European higher health care education curriculum: development of a cultural framework

This article concerns the European Curriculum in Cultural Care Project (2005-2009), which aimed at developing a curriculum framework for the enhancement of cultural competence in European health care education. The project was initiated and supported by the Consortium of Institutes in Higher Education in Health and Rehabilitation, whose goal is to nurture educational development and networking among member institutions. The framework is the result of a collaborative endeavor by nine nurse educators from five different European countries. The production of the framework will be described in accordance with the following tenets: developing cultural competence is a continuing process, cultural competence is based on sensitivity toward others, and cultural competence is a process of progressive inquiry. Critique concerning the framework will be presented.     

The distribution pattern of the hyaluronan receptor CD44 during human tooth development.

The aim was to investigate the expression pattern of the major cell-surface hyaluronan receptor CD44, as there are no existing data on its presence or absence in human dental structures at different developmental stages. Immunohistochemical localization of CD44 was studied using a monoclonal antibody, H3, that specifically recognizes an epitope in the common backbone of all CD44 isoforms. The dental lamina displayed a strong CD44 signal; the external enamel epithelium was negative. In the coronal region of the tooth germ the presecretory ameloblasts showed an intense reaction whereas the less differentiated inner enamel epithelial cells showed no signal at the cervical loop where they meet the external enamel epithelium. In the stellate reticulum a moderate reaction was detected. The secretory ameloblasts and the stratum intermedium showed a strong cell-surface CD44 signal. A strong signal was also observed on the odontoblasts and their processes. In the pulp, close to the odontoblastic layer, weak labelling was seen in the walls of capillary vessels. The distribution of CD44 in the human tooth germ corresponds to that of hyaluronan in most locations, suggesting that during tooth development this transmembrane protein plays an important part in hyaluronan-mediated events.     

Age matters: collagen birefringence of superficial articular cartilage is increased in young guinea-pigs but decreased in older animals after identical physiological type of joint loading

OBJECTIVE: To compare responses of the collagen network and glycosaminoglycans (GAGs) of articular cartilage to physiological type of joint loading in young growing and adult mature guinea-pigs. DESIGN: 10- and 44-week-old guinea-pigs were accustomed to treadmill running for 3 weeks. Thereafter the animals ran 2500 m/day, 5 days a week, for 15 weeks. Articular cartilage specimens from knee joints were collected at 28 and 62 weeks. Osteoarthritis (OA) prevalence and severity was evaluated by aid of light microscopy. The degree of collagen fibril network organization and content was analyzed with quantitative polarized light microscopy. The local concentration of GAGs was determined from cartilage sections with digital densitometry after safranin-O staining. RESULTS: In the young guinea-pigs, running increased up to 24% the optical retardation of polarized light by collagen in the superficial articular cartilage of femur, indicating either a higher degree of fibril assembly and organization or increased amount of collagen, or both. In contrast, in the adult mature animals the optical retardation decreased almost 50% after joint loading (P< 0.01-0.001). Running did not increase cartilage fibrillation. Significant changes in GAG content of cartilage were not found either in the young or adult mature runners. CONCLUSIONS: Increased birefringence of the superficial articular cartilage after joint loading in young guinea-pigs can be interpreted to be a sign of improved and decreased birefringence in older animals a sign of worsened property of the collagen network. It can be suggested therefore that joint loading strengthened the collagen network in the young runners. It can be hypothesized further that with time the inferior property of the collagen network predisposes the older runners to earlier OA than in controls.     

Epidermal caspase-3 cleavage associated with interferon-gamma-expressing lymphocytes in acute atopic dermatitis lesions

Keratinocyte apoptosis mediated by Fas/Fas ligand molecular interactions and subsequent caspase activation is believed to play an important role in the pathogenesis of atopic dermatitis (AD), in particular for the formation of spongiosis. To estimate epidermal caspase activation in normal and AD skin under in vivo conditions, we analysed caspase-3 cleavage by immunohistology. In normal skin as well as non-lesional AD skin, we detected caspase-3 cleavage in single cells of the basal layer. In contrast, in acute lesional AD skin, we not only obtained evidence for increased expression of cleaved caspase-3 in keratinocytes of the basal layer but also observed caspase-3 cleavage in one or more layers of the spinous cell layer, in particular in spongiotic areas. Short-term topical treatment of the skin lesions with tacrolimus or pimecrolimus abolished the expression of cleaved caspase-3 in the spinous layer. Moreover, epidermal caspase-3 cleavage correlated with the numbers of dermal interferon-gamma (IFN-gamma)-expressing CD4+ and CD8+ lymphocytes in skin lesions of AD patients, supporting the view that IFN-gamma is important for the activation of proapoptotic pathways in keratinocytes. This is also confirmed by the observation of increased Fas expression on keratinocytes in acute AD lesions that was markedly reduced following topical calcineurin inhibitor treatment. These data suggest that caspase-3 cleavage in the spinous layer of the epidermis is a pathologic event contributing to spongiosis formation in AD, whereas cleavage of caspase-3 in basal cells might represent a physiologic mechanism within the process of epidermal renewal.     

The adult sense of coherence scale is applicable to 12-year-old schoolchildren--an additional tool in health promotion

BACKGROUND: Two principal operations of sense of coherence (SOC) for the study of adults have been developed, one consisting of 29 and another consisting of 13 items. According to these studies, SOC is associated with various aspects of perceived health. Also, a 16-item scale for determining SOC in young children (相似文献   

Male breast cancer: management and follow-up recommendations

National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but similar guidelines on male breast cancers are less recognized. As an NCCN institution, our objective was to examine practice patterns and follow-up for male breast cancer compared to established guidelines for female patients. After Institutional Review Board approval, a prospective breast database from 1990 to 2009 was queried for male patients. Medical records were examined for clinico-pathological factors and follow-up. The 5-year survival rates with 95% confidence intervals were estimated using Kaplan-Meier method and Greenwood formula. Of the 19,084 patients in the database, 73 (0.4%) were male patients; 62 had complete data. One patient had bilateral synchronous breast cancer. The median age was 68.8 years (range 29-85 years). The mean/median invasive tumor size was 2.2/1.6 cm (range 0.0-10.0 cm). All cases had mastectomy (29 with axillary node dissection, 23 with sentinel lymph node biopsy only, 11 with sentinel node biopsy followed by completion axillary dissection). Lymph node involvement occurred in 25/63 (39.7%). Based on NCCN guidelines, chemotherapy, hormonal therapy, and radiation are indicated in 34 cases, 62 cases, and 14 cases, respectively. Only 20/34 (59%) received chemotherapy, 51/62 (82%) received hormonal therapy, and 10/14 (71%) received post-mastectomy radiation. Median follow-up was 26.2 months (range: 1.6-230.9 months). The 5-year survival estimates for node positive and negative diseases were 68.5% and 87.5%, respectively (p = 0.3). Despite the rarity of male breast cancer, treatment options based on current female breast tumors produce comparable results to female breast cancer. Increased awareness and a national registry for patients could help improve outcomes and tailor treatment recommendations to the male variant.     

Effect of physical exercise on indentation stiffness of articular cartilage in the canine knee

Using the indentation method, we investigated the effects of physical exercise (treadmill running 4 km/day for 15 weeks) on stiffness of the articular cartilage in the canine knee. Considering cartilage to be an elastic material with homogeneity and isotropy, we calculated elastic moduli for femoral, tibial, and patellar cartilages using instant and 15-s deformations after load application. Although the elastic moduli do not represent, because of the non-equilibrium condition, true elastic properties of articular cartilage, they characterize, together with the retardation time spectrum, the integrated response of articular cartilage during the first 15 s after load application. The moderate loading used in our training program caused no macroscopic changes on the articular surface. In running dogs, the mean stiffness of articular cartilage increased by 6% as compared with the controls. Stiffening, which was attributed to the decreased fluid flow in the cartilage, was significant (P less than 0.05) on the patellar surface of the femur and on the tibial condyles. In general, stiffness increased more (approximately 10%) in the cartilage areas, which were repeatedly heavily loaded during running exercise. This alteration in the biomechanical property as well as an increase (approximately 11%) in thickness were considered to be typical responses of articular cartilage to an increased, but physiologic loading pattern.     

Responses of young and older men during prolonged exercise in dry and humid heat

Summary Eight young, sedentary men (aged 34 years, SD 3) and six older moderately active, unacclimated men (aged 57 years, SD 2) walked on a treadmill at 30% of their maximum oxygen consumption up to 3.5 h in a thermoneutral [dry bulb temperature (T _db) 21°C, relative humidity (r.h.) 43%)], a warm humid (T _db 30°C, r.h. 80%) and a hot dry (T _db 40°C, r.h. 20%) environment while wearing ordinary working clothes (0.7 c/o). Their oxgen consumption, heart rate (f _c), rectal (T _re) and mean skin temperature (T_sk), sweat rate (SR), and evaporative rate (ER) were measured during the tests. The ratings of thermal sensation (TS) and perceived exertion (RPE) were assessed using standard scales. In the heat stress tests, the number of experiments discontinued did not significantly differ between the two groups. The mean levels and end-exercise values of T _re, T_sk, f _c, TS and RPE were not significantly different between the young and older subjects in any of the environments. In the warm humid environment, however, the T _re and RPE of the older subjects increased continuously (P<0.05) during the test compared to the young subjects. No significant difference between the groups was observed in SR or in ER. In the hot dry environment, however, the ER of older men increased more slowly compared to the young men. In spite of some time-related differences observed in T _re, RPE, and ER, the older subjects did not exhibit higher f _c during exercise in the heat, they were not more hyperthermic and their performance times were similar to the young subjects. Therefore, it was concluded that older calendar age is not necessarily associated with a reduced ability to exercise in a hot environment and other factors, such as physical activity habits and aerobic capacity, may be equally important in determining heat tolerance in the elderly.     

Proteoglycan alterations following immobilization and remobilization in the articular cartilage of young canine knee (stifle) joint

The distribution of proteoglycans (PGs) at 11 sites on the knee (stifle joint) cartilage of young female beagle dogs was studied following cast immobilization for 11 weeks in 90° flexion and after a subsequent remobilization for 15 weeks. Immobilization induced a reduction in PG uronic acid at all sites (mean of ?38%), but the greatest depletion ( ?64%) occured at the anterior and posterior extremes of the femoral condyles, i.e., at locations where the immobilized cartilage lost contact to the opposing cartilage. Following remobilization, the content of uronic acid remained lower than in the agematched controls (?18% on average), particularly at the minimum contact sites most affected by immobilization (?33%). The chondroitin-6-sulfate to chondroitin-4-sulfate ratio was reduced by immobilization in most locations (average of ?14%) and returned to control values after remobilization. There was no consistent change in the percentage of aggregating PGs observed in Sephacryl S-100 gel filtration after immobilization or remobilization. However, following remobilization, the aggregating PGs showed an enhanced proportion of the slower mobility band in agarose gel electrophoresis, indicative of a larger monomer size. In the contralateral, load-bearing knee joint, both the uronic acid content and PG monomer type distribution were identical to those observed in the experimental joint, suggesting that the state reached after the remobilization period was due to factor(s) influencing both side. The results suggest that contact forces between articulating surfaces are required to maintain normal PG content and that the control mechanism works locally at each cartilage site. Restriction of joint mobility and loading in young animals is concluded to cause persistent changes in cartilage matrix. Furthermore, the use of the contralateral joint as the sole control in this kind of studies, although experimentally convenient, seems not to be appropriate.