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Selected AbstractsEffectiveness of screening and monitoring tests for diabetic retinopathy , a systematic reviewDIABETIC MEDICINE, Issue 7 2000A. Hutchinson SUMMARY Aims To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances. Methods A systematic review of the English language literature, published from 1983 to April 1999. Results Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non-mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity. Conclusion Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test. [source] Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease,,HEPATOLOGY, Issue 5 2010Kausik Das There is a paucity of community-based epidemiological data on nonalcoholic fatty liver (NAFL) among nonaffluent populations in developing countries. Available studies are radiological and/or biochemical and lack histological assessment, limiting their strength. We conducted a prospective epidemiological study comprising a 1:3 subsample of all adult (>18 years) inhabitants of a rural administrative unit of West Bengal, India. Subjects positive for hepatitis B virus and/or hepatitis C virus infection and consuming any amount of alcohol were excluded. Diagnosis of NAFL was by dual radiological screening protocol consisting of ultrasonographic and computed tomographic examination of the liver. Transient elastographic examination and liver biopsy were performed in a subset to identify significant liver disease. The risk factors of having NAFL were analyzed. A total of 1,911 individuals were analyzed, 7% of whom were overweight and 11% of whom had abdominal obesity. The prevalence of NAFL, NAFL with elevated alanine aminotransferase, and cryptogenic cirrhosis was 8.7%, 2.3%, and 0.2%, respectively. Seventy-five percent of NAFL subjects had a body mass index (BMI) <25 kg/m2, and 54% were neither overweight nor had abdominal obesity. The subjects with the highest risk of having NAFL were those with a BMI >25 kg/m2 (odds ratio 4.3, 95% confidence interval 1.6-11.5). Abdominal obesity, dysglycemia (fasting plasma glucose >100 mg/dL or elevated homeostatic model assessment of insulin resistance), and higher income were the other risk factors. Even having a normal BMI (18.5-24.9 kg/m2) was associated with a 2-fold increased risk of NAFL versus those with a BMI <18.5 kg/m2. Conclusion: There is a significant prevalence of NAFL and potentially significant liver disease, including cryptogenic cirrhosis, in this predominantly nonobese, nonaffluent population in a developing country. NAFL will be a major determinant of future liver disease burden in countries of the developing world. (HEPATOLOGY 2010) [source] Mucocutaneous Splendore-Hoeppli phenomenonJOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2008Mahmoud R. Hussein Splendore-Hoeppli phenomenon (asteroid bodies) is the in vivo formation of intensely eosinophilic material (radiate, star-like, asteroid or club-shaped configurations) around microorganisms (fungi, bacteria and parasites) or biologically inert substances. This study presents a literature review concerning Splendore-Hoeppli reaction in the mucocutaneous diseases. It examines the histopathological features, nature and differential diagnosis of this reaction. It also discusses the mucocutaneous infections and the non-infective diseases associated with it. Available studies indicate that several mucocutaneous infections can generate Splendore-Hoeppli reaction. The fungal infections include sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis. The bacterial infections include botryomycosis, nocardiosis and actinomycosis. The parasitic conditions include orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans. In addition, Splendore-Hoeppli reaction may be seen with non-infective pathology such as hypereosinophilic syndrome and allergic conjunctival granulomas. The Splendore-Hoeppli reaction material comprises antigen-antibody complex, tissue debris and fibrin. Although the exact nature of this reaction is unknown, it is thought to be a localized immunological response to an antigen-antibody precipitate related to fungi, parasites, bacteria or inert materials. The characteristic formation of the peribacterial or perifungal Splendore-Hoeppli reaction probably prevents phagocytosis and intracellular killing of the insulting agent leading to chronicity of infection. To conclude, Splendore-Hoeppli reaction is a tell tale of a spectrum of infections and reactive conditions. The molecular pathways involved in the development of this reaction are open for future investigations. [source] Central GABAA but not GABAB Receptors Mediate Suppressive Effects of Caudal Hindbrain Glucoprivation on the Luteinizing Hormone Surge in Steroid-Primed, Ovariectomized Female RatsJOURNAL OF NEUROENDOCRINOLOGY, Issue 7 2005S. R. Singh Abstract The neurochemical mechanisms that link caudal hindbrain glucoprivic-,sensitive' neurones with the forebrain gonadotrophin-releasing hormone (GnRH)-pituitary luteinizing hormone (LH) axis remain unclear. Available studies indicate that the amino acid neurotransmitter, ,-aminobutyric acid (GABA), inhibits reproductive neuroendocrine function, and that caudal fourth ventricular administration of the glucose antimetabolite, 5-thioglucose (5TG), enhances GABA turnover within discrete septopreoptic structures that regulate LH secretion. The current experiments utilized the selective GABAA and GABAB receptor antagonists, bicuculline and phaclofen, as pharmacological tools to investigate whether one or both receptor subtypes function within neural pathways that suppress GnRH neuronal transcriptional activation and LH release during central glucose deficiency. During the ascending phase of the afternoon LH surge, groups of steroid-primed, ovariectomized female Sprague-Dawley rats were pretreated by lateral ventricular administration of bicuculline, phaclofen, or vehicle only, before fourth ventricular injection of 5TG or vehicle. The data indicate that, 2 h after 5TG treatment, Fos immunoexpression by rostral preoptic GnRH neurones and plasma LH levels were diminished relative to the vehicle-treated controls, and that inhibitory effects of 5TG on these parameters were attenuated by pretreatment with bicuculline, but not phaclofen. These results demonstrate that central GABAA, but not GABAB receptor stimulation during hindbrain glucoprivation, is required for maximal inhibition of reproductive neuroendocrine function by this metabolic challenge. The current studies thus reinforce the view that central GABAergic neurotransmission mediates regulatory effects of central glucoprivic signalling on the GnRH-pituitary LH axis. [source] Arm and leg substrate utilization and muscle adaptation after prolonged low-intensity trainingACTA PHYSIOLOGICA, Issue 4 2010J. W. Helge Abstract This review will focus on current data where substrate metabolism in arm and leg muscle is investigated and discuss the presence of higher carbohydrate oxidation and lactate release observed during arm compared with leg exercise. Furthermore, a basis for a possible difference in substrate partitioning between endogenous and exogenous substrate during arm and leg exercise will be debated. Moreover the review will probe if differences between arm and leg muscle are merely a result of different training status rather than a qualitative difference in limb substrate regulation. Along this line the review will address the available studies on low-intensity training performed separately with arm or legs or as whole-body training to evaluate if this leads to different adaptations in arm and leg muscle resulting in different substrate utilization patterns during separate arm or leg exercise at comparable workloads. Finally, the influence and capacity of low-intensity training to influence metabolic fitness in the face of a limited effect on aerobic fitness will be challenged. [source] Is there a SSRI dose response in treating major depression?DEPRESSION AND ANXIETY, Issue 1 2003The case for re-analysis of current data, for enhancing future study design Abstract It has been widely stated that the available research data has not demonstrated a SSRI dose response for major depression. We re-evaluated the methods used to analyze the SSRI data by clarifying two key alternative definitions of dose response and their implications for enhancing analysis of currently available data as well as future study design. We differentiated "potential" dose response, which focuses exclusively on response excluding tolerability effects and asks whether differences in dose can result in significant differences in response, from "expressed" dose response, which incorporates all tolerability effects currently associated with dose (including those caused by study protocol or treatment practice) and asks whether differences in dose do result in significant differences in response. To analyze potential dose response for all studies, one should use a "dose-tolerant" sample, i.e., an ITT sample from which dropouts due to adverse events have been removed. To analyze an expressed dose response, an ITT sample is the optimum sample if the study conforms to several design specifications. In the absence of conformance to these specifications, an ITT sample may be an approximation of the appropriate sample. Given design limitations of currently available studies, a dose-tolerant sample may provide a more informative approximation of an optimal sample to be used in evaluating the expressed dose response that could be expected in the best clinical practice. Future studies of dose-response relations could be enhanced by taking into account the principles noted above, and currently available data should be reanalyzed based on these principles. This re-analysis is performed in a companion article [Baker et al. 2003, Depress Anxiety 17:1-9]. Depression and Anxiety 17:10,18, 2003. © 2003 Wiley-Liss, Inc. [source] Are antidepressants safe in the treatment of bipolar depression?ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2008A critical evaluation of their potential risk to induce switch into mania or cycle acceleration Objective:, To address whether switch of depression into hypomania or mania or cycle acceleration in patients with bipolar disorder is caused by antidepressants or whether this phenomenon is attributable to the natural history of bipolar disorder itself. Method:, A critical review of the literature, pointing at sources of bias that have been previously overlooked. For examining the causation in question, the Bradford,Hill criteria were applied, i.e. specificity of the potential causative agent, strength of effect, consistency in findings, dose,response relation, temporal relation with exposure to agent preceding effect and biological plausibility. Results:, There is a scarcity of randomized studies addressing the question, and the available studies all suffer from various forms of bias. However, there is some evidence suggesting that antidepressants given in addition to a mood stabilizer are not associated with an increased rate of switch when compared with the rate associated with the mood stabilizer alone. Conclusion:, When combined with a mood stabilizer, antidepressants given for acute bipolar depression seemingly do not induce a switch into hypomania or mania. Whether antidepressants may accelerate episode frequency and/or may cause other forms of destabilization in patients with bipolar disorder remain to be properly studied. [source] Economic aspects of diabetic foot care in a multidisciplinary setting: a reviewDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2007Giovanni A. Matricali Abstract Background To evaluate the economic aspects of diabetic foot care in a multidisciplinary setting. Method A review of the English language literature, published from 1966 to November 2005. Results The results of available studies on the cost-of-illness of diabetic foot problems are difficult to compare. Nevertheless trends concerning excess of costs, protraction in time of costs, positive correlation to severity of ulcer and/or peripheral vascular disease, contribution of in-hospital stay and length of stay, and the patient's own contribution to total costs, are obvious. Only a few cost-effectiveness and cost-utility studies are available. Most use a Markov based model to predict outcome and show an acceptable result on long-term. Conclusions Diabetic foot problems are frequent and are associated with high costs. A multidisciplinary approach to diabetic foot problems has proved to be cost saving with regard to cost of treatment itself. Nevertheless, it remained unclear if these savings could offset the overall costs involved in implementing this kind of approach. The few studies that address this issue specifically all show an acceptable cost-effectiveness, but often the profit will be evident after some years only, because long-term costs are involved. Based on these data, policymakers should foresee sufficient reimbursement for preventive and early curative measures, and not only for ,salvage manoeuvres'. Copyright © 2007 John Wiley & Sons, Ltd. [source] Insulin treatment and cardiovascular disease; friend or foe?DIABETIC MEDICINE, Issue 2 2005A point of view Abstract Background Several observational studies have shown that higher insulin levels are associated with an increased risk of cardiovascular disease. If higher endogenous insulin levels are causally related to cardiovascular disease, one might expect an increased risk of cardiovascular disease in patients treated with insulin, as this results in high circulating insulin levels. Such risk elevation might counteract the benefits of tight glucose control. Our objective was to explore the relationship between insulin therapy and cardiovascular disease in Type 1 and Type 2 diabetes mellitus using information from available literature. Summary of comment Several experimental studies in animals and humans support the presence of a harmful effect of insulin on the vascular endothelium. In prospective follow-up studies increased insulin dosage was associated with increased risks of cardiovascular disease, although confounding by indication could not be excluded. Randomized controlled trials in diabetic patients, comparing conventional with intensive glucose-lowering treatment, although showing a reduction in microvascular disease, showed no significant difference in the incidence of cardiovascular disease. The results with respect to exposure to insulin are, however, difficult to interpret due to insufficient information on exposure to insulin levels as well as confounding by glycaemic control and body mass index. In addition, these studies were not designed to address the question whether higher insulin use relates to increased cardiovascular risk. Conclusion Published research provides conflicting evidence as to whether exposure to high levels of exogenous insulin in diabetes mellitus affects the risk of cardiovascular disease. The currently available studies have a number of serious methodological restraints that limit accurate interpretation and conclusions in this area. [source] The prognosis and expected outcome of apical surgeryENDODONTIC TOPICS, Issue 1 2005SHIMON FRIEDMAN Clinicians should possess current knowledge about the prognosis and expected outcome of endodontic treatment, including apical surgery. This knowledge cannot be acquired by indiscriminate review of the many available studies because they vary in the level of evidence they provide. Therefore, seven studies that best comply with methodology criteria defining the levels of evidence were selected and used as the basis of this review. In spite of their methodological consistency, the outcomes reported in these studies still differ considerably, mainly because of differences in inclusion criteria. According to these studies, 37,91% of teeth can be expected to be healed, while up to 33% can still be healing several years after surgery. Importantly, 80,94% of teeth can remain in symptom-free function, even if they are not healed. Several pre-operative factors may influence the outcome of treatment; the outcome may be better in teeth with small lesions and excessively short or long root canal fillings, and it may be poorer in teeth treated surgically for the second time. With regard to intra-operative factors, the choice of the root-end filling material and the quality of the root-end filling may influence the outcome, while the retrograde retreatment procedure clearly offers a better outcome than the standard root-end filling. In summary, the expected outcome of apical surgery is good and therefore, before considering tooth extraction and replacement, apical surgery should be attempted when it is feasible. [source] Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: how strong is the evidence for persistent brain damage?ADDICTION, Issue 3 2006E. Gouzoulis-Mayfrank ABSTRACT Background The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine: MDMA and some analogues) causes selective and persistent neurotoxic damage of central serotonergic neurones in laboratory animals. Serotonin plays a role in numerous functional systems in the central nervous system (CNS). Consequently, various abnormalities including psychiatric, vegetative, neuroendocrine and cognitive disorders could be expected in humans following MDMA-induced neurotoxic brain damage. Aims In recent years, the question of ecstasy-induced neurotoxicity and possible functional sequelae has been addressed in several studies with drug users. The aim of this paper was to review this literature and weigh the strength of the evidence for persistent brain damage in ecstasy users. Methods We used Medline to view all available publications on ,ecstasy' or ,MDMA'. All available studies dealing with ecstasy users entered this analysis. Findings and conclusions Despite large methodological problems the bulk of evidence suggests residual alterations of serotonergic transmission in MDMA users, although at least partial restitution may occur after long-term abstinence. However, functional sequelae may persist even after longer periods of abstinence. To date, the most consistent findings associate subtle cognitive, particularly memory, impairments with heavy ecstasy use. However, the evidence cannot be considered definite and the issues of possible pre-existing traits or the effects of polydrug use are not resolved. Recommendations Questions about the neurotoxic effects of ecstasy on the brain remain highly topical in light of its popularity among young people. More longitudinal and prospective studies are clearly needed in order to obtain a better understanding of the possible long-term sequelae of ecstasy use in humans. [source] Selection of Antiepileptic Drug Polytherapy Based on Mechanisms of Action: The Evidence ReviewedEPILEPSIA, Issue 11 2000Charles L. P. Deckers Summary: Purpose: When monotherapy with antiepileptic drugs (AEDs) fails, combination therapy is tried in an attempt to improve effectiveness by improving efficacy, tolerability, or both. We reviewed the available studies (both animal and human) on AED polytherapy to determine whether AEDs can be selected for combination therapy based on their mechanisms of action, and if so, which combinations are associated with increased effectiveness. Because various designs and methods of analysis were used in these studies, it was also necessary to evaluate the appropriateness of these approaches. Methods: Published papers reporting on AED polytherapy in animals or humans were identified by Medline search and by checking references cited in these papers. Results: Thirty-nine papers were identified reporting on two-drug AED combinations. Several combinations were reported to offer improved effectiveness, but no uniform approach was used in either animal or human studies for the evaluation of pharmacodynamic drug interactions; efficacy was often the only end point. Conclusions: There is evidence that AED polytherapy based on mechanisms of action may enhance effectiveness. In particular, combining a sodium channel blocker with a drug enhancing GABAergic inhibition appears to be advantageous. Combining two GABA mimetic drugs or combining an AMPA antagonist with an NMDA antagonist may enhance efficacy, but tolerability is sometimes reduced. Combining two sodium channel blockers seems less promising. However, given the incomplete knowledge of the pathophysiology of seizures and indeed of the exact mechanisms of action of AEDs, an empirical but rational approach for evaluating AED combinations is of fundamental importance. This would involve appropriate testing of all possible combinations in animal models and subsequent evaluation of advantageous combinations in clinical trials. Testing procedures in animals should include the isobologram method, and the concept of drug load should be the basis of studies in patients with epilepsy. [source] New insights into the pathophysiology of postoperative cognitive dysfunctionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010L. KRENK There is evidence that postoperative cognitive dysfunction (POCD) is a significant problem after major surgery, but the pathophysiology has not been fully elucidated. The interpretation of available studies is difficult due to differences in neuropsychological test batteries as well as the lack of appropriate controls. Furthermore, there are no internationally accepted criteria for defining POCD. This article aims to provide an update of current knowledge of the pathogenesis of POCD with a focus on perioperative pathophysiology and possible benefits achieved from an enhanced postoperative recovery using a fast-track methodology. It is concluded that the pathogenesis of POCD is multifactorial and future studies should focus on evaluating the role of postoperative sleep disturbances, inflammatory stress responses, pain and environmental factors. Potential prophylactic intervention may include minimal invasive surgery, multi-modal non-opioid pain management and pharmacological manipulation of the inflammatory response and sleep architecture. [source] Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfactionINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2008Susan Laschinger Abstract Background, Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. Objective, The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. Inclusion criteria,Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. Types of participants: This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. Types of outcome measures, Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. Search strategy, Using a defined search and retrieval method, the following databases were accessed for the period 1995,2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. Methodological quality, Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. Data collection, Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. Data synthesis, Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. Results, Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. Conclusion, At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed the sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function. [source] Independent comparative study of PCA, ICA, and LDA on the FERET data setINTERNATIONAL JOURNAL OF IMAGING SYSTEMS AND TECHNOLOGY, Issue 5 2005Kresimir Delac Abstract Face recognition is one of the most successful applications of image analysis and understanding and has gained much attention in recent years. Various algorithms were proposed and research groups across the world reported different and often contradictory results when comparing them. The aim of this paper is to present an independent, comparative study of three most popular appearance-based face recognition projection methods (PCA, ICA, and LDA) in completely equal working conditions regarding preprocessing and algorithm implementation. We are motivated by the lack of direct and detailed independent comparisons of all possible algorithm implementations (e.g., all projection,metric combinations) in available literature. For consistency with other studies, FERET data set is used with its standard tests (gallery and probe sets). Our results show that no particular projection,metric combination is the best across all standard FERET tests and the choice of appropriate projection,metric combination can only be made for a specific task. Our results are compared to other available studies and some discrepancies are pointed out. As an additional contribution, we also introduce our new idea of hypothesis testing across all ranks when comparing performance results. © 2006 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 15, 252,260, 2005 [source] Osteoporosis-Related Kyphosis and Impairments in Pulmonary Function: A Systematic Review,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2007Robyn A Harrison Abstract We conducted a systematic review to examine the relationship between osteoporotic vertebral fractures, kyphosis, and pulmonary function. Findings suggest modest but predictable declines in vital capacity related to the degree of kyphosis. However, there were only four studies, and all had significant methodologic limitations. Further high-quality research is needed. Introduction: Our objective was to systematically review the extent to which osteoporosis-related vertebral fractures and kyphosis affect pulmonary function. Materials and Methods: We used a literature search from 1966 to 2006 (using Medline, EMBASE, and hand searches of references) for studies examining pulmonary function in patients without known lung disease who had vertebral fractures or kyphosis secondary to osteoporosis. Two reviewers independently abstracted data. Heterogeneity precluded formal meta-analysis. Results: Initial searches yielded 453 articles. After applying eligibility criteria, only four case-control studies of limited quality (e.g., only one study was blinded) remained. Since 1966, only 109 patients (6 men) have been studied. All four studies reported reductions in vital capacity (VC), with values ranging from 68% to 94% of predicted values. This was quantified as a 9% reduction in predicted VC per vertebral fracture in one study. The degree of kyphosis clinically (one study) or radiographically (three studies) correlated with declines in VC; impairments were most notable at kyphotic angles >55°. Statistically significant differences in percent predicted VC were obtained only when arm span or recalled height, rather than measured height, was used (two studies). Conclusions: Despite conventional teaching, the evidence relating osteoporotic vertebral fractures or kyphosis to pulmonary function is limited. On the basis of available studies, declines in VC secondary to kyphosis seem modest and directly related to the number of vertebral fractures or degree of kyphosis. Future studies need longitudinal follow-up of larger numbers of men and women, appropriate proxies for height, standardized measures for pulmonary function and kyphosis, and efforts to blind outcomes ascertainment. [source] A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxietyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 1 2009Mark A. Reger Abstract Internet-and computer-based cognitive-behavioral treatments have been introduced as novel approaches to deliver standard, quality treatment that may reduce barriers to care. The purpose of this review is to quantitatively summarize the literature examining the treatment effects of Internet- or computer-based treatment (ICT) on anxiety. Nineteen randomized controlled ICT trials were identified and subjected to fixed and random effects meta-analytic techniques. Weighted mean effect sizes (Cohen's d) showed that ICT was superior to waitlist and placebo assignment across outcome measures (ds=.49,1.14). The effects of ICT also were equal to therapist-delivered treatment across anxiety disorders. However, conclusions were limited by small sample sizes, the rare use of placebo controls, and other methodological problems. In addition, the number of available studies limited the opportunity to conduct analyses by diagnostic group; there was preliminary support for the use of ICT for panic disorder and phobia. Large, well-designed, placebo-controlled trials are needed to confirm and extend the results of this meta-analysis. © 2008 Wiley Periodicals, Inc. J Clin Psychol 65: 1,21, 2009. [source] Alcohol, Psychological Dysregulation, and Adolescent Brain DevelopmentALCOHOLISM, Issue 3 2008Duncan B. Clark While adolescent alcohol consumption has been asserted to adversely alter brain development, research in human adolescents has not yet provided us with sufficient evidence to support or refute this position. Brain constituents actively developing during adolescence include the prefrontal cortex, limbic system areas, and white matter myelin. These areas serving cognitive, behavioral, and emotional regulation may be particularly vulnerable to adverse alcohol effects. Alternatively, deficits or developmental delays in these structures and their functions may underlie liability to accelerated alcohol use trajectories in adolescence. This review will describe a conceptual framework for considering these relationships and summarize the available studies on the relationships among risk characteristics, alcohol involvement and brain development during this period. The cross-sectional designs and small samples characterizing available studies hamper definitive conclusions. This article will describe some of the opportunities contemporary neuroimaging techniques offer for advancing understanding of adolescent neurodevelopment and alcohol involvement. [source] Use of dopamine in acute renal failureJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2007DACVECC, Nadja E. Sigrist DrMedVet Abstract Objective: To review the current understanding of dopamine and its use in the prevention and treatment of acute renal failure (ARF). Data sources: Original research articles and scientific reviews. Human data synthesis: Low-dose dopamine administration has been shown to increase natriuresis and urinary output in both healthy individuals and in a few small studies in human patients with renal insufficiency. However, in several large meta-analyses, dopamine treatment did not change mortality or the need for dialysis. Due to the potential side effects, the use of dopamine for prevention and treatment of ARF is no longer recommended in human medicine. Veterinary data synthesis: Low-dose dopamine increases urinary output in healthy animals and animal models of ARF if given before the insult. There are no available studies looking at the effect of low-dose dopamine therapy in naturally occurring ARF in dogs or cats. Conclusion: Due to the potential side effects of low-dose dopamine therapy, the results from large human trials, and the lack of information in veterinary medicine, the use of dopamine for treatment of ARF in veterinary patients should be further evaluated. [source] Transmission dynamics of lymphatic filariasis: vector-specific density dependence in the development of Wuchereria bancrofti infective larvae in mosquitoesMEDICAL AND VETERINARY ENTOMOLOGY, Issue 3 2006L. C. SNOW Abstract The principles of meta-analysis developed in a previous study were extended to investigate the process of Wuchereria bancrofti (Cobbold) (Filarioidea: Onchocercidae) infection in mosquito (Diptera: Culicidae) hosts, focusing specifically on the functional forms and strength of density dependence in the development of ingested microfilariae (mf) to infective (third instar) larvae (L3). Mathematical models describing observed mf,L3 functional responses for each of the major three parasite-transmitting vector genera, Aedes, Culex and Anopheles mosquitoes, were fitted to paired mf,L3 data collated from all available studies in the published literature. Model parameters were estimated and compared by deriving and applying a data synthetic framework, based on applying a non-linear weighted regression model for fitting mathematical models to multistudy data. The results confirm previous findings of the existence of significant between-genera differences in the mf,L3 development relationship, particularly with regard to the occurrence of limitation in Culex mosquitoes and facilitation in Aedes and Anopheles mosquitoes. New and unexpected findings regarding L3 development from ingested mf were discovered as follows: (1) for Culex, overcompensation in L3 development at higher intensities of mf (or a peaked mf,L3 functional response) was detected; (2) for Aedes mosquitoes, facilitation (with an apparent asymptotic constraint on L3 development at high mf densities) was shown to be the major process governing L3 development, and (3) for Anopheles, a stronger facilitation type of response with no apparent saturation in L3 development appears to govern L3 output from ingested mf. These results yield major new insights regarding filarial vector infection dynamics and their potential impacts on parasite control, and demonstrate the efficacy of employing a data synthetic approach to reveal and estimate parasitic infection processes in host populations. [source] Effect of Aging on the Structure and Function of Skeletal Muscle Microvascular NetworksMICROCIRCULATION, Issue 4 2006SHAWN E. BEARDEN ABSTRACT Humans are active creatures, yet physical activity and activity tolerance decline over the life span. One prevailing theme in the literature to account for a portion of the reduced activity tolerance with aging is the observation that the capacity to augment blood flow to skeletal muscle may be impaired with advancing age. This dysfunction may be due to adaptations in the structure or function of their microvascular networks, which collectively determine blood flow resistance. The intent of this review is to present the current knowledge of structure and function of microvascular networks from skeletal muscle with special regard to how these may adapt to, or persist through, the aging process. Skeletal muscles are supplied by an intricate branching network of arterioles and venules. The consistency of findings among available studies suggests that the overall arteriolar and venular network branching topology establishes early in development and varies little, if at all, over the life span. Microvascular networks are not a series of functionally isolated segmental branches. Rather, these networks transmit and communicate vasomotor signals along their lengths and among their branches. Current evidence suggests that aging is associated with a decrement in the capacity of upstream vessels to respond to downstream vasodilation and signals transmitted cell-to-cell along the vascular wall. [source] The impact of personality disorders on treatment outcome in bipolar disorder: A reviewPERSONALITY AND MENTAL HEALTH, Issue 1 2007Peter J. Bieling Bipolar disorder (BD) is a chronic psychiatric illness for which there are a number of efficacious and effective treatments. However, for many sufferers recovery is incomplete or tenuous. Factors associated with poor outcomes in the disorder are of special interest, and comorbidity of BD with personality disorder (PD) has been proposed as a possible predictor of poor outcome. We reviewed available studies (n = 12) in the literature that specifically assessed the impact of personality psychopathology on illness outcomes in BD including functioning, response to treatment and suicidality. Quality of methodology, assessment methods and number of participants in studies were highly variable. Despite these variations in study quality, the presence of a PD was robustly associated (usually medium size effects) with a worse outcome in BD. Patients with BD and a diagnosis of PD are more likely to be hospitalized, require more time to achieve symptom stabilization, have more chronic impairments in occupational and social functioning, are less compliant to medication, have greater levels of suicidality and utilize more psychiatric services than patients with BD alone. The implications of these findings for further research and clinical care in BD are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Religious transnationalism among Ghanaian immigrants in Toronto: a binary logistic regression analysisTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 3 2008JOSEPH MENSAH immigration; analyse logistique; transnationalisme religieux; Toronto Thanks to pioneering work within anthropology, students of international migration acknowledge that most immigrants do not sever their ties with the homeland, but rather maintain them through a variety of cross-border relationships. While scholarly work has proliferated, since the early 1990s, over the transnational economic and political activities of immigrants, to date, only few analysts have examined the religious practices with which immigrants sustain memberships in multiple locations. In addition, most available studies on transnational migration has dwelled on qualitative methods, such as participant observation, focus groups discussions and in-depth interviews with a handful of informants, with little or no inclination towards the quantitative measurement of key variables implicated in the process. The prevalence of ethnographic methods in this area of research has, quite understandably, engendered charges of exaggeration, given the tendency of such techniques ,to sample on the dependent variable', to borrow the phrase of Alejandro Portes. Using data collected from a survey among Ghanaian immigrant congregations in Toronto, this study seeks to statistically predict the propensity to engage in transnational religious practices by way of a binary logistic regression analysis. In addition, the study examines how the transnational religious activities of the sampled immigrants relate to, overlap with, and differ from other kinds of transnational practices they pursue. Le transnationalisme religieux chez les immigrants ghanéens de Toronto: une analyse de régression logistique binaire Grâce à des travaux pionniers en anthropologie, les étudiants qui s'intéressent à la migration internationale reconnaissent aujourd'hui que la plupart des immigrants ne vont pas rompre les liens avec leur terre d'origine mais, au contraire, les renforcer par un éventail de relations transfrontalières. Si les travaux universitaires portant sur les activités économiques et politiques transfrontalières des immigrants sont en plein essor depuis le début des années 1990, peu d'études ont abordé les pratiques religieuses par lesquelles les immigrants conservent leur adhésion à une multitude d'endroits. De plus, l'essentiel des études disponibles sur la migration transnationale insistent sur les méthodes qualitatives telles que l'observation participante, la tenue de groupes de discussion et les entrevues en profondeur auprès de quelques informateurs. Les variables principales comprises dans ce processus n'ont pas vraiment fait l'objet d'une évaluation quantitative. Les méthodes ethnographiques prédominent dans ce domaine de recherche, à qui on reproche d'être tombé dans l'exagération. Dans cette étude, les données recueillies à partir d'entrevues réalisées auprès d'immigrants ghanéens dans les congrégations de Toronto sont utilisées dans une analyse de régression logistiques binaire pour faire des prédictions statistiques sur la propension à s'engager dans des pratiques religieuses transnationales. De plus, cette étude examine comment les activités religieuses transnationales des immigrants compris dans l'échantillon s'apparentent, se superposent et se différencient par rapport aux autres types de pratiques transnationales auxquelles ils se livrent. [source] Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopyACTA PAEDIATRICA, Issue 4 2010R Mori Abstract Background:, Prompt diagnosis of urinary tract infection (UTI) in children is needed to initiate treatment but is difficult to establish without urine testing, and reliance on culture leads to delay. Urine dipsticks are often used as an alternative to microscopy, although the diagnostic performance of dipsticks at different ages has not been established systematically. Method:, Studies comparing urine dipstick testing in infants versus older children and urine dipstick versus microscopy were systematically searched and reviewed. Meta-analysis of available studies was conducted. Results:, Six studies addressed these questions. The results of meta-analysis showed that the performance of urine dipstick testing was significantly less in the younger children when compared with older children (p < 0.01). Positive likelihood ratio (LR) of both nitrite and leucocyte positive 38.54 [95% confidence interval (CI) 22.49,65.31], negative LR for both negative 0.13 (95% CI 0.07,0.25) are reasonably good, and those for young infants are less reliable [positive LR 7.62 (95% CI 0.95,51.85) and negative LR 0.34 (95% CI 0.66,0.15)]. Comparing microscopy and urine dipstick testing, using bacterial colony count on urine culture showed no significant difference between the two methods. Conclusion:, Urine dipstick testing is more effective for diagnosis of UTI in children over 2 years than for younger children. [source] Can we differentiate the low-molecular-weight heparins?CLINICAL CARDIOLOGY, Issue S1 2000Alexander G.G. Turpie M.B., F.A.C.C., F.A.C.P., F.R.C.P.(LOND., F.R.C.P.C., GLASG.) Abstract The low-molecular-weight heparins (LMWHs) have a number of therapeutic advantages, relative to standard unfractionated heparin (UFH). They are readily bioavailable when injected subcutaneously and can be given in fixed doses, allowing for far simpler administration. Several LMWHs are now commercially available, each demonstrating different physical and chemical properties and different activities in animal models of anticoagulation or hemorrhage. in clinical comparisons with placebo in the treatment of unstable coronary artery disease (UCAD), the LMWHs dal-teparin sodium and nadroparin calcium have demonstrated good anticoagulant efficacy. in comparisons with UFH, on the other hand, only enoxaparin has shown superior anticoagulant activity, as reported in the results of the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) and Thrombolysis in Myocardial Infarction (TIMI) 1 IB trials. However, close scrutiny of the methodology of the clinical trials in UCAD reveals considerable differences in study designs, dosage regimens, duration of administration of active treatments, and the timing and definition of endpoints. Therefore, it would not be scientifically sound to compare results with the different LMWHs based on the current available studies. It is also not possible to draw any conclusions with regard to the relative efficacy of the different LMWHs, since there are no properly-sized comparative data between dal-teparin sodium, enoxaparin sodium, and nadroparin calcium. [source] | |||||||||||||||||||||||||||||||