Ethical reasoning in nurses'' and physicians'' stories about care episodes

Twenty-three registered nurses and nine physicians reported 43 stories about ethically difficult care situations. Themes in nurses' and physicians' stories were described by means of narrative ethical theory. It turned out that nurses and physicians related different kinds of stories. They also seemed to use different kinds of ethical reasoning. This result was interpreted as mainly connected to the fact that the two professions have different tasks to accomplish and are trained in disciplines with different foci; nursing and medicine. The need to find a common frame story covering the two professional stories was stressed.     

High prevalence of Chlamydia pneumoniae infection in cyclosporin A-induced post-transplant gingival overgrowth tissue and evidence for the possibility of persistent infection despite short-term treatment with azithromycin.

BACKGROUND: Cyclosporin A (CsA) induces gingival overgrowth (GO) in up to a quarter of CsA-treated renal transplant recipients. A short-term therapy with azithromycin effectively reduces GO, indicating a possible involvement of microorganisms in the pathogenesis of CsA-induced GO. We aimed to determine if there could be any relationship between infection with Chlamydia pneumoniae and GO pathogenesis. In addition, we determined the long-term persistence rate of C. pneumoniae infection in residual GO tissue when azithromycin treatment failed to eliminate GO. METHODS: Chlamydia pneumoniae IgG and IgM antibody titres were measured by microimmunofluorescence technique in sera of kidney recipients with (n = 11) and without (n = 89) GO. GOs were rated and gingivectomies were performed before treatment with 500 mg of azithromycin for 3 days and at months 6 and 12 post-treatment when C. pneumoniae titres were re-evaluated. Nested polymerase chain reaction was performed to identify C. pneumoniae-specific DNA in GO tissues. Results of C. pneumoniae antibody titres from patients with GO were compared with pair-matched controls without GO. RESULTS: Chlamydia pneumoniae IgM titres were elevated in five of 11 patients with GO and in none without GO, whereas the difference of C. pneumoniae IgG titres between patients with GO and pair-matched controls did not reach significance (P<0.57). Chlamydia pneumoniae-specific DNA was found in 10 of 11 GO tissue samples pre-treatment. Azithromycin therapy effectively reduced GO and C. pneumoniae IgM titres. In residual GO, C. pneumoniae-specific DNA remained detectable after 1 year in all GO tissue samples despite azithromycin treatment. The C.pneumoniae IgM titres correlated with GO scores. CONCLUSION: Chlamydia pneumoniae infection is highly prevalent in CsA-induced GO. The infection can persist over a long period in residual GO despite short-term azithromycin therapy. The results indicate that CsA immunosuppression enhances C. pneumoniae infection rates in non-cardiovascular tissue.     

Reactions to music, touch and object presentation in the final stage of dementia. An exploratory study

Two patients in the final stage of dementia of Alzheimer type were stimulated with music, touch and object presentation during 12 consecutive days (16 trials per patient). Evaluations were made by direct observations, analysis of video-taped recordings and registrations of pulse and rate of respiration. Both patients reacted differently to music than to touch and object presentation.     

Tumour necrosis factor‐α and interleukin‐2 differentially affect hippocampal serotonergic neurotransmission, behavioural activity, body temperature and hypothalamic–pituitary–adrenocortical axis activity in the rat

Intraperitoneal endotoxin injection and central administration of interleukin (IL)-1β profoundly activate hippocampal serotonergic neurotransmission. This study was designed to investigate, using in vivo microdialysis, the effects of another endotoxin-induced proinflammatory cytokine, tumour necrosis factor-α, and the effects of the non-inflammatory cytokine, IL-2, on hippocampal extracellular levels of serotonin. To compare the effects of these cytokines on neurotransmission with the effects on physiological parameters and behaviour, hypothalamic–pituitary–adrenocortical (HPA) axis activity, body temperature and behavioural activity were monitored as well. Time-dependent changes in serotonergic neurotransmission and HPA axis activity were determined by measuring serotonin, its metabolite 5-hydroxyindoleacetic acid and free corticosterone in dialysates. Total behavioural activity was scored by assessing the time during which rats were active. Core body temperature was measured by biotelemetry. Intracerebroventricular injection of 50 or 100 ng recombinant murine tumour necrosis factor-α exerted no effect on hippocampal serotonergic neurotransmission, and induced no signs of sickness behaviour. However, these doses produced a dose-dependent increase in body temperature and free corticosterone levels. In contrast, intracerebroventricular administration of 500 ng, but not of 50 ng, recombinant human IL-2 produced a marked increase in hippocampal extracellular concentrations of serotonin and 5-hydroxyindoleacetic acid, accompanied by a pronounced behavioural inhibition and other signs of sickness. Moreover, both doses of IL-2 caused a dose-dependent increase in body temperature and free corticosterone levels. Interestingly, intracerebroventricular pretreatment with the IL-1 receptor antagonist showed that the effects of IL-2 on hippocampal serotonin were completely dependent on endogenous brain IL-1. However, IL-1 seemed to play only a minor role in the IL-2-induced increase in free corticosterone. Taken together, the results show that cytokines produce partially overlapping brain-mediated responses, but are selectively effective in stimulating hippocampal serotonergic neurotransmission and inducing sickness behaviour. Moreover, we postulate that activation of hippocampal serotonin release is instrumental in the full development of behavioural inhibition.     

Integrity-promoting care of demented nursing home patients: Psychological and biochemical changes

The effects of integrity-promoting care in a nursing home with demented patients were studied. In one ward the staff were given special training. The results showed that the treatment induced a reduction of distractability, confusion, anxiety and depressed mood, and improvement in motor performance. At the same time the cerebrospinal fluid concentrations of somatostatin increased.     

Evaluation of linkage disequilibrium on the Xq13.3 region: Comparison between the Azores islands and mainland Portugal

The design of genetic studies of complex diseases is dependent on the extent and distribution of linkage disequilibrium (LD) across the genome in different populations. Here, we characterize the extent of LD in the Azores (Western, Central, and Eastern island groups) and mainland Portugal populations. LD was evaluated in the Xq13.3 region by genotyping eight STR markers spanning 20.9 Mb. Standardized multiallelic disequilibrium coefficient (D′) analysis indicates that the Western group presents higher values when compared with the Central and Eastern groups. However, all island groups show values of D′ lower than 0.5 and 0.33, suggesting no extensive LD in these populations. Taken together, the data show that the Azorean population presents a lower D′ (0.142) than mainland Portugal (0.226). Although, both populations do not show extensive LD, the easy reconstruction of large pedigrees in the Azorean population is a valuable resource for the fine mapping of disease genes. Am. J. Hum. Biol., 2008. © 2008 Wiley‐Liss, Inc.     

Screening for domestic violence among patients admitted to a French emergency service.

OBJECTIVE: The authors assessed the prevalence of domestic violence among patients examined in the emergency service of a general hospital. They compared the socio-demographic status and psychiatric comorbidity of victims of domestic violence and other patients. METHOD: An assessment was made on 126 consecutive patients received by the emergency service of Bichat-Claude Bernard hospital (Paris, France). Assessment of domestic violence was made through the use of a specific questionnaire. RESULTS: The prevalence rate of domestic violence was 18% among patients examined by the emergency service. Thirty-five percent of the cases were physical violence, 22% sexual violence, 17% psychological violence and 26% multiple forms of domestic violence. Domestic violence had been going on for less than 1 month in only one case. In 74% of the cases, violence lasted for more than 1 year. No differences were found in terms of socio-demographic characteristics (age, marital status, rate of unemployment, sex ratio) and psychiatric comorbidity between victims of domestic violence and others. CONCLUSION: Patients seen in an emergency service must be identified as a population at risk for domestic violence (18%). These situations can be identified only by a systematic assessment using a standardized questionnaire.     

Mapping of neuronal networks underlying generalized seizures induced by increasing doses of pentylenetetrazol in the immature and adult rat: a c‐Fos immunohistochemical study

Previous studies from our group have shown that pentylenetetrazol (PTZ)-induced status epilepticus (SE) leads to age-dependent acute and long-term metabolic and circulatory changes in immature rats. In order to define the neural substrates involved in PTZ seizures according to age, the purpose of the present study was to map the areas of cellular activation during seizures of increasing severity in 10-day-old (P10), 21-day-old (P21) and adult rats. Seizures were induced by repetitive injections of subconvulsive doses of PTZ. The total dose received by the animals ranged from 4 to 125 mg/kg. These doses induced a variety of seizure profiles including absence-like, clonic seizures and SE. The cellular activation was measured as the density of c-Fos immunoreactive cells in animals at 2 h after the onset of the seizures. In P10 rats receiving a behaviourally non-active dose of PTZ, c-Fos immunoreactivity appeared only in the amygdala. The dose of 40 mg/kg that induced absence-like seizures led to a weak c-Fos expression in the medial thalamus, some cortical areas and globus pallidus. Clonic seizures reinforced labelling in the previous areas and induced a spread of c-Fos immunoreactivity to other cortical areas, thalamus, hypothalamus and some brainstem nuclei. At that age, only SE led to a widespread and stronger expression of c-Fos which was, however, totally lacking in the midbrain, and remained incomplete in the brainstem and forebrain limbic system, including the hippocampus. In P21 and adult rats, the inactive dose of PTZ induced c-Fos immunoreactivity in thalamus and hypothalamus. With absence-like seizures, c-Fos labelling spread to the cerebral cortex, amygdala, septum and some brainstem regions. With clonic seizures, immunoreactivity was reinforced in all areas already activated by absence-like seizures, and appeared in the striatum, accumbens, brainstem and hippocampus, except in CA1. After SE, c-Fos was strongly expressed in all brain areas. The intensity of c-Fos labelling was higher in most regions of P21 compared to adult rats. These data are in agreement with the immaturity of cellular and synaptic connectivity in P10 rats, the known greater sensitivity of rats to various kinds of seizures during the third week of life and the nature of the neural substrates involved in PTZ seizures.