bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytokine production by cord blood mononuclear cells stimulated with cows milk proteins in vitro: interleukin‐4 and transforming growth factor β‐secreting cells detected in the CD45RO T cell population in children of atopic mothers
Authors: Hauer A. C. , Riederer M. , Griessl A. , Rosegger H. , MacDonald T. T.
Published: May 2003

Background Food antigens from the maternal circulation may sensitize fetal T cells in utero and be an important determinant in the development of food allergy.

Methods Here we have examined the spontaneous and recall response to cow's milk proteins of cord blood mononuclear cells (CBMC) of newborn children, using single cell ELISPOT assays.

Results In term newborns, confirming previous studies, the spontaneous cytokine response of CBMC is dominated by IL‐4, IL‐5, IL‐10, and as shown here for the first time, TGF‐β. For TGF‐β only, the response of samples from infants of atopic mothers was significantly lower than samples from infants of non‐atopic mothers. In vitro stimulation of CBMC with bovine serum albumin, casein and β‐lactoglobulin resulted in a significant increase of all cytokine‐secreting cells, again dominated by T helper type 2 (Th2) cytokines. There was a clear tendency for samples from infants of atopic mothers to have lower Th2 responses than samples from infants of non‐atopic mothers, which was particularly significant for both IL‐4 and TGF‐β. Spontaneous cytokine secreting cells were virtually absent in cord blood from infants < 34 weeks gestation, as were cows milk protein‐induced responses, although they were readily detectable in samples from infants aged > 34 weeks. To explore whether the cytokine secreting cells were in the naive CD4+ CD45RA population or memory CD4+ CD45RO T cells, these subsets were purified by positive and negative selection and tested for spontaneous and cows milk protein‐induced cytokine responses. Strikingly, although the responses were small, the CD45RO+ cells from children of atopic mothers showed significant spontaneous and antigen‐specific IL‐4 and TGF‐β responses, whereas the same population from infants of non‐atopic mothers showed virtually no response. In addition CD45RA+ cells from infants of mothers with maternal atopy showed decreased IL‐4 and TGF‐β responses, especially the latter.

Conclusions The cows milk antigen‐specific IL‐4 and TGF‐β responses preferentially seen in the memory cell subset of infants with a maternal history of atopy strongly suggests Th2 skewing to dietary antigens in utero.
Dissociation of T helper type 2 cytokine‐dependent airway lesions from signal transducer and activator of transcription 6 signalling in experimental chronic asthma
Authors: Foster P. S. , Webb D. C. , Yang M. , Herbert C. , Kumar R. K.
Published: May 2003

Background Type 2 T helper lymphocytes (Th2 cells) and their cytokine products are important in the pathogenesis of asthma.

Objective To examine the contribution of the signal transducer and activator of transcription (STAT) 6 pathway, involved in Th2 cytokine signalling, to the development of lesions of chronic asthma.

Methods BALB/c mice sensitized to ovalbumin were chronically challenged by inhalational of low mass concentrations of antigen for 6 weeks. Airway lesions in wild‐type mice were compared with those in STAT6‐deficient mice and in IL‐4/13 double‐deficient mice by histomorphometry and immunohistochemistry. Airway responses to methacholine were evaluated by whole‐body plethysmography. Cytokine production by peribronchial lymph node cells was quantified by enzyme immunoassay.

Results STAT6–/– mice developed a variety of airway lesions that were at least equivalent to those in wild‐type mice, including accumulation of intraepithelial eosinophils and of chronic inflammatory cells in the lamina propria, subepithelial fibrosis and epithelial thickening. In addition, STAT6–/– mice exhibited exaggerated airway hyper‐reactivity (AHR) compared to wild‐type animals. This was despite a shift from a Th2 to a Th1 pattern of immunoglobulin production by plasma cells in the inflammatory infiltrate and diminished mucous cell hyperplasia/metaplasia, together with increased production of IFN‐γ by peribronchial lymph node cells, consistent with absence of signalling via the STAT6 pathway. In contrast, gene‐targeted IL‐4/13–/– mice exhibited markedly diminished eosinophil recruitment and airway remodelling, as well as absence of AHR.

Conclusions In this model, the effects of STAT6 deficiency were in marked contrast to the suppression of inflammation and AHR described in models of allergic bronchopulmonary inflammation. These results, which provide evidence of STAT6‐independent AHR in an inhalational challenge model of chronic asthma, emphasize the critical effector roles of IL‐4 and IL‐13, as well as the need to use appropriate models to understand cytokine signalling pathways that may be potential therapeutic targets in asthma.
Generation of monoclonal antibodies against Blo t 3 using DNA immunization with in vivo electroporation
Authors: Yang L. , Cheong N. , Wang D. Y. , Lee B. W. , Kuo I. C. , Huang C. H. , Chua K. Y.
Published: May 2003

Background House dust mite allergy is closely associated with allergic diseases. Blomia tropicalis mite species is an important clinical species in the tropics. The cDNA clone encoding Blo t 3, a group 3 allergen from B. tropicalis, has been isolated in our laboratory.

Objective This study was designed to generate Blo t 3‐specific monoclonal antibodies (mAbs) for the detection, characterization and purification of this allergen.

Methods Mice were immunized intramuscularly with naked plasmid DNA encoding Blo t 3 gene with in vivo electroporation. Hybridomas were generated by the fusion of the splenocytes to X63‐Ag8.653 myeloma cells. Purified native Blo t 3 was obtained by mAb immuno‐affinity purification and the allergenicity of native Blo t 3 was determined by human IgE enzyme‐linked immunosorbent assay (ELISA).

Results A panel of class‐switched and high‐affinity mAb recognizing a wide spectrum of Blo t 3 epitopes have been generated. These mAbs are useful for western immunoblot assay, sandwich ELISA and affinity purification of native Blo t 3. Allergenicity of native Blo t 3 protein was examined with 44 mite‐allergic sera and approximately 57% of the tested sera had positive serum IgE reactivity to the native Blo t 3.

Conclusions These results demonstrated that intramuscular injection of naked DNA encoding Blo t 3 gene combined with in vivo electroporation is an effective and simple method to raise monoclonal antibodies that can be used for characterization and purification of Blo t 3.
Differences in circulating dendritic cell subtypes in cord blood and peripheral blood of healthy and allergic children
Authors: Hagendorens M. M. , Ebo D. G. , Schuerwegh A. J. , Huybrechs A. , Van Bever H. P. , Bridts C. H. , De Clerck L. S. , Stevens W. J.
Published: May 2003

Background Different types of circulating dendritic cells have been described. Dendritic cells influence differentiation of naive T lymphocytes into T helper type 1 (Th1) and Th2 effector cells.

Objective The purpose of this study was to evaluate the number of circulating DC subtypes in peripheral blood of allergic and healthy children and in cord blood of neonates from allergic and non‐allergic parents.

Methods Circulating dendritic cells were flow cytometrically identified in whole blood samples as lineage (CD3, CD14, CD16, CD19, CD20, CD56) negative, CD34 negative and HLA‐DR‐positive cells. According to the expression of CD123 and CD11c, different DC subtypes were identified.

Results Apart from DC1 (CD11c+ CD123dim+) and DC2 (CD11c– CD123high+), a third DC population was described with less differentiated phenotypic characteristics, namely CD11c– CD123dim+, and therefore defined here as less differentiated DC (ldDC). These ldDC represented the major DC population in cord blood and showed an age‐depended decrease. The highest level of ldDC was detected in children with atopic dermatitis, whereas asthmatic children showed the lowest ldDC counts. Furthermore, high‐dose inhaled corticosteroid treatment in asthmatic children was related to a decreased ldDC number. The number of circulating DC2 was significantly lower in allergic children, especially in asthmatics, compared to healthy children. In cord blood, no differences in DC subtypes were detectable between neonates at low and high risk for allergic disorders.

Conclusion These results indicate that, apart from DC1 and DC2, a third population of dendritic cells, identified as CD11c– CD123dim+ cells and defined as less differentiated DC, must be considered in the evaluation of circulating DC. Furthermore, DC2 counts were decreased in allergic children, especially in asthmatics, which might be the consequence of an increased recruitment to the target organs.
Mucosal and systemic inflammatory changes in allergic rhinitis and asthma: a comparison between upper and lower airways
Authors: Braunstahl G.‐J. , Fokkens W. J. , Overbeek S. E. , KleinJan A. , Hoogsteden H. C. , Prins J.‐B.
Published: May 2003

Background Local airway inflammation and airway remodelling are considered important in the clinical expression of allergic asthma.

Objective The aim of this study was to compare airway inflammation and remodelling in nasal and bronchial mucosa of subjects with allergic rhinitis with or without asthma.

Methods Four experimental groups were formed: allergic asthma and rhinitis (n = 19); allergic rhinitis, no asthma (n = 18); atopic subjects, no asthma, no rhinitis (n = 8) and non‐allergic healthy control subjects (n = 16). Blood samples, nasal and bronchial biopsy specimens were collected during stable disease. Immunohistochemistry was performed for eosinophils (MBP), mast cells (CD117) and vascular endothelium (CD31). Epithelial loss, reticular basement membrane (RBM) thickness and subepithelial vascularity was assessed with a computer‐assisted image analysis system.

Results In nasal and bronchial mucosa, numbers of eosinophils were significantly higher in rhinitis patients with and without asthma than in asymptomatic atopics (P < 0.05) and controls (P ≤ 0.01). In bronchial mucosa, the RBM was significantly thickened in rhinitis patients with and without asthma compared to asymptomatic atopics (P < 0.05) and controls (P < 0.01), while in nasal mucosa no differences were seen. Patients with asthma and rhinitis had increased numbers of blood eosinophils (P = 0.05) and skin test reactivity (P = 0.01) compared to patients with rhinitis only. No significant differences could be found between the investigated groups with respect to serum IL‐5 and eotaxin levels, the number of mucosal mast cells and the degree of epithelial loss and subepithelial vascularity. Epithelial desquamation was significantly increased in the bronchial mucosa compared to nasal mucosa, not only in asthmatics (P < 0.001), but also in atopics without asthma and rhinitis (P = 0.02).

Conclusions This study shows that allergic inflammation, increased basement membrane thickness and epithelial desquamation are present in the lower airways of atopic subjects, even before the onset of clinical symptoms. Despite the presence of inflammatory cells, no structural changes could be assessed in nasal mucosa of allergic patients.
Monomeric immunoglobulin E stabilizes FcεRIα from the human basophil cell line KU812 by protecting it from natural turnover
Authors: Jensen B. M. , Hansen J. B. , Dissing S. , Gerwien J. , Skov P. S. , Poulsen L. K.
Published: May 2003

Background The high affinity IgE receptor (FcεRI) on mast cells and basophils is up‐regulated by its own ligand IgE; however, the mechanism is unknown.

Objective To study the IgE‐mediated effect on FcεRI on basophils by using the human basophilic cell line KU812.

Methods Expression of cell surface FcεRI was assessed by flow cytometry. Western blot technique was used to illustrate tyrosine‐phosphorylation and the Ca2+ level in KU812 was measured by fluorescence of Fura‐2. Soluble specimens of the α‐chain from FcεRI (FcεRIα) were obtained by lysing 107 KU812 pr. mL. FcεRIα was detected by a sandwich immunoradiometric assay employing the IgE‐binding capacity of FcεRIα in conjunction with a monoclonal antibody. Polyclonal rabbit anti‐FcεRIα was used for detection of FcεRIα by Western blotting.

Results We found that monomeric IgE did not induce tyrosine‐phosphorylation in KU812, which was the case when stimulating with IgE cross‐linked by anti‐IgE binding. Further, only cross‐linking of IgE, but not monomeric IgE, increased the Ca2+ level. Using the immunoradiometric assay, we found a temperature dependent reduction in the amount of FcεRIα. Samples incubated at 37 °C for 5 h displayed a 16‐fold decrease in the FcεRIα level compared with samples incubated at 4 °C. In the presence of IgE the reduction at 37°C was only threefold.

Conclusion These results indicate that IgE does not induce intracellular signals in KU812, i.e., tyrosine‐phosphorylation or Ca2+ release. Instead it appears that FcεRIα is an unstable protein that IgE stabilizes and thereby protects from a temperature dependent turnover.
Effect of lysed Enterococcus faecalis FK‐23 (LFK) on allergen‐induced peritoneal accumulation of eosinophils in mice
Authors: Shimada T. , Cheng L. , Ide M. , Fukuda S. , Enomoto T. , Shirakawa T.
Published: May 2003

Background The interest in anti‐allergy immunoregulation by lactic acid bacteria has been growing for the last few decades. There is some evidence to suggest that lysed Enterococcus faecalis FK‐23 (LFK) could relieve the clinical symptoms of pollinosis. However, the mechanism responsible for this phenomenon remains unknown.

Objective To identify the effect of LFK, a lysozyme treated and heat‐killed preparation from the lactic acid bacteria Enterococcus faecalis FK‐23 strain, on allergen‐induced eosinophil accumulation.

Methods BALB/c mice were sensitized with ragweed pollen extract, and peritoneal accumulation of eosinophils was induced. A total of 60 mg (0.5 mL) LFK was orally administered to the experimental mouse every day during 21 days of the sensitization period. In addition, LFK 4 mg, 25 mg and 60 mg (each 0.5 mL) were also orally administered to a mouse of each group every day for 21 days. Saline was fed in a dose of 0.5 mL/mouse per day for the same duration as a control.

Results Compared with control mice, LFK‐treated mice exhibited decreased ragweed pollen allergen‐induced peritoneal accumulation of eosinophils (P = 0.013), which showed a tendency to be in a dose‐dependent fashion (P = 0.14).

Conclusion The results provide laboratory evidence of the role for LFK, a lactic acid bacteria preparation, in combating eosinophil accumulation.
Characterization of wheezing phenotypes in the first 10 years of life
Authors: Kurukulaaratchy R. J. , Fenn M. H. , Waterhouse L. M. , Matthews S. M. , Holgate S. T. , Arshad S. H.
Published: May 2003

Background Childhood wheezing illnesses are characterized into different phenotypes. However, severity of the disease associated with these phenotypes has not been extensively studied.

Objectives To determine characteristics of childhood wheezing phenotypes in the first decade of life using health outcomes plus measurements of atopy, lung function and bronchial hyper‐responsiveness.

Methods A whole population birth cohort (n = 1456) was prospectively studied to examine the natural history of childhood wheezing. Children were seen at 1, 2, 4 and 10 years for questionnaire completion and prospectively collected data used to define wheezing phenotypes. Assessment was made of adverse health outcomes plus spirometry, bronchial hyper‐responsiveness, serum IgE measurement at 10 years and skin test sensitization at both 4 and 10 years for wheezing phenotypes.

Results Phenotypic analysis identified that 37% early life wheezers (symptom onset by age 4 years) still wheezed at 10 years. These persistent wheezers showed significantly more physician‐diagnosed asthma in early life (P < 0.005 at 2 years) than early transient wheezers (wheezing transiently with onset by age 4 years). Overall they experienced greater multiple hospital admissions (P = 0.024), specialist referral (P = 0.009) and use of inhaled (P < 0.001) and oral steroids (P < 0.001) than early transient wheezers. They also demonstrated enhanced bronchial hyper‐responsiveness compared with early transient wheezers (P < 0.001). However, both groups of early life wheezers showed impairment of baseline lung function at 10 years in comparison with non‐wheezers: FEV1 (P < 0.029) and FEV1/FVC ratio (P < 0.001) with persistent wheeze and PEF (P = 0.036) with early transient wheeze. Late‐onset wheezers (onset from 5 years onwards) had similar BHR to persistent wheezers but maintained normal lung function at age 10 and had lower cumulative prevalence of adverse health outcomes than persistent wheezers.

Conclusions Persistent wheezing with early childhood onset is associated with substantial morbidity in the first decade of life in association with high levels of atopy, bronchial hyper‐responsiveness and impaired lung function at 10 years of age. Late‐onset wheezing in the first decade of life could harbour potential for similarly significant disease subsequently.
Longitudinal decline in pulmonary function in atopic cough and cough variant asthma
Authors: Fujimura M. , Nishizawa Y. , Nishitsuji M. , Abo M. , Kita T. , Nomura S.
Published: May 2003

Objective Cough variant asthma and atopic cough are different clinical manifestations of eosinophilic airway inflammation presenting with isolated chronic non‐productive cough. The aim of this study was to examine the longitudinal change in pulmonary function in cough variant asthma and atopic cough.

Methods Longitudinal change in FEV1 was prospectively examined in 20 patients with cough variant asthma, 14 patients with atopic cough and 271 asymptomatic healthy subjects. All were lifetime non‐smokers. Of the 20 cough variant asthma patients, 13 were taking long‐term inhaled corticosteroid therapy (ICS) (beclomethasone dipropionate 615 ± 58 µg/day) and the other seven were not. Spirometry was taken at first visit, after cough was almost completely relieved on therapy, and at least once every year for 5 or more years afterwards.

Results The slope of longitudinal change in FEV1 was not significantly different among cough variant asthma patients (− 0.029 ± 0.007/year), atopic cough patients (− 0.021 ± 0.022/year) and asymptomatic subjects (− 0.028 ± 0.002 L/year). In patients with cough variant asthma, the slope in patients not taking inhaled corticosteroids (ICS) was 0.032 ± 0.007 L/year, which was not significantly different from that in patients taking ICS (− 0.027 ± 0.010 L/year).

Conclusion Pulmonary function decline is not greater in cough variant asthma than atopic cough and the normal population, and long‐term ICS has no effect on the decline in cough variant asthma.
Neonatal interleukin‐12 capacity is associated with variations in allergen‐specific immune responses in the neonatal and postnatal periods
Authors: Prescott S. L. , Taylor A. , King B. , Dunstan J. , Upham J. W. , Thornton C. A. , Holt P. G.
Published: May 2003

Background and objectives A reduced capacity of antigen presenting cells (APC) to provide pro‐T helper 1 (Th1) signals, such as IL‐12, to T cells during early life may be implicated in the development of T helper 2 (Th2)‐mediated allergic disease. In this study we examined the relationships between the capacity for IL‐12 responses in the neonatal period and atopic risk (family allergy), in vitro T cell responses to allergens, and the subsequent development of allergic disease at 6 years

Methods The capacity of circulating neonatal (and maternal) APC to produce IL‐12 p70 in response to LPS (and IFN‐γ) stimulation was assessed in a group of 60 children with previously well‐characterized immune responses to allergens and atopic outcomes. The IL‐12 responses were compared with allergen‐induced lymphoproliferation (to house dust mite (HDM) ovalbumin (OVA), cat and β‐lactoglobulin (BLG)) and IL‐13 and IFN‐γ cytokine responses (to OVA, HDM and phytohaemaglutinin (PHA)) in the neonatal and postnatal periods. IL‐12 responses were also compared according to atopic risk and atopic outcomes (doctor‐diagnosed asthma, eczema, food allergies and sensitization as evidenced by skin prick testing) at 6 years clinical follow‐up.

Results Maternal peripheral blood mononuclear cells (PBMC) synthesized significantly greater amounts of IL‐12 than neonatal PBMC, though within maternal‐infant pairs IL‐12 responses were significantly correlated (r = 0.4, P = 0.019). Moreover, neonatal IL‐12 responses were positively correlated with neonatal allergen proliferation for HDM (r = 0.6, P < 0.0001), OVA (r = 0.55, P < 0.0001), cat (r = 0.5, P = 0.003) and BLG (r = 0.55, P = 0.001), but negatively correlated with neonatal IL‐13 responses to both allergens tested (HDM: r = − 0.4, P = 0.03 and OVA: r = − 0.5, P = 0.001). Both neonatal and maternal IL‐12 responses were positively correlated with postnatal IFN‐γ responses to HDM at 12, 18 and 24 months of age (responses after age of 2 years were not assessed). There was no relationship between atopic risk and IL‐12 capacity in the neonatal period, but there was a (non‐significant) trend for neonatal IL‐12 responses to be lower in the high‐risk children who developed clinical allergy at 6 years (compared with the low risk group) although the number in this analysis was small.

Conclusions Reduced APC IL‐12 production in the perinatal period was associated with reduced T cell activation (lymphoproliferation), stronger neonatal Th2 responses, and weaker Th1 responses to allergen in the postnatal period. This supports the notion that variations in APC function in early life may contribute to altered allergen‐specific cytokine responses associated with later allergy.
CD63 expression on basophils as a tool for the diagnosis of pollen‐associated food allergy: sensitivity and specificity
Authors: Erdmann S. M. , Heussen N. , Moll‐Slodowy S. , Merk H. F. , Sachs B.
Published: May 2003

Background Basophil activation is associated with the expression of CD63. Because allergens can induce basophil activation by cross‐linking specific IgE, increased CD63 expression has been proposed as a novel in vitro test for immediate type allergy.

Objective We compared the CD63‐based basophil activation test (BAT) in the diagnosis of allergy to carrot, celery and hazelnut with skin prick tests (SPT) and measurement of allergen‐specific IgE.

Methods Twenty‐nine patients with a history of an oral allergy syndrome induced by carrot, celery or hazelnut (n = 20 for each allergen) and 20 controls were studied. SPT were performed with standardized and native carrot, celery and hazelnut extracts. Allergen‐specific IgE was determined by the CAP FEIA method and basophil activation was determined by flow cytometry upon double staining with anti‐IgE/anti‐CD63 mAb.

Results SPT with native carrot, celery and hazelnut showed sensitivities of 100%, 100% and 90%, and specificities of 80%, 80% and 90%. SPT with commercial extracts of the same allergens gave sensitivities of 85%, 80% and 85%, and specificities of 80%, 80% and 90%. Sensitivity of allergen‐specific IgE and the BAT for carrot, celery and hazelnut was 80% vs. 85%, 70% vs. 85%, and 80% vs. 90%, with corresponding specificities of 80% vs. 85%, 80% vs. 80%, and 95% vs. 90%. The cut‐off for a positive BAT was 10% CD63+ basophils. Moreover, there was a positive correlation between IgE reactivity and the number of CD63+ basophils for all food allergens (carrot: r = 0.69, celery: r = 0.67, hazelnut: r = 0.66).

Conclusions Quantification of basophil activation by CD63 expression is a valuable new in vitro method for diagnosis of immediate type food sensitization. Although double‐blind placebo‐controlled food challenges remain the gold standard, the CD63‐based BAT may supplement routine diagnostic tests such as SPT or allergen‐specific IgE in the future.
Food hypersensitivity among Finnish university students: association with atopic diseases
Authors: Mattila L. , Kilpeläinen M. , Terho E. O. , Koskenvuo M. , Helenius H. , Kalimo K.
Published: May 2003

Background Food hypersensitivity (FH) is commonly suspected, especially among adults with atopic diseases. Symptoms of FH vary from oral allergy syndrome (OAS) to gastrointestinal, respiratory and systemic reactions. More data are needed regarding patient groups at risk for FH, and symptoms and foods responsible for the reactions.

Methods FH was studied in 286 Finnish university students. Four study groups were selected: subjects (i) with current atopic dermatitis (AD) with or without allergic rhinoconjunctivits (ARC) or asthma (n = 41); (ii) with past AD with or without ARC or asthma (n = 89); (iii) with ARC or asthma (n = 69); (iv) without clinically confirmed atopic disease (n = 87). A thorough clinical examination was performed with a questionnaire specifying adverse events to foods. In addition, IgE specific to five foods, and skin prick tests to four foods were determined.

Results FH was reported by 172 subjects (60.1%), more often by females (66.3%) than by males (47.9%) (P = 0.003). FH was most frequent among subjects with AD, among those with current AD in 73.2%, with past AD in 66.3%, and with ARC or asthma in 63.8%; 44.8% of subjects without any atopic disease reported FH. Kiwi fruit caused symptoms most frequently (38.4%), followed by milk (32.6%), apple (29.1%), tomato (27.9%), citrus fruits (25.0%), tree nuts (23.3%), and peanut (17.4%). A total of 720 separate symptoms to 25 food items were reported. OAS was most common (51.2%), followed by gastrointestinal symptoms (23.5%), worsening of AD (11.4%), urticaria (4.2%), rhinitis or conjunctivitis (5.7%) and asthma (4.0%). Severe reactions occurred in 3.5% (25/720). Negative IgE and skin prick test to foods predicted well negative history, but the value of positive test results was limited.

Conclusions FH was reported most often by students with current AD and multiple atopic diseases. Severe reactions occurred especially in patients with ARC and asthma. After excluding lactose intolerance, milk hypersensitivity was frequently reported.
Conducting a qualitative child interview: methodological considerations
Authors: Kortesluoma Riitta‐Liisa , Hentinen Maija , Nikkonen Merja
Published: May 2003

Background. Studies of children have a long history, but the literature related to young children consists for the most part of studies on rather than with children and taking little account of what is regarded as significant and meaningful by children themselves. Researchers have relied almost exclusively on adults when collecting data about children's thoughts, feelings and experiences. Interviewing children, however, gives an opportunity to gain information about their subjective experiences.

Aim. The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described.

Method. This paper is based on literature and the experience of one of the authors in interviewing children aged from 4 to 11 years about their experiences of pain.

Findings and conclusion. A consideration of literature dealing with the principles of child interviewing shows that there is surprisingly little guidance available on conversational methods involving children. The empirical and conceptual foundation for child interviewing is not very clear. Novice researchers especially may need recommendations about how to conduct a qualitative child interview. The method must suit both the purpose and the context.
Impact of clinical nurse specialists in multiple sclerosis – synthesis of the evidence
Authors: Forbes Angus , While Alison , Dyson Liz , Grocott Tricia , Griffiths Peter
Published: May 2003

Background. Multiple sclerosis is a chronic neurological condition demanding a broad range of interventions and support. Multiple sclerosis nurse specialists are emerging as a leading force in providing care to this group of patients.

Aim. This review aimed to identify and synthesize the evidence on the role of clinical nurse specialists in meeting the care needs of people with multiple sclerosis.

Methods. A systematic review of the literature addressing the role of the multiple sclerosis nurse specialist was undertaken. The review examined both the appropriateness and effectiveness of the multiple sclerosis nurse specialist role. The content of each item identified in the review was analysed, examining the structure, process and outcomes variables associated with the role. Materials containing an explicit methodology were critically appraised using established schedules and graded as strong, moderate or weak. The data were then synthesized in tables, thematically and using a quasi‐judicial approach called the ‘System of Reasoning’.

Findings. Fifty‐five items were examined and most (53%; n = 18) were descriptive in nature. There was insufficient evidence to demonstrate that the multiple sclerosis nurse role makes a difference to care. However, evidence was found to support current descriptions of the role – meaning? and there appeared to be a good fit between the role and the care needs of people with multiple sclerosis.

Conclusion. A systematic overview of the attributes of the multiple sclerosis nurse role is provided which should help service providers, nurses and other professionals consider how multiple sclerosis nurse specialists roles can contribute to the care of people with this condition. While there is little current evidence of effectiveness for the multiple sclerosis nurse specialist role, there is evidence for its appropriateness, although more rigorous primary research is required to test this.
Tiredness and fatigue in the postnatal period
Authors: McQueen Anne , Mander Rosemary
Published: May 2003

Aims of the paper. This paper aims to analyse critically a selective review of the literature on tiredness and fatigue in health and illness. This analysis is then applied to the experience of the new mother in the postnatal period.

Background and rationale. Although the twin concepts of tiredness and fatigue are well known in both sickness and health, our understanding of them is less complete. This paradox of familiarity and lack of understanding applies particularly to the postnatal period.

Method. A literature search was undertaken using MEDLINE, CINAHL and Web of Science. The search terms ‘tiredness’, ‘fatigue’ and ‘post natal’ were used.

Findings. This search of the literature produced a small number of articles. Few of these, however, addressed the problem of tiredness or fatigue in the postnatal period, suggesting that this problem needs more research attention.

Conclusions. On the basis of this analysis, it is suggested that childbirth education could be extended to foster more realistic expectations and more effective coping skills to facilitate women's adjustment to motherhood. The possibility of midwives educating mothers about the need to access, recruit and delegate some household activities to willing helpers is addressed. We propose that midwives can help women to have more realistic expectations about life after the birth, by providing advice and legitimating the need for support and the use of coping mechanisms to assist the transition to motherhood.
Effect of positioning on back pain after coronary angiography
Authors: Chair Sek Ying , Taylor‐Piliae Ruth E. , Lam Gay , Chan Sophia
Published: May 2003

Background. Coronary angiography is a routine cardiac diagnostic procedure in Hong Kong. Patients are restricted to bedrest after the procedure due to potential vascular complications from using a femoral approach. Many patients are required to remain on bedrest for up to 24 hours after the procedure. The effects of reducing this bedrest time is still under investigation. In the meantime, nursing interventions aimed at decreasing patient discomfort due to prolonged bedrest are feasible to implement.

Aims. The aims of this study were to evaluate the severity of back pain related to bedrest duration after coronary angiography and to compare the effects of changing patients' position in bed on their perceptions of back pain and on vascular complications.

Methods. An experimental design was used, with patients randomly assigned either to a control or experimental group. The control group received the usual care, remaining supine and flat for 8–24 hours, with the affected leg straight. The experimental group changed their body position hourly, varying between supine, right side‐lying, and left side‐lying during the first 7 hours after coronary angiography.

Results. A total of 419 patients participated in the study (control, n = 213; experimental, n = 206). Regardless of group assignment, back pain intensity increased with longer time on bedrest. In addition, the control group reported higher levels of pain at all five assessment times. Vascular complications in terms of bleeding at the femoral site were not significantly different between the control and experimental groups.

Conclusion. The study findings suggest that patients may be able safely to change their position in bed earlier in the postcoronary angiography period than currently recommended in practice protocols. Changing position in bed may also reduce back pain, promote physical comfort, and possibly reduce patients' negative feelingstoward coronary angiography.
Effects of a self‐management course for patients with systemic lupus erythematosus
Authors: Sohng Kyeong Yae
Published: May 2003

Background. For people living with systemic lupus erythematosus, the disease's potential variety and severity of manifestations and unpredictable course present challenges and repercussions in all arenas of life.

Aim. A quasi‐experimental study was conducted to examine the effects of a systemic lupus erythematosus self‐management course for Korean patients on fatigue, coping skills, self‐efficacy, depression, pain and disease activity.

Methods. In a two‐group pre‐ and post‐test design, a total of 41 participants were assigned to the experimental group (21 participants) and to the control group (20 participants). The experimental group received six weekly 2‐hour sessions for groups of 10–15 literate adults of all ages, while the control group did not receive any intervention. Outcome measures included fatigue, coping skills, self‐efficacy, depression, pain and disease activity.

Results. Patients who participated in the self‐management course showed significant improvement in fatigue (P = 0·049), coping skills (P = 0·007), self‐efficacy (P = 0·001), and depression (P = 0·025). There were no significant changes in pain and disease activity after the intervention.

Conclusions. The systemic lupus erythematosus self‐management course had effects in reducing fatigue and depression and improving coping skills and self‐efficacy. This course is potentially a good nursing intervention that can be offered in community settings.
Converting to insulin in primary care: an exploration of the needs of practice nurses
Authors: Greaves Colin J. , Brown Patricia , Terry Rohini T. , Eiser Christine , Lings Pam , Stead J.W.
Published: May 2003

Background. In order to optimize glycaemic control, substantial numbers of people with type 2 diabetes may require transfer from oral medication to insulin therapy. Although insulin conversion is traditionally a specialist secondary care function, as nursing roles change and expand there is growing pressure for this to be performed within primary care. However, little is known about the potential barriers to such a change, particularly from the standpoint of the frontline staff involved.

Aims. The study aimed to explore the views of practice nurses in the United Kingdom (UK) about converting diabetic patients from oral hyperglycaemic agents to injected insulin within primary care, and to investigate what structures and resources might be useful in supporting such a change.

Methods. Semi‐structured interviews were conducted with 25 practice nurses, and interpreted using content analysis to extract key conceptual themes from the transcribed interview texts.

Findings. Most of the nurses felt that converting to insulin in primary care had considerable benefits for patients. However, issues of time, training, confidence about performing the change, and the adequacy of support systems, both for patient and nurse, emerged as the main perceived barriers to performing insulin conversions in primary care. Worries about legal and accountability issues surrounding the nurse prescribing elements were also raised.

Conclusions. Where insulin conversion within primary care is being considered, it is suggested that specific training is provided for practice nurses and general practitioners, protected time is made available, and a team‐working approach is fostered to prevent isolation and boost patient support. Formal mentoring or supervision support for practice nurses may also help them to adapt to this new approach.

Limitations. These findings are based on the views of nurses from a single UK locality, and so widespread consultation is recommended before applying them in other settings.
Understanding the roles of registered general nurses and care assistants in UK nursing homes
Authors: Perry Michelle , Carpenter Iain , Challis David , Hope Kevin
Published: May 2003

Background. The recent government decision to fund the costs of Registered nursing time in long‐term care facilities in England through the Registered Nurse Contribution to Care renders the need to distinguish the role of Registered General Nurses (RGNs) from that of Care Assistants (CAs) in nursing homes increasingly important.

Aim. The objective of this qualitative study was to obtain an in‐depth understanding of the main differences between the roles and functions of RGNs and CAs working in nursing homes in the United Kingdom (UK).

Design. Data were collected through interviews with nine RGNs and 12 CAs employed in four different nursing homes across England.

Findings. Our findings suggest that RGNs have difficulty defining and limiting their roles because they have all‐embracing roles, doing everything and anything within the home. By contrast, CAs define their role in terms of what they are not allowed to do. This difficulty in limiting their role, in addition to their sense of professional accountability for residents' care, leads RGNs to experience difficulty in delegating tasks to CAs. Both RGNs and CAs agreed that an increase in the number of assistive staff is needed to provide residents with good quality care and suggested that a measure of resident dependency would be a good method by which to determine staffing levels.

Conclusions. We recommend that job descriptions that clearly define the roles and responsibilities of both RGNs and CAs are developed so that caregivers at all levels understand each others' roles and work together to co‐ordinate, plan and provide residents' care.
Nurse managers' professional networks, psychosocial resources and self‐rated health
Authors: Lindholm M. , Dejin‐Karlsson E. , Östergren P.‐O. , Udén G.
Published: May 2003

Background. Nurse managers act under constant pressure to develop strategies in response to professional challenges within a changing and restructured health care system. When such environmental stress is present, they need access to sufficient psychosocial recourses.

Aim. The study aimed to investigate whether nurse managers' professional networks, psychosocial work conditions, job support, social network and support were associated with self‐rated health, sick‐leave and salary.

Methods. From a total of 268 Swedish nurse managers, active in management positions, 205 (77%) agreed to participate in the study by answering a self‐report questionnaire. Cronbach's α was used to calculate internal consistency. Odds ratios were used to estimate the bivariate association between self‐rated health and psychosocial resources.

Results. Nurse managers exposed to high job demands had significantly increased odds for low self‐rated health. It was also found that low level of support from professional network, job support, social network and social support outside work displayed increased odds for low self‐rated health, independently of age, gender and education. There were additive (but no synergistic) effects found for job demand in combination with professional networks, job support and emotional support and in relation to self‐rated health.

Conclusion. The study showed that nurse managers exposed to high job demands had elevated odds for low self‐rated health, regardless of level of psychosocial resources within or outside work. Two‐thirds of the nurse managers who were affiliated to professional networks did not consider this a supporting factor in their management work. Those with low job support had increased odds for sick‐leave compared with those with high support. No significant associations were found between psychosocial characteristics and salary.
Evaluation of a pilot mentoring programme for nurse managers
Authors: Waters Donna , Clarke Marie , Ingall Athena Harris , Dean‐Jones Megan
Published: May 2003

Background. The Institute of Nursing Executives is a professional organization with a membership of approximately 150 Australian nurse managers and administrators. Members of rural zones were concerned by the lack of support available to new managers working in isolated areas and sought to develop a mentoring programme that would establish both professional development and support networks for these managers. A pilot programme was developed for two rural areas of New South Wales and one metropolitan site (the city of Sydney).

Aim. The evaluation reported here aimed to determine participant expectations of mentoring and outcomes of the pilot programme.

Method. The programme included matching and self‐selection of mentor and mentee roles and attendance at a full‐day Mentoring Workshop. The programme was evaluated by voluntary and anonymous pre‐ and postworkshop questionnaires sent to all participants, and postworkshop telephone interviews.

Results. Thirty‐seven participants (79% of those enrolled in workshop) responded to the preworkshop questionnaire (20 identifying as mentees; 17 as mentors). Findings reiterated the lack of professional support and access for rural/remote area nurse managers and illustrated that new nurse managers lacked confidence in coaching and stimulating staff. Expectations of both mentors and mentees were similar in valuing a confidential, on‐going mentoring relationship. Postworkshop questionnaires (n = 16) and telephone interviews (n = 11) highlighted issues about personal choice and timing, expectations of a structured programme and making greater use of existing technology to support and maintain networks.

Conclusion. The pilot mentoring programme was highly successful in identifying strategies for the development of a tailored and sustainable programme for newly appointed nurse managers. Provision of a highly structured and facilitated programme carries high expectations of continued external support. Nurse managers also expressed a desire to choose when, how and whom they would select as mentors. Suggestions for the future included a greater use of technology to facilitate e‐mail and internet‐based discussion groups and mentor support.
Sacrificing the personal to the professional: community mental health nurses
Authors: Majomi Pamela , Brown Brian , Crawford Paul
Published: May 2003

Background. The study of stress in mental health nurses has almost always focused on factors intrinsic to their job roles and has neglected the interaction between work and home roles, which may also be a source of stress. Moreover, role theory has not provided an adequate account of either personal or occupational change, especially when this results from the experience of stress.

Methods. Twenty community mental health nurses agreed to participate in semi‐structured interviews about the stresses they experienced at work and at home. A grounded theory analysis disclosed the centrality of conflicts between work and home roles in participants' accounts and this provided the focus for subsequent detailed readings of the interview transcripts.

Findings. Participants described how difficult and often demanding family situations were integrated with professional careers in a climate of rapid organizational change in the health service. As well as being an ongoing source of strain, these competing role demands were often described as leading to sudden changes for individual workers, such as periods of illness or re‐evaluation of their work role. To assist in making sense of this process, the term ‘punctuated equilibria’ was adopted to illuminate the build‐up of tension between work and domestic lives, which was described by some workers as leading to a sudden reformulation of their relationship to their work roles and employing organizations.

Conclusions and limitations. The study was small‐scale and relied on retrospective self‐reports. Nevertheless, it emphasized the importance of considering all the roles that individuals play and highlights the possibility that, even when staff are apparently coping with their roles at work and home, difficulties may be building up which could lead to a sudden period of absenteeism or disillusionment.
Long‐term fitness consequences of early conditions in the kittiwake
Authors: Cam Emmanuelle , Monnat Jean‐Yves , Hines James E.
Published: May 2003

The long‐term fitness consequences of conditions during development are receiving growing attention: they are at the interface between ecological and evolutionary pro∖cesses. We addressed the influence of the length of the rearing period and ‘rank’ on fitness components in a long‐lived seabird species with deferred breeding: the kittiwake (Rissa tridactyla). Rank, which depends on hatching order, was used as a surrogate for domin∖ance status in the brood. Rank could be viewed as a random factor affecting individuals regardless of their possible ‘intrinsic quality’ at birth. The length of the rearing period was used as a surrogate for parental effort. It reflects the interaction between numerous factors such as environmental conditions, parental quality, reproductive decisions and effort, and also offspring decisions and intrinsic quality at birth.

There was evidence of an influence of the length of the rearing period on local survival before recruitment. Individuals with shorter rearing periods had lower local survival during the first winter (e.g. the relationship was positive). They may incur higher mortality. In rank 1 prebreeders, this relationship was negative in older age‐classes. Longer rearing periods and better condition at independence may be associated with stronger migrating ability, and prebreeders that have not yet made settlement decisions may emigrate permanently to distant locations. Such a complex pattern may reflect age‐related changes in the relative contribution of mortality and permanent emigration to local survival.

The length of the rearing period had long‐term consequences on reproductive performance. The relationship was positive but the rate of increase decreased slightly at higher values of the covariate.

There was an unambiguously negative influence of rank on survival before recruitment and recruitment probability, but not on demographic parameters specific to the reproductive stage. Juniors recruited later than elder siblings. The disadvantage of juniors may be expressed mainly in terms of higher mortality and disappearance from the population before recruitment.