Considering place in community health nursing.

When a geographic location is assigned meaning, it becomes a place. The authors argue that place matters as both geographical location and lived experience. They extend the current conceptualization of nursing geography to encompass community health nursing and address intricacies of community nursing practice and research that often go unnoticed. They do so by exploring the notion of place in home and community, including the structural/spatial dimensions of the nurse-client relationship. The authors review the health geography literatures, then discuss the implications for practice and research in community health. They invite community health nurses to critically examine their practice and research with reference to such issues as the power of the nurse, marginalized places as determinants of health, and how best to care for clients living in diverse community settings.     

Helicobacter pylori and atrophic gastritis.

Sixty-four consecutive patients which on upper gastrointestinal endoscopy had endoscopic signs of atrophic body gastritis were investigated with standard histology examinations of gastric biopsies, serology and/or culture for Helicobacter pylori and with standard blood chemistry profile. A histologic diagnosis of atrophy could be made in only 27 of the 64 patients (42%). Of these 27 patients, 5 had the pernicious anaemia (PA) type (19%), 22 had not (81%). Past and/or present H. pylori infection was found in 16/22 non-PA patients (73%) but in none of the PA patients (p = 0.00572). The present study thus confirms earlier findings that non-PA type atrophic body gastritis is more common than the PA type and suggests that, as opposed to PA-type atrophy, it is related to H. pylori infection.     

Post-migration changes in gender relations among Ethiopian couples living in Canada.

The Ethiopian community ofToronto, Canada, has identified the prevention of marital conflict and partner abuse as a priority issue. Previous research and community discussions suggested that changes in gender relations following migration contribute to both marital conflict and partner abuse. The objective of this community-based pilot study was to explore post-migration changes in gender relations among Ethiopian couples in order to inform the development of violence-prevention strategies. Qualitative research methods and analyses were used. In-depth interviews and focus-group discussions were conducted with 8 couples who had been married in Ethiopia and migrated to Toronto. The findings indicate changes in gender relations following migration as well as concordant and discordant patterns of change. Change was found to be associated with factors such as age, number of years married, experience in a third country, and gender-role socialization. Implications for future research and nursing practice are discussed.     

Intersectionalities of influence: researching the health of immigrant and refugee women.

There is a growing recognition of the complexity surrounding multiple axes or dimensions of social identity and how they intersect to influence the health of immigrant and refugee women. The concept of intersectionalities of influence is particularly relevant in addressing diversity in nursing research.The purpose of this paper is to theorize and operationalize the concept in mental health promotion research with immigrant and refugee women. At the conceptual level, the authors propose an approach to inquiry that is informed by critical scholarship and draws from postcolonial and feminist perspectives. At the operational level, they apply an ecosystemic framework to help locate individual health issues within the familial, community, and social realms. They introduce Participatory Action Research as a way of putting these concepts into action within the research process.Their aim is to introduce a new way of inquiry that can benefit immigrant and refugee women while furthering the nursing agenda for community-based research.     

International research collaboration as social relation: an Ethiopian-Canadian example

International collaboration in nursing and other health disciplines is vital for addressing global health issues. While the results and processes of such collaborations have been reported, few publications have addressed their philosophical or theoretical underpinnings, particularly with respect to collaboration between those in low- and high-income countries. Piaget's notion of social relations of cooperation and constraint and Habermas's notion of "lifeworld" provide a theoretical lens through which to examine international collaboration as a construction of knowledge. This article is an exploration of these ideas as seen in the collective experience of Canadians and Ethiopians organizing an interdisciplinary forum on intimate partner violence in Ethiopia. The project is presented as a case study for reflecting on international collaboration as a manifestation of social relations. Such re-visioning of international collaboration may be useful for improving collaborative processes and their outcomes.     

Perceptions of factors contributing to intimate partner violence among Sri Lankan Tamil immigrant women in Canada

In this article we explore Sri Lankan Tamil immigrant women's views on factors contributing to intimate partner violence (IPV). We conducted eight focus groups with young, midlife, and senior women and women who experienced IPV. Three main themes emerged: postmigration sources of stress and conflict, patriarchal social norms that dictated gendered behavior, and individual male attributes and behaviors. Study participants recognized gender inequality and financial dependence as contributing factors and the role of women in promoting marital harmony. Findings suggest that pre- and postmigration factors need to be considered in the prevention of IPV in newcomer communities.     

Host-dependent Lewis (Le) antigen expression in Helicobacter pylori cells recovered from Leb-transgenic mice

Variation of surface antigen expression is a mechanism used by microbes to adapt to and persist within their host habitats. Helicobacter pylori, a persistent bacterial colonizer of the human stomach, can alter its surface Lewis (Le) antigen expression. We examined H. pylori colonization in mice to test the hypothesis that host phenotype selects for H. pylori (Le) phenotypes. When wild-type and Le^b-expressing transgenic FVB/N mice were challenged with H. pylori strain HP1, expressing Le^x and Le^y, we found that bacterial populations recovered after 8 mo from Le^b-transgenic, but not wild-type, mice expressed Le^b. Changes in Le phenotype were linked to variation of a putative galactosyltransferase gene (β-(1,3)galT); mutagenesis and complementation revealed its essential role in type I antigen expression. These studies indicate that H. pylori evolves to resemble the host''s gastric Le phenotype, and reveal a bacterial genetic locus that is subject to host-driven selection pressure.For microbes that are obligatory parasites of outbred host species, an important challenge is to adapt to each new individual host (Moxon et al., 1994; Falk et al., 2000; Bayliss et al., 2004; Blaser and Kirschner, 2007). Such coevolved bacteria use multiple strategies, including stealth, variation, and antidefense (Monack et al., 2004; Blaser and Kirschner, 2007). One mechanism to generate variation is the use of contingency genes to change expression of bacterial cell-surface structures relevant to the hosts being colonized (Moxon et al., 1994; Bayliss et al., 2001; Bayliss et al., 2004).Humans are polymorphic for the expression of the fucosylated Lewis (Le) antigens on erythrocytes and in other body compartments, including the gastric epithelium (Sakamoto et al., 1989). Helicobacter pylori, the dominant human gastric bacteria (Bik et al., 2006; Andersson et al., 2008), are also polymorphic for expression of Le antigens (Fig. S1; Wang et al., 2000). Most strains predominately express Le^x and Le^y (type II antigens), which are major human gastric antigens (Simoons-Smit et al., 1996), whereas <5% express Le^a and Le^b (type I antigens; Wirth et al., 1996), which are also expressed in the stomach (Sakamoto et al., 1989). H. pylori may vary type II Le expression using a variety of genetic mechanisms (Appelmelk et al., 1998; Wang et al., 1999; Wirth et al., 2006; Sanabria-Valentín et al., 2007; Nilsson et al., 2008).We have hypothesized that H. pylori Le expression reflects host selection operating on a population of stochastically varying strains that have differential fitness in particular hosts (Webb and Blaser, 2002). Observations in humans naturally colonized with H. pylori (Wirth et al., 1997) and in rhesus monkeys experimentally infected with H. pylori (Wirth et al., 2006) support this hypothesis. However, these studies are not conclusive, because the human studies were correlative, and the monkey studies were an experimental challenge with multiple strains and a small number of study animals (Wirth et al., 1997; Wirth et al., 2006).Wild-type mice do not express Le^b in their stomach. The creation of transgenic mice that express a human α-1,3/4 fucosyltransferase (accession no. EC 2.4.1.65 from the IntEnz database, available at http://www.ebi.ac.uk/intenz/index.jsp) in their mucus-producing gastric pit cells led to Le^b expression (Falk et al., 1995; Guruge et al., 1998). The presence of Le^b in the gastric mucosa of these mice and its absence in their nontransgenic littermates presented an opportunity to examine whether host phenotype selects for H. pylori phenotypic (Le antigen) expression. We hypothesized that among H. pylori strains introduced into “humanized” Le^b-transgenic mice but not their isogenic Le^b-negative (wild-type) littermates, there would be selection for bacterial Le^b expression. In the present study, we verify this hypothesis, and characterize the genetic loci and mechanisms responsible for the changed H. pylori phenotype.     

Biochemical Responses and Accumulation Properties of Long-Chain Perfluorinated Compounds (PFOS/PFDA/PFOA) in Juvenile Chickens (<Emphasis Type="Italic">Gallus gallus</Emphasis>)

One-day-old male chickens were exposed via oral gavage to mixtures of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorodecanoate (PFDA) at either a low dose (0.1 mg/kg body weight [b.w.]) or a high dose (1.0 mg/kg b.w.), or a saline/ethanol vehicle control, three times a week for 3 weeks. After 3 weeks of exposure, half of the chicks were sacrificed and the other half were allowed to depurate for a further 3 weeks. No dose-dependent statistically significant differences in body/organ weights were observed among treatment and control groups after 3 weeks of exposure or after three 3 of depuration. Neither 15 histological nor 14 measured plasma biochemical parameters were significantly different in chicks from the exposed groups and vehicle controls. PFOS, PFDA, and PFOA concentrations in blood/liver/kidney samples were measured throughout the exposure and depuration periods at different time intervals. PFOS and PFDA accumulated at much higher concentrations than PFOA during the experimental periods. Interestingly, PFOS and PFDA accumulation patterns in the blood were similar during the exposure and depuration periods. The half-lives for each PFC at the 0.1 and 1.0 mg/kg doses were, respectively, approximately 15 and 17 days for PFOS, 11 and 16 days for PFDA, and 3.9 and 3.9 days for PFOA. PFDA accumulation in organs was greater than or similar to that of PFOS: the liver was the main target during exposure and the blood was the main reservoir during depuration. These results indicate that exposure to a 1.0-mg mixture of PFOS/PFDA/PFOA/kg b.w. has no adverse effect on juvenile chickens.     

Distribution and Relationships of Antimicrobial Resistance Determinants among Extended-Spectrum-Cephalosporin-Resistant or Carbapenem-Resistant Escherichia coli Isolates from Rivers and Sewage Treatment Plants in India

To determine the distribution and relationship of antimicrobial resistance determinants among extended-spectrum-cephalosporin (ESC)-resistant or carbapenem-resistant Escherichia coli isolates from the aquatic environment in India, water samples were collected from rivers or sewage treatment plants in five Indian states. A total of 446 E. coli isolates were randomly obtained. Resistance to ESC and/or carbapenem was observed in 169 (37.9%) E. coli isolates, which were further analyzed. These isolates showed resistance to numerous antimicrobials; more than half of the isolates exhibited resistance to eight or more antimicrobials. The bla_NDM gene was detected in 14/21 carbapenem-resistant E. coli isolates: bla_NDM-1 in 2 isolates, bla_NDM-5 in 7 isolates, and bla_NDM-7 in 5 isolates. The bla_CTX-M gene was detected in 112 isolates (66.3%): bla_CTX-M-15 in 108 isolates and bla_CTX-M-55 in 4 isolates. We extracted 49 plasmids from selected isolates, and their whole-genome sequences were determined. Fifty resistance genes were detected, and 11 different combinations of replicon types were observed among the 49 plasmids. The network analysis results suggested that the plasmids sharing replicon types tended to form a community, which is based on the predicted gene similarity among the plasmids. Four communities each containing from 4 to 17 plasmids were observed. Three of the four communities contained plasmids detected in different Indian states, suggesting that the interstate dissemination of ancestor plasmids has already occurred. Comparison of the DNA sequences of the bla_NDM-positive plasmids detected in this study with known sequences of related plasmids suggested that various mutation events facilitated the evolution of the plasmids and that plasmids with similar genetic backgrounds have widely disseminated in India.