Do nurses feel stressed? A perspective from primary health care

This study describes nurses' experiences of stress in primary healthcare settings, and examines correlations between stress and personal factors. There were 187 nurses from 18 public primary care centers participating, drawn from one county of Lithuania. The Expanded Nursing Stress Scale was used to evaluate the study data. The study indicates that in primary healthcare centers, nurses working with adult patients experienced less stress than those working with younger patients. The most frequently reported stressors were those related to death and dying, and conflicts with physicians and patients and their families. In particular, older nurses more frequently experienced stress related to death and dying. The intensity of nurses' stress in conflict situations with physicians was related to age, however, the depth of work experience in the healthcare setting was more influential. Findings indicate that more detailed research is needed regarding stress experiences in primary health care, and especially the related impact of the social contexts involved in the setting.     

Ghrelin inhibits the proliferative activity of immature Leydig cells in vivo and regulates stem cell factor messenger ribonucleic acid expression in rat testis

Ghrelin has emerged as putative regulator of an array of endocrine and nonendocrine functions, including cell proliferation. Recently, we provided evidence for the expression of ghrelin in mature, but not in undifferentiated, Leydig cells of rat and human testis. Yet testicular actions of ghrelin, other than modulation of testosterone secretion, remain unexplored. In the present study we evaluated the effects of ghrelin on proliferation of Leydig cell precursors during puberty and after selective elimination of mature Leydig cells by treatment with ethylene dimethane sulfonate. In these settings, intratesticular injection of ghrelin significantly decreased the proliferative activity of differentiating immature Leydig cells, estimated by 5-bromodeoxyuridine labeling. This response was selective and associated, in ethylene dimethane sulfonate-treated animals, with a decrease in the mRNA levels of stem cell factor (SCF), i.e. a key signal in spermatogenesis and a putative regulator of Leydig cell development. Thus, the effects of ghrelin on SCF gene expression were evaluated. In adult rats, ghrelin induced a significant decrease in SCF mRNA levels in vivo. Such an inhibitory action was also detected in vitro using cultures of staged seminiferous tubules. The inhibitory effect of ghrelin in vivo was dependent on proper FSH input, because it was detected in hypophysectomized rats only after FSH replacement. Overall, it is proposed that acquisition of ghrelin expression by Leydig cell precursors during differentiation may operate as a self-regulatory signal for the inhibition of the proliferative activity of this cell type through direct or indirect (i.e. SCF-mediated) mechanisms. In addition, we present novel evidence for the ability of ghrelin to modulate the expression of the SCF gene, which may have implications for the mode of action of this molecule in the testis as well as in other physiological systems.     

Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform

Objectives In Finland, a dental subsidization reform, implemented in 2001–2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n?=?2157), in 2004 (n?=?1814) and in 2007 (n?=?1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.     

Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma?

Sentinel lymph node biopsy (SNB) seems to be a promising method for staging clinically N0 neck in patients with oral squamous cell carcinoma (OSCC). In the present study, SNB was performed on 46 patients having elective neck dissection (END; six bilateral dissections) for T1–T3N0 OSCC. Sentinel lymph nodes (SLN) were first examined according to only slightly modified standard histopathologic protocol including sections at 1–2 mm intervals and H&E staining. SLN that appeared false negative (i.e. metastatic non-SLN without metastasis in a SLN) after the initial histopathologic examination were further assessed by step sectioning at 150 μm intervals and immunohistochemistry. Of the 47 neck sides with at least one SLN identified, nine contained metastasis in nine patients. After the initial histopathologic examination, SLNs were negative for malignant cells in four out of the nine metastatic neck sides. In one neck side, two metastatic SLNs were detected after the additional meticulous histopathologic work-up of the initially false negative SLNs. Therefore, in three neck sides the SLN did not contain metastasis although there was a metastasis in a non-SLN. In all these three cases with a false negative SLN, only one SLN had been identified. The sensitivity of the method (employing extensive histopathologic work-up) for detection of occult cervical metastasis was 67% (6/9 neck sides). The sensitivity of SNB for detection of occult metastasis seems to be poor in cases where only one SLN can be identified. The results of this study do not entitle us to entirely replace END by SNB in patients with OSCC.     

The role of potassium in postural hypotension: electrolytes and neurohumoral factors in elderly hypertensive patients using diuretics

Abstract. Objective . To study the association between postural hypotension and (i) electrolyte levels and (ii) neurohumoral factors in elderly hypertensive patients using diuretics. Design . Cross-sectional study of patients and controls. Setting . The subjects were gathered from senior citizen clubs or they were referred to the study by general practitioners. The subjects were examined on a geriatric ward in Turku City Hospital. Subjects . Seven subjects with postural hypotension and 13 controls. Measurements . Plasma electrolyte levels and neurohumoral response to head-up tilt. Results . There were significantly more hypokalemic subjects in the postural hypotension group (5/7) than in the control group (1/13) (P < 0.01). The plasma potassium level was negatively correlated to plasma aldosterone (r = –0.57; P < 0.01) and renin activity (r = –0.69; P < 0.001). Subjects with postural hypotension had higher levels of noradrenaline, both supine (P < 0.05) and during tilt (P < 0.05). There were no significant differences in supine or tilt levels of plasma adrenaline, vasopressin, atrial natriuretic peptide, aldosterone and renin activity between the groups. Conclusion . The results suggest that potassium depletion is associated with postural hypotension in elderly hypertensive patients using diuretics. However, it is unclear whether there is a causative link between potassium depletion and postural hypotension or whether they are both caused by some other factor, e.g. volume contraction.     

Free microvascular TRAM flaps for breast reconstruction: the first 50 patients

Skin blood flow in the free TRAM flap has been shown to be superior to that in the pedicled TRAM flap, and in 1990 the free TRAM flap was adopted as the procedure of choice for breast reconstructions. The findings in the first 50 patients whose breasts were reconstructed with free microvascular TRAM flaps are reported. Although 92% of the patients had undergone previous axillary operation and 78% had received radiotherapy, recipient vessels could be found in all axillae. Fortyeight patients had unilateral and two bilateral reconstructions. Reduction or mastopexy was performed on the opposite breast in 50% of the patients. One flap was lost. Skin edge necrosis was found in two patients. Acceptable results with good symmetry or slight asymmetry were achieved in 96%. Seven patients had abdominal laxity due to use of Gore-Tex sutures for closure. Abdominal wall complications ceased once the suture material was changed. The complication rate decreases quickly, as experience increases. Nineteen immediate postoperative or later complications occurred in the first 25 free TRAM flap patients but only 5 in the second 25 patients. The free TRAM flap results in fewer skin problems and is an easier operation for the patient than a pedicled TRAM.     

The effect of radial artery reconstruction on the radial forearm donor site: a prospective study

The purpose of this study was to evaluate the effect of radial artery reconstruction after radial forearm flap elevation and to study whether a vein graft can stay patent in this position. Ten consecutive oral cancer patients were included in the study. Pre-operative Allen's test was performed, and the flow velocity of both radial and ulnar arteries was recorded using colour Doppler ultrasonography. After flap elevation, the radial artery was reconstructed using the cephalic vein of the donor forearm as a free vein graft. The reconstructed artery was completely covered with surrounding skin, while the actual donor defect was covered with a split thickness skin graft. Colour Doppler ultrasonography was performed at 1–2 weeks and at 6–12 months post-operatively to record long-term patency. Radial artery reconstruction did not prolong the operations. All donor sites healed uneventfully. All of the reconstructed arteries were patent at the post-operative controls. In one patient, graft flow was missing on the first post-operative day but normal in the follow-up. A vein graft can remain patent with a very high success rate after radial artery reconstruction. A negative Allen’s test is not an absolute contraindication of a radial forearm flap as radial artery reconstruction can be performed.     

Physical activity and bone

It has been shown in many circumstances that immobilization can cause loss of bone mineral content. There is also evidence that athletes from various sports have higher bone mineral density than less active controls. In studies of non-athletic populations the relationship between exercise and bone has not been unambiguous. However, physically active life-style is recommended as an effective means of preventing bone loss with age. In addition, exercise maintains and improves muscle strength, coordination and balance and may thus reduce the risk of fractures.