A prospective, randomised, controlled trial comparing 3 hour and 24 hour postoperative removal of bladder catheter and vaginal pack following vaginal prolapse surgery

BACKGROUND: The aim of this prospective, randomised, study was to determine whether or not there was a higher incidence of bleeding, reoperation, urinary retention or bacterial count in the urine, depending on whether urinary catheter and vaginal pack was removed 3 h or 24 h after vaginal prolapse surgery. METHODS: Some 136 women were randomised into Group 1 (removal of catheter and vaginal pack after 3 h), and Group 2 (removal of catheter and vaginal pack after 24 h). Data on postoperative bleeding, reoperation, and urinary retention were collected. Preoperatively, day after operation, and 14 days after operation, a urine culture was performed. RESULTS: There was no tendency towards more bleeding with early removal of vaginal pack and urinary catheter. No patients in either group were reoperated during the first 48 postoperative hours. Three patients in Group 1 required sterile intermittent catheterisation postoperatively, however, only once in 2 patients. There was a trend towards a higher postoperative bacterial count in patients in Group 2 (p=0.306). CONCLUSION: We recommend removing the vaginal pack and urinary catheter after 3 h with careful monitoring of the patient's voiding.     

Nasal drug delivery--possibilities, problems and solutions.

This paper discusses the problems associated with nasal drug delivery and how it is possible, sometimes by means of quite simple concepts, to improve transport across the nasal membrane. In this way it is feasible to deliver efficiently challenging drugs such as small polar molecules, peptides and proteins and even the large proteins and polysaccharides used in vaccines or DNA plasmids exploited for DNA vaccines. The transport of drugs from the nasal cavity directly to the brain is also described and examples of studies in man, where this has been shown to be feasible, are discussed. Recent results from Phase I/II studies in man with a novel nasal chitosan vaccine delivery system are also described. Finally, the author's thoughts about the future for nasal drug delivery are also depicted.     

Molecular structure and dynamics of serotonin.

The electronic structure and low-energy conformations of the protonated serotonin molecule were examined by quantum mechanical and molecular mechanical calculations based on the AMBER force field. The flexibility and internal motions of the molecule, which may be important for its mode of receptor interaction, were examined by molecular dynamics simulations in vacuo and in aqueous solution. Two crystal structures and four computed serotonin structures were used as starting points in the calculations. Both gauche and anti conformers were observed during molecular dynamics simulations in aqueous solution, but only gauche conformers of serotonin were observed in vacuo. The simulations demonstrated that the side chain conformation may adjust in order to fit into a receptor binding site. Energy refined gauche conformers had lowest molecular energies both in vacuo and in aqueous solution. Ab initio molecular electrostatic potentials were calculated in 4 layers surrounding the molecule and projected into net atomic point charges. The effect of the hydroxyl group in lowering the molecular electrostatic potentials around the phenyl ring was highly dependent on the conformation of the side chain. Conformers with an extended side chain had significantly lower electrostatic potentials over the phenyl ring than those with a folded conformation.     

La reconstruction des enveloppes psychiques et environnementales dans les dessins d’enfants des rues en Haïti : une étude post-séisme

Objectives

The objective of this paper is to show how children and adolescents, living in the street in Haïti after the 2010 earthquake, use the street as a space to rebuild their identity. Using drawings of children and adolescents encountered in the context of research on resilience and the creative process among child and adolescent victims of the earthquake (ANR-10-HAIT-002 RECREAHVI), we explored the difficulties, the trauma and the creative expression of these children in the aftermath of the earthquake. These young people found themselves in a particularly vulnerable situation, whether socially, psychologically, or in terms of their safety. Their environmental envelopes were uncertain, fluctuating or damaged, so that the psychic envelopes of these street children was also put to the test. This article concerns the analysis of the drawings of street children and adolescents. We focus on the characteristics of the graphic envelopes to understand how these young street-dwellers symbolize the damage to their environmental and psychic envelopes, and how they express their needs for reconstruction.

Disability Pension Rates Among Immigrants in Norway

Immigrants from low-income countries are more likely than ethnic Norwegians to receive disability pensions. In a previous study in Oslo, we showed that occupational position probably accounted for all of this difference. The present article presents a study of the total population, with data on education and age at receipt of pension. Census and social security data for all persons living in Norway from 1992 to 2003 were used to identify new disability pensions to those aged 30–55 years and eligible in 1992, comprising 15.9% females and 11.4% males. Age-adjusted relative risk was 2.03 (95% CI 1.97–2.08) for non-Western males and 1.30 (1.26–1.36) for non-Western females compared with Westerners, and more than three times higher for males from North Africa/the Middle East. Education did not explain any of the risk differences, but when adjusting for age at pension receipt the differences disappeared completely. This is probably due to their being in predominantly unskilled occupations where there is also a low pension age among ethnic Norwegians.     

Positive life orientation–an inner health resource among older people

Scand J Caring Sci; 2010; 24; 349–356
Positive life orientation–an inner health resource among older people As pertains to life orientation, the study's conceptual framework demonstrates the importance of close relationships, meaning in life, and the strength of individuals to look forward and make plans for future. The aim of this study is to discover, in relation to background factors such as language, living situation, and culture, how people aged 65 and 75 experience life orientation. The study is a population‐based cross‐sectional survey with its material taken from 3,370 questionnaires which included the six‐question Life Orientation scale. The SPSS static program, version 14.0, was used for all calcuations and the Chi‐squared test was applied to determine if any significant differences between the groups existed. As seen in this study, most respondents aged 65 (85%) and 75 (73.2%) experienced a high degree of positive life orientation, clearly expressing a zest for life (93.5%), overall satisfaction with their lives (88.4%), and feelings of being needed (83.7%). Lower scores were given for never/seldom being depressed/sad (55.3%) and never/seldom feeling lonely (71.8%). Approximately every second respondent (51.9%) had plans for the future. A clear decreasing trend was seen in all questions for respondents aged 75 in comparison to those aged 65: only ``are you satisfied with life?'' showed no significant differences. Language/culture seems to clearly affect experiences of life orientation and well‐being. Additionally, older people living alone reported significantly more negative response to all dimensions of life orientation. Positive life orientation is an important inner health resource for older. Accordingly, health promotion for older people should focus on facilitating the maintenance of important and close relationships and should include supporting older people's need to be needed.     

Fatigue in adults with cerebral palsy in Norway compared with the general population

Fatigue is commonly reported among adults with cerebral palsy (CP) and in the general population. The aim of this study was to examine the prevalence of perceived fatigue in adults with CP compared with the general Norwegian population. A multidimensional questionnaire, containing among other instruments the Fatigue Questionnaire, was sent to persons with CP aged 18 years or older with no intellectual disabilities documented in their medical records. Results were compared with recently published results of a study of fatigue in the general population in Norway. There were 406 respondents (209 males, 197 females; mean age 34 years, SD 11 years; age range 18 to 72 years). Distribution of the different types of CP coincided with international epidemiological studies on CP. Adults with CP reported significantly more physical, but not more mental fatigue, than the general population. The strongest predictors associated with fatigue were bodily pain, deterioration of functional skills, limitations in emotional and physical role function, and low life satisfaction. Fatigue was not significantly associated with type of CP but was most prevalent in persons with a self-reported moderate grade of CP. Results of the present study indicate that physical fatigue is a pronounced problem in adults with CP, which has an impact on the preservation of functional skills and life satisfaction. Fatigue and factors related to fatigue should be addressed specifically in follow-up programmes for persons with CP.     

Total length of nerve fibers in prefrontal and global white matter of chronic schizophrenics

It has been suggested that the dysfunction of the prefrontal cortex in schizophrenics is due to dysfunctional connections between the prefrontal cortex and more posterior structures. The present study uses a recent stereological method that allows quantitation of the myelinated nerve fibers in the brain white matter. As especially the prefrontal region is of interest in schizophrenics, the prefrontal white matter was quantitated separately. The total length of nerve fibers in post-mortem brains was estimated from eight male chronic schizophrenics and nine male controls (age-range: 40–81 years). Samples were taken systematically and randomly from both the entire white matter and selectively from the prefrontal white matter. The biopsies were rotated randomly before sectioning to avoid bias due to the anisotropic nature of nerve fibers. The fibers were counted at light microscopic level at about 10,000× magnification and the fiber diameter of each counted fiber was measured to get the size distribution of the fibers. The schizophrenics had a total of 129,000 km myelinated fibers in the white matter and 25,700 km in the prefrontal white matter, which was non-significantly different from a total of 137,000 km in the entire white matter and 27,600 km in the prefrontal white matter in controls. The size distribution of the fibers in schizophrenics was within normal limits compared to controls. Our results do not show a larger loss of nerve fibers in neither the white matter globally or in the prefrontal white matter of schizophrenics.     

Laser assisted delivery of topical anesthesia for intramuscular needle insertion in adults

BACKGROUND AND OBJECTIVES: Currently there is no safe, effective, and rapid means to eliminate the pain associated with a needle insertion through the skin. It is hypothesized that ablation of the stratum corneum layer using a low energy Erbium(Er):YAG laser would allow rapid local anesthesia from a lidocaine product. STUDY DESIGN/MATERIALS AND METHODS: Eighty volunteers participated in a placebo-controlled, double blind, cross-over study employing the Norwood-Abbey (Chelsea Heights, Victoria, Australia) laser anesthesia device (LAD) and two lidocaine preparations. Upper-arm skin ablation was followed by a 5-minute application of study treatment. Pain scores were registered immediately following a needle insertion. RESULTS: Comparing the combined lidocaine preparations to placebo, there was a statistically significant reduction in pain when the LAD was employed (P < 0.001). The median pain reduction for lidocaine was 51.3% (95% CI = [40.9, 76.1]). CONCLUSIONS: Use of the low energy Er:YAG LAD device in combination with a 5-minute application of lidocaine significantly reduced the pain associated with a needle insertion.