Follicular fluid antibodies to Chlamydia trachomatis and human heat shock protein-60 kDa and infertility in women

BACKGROUND: The objective of this study was to establish the relationship between presence of anti-Chlamydia trachomatis and anti-HSP60 antibodies in serum and follicular fluid of infertile women. METHODS: Serum IgG and follicular fluid IgA to Chlamydia trachomatis and human heat shock protein 60 (HSP60) were determined in 41 women undergoing in vitro fertilization (IVF). RESULTS: A significant association was found between presence of bacterial antibodies in serum and IgA anti-HSP60 in follicular fluid. CONCLUSIONS: Chlamydia trachomatis infection might be triggering an autoimmune process that could negatively affect the success of IVF.     

Having the talk--and it's not about sex!

The end of life is a difficult time for individuals and their families; some families find it devastating. Although the majority of Americans express a desire to die at home, only 25% achieve this goal. This finding and others from the landmark Last Acts state-by-state report card suggest we can do more to help ease the end-of-life transition. Report card results are reported, highlighting the need for better communication between physicians and patients. Physicians have a key role to play in helping individuals and their families understand their choices and deal with end-of-life care issues. Resources and recommendations are offered to help facilitate planning discussions. Information about hospice use and eligibility is also outlined.     

Development of the Start Healthy Feeding Guidelines for Infants and Toddlers

This paper outlines the three different methods used to develop the Start Healthy Feeding Guidelines for Infants and Toddlers. The resulting consensus on each guideline area is given in the accompanying paper (3), which should prove useful for both parents and professionals.11112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180     

Effects of coronary artery bypass related conduction defects: a 10-year follow-up study

OBJECTIVES: The aim of this study is to determine the long-term prognostic significance of new permanent conduction defects (CDs) related to coronary artery bypass grafting (CABG), and to assess predisposing factors for increased mortality after CABG. DESIGN: One hundred and eighty patients who underwent an elective CABG without any evidence of preoperative CDs were followed on average for 9.6 years. Long-term outcome was observed in terms of Kaplan-Meier survival analysis, and several potential pre-, intra- and postoperative factors for increased mortality were analysed using the Cox regression model. RESULTS: Sixty-three (35.0%) of the patients developed a new CD (CD+ group) before hospital discharge. Early (<30 days) and long-term (>30 days) survival rates were 98.9 and 86.1%, respectively. The long-term survival in CD+ patients was significantly lower that in CD- patients (77.8% vs 90.4%, p = 0.02). However, cardiac survival in CD+ patients and CD- patients did not differ from each other (88.9% and 92.3%, respectively, p=NS). Five independent predictors for increased all cause mortality were identified: diabetes (relative risk ratio 5.99 [2.43-14.78]), number of distal anastomoses (3.20 [1.30-7.88]), a new intraoperative conduction defect (2.83 [95% CI 1.24-6.49]), preoperative ejection fraction <50% (2.60 [1.08-6.27]) and perfusion time (1.02 [1.01-1.03]). CONCLUSIONS: Excellent survival rates can be obtained 10 years after CABG. CDs were not related to increased cardiac mortality. The appearance of preoperative diabetes, intraoperative perfusion time, number of distal anastomoses performed, CABG derived permanent CDs and low preoperative ejection fraction are associated with higher all cause mortality during the long-term follow-up.     

Place, discourse and vulnerability--a qualitative study of young adults living in a Swedish urban poverty zone

This paper presents findings from a qualitative study of young adults living in a relatively deprived metropolitan area in Sweden. The analysis of interview data yielded four separate types of neighbourhood discourses, each related to a major hegemonic 'discourse of the problematic area'. The discursive model was used to disclose different patterns of vulnerability, at both the individual and the community level. The discourses are suggested to function as mechanisms through which the spatial context, defined in structural and relational terms, could be linked to health and well-being.     

Power and leadership

The author's role as a nurse consultant in a Mental Health Trust in the north of England is particularly interesting because of the peculiar position of the nurse consultant. One of the main components of the role is leadership, yet they are not operational managers so cannot draw on traditional positional power as a way of influencing people. This led the author to explore the concept of power and its implications for leadership. The paper is the result of this exploration: it reviews theories of power and how these can be applied to an understanding of leadership.     

The issue of death and dying

This study brings about a reflection on death and dying, commented as if they had the same meaning. Nowadays, one talks about death as seldom as possible and, by its negation, there appeared the negation of diseases, thus causing the diseased people to become totally dependant on health teams. Technological and scientific advances led to postponing death, and it is possible to temporarily extend what humans decided to call life. This has become the great piece of criticism by scholars that seek to lead death again to its place by trying to bring it again into the center of reflections, analyses and discussions within the most diverse areas.     

An approach to studying social disparities in health and health care

OBJECTIVE: We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care. METHODS: Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention. RESULTS: We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities. CONCLUSIONS: This systematic approach should be useful for studying and monitoring disparities in other indicators of health and health care.