'Maternity clinic on the net service' and its introduction into practice: experiences of maternity-care professionals

OBJECTIVE: To describe the experiences of maternity-care professionals using an Internet-based network service, called Net Clinic, and the opportunities and obstacles they encountered in Net Clinic while organising their work and developing their know-how. DESIGN: Qualitative information gathered from semi-structured thematic interviews. SETTING: Four maternity care units in Eastern Finland (one antenatal ward in a university hospital, one antenatal ward in a central hospital, two maternity clinics in the community). PARTICIPANTS: Five midwives, two public health nurses and three doctors. FINDINGS: All participants considered adequate privacy protection a prerequisite for development. They anticipated that because of their computer skills, young people would be able to use information and communication technology (ICT) as part of maternity-care services naturally. Managerial support, such as allocation of time and equipment, was extremely important during the introductory phase. The participants were divided into three groups based on their experiences of implementing Net Clinic: (1) 'doubters' did not believe in their own ICT competence and were afraid of using Net Clinic. They also showed resistance to Net Clinic. Doubters wanted versatile and personal guidance in ICT skills; (2) 'accepters' agreed that progress in ICT would inevitably affect their work. Development was considered difficult without awareness of the benefits of ICT, and Net Clinic was expected to increase their workload. Accepters preferred to have one-to-one ICT training; (3) 'future confidents' saw ICT as a useful tool for developing maternity care. They recognised the opportunities implicit in network collaboration and wanted versatile user training in ICT. They wanted successful network service models and were eager to develop them. IMPLICATIONS FOR THE FUTURE: Families will increase their knowledge levels, as those who will be future parents are learning to use public network services at school. The increasing diversity of family structure will be a challenge to maternity care. Changes in maternity services can be accomplished with new e-Working models developed through diversified co-operation and with managerial support. The crucial question will be the attitude of maternity-care professionals towards Internet-based network service in their work.     

Seasonal variations in [3H]citalopram platelet binding between healthy controls and violent offenders in Finland

Monthly binding densities (B(max)) of [3H]citalopram to the platelet serotonin transporter (SERT) was measured longitudinally over 1 year in a control group of 18 healthy Finnish male volunteers. Single platelet samples were also analysed from 33 men who were incarcerated for violent crimes during the same calendar year. A statistically significant seasonal variation in SERT B(max) was observed in both data sets, and bi-monthly floating averages for SERT B(max) were calculated and then fit to an annual sinusoidal curve for both groups. The B(max) for platelet [3H]citalopram binding showed a statistically significant (p = 0.001) seasonal variance between a winter (January-February) maximum of 1590 fmol/mg protein and a summer (July-August) minimum of 1216 fmol/mg protein for the control group, with an R2 of 70% for the annual sinusoidal curve fit. A statistically significant (p = 0.007) seasonal variance was also observed between a winter (January-February) maximum of 1980 fmol/mg protein and an autumnal (August-September) minimum of 1234 fmol/mg protein for the violent offenders, again with an R2 of 70% for the annual sinusoidal curve fit. This observation lends additional support to the idea that violent human behavior and impulsivity may be directly linked to values of SERT B(max), which can be affected by various psychoactive drugs and also varies with the natural change of seasons.     

Allergy as an epithelial barrier disease

ABSTRACT: The objective of this review is to focus on putative modified epithelial functions related to allergy. The dysregulation of the epithelial barrier might result in the allergen uptake, which could be the primary defect in the pathogenesis of allergic reaction. We review the literature of the role of respiratory epithelium as an active barrier, how allergens are transported through it and how it senses the hostile environmental allergens and other dangerous stimuli.     

Immune reconstitution in children following chemotherapy for haematological malignancies: a long-term follow-up

Modern intensive chemotherapy for childhood haematological malignancies has led to high cure rates, but has detrimental effects on the immune system. There is little knowledge concerning long-term recovery of the adaptive immune system. Here we studied the long-term reconstitution of the adaptive immune system in 31 children treated for haematological malignancies between July 2000 and October 2006. We performed detailed phenotypical and functional analyses of the various B and T cell subpopulations until 5 years after chemotherapy. We show that recovery of newly-developed transitional B cells and naive B and T cells occurred rapidly, within months, whereas recovery of the different memory B and T cell subpopulations was slower and incomplete, even after 5 years post-chemotherapy. The speed of B and T cell recovery was age-independent, despite a significant contribution of the thymus to T cell recovery. Plasmablast B cell levels remained above normal and immunoglobulin levels normalised within 1 week. Functional T cell responses were normal, even within the first year post-chemotherapy. This study shows that after intensive chemotherapy for haematological malignancies in children, numbers of several memory B and T cell subpopulations were decreased on the long term, while functional T cell responses were not compromised.     

Is Exposure to Domestic Violence and Violent Crime Associated with Bullying Behaviour Among Underage Adolescent Psychiatric Inpatients?

We examined the relationship of exposure to domestic violence and violence occurring outside home to bullying behaviour in a sample (508; 40.9% males, 59.1% females) of underage psychiatric inpatient adolescents. Participants were interviewed using K-SADS-PL to assess DSM-IV psychiatric diagnoses and to gather information about domestic and other violence and bullying behaviour. Witnessing interparental violence increased the risk of being a victim of bullying up to 2.5-fold among boys. For girls, being a victim of a violent crime was an over 10-fold risk factor for being a bully–victim. Gender differences were seen in witnessing of a violent crime; girls were more likely to be bullies than boys. Further, as regards being a victim of a violent crime outside home and physical abuse by parents at home, girls were significantly more often bully–victims than boys. When interfering and preventing bullying behaviour, it is important to screen adolescents’ earlier experiences of violence.     

Bacterial endotoxin activity in human serum is associated with dyslipidemia, insulin resistance, obesity, and chronic inflammation

OBJECTIVE

To investigate whether bacterial lipopolysaccharide (LPS) activity in human serum is associated with the components of the metabolic syndrome (MetS) in type 1 diabetic patients with various degrees of kidney disease and patients with IgA glomerulonephritis (IgAGN).

RESEARCH DESIGN AND METHODS

Serum LPS activity was determined with the Limulus Amoebocyte Lysate chromogenic end point assay in type 1 diabetic patients with a normal albumin excretion rate (n = 587), microalbuminuria (n = 144), macroalbuminuria (n = 173); patients with IgAGN (n = 98); and in nondiabetic control subjects (n = 345). The relationships of the LPS/HDL ratio and MetS-associated variables were evaluated with Pearson correlation.

RESULTS

The MetS was more prevalent in type 1 diabetic patients (48%) than in patients with IgAGN (15%). Diabetic patients with macroalbuminuria had a significantly higher serum LPS/HDL ratio than patients with IgAGN. In the normoalbuminuric type 1 diabetic group, patients in the highest LPS/HDL quartile were diagnosed as having the MetS three times more frequently than patients in the lowest quartile (69 vs. 22%; P < 0.001). High LPS activity was associated with higher serum triglyceride concentration, earlier onset of diabetes, increased diastolic blood pressure, and elevated urinary excretion of monocyte chemoattractant protein-1.

CONCLUSIONS

High serum LPS activity is strongly associated with the components of the MetS. Diabetic patients with kidney disease seem to be more susceptible to metabolic endotoxemia than patients with IgAGN. Bacterial endotoxins may thus play an important role in the development of the metabolic and vascular abnormalities commonly seen in obesity and diabetes-related diseases.In patients with type 1 diabetes, long duration of the disease and poor glycemic control increase the risk for micro- and macrovascular complications. A significant proportion of type 1 diabetic patients who develop these complications exhibit clinical features commonly seen in subjects with the metabolic syndrome (MetS), including dyslipidemia, insulin resistance, obesity, hypertension, and chronic inflammation (1,2). Vascular diseases are also common in patients with IgA glomerulonephritis (IgAGN), and those with a progressive form of the disease run a significantly elevated risk of developing different cardiovascular sequela (3). Whether the MetS is independently associated with the progression of IgAGN is currently unclear, but at least several related factors, including hyperuricemia, hypertriglyceridemia, weight, insulin resistance, and inflammation, seem to associate with the development of kidney dysfunction in IgAGN (4,5).Many of these clinical subphenotypes likely emerge from the complex interactions between a genetic background, lifestyle, and environmental factors. Recent studies have highlighted the role of the innate immune system in the developmental process of these metabolic abnormalities (6). Our living environment is inhabited with commensal and pathogenic bacteria, which have both beneficial and detrimental effects on human health. If the immune defense functions properly, these microorganisms rarely cause any serious infections in healthy individuals. The situation is different in immunocompromised patients—local infections, use of antibiotics, and even diet may lead to the colonization of opportunistic bacteria in various sites of the body. In diabetic patients, long duration of the disease and poor glycemic control increase the risk for urinary tract, pulmonary, oral, and skin infections (6,7).Lipopolysaccharides (LPS) are unique glycolipids in the cell wall of gram-negative bacteria. LPS molecules, also known as bacterial endotoxins, may trigger acute and chronic inflammation, leading to immune cell activation and cytokine release. HDL cholesterol is one of the most important factors involved in the elimination of LPS molecules from circulation. In healthy subjects, LPS is mainly bound to HDL, whereas in patients with sepsis, LPS is redistributed toward LDL and VLDL lipoproteins (8). High LPS activity combined with low HDL levels increases the risk for cardiovascular disease (9).LPS infusion in mammals leads to the appearance of factors known to be associated with the MetS: elevated levels of proinflammatory markers, dyslipidemia, fasting hyperglycemia, insulin resistance, and obesity (10–12). In some research applications, bacterial endotoxins have been used to induce acute kidney injury in animals. Monocyte chemoattractant protein-1 (MCP1) is a potential marker for progressive renal disease because its expression and excretion are also regulated by bacterial endotoxins (13,14).We have recently shown that high serum levels of LPS activity are associated with the development and progression of kidney disease in Finnish type 1 diabetic patients. Most of the patients with high serum LPS activity exhibited features of dyslipidemia and insulin resistance (15). These metabolic abnormalities are frequently observed in diabetic patients with micro- or macrovascular complications (2). To our knowledge, no previous studies have explored the potential links between bacterial endotoxins and the MetS in subjects with impaired kidney function. Therefore, we wanted to investigate whether serum LPS activity is associated with metabolic risk factors in three distinct study populations: type 1 diabetic patients with various degrees of kidney disease, patients with IgAGN, and nondiabetic subjects.     

Nutrition in patients receiving home care in Finland: tackling the multifactorial problem

This study describes the nutritional status of Finnish home care patients (n=178), their problems related to eating, digestion, and diet; their use of Meals on Wheels services; and informal caregivers' role in nutritional support. Half of the patients were at risk for malnutrition and 3% were malnourished according to Mini Nutritional Assessment (MNA) results. Most patients had problems with food intake, which were related to lower MNA scores. One-third of the participants had an unbalanced diet, and approximately half received assistance with shopping and food preparation from an informal caregiver. Home care patients' nutritional status, including all related aspects, such as shopping, food preparation, eating, and digestion, must be evaluated regularly and comprehensively.     

Reduction in fluoroquinolone susceptibility among non-typhoidal strains of Salmonella enterica isolated from Finnish patients

OBJECTIVES: The proportion of Salmonella isolates with reduced susceptibility to fluoroquinolones has increased during recent years in many countries, especially in South-east Asia. The present study was performed to evaluate the incidence of and changes in quinolone resistance in Salmonella isolates of either foreign or domestic origin in Finland. METHODS: A total of 1004 Salmonella isolates collected from Finnish patients between 2000 and 2004 were analysed for ciprofloxacin susceptibility. Of these isolates, 504 were of domestic origin and 500 were of foreign origin, collected from travellers to 43 different countries. The Salmonella collection consisted of 89 different serotypes. All isolates belonged to non-typhoidal Salmonella enterica. RESULTS: Of all isolates, 3 (0.3%) were ciprofloxacin-resistant (MIC > or = 4 mg/L) and 214 (21.3%) exhibited reduced susceptibility to ciprofloxacin (MIC > or = 0.125-2 mg/L). The annual proportion of reduced susceptibility varied between 3 and 15% among the domestic Salmonella isolates (P = 0.123). Between 2000 and 2004, the annual proportion of reduced susceptibility increased significantly (from 23 to 39%; P = 0.001) among all foreign isolates as well as among those from Spain alone (from 4 to 73%; P < 0.001). Among the isolates from Thailand, reduced ciprofloxacin susceptibility remained at a constantly high level (52-66%) throughout the study. CONCLUSIONS: Our results show that reduced fluoroquinolone susceptibility in S. enterica is not restricted to South-east Asia alone but continues to grow rapidly in many parts of the world including countries of the European Union.     

Clinical Significance and Outcome of Gastric Mucosal Erosions: A Long-Term Follow-Up Study

Our purpose was to evaluate the long-term clinical significance of gastric erosions. A series of 117 patients with gastric erosions without peptic ulcer disease, and matched controls were studied in 1974–1979. All available subjects were reinvestigated 17 years later, including detailed clinical history and laboratory analysis. At follow-up, erosions were still more prevalent (39%; 20/50) in the erosion group than in the controls (11; 7/66). In Helicobacter pylori–positive participants, peptic ulcer or a scar was more common in the erosion group (17%; 9/52) than in controls (5%; 3/66). Overall malignancy rate was higher in controls (15%; 17/117) than in erosion group (5%; 6/117; P = .025), but no other differences were seen between the groups or related with current erosion. We conclude that a significant proportion of gastric erosions are chronic or recurrent but mostly without serious complications. However, H. pylori–positive patients with erosions have significant risk to develop a peptic ulcer.