Parents' experiences of early support

In Finland, support for families with children is given, as far as possible, as part of basic services. However, to support basic services, services of this kind have also been generated as the result of several projects. The public sector itself has been reorganized and reformed to more resemble a project. In this article, the experiences of parents with children receiving project‐based support are studied qualitatively. Preventive support was offered via child health and maternity clinics in the form of home visiting. The reform of the municipal and service structure has made the development of preventive services an issue of even greater current relevance. The purpose of the study was to collect and explore the experiences of parents as reported in their own voices. The research question is, how did families experience this novel support model in practice? The data consist of interviews with six client families, including mothers and fathers, nine parents in all. A qualitative and narrative approach to the interview data was used. Analysis of the interviews yielded the following themes: being critical about the support given, building trust between parents and the professionals and empowering parents through support. According to the results, parents experienced receiving early support, and especially home visiting, as useful. The purpose of home visiting was not always clear to begin with, and consequently, some parents had reservations about them. Experiences of maternity and child health clinics varied. In addition to the health professionals' skills, their personality, familiarity and supportive and trustful way of working was felt to be most important. Parents felt that their parenting skills and relationships met with approval during the family work. Further research is needed on this kind of early support, especially support delivered at home, to develop these services.     

Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital

Context

Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.

The Role of the Template in Prosthetically Guided Implantology

In prosthetically guided implantology, where ideal placement of implants is determined by the definitive restoration, the use of a radiographic/surgical template plays an essential role. This article describes how to fabricate a radiographic/surgical template to be used for radiographic diagnosis of the selected implant sites and as a guide during surgery for the insertion of the implant with correct angulation.     

HLA-haploidentical blood progenitor cell transplantation in osteopetrosis

Infantile osteopetrosis (OP) carries an extremely poor prognosis unless treated early by hematopoietic stem cell transplantation. We explored the use of purified blood progenitor cells from HLA-haploidentical parents in 7 patients lacking suitable matched donors. Blood progenitor cells were purified by positive selection and by additional T-cell depletion using rosette formation. For conditioning, patients received busulfan, thiotepa, and either cyclophosphamide (5 patients) or fludarabine (2 patients). Stable donor engraftment developed in 6 of 7 patients. Graft-versus-host disease was not observed. Three of the 7 patients had no major complications and 4 of 7 had both veno-occlusive disease and respiratory failure. Five of 7 patients survive with complete cure of OP at a median of 4 years. Patients with OP lacking HLA-matched donors can be successfully treated by transplantation of purified blood progenitor cells from HLA-haploidentical donors.     

Probability of liver cancer and survival in HCV-related or alcoholic-decompensated cirrhosis. A study of 377 patients.

BACKGROUND: Although chronic alcohol intake and chronic hepatitis C may progress to cirrhosis and hepatocellular carcinoma (HCC), few data are available about survival and probability of developing HCC in decompensated cirrhosis of both aetiologies. METHODS: This study identified factors related with probability of developing HCC and survival in a cohort of 377 consecutive patients with decompensated HCV-related cirrhosis (200 cases) or alcoholic cirrhosis (177 cases) without known HCC, hospitalized for their first hepatic decompensation, as well as to evaluate differences between both aetiologies. Patients were followed for a mean period of 39 +/- 2 months. RESULTS: During follow-up, 42 patients (11.1%) developed HCC (16.5% vs 5.1%) in groups HCV and alcohol, respectively; p = 0.0008), and 131 patients (34.7%) died (42% vs 26.6% in groups HCV and alcohol, respectively; p = 0.002). Age and HCV-cirrhosis were independently related to HCC development, while baseline age and Child-Turcotte-Pugh score were independently correlated with survival. CONCLUSION: Survival in decompensated HCV-related or alcoholic cirrhosis is influenced by age and baseline Child-Turcotte-Pugh score, without differences in cirrhosis aetiology. The risk of developing HCC is greater in HCV-related cirrhosis than in alcoholic cirrhosis.     

Evaluation of interleukin-6 and its soluble receptor components sIL-6R and sgp130 as markers of inflammation in inflammatory bowel diseases

Purpose

Interleukin-6 (IL-6) production and signalling are increased in the inflamed mucosa in inflammatory bowel diseases (IBD). As published serum levels of IL-6 and its soluble receptors sIL-6R and sgp130 in IBD are from small cohorts and partly contradictory, we systematically evaluated IL-6, sIL-6R and sgp130 levels as markers of disease activity in Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

Consecutive adult outpatients with confirmed CD or UC were included, and their disease activity and medication were monitored. Serum from 212 CD patients (815 measurements) and 166 UC patients (514 measurements) was analysed, and 100 age-matched healthy blood donors were used as controls.

Results

IL-6 serum levels were significantly elevated in active versus inactive CD and UC, also compared with healthy controls. However, only a fraction of IBD patients showed increased serum IL-6. IL-6 levels ranged up to 32.7 ng/mL in active CD (>?5000-fold higher than in controls), but also up to 6.9 ng/mL in inactive CD. Increases in active UC (up to 195 pg/mL) and inactive UC (up to 27 pg/mL) were less pronounced. Associations between IL-6 serum levels and C-reactive protein concentrations as well as leukocyte and thrombocyte counts were observed. Median sIL-6R and sgp130 levels were only increased by up to 15%, which was considered of no diagnostic significance.

Conclusions

Only a minority of IBD patients shows elevated IL-6 serum levels. However, in these patients, IL-6 is strongly associated with disease activity. Its soluble receptors sIL-6R and sgp130 do not appear useful as biomarkers in IBD.

     

Epidemiology and prevention: Association of Chlamydia pneumoniae and acute coronary heart disease events in non-insulin dependent diabetic and non-diabetic subjects in Finland

OBJECTIVE: It has been suggested that Chlamydia pneumoniae, a Gram-negativeintracellular bacterium, is a risk factor for both myocardialinfarction and chronic coronary heart disease. Previous studieshave been done predominantly in non-diabetic subjects and thusthe effect of diabetes on the association between C. pneumontaeantibodies and coronary heart disease has not been analysed.The aim of our study was to investigate the association betweenprior chlamydial infection and the risk of serious coronaryheart disease events (myocardial infarction or coronary death)in a 7-year prospective study of cohorts of diabetic and non-diabeticsubjects in two areas of Finland. RESULTS: It was found that the prevalence of elevated chlamydial antibodiesat baseline was higher in non-diabetic subjects who had seriouscoronary heart disease events during the follow-up than in subjectswithout coronary heart disease events (32 vs 15%, relative risk2·56, P=0·013) in East Finland. In non-diabeticsubjects living in West Finland we did not find this association.The association between the C pneumoniae antibodies and coronaryheart disease events did not markedly change after controllingfor other risk factors for coronary heart disease (OR 2·44,P=0·055) in non-diabetic subjects living in eastern Finland.In diabetic patients we did not find any association betweenchlamydial antibodies and coronary heart disease events. CONCLUSION: We found an association between C. pneumoniae antibodies andcoronary heart disease events in non-diabetics living in easternFinland. This association remained strong even after controllingfor the other risk factors for coronary heart disease. In diabeticpatients with high risk for coronary heart disease, C. pneumnoniaewas not a risk factor for coronary heart disease.(Eur HeartJ 1996; 17: 682–688)