bluuebunny/crossref_metadata_2025 huggingface dataset:
Views of patients and general dental practitioners on the organizational aspects of a general dental practice
Authors: Sonneveld Rutger , Brands Wolter , Bronkhorst Ewald , Truin Gert‐Jan
Published: November 2011

Objective  To examine the views of patients and general dental practitioners (GDPs) on the organizational aspects of a general dental practice and to see whether their views differ.

Background  Health care has increasingly centred on the patient over the last two decades, and the patients’ opinions have been taken more seriously. Although in other health‐care sectors research on organizational aspects has been performed, research in dental care is lacking on this subject.

Design  We developed two questionnaires covering 41 organizational aspects of a general dental practice: one for GDPs and one for dental patients. The questionnaires were handed out in dental practices to 5000 patients and sent to 500 GDPs.

Results  We describe the results of the organizational aspects mentioned most by 25% of the dental patients. For most aspects, the views of the patients and GDPs differed significantly. However, both respondent groups mentioned the same category the most.

Conclusions  The results of this study could be used on a policy level for the development of guidelines and on a practice level for individual GDPs to adjust practice management to the preferences of patients.
Willingness to pay as patient preference to bariatric surgery
Authors: Khawali Cristina , Ferraz Marcos B. , Zanella Maria T. , Ferreira Sandra R. G.
Published: November 2011

Background  An obesity epidemic is spreading worldwide. In addition to comorbidities, social and emotional problems contribute to reduce the quality of life (QoL) of obese people. Considering the heterogeneity of outcomes from clinical and surgical approaches, it is recommended that severely obese patients participate in their treatment decisions. This study evaluated preferences of severely obese patients for obesity surgical treatment using the willingness to pay (WTP) and to assess the impact of the presence of some clinical disorders, socioeconomic conditions and QoL on their decisions.

Methods  The selected patients were invited to answer the WTP questionnaire using two formats of contingent valuation questions: dichotomous choice (yes/no) and a bidding game. The answers were correlated with clinical features, QoL assessed by the SF‐36 and the Moorehead‐Ardelt Quality of Life Questionnaire II, Brazilian socioeconomic classification, and family and personal incomes.

Results  The group of patients who accepted the first bid was older and had higher frequency of sleep apnoea when compared to those who rejected the offer. A significant correlation between the bidding game value and family income was found (r = 0.28; P < 0.02). In the logistic regression model, socioeconomic classification and sleep apnoea were shown to be independently associated with acceptance the bid.

Conclusions  Sleep apnoea was the comorbidity that most influenced the acceptance in dichotomous choice for bariatric surgery, probably due to the deleterious effects on daily activities induced by sleep disturbances. Our findings also suggest that the frequency of surgical procedures is below the preference of the obese population in Brazil.
The role of perceived benefits and costs in patients’ medical decisions
Authors: Singer Eleanor , Couper Mick P. , Fagerlin Angela , Fowler Floyd J. , Levin Carrie A. , Ubel Peter A. , Van Hoewyk John , Zikmund‐Fisher Brian J.
Published: November 2011

Background  Many decisions can be understood in terms of actors’ valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the importance attached to benefits and costs predicts action or inaction; and (iii) how such valuations are related to decision confidence.

Methods  In a national random digit dial telephone survey of U.S. adults, patients rated the importance of various reasons for and against medical decisions they had made or talked to a health‐care provider about during the past 2 years. Participants were 2575 English‐speaking adults age 40 and older. Data were analysed by means of logistic regressions predicting action/inaction and linear regressions predicting confidence.

Results  Aggregating individual reasons into those that may be regarded as benefits and those that may be regarded as costs, and weighting them by their importance to the patient, shows the expected relationship to action. Perceived benefits and costs are also significantly related to the confidence patients report about their decision.

Conclusion  The factors patients say are important in their medical decisions reflect a subjective weighing of benefits and costs and predict action/inaction although they do not necessarily indicate that patients are well informed. The greater the difference between the importance attached to benefits and costs, the greater patients’ confidence in their decision.
What motivates Australian health service users with chronic illness to engage in self‐management behaviour?
Authors: Jowsey Tanisha , Pearce‐Brown Carmen , Douglas Kirsty A. , Yen Laurann
Published: November 2011

Context  Health policy in Australia emphasizes the role of health service users (HSU) in managing their own care but does not include mechanisms to assist HSUs to do so.

Objective  To describe motivation towards or away from self‐management in a diverse group of older Australians with diabetes, chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) and suggest policy interventions to increase patient motivation to manage effectively.

Design  Content and thematic analyses of in‐depth semi‐structured interviews. Participants were asked to describe their experience of having chronic illness, including experiences with health professionals and health services. Secondary analysis was undertaken to expose descriptions of self‐management behaviours and their corresponding motivational factors.

Participants  Health service users with diabetes, COPD and/or CHF (N = 52).

Results  Participant descriptions exposed internal and external sources of motivation. Internal motivation was most often framed positively in terms of the desire to optimize health, independence and wellness and negatively in terms of avoiding the loss of those attributes. External motivation commonly arose from interactions with family, carers and health professionals. Different motivators appeared to work simultaneously and interactively in individuals, and some motivators seemed to be both positive and negative drivers.

Conclusion  Successful management of chronic illness requires recognition that the driving forces behind motivation are interconnected. In particular, the significance of family as an external source of motivation suggests a need for increased investment in the knowledge and skill building of family members who contribute to care.
A specialist root herbivore exploits defensive metabolites to locate nutritious tissues
Authors: Robert Christelle A. M. , Veyrat Nathalie , Glauser Gaétan , Marti Guillaume , Doyen Gwladys R. , Villard Neil , Gaillard Mickaël D. P. , Köllner Tobias G. , Giron David , Body Mélanie , Babst Benjamin A. , Ferrieri Richard A. , Turlings Ted C. J. , Erb Matthias
Published: November 2011

Ecology Letters (2011) 14: 55–64

The most valuable organs of plants are often particularly rich in essential elements, but also very well defended. This creates a dilemma for herbivores that need to maximise energy intake while minimising intoxication. We investigated how the specialist root herbivore Diabrotica virgifera solves this conundrum when feeding on wild and cultivated maize plants. We found that crown roots of maize seedlings were vital for plant development and, in accordance, were rich in nutritious primary metabolites and contained higher amounts of the insecticidal 2,4‐dihydroxy‐7‐methoxy‐1,4‐benzoxazin‐3‐one (DIMBOA) and the phenolic compound chlorogenic acid. The generalist herbivores Diabrotica balteata and Spodoptera littoralis were deterred from feeding on crown roots, whereas the specialist D. virgifera preferred and grew best on these tissues. Using a 1,4‐benzoxazin‐3‐one‐deficient maize mutant, we found that D. virgifera is resistant to DIMBOA and other 1,4‐benzoxazin‐3‐ones and that it even hijacks these compounds to optimally forage for nutritious roots.
Welcome to the neighbourhood: interspecific genotype by genotype interactions in Solidago influence above‐ and belowground biomass and associated communities
Authors: Genung Mark A. , Bailey Joseph K. , Schweitzer Jennifer A.
Published: November 2011

Ecology Letters (2011) 14: 65–73

Intra‐ and interspecific plant–plant interactions are fundamental to patterns of community assembly and to the mixture effects observed in biodiversity studies. Although much research has been conducted at the species level, very little is understood about how genetic variation within and among interacting species may drive these processes. Using clones of both Solidago altissima and Solidago gigantea, we found that genotypic variation in a plant’s neighbours affected both above‐ and belowground plant traits, and that genotype by genotype interactions between neighbouring plants impacted associated pollinator communities. The traits for which focal plant genotypic variation explained the most variation varied by plant species, whereas neighbour genotypic variation explained the most variation in coarse root biomass. Our results provide new insight into genotypic and species diversity effects in plant–neighbour interactions, the extended consequences of diversity effects, and the potential for evolution in response to competitive or to facilitative plant–neighbour interactions.
Randomized pilot study of cabergoline, a dopamine receptor agonist: effects on body weight and glucose tolerance in obese adults
Authors: Gibson C. D. , Karmally W. , McMahon D. J. , Wardlaw S. L. , Korner J.
Published: November 2011

Aim: Dopaminergic hypofunction and hyperprolactinaemia have been implicated in the pathogenesis of obesity and glucose intolerance. The aim of this pilot study was to determine the efficacy of cabergoline, a dopamine receptor agonist, on body weight and glucose tolerance in obese non‐diabetic persons with normal plasma prolactin levels.

Methods: This 16‐week double blind, placebo‐controlled pilot study randomized non‐diabetic obese adults (body mass index 30–42 kg/m2) to placebo or cabergoline (0.25 mg twice weekly for 4 weeks followed by 0.5 mg twice weekly for the next 12 weeks). Of 40 subjects enrolled, 29 completed 16 weeks: 16 randomized to placebo and 13 to cabergoline. All subjects were counselled on a 500 kcal/day calorie deficit diet. A 75‐g oral glucose tolerance test was performed at baseline and at 16 weeks.

Results: As expected, prolactin levels decreased after cabergoline (p < 0.001). Weight loss was similar after placebo compared with cabergoline treatment: 1.0 vs. 1.2% body weight, respectively. Fasting glucose levels did not differ between groups after treatment, however, 90‐min postprandial glucose and insulin decreased in the cabergoline group only (p = 0.029). HOMA‐IR (homeostasis model of assessment) increased by 40% after placebo and 1.5% after cabergoline treatment.

Conclusions: This pilot study suggests that cabergoline therapy may improve glucose tolerance independent of weight loss, however, a larger, longer term study of dopamine receptor agonist therapy in obese individuals is warranted to confirm this finding.
Comparison of salt stress resistance genes in transgenic Arabidopsis thaliana indicates that extent of transcriptomic change may not predict secondary phenotypic or fitness effects
Authors: Chan Zhulong , Bigelow Patrick J. , Loescher Wayne , Grumet Rebecca
Published: November 2011

Engineered abiotic stress resistance is an important target for increasing agricultural productivity. There are concerns, however, regarding possible ecological impacts of transgenic crops. In contrast to the first wave of transgenic crops, many abiotic stress resistance genes can initiate complex downstream changes. Transcriptome profiling has been suggested as a comprehensive non‐targeted approach to examine the secondary effects. We compared phenotypic and transcriptomic effects of constitutive expression of genes intended to confer salt stress tolerance by three different mechanisms: a transcription factor, CBF3/DREB1a; a metabolic gene, M6PR, for mannitol biosynthesis; and the Na+/H+ antiporter, SOS1. Transgenic CBF3, M6PR and SOS1 Arabidopsis thaliana were grown together in the growth chamber, greenhouse and field. In the absence of salt, M6PR and SOS1 lines performed comparably with wild type; CBF3 lines exhibited dwarfing as reported previously. All three transgenes conferred fitness advantage when subjected to 100 mm NaCl in the growth chamber. CBF3 and M6PR affected transcription of numerous abiotic stress‐related genes as measured by Affymetrix microarray analysis. M6PR additionally modified expression of biotic stress and oxidative stress genes. Transcriptional effects of SOS1 in the absence of salt were smaller and primarily limited to redox‐related genes. The extent of transcriptome change, however, did not correlate with the effects on growth and reproduction. Thus, the magnitude of global transcriptome differences may not predict phenotypic differences upon which environment and selection act to influence fitness. These observations have implications for interpretation of transcriptome analyses in the context of risk assessment and emphasize the importance of evaluation within a phenotypic context.
Exploring consumer orientation toward returns: unethical dimensions
Authors: Wachter Kathy , Vitell Scott J. , Shelton Ruth K. , Park Kyungae
Published: November 2011

As customer return rates increase, retailer bottom lines suffer from customers’ misuse of the policies and to the ethics of such practice. The purpose of this study is to explore customers’ orientation toward return behaviors, and to develop a return orientation assessing these dimensions. This research identified three dimensions relevant to consumer return behavior: the planned/unethical returner; the eager returner; and the reluctant/educated returner. A retest with another sample confirmed these three dimensions. Each dimension was analyzed for its relationship with consumer ethical beliefs as measured by the Muncy–Vitell Consumer Ethics Scale, ethical philosophies and shopping behaviors. These relationships supported the ethical and unethical aspects of returner orientation. Results of this research imply that the core aspect of returner orientation is relevant to ethical behavior and misuse of retail return policies. The three return orientations identified partially support the Rosenbaum & Bitner‐Olson research.
Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care
Authors: Thorup Charlotte B. , Rundqvist Ewa , Roberts Christel , Delmar Charlotte
Published: November 2011

Scand J Caring Sci; 2012; 26; 427–435

Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care

The aim of the study was to explore nurses’ experience of how their own vulnerability and suffering influence their ethical formation and their capacity to provide professional care when they are confronted with the patient’s vulnerability and suffering. Care is shaped in the meeting between human beings. Professional care is informed by the patient’s appeal for help as it is expressed in the meeting. Ethical formation is understood as a personal ethical and existential process, resulting in the capacity to provide professional care. A nurse must have the sense of being a complete human being with own personal attributes and sensitivity in order to be able to relate to other people. The study is based on qualitative interviews with 23 experienced nurses from Sweden, Finland and Denmark. The analyses and interpretation were carried out in line with Steinar Kvale’s three levels of interpretation. The study clarifies that ethical formation is a union of the nurse’s personal attributes and professional qualifications and that ethical formation is developed over time. Moreover, it also demonstrates that the nurse’s personal and professional life experiences of vulnerability and suffering influence ethical formation. Vulnerability and suffering have proven to be sensitive issues for nurses, like a sore point that either serve as an eye‐opener or cause the development of blind spots. Furthermore, vulnerability, suffering and the sore points are seen to shape the nurse’s courage in relation to care. Courage appears to be a significant unifying phenomenon that manifests itself as the courage to help patients face their own vulnerability and suffering, to bear witness to patients’ vulnerability and suffering and to have faith in oneself in arguing for and providing professional care. Courage thus seems to play a significant role in nurses’ ability to engage in care. Nurses’ own vulnerability, suffering and sore points seem to shape their courage.
Cellular therapies supplement: the peritoneum as an ectopic site of hematopoiesis following in utero transplantation
Authors: Muench Marcus O. , Chen Jeng‐Chang , Beyer Ashley I. , Fomin Marina E.
Published: November 2011

BACKGROUND: In utero transplantation (IUT) has the potential to treat birth defects early before full development of the immune system. Relatively small grafts, which are not matched for major histocompatibility antigens, can be delivered even before onset of disease symptoms. IUT of hematopoietic stem cells is usually performed via intraperitoneal injection, yet the fate of donor cells in the peritoneal cavity is not fully understood. We review our recent work and present new data demonstrating that the peritoneum can be a site of ectopic hematopoiesis with implications for IUT and immune tolerance induction.

STUDY DESIGN AND METHODS: Haplogeneic and allogeneic fetal transplants were performed in mice and engraftment tracked by flow cytometry. Immune tolerance was studied by mixed lymphocyte reactions and skin transplantation. Adult syngeneic murine transplants and xenogeneic human into immunodeficient mouse transplants were performed to follow hematopoietic retention in the peritoneum and engraftment of the marrow.

RESULTS: Although most transplanted cells rapidly clear the peritoneum, hematopoietic cells and cells with the phenotype of hematopoietic precursors can remain in the peritoneal cavity for months after transplant. The presence of donor cells in the peritoneum can contribute to donor‐specific tolerance, but sufficient peripheral blood chimerism is required to ensure acceptance of donor skin grafts.

CONCLUSION: Ectopic hematopoiesis and the survival of stem cells in the peritoneum offer the possibility of better using the peritoneal cavity to delivery stem cells and foster the development of immune tolerance to alloantigens or other foreign antigens.
On how Rac controls hematopoietic stem cell activity
Authors: Cancelas J.A.
Published: November 2011

Rac GTPases form part of the family of Rho small GTPases. Rac GTPases, like other Rho family GTPases, are key molecular switches controlling the transduction of external signals to cytoplasmic and nuclear effectors. The development of genetic and pharmacological tools has allowed a more precise definition of the specific roles of Rac GTPases in hematopoietic stem cells (HSCs). Our current knowledge has enabled dissection of their specific and redundant roles. Rac GTPases are now known to be crucial in the response of HSCs to the hematopoietic microenvironment cues. This review will briefly summarize the known HSC functions that are regulated by Rac GTPases, focusing on adhesion, migration, retention, proliferation, and survival, and how Rac relates to the physiological functions of HSC. The development of small molecule inhibitors with the ability to interfere with Rac GTPase activation offers new therapeutic strategies to manipulate the function of HSC in vivo and ex vivo.
Women's Prenatal Concerns Regarding Breastfeeding: Are They Being Addressed?
Authors: Archabald Karen , Lundsberg Lisbet , Triche Elizabeth , Norwitz Errol , Illuzzi Jessica
Published: November 2011

Introduction: This study sought to identify women's concerns regarding breastfeeding during the prenatal period and determine whether women thought that health care providers addressed these concerns.

Methods: A structured interview with both open‐ended and closed‐ended questions addressing the study objectives was administered to a cross‐sectional sample of 130 English‐speaking or Spanish‐speaking postpartum women at Yale‐New Haven Hospital.

Results: When asked an open‐ended question regarding whether they had concerns about breastfeeding while making their decisions about feeding their infants, 81.5% of women identified at least 1 concern. Of these women, only 25.4% reported that this concern was addressed by the provider during prenatal care. When prompted with 8 common concerns regarding breastfeeding during the prenatal period, 95.4% of women identified at least 1 of these preidentified concerns. Only 17.4% of women who identified any of these 8 concerns reported that the concerns had been discussed with a provider.

Discussion: Women's recall of prenatal health care discussions strongly suggests that providers are not adequately addressing women's concerns about breastfeeding.
Family Stories: Narrative Genetics and Conceptions of Heritability in Pregnant Women
Authors: Hurst Marsha , Lieber Caroline , Lewis Linwood J. , Grob Rachel
Published: November 2011

As our understanding of genetics has grown, and its importance has increased in clinical care, pregnancy and the fetus are often seen through a genetic lens. Clinicians who care for pregnant women are charged with explaining genetic risk and overseeing prenatal screening. For the clinician, genetics represents clearly defined application of a particular kind of scientific knowledge. Further, heritability in clinical terms is understood as purely genetic. Pregnant women themselves, however, may not give these genetic explanations the same primacy or meaning. In order to better understand the way pregnant women actually understand and explain heritability, we completed in‐depth interviews with 26 pregnant women, listening as they gave weight and substance to the various factors they describe as influencing the personhood of their unborn children. Two‐thirds of our respondents were Hispanic or African American. Most were recruited through programs that serve low‐income women. The interviews were coded and analyzed by using categories that emerged directly from the narratives captured in the interviews and that revealed the broad, cross‐cutting, overlapping parameters of women's deeply‐held beliefs about heritability. These stories represent narratives of heritability that are profoundly familial and cultural. They incorporate belief in the authoritative knowledge of medicine—including any genetic information—into a complex and usually multicultural context, woven together by ancestry, household, and community.
From a Woman's Perspective: Life as a Partner of a Prostate Cancer Survivor
Authors: Tanner Tanya , Galbraith Michael , Hays Laura
Published: November 2011

Introduction: The purpose of this analysis was to provide a better understanding of the experiences of partners of prostate cancer survivors. Concerns and needs of women who are partners of prostate cancer survivors are often not acknowledged or addressed in clinical practice. By increasing their awareness of the impact of this situation on women, primary health care providers can offer more holistic, individualized, woman‐centered care.

Methods: Qualitative descriptive analyses were conducted on narrative data generated from 2 open‐ended questions embedded within 2 longitudinal survey studies that spanned 8 years. Questions were focused on the quality of life and relationships for prostate cancer survivors and their partners.

Results: Results reflect the comprehensive impact of prostate cancer on the lives of the partners of the survivors. Three overarching themes were identified: 1) coping with life in the face of cancer, 2) encountering difficult emotions related to a partner's illness, and 3) learning to live with relationship changes.

Discussion: Women's responses highlight the significant impact of the experience on their lives and illuminate to primary care providers the importance of assessing, recognizing, and appropriately addressing their specific concerns.
CenteringPregnancy: An Integrative Literature Review
Authors: Manant Annette , Dodgson Joan E.
Published: November 2011

Introduction: A critical analysis of the CenteringPregnancy model of care research has not been conducted across studies. The aims of this project were to describe 1) the conceptual components of the CenteringPregnancy practice model, 2) the characteristics of the CenteringPregnancy literature, and 3) the research methods and outcomes across the CenteringPregnancy research literature.

Methods: An integrative literature review methodology was used to assess the CenteringPregnancy literature published between 1994 and 2009.

Results: The sample consisted of 26 articles (14 narrative descriptions, 10 quantitative studies, 1 mixed methods study, and 1 qualitative study) published predominantly in nursing and midwifery journals. The majority of quantitative studies were exploratory or quasi‐experimental and longitudinal designs with the exception of 1 large, federally funded, randomized, controlled trial. Variables were individual and community level outcomes, which were not uniformly operationally defined or measured consistently across studies. Significant results for prenatal care attendance rates, adequate prenatal care, and breastfeeding rates were reported in a number of studies. Other results were often mixed or nonsignificant.

Discussion: Positive outcomes for the CenteringPregnancy model have been suggested by research findings to date but require more systematic approaches to developing knowledge about the factors inherent in this model that promote participant behavior changes, which lead to better perinatal outcomes as well as circumstances that maximize the effectiveness of this model. Areas for improving the strength of the evidence are discussed. Building consistently demonstrated relationships across studies is essential for creating the evidence base on which practice decisions can be made. Further research is required for developing clarity and understanding about this model's effectiveness.
Referrals for Dental Care During Pregnancy
Authors: Kloetzel Megan K. , Huebner Colleen E. , Milgrom Peter
Published: November 2011

Oral health is essential to overall health in the prenatal period. Pregnancy is not a time to delay dental care. Several studies have shown an association between periodontal disease and poor pregnancy outcomes including preterm birth. Interventions to provide periodontal treatment to pregnant women yield inconsistent results regarding preterm birth but have established the safety of periodontal therapy during pregnancy. Postpartum women in poor dental health readily transmit the tooth decay pathogen Streptococcus mutans from their saliva to their infants, resulting in increased risk of early childhood caries. Preventive services and treatment for acute problems should be recommended, fears allayed, and women referred. Dental radiographs may be performed safely with the use of appropriate shielding. Nonemergent interventions are best provided between 14 and 20 weeks' gestation for comfort and optimal fetal safety. Most gravid women do not seek dental care. Increased interprofessional communication to encourage dentists to treat pregnant women will reduce the number of women without care. In states where it is available, Medicaid coverage of dental services for pregnant women is typically allowed during pregnancy and for 2 months postpartum. Women's health providers should understand the importance of protecting oral health during pregnancy and educate their patients accordingly.
International Clinical Experience for Midwifery Students
Authors: Latta Summer , Faucher Mary Ann , Brown Sarah , Bradshaw Martha
Published: November 2011

Introduction: The purpose of this survey was to obtain information that would elucidate what types and amounts of international clinical experiences are available to midwifery students in accredited midwifery programs. Furthermore, the survey assessed the need for and interest in an online pre‐trip preparation course and the possibility of future collaborative efforts between midwifery programs.

Methods: A formal electronic descriptive survey was sent to eligible directors of midwifery education (DOME) from 38 accredited institutions in the United States.

Results: Twenty‐nine of 38 (76%) responded to the survey, and 9 of 29 programs (31%) offer international clinical experiences. Sixteen (80%) of the 20 programs not currently offering international experiences indicated interest in offering these experiences. Of the 9 programs that have international experiences, only 1 reported offering a formal pre‐trip course.

Discussion: The results of this survey suggest that there is interest in collaborative efforts for developing a formal pre‐trip preparation course and sharing international experiences that would promote sustainable programs of international experiences for student midwives.
Governmental Oversight of Prescribing Medications: History of the US Food and Drug Administration and Prescriptive Authority
Authors: Plank Linda S.
Published: November 2011

The evolution of drug regulation and awarding of prescriptive authority is a complex and sometimes convoluted process that can be confusing for health care providers. A review of the history of how drugs have been manufactured and dispensed helps explain why this process has been so laborious and complicated. Because the federal and state governments have the responsibility for protecting the public, most regulations have been passed with the intentions of ensuring consumer safety. The current system of laws and regulations is the result of many years of using the legal system to correct drug marketing that had adverse health consequences. Government oversight will continue as prescribing medications transitions to an electronic form and as health care professionals in addition to physicians seek to gain prescriptive authority.
Pharmacologic Management of Asymptomatic Bacteriuria and Urinary Tract Infections in Women
Authors: O’Dell Katharine K.
Published: November 2011

Many factors influence the decision to institute treatment for the common problems of urinary tract symptoms and/or the presence of microorganisms in the urine of women. This article summarizes current evidence related to treatment choice and compares selected treatment practice guidelines. Evidence related to prevention of recurrent infection without the use of antibiotics is included.
Introductory Pharmacology for Clinical Practice
Authors: Corbett Robin Webb , Owens Laura Williford
Published: November 2011

The average woman will take many medications, both prescription and nonprescription, as well as herbs or other dietary supplements over the course of her lifetime. These chemicals can produce therapeutic benefits but can also cause toxic effects. Pharmacokinetics, pharmacodynamics, pharmacotherapy, adverse drug reactions, and research in pharmacology are discussed as applied to women's health. Clinicians must have a firm understanding of the basic principles of pharmacology so that they can appropriately administer medications, monitor for anticipated effects and adverse reactions, and communicate as needed with women, their families, and other health care team members.
ASSESSMENT OF ANAL SYMPTOMS IN PRIMIPAROUS WOMEN FOLLOWING SPONTANEOUS VAGINAL BIRTH AT TERM
Authors: Angelini Diane J. , Myers Deborah , Raker Christine
Published: November 2011

Background: The purpose of this prospective survey‐design study of primiparas was to assess anal symptoms following spontaneous vaginal birth at term. Methods: A survey was designed for the study using the Wexner Scale. Inclusion criteria: primiparas undergoing spontaneous vaginal birth with either intact, first or second‐degree laceration; read and write English; and no previous anal injury or defect. P < .05 was statistically significant. Demographic and labor variables along with Wexner Scale results were collected. Results: 322 postpartum women were enrolled with 164 responding for a 51% return rate. Two demographic and labor‐related variables by laceration severity proved significant: maternal age (P= .001) and fetal weight at birth (P= .01). Within the Wexner Scale, when frequency of items was grouped, the odds of frequent liquid stool incontinence were 1.3 times higher in the second‐degree laceration group although not statistically significant. The odds of frequent uncontrollable flatus were 1.5 times higher in the second‐degree laceration group although not statistically significant (P= 0.2). Conclusion: The significant findings of age and fetal size are consistent with other studies assessing anal symptoms. Uncontrollable flatus needs a larger power analysis to show any significance. In women without significant perineal tears, age and fetal size can add to anal symptoms postpartum, and with increased laceration severity, more anal symptoms were noted.
THE MIDWIFERY MODEL IN CHILE: AN IMPLEMENTATION ASSESSMENT
Authors: Binfa Lorena
Published: November 2011

Introduction: Professionally trained midwives provide care to approximately 80% of the childbearing population in Chile. Prior to 2007, however, intrapartum care had become medicalized. In 2007, the Chilean Minister of Public Health adopted the Model of Integrated and Humanized Health Services, concurrently with the Clinical Guide for the Humanized Attention of Labour and Delivery. The main objective of this guide is to guarantee access to all pregnant women in Chile adequate professional assistance during labour and delivery, with “a safe, personalized and human delivery.” This attention includes continuous emotional support, reduction of intrapartum continuous fetal monitoring, use of alternative modes of pain relief, promotion of free position change and walking, restriction of episiotomy, elimination of the use of enema and genital shaving, and promotion of mother and newborn early skin‐to‐skin contact. Aims: The aims of this study are 1) to explore perceptions of this humanized attention during labour and delivery by both the professional staff (obstetricians and midwives) and consumers; 2) to identify the degree of maternal‐newborn well‐being; and 3) to describe selected obstetric outcomes of the women enrolled in the study who received care within this model. Methods: A cross‐sectional, descriptive study conducted of 450 women who gave birth in 2 major hospitals within the National Health System in the Metropolitan Area, Santiago, Chile, from September 2010 until June 2011. Qualitative methods include focus groups of midwives, obstetricians, and consumers. Quantitative methods include a validated survey of maternal well‐being and an adaptation of the American College of Nurse‐Midwives’ standardized antepartum and intrapartum data set. Results: Preliminary results show that 98% of births used oxytocin, 88% used continuous monitoring, 83% used the lithotomy position, and 60% had undergone episiotomy. Conclusions: Medicalization of birth still occurs; no changes have been observed since the implementation of the Clinical Guide for the Humanized Attention of Labor and Delivery in Chile.
EXPLORING THE RECOGNITION OF AND INITIAL RESPONSE TO PROLONGED LABOR AND BIRTH ASPHYXIA IN DHAKA, DINAJPUR, AND MATLAB, BANGLADESH
Authors: Haqqani Nazish , VanderEnde Kristin , Moran Allisyn , Afsana Kaosar , Day Louise T. , Sibley Lynn
Published: November 2011

Purpose: This study investigated the knowledge and behaviors of Bangladeshi women and their caregivers regarding the recognition of and initial response to prolonged labor (PL) and birth asphyxia (BA) in homebirth settings. Methods: Survey data on cultural knowledge about the causes, signs, and treatments for PL/BA were collected through structured interviews of 360 randomly‐selected respondents. Integrated illness history (IIH) narratives were conducted with women who experienced PL/BA and their caregivers (n=19 PL, 16 BA groups). Congruence was determined between structured interviews and IIH interviews. Results: PL: The highest rates of congruence (ie, agreement between knowledge and behavior) occurred when perceived cause was malnourishment of mother/baby, treatment was seeking professional care, and symptom was increasing pain strength. The highest rates of incongruence occurred when perceived cause was spirits. BA: The highest rates of congruence occurred when perceived cause was PL, treatments were stimulating the baby and seeking professional care, and symptom was baby's inability to move. The highest rates of incongruence occurred when perceived cause was spirits, treatments were covering and oil‐massaging the baby, and symptom was baby's inability to cry. Conclusions: During complications, inconsistency between knowledge and behavioral response may delay the seeking of appropriate care, adversely impacting outcomes. Causes, signs, symptoms, and treatments eliciting these responses should be addressed appropriately. Funding: Scholarly Inquiry and Research at Emory (SIRE), Global Health Institute, Emory University.
An analysis of bundle pricing in horizontal and vertical markets: The case of the U.S. cottonseed market
Authors: Shi Guanming , Stiegert Kyle W. , Chavas Jean P.
Published: November 2011

The U.S. cottonseed market has seen the rapid development and adoption of seeds with differing bundles of genetically modified (GM) traits. It has also seen an increase in vertical integration by biotechnology firms. In this article, we investigate the price impacts associated with structural changes in the U.S. cottonseed market from 2002 to 2007. We develop a structural model to examine the substitution/complementarity relationships among cottonseeds sold with different genetic trait bundles and under different vertical arrangements. We examine the price impacts emanating from product differentiation, market concentration, and market size. The econometric investigation finds evidence of subadditive bundle pricing in patented biotech traits. While higher own‐market concentrations are found to be associated with higher prices, we also uncover evidence of cross‐product complementarity effects that lead to lower prices. Simulations are used to evaluate net price effects, illustrating the usefulness of the approach in the analysis of changing market structures.
Does acquisition of a cooperative generate profits for the buyer? The Dairyworld case
Authors: Lamprinakis Lampros , Fulton Murray
Published: November 2011

This article examines the takeover of a cooperative (Dairyworld) by an investor‐owned firm (Saputo) that was not previously present in the industry, determines if this takeover generates greater returns for the investor‐owned firms (IOF), and on the basis of this evidence makes some inferences about the behavior and performance of cooperatives and IOFs. The empirical evidence strongly supports the conclusion that Saputo's stock price rose with its takeover announcement. This outcome is consistent with a number of explanations, including that Saputo was unaffected by hubris, a factor often suggested as the reason that many firms overbid when they undertake acquisitions. Dairyworld's poor liquidity and capital shortage problems, as well as a limited number of suitors, may have weakened its bargaining position in its dealings with Saputo. The observed increase in Saputo's stock price is also consistent with the possibility that, by taking over a cooperative, Saputo was able to decrease competition and thus increase its profits. A fruitful area for future research would be a rigorous theoretical and empirical determination of the impact that these various factors have on acquisition profitability. Such analysis is required before inferences about the behavior and performance of cooperatives and IOFs can be fully answered.
Serum bone formation marker correlation with improved osseointegration in osteoporotic rats treated with simvastatin
Authors: Du Zhibin , Chen Jiang , Yan Fuhua , Doan Nghiem , Ivanovski Saso , Xiao Yin
Published: November 2011

Objective

Simvastatin has been shown to enhance osseointegration of pure titanium implants in osteoporotic rats. This study aimed to evaluate the relationship between the serum level of bone formation markers and the osseointegration of pure titanium implants in osteoporotic rats treated with simvastatin.

Materials and methods

Fifty‐four female Sprague‐Dawley rats, aged 3 months, were randomly divided into three groups: Sham‐operated group (SHAM; n = 18), ovariectomized group (OVX; n = 18), and ovariectomized with simvastatin treatment group (OVX + SIM; n = 18). Fifty‐six days after ovariectomy, screw‐shaped titanium implants were inserted into the tibiae. Simvastatin was administered orally at 5 mg/kg each day after the placement of the implant in the OVX + SIM group. The animals were killed at either 28 or 84 days after implantation and the undecalcified tissue sections were processed for histological analysis. Total alkaline phosphatase (ALP), bone‐specific alkaline phosphatase (BALP) and bone Gla protein (BGP) were measured in all animal sera collected at the time of euthanasia and correlated with the histological assessment of osseointegration.

Results

The level of ALP in the OVX group was higher than the SHAM group at day 28, with no differences between the three groups at day 84. The level of BALP in the OVX + SIM group was significantly higher than both OVX and SHAM groups at days 28. Compared with day 28, the BALP level of all three groups showed a significant decrease at day 84. There were no significant differences in BGP levels between the three groups at day 28, but at day 84, the OVX + SIM group showed significantly higher levels than both the OVX and SHAM groups. There was a significant increase in BGP levels between days 28 and 84 in the OVX + SIM group. The serum bone marker levels correlated with the histological assessment showing reduced osseointegration in the OVX compared to the SHAM group which is subsequently reversed in the OVX + SIM group.

Conclusion

The results from this study indicate that the serum level of bone formation markers, especially BALP and BGP, could be correlated with the degree of osseointegration around titanium implants in osteoporotic rats treated with simvastatin.
Reactions of non‐immunologic contact urticaria on scalp, face, and back
Authors: Zhai Hongbo , Zheng Yue , Fautz Rolf , Fuchs Anne , Maibach Howard I.
Published: November 2011

Background

This study compared the reactivity of scalp, face, and back to nonimmunologic contact urticants (NICU) to ascertain relative responsiveness.

Methods

Model urticants, benzoic acid (BA) and hexyl nicotinate (HN) with 3 concentrations of each were applied to marked skin of 10 bald males during 6 weeks. One urticant was applied to one side of nasolabial fold, back, and scalp and the other applied to the contralateral side. Reactivity was assessed by visual scores (VS) and biophysical instruments. Subjects ranked skin sensation with a 10‐point visual analogue scale.

Results

With 0.25% HN application, upper back VS significantly (p<0.05) exceeded scalp and back VS also showed significantly (p<0.05) stronger reaction than face at 60 min post‐application; however, at 2.5% BA site, VS of face exhibited significantly (p<0.05) higher than back at 15 min post‐application but with 0.625% BA site, VS of back was significantly (p<0.05) higher than face. The a* value was significantly (p<0.05) higher on back than scalp with 0.625% BA treatment.

Conclusion

Thus symptoms and measurements vary among sites. Differences may be related to solubility related percutaneous penetration. We encourage investigation into this relatively neglected but clinically important arena, to help explain difference in consumer/patient acceptance of topical formulations.
Severity of pandemic H1N1 2009 influenza virus infection may not be directly correlated with initial viral load in upper respiratory tract
Authors: Wu Un‐In , Wang Jann‐Tay , Chen Yee‐Chun , Chang Shan‐Chwen
Published: November 2011

Please cite this paper as: Wu et al. (2012) Severity of pandemic H1N1 2009 influenza virus infection may not be directly correlated with initial viral load in upper respiratory tract. Influenza and Other Respiratory Viruses 6(5), 367–373.

Background  Recent studies have demonstrated that rapid influenza diagnostic tests (RIDTs) have a relatively low sensitivity in detecting severe cases of pandemic H1N1 2009 influenza virus (pH1N1) infection. We hypothesized that viral load in upper respiratory specimens obtained on presentation may not be correlated with disease severity.

Methods  We conducted a prospective study to compare patterns of viral shedding using nasopharyngeal swab specimens, according to the number of days of post‐symptom onset and post‐antiviral therapy, between patients with and without complications.

Results  From July 15, 2009 through July 23, 2010, we collected and processed a total of 141 nasopharyngeal swab specimens from 64 inpatients and outpatients with laboratory‐confirmed pH1N1 infection. These included 46 patients without any complications (uncomplicated group) and 18 patients who required hospital admission (complicated group). The mean initial viral load was higher in the uncomplicated group than in the complicated group (3·4 ± 1·6 log10 copies/μl versus 1·9 ± 1·7, P = 0·02). However, prolonged viral shedding was only detected in the complicated group (44% by day 7 of antiviral therapy). By multivariate analysis, we found that age (OR, 1·1; 95% CI, 1·0–1·1) and initial nasopharyngeal viral load (OR, 0·5; 95% CI, 0·3–0·8) were significant factors associated with complications.

Conclusion  Given that patients with severe pH1N1 infection may have relatively lower initial viral load in the upper respiratory tract, cautious interpretation of negative RIDT results is particularly warranted in this patient population.
Production Technologies for Reduced Alcoholic Wines
Authors: Schmidtke Leigh M. , Blackman John W. , Agboola Samson O.
Published: November 2011

Abstract:  The production and sale of alcohol‐reduced wines, and the lowering of ethanol concentration in wines with alcohol levels greater than acceptable for a specific wine style, poses a number of technical and marketing challenges. Several engineering solutions and wine production strategies that focus upon pre‐ or postfermentation technologies have been described and patented for production of wines with lower ethanol concentrations than would naturally arise through normal fermentation and wine production techniques. However, consumer perception and acceptance of the sensory quality of wines manufactured by techniques that utilize thermal distillation for alcohol removal is generally unfavorable. This negative perception from consumers has focused attention on nonthermal production processes and the development or selection of specific yeast strains with downregulated or modified gene expression for alcohol production. The information presented in this review will allow winemakers to assess the relative technical merits of each of the technologies described and make decisions regarding implementation of novel winemaking techniques for reducing ethanol concentration in wine.