Child psychiatric networks of health centre doctors

OBJECTIVE: To ascertain the personal networks GPs use when managing children with psychiatric problems. DESIGN: Cross-sectional postal study. SETTING: Health centres in the catchment area of Tampere University Hospital, Finland. SUBJECTS: GPs (n = 755) were sent a postal questionnaire. The response rate was 66.1%. MAIN OUTCOME MEASURES: A fill-in picture was used to identify professionals within the network of each GP. The quality of collaboration between GPs and professionals in health centres, other municipal authorities and secondary health care was assessed on a four-step Likert scale. RESULTS: A majority of respondents (64%) could name at least one person from their health centre with whom they cooperate in child psychiatric cases. The corresponding number in contact with other municipal authorities was 40%, and 25% with secondary care level. Almost all GPs (95%) had mostly positive experiences of cooperation with different professionals in the health centres, 73% with other municipal authorities and 47% with child psychiatric specialist care. CONCLUSION: The personal networks of health centre doctors call for improvement if the increasing child psychiatric problems are to be kept under control. This is a challenge for both primary and secondary care level doctors.     

Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age

Aim

To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.

New dip-and-read test for determining leukocytes in urine

A new reagent strip for the determination of leukocytes in urine (LEUKOSTIX; Ames) is described. The test is based on the esterase activity in leukocytes as a marker. Upon contact between the reagent matrix and a urine containing leukocytes, an amino acid ester is hydrolyzed by the esterase to its corresponding alcohol. The free alcohol then couples with a diazonium salt to produce a purple azo dye. The relative concentration of leukocytes in the urine is obtained by visually comparing the strip reaction with a color chart. Performance of the strip was evaluated in a clinical study involving eight different sites and 867 urine specimens. The comparison method was sediment microscopy; specimens containing five cells or more per high-power field were considered to be positive. Sensitivity was 76.3%, specificity 80.8%. Performance was comparable with that of the CHEMSTRIP LN (Boehringer-Mannheim Diagnostics, Inc.) leukocyte test, which we evaluated concurrently.     

Effects of Early Bedside Cycle Exercise on Intracranial Pressure and Systemic Hemodynamics in Critically Ill Patients in a Neurointensive Care Unit

Background

Physiotherapy is an important part of treatment after severe brain injuries and stroke, but its effect on intracranial and systemic hemodynamics is minimally investigated. Therefore, the aim of this study was to assess the effects of an early bedside cycle exercise on intracranial and systemic hemodynamics in critically ill patients when admitted to a neurointensive care unit (NICU).

Methods

Twenty critically ill patients suffering from brain injuries or stroke were included in this study performed in the NICU at Sahlgrenska University Hospital. One early implemented exercise session was performed using a bedside cycle ergometer for 20 min. Intracranial and hemodynamic variables were measured two times before, three times during, and two times after the bedside cycling exercise. Analyzed variables were intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO₂), cardiac output (CO), stroke volume (SV), and stroke volume variation (SVV). The cycling intervention was conducted within 7 ± 5 days after admission to the NICU.

Results

Cycle exercise increased MAP (p = 0.029) and SV (p = 0.003) significantly. After exercise CO, SV, MAP, and CPP decreased significantly, while no changes in HR, SVV, SpO₂, or ICP were noted when compared to values obtained during exercise. There were no differences in data obtained before versus after exercise.

Conclusion

Early implemented exercise with a bedside cycle ergometer, for patients with severe brain injuries or stroke when admitted to a NICU, is considered to be a clinically safe procedure.

     

Nursing care as a moral, practical, communicative and creative activity

In this paper nursing care is studied by philosophical inquiry. According to the outlined philosophical theory, nursing can be conceived as a moral, practical, communicative and creative activity. This means that nursing care is viewed as a manifestation of a conception of the good life, that it is related to some kind of changes or non-changes with respect to the patient, that it is oriented towards reaching understanding and that something new, unpredictable and meaningful is created in the nursing interaction. The theory is defended by scientific, moral and practical arguments. Habermas' theory of communicative action plays a central part in the outlined theory of nursing care.     

Type 2 Diabetes Risk Alleles Are Associated With Reduced Size at Birth

OBJECTIVE

Low birth weight is associated with an increased risk of type 2 diabetes. The mechanisms underlying this association are unknown and may represent intrauterine programming or two phenotypes of one genotype. The fetal insulin hypothesis proposes that common genetic variants that reduce insulin secretion or action may predispose to type 2 diabetes and also reduce birth weight, since insulin is a key fetal growth factor. We tested whether common genetic variants that predispose to type 2 diabetes also reduce birth weight.

RESEARCH DESIGN AND METHODS

We genotyped single-nucleotide polymorphisms (SNPs) at five recently identified type 2 diabetes loci (CDKAL1, CDKN2A/B, HHEX-IDE, IGF2BP2, and SLC30A8) in 7,986 mothers and 19,200 offspring from four studies of white Europeans. We tested the association between maternal or fetal genotype at each locus and birth weight of the offspring.

RESULTS

We found that type 2 diabetes risk alleles at the CDKAL1 and HHEX-IDE loci were associated with reduced birth weight when inherited by the fetus (21 g [95% CI 11–31], P = 2 × 10⁻⁵, and 14 g [4–23], P = 0.004, lower birth weight per risk allele, respectively). The 4% of offspring carrying four risk alleles at these two loci were 80 g (95% CI 39–120) lighter at birth than the 8% carrying none (P_trend = 5 × 10⁻⁷). There were no associations between birth weight and fetal genotypes at the three other loci or maternal genotypes at any locus.

CONCLUSIONS

Our results are in keeping with the fetal insulin hypothesis and provide robust evidence that common disease-associated variants can alter size at birth directly through the fetal genotype.Reduced birth weight is associated with late-onset diseases including type 2 diabetes, hypertension, and heart disease (1). The cause of this association is not known. It is often proposed to reflect fetal programming in utero in response to maternal malnutrition in pregnancy (2). An alternative explanation is that genetic variants that increase disease risk could also reduce fetal growth. In accordance with the fetal insulin hypothesis (3), we proposed that genetic variants that reduce insulin secretion or insulin sensitivity might reduce birth weight as well as predisposing to type 2 diabetes in adulthood, since fetal insulin is a key fetal growth factor.The fetal insulin hypothesis was initially based on observations of subjects with glucokinase (GCK) mutations, whose birth weight is reduced by 533 g (4) and who have mild hyperglycemia postnatally. Markedly reduced birth weights in patients with monogenic diabetes due to mutations in the INS, INSR, IPF1, KCNJ11, ABCC8, and HNF1B genes (3,5–8) have further established the principle that gene variants can cause both low birth weight and diabetes. However, mutations causing monogenic diabetes are too rare to explain the association between reduced birth weight and type 2 diabetes observed in population studies.There is epidemiological support for the fetal insulin hypothesis. Offspring of fathers who go on to develop type 2 diabetes later in life have lower birth weights than those born to fathers who do not develop diabetes (9–12). This is consistent with the fetus inheriting, on average, 50% of the father''s genetic predisposition to diabetes and this genetic predisposition reducing fetal growth.Maternal genotypes may have opposing effects on offspring birth weight compared with fetal genotypes (4). Type 2 diabetes risk alleles, which are present in the mother and which raise maternal glycemia in pregnancy, will increase fetal growth by increasing fetal insulin secretion. Maternal inheritance of common risk alleles in the GCK and TCF7L2 genes, which predispose to hyperglycemia and type 2 diabetes, respectively, were reproducibly associated with higher offspring birth weight (13,14). However, neither of these risk alleles at TCF7L2 and GCK or the type 2 diabetes risk alleles in the PPARG and KCNJ11 genes was associated with birth weight directly through the fetal genotype (13–15).In this study, we aimed to further test the relationship between known type 2 diabetes variants and size at birth. We selected variants at five loci (CDKAL1, CDKN2A/B, HHEX-IDE, IGF2BP2, and SLC30A8), recently identified through type 2 diabetes genome-wide association studies (16–21), that have not been investigated in relation to fetal growth. Each of these loci has been shown to predispose to diabetes by reducing insulin secretion (22–24). We used data from 19,200 offspring and 7,986 mothers from four studies of white Europeans to test the hypothesis that these variants are associated with birth weight, either through the fetal or maternal genotype.     

The HIV prevention needs of injection drug users in Estonia

To assess the relationships between HIV transmission risk behaviours, HIV serostatus and knowledge of HIV serostatus among active injection drug users (IDUs) residing in Tallinn, Estonia, we conducted HIV testing and administered a standardized interview to 266 participants reporting recent injection drug use. In total, 45% were HIV positive, and of those, 39% knew their HIV serostatus. Those who knew their HIV-positive serostatus were less likely to report giving someone else their needle after they used it (9%) than were HIV-negative participants (23%) and those who were HIV positive but unaware of their HIV-positive serostatus (25%). There were no statistically significant differences in unprotected sex or other drug use behaviours between the groups. Most participants reported that HIV can be transmitted through sharing needles (98%) and unprotected sexual activity (93%). Prevention needs of IDUs in this area include increasing the rates of HIV testing and implementing effective programmes to reduce sexual and drug use risk behaviours.     

Obstructed pancreaticojejunostomy partly explains exocrine insufficiency after pancreatic head resection

OBJECTIVE: The majority of patients with long-term survival after pancreatic head resection suffer from pancreatic exocrine insufficiency. The objective of this study was to investigate whether this is due to glandular malfunction or obstructed pancreaticojejunal anastomosis. MATERIAL AND METHODS: Twenty-six patients (10 M, 16 F, mean age 61 years, range 34-81 years) were re-examined a median of 52 months (range 3-76 months) after pancreatic head resection and end-to-end invaginated pancreaticojejunostomy. Pancreatic exocrine function was measured by fecal elastase-1 assay. The size of the pancreatic remnant, glandular secretion and the flow through the anastomosis were analyzed with secretin-stimulated dynamic magnetic resonance pancreatography (D-MRP). RESULTS: All patients had pancreatic exocrine insufficiency, 24 (92%) of them having severe insufficiency. Eighteen patients (69%) reported moderate to severe diarrhea. Lowest fecal elastase-1 concentrations were associated with the initial diagnosis of chronic pancreatitis or ductal adenocarcinoma, suggesting preoperative primary or secondary chronic pancreatitis as important determinants. The size of the remnant gland did not correlate with the fecal elastase-1 concentrations. D-MRP failed in three patients. Severe glandular malfunctions were found in 7 (30%) of the 23 successful D-MRP examinations. The anastomosis was totally obstructed in 5 patients (22%) or partially obstructed in 6 (26%) but remained perfectly open in 5 patients (22%). The five patients with perfect anastomoses had the highest measured median fecal elastase-1 activity. CONCLUSIONS: Although late diarrhea and pancreatic exocrine insufficiency may be partly induced already by the disease treated with resection, at least half may be explained by obstructed anastomosis. To obtain better late functional results, improvements may be required in the surgical techniques.     

Inappropriate treatment of people with dementia in residential and day care

Dependence on the help provided by other people increases the risk of a person being inappropriately treated. Our objective was to investigate inappropriate treatment and its context in the care of people with dementia. Some 85 clients across eight care units providing dementia care were observed by means of a structured Dementia Care Mapping method (DCM). Of the 17 DCM categories for inappropriate treatment, withholding, invalidation, and objectification were the categories coded most frequently. Inappropriate treatment episodes were mostly associated with eating and situations in which a client had a need or request. Most episodes occurred accidentally. The results show that nurses involved in dementia care need more knowledge of how illnesses causing dementia change the way the affected person experiences reality, and of the ethical aspects of their work.