 and to 523 American university students (64% women) in study 2. Measurements Inclinations to drink and to not drink (AAAQ), drinking behaviour (quantity and frequency), drinking problems (Young Adult Alcohol Problems Screening Test; YAAPST) and readiness for change (Stages of Change Readiness and Treatment Eagerness Scale; SOCRATES). Findings The expanded two-dimensional neuroanatomical model provided the best fit to the data. The AAAQ explained a substantial proportion of the variance in drinking frequency (41,53%), drinking quantity (49,60%) and drinking problems (43%). AAAQ profiles differed as a function of drinking-related risk, and the three AAAQ scales differentially predicted readiness for change. Conclusions Approach and avoidance inclinations toward alcohol are separable constructs, and their activation may not be invariably reciprocal. Craving can be defined as the relative activation of substance-related response inclinations along these two primary dimensions. There may be a threshold of intensity that separates mild from intense approach inclinations. [source] Neurons with distinctive firing patterns, morphology and distribution in laminae V,VII of the neonatal rat lumbar spinal cordEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2003Péter Szűcs Abstract It is generally accepted that neurons in the ventral spinal grey matter, a substantial proportion of which can be regarded as constituents of the spinal motor apparatus, receive and integrate synaptic inputs arising from various peripheral, spinal and supraspinal sources. Thus, a profound knowledge concerning the integrative properties of interneurons in the spinal ventral grey matter appears to be essential for a fair understanding of operational principles of spinal motor neural assemblies. Using the whole cell patch clamp configuration in a correlative physiological and morphological experimental approach, here we demonstrate that the intrinsic membrane properties of neurons vary widely in laminae V,VII of the ventral grey matter of the neonatal rat lumbar spinal cord. Based on their firing patterns in response to depolarizing current steps, we have classified the recorded neurons into four categories: ,phasic', ,repetitive', ,single' and ,slow'. Neurons with firing properties characteristic of the ,phasic', ,repetitive' and ,single' cells have previously been reported also in the superficial and deep spinal dorsal horn, but this is the first account in the literature in which ,slow' neurons have been recovered and described in the spinal cord. The physiological heterogeneity in conjunction with the morphological correlation and distribution of neurons argues that different components of motor neural assemblies in the spinal ventral grey matter possess different signal processing characteristics. [source] Roots, rhizosphere and soil: the route to a better understanding of soil science?EUROPEAN JOURNAL OF SOIL SCIENCE, Issue 1 2006P.J. Gregory Summary The centenary of Hiltner's recognition of a rhizosphere effect is a convenient point to assess the impact of such thinking on the direction of soil science. A review of the major soil journals suggests that for much of the last century, Hiltner's insight had little effect on mainstream thinking outside of soil microbiology, but this situation is changing rapidly as the consequences of spatial and temporal heterogeneity on soil functioning assumes greater importance. Studies of root growth, root distributions and of rhizosphere processes over the last 25 years demonstrate both the size and distribution of root systems and the associated inputs from roots to soils. These inputs result in a plethora of dynamic reactions at the root,soil interface whose consequences are felt at a range of temporal and spatial scales. Root growth and respiration, rhizodeposition, and uptake of water and nutrients result in biological, chemical and physical changes in soils over variable distances from the root surface so that the rhizosphere has different dimensions depending on the process considered. At the root length densities common for many crop species, much of the upper 0.1 m of soil might be influenced by root activity for mobile nutrients, water and root-emitted volatile compounds for a substantial proportion of the growing season. This brief review concludes that roots are an essential component of soil biology and of soil science. [source] BALANCING SELECTION, RANDOM GENETIC DRIFT, AND GENETIC VARIATION AT THE MAJOR HISTOCOMPATIBILITY COMPLEX IN TWO WILD POPULATIONS OF GUPPIES (POECILIA RETICULATA)EVOLUTION, Issue 12 2006Cock van Oosterhout Abstract Our understanding of the evolution of genes of the major histocompatibility complex (MHC) is rapidly increasing, but there are still enigmatic questions remaining, particularly regarding the maintenance of high levels of MHC polymorphisms in small, isolated populations. Here, we analyze the genetic variation at eight microsatellite loci and sequence variation at exon 2 of the MHC class IIB (DAB) genes in two wild populations of the Trinidadian guppy, Poecilia reticulata. We compare the genetic variation of a small (Ne, 100) and relatively isolated upland population to that of its much larger (Ne, 2400) downstream counterpart. As predicted, microsatellite diversity in the upland population is significantly lower and highly differentiated from the population further downstream. Surprisingly, however, these guppy populations are not differentiated by MHC genetic variation and show very similar levels of allelic richness. Computer simulations indicate that the observed level of genetic variation can be maintained with overdominant selection acting at three DAB loci. The selection coefficients differ dramatically between the upland (s 0.2) and lowland (s, 0.01) populations. Parasitological analysis on wild-caught fish shows that parasite load is significantly higher on upland than on lowland fish, which suggests that large differences in selection intensity may indeed exist between populations. Based on the infection intensity, a substantial proportion of the upland fish would have suffered direct or indirect fitness consequences as a result of their high parasite loads. Selection by parasites plays a particularly important role in the evolution of guppies in the upland habitat, which has resulted in high levels of MHC diversity being maintained in this population despite considerable genetic drift. [source] Dimensions of Mothers' and Fathers' Differential Treatment of Siblings: Links With Adolescents' Sex-Typed Personal Qualities,FAMILY RELATIONS, Issue 1 2003Corinna Jenkins Tucker We explored mothers' and fathers' differential treatment (PDT) of their adolescent offspring in five domains (privileges, chores, affection, discipline, and temporal involvement) and examined how siblings' personal qualities were associated with PDT. Participants were 188 families with first- and secondborn adolescents. Equal treatment was the modal parental style except for privileges and discipline. Even where equal treatment was normative a substantial proportion of parents reported differential treatment. Further, the similarity of the nature of parents' differential treatment varied by domain. Sex was associated with parents' differential temporal involvement. Sex-typed personal qualities were related to parents' differential discipline. Both sex and sex-typed personal characteristics were linked to differential affection. Privileges and chores were associated with age and birth order. [source] Domestic Violence and Out-of-hospital ProvidersA Potential Resource to Protect Battered WomenACADEMIC EMERGENCY MEDICINE, Issue 3 2000M. Elaine Husni MD Abstract Objective: The primary objective was to determine the prevalence of domestic violence (DV) in a subset of women presenting to the Boston emergency medical services (EMS) system and to evaluate documentation. A secondary objective was to determine the rate of refusal of transport to the hospital for DV-positive patients, compared with the general population. Methods: A retrospective chart review of ambulance run sheets from a nonconsecutive, convenience sample between July and December 1995 was performed. Women presenting with injury, obstetric/gynecologic complaints, or psychiatric complaints were included. Records were reviewed, and labeled as positive, probable, suggestive, or negative for DV, based on a previously used classification system. A weighted kappa test was performed, and data were analyzed using chi-square and t-test. Results: Among 1,251 charts reviewed, 876 met criteria for inclusion. The percentage of positive cases was 5.4% (95% CI = 3.9% to 6.9%), probable 10.8% (8.8% to 12.9%), suggestive 2.6% (1.6% to 3.7%), and negative 81.2% (78.6% to 83.6%). Among DV-positive patients, the refusal to transport rate was 23.4% (11.3% to 35.5%), compared with a 7.1% (5.8% to 9.3%) rate for the entire study population (n= 876), and 4.7% for the general Boston EMS population during the same year. More DV patients presented during the night shift compared with other shifts. Conclusions: Domestic violence is common in this high-risk population. A substantial proportion of women in this population refuse transport to the hospital. Out-of-hospital personnel should be trained with the tools to identify and document DV, assess patient safety, offer timely resources, and empower victims to make choices. [source] IL-6 inhibition in the treatment of rheumatoid arthritisFUTURE PRESCRIBER, Issue 3 2007FRCP Professor of experimental rheumatology, Peter Taylor MA, honorary consultant rheumatologist The armentarium of potential therapeutics for rheumatoid arthritis (RA) has grown with the identification of relevant disease molecules. Of these, biologic therapeutics targeting tumour necrosis factor-alpha (TNF-alpha), particularly when used in combination with oral methotrexate, have enjoyed notable success in suppressing inflammation and markedly inhibiting the progression of structural damage previously thought to be an unavoidable characteristic of RA.1,2 However, despite the unprecedented clinical and commercial successes of TNF inhibitors, their availability is restricted by high costs and the failure of a substantial proportion of patients to demonstrate significant clinical responses. Copyright © 2007 John Wiley & Sons, Ltd. [source] Prevalence and characteristics of older community residents with mild cognitive declineGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2002Yoshinori Fujiwara Background:, Cognitive impairment is a major health issue, but epidemiological data on mild cognitive decline have been almost absent in Japan. Methods: Of all residents aged 65 years and over living in Yoita town, Niigata Prefecture, Japan in the year 2000 (n = 1673), 1544 participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio-demographic, psychological, physical and medical, and social activity items. Higher-level functional capacities were evaluated with the Tokyo Metropolitan Index of Competence (TMIG-Index of Competence). According to subject's age and MMSE score, all subjects were classified into 3 groups: control (MMSE,>,1 SD below age-specific means), mild cognitive decline (MMSE,,,21 and ,,1 SD below age-specific means), and severe cognitive decline (MMSE,,,20), and compared various characteristics among these groups. Results: Mean MMSE score of the subjects showed a linear decline with advancing age. Among the participants, 232 (15.2%) were classified as mild cognitive decline. Compared with the controls, the subjects with mild cognitive decline reported poorer subjective health, more depressive moods, more history of stroke, more prevalence of basic activity of daily living (BADL) disability, and lower higher-level functional capacity, even after controlling for possible confounding factors. They also reported a low level of social activities: both participating in group activities and enjoying hobbies were less frequent. Their food intake pattern tended to be monotonous. Conclusions: Older persons with mild cognitive decline comprised a substantial proportion (15.2%) of the community-dwelling older population. In addition to lower cognitive function, they had lower levels of functional capacity and social activity. [source] Dental status and dental caries in 85-year-old DanesGERODONTOLOGY, Issue 1 2007Lene Vilstrup Objectives:, This study reports findings on the dental status and the prevalence of dental caries among a group of 85-year-old Danes from the Glostrup 1914 Cohort, Denmark. The purpose of the study was to analyse whether caries experience was related to number of teeth and to indicators of functional ability and cognitive function. Methods:, A total of 191 individuals (78 men and 113 women) participated in a cross-sectional population study conducted in 2000. Using mobile dental equipment, a clinical oral examination and an interview were administered to all participants in their homes. Functional ability was measured by the Mob-H scale and cognitive function was assessed by the Mini-Mental State Examination. Results:, Fifty-nine per cent of the participants had their own natural teeth and for the dentate participants, the mean number of teeth was 13 (range 1,27). A high prevalence of active caries on coronal and root surfaces was observed. Older adults with few natural teeth had a higher prevalence of active coronal and root caries and a higher unmet treatment need than older adults with many teeth. Further, the study showed that 85-year-old persons with reduced functional ability and cognitive impairment tended to have more active caries than 85-year-olds with no impairment. Conclusions:, A substantial proportion of 85-year-old individuals had retained a natural dentition; however, active dental caries is a problem of concern among the most elderly. [source] Clinical Efficacy of Frovatriptan: Placebo-Controlled StudiesHEADACHE, Issue 2002R. Ryan MD Objective.,To confirm the clinical efficacy of frovatriptan 2.5 mg. Background.,Frovatriptan is a new 5-hydroxytryptamine (5-HT)1B/1D receptor agonist being developed for the acute treatment of migraine with or without aura. Results from preclinical and clinical pharmacology studies showed frovatriptan to be a potent 5-HT1B receptor agonist with a long terminal elimination half-life (26 hours) and a broad therapeutic index. Design.,Three randomized, placebo-controlled, double-blind, parallel-group trials, in a total of 2676 patients, were performed to confirm the clinical efficacy of frovatriptan 2.5 mg for the acute treatment of migraine. Results.,In all three studies, headache response 2 hours after frovatriptan dosing was significantly greater than that seen with placebo (P.001) with approximately a two-fold measure of effect over placebo for headache response at 2 and 4 hours postdosing. Time to headache response occurred within 1.5 hours in a substantial proportion of patients. The incidence of 24-hour headache recurrence with frovatriptan was low (10% to 25%). Frovatriptan therapy also was associated with a high degree of patient satisfaction. Conclusions.,Frovatriptan represents a consistently effective acute treatment for migraine and accompanying symptoms. [source] Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false resultsHEALTH EXPECTATIONS, Issue 4 2002Heather M. Davey BPsych (Hons) Abstract Objective, To determine women's preferences for and reported experience with medical test decision-making. Design, Computer-assisted telephone survey. Setting and participants, Six hundred and fifty-two women resident in households randomly selected from the New South Wales electronic white pages. Main outcome measures, Reported and preferred test and treatment (for comparison) decision-making, satisfaction with and anxiety about information on false results and side-effects; and effect of anxiety on desire for such information. Results, Overall most women preferred to share test (94.6%) and treatment (91.2%) decision-making equally with their doctor, or to take a more active role, with only 5.4,8.9% reporting they wanted the doctor to make these decisions on their behalf. This pattern was consistent across all age groups. In general, women reported experiencing a decision-making role that was consistent with their preference. Women who had a usual doctor were more likely to report experiencing an active role in decision-making. More women reported receiving as much information as they wanted about the benefits of tests and treatment than about the side-effects of tests and treatment. Most women wanted information about the possibility of false test results (91.5%) and test side-effects (95.6%), but many reported the doctor never provided this information (false results = 40.0% and side-effects = 31.3%). A substantial proportion said this information would make them anxious (false results = 56.6% and side-effects = 43.1%), but reported they wanted the information anyway (false results = 77.6% and side-effects = 88.1%). Conclusions, Women prefer an active role in test and treatment decision-making. Many women reported receiving inadequate information. If so, this may jeopardize informed decision-making. [source] Mucosal Production of Antigastric Autoantibodies in Helicobacter pylori GastritisHELICOBACTER, Issue 3 2000Gerhard Faller Background. Apart form bacterial virulence factors of Helicobacter pylori, certain host factors influence the pathogenesis of H. pylori gastritis. In particular, antigastric autoantibodies that are detectable in the sera of a substantial proportion of H. pylori were shown to correlate with the development of gastric atrophy. The aim of this study was to analyze the possible antigastric autoimmune response in H. pylori gastritis at the site where the action is, i.e., in the gastric mucosa. Material and Methods. Gastric biopsy specimens from antrum and corpus mucosa of 24 H. pylori,infected and of 33 noninfected patients were cultured for 3 days, and tissue culture supernatants were analyzed for the amount of locally produced IgA and IgG. Antigastric autoantibodies were screened in the sera and in the supernatants by means of immunohistochemistry. Results. The infected patients had significantly higher concentrations of locally produced IgA, whereas the IgG concentrations were virtually the same in infected and noninfected patients. IgG or IgA antigastric autoantibodies, or both, were detectable only in the sera (38%) and supernatants (17%) of infected patients. Interestingly, the patient with the strongest local autoimmune response showed body-predominant H. pylori gastritis, with destruction of gastric glands and atrophy of the body mucosa. Conclusions. These results demonstrate that antigastric autoimmune reactions are detectable at the site of the disease and might be relevant for the pathogenesis of gastric mucosa atrophy in H. pylori gastritis. [source] IP-10 predicts viral response and therapeutic outcome in difficult-to-treat patients with HCV genotype 1 infection,HEPATOLOGY, Issue 6 2006Martin Lagging Plasma from 173 patients with HCV genotype 1 infection was analyzed for IP-10 levels prior to treatment with pegylated interferon-,-2a and ribavirin. Significantly lower IP-10 levels were observed in patients achieving a rapid viral response (RVR) (P < .0001), even in those with body mass index (BMI) , 25 kg/m2 (P = .004) and with baseline viral load , 2 million IU/mL (P = .001). Similarly, significantly lower IP-10 levels were observed in patients obtaining a sustained viral response (SVR) (P = .0002), including those having higher BMI (P < .05), higher viral load (P = .0005), and both higher BMI and viral load (P < .03). In multivariate logistic regression analyses, a low IP-10 value was independently predictive of both RVR and SVR. A baseline cutoff IP-10 value of 600 pg/mL yielded a negative predictive value (NPV) of 79% (19/24) for all genotype 1,infected patients, which was comparable with that observed using a reduction in HCV-RNA by at least 2 logs after 12 weeks of therapy (NPV 86%; 19/22); by combining the two, 30 of 38 patients (NPV 79%) potentially could have been spared unnecessary therapy. In patients having both higher BMI and viral load, cut-off levels of 150 and 600 pg/mL yielded a positive predictive value (PPV) of 71% and NPV of 100%, respectively. In conclusion, pretreatment IP-10 levels predict RVR and SVR in patients infected with HCV genotype 1, even in those with higher BMI and viral load. A substantial proportion of the latter patients may achieve SVR in spite of unfavorable baseline characteristics if their pretreatment IP-10 level is low. Thus, pretreatment IP-10 analysis may prove helpful in decision-making regarding pharmaceutical intervention. (HEPATOLOGY 2006;44:1617,1625.) [source] Case,control genetic association study of fibulin-6 (FBLN6 or HMCN1) variants in age-related macular degeneration (AMD),HUMAN MUTATION, Issue 4 2007Sheila A. Fisher Abstract This article reports a well-powered age-related macular degeneration (AMD) case,control association study in the HMCN1 gene, showing that common variants do not account for a substantial proportion of AMD cases. Thus, the consistent linkage peak observed by several genome-wide linkage scans within the 1q32 region is unlikely to be attributed to polymorphisms at the HMCN1 locus. In addition, the analysis provides comprehensive data suggesting that low-frequency variants encoding possible functional amino acid polymorphisms in the HMCN1 gene may not contribute substantially to disease, although HMCN1 mutations may still confer disease susceptibility in a small subset of patients. Interestingly, the HMCN1 p.Gln5346Arg mutation, which is thought to be a causal mutation in a large AMD pedigree segregating the disease as a single-gene trait, appears to occur in our control cohort as a low-frequency polymorphism with an allele frequency of approximately 0.0026. Hum Mutat 28(4), 406,413, 2007. © 2007 Wiley-Liss, Inc. [source] Novel germline BRCA1 and BRCA2 mutations in breast and breast/ovarian cancer families from the Czech Republic ,,HUMAN MUTATION, Issue 6 2001Eva Machackova Abstract Germline mutations in breast cancer susceptibility genes, BRCA1 and BRCA2, are responsible for a substantial proportion of high-risk breast and breast/ovarian cancer families. To characterize the spectrum of BRCA1 and BRCA2 mutations, we screened Czech families with breast/ovarian cancer using the non-radioactive protein truncation test, heteroduplex analysis and direct sequencing. In a group of 100 high-risk breast and breast/ovarian cancer families, four novel frame shift mutations were identified in BRCA1 and BRCA2 genes. In BRCA1, two novel frame shift mutations were identified as 3761-3762delGA and 2616-2617ins10; in BRCA2, two novel frame shift mutations were identified as 5073-5074delCT and 6866delC. Furthermore, a novel missense substitution M18K in BRCA1 gene in a breast/ovarian cancer family was identified which lies adjacent just upstream of the most highly conserved C3HC4 RING zinc finger motif. To examine the tertiary structure of the RING zinc finger domain and possible effects of M18K substitution on its stability, we used threading techniques according to the crystal structure of RAG1 dimerization domain of the DNA-binding protein. © 2000 Wiley-Liss, Inc. [source] Beyond the enterprise: trade union representation of freelances in the UKHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 2 2004Edmund Heery Interest has grown in the methods that trade unions can use to organise and represent the substantial proportion of the workforce engaged in ,contingent work'. This article examines trade union representation of self-employed freelances in the UK. Empirical material is presented from case studies of the media and entertainment unions, with their long history of representing freelances, and more recently established unions representing freelance tour guides, interpreters and translators. The analysis indicates that there is a distinctive form of freelance unionism in the UK which is distinguished by its emphasis on organising and representing workers in the external labour market where they seek work and develop a mobile career. This orientation ,beyond the enterprise' distinguishes freelance unionism from the dominant form of unionism in Britain. [source] Elevated metabolic costs while resting on water in a surface feeder: the Black-legged Kittiwake Rissa tridactylaIBIS, Issue 1 2007ELIZABETH M. HUMPHREYS Measurements of the energy costs of individual behaviours provide insights into how animals trade-off resource allocation and energy acquisition decisions. The energetic costs while resting on water are poorly known for seabirds but could comprise a substantial proportion of their daily energy expenditure. We measured the cost of resting on water in Black-legged Kittiwakes Rissa tridactyla, a species which does not fly during the night and for which estimating energy expenditure while resting on the water is therefore important. Their resting metabolic rate on water at 12.5 °C was at least 40% higher compared with resting at the same temperature in air. This indicates that, at comparable temperatures, metabolic costs are elevated for birds resting at sea compared with on land. We argue that Kittiwakes meet much of this extra thermoregulatory demand by dedicated metabolic activity. During the winter months, their costs are likely to be even higher owing to lower sea temperatures. Accordingly, we suggest that migration to milder latitudes, following breeding, will provide enhanced benefits, particularly to seabirds such as Kittiwakes which rest on the sea surface during darkness. [source] Prevalence of BRCA1 and BRCA2 mutations in Pakistani breast and ovarian cancer patientsINTERNATIONAL JOURNAL OF CANCER, Issue 12 2006Muhammad U. Rashid Abstract Among Asian countries, Pakistan has the highest rates of breast and ovarian cancer. To assess the contribution of the BRCA1 and BRCA2 germ line mutations to these high rates, we conducted the first study of 176 Pakistani breast and ovarian cancer patients, selected on family history and on age of diagnosis. Comprehensive BRCA mutation screening was performed using a range of techniques, including denaturing high-pressure liquid chromatography, single strand conformational polymorphism analysis and protein truncation test, followed by DNA sequencing. Thirty deleterious germ-line mutations were identified in the 176 families (17.0%), including 23 in BRCA1 and 7 in BRCA2. Four mutations, 185delAG, 185insA, S1503X and R1835X, were recurrent; these accounted for 52% of all identified BRCA1 mutations. Haplotype analyses suggested founder effects for 3 of these. The prevalence of BRCA1 or BRCA2 mutations was 42.8% for families with multiple cases of breast cancer, and was 50.0% for the breast/ovarian cancer families. The prevalence of mutations was 11.9% for single cases of early-onset breast cancer (,30 years) and was 9.0% for single cases of early-onset ovarian cancer (,45 years). Our findings show that BRCA mutations account for a substantial proportion of hereditary breast/ovarian cancer and early-onset breast and ovarian cancer cases in Pakistan. © 2006 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||||||||||||||