Is bone infection of endogenous or exogenous origin? A pathophysiological approach

Osteomyelitis is a bacterial implant in bone matrix. Infection occurs as a result of a bacteremia, an inoculation during aseptic or orthopedic surgery, or a contiguous infectious focus. Persistent and relapsing infection may be due to three situations: underlying conditions such as diabetes mellitus or rheumatoid arthritis, presence of foreign surgical implant, and a causative bacterial strain. The pathogenesis of osteomyelitis has been explored through various experimental models, involving mostly Staphylococcus (S. aureus, S. epidermidis) and has given new insights. Bacterial adherence to implanted devices or bone matrix via surface proteins is critical for bacterial survival. Further bacterial growth depends on various mechanisms: the capacity to exhibit matrix-embedded lifestyle known as biofilm and the ability for bacterial subpopulations to switch to a dormant metabolic state known as small colony variants. In addition to bacterial factors, the presence of foreign material induces a defect in local inflammatory response partly responsible for the high susceptibility to infection.     

Mandatory or voluntary vaccinations? Juridical and medico-legal aspects

The Italian juridical and legislative aspects of vaccination based on a compulsory system are presented considering the medico-legal questions. The prospective of a voluntary system, as anticipated by many normatives and other official documents, is examined. The experience of some local health authorities on cases of in observance of the vaccinal obligation are detailed Finally professional risks for vaccinal operators are examined and the need of specific guidelines for parents' consent to compulsory vaccination during infancy is prospected.     

Legal aspects of video registration during operations--the digital operating room assistant: opportunity or threat?

Video registration in hospitals is becoming increasingly frequent and an increasing number of surgical procedures are performed with the help of video imaging. The Technical University of Delft is developing a safety system that will use video images to directly inform medical staff of technical problems during surgery so that necessary adjustments can be made in time: the digital operating room assistant. However, the saving of video images is legally considered to be processing of personal data. Dutch privacy legislation requires that certain legal demands are taken into consideration. From legal point of view three situations can be distinguished where video images are being used: (a) as an essential part of treatment (endoscopic surgery, for example), (b) to enhance the quality of the procedure, and (c) for the purposes of peer assessment or education. To whom and in which way consent has to be asked, differs per situation. We recommend that video recordings of crucial points in the operation are included in the patient file. The same counts for incidental findings or complications if, according to the standard of a good caregiver, this is necessary for the further treatment of the patient. In addition to the doctor and the patient, in certain circumstances, access to the video recordings may also be granted to the Health Care Inspectorate and, to the Public Prosecutor. Covert video recording of an employee is a breach of privacy and essentially punishable by law. Video recordings may not themselves be used to assess the performance of the surgeon involved.     

Are orgasms in the mind or the body? Psychosocial versus physiological correlates of orgasmic pleasure and satisfaction

We investigated the hypothesis that the subjective experience of orgasmic pleasure and satisfaction depends more on psychological and psychosocial than on physical factors. Male and female participants rated adjectives to describe orgasm attained during either solitary masturbation (n = 356) or sex with a partner (n = 442). Orgasmic pleasure and satisfaction were related more to (a) the cognitive-affective than sensory aspects of the orgasm experience; (b) the overall physical and psychological intensity of orgasm but not to anatomical location of orgasm sensations; and (d) relationship satisfaction. These findings emphasize the importance of psychosocial determinants of the orgasm experience.     

US Black vs White disparities in foetal growth: physiological or pathological?

BACKGROUND: Birthweight for gestational age is lower in US Black infants than in US White infants. It is unknown, however, whether this difference is 'normal' (i.e. physiological) or reflects pathological foetal growth restriction. METHODS: We applied an analytic approach based on foetuses at risk to compare gestational age-specific rates of live birth, 'revealed' small-for-gestational-age (SGA), and neonatal mortality among singleton infants >or=22 weeks of gestation and >or=500 g born in 1998-2000 to US White (n = 9 012 194), US-born Black (n = 1 554 382), and foreign-born Black (n = 200 395) mothers. Graphical methods and Cox proportional hazards regression analyses were used to compare outcomes in the three ethnic groups. RESULTS: Rates of live birth and neonatal mortality were highest at all gestational ages in US-born Blacks, lowest in Whites, and intermediate in foreign-born Blacks. The revealed SGA pattern cohered much more closely with the observed pattern for neonatal mortality when SGA was defined based on a single, overall standard of birthweight for gestational age than when based on ethnic group-specific standards. CONCLUSION: The closer coherence of revealed SGA and neonatal mortality rates based on a single standard and the intermediate pattern among foreign-born Blacks strongly suggest that Black-White differences in birthweight for gestational age are pathological, rather than physiological.     

Increased dairy product or calcium intake: is body weight or composition affected in humans?

To assess the possible impact of increased intakes of dairy products or calcium on body weight or composition, a MEDLINE search was conducted to identify randomized trials of supplementation with calcium or dairy products. Nine studies of dairy product supplementation were located: In seven, no significant differences in the change in body weight or composition were detected between treatment and control groups. However, two studies conducted in older adults observed significantly greater weight gain in the dairy product groups. The interpretation of these findings is complicated by the inability to accurately determine the extent of dietary compensation for the increment in energy intake provided by the added dairy products. This is not an issue in the interpretation of studies of calcium supplementation, of which 17 were identified. Only one study found greater weight loss in the supplemented group; in the remaining studies, changes in body weight and/or body fat were strikingly similar between groups. In conclusion, the data available from randomized trials of dairy product or calcium supplementation provide little support for an effect in reducing body weight or fat mass. However, the studies reviewed were not specifically designed or powered to address this issue; such studies are required.     

Message Sensation and Cognition Values: Factors of Competition or Integration?

Using the Activation Model of Information Exposure and Elaboration Likelihood Model as theoretical frameworks, this study explored the effects of message sensation value (MSV) and message cognition value (MCV) of antismoking public service announcements (PSAs) on ad processing and evaluation among young adults, and the difference between high sensation seekers and low sensation seekers in their perceptions and responses toward ads with different levels of sensation and cognition value. A 2 (MSV: high vs. low) × 2 (MCV: high vs. low) × 2 (need for sensation: high vs. low) mixed experimental design was conducted. Two physiological measures including skin conductance and heart rate were examined. Findings of this study show that MSV was not a distraction but a facilitator of message persuasiveness. These findings contribute to the activation model. In addition, need for sensation moderated the interaction effect of MSV and MCV on ad processing. Low sensation seekers were more likely to experience the interaction between MSV and MCV than high sensation seekers. Several observations related to the findings and implications for antismoking message designs are elaborated. Limitations and directions for future research are also outlined.     

Occupational therapy evaluation: use of self-report and/or observation?

Background: The Occupational Therapy Intervention Process Model (OTIPM) serves to guide occupational therapists in their professional reasoning. The OTIPM prescribes evaluation of task performance based on both self-report and observation. Although this approach seems ideal, many clinicians raise the issue that time to perform evaluations is limited. It is, therefore, relevant to examine whether similar information concerning task performance can be obtained using self-report or observation. Objective: The aims were to investigate what information can be obtained regarding the quality of ADL task performance based on self-report and observation, respectively, and to examine the relationship between measures of self-reported and observed quality of ADL task performance. Methods: The quality of ADL task performance among 20 adults with depression was evaluated using the ADL Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS). Results and conclusions: Results indicated that participants both reported and demonstrated increased effort and/or fatigue, increased use of time, need for assistance, and safety problems. However, little relationship was found between measures of self-reported and observed quality of ADL task performance, supporting the use of both self-report and observation as part of the evaluation phase outlined in the OTIPM.     

Women and health consequences of natural disasters: Challenge or opportunity?

ABSTRACT

Disasters do not affect people equally; the impact of disasters on the lives of women is different from other groups of a community. Women’s fundamental rights to health and safety are violated after disasters. The authors of this study aimed to explore various factors of women’s health with reference to previous natural disasters in Iran. A qualitative approach using in-depth unstructured interviews and field observations was employed to explore women’s health factors in the affected regions. A total of 22 participants affected by disasters, as well as key informants, were interviewed applying the purposeful sampling method. Data were collected in 2014 in three provinces, including East Azerbaijan, Bushehr, and Mazandaran. A content analysis using the Graneheim approach was performed for analyzing the transcribed interviews. Two themes and four categories were extracted from the data. The themes that emerged included psycho-physical effects and women’s health status. Physical and psycho-emotional effects and reproductive and environmental health effects were the four emergent categories. The findings implied that managing women’s health challenges may result in reducing the distressing effects of disaster. These findings support identification and application of the mechanisms by which women’s well-being in physical, mental, reproductive, and environmental aspects can be protected after disasters.     

Do enkephalins and other endogenous opioids participate in regulation of cancer growth?

Attempts are interesting exploratory trend to define precisely relations between endogenous opioid system and neoplastic process development. Mechanism in which enkephalins and other endogenous opioides could influence on cancer growth is not clear. Several hypothesis were put and presented in the paper.     

Gossip and nurses: malady or remedy?

Gossip is a natural part of every social setting and has a profound influence on organizational behaviors. As the primary care givers in the hospital setting, nurses are the front line in generating and controlling gossip. It is essential that management recognize this dynamic in the nursing workforce so they can be proactive in developing strategies to effectively control gossip. This article highlights the positive and negative aspects of gossip and provides strategies to help nursing professionals effectively manage this workplace issue. Unmanaged gossip can have a negative effect on the workplace by damaging relationships and reputations. Gossip that is managed effectively can have a positive effect on the workplace by building social bonds within the nursing unit.     

Physicians and nurses: friends or foes?

Changes in the roles of physicians and nurses have resulted in interdisciplinary tension and conflict between these professionals. A strong collaborative practice is critical not only to the delivery of high-quality, cost-efficient patient care but also to the personal and professional satisfaction of physicians and nurses. Cooperation in caregiving starts with a shared vision and stated behavior expectations; implementation of this vision then leads to collaboration. Hospital executives and managers are responsible for supporting and facilitating the processes related to this vision implementation. Specifically, they should ensure that systems within the organization do not promote conflict between caregivers. In addition, they should augment the vision and behavior-change initiatives with joint nurse-physician activities that are centered around both professionals' shared interest in good patient care. An example of such an activity is creating opportunities for physicians and nurses to together discuss and plan improvements in delivery of care.