Bacterial and mammalian cell response to poly(3-sulfopropyl methacrylate) brushes loaded with silver halide salts

This study investigates the antibacterial and cytotoxic effect of surfaces with sulphonate brushes containing silver salts. By using the same type of samples for both cytotoxicity and antibacterial studies, these two parameters could be compared in a controlled way. The silver was incorporated into the brush in four different forms to enable release of silver ions at different concentrations and different rates. It was found that although the surfaces displayed very good antibacterial properties in buffer solutions, this effect disappeared in systems with high protein content. Similarly, the silver-containing surfaces displayed cytotoxic effects in the absence of serum proteins but this effect was reduced in the presence of serum. The speciation of silver in the different solutions is discussed. Cytotoxic and antibacterial effects are compared at the different silver concentrations released. The implications of a concentration range where silver could be used to kill bacterial without harmful effects on mammalian cells are also discussed and questioned.     

Effects of in utero arsenic exposure on child immunity and morbidity in rural Bangladesh

Chronic exposure to arsenic, a potent carcinogen and toxicant, via drinking water is a worldwide public health problem. Because little is known about early-life effects of arsenic on immunity, we evaluated the impact of in utero exposure on infant immune parameters and morbidity in a pilot study. Pregnant women were enrolled at 6–10 weeks of gestation in Matlab, a rural area of Bangladesh, extensively affected by arsenic contamination of tubewell water. Women (n = 140) delivering at local clinics were included in the study. Anthropometry and morbidity data of the pregnant women and their children, as well as infant thymic size by sonography were collected. Maternal urine and breast milk were collected for immune marker and arsenic assessment. Maternal urinary arsenic during pregnancy showed significant negative correlation with interleukin-7 (IL-7) and lactoferrin (Ltf) in breast milk and child thymic index (TI). Urinary arsenic was also positively associated with fever and diarrhea during pregnancy and acute respiratory infections (ARI) in the infants. The effect of arsenic exposure on ARI was only evident in male children. The findings suggest that in utero arsenic exposure impaired child thymic development and enhanced morbidity, probably via immunosuppression. The effect seemed to be partially gender dependent. Arsenic exposure also affected breast milk content of trophic factors and maternal morbidity.     

Vascular endothelial growth factor is a strong predictor of early distant recurrences in a prospective study of premenopausal women with lymph-node negative breast cancer

We investigate the prognostic significance of the pro-angiogenic cytokine vascular endothelial growth factor (VEGF), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1), and S-phase fraction (SPF) for distant disease free survival (DDFS) in 219 premenopausal patients with node-negative breast cancer (NNBC). In univariate analysis significantly shorter DDFS was observed for patients with high VEGF (p=0.006), high uPA (p=0.001), and high SPF (p<0.001). The prognostic significance of VEGF varied over time being very strong for early relapses (0-2.25 years follow-up) (HR=7.9; p=0.006) while no difference was seen in the subsequent follow-up period (HR=1.3; p=0.62). In a series of bivariate analyses VEGF provided prognostic information during the whole observation period (0-72 months) in addition to age, tumour size, oestrogen receptor (ER), progesterone receptor (PgR), and uPA. Also this effect was more pronounced during the first follow-up period suggesting VEGF as a marker of early recurrences.     

Changes in the effects of process-oriented group supervision as reported by female and male nursing students: a prospective longitudinal study

The aim of this prospective longitudinal study was to perform a large-scale investigation over a longer period of time, to evaluate changes in the effects of process-oriented group supervision (PGS) as reported by female and male nursing students undergoing a 3-year nursing education. The study included nursing students (n = 183) who were followed during their 3-year study period in relation to their participation in PGS.
Methods:  A questionnaire consisting of three subscales: supportive (six items), educational (six items) and developmental (six items) as well as three items of a socio-demographic character (age, gender and previous experience of healthcare work) was used. Student's t -test was conducted to compare the educational, supportive and developmental subscales between the first and third year.
Results:  Females had a significant increase in the educational subscale (p = 0.018) over the 3-year study period, while no such difference was found for the males (p = 0.733). The female students also exhibited an increase in the supportive subscale (p = 0.031) over the 3-year period, while there was no difference for the male students (p = 0.426). There was also an increase in the developmental subscale for the female students over the 3-year period (p = 0.047) but no significant difference for their male counterparts (p = 0.912). For the study group as a whole, an increased positive effect of supervision was observed in the educational subscale (p = 0.020).
Conclusions:  The findings have strengthened the argument for the use of PGS in nursing education. To achieve the goal of PGS, which is supportive, educational and developmental in nature, it is important to bear in mind that the supervision needs of women and men can differ. Further research should therefore map out the supervisees' experiences and expectations of participating in a single sex group.     

Psychometric characteristics of a self-report questionnaire (HPIQ) focusing on health promotion interventions in mental health services

The aim of this study was to develop and investigate psychometric properties of the Health Promotion Intervention Questionnaire, a newly developed instrument intended to measure patients' subjective experiences of health promotion interventions in the mental health services. Health promotion practice has often been contested; therefore, it is important to produce convincing evidence that health promotion initiated by the health-care services actually works. A cross-sectional study was performed in order to investigate health promotion interventions among mental health service outpatients. A sample of 135 patients was used to test the psychometric properties of a new questionnaire designed to measure subjective experiences of health promotion interventions carried out by the mental health services. The factor structure of the questionnaire was tested by means of principal component factor analysis with varimax rotation. Reliability was measured in terms of internal consistency of the factors and test-retest reliability in a subsample of patients. The final scale contained 19 items derived from four factors: alliance, empowerment, educational support, and practical support. In terms of internal consistency, reliability was found to be good, both for the overall scale and the subscales. Test-retest reliability was moderate or higher in 13 out of 19 items and poor in only one item. This questionnaire, developed to evaluate patients' experiences of health promotion interventions in mental health services, may be used as an alternative in further empirical studies. With additional testing, the questionnaire could facilitate the work of defining and evaluating health promotion interventions conducted by the mental health services.     

Fluoride release from NaF- and AmF-impregnated toothpicks and dental flosses in vitro and in vivo

The aim of this study was to determine the fluoride release from toothpicks and dental flosses in vitro and in vivo, and to evaluate various approximal administration methods. In vitro, a total of 23 commercially available toothpicks and dental flosses and 3 prototypes impregnated with sodium fluoride (NaF), amine fluoride (AmF) or a combination of these two were tested. Fluoride release was determined for up to 24 h using an ion-specific electrode. A large variation was found between the products; most fluoride being released after 30 min. Generally speaking, toothpicks produced higher values than flosses. In vivo, the fluoride concentration in both treated and non-treated approximal areas was evaluated after using 2 different types of toothpicks and 4 dental flosses and after different application methods--such as a fluoride gel and fluoride solution. The mean fluoride concentration in oral fluid was up to 10 times higher at the treated sites than at the non-treated sites. Use of a fresh toothpick or a fresh piece of dental floss in each approximal space resulted in higher values compared with using one and the same toothpick/floss for the whole dentition. An interdental brush dipped in 0.2% NaF gel and a mouthrinse with 0.2% NaF resulted in elevated fluoride concentrations at the same level as when multiple toothpicks were used. To conclude, there are large variations in the fluoride release from various brands of fluoridated toothpicks and dental flosses. Treatment with a fluoridated toothpick or a dental floss can be expected to give elevated fluoride concentrations in the approximal area up to 60 min. Another interesting method for administering fluoride in the approximal area is to use an interdental brush dipped in fluoride gel.     

Rehabilitation nurses practices in relation to urinary incontinence following stroke: a cross‐cultural comparison

Aim. To explore nurses’ practices and influences in relation to urinary incontinence following stroke, in the UK, Sweden and China. Background. Urinary incontinence following stroke is common, under‐recognised and poorly researched. Before appropriate rehabilitation interventions can be developed, an understanding of nurses’ current management approaches and cultural influences is required. Design. Qualitative. Methods. Semi‐structured interviews were undertaken with ten registered nurses from at least four different stroke units in three countries (n = 30). Interviews were carried out in the participants’ first language, using an agreed interview guide. Following translation, thematic analysis focusing on manifest meaning was undertaken, using an iterative approach involving electronic and face‐to‐face discussions. Results. The consequence of only superficial assessment was no systematic identification of types or causes of urinary incontinence and no individualised plans developed. A process model of practice, common to all three countries, was identified for stroke survivors with urinary incontinence. Routine core activities were followed by the palliative pathway (most frequently), where urinary incontinence was contained to protect the stroke survivors’ safety and ensure social continence; or the rehabilitative route (more rarely), where simple continence promoting activities were implemented with the purpose of facilitating recovery of bladder function. Conclusions. Nurses’ reactively manage urinary incontinence following stroke, adopting a routinised approach based on local custom and practice. Promotion of urinary continence is not a priority area of stroke rehabilitation for nurses in western or eastern countries. Relevance to clinical practice. The dearth of evidence‐based interventions available to rehabilitate bladder function following stroke means that stroke nursing practice is an experience‐based endeavour. This study explains the nurses’ focus on containment and social continence and highlights the need to systematically assess stroke survivors’ bladder rehabilitation needs, identify types of urinary incontinence and adopt appropriate urinary continence promoting practices.     

Successful retrieval of fine-needle aspiration biopsy material from previously stained smears for immunocytochemistry: a novel technique applied to three soft tissue tumors.

Fine-needle aspiration biopsies of soft tissue tumors are often not fully diagnostic on conventional Papanicolaou or Giemsa stains. Often, more useful information can be gleaned from preparing cell blocks, which are amenable to immunocytochemistry. However, sufficiently diagnostic cell block material is not always forthcoming. We subvent this problem by employing a new 'cytoscrape' technique to create cell blocks from previously Papanicolaou-stained smear material in two cases of mesenchymal tumors where smear diagnoses were limited to 'sarcoma, not otherwise specified'. After thorough text and photographic documentation of the smear results, the slides were decolorized and tumor cells were removed for processing as for routine preparation of cell blocks. Sections cut were then submitted for immunocytochemical profiling. This resulted in definitive diagnoses in both cases, averting the need for more invasive diagnostic procedures. We applied the same technique to a third case of a lung nodule, in which the smear was inconclusive and the original cell block nondiagnostic. The subsequent immunocytochemical testing enabled a definitive diagnosis to be made. This novel technique is described here; its value and applicability are discussed in the context of fine-needle aspiration biopsies of soft tissue tumors.     

Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results.

Despite refinements in surgical technique, including bone grafting and sophisticated prosthetic reconstructions, there are limitations to what can be achieved with bone-anchored fixed prostheses in patients with advanced atrophy of the maxillae. A new approach was suggested by a long-term study on onlay bone grafting and simultaneous placement of a fixture based on a new design: the zygoma fixture, and the aim of this study was to assess its potential. Twenty-eight consecutive patients with severely resorbed edentulous maxillae were included, 13 of whom had previously had multiple fixture surgery in the jawbone that had failed. A total of 52 zygoma fixtures and 106 conventional fixtures were installed. Bone grafting was deemed necessary in 17 patients. All patients have been followed for at least five years, and nine for up to 10 years. All patients were followed up with clinical and radiographic examinations, and in some cases rhinoscopy and sinoscopy as well. Three zygoma fixtures failed; two at the time of connection of the abutment and the third after six years. Of the conventional fixtures placed at the time of the zygoma fixture, 29 (27%) were lost. The overall prosthetic rehabilitation rate was 96% after at least five years of function. There were no signs of inflammatory reaction in the surrounding antral mucosa. Four patients with recurrent sinusitis recovered after inferior meatal antrostomy. To conclude, the zygoma fixture seems to be a valuable addition to our repertoire in the management of the compromised maxilla.     

Variable increases of IgG and IgM antibodies in milk of IgA deficient women

Serum, milk and saliva from seven IgA deficient mothers were studied for the presence of IgA, IgG and IgM antibodies to Escherichia coli and polio virus antigens. Different variable patterns were obtained. One mother had very much increased IgM and IgG antibodies in milk and saliva against both antigens; the milk IgG antibodies were 11–14 times higher than the reference milk pool. Another mother showed also striking increases of both IgM and IgG antibodies in milk, as well as in saliva where the increases were much higher for the poliovirus than the E. coli antibodies. Yet another mother showed a certain increase of IgM but not of IgG antibodies in the milk. The uneven appearance of IgG and IgM antibodies in serum and secretions suggests local production. So do the differences ot antibody avidities, the variations in IgG subclass distribution of antibodies and different patterns after isoelectric focusing (IEF) /immunoblotting analysis of antibody spec-trotypes in secretions and serum.
The study illustrates the variable patterns of compensatory increases of IgG and IgM antibodies which may occur in IgA deficiency. It also shows that the milk from IgA deficient mothers can still be rich in antibodies, in spite of the lack of secretory IgA.