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Selected AbstractsAcupuncture , a critical analysisJOURNAL OF INTERNAL MEDICINE, Issue 2 2006E. ERNST Abstract. Even though widely used in today's clinical practice, acupuncture has remained a controversial subject. Many reviews are currently available but most lack a critical stance and some are overtly promotional. The aim of this overview is to provide a balanced, critical analysis of the existing evidence. Some of the original concepts of traditional acupuncture are not supported by good scientific evidence. Several plausible theories attempt to explain how acupuncture works but none are proved beyond doubt. The clinical effectiveness of acupuncture continues to attract controversy. Many controlled clinical trials and numerous systematic reviews of these studies have been published. Considerable problems are encountered when interpreting these data. Heterogeneity is a significant drawback of both clinical trials and systematic reviews. Some of the controversies may be resolved through the use of the new ,placebo needles' which enable researchers to adequately control for placebo effects of acupuncture. The majority of studies using such devices fails to show effects beyond a placebo response. Acupuncture has been associated with serious adverse events but most large-scale studies suggest that these are probably rare. Nonserious adverse effects occur in 7,11% of all patients. In conclusion, acupuncture remains steeped in controversy. Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response. [source] Behavioural treatment of urinary incontinence and encopresis in children with learning disabilities: transfer of stimulus controlDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2000Linda Smith MAMSc Clinical Psychologist Urinary and faecal incontinence present a considerable problem in people with learning disabilities, despite the general effectiveness of behavioural techniques in continence training. Children with learning disabilities and obsessional behaviour may be particularly resistant to toilet training, even where relatively cognitively able, and often despite a substantial degree of control over their eliminatory functions. Their resistance may be more appropriately regarded as a challenging behaviour and their incontinence better explained by factors other than a simple failure to learn. A 'stimulus-control'hypothesis proposes that the child's nappy (diaper) /potty/underwear has developed strong stimulus control over the elimination response. This report describes three case studies in which treatment-resistant children, aged between 8 and 12 years, with mild or moderate learning disabilities, were successfully treated for nappy-dependent nocturnal encopresis or diurnal urinary incontinence. The children were routine case referrals for whom previous attempts to train bowel or bladder control had failed. Behavioural techniques, such as 'shaping'(gradually increasing the proximity to the toilet),,fading'(reducing the presence of the nappy), and rewards for eliminating, effected successful transfer of stimulus control over elimination from nappy to toilet. Treatment times varied, depending on the degree of the child's obsession and resistance to change. [source] EFNS guideline on the diagnosis and management of alcohol-related seizures: report of an EFNS task forceEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2005G. Bråthen Despite being a considerable problem in neurological practice and responsible for one-third of seizure-related admissions, there is little consensus as to the optimal investigation and management of alcohol-related seizures. The final literature search was undertaken in September 2004. Consensus recommendations are given graded according to the EFNS guidance regulations. To support the history taking, use of a structured questionnaire is recommended. When the drinking history is inconclusive, elevated values of carbohydrate-deficient transferrin and/or gammaglutamyl transferase can support a clinical suspicion. A first epileptic seizure should prompt neuroimaging (CT or MRI). Before starting any carbohydrate containing fluids or food, patients presenting with suspected alcohol overuse should be given prophylactic thiamine parenterally. After an alcohol withdrawal seizure (AWS), the patient should be observed in hospital for at least 24 h and the severity of withdrawal symptoms needs to be followed. For patients with no history of withdrawal seizures and mild to moderate withdrawal symptoms, routine seizure preventive treatment is not necessary. Generally, benzodiazepines are efficacious and safe for primary and secondary seizure prevention; diazepam or, if available, lorazepam, is recommended. The efficacy of other drugs is insufficiently documented. Concerning long-term recommendations for non-alcohol dependant patients with partial epilepsy and controlled seizures, small amounts of alcohol may be safe. Alcohol-related seizures require particular attention both in the diagnostic work-up and treatment. Benzodiazepines should be chosen for the treatment and prevention of recurrent AWS. [source] Exploring social mobility with latent trajectory groupsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2008Patrick Sturgis Summary., We present a new methodological approach to the study of social mobility. We use a latent class growth analysis framework to identify five qualitatively distinct social class trajectory groups between 1980 and 2000 for male respondents to the 1970 British Cohort Study. We model the antecedents of trajectory group membership via multinomial logistic regression. Non-response, which is a considerable problem in long-term panels and cohort studies, is handled via direct maximum likelihood estimation, which is consistent and efficient when data are missing at random. Our results suggest a combination of meritocratic and ascriptive influences on the probability of membership in the different trajectory groups. [source] Significance of hypocarbia in the development of periventricular leukomalacia in preterm infantsPEDIATRICS INTERNATIONAL, Issue 3 2004Christina Giannakopoulou AbstractBackground:,Despite rapid advances in the management of preterm infants, periventricular leukomalacia (PVL) remains a considerable problem in neonatal intensive care. The aim of this study was to determine whether hypocarbia is associated with the development of PVL in mechanically ventilated, preterm infants and to emphasize the importance of avoiding this disturbance. Methods:,The authors evaluated 52 mechanically ventilated infants with a gestational age of <34 weeks, who exhibited hypocarbia in the first three postnatal days (lowest carbon dioxide tension being <25 mmHg). These infants were then compared with 52 infants in a control group not exhibiting hypocarbia, matched for birthweight and gestational age. A diagnosis of PVL was made on the basis of the results of cranial ultrasonography. Confounding factors potentially associated with the development of PVL were controlled in logistic regression analyses. Results:,Of the 52 mechanically ventilated preterm infants with hypocarbia, 10 (19.2%) developed cystic PVL, and six (11.5%) developed periventricular echodensity. Of the 52 infants in the control group only two (3.8%) developed cystic PVL, and one (1.9%) infant developed periventricular echodensity. The authors observed no significant differences in other prenatal and perinatal risk factors between the two groups. Conclusion:,Hypocarbia in mechanically ventilated preterm infants during the first days of life is suggested as being an independent predictor of PVL, predisposing these infants to subsequent neurodevelopmental delay. [source] Malnutrition after oesophageal cancer surgery in SwedenBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2007L. Martin Background: Oesophageal cancer resection carries a risk of nutritional disorders. The aim of this study was to estimate weight change after surgery in a population-based setting and to identify nutritional problems that might correlate with weight loss. Methods: Data were collected through the Swedish Esophageal and Cardia Cancer Register, a nationwide registry of oesophageal cancer surgery. Patients who underwent oesophageal cancer surgery between 2001 and 2004 were followed up until April 2005, and data on patient and tumour characteristics and surgical treatment were collected. Six months after surgery the patients were asked to complete a questionnaire about weight and a health-related quality of life questionnaire (European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) with an oesophageal-specific module (EORTC QLQ-OES18)). Results: The response rate to the questionnaire was 76·9 per cent and weight change in 226 patients was analysed. Six months after operation 63·7 per cent had lost more than 10 per cent of their preoperative BMI, and 20·4 per cent had lost more than 20 per cent. Appetite loss, eating difficulties and odynophagia were significantly linked to postoperative weight loss, whereas dysphagia or reflux did not correlate with malnutrition. Conclusion: Malnutrition is a considerable problem after oesophagectomy, and is linked to appetite loss, eating difficulties and odynophagia. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Prevalence and characteristics of child physical abuse in Sweden , findings from a population-based youth surveyACTA PAEDIATRICA, Issue 8 2010E-M Annerbäck Abstract Aim:, To examine prevalence rates of child physical abuse perpetrated by a parent/caretaker, abuse characteristics and the extent of disclosures. Methods:, A population-based survey was carried out in 2008 amongst all the pupils in three different grades (n = 8494) in schools in Södermanland County, Sweden. The pupils were asked about their exposure to violence and their experiences of parental intimate-partner violence. Data were analysed with bi- and multivariate models and a comparison between means of accumulating risk factors between three groups were performed. Results:, A total of 15.2% of the children reported that they had been hit. There were strong associations between abuse and risk factors and there was a dose,response relationship between risks and reported abuse. It was shown that children who reported parental intimate-partner violence were at a considerably higher risk for abuse than other children and that only 7% of the children exposed to violence had disclosed this to authorities. Conclusion: Even though child abuse in Sweden has decreased markedly during the last 40 years, violence against children is still a considerable problem. It is a challenge to develop methods of assessment and interventions that will ensure that the violence and its underlying causes are directly addressed. [source] Electrochemical Nitric Oxide Sensors for Biological Samples , Principle, Selected Examples and ApplicationsELECTROANALYSIS, Issue 1 2003Fethi Bedioui Abstract The discoveries made in the 1980s that NO could be synthesized by mammalian cells and could act as physiological messenger and cytotoxic agent had elevated the importance of its detection. The numerous properties of NO, that enable it to carry out its diverse functions, also present considerable problems when attempting its detection and quantification in biological systems. Indeed, its total free concentration in physiological conditions has been established to be in nanomolar range. Thus, detection of nitric oxide remains a challenge, pointing out the difficult dual requirements for specificity and sensitivity. Exception made for the electrochemical techniques, most of the approaches (namely UV-visible spectroscopy, fluorescence, electron paramagnetic resonance spectroscopy) use indirect methods for estimating endogenous NO, relying on measurements of secondary species such as nitrite and nitrate or NO-adducts. They also suffer from allowing only ex situ measurements. So, the only strategies that allow a direct and in vivo detection of NO are those based on the use of ultramicroelectrodes. The reality is that surface electrode modification is needed to make the ultramicroelectrode material selective for NO. Therefore, the design of modified electrode surfaces using organized layers is very attractive and provides the ideal strategy. This review addresses a global description of the various approaches that have involved chemically modified microelectrodes specially designed for the electrochemical detection of NO in biological media. Selected significant examples of applications in biological tissues are also reported in order to highlight the importance of this approach in having new insights into the modulatory role of NO in physiology and pathophysiology. [source] Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countriesJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 1 2009Archana Rastogi Abstract Background and Aim:, A major challenge in neonatal cholestasis (NC) is to differentiate biliary atresia (BA) from other non-atretic causes. In developing countries there are considerable problems of late referral of NC cases and performing surgery without prelaparotomy liver biopsy that contributes to a high proportion of negative laparotomy and increased morbidity. We evaluated the hepatic histopathology for presence of features that correlate best with the diagnosis of BA and assessed the accuracy of percutaneous liver biopsy. Methods:, Fifty-five cases of NC that fulfilled the selection criteria and had liver biopsy available were analyzed. Among the 49 adequate liver biopsies, 28 cases were diagnosed as BA, 15 neonatal hepatitis (NH) and 6 were due to other causes. Validity of percutaneous liver biopsy diagnoses was compared with confirmed cases by laparotomy findings and 1-year follow up. Twelve histological parameters of confirmed cases of BA and NH were evaluated by logistic regression analyses. Results:, Ductular proliferation (P = 0.0002), bile duct and ductular bile plugs (P = 0.009), and portal fibrosis (P = 0.002) were the best indicators of BA and among them ductular proliferation was the most important in distinguishing BA from NH. Ductal plate malformation was observed in 17.9% cases of BA. Sensitivity and specificity of percutaneous liver biopsy for diagnosing BA was 88.2% each. Conclusion:, Percutaneous liver biopsy is highly accurate (88.2%) in diagnosing BA. In developing countries. This investigation should be done to decrease the frequency of negative laparotomy and to achieve cost,benefit with reduced morbidity. [source] Mixed method approaches to the investigation and mapping of buried Quaternary deposits: examples from southern EnglandARCHAEOLOGICAL PROSPECTION, Issue 2 2007Martin R. Bates Abstract The lower reaches of major river valleys usually present archaeologists with considerable problems where thick sequences of stratified alluvium bury archaeology. These situations are typical of the lower reaches of major river systems that are currently under intense pressure from urban development where the archaeological resource is consequently at risk. Here we demonstrate how mixed method approaches, utilizing a range of borehole methods, cone penetration testing and surface and subsurface geophysics coupled with microfossil assessment (Foraminifera/Ostracoda), can be used to model these deposits and predict locations and depths at which important archaeological remains may be located. The novelty of this approach is not in the application of individual techniques to the problem but in the combined methodology, which enables a structured and cost effective programme of works to be formulated and provides the best chance to understand the subsurface. Although this approach has been developed to facilitate the location of archaeological sites buried at depth within the route corridor of development projects it is also suitable for locating fossil-bearing sequences and mapping stratigraphical units in Quaternary science. We demonstrate the approach using two examples from southern England. Copyright © 2007 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||