Cooking skills are important competencies for promoting healthy eating in an urban Indigenous health service

Aim: A recent article in this journal asked whether cooking should be a dietetic competency and recommended finding dietitians’ views on the use of cooking skills interventions as nutrition education. This article presents views about the value of cooking skills in the work of nutrition professionals and students working in an urban Indigenous health service. Methods: We reflect on our experience facilitating a series of practical cooking workshops in adult Aboriginal and Torres Strait Islander groups and the importance of cooking skills for professionals promoting nutrition in community contexts. Results: Cooking skills were essential for facilitating practical workshops to promote healthy cooking and eating among urban community groups. The workshops provided participants with new cooking ideas, opportunities to cook new recipes and some unfamiliar ingredients as well as learning new cooking skills. These enabled participants to be more confident preparing healthy meals at home. Cooking skills enhanced the processes of both effective community engagement and nutrition promotion. Conclusion: Cooking interventions make an important contribution to promoting nutrition in urban Indigenous contexts and cooking skills are therefore important competencies for nutrition and dietetic professionals delivering practical community nutrition programs.     

In reply to 'The categorization and control of people with disabilities'

Objective: to define the use of disablement resettlement officers (DRO) by patients with locomotor disorders. Design: questionnaire for patients with locomotor disorders potentially handicapping them from obtaining work. Setting: outpatient clinics. Patients: 52 patients, capable of work, aged 55 years or less, with a locomotor disorder; 19 had chronic arthritis and 18 back disorders. Questionnaire: obtained details of diagnosis, work status, contact with DRO and results of referral. Results: 21 had seen the DRO and three of these were dissatisfied; 15 were referred to the DRO and only three of these were placed in employment; 16 did not want referral to the DRO; overall 60% were unemployed. Conclusions: Many patients are reluctant to see the DRO. Only a minority either attend or find work on referral. A modified system is needed to improve the employment prospects of patients with locomotor disorders.     

Effect of cold and warm ischaemia on drug metabolism in isolated hepatocytes and slices from human and monkey liver

1. The influence of short-term cold storage in University of Wisconsin organ preservation solution (UW) on the ability to metabolize lidocaine, testosterone and 7-ethoxycoumarin in isolated human and cynomolgus monkey (Macaca fascicularis) hepatocytes and liver slices has been investigated. 2. The human liver tissue was obtained from two different sources, i.e. healthy liver tissue from patients undergoing partial hepatectomy because of metastases of colorectal carcinoma (PH livers) and donor tissue remaining as surgical waste after reduced size or split liver transplantation (Tx livers). Tx livers were perfused in situ with ice-cold UW avoiding warm ischaemia. This in contrast with PH livers, where the operation caused warm ischaemia for 5-90 min. 3. Liver slices and hepatocytes from cynomolgus monkey liver showed comparable metabolic rates for the substrates tested, indicating that all hepatocytes in the slice are participating in the biotransformation of the substrates. These monkey liver preparations can be stored up to 18 h with only a slight loss of their metabolic capacity. 4. Liver slices and isolated hepatocytes from the Tx livers as well as isolated cells from the PH livers could also be stored up to 18 h without losing metabolic capacity. However, for liver slices prepared from PH livers cold storage is not recommended, because metabolic function was reduced by approximately 40% after 18 h.     

Irritant susceptibility and weal and flare reactions to bioactive agents in atopic dermatitis. II. Influence of season

Many atopic dermatitis (AD) patients have exacerbations of their skin disease in winter. These exacerbations may be caused by non-immunological ‘non-specific’ factors, such as low sun exposure and low temperature. To date, the influence of season on non-specific skin reactivity in AD has not been studied. The aim of the present investigation was to assess the influence of season on two skin parameters which may be used as quantitative measures of non-specific skin reactivity in AD: (i) susceptibility to repeated epicutaneous irritant (sodium lauryl sulphate, SLS) exposure, and (ii) weal and flare responses to intracutaneous injection of bioactive agents (codeine, FMLP, histamine, methacholine, substance P, trypsin). Four of 16 AD patients had dermatitis which was more severe in November than in July. Susceptibility to SLS was increased in November, both in AD patients and in control subjects. AD patients were more susceptible to SLS than control subjects in both July and November, Pre-exposure barrier function and skin hydration were reduced in November. The increased irritant susceptibility in November may be attributed to reduced barrier function, reduced skin hydration, and/or absence of the beneficial effects of ultraviolet light on cellular targets beneath the stratum corneurn, Flare responses to codeine, methacholine, substance P and trypsin were also increased in November compared with July, especially in AD patients. However, smaller Hares were observed in AD patients than in control subjects, in both July and November, Flare values were negatively correlated with dermatitis severity, probably because of down-regulation. Weal responses did not show a clear seasonal variation. Hence, susceptibility to epicutaneous irritants and reactivity to intracutaneousty injected bioactive agents are parameters which may be used to monitor season dependent changes in non-specific skin reactivity.     

Irritant susceptibility and weal and flare reactions to bioactive agents in atopic dermatitis. I. Influence of disease severity

The two main pathogenetic characteristics of atopic dermatitis (AD) are: (i) antigen-dependent ‘specific’ reactivity, and (ii) altered non-immimological ‘non-specific’ reactivity. Our understanding of the role of non-specific reactivity is hampered by the fact that methods available for its quantification are limited. The aim of the present study was to assess the usefulness of two parameters as quantitative measures of non-specific skin reactivity in AD: (i) susceptibility to repeated epicutaneous exposure to an irritant (sodium lauryl sulphate, SLS), assessed by visual scoring and transepidermal water loss(TEWL) measurement, and (ii) reactivity to intracutaneously injected bioactive agents (codeine, FMLP, histamine, methacholine, substance P, trypsin), assessed by measurement of weal and flare size. These two parameters were tested in a group of AD patients, subdivided according to the severity of their dermatitis, and a control group. The visual score and TEWL after SLS exposure tended to be higher in the AD group than in the control group. Furthermore, visual score and post-exposure TEWL were positively correlated with the dermatitis severity score. Weal size following injection of codeine, histamine and substance P, and flare size following injection of all agents, except methacholine, were significantly lower in the AD group than in the control group. Negative correlations were found between weal and flare sizes and the dermatitis severity score. These findings can be explained by down-regulation of structures involved in weal and flare reactions. In conclusion, we propose that epicutaneous irritant susceptibility and reactivity to intracutaneous bioactive agents may be useful indicators of non-specific skin reactivity in AD.     

Molecular prognostic markers in ovarian cancer: toward patient-tailored therapy

Abstract.   Crijns APG, Duiker EW, de Jong S, Willemse PHB, van der Zee AGJ, de Vries EGE. Molecular prognostic markers in ovarian cancer: toward patient-tailored therapy. Int J Gynecol Cancer 2006; 16(Suppl. 1): 152–165.
In ovarian cancer the ceiling seems to be reached with chemotherapeutic drugs. Therefore a paradigm shift is needed. Instead of treating all patients according to standard guidelines, individualized molecular targeted treatment should be aimed for. This means that molecular profiles of the distinct ovarian cancer subtypes should be established. Until recently, most studies trying to identify molecular targets were single-marker studies. The prognostic role of key components of apoptotic and prosurvival pathways such as p53, EGFR, and HER2 has been extensively studied because resistance to chemotherapy is often caused by failure of tumor cells to go into apoptosis. However, it is more than likely that different ovarian cancer subtypes with extensive molecular heterogeneity exist. Therefore, exploration of the potential of specific tumor-targeted therapy, based on expression of a prognostic tumor profile, may be of interest. Recently, new profiling techniques, such as DNA and protein microarrays, have enabled high-throughput screening of tumors. In this review an overview of the current status of prognostic marker and molecular targeting research in ovarian cancer, including microarray studies, is presented.     

Localized Intradermal Microinjection of Tranexamic Acid for Treatment of Melasma in Asian Patients: A Preliminary Clinical Trial

BACKGROUND: Melasma is a common cosmetic problem among Asians. While various treatments are currently being used, there is no entirely satisfactory treatment. It was recently reported that the topical plasmin inhibitor is an effective treatment for ultraviolet-induced hyperpigmentation. OBJECTIVE: Because there are no studies assessing the efficacy and safety of localized microinjection of tranexamic acid (TA) for the treatment of melasma, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new method for the treatment of melasma in Korean women. METHODS: A total of 100 women with melasma, after written consent, were enrolled for a prospective open pilot study of 12 weeks. After applying topical anesthesia, 0.05 mL TA (4 mg/mL) was injected intradermally into the melasma lesion at 1 cm intervals by using a 0.5 mL insulin syringe with a 30-gauge needle. This was repeated weekly for 12 weeks. A clinical investigator evaluated the results by using the Melasma Area and Severity Index (MASI) at baseline and at 4, 8, and 12 weeks. The patient satisfaction questionnaire was documented at 12 weeks. Safety evaluations were performed at each follow-up visit. RESULTS: Eighty-five patients completed the trial. A significant decrease in the MASI from baseline to 8 and 12 weeks was observed (13.22+/-3.02 vs 9.02+/-2.62 at week 8 and vs. 7.57+/-2.54 at week 12; p<.05 for both). The patients' self-assessment of melasma improvement was as follows: 8 of 85 patients (9.4%) rated as good (51-75% lightening), 65 patients (76.5%) as fair (26-50% lightening), and 12 patients (14.1%) as poor (0-25% lightening). Side effects were minimal and all the patients tolerated the treatment well. CONCLUSION: Based on these results, we suggest that the intralesional localized microinjection of TA acid can be used as a potentially new, effective, and safe therapeutic modality for the treatment of melasma.     

Prognostic factors in Fournier gangrene

AIMS: Fournier gangrene is a rapidly progressive necrotizing fasciitis involving the genitalia. It can be treated with antibiotics and immediate debridement along with treatment of the predisposing condition. We evaluated the prognostic factors, clinical characteristics and treatment of patients of the Fournier gangrene. METHODS: The subjects were 40 male patients diagnosed with Fournier gangrene who visited Wonkwang University Hospital, Iksan, Korea between January 1991 and December 2000. Their medical records were reviewed with respect to demographics, medical history, symptoms and signs, physical examination, laboratory data, bacteriology, extent of disease, clinical course, and therapy. The extent of disease was quantified for each patient using a modification of the diagram used to assess the extent of burns. RESULTS: The average age was 55.3 years (range 29.6-92.8). Of the 40 patients, 11 died (36%) and 29 survived (64%). Anorectal infections were the underlying local disease most commonly associated with high mortality (75%). Although the most common associated illness was diabetes, it was not related to the prognosis (death rate: 20.0%). In contrast, the death rate was highest in chronic renal failure, reaching 50%. The mortality rate increased with the duration of symptoms before hospitalization. Patients with <6% surface area involvement were more likely to survive. On admission, serum blood urea nitrogen (s-BUN) and serum creatinine were significantly higher in the patients who died. CONCLUSION: Survival is associated significantly with anorectal infection, chronic renal failure, the duration of symptoms before hospitalization, the extent of gangrene, and s-BUN and creatinine level on admission.     

PROLONGED TREATMENT WITH THE GnRH ANALOGUE BUSERELIN DOES NOT AFFECT α-SUBUNIT PRODUCTION BY THE PITUITARY GONADOTROPH

Seven patients with metastatic prostatic cancer were treated with biodegradable implants of the GnRH analogue buserelin and six were treated with buserelin intranasally. After 4-24 weeks of treatment mean serum testosterone concentrations were significantly lower in the patients treated with implants than in those treated intranasally (0.7 vs 1.7nmol/1 respectively; P < 0.01). Also, serum LH concentrations were significantly lower in the group treated with implants. Serum α-subunit concentrations were significantly higher than pretreatment values during buserelin treatment. However, the sum of the concentrations of α-subunit present either as free α-subunit or as a part of LH did not differ significantly from pre-treatment values after 8 weeks or more of buserelin treatment. During buserelin treatment serum LH concentrations measured by radioimmunoassay (RIA) were higher than those measured by immunoradiometric assay (IRMA). Cross-reactivity of α-subunit in the LH RIA accounted for many, but not all, of the observed discrepancies. We conclude that: (1) the principal long-term effect of prolonged buserelin administration on the pituitary gonadotroph is the suppression of LHβ production, while α-subunit production is not affected; (2) the serum concentrations of bioactive LH are better reflected by LH concentrations measured by IRMA than by those measured by RIA. (3) Subcutaneous application of biodegradable buserelin implants is more effective in suppressing serum LH and testosterone concentrations than intranasal buserelin application.     

Policy on AIDS and drug users: the state of affairs in The Netherlands

In The Netherlands injecting drug users (IDUs) account for 8.8%of the AIDS diagnose (135/1531 asperJanuary 1991). Data on HIVprevalence among IDUs is limited to Amsterdam. The AIDS anddrug policy is based on risk and harm reduction through informationcampaigns, needle and syringe exchange programmes and extracare. All efforts do not seem to be sufficient to stop the spreadof HIV infection among this group. Evaluation of existing projectsis carried out and additional programmes are now initiated.In the prevention policy more emphasis is laid on outreachingactivities and involving other sectors outside the drug treatmentsector in AIDS prevention. Also the needle distribution at locallevel should be improved and more ways should be encouragedto involve drug users in the AIDS policy. With respect to thecare field more pressure to start specific care facilities forHIV-infected drug users can be expected in the near future.