Attention orienting by another's gaze direction in children with autism

BACKGROUND: The aim of this study was to investigate attention orienting triggered by another's gaze direction in autism. METHOD: Twelve high-functioning children with autism and gender- and age-matched normal control children were studied using two tasks. In the first task, children were asked to detect laterally presented target stimuli preceded by centrally presented facial cue stimuli in which gaze was either straight ahead or averted. The direction of the cue was either congruent, neutral, or incongruent with respect to the laterality of the target stimulus. In the second task, children were asked to discriminate the direction of eye gaze. RESULTS: The results showed that another person's static gaze direction triggered an automatic shift of visual attention, both in children with autism and in normally developing children. The children in both groups were also able to overtly discriminate the direction of the gaze. CONCLUSION: These results seem to suggest that, in children with autism, the visual system processes information about another person's gaze direction and sends this information to those areas that subserve reflexive attention orienting. However, future studies are needed to investigate whether the processing of eyes and gaze direction relies on similar neural mechanisms in children with autism and in normally developing children.     

Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion

In a prospective randomised study with a 2-year follow-up, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage (CIFC) or the Cloward procedure (CP). The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiological variables for the clinical outcome. Gender, age, smoking habits, disc height, segmental kyphosis and type of surgical procedure were used as independent (before surgery) variables in a multiple regression model. Male gender, one-level surgery and CP treatment were significant predictors of fusion and explained 14% of the variability of fusion status at follow-up. Number of levels operated on, however, did not influence the clinical outcome. Fifty-two per cent of the women and 17% of the men in the CIFC group, and 25% of the women and 8% of the men in the CP group, had pseudarthrosis. Although patients with a healed fusion had significantly less pain intensity than patients with pseudarthrosis, radiological variables explained only 4% of the variability of pain at follow-up. Apart from a significant correlation between preoperative kyphosis and neck disability index at follow-up, no significant correlation between either postoperative kyphosis or preoperative or postoperative disc height and clinical outcome was found. Neither degree of segmental kyphosis nor disc height was different between patients with healed fusion and pseudarthrosis. One can conclude that male gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected outcome. In contrast to the commonly held view based mainly on theoretical considerations, no effect on clinical outcome could be demonstrated for segmental kyphosis and disc height at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited.     

Development and characterization of an endometrial tissue culture system

A culture system has been developed for pieces of whole endometrium, comprising many different cell types. The system maintains the integrity of all compartments important for tissue function and allows functional studies of the human endometrium. Endometrial biopsy strips were collected from fertile women. The strips were cut into small pieces and cultured for 8 h on dishes pre-coated with Matrigel. The oxygen concentration was kept low (5%), since it was shown to be beneficial for the culture in preliminary studies. Scanning electron microscopy and immunohistochemical detection of proliferating cell nuclear antigen (PCNA), oestrogen receptor alpha (ERalpha), progesterone receptor (PR) A + B and B and TUNEL were used to characterize the endometrium. During culture, the luminal and glandular epithelial cells began to cover the surface injured when cutting the sample, suggesting a healing process. The luminal epithelial surface appeared normal after culture. There was an increased sensitivity to culture after the implantation window. This new method for culture of endometrial strips in vitro has proven successful and may be used for functional studies of the human endometrium.     

A holistic-existential approach to health promotion

Health promotion seems to be implicit in many nursing theories, but the theoretical and philosophical basis of health promotion in nursing is not always explicitly stated. The interpretation of health promotion is closely related to the interpretation of man, health, illness and nursing. There is a need to clarify, refine and redefine health promotion in nursing because the concept is partly nonspecific and has not been used to identify a distinctive nursing focus. The aim of this study was to formulate a stipulative definition of health promotive nursing with a holistic-existential approach. A philosophical frame of reference in combination with conceptual analysis and theoretical synthesis were used as the methodological approach. The philosophical framework served as a basis in selecting the nursing theories and influenced the analysis. Two nursing theories and one nursing model were selected due to their influence on Norwegian nursing and because of their philosophical basis. Through analysis and synthesis of the selected nursing theories, the concepts man, health, illness/disease and nursing were analysed. The paper proposes a stipulative definition of health promotion in nursing based on a holistic-existential approach, supported by five necessary conditions. The definition and conditions needs to be further investigated by both empirical studies and by comparing with other relevant nursing theories, in order to formulate theoretical statements. The proposed definition may be the first step in a process of developing a theoretical framework of health promotive nursing with a holistic-existential approach.     

Validity of a single-item measure of stress symptoms

OBJECTIVES: The objective of the study was to investigate the content, criterion, and construct validity of a single-item measure of stress symptoms. Such a concise measure would be useful in monitoring stress at work. The criteria for validity were convergence with conceptionally close measures, the plausibility of associations with health and work characteristics, and the power to discriminate between groups. METHODS: Four sets of independent cross-sectional data were used. The first data set, from Finland Post, comprised symptoms of ill health and mental resources (N=1014). The second, from four Nordic countries, included well-known validated scales on exhaustion, mental health, sleep, vitality, and optimism, and therefore the convergence between the measures could be studied (N=1015). The third, from a metal factory, included three indicators of health and four work characteristics (N=773). The fourth, representing the Finnish working population, described group differences in stress symptoms (N=2156) and allowed comparison with a study on emotional exhaustion in the working population. Distributions, correlations, and factor analysis were used for the study. RESULTS: The stress-symptoms item converged with items on psychological symptoms and sleep disturbances and with validated measures of well-being. It had theoretically grounded associations with indicators of health and psychosocial work characteristics, and it discriminated between gender and age groups and industrial branches in accordance with the validated emotional exhaustion scale. CONCLUSIONS: The stress-symptoms item showed satisfactory content, criterion, and construct validity for group-level analysis. It is suggested that the longer scales used to measure psychological stress can be replaced with it in survey research.     

The Swedish coeliac disease epidemic with a prevailing twofold higher risk in girls compared to boys may reflect gender specific risk factors

In the mid 1980s the incidence of coeliac disease in Swedish children below 2 years of age increased threefold within a few years, and after a 10-year high incidence period returned equally rapidly to the previous level. Analysing the epidemic with respect to any change in female to male ratio over time, or shift in age at diagnosis, may increase the understanding of coeliac disease aetiology. In a population-based incidence study of childhood coeliac disease, 2151 cases (811 boys/1340 girls) were diagnosed from 1973 to 1997. Incidence rates and relative risks (RRs) were calculated by gender, age at diagnosis and calendar time. Cumulative incidences by age and gender were calculated for different birth cohorts. A twofold higher risk (RR: 1.9, 95% confidence interval (CI) 1.7–2.1) for coeliac disease in girls as compared to boys prevailed throughout the epidemic. Further, during the post-epidemic period there was an upward shift in age at diagnosis. So far, however, a majority of the cases diagnosed at older ages belong to birth cohorts of the epidemic period, i.e. cohorts that already had a high coeliac disease risk before 2 years of age. Our results suggest that girls as compared to boys may be genetically more vulnerable to environmental exposures influencing the immunological processes towards coeliac disease. Further, an increased risk for coeliac disease during the first years of life due to, for example, unfavourable infant dietary habits, may result in an increased total childhood risk for coeliac disease. A longer follow-up, even into adulthood, is needed to determine whether or not the lifetime risk has changed.     

Elbow synovectomy on patients with juvenile rheumatoid arthritis

Twenty-four primary elbow synovectomies were done between 1991 and 1998 at the authors' institution on 19 patients (15 females, four males) with juvenile rheumatoid arthritis. Five bilateral and 14 unilateral procedures were done. The mean age of the patients was 29 years (range, 11-64 years) at the time of surgery and the mean disease duration was 19 years (range, 2-51 years). Preoperatively radiographic destruction of Larsen Grade 1 was detected in 21% of elbows, Grade 2 in 54%, and Grade 3 in 4%. In 21% of elbows no radiographic destruction was present (Grade 0). The cumulative survival rate of elbow synovectomy was 84% (95% confidence interval, 68-98) at 5 years. Four resynovectomies and two elbow replacement arthroplasties were done during the followup period. Complete pain relief was documented in 44% of patients and subjective outcome was excellent or good in 72% of patients. No significant improvement was observed in functional ability or range of motion in extension and flexion or pronation and supination. The results of the current study (mean followup, 5 years; range, 2-9 years) are slightly worse compared with the short-term results of elbow synovectomy in patients with adult-onset rheumatoid arthritis.     

Cognitive performance of children who have undergone liver transplantation

BACKGROUND: We investigated the cognitive status and quality of life (QoL) in the late postoperative phase of children who had undergone liver transplantation (LTx). METHODS: The sample consisted of 29 children who had undergone LTx at our center. The children were at least 6 years of age and had received the transplant between 3 and 10 years (mean 6.4 years) previously. In 16 of the 29 children, a living-related transplantation had been performed. Cognitive function was assessed with the three subscales of the Kaufman Assessment Battery for Children (K-ABC): the sequential processing scale, simultaneous processing scale, and achievement scale. QoL was measured with a specific questionnaire for children. RESULTS: The children scored below the population mean but within the normal range on all subscales of the K-ABC, except for the sequential processing scale, on which the children scored significantly below the norm and below their own performance on the simultaneous processing scale. Scores were below average for everyday and psychic functions and in the normal range for social and physical functions on the QoL questionnaire. Age at transplantation and achievement in the K-ABC were highly negatively correlated. A multiple regression analysis revealed that age and height at transplantation, and also to a lesser degree the type of transplantation, predict the level of cognitive functioning in the late postoperative phase. CONCLUSION: We conclude that the cognitive functions and QoL of children in the late postoperative phase who have undergone LTx are at the lower end of the norm in the long-term follow-up. Children who are younger and more physically developed at the time of transplantation will have a better mental-development prognosis.     

Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm,Sweden

Background data were collected from patients presenting with fatigue at the clinic of infectious diseases at Huddinge University Hospital, Stockholm. The main purpose was to look for differences as to demographic and functional status for patients fulfilling criteria for chronic fatigue syndrome (CFS) and chronic fatigue (CF). A cross-sectional questionnaire survey was performed using a variety of instruments. A thorough medical investigation was performed. No difference was found as to social situation, occupation and illness attributions for patients in the two categories. Patients with CFS reported in general a higher degree of 'sickness' with more self-reported somatic symptoms, more self-reported functional impairment and more absence from work. A higher degree of psychiatric comorbidity was observed in CF than in CFS patients. A majority of CFS patients (80%) had an acute infectious onset compared to 43% in the CF group. Presently used criteria might, according to findings presented here, define two different patient categories in a population characterized by severe, prolonged fatigue. Because CFS patients (compared to patients with CF) have more somatic symptoms, more often report an infectious, sudden onset and have less psychiatric comorbidity, and CF patients seem to have more of an emotional, burn-out-like component one could speculate about the existence of different pathogenetic backgrounds behind the two diagnoses.