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Selected Abstracts,Balance' is in the eye of the beholder: providing information to support informed choices in antenatal screening via Antenatal Screening Web ResourceHEALTH EXPECTATIONS, Issue 4 2007Shenaz Ahmed BSc (Hons) PhD Abstract Objectives, The Antenatal Screening Web Resource (AnSWeR) was designed to support informed prenatal testing choices by providing balanced information about disability, based on the testimonies of disabled people and their families. We were commissioned by the developers to independently evaluate the website. This paper focused on how participants evaluated AnSWeR in terms of providing balanced information. Setting, West Yorkshire. Participants, A total of 69 people were drawn from three groups: health professionals, people with personal experience of tested-for conditions (Down's syndrome, cystic fibrosis and spina bifida) and people representing potential users of the resource. Method, Data were collected via focus groups and electronic questionnaires. Results, Participants believed that information about the experience of living with the tested-for conditions and terminating a pregnancy for the conditions were important to support informed antenatal testing and termination decisions. However, there were differences in opinion about whether the information about the tested-for conditions was balanced or not. Some people felt that the inclusion of photographs of people with the tested-for conditions introduced biases (both positive and negative). Many participants were also of the opinion that AnSWeR presented insufficient information on termination of an affected pregnancy to support informed choice. Conclusion, This study highlighted the difficulty of designing ,balanced' information about tested-for conditions and a lack of methodology for doing so. It is suggested that AnSWeR currently provides a counterbalance to other websites that focus on the medical aspects of disability. Its aim to provide ,balanced' information would be aided by increasing the number and range of case studies available on the website. [source] Improving access to the international coverage of reports of controlled trials in electronic databases: a search of the Australasian Medical IndexHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 1 2002Steve McDonald Introduction: Locating reports of trials from journals not indexed in the major databases presents difficulties to systematic reviewers, and may be a factor in improving the reliability of the reviews. Objectives: To identify and make available reports of controlled trials from the Australasian Medical Index (AMI). To measure the quality of indexing of trials in AMI. Methods: Using a highly sensitive search strategy consisting of methodology indexing and free-text terms, records from AMI were read for reports of controlled trials. Trials meeting the criteria were submitted for inclusion in The Cochrane Controlled Trials Register (CCTR) and assessed for the quality of their indexing. Results: 3621 records were downloaded, of which 512 were identified as reports of controlled trials (317 RCTs; 195 CCTs) and submitted to CCTR. The precision of methodology indexing terms was 60%, but sensitivity just 18%. The quality of indexing of trials was generally poor with only 50 tagged with the RCT/CCT publication type term. 453 reports (88%) were not previously available in CCTR. Conclusions: The large proportion of trials found to be unique to the AMI database increases the pool of studies available to systematic reviewers, and helps ensure CCTR remains the most comprehensive source of trials. [source] Iloperidone for schizophrenia: a review of the efficacy and safety profile for this newly commercialised second-generation antipsychoticINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2009L. Citrome Summary Objective:, The aim of the study was to describe the efficacy and safety of iloperidone for the treatment of schizophrenia. Data sources:, The pivotal registration trials were accessed by querying http://www.pubmed.gov, http://www.fda.gov and http://www.clinicaltrials.gov for the search term ,iloperidone'. Study selection:, Four published primary reports of phase III studies were identified as well as preclinical animal and receptor affinity studies that describe potential mechanisms of action and pharmacogenomic studies that identify potential genetic biomarkers for efficacy and tolerability. Product labelling provided additional data. Data extraction:, Descriptions of the principal results and calculation of number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the study reports. Additional safety outcomes subject to NNH analysis were obtained from product labelling. Data synthesis:, Iloperidone is a second-generation antipsychotic agent indicated for the acute treatment of schizophrenia in adults. Iloperidone has been evaluated in several double-blind placebo-controlled clinical trials. The oral formulation has demonstrated efficacy in reducing the symptoms of acute schizophrenia at fixed daily doses ranging from 12 to 24 mg. Data reported for categorical definitions of response using the Positive and Negative Syndrome Scale were limited to one study and specifically to rates of achieving a , 20% decrease in the positive subscale from baseline; significantly more patients receiving iloperidone 24 mg/day (72%) than placebo (52%) met this criterion, yielding a NNT of five. Iloperidone should be titrated slowly to avoid orthostatic hypotension, potentially delaying the achievement of a therapeutic dose level. There appears to be a dose relationship for adverse events such as dizziness, somnolence and dry mouth; for example NNH vs. placebo for somnolence was 25 for iloperidone 10,16 mg/day and 10 for 20,24 mg/day. There is a possibility of a therapeutic dose response as well. Iloperidone is essentially free of extra-pyramidal side effects. Iloperidone is associated with weight gain comparable with risperidone. Long-term double-blind maintenance studies have demonstrated iloperidone's non-inferiority to haloperidol for relapse prevention. Product labelling includes a warning about the potential for QT interval prolongation. At present there are no efficacy studies available that are powered to directly compare iloperidone with other second-generation antipsychotics. The development of a depot formulation of iloperidone as well as efforts to identify genetic biomarkers for prediction of both efficacy and tolerability are in progress. Conclusions:, Aside from paliperidone, iloperidone is the first new second-generation antipsychotic to be commercialised in the USA since 2002. From the limited registration data, iloperidone appears to be relatively well tolerated once titrated to a therapeutic level and can be a useful option to consider. The development of a depot formulation and potential for genetic biomarkers may make this agent compelling. Further comparisons with other available agents among patients with schizophrenia in the ,real world' are needed. [source] Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusionINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 6 2005Ann Callaghan RN RM BNurs(Hons) Executive summary Objective, To critically review all literature related to pacifier use for full-term healthy infants and young children. The specific review questions addressed are: What is the evidence of adverse and/or positive outcomes of pacifier use in infancy and childhood in relation to each of the following subtopics: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Inclusion criteria, Specific criteria were used to determine which studies would be included in the review: (i) the types of participants; (ii) the types of research design; and (iii) the types of outcome measures. To be included a study has to meet all criteria. Types of participants,The participants included in the review were healthy term infants and healthy children up to the age of 16 years. Studies that focused on preterm infants, and infants and young children with serious illness or congenital malformations were excluded. However, some total population studies did include these children. Types of research design, It became evident early in the review process that very few randomised controlled trials had been conducted. A decision was made to include observational epidemiological designs, specifically prospective cohort studies and, in the case of sudden infant death syndrome research, case,control studies. Purely descriptive and cross-sectional studies were excluded, as were qualitative studies and all other forms of evidence. A number of criteria have been proposed to establish causation in the scientific and medical literature. These key criteria were applied in the review process and are described as follows: (i) consistency and unbiasedness of findings; (ii) strength of association; (iii) temporal sequence; (iv) dose,response relationship; (v) specificity; (vi) coherence with biological background and previous knowledge; (vii) biological plausibility; and (viii) experimental evidence. Studies that did not meet the requirement of appropriate temporal sequencing of events and studies that did not present an estimate of the strength of association were not included in the final review. Types of outcome measures,Our specific interest was pacifier use related to: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Studies that examined pacifier use related to procedural pain relief were excluded. Studies that examined the relationship between pacifier use and gastro-oesophageal reflux were also excluded as this information has been recently presented as a systematic review. Search strategy, The review comprised published and unpublished research literature. The search was restricted to reports published in English, Spanish and German. The time period covered research published from January 1960 to October 2003. A protocol developed by New Zealand Health Technology Assessment was used to guide the search process. The search comprised bibliographic databases, citation searching, other evidence-based and guidelines sites, government documents, books and reports, professional websites, national associations, hand search, contacting national/international experts and general internet searching. Assessment of quality, All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms, and a full report was retrieved for all studies that met the inclusion criteria. Studies identified from reference list searches were assessed for relevance based on the study title. Keywords included: dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care. Initially, studies were reviewed for inclusion by pairs of principal investigators. Authorship of articles was not concealed from the reviewers. Next, the methodological quality of included articles was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All 20 studies that were accepted met minimum set criteria, but few passed without some methodological concern. Data extraction, To meet the requirements of the Joanna Briggs Institute, reasons for acceptance and non-acceptance at each phase were clearly documented. An assessment protocol and report form was developed for each of the three phases of review. The first form was created to record investigators' evaluations of studies included in the initial review. Those studies that failed to meet strict inclusion criteria were excluded at this point. A second form was designed to facilitate an in-depth critique of epidemiological study methodology. The checklist was pilot tested and adjustments were made before reviewers were trained in its use. When reviewers could not agree on an assessment, it was passed to additional reviewers and discussed until a consensus was reached. At this stage, studies other than cohort, case,control and randomised controlled trials were excluded. Issues of clarification were also addressed at this point. The final phase was that of integration. This phase, undertaken by the principal investigators, was assisted by the production of data extraction tables. Through a process of trial and error, a framework was formulated that adequately summarised the key elements of the studies. This information was tabulated under the following headings: authors/setting, design, exposure/outcome, confounders controlled, analysis and main findings. Results, With regard to the breast-feeding outcome, 10 studies met the inclusion criteria, comprising two randomised controlled trials and eight cohort studies. The research was conducted between 1995 and 2003 in a wide variety of settings involving research participants from diverse socioeconomic and cultural backgrounds. Information regarding exposure and outcome status, and potential confounding factors was obtained from: antenatal and postnatal records; interviews before discharge from obstetric/midwifery care; post-discharge interviews; and post-discharge postal and telephone surveys. Both the level of contact and the frequency of contact with the informant, the child's mother, differed widely. Pacifier use was defined and measured inconsistently, possibly because few studies were initiated expressly to investigate its relationship with breast-feeding. Completeness of follow-up was addressed, but missing data were not uniformly identified and explained. When comparisons were made between participants and non-participants there was some evidence of differential loss and a bias towards families in higher socioeconomic groups. Multivariate analysis was undertaken in the majority of studies, with some including a large number of sociodemographic, obstetric and infant covariates and others including just maternal age and education. As might be expected given the inconsistency of definition and measurement, the relationship between pacifier use and breast-feeding was expressed in many different ways and a meta-analysis was not appropriate. In summary, only one study did not report a negative association between pacifier use and breast-feeding duration or exclusivity. Results indicate an increase in risk for a reduced overall duration of breast-feeding from 20% to almost threefold. The data suggest that very infrequent use may not have any overall negative impact on breast-feeding outcomes. Six sudden infant death syndrome case,control studies met the criteria for inclusion. The research was conducted with information gathered between 1984 and 1999 in Norway, UK, New Zealand, the Netherlands and USA. Exposure information was obtained from a variety of sources including: hospital and antenatal records, death scene investigation, and interview and questionnaire. Information for cases was sought within 2 days after death, within 2,4 weeks after death and in one study between 3 and 11 years after death. Information for controls was sought from as early as 4 days of a nominated sudden infant death syndrome case, to between 1 and 7 weeks from the case date, and again in one study some 3,11 years later. In the majority of the studies case ascertainment was determined by post-mortem. Pacifier use was again defined and measured somewhat inconsistently. All studies controlled for confounding factors by matching and/or using multivariate analysis. Generally, antenatal and postnatal factors, as well as infant care practices, and maternal, family and socioeconomic issues were considered. All five studies reporting multivariate results found significantly fewer sudden infant death syndrome cases used a pacifier compared with controls. That is, pacifier use was associated with a reduced incidence of sudden infant death syndrome. These results indicate that the risk of sudden infant death syndrome for infants who did not use a pacifier in the last or reference sleep was at least twice, and possibly five times, that of infants who did use a pacifier. Three studies reported a moderately sized positive association between pacifier use and a variety of infections. Conversely, one study found no positive association between pacifier use at 15 months of age and a range of infections experienced between the ages of 6 and 18 months. Given the limited number of studies available and the variability of results, no meaningful conclusions could be drawn. Five cohort studies and one case,control study focused on the relationship between pacifier use and dental malocclusion. Not one of these studies reported a measure of association, such as an estimate of relative risk. It was therefore not possible to include these studies in the final review. Implications for practice, It is intended that this review be used as the basis of a ,best practice guideline', to make health professionals aware of the research evidence concerning these health and developmental consequences of pacifier use, because parents need clear information on which they can base child care decisions. With regard to the association between pacifier use and infection and dental malocclusion it was found that, due to the paucity of epidemiological studies, no meaningful conclusion can be drawn. There is clearly a need for more epidemiological research with regard to these two outcomes. The evidence for a relationship between pacifier use and sudden infant death syndrome is consistent, while the exact mechanism of the effect is not well understood. As to breast-feeding, research evidence shows that pacifier use in infancy is associated with a shorter duration and non-exclusivity. It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven. Because breast-feeding confers an important advantage on all children and the incidence of sudden infant death syndrome is very low, it is recommended that health professionals generally advise parents against pacifier use, while taking into account individual circumstances. [source] Comparison of the specificity and sensitivity of traditional methods for assessment of nephrotoxicity in the rat with metabonomic and proteomic methodologiesJOURNAL OF APPLIED TOXICOLOGY, Issue 4 2005Andy Gibbs Abstract There is currently a great deal of scientific interest and debate concerning the possible advantages that proteomic and metabonomic technologies might have over traditional biomarkers of toxicity (blood and urine chemistry, histopathology). Numerous papers have been published that make impressive claims concerning potential applications for these novel technologies, however there appears to be little hard evidence in the literature of their advantages over the traditional techniques for assessing toxicity. The aim of this review was to evaluate the relative sensitivity and specificity of proteomic and metabonomic techniques, compared with traditional techniques, for assessing xenobiotic-induced nephrotoxicity. A review of studies was performed where both one of the novel methods as well as traditional techniques were used for assessment of xenobiotic-induced nephrotoxicity. There was no consistent evidence from the literature that the novel methodologies were any more sensitive than the traditional methods for assessing nephrotoxicity. This could be due to the relatively small number of studies available for review (n = 13), the fact that generally these studies were not aimed at determining relative sensitivity or specificity and may not be the case with other target organs, such as the liver. However, it was clear that the novel methodologies were able to discriminate between the effects caused by different toxicants. There was evidence both that this discrimination was on the basis of different mechanisms of toxicity and on the basis of different locations of nephrotoxic lesion. A great deal of validation work is necessary before these techniques could gain full acceptance by regulatory authorities, and it is unclear whether their use in anything other than non-regulatory, mechanistic studies is likely to become widespread. Copyright © 2005 John Wiley & Sons, Ltd. [source] Clinical versus statistical prediction: The contribution of Paul E. MeehlJOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2005William M. GroveArticle first published online: 22 JUL 200 The background of Paul E. Meehl's work on clinical versus statistical prediction is reviewed, with detailed analyses of his arguments. Meehl's four main contributions were the following: (a) he put the question, of whether clinical or statistical combinations of psychological data yielded better predictions, at center stage in applied psychology; (b) he convincingly argued, against an array of objections, that clinical versus statistical prediction was a real (not concocted) problem needing thorough study; (c) he meticulously and even-handedly dissected the logic of clinical inference from theoretical and probabilistic standpoints; and (c) he reviewed the studies available in 1954 and thereafter, which tested the validity of clinical versus statistical predictions. His early conclusion that the literature strongly favors statistical prediction has stood up extremely well, and his conceptual analyses of the prediction problem (especially his defense of applying aggregate-based probability statements to individual cases) have not been significantly improved since 1954. © 2005 Wiley Periodicals, Inc. J Clin Psychol 61: 1233,1243, 2005. [source] Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage?JOURNAL OF PERIODONTAL RESEARCH, Issue 5 2007A systemic review Background and Objective:, This study is a systemic review of coronally positioned flap, coronally positioned flap + chemical root surface conditioning, or coronally positioned flap + enamel matrix derivative (EMD) for the treatment of Miller class I and II gingival recession. Material and Methods:, All studies available through the Medline database by the end of October 2005 were used. Each study provided mean clinical attachment level, keratinized tissue, probing pocket depth, gingival recession depth and root coverage percentage before and after treatment with coronally positioned flap alone, coronally positioned flap + chemical root surface conditioning , or coronally positioned flap + EMD. Effectiveness was evaluated by comparing the weighted mean average in gingival recession depth, probing pocket depth, clinical attachment level, keratinized tissue and root coverage percentage achieved with the three treatments. Results:, Seven studies for the coronally positioned flap + EMD group, four studies for the coronally positioned flap + chemical root surface conditioning group, and seven studies for the coronally positioned flap group were retrieved for this weighted mean analysis. The results of clinical attachment level, gingival recession depth, and root coverage percentage in the coronally positioned flap + EMD group were statistically significantly better than the changes in the coronally positioned flap and coronally positioned flap + chemical root surface conditioning group at 6 and 12 mo (p < 0.001). There was no significant difference at the 6-mo comparison among clinical attachment level, keratinized tissue, probing pocket depth, and gingival recession depth, except in the root coverage percentage for coronally positioned flap and coronally positioned flap + chemical root surface conditioning groups. Conclusion:, The results suggest that root coverage by the coronally positioned flap and coronally positioned flap + chemical root surface conditioning procedures were unpredictable but became more predictable when the coronally positioned flap procedure was improved by the modification of adding EMD. [source] Quality of different chondroitin sulfate preparations in relation to their therapeutic activityJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 10 2009Prof. Nicola Volpi Abstract Objectives Chondroitin sulfate is currently recommended by the European League Against Rheumatism (EULAR) as a SYSADOA (symptomatic slow acting drug for osteoarthritis) in Europe in the treatment of knee and hand osteoarthritis based on research evidence and meta-analysis of numerous clinical studies. Furthermore, recent clinical trials demonstrated its possible structure-modifying effects. Chondroitin sulfate, alone or in combination with glucosamine or other ingredients, is also utilized as a nutraceutical in dietary supplements in Europe and the USA. However, it is derived from animal sources by extraction and purification processes. As a consequence, source material, manufacturing processes, the presence of contaminants and many other factors contribute to the overall biological and pharmacological actions of these agents. We aim to review the quality control of chondroitin sulfate in pharmaceutical-grade preparations and nutraceuticals. Key findings Pharmaceutical-grade formulations of chondroitin sulfate are of high and standardized quality, purity and properties, due to the stricter regulations to which this drug is subjected by local national health institutes as regards production and characteristics. On the contrary, as several published studies available in literature indicate, the chondroitin sulfate quality of several nutraceuticals is poor. Additionally, there are no definite regulations governing the origin of the ingredients in these nutraceuticals and the origin of the ingredients in natural products is the most important factor ensuring quality, and thus safety and efficacy, in particular for chondroitin sulfate, due to its extraction from different sources. Conclusions Due to the poor chondroitin sulfate quality of some nutraceuticals, we conclude that stricter regulations regarding their quality control should be introduced to guarantee the manufacture of high quality products for nutraceutical utilization and to protect customers from low-quality, ineffective and potentially dangerous products. There is a need for specific and accurate analytical procedures, which should be enforced to confirm purity and label claims both for raw materials and finished chondroitin sulfate products, and also to govern the origin of ingredients. Until these stricter regulations are in place, then it is strongly recommended that pharmaceutical-grade chondroitin sulfate is used rather than food supplements. [source] Assertive outreach nurses' experience of engagementJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2004J. ADDIS rgn rmn msc There are currently no studies available in the literature to highlight nurses' experiences of the assertive outreach (AO) engagement process. This study aimed to understand how AO nurses experience this process and what can be learned from it. The participants were five nurses working in a rural AO service in one county. Methodological considerations were rooted in the work of Martin Heidegger and the data analysed using the hermeneutic phenomenological thematic method. The data-gathering tool was semi-structured interviews. Seven major themes emerged to construct the nurses' understanding of their experience of assertive engagement. These were: (1) having time; (2) anticipatory persistence and tired dejection; (3) pressure, relief and satisfaction; (4) being the human professional confluence; (5) accepting anxiety and fear; (6) working and learning together; and (7) bringing the caring attitude. This paper focuses on the seven emerging themes and discusses the implications and recommendations for nurses practising in the AO setting. [source] A qualitative systematic review of peri-operative dextromethorphan in post-operative painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2006T. H. Duedahl Background:, The N -methyl- d -aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods:, Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results:, DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one-half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid-related side-effects was established in some studies. Conclusion:, Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect. [source] CryolipolysisÔ for subcutaneous fat layer reduction,LASERS IN SURGERY AND MEDICINE, Issue 10 2009Mathew M. Avram MD Abstract Background and Objective Cryolipolysis is a unique non-invasive method for the selective reduction of fat cells with controlled, localized cooling. It is important, therefore, to understand the potential efficacy and safety of this new procedure for fat layer reduction. Materials and Methods A review of the literature associated with cryolipolysis was performed to evaluate the findings from pre-clinical and clinical studies with respect to the mechanism of action, efficacy, and safety. Results Cryolipolysis has demonstrated efficacy in both human and animal studies. Histology findings also confirm the selective reduction of fat in both humans and animals, with evidence of a gradual thinning of the fat layer over a period of two to four months. Importantly, cryolipolysis has not produced any significant adverse side effects in studies to date and any noted effects have been minor and temporary. Conclusion Although the mechanism of action for cryolipolysis is not yet completely understood, the efficacy and safety of this non-invasive procedure for fat layer reduction has been demonstrated in the studies available to data. Further studies willl assist in identifying the mechanism and elucidate the full potential of this technology to perform safe, non-invasive fat reduction for areas of local fat accumulation. Lasers Surg. Med. 41:703,708, 2009. © 2009 Wiley-Liss, Inc. [source] Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic reviewLIVER INTERNATIONAL, Issue 9 2010Eric Chak Abstract Orthotopic liver transplant (OLT) is an established life saving procedure for both acute and chronic liver failure, but incidences and risk factors for development of these malignancies are yet to be established. To determine the incidences and risk factors associated with de novo malignancy after OLT. We performed a systematic review of relevant epidemiological studies available on MEDLINE, which provided information on the incidences and risk factors for the development malignancies in adult OLT recipients published from 1983 to 2009. All data was compiled from retrospective studies. Independent risk factors for the development of de novo malignancy in adult OLT recipients were identified to be statistically significant including immunosuppression, hepatitis C virus infection, smoking, alcoholic cirrhosis and sun exposure. OLT recipients with smoking and alcohol history are of particular risk for head and neck and lung cancers. Primary sclerosing cholangitis and inflammatory bowel disease were found to be independent risk factors for colon cancer. Adult OLT recipients are at increased risk for the development of post-transplant malignancies and obviates the need for surveillance protocols that are safe and cost-effective. OLT recipients should be advised on taking proper precautions in the sun, smoking cessation, and eliminating alcohol consumption. Given the emergence of alcoholic cirrhosis as a leading indication for liver transplantation, the early detection of lung and head and neck cancers is of particular importance. [source] Skin cancer and Parkinson's disease,MOVEMENT DISORDERS, Issue 2 2010Joaquim J. Ferreira MD Abstract The report of an increased frequency of melanoma during the clinical development of rasagiline prompted a renewed interest in a possible association between skin cancer and Parkinson's disease (PD). The evaluation of this risk ended in a recommendation to perform a periodic dermatological examination as a follow-up measure of their treatment. The recognition of this safety concern lead to the need to clarify if the risk of skin cancer is indeed associated with PD and if levodopa or other anti-parkinsonian drugs might contribute to increase such risk. To answer these questions, we critically reviewed all clinical studies available concerning the association between skin cancer and PD. We found 26 studies on cancer occurrence in PD. The best data available suggest the risk of cancer is reduced in PD patients. However, specific cancers like thyroid and the female breast were reported at higher-than-expected rates. Additionally, it was suggested that PD patients have a higher frequency of melanoma and non-melanoma skin cancers than the general population. The data on non-melanoma skin cancer are less robust than the data on melanoma. Causal factors remain unknown. Due to the weak association between skin cancer and PD, no robust recommendation can be made regarding the need for periodic dermatological screening. © 2010 Movement Disorder Society [source] Rheumatoid arthritis patients' knowledge of the disease and its treatments: A descriptive studyMUSCULOSKELETAL CARE, Issue 1 2009P. Mäkeläinen MNSc Abstract Objective:,The purpose of rheumatoid arthritis (RA) patient education is to increase patients' knowledge levels. However, there are only a limited number of studies available concerning these patients' knowledge of their disease and its various treatments. The purpose of this study was to describe RA patients' understanding of their disease and its treatments. Methods:,A total of 252 RA patients participated in this survey in August 2004 (response rate 53.2%). The knowledge levels of the patients and their physical functioning were measured using self-reported questionnaires. The data were analysed using descriptive and non-parametric statistical methods. Results:,RA patients' knowledge of the disease and its treatments was, on average, good. However, the total scores of the Patient Knowledge Questionnaire ranged from 2 to 29 (maximum score 30). The patients knew well the aetiology and symptoms of RA, the blood tests and the physical exercise; they knew moderately well the facts relating to joint protection, energy conservation and how to use anti-rheumatic drugs and non-steroidal anti-inflammatory drugs. Young patients, women and patients with a long disease duration knew the most. There was a weak correlation between patient knowledge and physical functioning: the weaker the patient's functioning, the higher the knowledge level. Conclusions:,RA patients' knowledge of their disease and its treatments varied from poor to good in this group. These results can be used for advancing RA patient education. However, more research is needed to evaluate RA patients' knowledge levels. Copyright © 2008 John Wiley & Sons, Ltd. [source] Apple polyphenols and cardiovascular disease , a review of the evidenceNUTRITION BULLETIN, Issue 2 2010E. Weichselbaum Summary A diet high in fruits and vegetables has been associated with a lower risk of some diseases, including cardiovascular disease. Besides food constituents, such as fibre or beta-carotene, other bioactive plant compounds such as polyphenols have been suggested to contribute to this protective effect. Apples are one of the most popular fruits in the UK, and apples and apple products, such as fruit juices and apple purées, contribute to the total polyphenol intake of the UK population, although data on the extent of their contribution are not available. The aim of this review was to summarise the evidence available from human studies on the effect of polyphenols found in apples on cardiovascular risk factors, including blood lipids and blood pressure. The literature search comprised randomised clinical trials carried out in humans using either apples or apple products, or other foods or supplements containing a significant amount of one or more polyphenols present in apples. Our search showed that there is very limited evidence available from human studies. Preliminary findings show that polyphenols present in apples may potentially have a positive influence on blood lipid parameters and blood pressure in humans. However, firm conclusions cannot be made based on the limited studies available. Further research is needed to evaluate the full potential of polyphenols and their effect on human health. [source] Changes in lymphocyte populations in suckling piglets during primary infections with Isospora suisPARASITE IMMUNOLOGY, Issue 4 2010H. L. WORLICZEK Summary Isospora suis, a common intestinal parasite of piglets, causes neonatal porcine coccidiosis, which results in reduced and uneven weaning weights and economic losses in pig production. Nevertheless, there are no detailed studies available on the immune response to I. suis. The aim of this study was to carry out phenotypical characterization of lymphocytes during primary infections on day 3 after birth. Infected and noninfected piglets were investigated between days 7 and 16 after birth. Lymphocytes from the blood, spleen and mesenteric lymph nodes (flow cytometry) and of the jejunal mucosa (immunohistochemistry) were analysed. A decrease in T cells, especially with the phenotype of resting T-helper cells, T-cell receptor-,,-T cells, and regulatory T cells in the blood, spleen and mesenteric lymph nodes was noticeable. An increase in cells with the phenotype of natural killer cells in the spleen of infected animals was found, and the subset of TcR-,,-T cells was strongly increased in the gut mucosa. Our findings suggest an accelerated migration of those cells into the gut. This study provides a strong indication for the involvement of adaptive and innate immune response mechanisms in the primary immune response to I. suis, especially of TcR-,,-T cells as a linkage between innate and adaptive immunity. [source] Psychiatric morbidity in psoriasis: A reviewAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2004Paul AJ Russo SUMMARY Psoriasis is a common condition, affecting 1.5,2% of the population of industrialized countries. It is important for clinicians to be aware that psoriasis can have a substantial emotional impact on an individual, which is not necessarily related to the extent of skin disease. This review examines current literature addressing the psychological and emotional aspects of psoriasis. A literature search of the MEDLINE (1966,2002) and PsycINFO (1984,2002) computer databases and bibliographies was carried out. Papers selected for the review included English language reviews and all original research relevant to the topic, in the form of randomized controlled trials, cohort studies, case,control studies, cross-over and uncontrolled clinical trials, patient surveys, quality-of-life studies, case series and case reports. Despite significant shortcomings, the available prevalence studies showed uniformly high rates of psychopathology among psoriasis sufferers. The few intervention studies available are summarized and critically discussed. Psoriasis is associated with a variety of psychological problems, including poor self esteem, sexual dysfunction, anxiety, depression and suicidal ideation. The clinical severity of the psoriasis may not reflect the degree of emotional impact of the disease. A number of psychological interventions have shown promise in recent trials. It is important that clinicians consider the psychosocial aspects of this illness. [source] Why Do Some Tropical Forests Have So Many Species of Trees?BIOTROPICA, Issue 4 2004Egbert Giles Leigh Jr. ABSTRACT Understanding why there are so many kinds of tropical trees requires learning, not only how tree species coexist, but what factors drive tree speciation and what governs a tree clade's diversification rate. Many report that hybrid sterility evolves very slowly between separated tree populations. If so, tree species rarely originate by splitting of large populations. Instead, they begin with few trees. The few studies available suggest that reproductive isolation between plant populations usually results from selection driven by lowered fitness of hybrids: speciation is usually a response to a "niche opportunity." Using Hubbell's neutral theory of forest dynamics as a null hypothesis, we show that if new tree species begin as small populations, species that are now common must have spread more quickly than chance allows. Therefore, most tree species have some setting in which they can increase when rare. Trees face trade-offs in suitability for different microhabitats, different-sized clearings, different soils and climates, and resistance to different pests. These trade-offs underlie the mechanisms maintaining ,-diversity and species turnover. Disturbance and microhabitat specialization appear insufficient to maintain ,-diversity of tropical trees, although they may maintain tree diversity north of Mexico or in northern Europe. Many studies show that where trees grow readily, tree diversity is higher and temperature and rainfall are less seasonal. The few data available suggest that pest pressure is higher, maintaining higher tree diversity, where winter is absent. Tree a-diversity is also higher in regions with more tree species, which tend to be larger, free for a longer time from major shifts of climate, or in the tropics, where there are more opportunities for local coexistence. RESUMEN Comprender por qué hay tantos tipos de árboles tropicales, se requiere aprender no sólo cómo las especies de árboles coexisten, sino también, cuáles factores conducen a su especiación, y qué determina la velocidad de diversificación de un clado de árboles. Muchos reportan que la esterilidad hibrida evoluciona muy lentamente entre poblaciones separadas de árboles. De ser asi, las especies de árboles raramente se originarian por la separación de grandes poblaciones; más bien empezarian con pocos árboles. Los pocos estudios disponibles sugieren que el aislamiento reproductivo entre las poblaciones vegetales usualmente resulta de selección derivada del bajo éxito de los hibridos: la especiación general-mente responde a una "oportunidad de nicho". Usando la teoria neutral de Hubbell de dinámica de bosques como hipótesis nula, nosotros mostramos que si las nuevas especies de árboles comienzan como poblaciones pequeñas, especies que ahora son communes deberian haberse expandido más rápido que lo que el azar permite. Por lo tanto, la mayoria de las especies de árboles tendrian alguna condición donde sus poblaciones podrian crecer cunando son raras. Los árboles enfrentan compromises en su adecuación por diferentes microhábitats, claros de differentes tamanos, diferentes suelos y climas, y resistencia a differentes plagas. Esros compromises sirven de base para los mecanismos que mantienen la diversidad , y al reemplazo especial de especies. Los distrubios y la especialización de microhabitats parecen ser insuficiente para mantener la diversidad , de árboles tropicales, sin embargo elloss pueden mantener diversidad de árboles al norte de México o en Europa del norte. Muchos estudios muestran que en lugares donde los árboles cresen fácilmente, la diversidad de árboles es mayor donde la temperatura y la lluvia son menos estacionales. Los pocos estudios disponibles sugieren que la presión de las plagas es mayor, manteniendo asl la diversidad de árboles en lugares donde no hay invierno. La diversidad , de árboles también es más alta en regions con más especies de árboles, las culaes tienden a ser más largas, exentas por un largo periodo de tiempo de grandes cambios climáticos, oen los trópicos donde hay más oportunidades de coexistir localmente. [source] Bipolar II disorder: a reviewBIPOLAR DISORDERS, Issue 1 2005Michael Berk Objectives:, To review the current knowledge of bipolar II disorder. Methods:, Literature was reviewed after conducting a Medline search and a hand search of relevant literature. Results:, Bipolar II disorder is a common disorder, with a prevalence of approximately 3,5%. Distinct clinical features of bipolar II disorder have been described. The key to diagnosis is the recognition of past hypomania, while depression is the typical presenting feature of the illness. This is responsible for a significant rate of missed diagnosis, and consequent management according to unipolar guidelines. It is unclear if bipolar II disorder is over-represented amongst resistant depression populations and if abrupt offset of antidepressant action is a phenomenon over represented in bipolar II disorder, reflecting induction of predominantly depressive cycling. A few mood-stabilizer studies available provide provisional suggestion of utility. A supportive role for psychosocial therapies is suggested, however, there is a sparsity of published studies specific to bipolar II disorder cohorts. A small number of short-term antidepressant trials have suggested efficacy, however, compelling long-term maintenance data is absent. Conclusions:, An emerging literature on the specific clinical signature and management of the disorder exists, however, this is disproportionately small relative to the epidemiology and clinical significance of the disorder. [source] The potential antioxidant effect of raloxifene treatment: a study on heart, liver and brain cortex of ovariectomized female ratsCELL BIOCHEMISTRY AND FUNCTION, Issue 3 2007Sibel Konyalioglu Abstract The antioxidant activity of some compounds buffer the free radicals generated either endogenously or exogenously, thus decreasing the potential damage mediated by oxidation. Recent studies documented that raloxifene has antioxidant properties in vitro. However, there are limited animal studies available to show raloxifene's antioxidant properties. We aimed to investigate the effects of raloxifene on antioxidant enzymes such as SOD, CAT and GPX, TrxR and the levels of GSH and MDA in heart, liver and brain cortex of ovariectomized female rats. Female Sprague Dawley rats weighing 300,350,g (n,=,24) were divided into three groups: (I) Eight non-ovariectomized rats were used as naive controls without any treatment (non-ovariectomized group, n,=,8). Five weeks after ovariectomy, (II) Ovariectomized placebo group (n,=,8) was given physiological saline, and (III) Raloxifene group (n,=,8) was given raloxifene 1,mg/kg,sc. daily for 12 days. Ovariectomy induced significant increases on SOD, GPX, CAT activity and MDA levels in brain, heart and liver tissues compared to non-ovariectomized rats (,p,<,0.05). Raloxifene treatment led to decreased levels of SOD activity in heart, GPX activity in brain and CAT activity in liver tissue when compared to ovariectomized group (,p,<,0.05) but there was no change in activity of TrxR in all groups. The levels of MDA in brain, heart and liver tissues increased in ovariectomized group when compared to non-overiectomized rats (,p,<,0.05). Raloxifene had a significant attenuating effect on the levels of MDA in brain and heart tissues. Our results also indicate that the levels of GSH in brain, heart and liver tissue decreased when compared to non-ovariectomized rats. Raloxifene treatment was observed to significantly increase the levels of GSH in brain and heart tissues (,p,<,0.05). However, there were insignificant differences for the GSH levels in liver tissues of ovariectomized placebo or raloxifene groups. In conclusion, our results demonstrate that raloxifene may be more effective against oxidative stress in heart and brain than in liver tissue. Copyright © 2006 John Wiley & Sons, Ltd. [source] | ||||||||||||||||