bluuebunny/crossref_metadata_2025 huggingface dataset:
Transendothelial migration confers a survival advantage to activated T lymphocytes: role of LFA-1/ICAM-1 interactions
Authors: BORTHWICK N J , AKBAR A A , BUCKLEY C , PILLING D , SALMON M , JEWELL A P , YONG K L
Published: October 2003

The clearance of activated T lymphocytes by apoptosis is an essential component in the resolution of the immune response; however, certain signals received within inflamed tissue may result in the persistence of activated T cells. Our previous work has shown that, when compared with resting cells, effector cells migrate more efficiently across endothelium, thus such cells may be selectively recruited to sites of inflammation. We hypothesized that transmigration of T cells across endothelium might influence cell survival. We have generated T cell lines by culturing in IL-2 following PHA activation. These T cell lines die rapidly by apoptosis when deprived of IL-2 (53·7 ± 4·0% survival after 24 h). In contrast, cells that have migrated across human umbilical vein endothelial cells (HUVEC) survived significantly better than control cells (80·3 ± 3·6%, n= 18, P < 0·001). Endothelial cell conditioned medium was also able to reduce apoptosis, but this effect was small when compared with the protective effect of transmigration. Culture of T lymphocytes on fibronectin, or RGD peptides, or in suspension with a range of chemokines active on T cells, including RANTES and lymphotactin had no effect on survival. In contrast, blocking LFA-l/ICAM-l interactions reduced the protective effect of transmigration (42·3 ± 6·7% reduction). Culture of activated T cells on immobilized ICAM-l alone also increased survival. These results indicate that signals received by activated T cells during extravasation can influence their subsequent survival within tissue, and implicates the involvement of LF A-l/ICAM-l interactions.
Immune response measured in human volunteers vaccinated with autoclavedLeishmania majorvaccine mixed with low dose of BCG
Authors: MAHMOODI M , KHAMESIPOUR A , DOWLATI Y , RAFATI S , MOMENI A Z , EMAMJOMEH M , HEJAZI H , MODABBER F
Published: October 2003

The immune responses induced against Leishmania antigens in volunteers who were vaccinated in a double-blind, randomized field efficacy trial of a preparation of autoclaved Leishmania major (ALM) mixed with a low dose of Bacille Calmette–Guerin vaccine (BCG) who developed either a cutaneous leishmaniasis (CL) lesion due to exposure to infected sandfly bite(s) or did not develop a lesion during the course of the trial were studied and compared with those of non-vaccinated controls. Blood samples were also assayed from different groups including volunteers with history of CL and volunteers with previous positive or negative leishmanin skin test (LST) without a history of CL. The vaccinated volunteers had received a single dose of either ALM mixed with a low dose of BCG or the same dose of BCG alone. The LST and in vitro proliferative response (stimulation index, SI), interferon gamma (IFN-γ) production and, in a few cases, interleukin (IL)-4 production of peripheral blood mononuclear cells to soluble Leishmania antigens were measured. The results indicated that volunteers who developed CL in the vaccine arm showed a slightly higher SI than cases who received BCG alone. Volunteers with history of CL and volunteers with positive LST demonstrated the strongest proliferation indices and IFN-γ production. The data suggest that a single dose of ALM + BCG induces a weak Th1 response in vaccinated volunteers that is far lower than that in volunteers with prior subclinical infection or volunteers with history of CL, who are presumed to be immune.
The bi-specific CD3 × NCAM antibody: a model to preactivate T cells prior to tumour cell lysis
Authors: JENSEN M , ERNESTUS K , KEMSHEAD J , KLEHR M , VON BERGWELT-BAILDON M S , SCHINKÖTHE T , SCHULTZE J L , BERTHOLD F
Published: October 2003

To target the neural cell adhesion molecule (NCAM, CD56) on neuroblastoma by T cell-based immunotherapy we have generated a bi-specific CD3 × NCAM antibody (OE-1). This antibody can be used to redirect T cells to NCAM+ cells. Expectedly, the antibody binds specifically to NCAM+ neuroblastoma cells and CD3+ T cells. OE-1 induces T cell activation, expansion and effector function in peripheral blood mononuclear cell (PBMC)-derived CD4+ and CD8+ T cells. T cell activation was shown to depend on the presence of normal natural killer (NK) cells in the culture. Interestingly, while PBMC- derived T cells were activated by OE-1, NK cells were almost completely depleted, suggesting that T cells activated by OE-1 deleted the NK cells. Activated CD4+ and CD8+ T cells differentiate into a larger CCR7+ central memory and a smaller CCR7– effector memory cell population. Most importantly, preactivated T cells were highly cytotoxic for neuroblastoma cells. In eight of 11 experiments tumour-directed cytotoxicity was enhanced when NK cells were present during preactivation with OE-1. These data strongly support a bi-phasic therapeutic concept of primarily stimulating T cells with the bi-specific antibody in the presence of normal NCAM+ cells to induce T cell activation, migratory capacity and finally tumour cell lysis.
Effects of deviating the Th2-response in murine mercury-induced autoimmunity towards a Th1-response
Authors: HÄGGQVIST B , HULTMAN P
Published: October 2003

T-helper cells type 1 (Th1) and type 2 (Th2) play an important role in the pathogenesis of autoimmune diseases. In many Th1-dependent autoimmune models, treatment with recombinant interleukin-12 (rIL-12) accelerates the autoimmune response. Mercury-induced autoimmunity (HgIA) in mice is an H-2 regulated condition with antinucleolar antibodies targeting fibrillarin (ANoA), systemic immune-complex (IC) deposits and transient polyclonal B-cell activation (PBA). HgIA has many characteristics of a Th2 type of reaction, including a strong increase of IgE, but disease induction is critically dependent on the Th1 cytokine IFN-γ. The aim of this study was to investigate if a strong deviation of the immune response in HgIA towards Th1 would aggravate HgIA. Injections of both rIL-12 and anti-IL-4 monoclonal antibody (α-IL-4) reduced the HgCl2-(Hg-)induced concentration of the Th2-dependent serum IgE and IgG1, but increased the Th1-dependent serum IgG2a. The IgG-ANoA developed earlier and attained a higher titre after combined treatment, and the ANoA titre of the IgG1 isotype decreased while the ANoA titre of the Th1-associated IgG2a, IgG2b and IgG3-ANoA isotypes increased. Treatment with rIL-12 alone increased the Hg-induced IgG2a and IgG3 ANoA titres, the PBA, and the IC deposits in renal and splenic vessel walls, while treatment with α-IL-4 + Hg inhibited renal but not splenic vessel wall IC deposits. We conclude that manipulating the cytokine status, by altering the Th1/Th2 balance, will influence autoimmune disease manifestations. This might be an important way of modulating human autoimmune diseases.
The effects of fruit juices on drug disposition: a new model for drug interactions
Authors: Dresser G. K. , Bailey D. G.
Published: October 2003

Grapefruit juice produces mechanism‐based inhibition of intestinal drug metabolism when consumed in normal quantities. This can produce clinically important increases in oral drug bioavailability when coadministered with substrates of cytochrome P450 3A4 (CYP3A4) that undergo high presystemic metabolism. Furanocoumarins such as bergamottin and 6′,7′‐dihydroxybergamottin have been identified as probable active constituents. Grapefruit juice may also inhibit intestinal P‐glycoprotein‐mediated efflux transport of drugs such as cyclosporine to increase its oral bioavailability. However, grapefruit juice does not enhance the absorption of digoxin, a prototypical P‐glycoprotein substrate, likely because it has high inherent oral bioavailability. Grapefruit and other fruit juices have recently been shown to be potent in vitro inhibitors of a number of organic anion‐transporting polypeptides (OATPs). These juices were also found to decrease the absorption of the nonmetabolized OATP substrate, fexofenadine. Taken together, the data support inhibition of intestinal uptake transporters by fruit juices to decrease drug bioavailability. This would represent a new mechanism for food–drug interactions. These findings with grapefruit and other fruit juices continue to enhance our understanding of the complex nature of food–drug interactions, and their possible influence on the clinical effects of medications.
Pharmacogenetics of cytochrome P4502D6: genetic background and clinical implication
Authors: Cascorbi I.
Published: October 2003

Interindividual differences in the pharmacokinetics of a number of drugs are often due to hereditary polymorphisms of drug‐metabolizing enzymes. Most important is cytochrome P4502D6 (CYP2D6), also known as debrisoquine/sparteine hydroxylase. It catalyzes hydroxylation or demethylation of more than 20% of drugs metabolized in the human liver, such as neuroleptics, antidepressants, some β‐blockers and many others like codeine. About 7%−10% of Caucasians lack any CYP2D6 activity due to deletions and frame‐shift or splice‐site mutations of the gene. About 1%−3% of Middle‐Europeans, but up to 29% of Ethiopians display gene duplications, leading to elevated so‐called ultrarapid metabolization rates. Meanwhile there is now a much better understanding of the genetic background of poor, intermediate, extensive and ultrarapid metabolizers, enabling a more precise DNA genotyping‐based prediction of plasma levels. Since there is evidence that deteriorated drug elimination partly accounts for drug side‐effects, CYP2D6 genotyping could contribute to an individualized and therefore optimized drug therapy.
Importance of P‐glycoprotein for drug disposition in humans
Authors: Fromm M. F.
Published: October 2003

The ATP‐binding cassette transporter P‐glycoprotein is now recognized as an important determinant for disposition of multiple drugs. The use of P‐glycoprotein‐expressing cell lines, the generation of P‐glycoprotein knockout mice as well as studies in animals and humans contributed to a better understanding on the role of active transport processes for drug disposition. P‐glycoprotein is located in tissues with excretory function such as intestine, liver and kidney. Moreover, due to its expression in important blood–tissue barriers (blood–brain and blood–testis barriers), in lymphocytes and in placenta it limits tissue penetration of its substrates. Induction and inhibition of P‐glycoprotein have now been identified as important underlying mechanisms of drug interactions in humans. Using selected examples, this review summarizes currently available data on the impact of P‐glycoprotein for bioavailability of drugs, drug interactions and drug effects.
Organic anion‐transporting polypeptide (OATP) transporter family and drug disposition
Authors: Kim R. B.
Published: October 2003

Drug transporters are increasingly recognized as a key determinant of drug disposition. Recent studies have revealed that targeted expression of drug uptake and efflux transporters to specific cell membrane domains allows for the efficient directional movement of many drugs in clinical use. While the role of certain efflux transporters such as MDR1 (P‐glycoprotein) in drug disposition has been extensively studied, emerging evidence suggests that uptake transporters may also be important to the intestinal absorption and renal or hepatic elimination of drugs. Members of the organic anion‐transporting polypeptide (OATP) family of drug uptake transporters have been found capable of transporting a large array of structurally divergent drugs. Moreover, expression of OATP isoforms in the gastrointestinal tract, liver and kidney, as well as at the level of the blood–brain barrier, has important implications for our understanding of the factors governing drug absorption, elimination and tissue penetration.
Clinical relevance of genetic polymorphisms in the human CYP2C9 gene
Authors: Schwarz U. I.
Published: October 2003

Cytochrome P450 (CYP) 2C9 hydroxylates about 16% of drugs in current clinical use. Of special interest are those with a narrow therapeutic index, such as S‐warfarin, tolbutamide and phenytoin, where impairment in CYP2C9 metabolic activity might cause difficulties in dose adjustment as well as toxicity. Single‐nucleotide polymorphisms (SNP) in the CYP2C9 gene have increasingly been recognized as determinants of the metabolic phenotype that underlies interindividual and ethnic differences. Apart from the wild‐type protein CYP2C9*1 at least five allelic variants produce allozymes with reduced or deficient metabolic activity. Among white populations only CYP2C9*2 and CYP2C9*3 variants are of significance, with allelic frequencies of 0·08–0·14 and 0·04–0·16, respectively. In contrast, in Africans (African‐Americans and Ethiopians) and Asians both variants are much less frequent (0·005–0·04), and CYP2C9*2 has not yet been detected in Asians. CYP2C9*4 has been exclusively identified in Japanese patients, and CYP2C9*5 and *6 were only found among African‐Americans with a low allelic frequency of 0·017 and 0·006, respectively. Furthermore in Japanese a CYP2C9 promotor variant of four linked SNPs was correlated with reduced intrinsic clearance of phenytoin in vitro. Subjects who are carriers of one or more variant alleles may be at risk for adverse drug reactions/toxicities when prescribed drugs extensively metabolized by CYP2C9.
Orthograde retreatment and apexification after unsuccessful endodontic treatment, retreatment and apicectomy
Authors: Sedgley C. M. , Wagner R.
Published: October 2003

Aim  To describe a case where a second orthograde retreatment was successful in the management of an infected mandibular right first molar that previously had received both orthograde and retrograde treatments.

Summary  Periapical surgery is unlikely to be successful unless the root canal system has been adequately debrided and sealed. A case is described where orthograde endodontic treatment, retreatment and apicectomy were unsuccessful in the management of an infected mandibular right first molar. The periapical radiolucency eventually disappeared following a second orthograde retreatment. The second retreatment included 12 months of intracanal calcium hydroxide placement to promote apexification, thus allowing subsequent controlled obturation with gutta percha and AH26. At a 5‐year review following completion of treatment, the tooth remained asymptomatic and was in normal function.

Key learning points 

Orthograde retreatment is a treatment option to manage refractory lesions in teeth that have previously received endodontic treatment, retreatment and apicectomy.

Orthograde retreatment using long‐term intracanal calcium hydroxide can help promote root‐end closure of a resected apex.
Comparative study of root‐canal preparation using Lightspeed and Quantec SC rotary NiTi instruments
Authors: Hülsmann M. , Herbst U. , Schäfers F.
Published: October 2003

Aim  To compare several parameters of root‐canal preparation using two different rotary nickel–titanium (NiTi) instruments: Lightspeed (Lightspeed Inc, San Antonio, TX, USA) and Quantec SC (Tycom, Irvine, USA).

Methodology  Fifty extracted mandibular molars with root‐canal curvatures between 20° and 40° were embedded into a muffle system. All root canals were prepared to size 45 followed by a stepback in 1‐mm increments to size 70 (Lightspeed) or 45 (Quantec SC), using a high‐torque motor at 1300 or 350 r.p.m. respectively. In both groups, irrigation was performed with 2 mL NaOCl (3%) after each instrument size. RC‐Prep (Premier, PA, USA) was used as a chelating agent. The following parameters were evaluated: straightening of curved root canals, postoperative root‐canal diameter, working safety (instrument fractures, perforations, apical blockages, loss of working length (WL)), cleaning ability and working time. Cleanliness of the root‐canal walls was investigated under SEM using 5‐score indices for debris and smear layer. Statistical analysis was performed using the Wilcoxon's test (P < 0.05) for straightening and Fisher's exact test (P < 0.05) for comparison of cross‐sections, contact between pre‐ and postoperative diameter, root‐canal cleanliness and working time.

Results  Both NiTi systems maintained the curvature well: the mean degree of straightening was 1.8° for Lightspeed and 1.7° for Quantec SC; differences were not significant. Procedural incidents occurred with Quantec SC in 12 root canals (three fractures, four apical blockages and five cases of loss of WL), preparation with Lightspeed resulted in five fractures, one apical blockage and five cases of loss of WL (11 incidents). Following preparation with Lightspeed, 55.5% of the root canals had a round diameter, 25% an oval and 19.5% an irregular diameter; Quantec SC preparations resulted in a round diameter in 51.5%, oval shape in 33.3% and irregular cross‐sections in 15.2% of the cases. Mean working time was similar for Quantec SC (161 s) and Lightspeed (155 s); the difference was not significant. For debris, Lightspeed and Quantec achieved 64 and 63% for scores 1 and 2, respectively. For smear layer, Lightspeed and Quantec achieved only 13.3 and 27.4% for scores 1 and 2, respectively. Differences were not significant for either debris or smear layer.

Conclusions  Both systems respected original root‐canal curvature well and prepared acceptable diameter forms. The cleaning ability was judged not satisfactory for both systems. Both systems showed deficiencies in working safety.
Coronal pulp size in molars: a study of bitewing radiographs
Authors: Chandler N. P. , Pitt Ford T. R. , Monteith B. D.
Published: October 2003

Aim  To: (i) study coronal pulp dimensions in human first molar teeth; (ii) investigate the effects of restorations on pulp size; (iii) determine differences in dimensions between teeth of Mongoloid patients and teeth of other ethnic groups; and (iv) record the presence of pulp stones.

Methodology  Bitewing radiographs of 121 subjects (mean age, 20.9 years) were taken under standardized conditions. The films were digitally scanned and nine measurements were made from the image of each first molar. The data were analysed in terms of presence or absence of restorations and in terms of racial group. Differences were examined using Student's t‐test, Pearson correlations and Levene's test.

Results  A total of 445 teeth were analysed. Large crowns were correlated to large pulps. Teeth restored with occlusal and proximal restorations had significantly smaller pulps (P = 0.044 and 0.004, respectively), but no difference was found in pulp area in the clinical crown between the restoration types. Mongoloid crowns were shorter and more bulbous. Pulp areas of maxillary molars and pulp widths at the cervix of mandibular molars were significantly larger in Mongoloids. The pulp area in the clinical crown correlated to pulp horn height for Mongoloids and others and for maxillary and mandibular teeth. No differences were found between the heights of pulp horns in the Mongoloid and other teeth. Four of the pulp measurements demonstrated sexual dimorphism. Stones were present in almost 10% of the subjects, representing 4% of the tooth pulps examined.

Conclusion  Even teeth with shallow occlusal restorations had reduced pulp spaces. There were significant differences in pulp and crown dimensions between the teeth of Mongoloid patients and those of other patients.
An in vitro study of the torsional properties of new and used K3 instruments
Authors: Yared G. , Kulkarni G. K. , Ghossayn F.
Published: October 2003

Aim  To compare torque and angle of rotation at fracture of new and used K3 rotary instruments. The relation between size of instrument and torque at fracture was also investigated.

Methodology  Nickel–titanium (Ni‐Ti) .06 K3 rotary instruments were used in a crown‐down manner at 300 r.p.m. to prepare canals in resin blocks. The torque and angle of rotation at fracture of new and the used Ni‐Ti .06 K3 rotary instruments (sizes 15–40) were determined according to ANSI/ADA Specification no. 28. Analysis of variance was used to compare the torque and angle of rotation at fracture amongst the different sizes of the new instruments and between new instruments and instruments of the same size, which had been used in resin blocks (α = 0.05). The relationship between torque at fracture and size of instrument was subjected to regression analysis.

Results  Torque at fracture of the new instruments increased significantly with the diameter. The used instruments (sizes 15, 20, 30, 35 and 40) had lower torque at fracture compared to the new ones (P < 0.0001). The means of angle of rotation at fracture between the different sizes of new instruments were significantly different (P < 0.0001) except for sizes 15–20 (P = 0.2561). The used instruments (sizes 20–40) had lower angle of rotation at fracture compared to the new ones (P < 0.05). A linear relationship was found between the size of the file and the torque at fracture for the new instruments (r2 = 0.84; P < 0.0001) and the used ones (r2 = 0.82; P < 0.0001).

Conclusions  In general, the results suggested that the torque and angle of rotation at fracture were significantly affected by the repeated use of .06 K3 instruments in resin blocks.
In vitro fracture resistance of root‐filled teeth using new‐generation dentine bonding adhesives
Authors: Hürmüzlü F. , Serper A. , Siso Ş. H. , Er K.
Published: October 2003

Aim  To compare the fracture resistance of root‐filled premolar teeth restored with new‐generation dentine bonding adhesives.

Methodology  Sixty extracted single‐rooted human maxillary premolar teeth were used. Access cavities were prepared, and the roots were instrumented with K‐files to an apical size 50 using a step‐back technique. Root fillings were accomplished using gutta percha (Sure‐Endo, Seoul, Korea) and AH Plus root canal sealer (Dentsply DeTrey, Konstanz, Germany) using the lateral condensation technique. The teeth were then randomly divided into six groups of 10 teeth each. A mesiodistocclusal (MOD) cavity was prepared in the teeth to the level of the canal orifices so that the thickness of the buccal wall of the teeth measured 2 mm at the occlusal surface and 3 mm at the cemento‐enamel junction. Preparations were restored using the following adhesive systems: Etch & Prime 3.0 (Degussa AG, Hanau, Germany), Clearfil SE Bond (Kuraray, Osaka, Japan), Prompt L‐Pop (ESPE, Seefeld, Germany), Panavia F (Kuraray, Osaka, Japan), Optibond Plus (Kerr, Orange, CA, USA) and Admira Bond (Voco, Cuxhaven, Germany); all preparations except those of the Panavia F and Admira Bond groups were further restored with resin composites. The Panavia F group was restored with amalgam and the Admira Bond group with Ormocer (Voco, Cuxhaven, Germany). The teeth were mounted in a Universal Testing Machine (Hounsfield, Surrey, UK), and the buccal walls were subjected to a slowly increasing compressive force until fracture occurred. The force of fracture of the walls of each tooth was recorded and the results in the various groups were compared. Statistical analysis of the data was accomplished using one‐way anova.

Results  There was no significant difference in the fracture resistance of any of the test groups.

Conclusions  In this laboratory study, the type of dentine bonding agents had no influence in the fracture resistance of teeth.
Examination of tumour histopathology and gene expression in a neu/S100A4 transgenic model of metastatic breast cancer
Authors: Simpson Peter T. , Shoker Balvinder S. , Barraclough Roger , Halliwell Nigel , Rudland Philip S. , Sibson D. Ross , Davies Michael P. A.
Published: October 2003

Summary.  Elevated levels of the calcium‐binding protein S100A4 have been causally linked to the metastatic spread of breast cancer cells in several in vitro and in vivo model systems and, more recently, correlated with patient death in a series of human breast cancer specimens. In transgenic mice expressing MMTV‐neu transgenes in mammary gland, additional expression of S100A4 transgenes results in an enhanced metastatic capability. Despite this phenotypic difference arising from elevated S100A4, it is now shown that the primary breast tumours in all mice examined are histopathologically very similar and resemble those human tumours associated with elevated c‐erbB‐2. Using a panel of genes identified by suppression subtractive hybridization of cDNAs from individual primary tumours and a metastasis, some cDNAs were found to exhibit a differential pattern of expression associated with the expression of S100A4 protein (including osteopontin, S100A9, claudin 2 and several Expressed Sequence Tags sequences). Whilst confirming differential expression of these genes, it was demonstrated that individual primary tumours of matched transgenic status, histology and grade exhibit some degree of heterogeneity at the mRNA level by reverse Northern and Northern hybridizations. This intertumour heterogeneity of mRNA level was confirmed by cDNA array analysis and suggests that even in a transgenic model, which exhibits far less variation than the human disease, there may be multiple mechanisms of disease progression.
Acute effects of acidosis on protein and amino acid metabolism in perfused rat liver
Authors: HoleČek Milan , Šafránek Roman , Ryšavá Radana , KadlČíková Jana , Šprongl LudĚk
Published: October 2003

Summary.  Acidosis is frequently associated with protein wasting and derangements in amino acid metabolism. As its effect on protein metabolism is significantly modulated by other abnormal metabolic conditions caused by specific illnesses, it is difficult to separate out the effects on protein metabolism solely due to acidosis. The aim of the present study was to evaluate, using a model of isolated perfused rat liver, the direct response of hepatic tissue to acidosis. We have compared hepatic response to perfusion with a solution of pH 7.2 and 7.4 (controls). Parameters of protein and amino acid metabolism were measured using both recirculation and single‐pass technique with 4,5‐[3H]leucine, [1–14C]leucine and [1–14C]ketoisocaproate (ketoleucine) as tracers and on the basis of difference of amino acid levels in perfusion solution at the beginning and end of perfusion. In liver perfused with a solution of pH 7.2, we observed higher rates of proteolysis, protein synthesis, amino acid utilization and urea production. Furthermore, the liver perfused with a solution of pH 7.2 released a higher amount of proteins to perfusate than the liver perfused with a solution of pH 7.4. Enhanced decarboxylation of ketoisocaproate in liver perfused by a solution of a lower pH indicates increased catabolism of branched‐chain amino acids (leucine, valine and isoleucine), decreased reamination of branched‐chain keto acids to corresponding essential amino acids and increased ketogenesis from leucine.
Minor illness education for parents of young children
Authors: Robbins Helen , Hundley Vanora , Osman Liesl M
Published: October 2003

Background. A number of previous studies on minor illness have concentrated on nurse‐led clinics and the role of nurse practitioners. This study examines the effect of a minor illness education programme which aimed to increase parents’ confidence and knowledge in managing childhood illnesses.

Aim. The primary aim of this study was to evaluate the effectiveness of a home visit and booklet in providing education to parents about minor infant illnesses.

Design. A randomized controlled trial was conducted. The intervention involved a home visit to discuss parents’ concerns and provide advice and information, and a booklet advising parents what to do and when to consult about infant illnesses.

Method. A total of 120 parents of 6 week old babies were identified over a 6 month period, using health visitors’ caseloads, and randomized to an intervention group (60), that received a visit and a booklet, or a control group (60) that received standard care. Groups were compared on entry to the study and at 7 months, in terms of parental knowledge and confidence about childhood illnesses, the intended use of home care activities, intention to consult professionals and actual use of health services. Data were collected by self‐completed questionnaire and case note review.

Findings. The educational intervention resulted in a reduction in visits to the child health clinic but had little effect on use of other services. Parents in the intervention group showed a general trend towards greater certainty about the home care options they would choose, and a reduction in intention to consult a doctor. However, they also indicated a feeling of reduced confidence and knowledge.

Conclusion. The trial showed no effect on use of services but did demonstrate reduction in parents’ intentions to consult a doctor, which appeared to be because of increased certainty about home care. However, it is of concern that they indicated feeling less confident and knowledgeable. It is not possible to clarify whether this represented anxiety that was constructive, enhancing decision‐making or was destructive. Further work into the role of education in parental decision‐making, anxiety levels and enhancement of confidence is required.
Early detection and treatment of postnatal depression in primary care
Authors: Davies Bronwen R. , Howells Sarah , Jenkins Meryl
Published: October 2003

Background. Postnatal depression has a relatively high incidence and gives rise to considerable morbidity. There is sound evidence supporting the use of the Edinburgh Postnatal Depression Scale as a screening tool for possible postnatal depression.

Aim. This paper reports on a project developed by two health visitors and a community mental health nurse working in the United Kingdom. The aim of the project was to improve the early detection and treatment of postnatal depression in the population of the general practice to which they were attached.

Method. The health visitors screened for postnatal depression in the course of routine visits on four occasions during the first postpartum year. Women identified as likely to be suffering from postnatal depression were offered ‘listening visits’ as a first‐line intervention, with referral on to the general practitioner and/or community mental health nurse if indicated.

Findings. Data collected over 3 years showed that the project succeeded in its aim of enhancing early detection and treatment of postnatal depression. These findings replicate those of other studies. The data also showed that a substantial number of women were identified for the first time as likely to be suffering from postnatal depression at 12 months postpartum. Women screened for the first time at 12 months were at greater risk than those who had been screened earlier than this.

Conclusions. Health visitors should screen for postnatal depression throughout the period of their contact with mothers, not solely in the immediate postnatal period. It is particularly important to screen women who, for whatever reason, were not screened when their child was younger. The knowledge and skills needed to use the Edinburgh Postnatal Depression Scale and provide first‐line intervention and onward referral can be developed at practitioner level through close collaborative working.
Adherence to diabetes control recommendations: impact of nurse telephone calls
Authors: Kim Hee‐Seung , Oh Jeong‐Ah
Published: October 2003

Background. Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications.

Aim. The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin (HbA1c) levels and adherence to diabetes control recommendations.

Methods. A randomized design with control and experimental groups being assessed pre‐ and postintervention was used to assess the effectiveness of nurse telephone calls. Twenty patients were randomly assigned to an intervention group and 16 to a control group. The goal of the intervention was to keep blood glucose concentrations close to the normal range (HbA1c < 7%). The intervention was applied to the intervention group for 12 weeks, and consisted of continued education and reinforcement of diet, exercise, medication adjustment recommendations, as well as frequent self‐monitoring of blood glucose levels. Telephone intervention was performed twice per week for the first month and then weekly for the second and third month. Participants were requested to write self‐management logs including blood glucose levels, diet and an exercise diary. A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail. All medication adjustments were communicated to participants’ doctors. The HbA1c and diabetes adherence were measured before and after the intervention.

Results. Patients in the intervention group had a mean decrease of 1·2% in HbA1c levels and those in the control group had a mean increase of 0·6% in HbA1c levels. The intervention group had greater diet and blood glucose testing adherence than the control group.

Conclusion. These findings indicate that a nurse telephone intervention can improve HbA1c, and diet and blood glucose testing adherence.
Anxiety and well‐being in older people after discharge from hospital
Authors: Kvaal Kari , Laake Knut
Published: October 2003

Background. A previous study using the State‐Trait Anxiety Inventory (STAI) has documented a very high prevalence of anxiety symptoms among older inpatients. The STAI produced two main concepts on factor analysis –‘Nervousness’ and ‘Well‐being’– and high scores on both caused the high overall score in these patients.

Aim. To investigate how the scorings on the STAI evolve after discharge in older patients in order to understand better the reasons for their high scorings while in hospital.

Methods. Sixty‐three patients who had been scored on the STAI during their stay in an elder care department were followed up at 1–3 and 12 months after discharge. Data were analysed by ancova for unbalanced designs.

Results. The mean STAI sum score increased significantly (3·5 points adjusted for the baseline scoring, age and gender, P < 0·001) from the first follow‐up while in hospital to 1–3 months after discharge, with no significant change between the second and the last follow‐up. This increase resulted primarily from a significant worsening of the score on ‘well‐being’. The score on ‘nervousness’ remained unchanged. Age did not influence the scores, while females scored higher. No interaction effects were observed, indicating that the evolvement of nervousness and anxiety after discharge is independent of gender and age. Item analysis showed that the worsening of the score on ‘well‐being’ in these patients during the first 1–3 months after discharge was primarily caused by a lower score on the item ‘I feel secure’.

Conclusion. The study does not support the hypothesis that a high level of nervousness and lack of well‐being among hospitalized older patients results from acute illness and hospitalization. The worsening in the score on well‐being after discharge of such patients is primarily caused by low levels of feelings of security. This represents a challenge to nurses providing home‐based care.
Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing
Authors: Williamson Graham R.
Published: October 2003

Aim. This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P‐value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed.

Background. Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P‐values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable.

Discussion. The key ideas of random sampling and probability theory for statistical testing (for generating a P‐value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed.

Review limitations. This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s).

Conclusion. Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.
Becoming a web‐based learner: registered nurses’ experiences
Authors: Atack Lynda
Published: October 2003

Aims. The purpose of the study was to describe Registered Nurses’ experiences when taking a web‐based course from either the workplace or home, and the impact of their learning on clinical practice.

Rationale. Little is known about the web‐based learners’ experience, particularly when courses are accessed from the nursing practice setting. Even less is known about whether nurses transfer their web‐based learning to clinical practice.

Methods. A qualitative design employing focus group interviews was used. Participants included hospital and community nurses from three Canadian provinces and one territory. Data were collected at three points over a 6‐month period and analysed using a thematic analysis process. These findings emanate from a larger study using survey method and focus group interviews.

Results. The focus group interviews captured the hurdles nurses faced during the first weeks when they struggled with technology, re‐framed their views of teaching and adjusted to web‐based learning from home and work. These first stressful weeks were followed by a period during which nurses developed relationships with the teacher and peers that enabled them to focus on learning and prevented attrition. Most nurses reported the web course was convenient and that they would be interested and comfortable using technology for learning and work purposes in the future. Six weeks after the course was completed, nurses articulated a number of ways the course had improved their practice.

Conclusion. Initial weeks in a web‐based course can be very challenging for novice Internet users, however, most nurses who completed the course reported a positive learning experience. Nurses, employers and educators should evaluate computer skills, computer access and the learning environment when preparing for web‐based learning.
Critical thinking disposition of Hong Kong Chinese and Australian nursing students
Authors: Tiwari Agnes , Avery Alan , Lai Patrick
Published: October 2003

Background. Critical thinking is frequently cited as a desirable professional attribute and a highly valued educational outcome. Despite the abundance of literature on the subject, validation of the critical thinking construct in different cultural populations is under‐researched.

Aim. The purpose of this study was to compare the critical thinking dispositions of Hong Kong Chinese and Australian nursing students.

Design. A cross‐sectional design was used with two groups of nursing students in two universities, one in Hong Kong and the other in Australia. Critical thinking disposition was measured using the California Critical Thinking Disposition Inventory (CCTDI).

Results. Significant differences were detected in critical thinking disposition between the two groups of students (P < 0·05), with the Hong Kong Chinese students failing to show a positive disposition toward critical thinking on the CCTDI total mean score, while the Australian students showed a positive disposition. Similarities and differences were also noted between the groups in CCTDI subscale mean scores.

Conclusion. The findings contribute to knowledge of critical thinking by demonstrating differences and similarities between Hong Kong Chinese and Australian nursing students. The study raises questions about the effects of institutional, educational, professional and cultural factors on the disposition to think critically.
Training needs of midwifery assistants
Authors: McKenna Hugh , Hasson Felicity , Smith Miriam
Published: October 2003

Background. Increasingly in the United Kingdom (UK) assistants are being introduced as part of the midwifery workforce. However, there appears to be little standardization in the qualifications and training provided.

Aim. The aim of this study was to investigate what an educational programme for midwifery assistants should contain.

Research methods. A total of 100 qualified midwives and 58 midwifery students were asked to complete a mailed questionnaire and subsequently 20 of these respondents were interviewed.

Results. Respondents identified three levels of competencies that midwifery assistants should possess. They also acknowledged that midwives required specific training in how best to supervise assistants. Respondents maintained that each assistant should have a clinically‐based midwifery mentor and that rotation around different clinical areas should be included as part of a training programme. Furthermore, it was stressed that because midwives initiate, teach and supervise assistants, they should have a key role in planning training programmes and in the teaching and assessment processes. Nonetheless, it was accepted that such a role could divert the midwife from valuable contact time with the mother and baby, the opposite of what the introduction of assistants was intended to do.

Conclusions. Before working in clinical areas midwifery assistants need practice‐based training that focuses on skills development. Communications and interpersonal skills should be included in the training as should placement experience in a variety of clinical settings. Midwives have a role in providing this training, and in mentoring and supervising midwifery assistants, but it is accepted that this could add to their workloads. Developments of this kind need to be evaluated, especially in terms of the impact on direct care by midwives.
Review of research on the health of caregiving grandparents
Authors: Grinstead Linda Nicholson , Leder Sharon , Jensen Susan , Bond Linda
Published: October 2003

Aim. To provide a critical review of research literature on the health of grandparents raising grandchildren, and identify directions for future research.

Methods. Approaches used to access the research studies for this review included a comprehensive search using relevant electronic databases and a thorough examination of the references in each published study.

Findings. All studies but one were published after 1990. Samples consisted primarily of African‐American and Caucasian grandmothers in the United States of America. Earlier studies tended to describe health and other related concepts while more recent studies began to examine relationships between concepts. Most of the studies had a cross‐sectional design and only one evaluated interventions. Inconsistencies in the results of these studies were prevalent.

Conclusions. Evaluation studies, longitudinal designs, and more varied study samples including cross‐cultural comparisons are needed to advance knowledge about grandparent caregivers’ health.
The effects of HEMA‐monomer and air atmosphere treatment of glass fibre on the transverse strength of a provisional fixed partial denture resin
Authors: Keyf F. , Uzun G. , Mutlu M.
Published: October 2003

summary  This study focused on some mechanical properties such as the transverse strength, the maximal deflection, and the modulus of elasticity of resin reinforced with two different types of agents‐treated and with untreated glass fibre, and without fibre. A Teflon mould was used to prepare six groups of specimens. Two different types of chemical modification agents, hydroxyethyl‐methacrylate (HEMA)‐monomer and air atmosphere were applied to create hydrophilic surfaces on the glass fibres. The flow rate was kept at two different levels, 25 and 60 mL min−1. The discharge powers of the surface treatment process were 15 or 20 W. The fibres were exposed to glow discharge conditions for the periods of 10 or 15 min. Without fibre specimens were the control group. The provisional resin was same in all groups. All the specimens were subjected to transverse testing with a cross‐head speed of 5 mm min−1. The three‐point load test was used to record the load of the fracture for each specimens. The Kruskal–Wallis analysis of variance was used to compare the transverse strength, the maximal deflection and the modulus of elasticity. The differences in the transverse strength and the maximal deflection between the six groups were found statistically significant but the modulus of elasticity was not statistically significant. The transverse strength of HEMA‐monomer (group A) was shown the highest value (66·3 MPa). For without‐fibre group, the value was 52·9 MPa. This difference was statistically significant when the Mann–Whitney U‐test was used for comparing. Repairing or remaking provisional restorations can be a time‐consuming endeavour. The added strength of the polymethyl methacrylate with the fibre can reduce clinical failures of provisional fixed partial dentures. The surface treatment process was increased the transverse strength and the maximal deflection. The clinical implication of chemical modification agents‐coated fibres is reduced incidence of fixed provisional restoration failure.
Effects of chemical disinfectants on the transverse strength of denture base acrylic resins
Authors: Pavarina A. C. , Machado A. L. , Giampaolo E. T. , Vergani C. E.
Published: October 2003

summary  The disinfection of dental prostheses by immersion in a chemical solution should be capable of rapid inactivation of pathogenic microorganisms, without causing any adverse effect on the denture base resins. This study evaluated the effect of disinfection immersion on the transverse strength of two heat‐cured resins. The denture base resins (Lucitone 550 and QC 20) were polymerized according to the manufacturers' instructions. After polymerization, the specimens were polished, and then stored in water at 37 °C for 50 ± 2 h prior immersion in one of the following solutions for 10 min: 4% chlorhexidine, 1% sodium hypochlorite and 3·78% sodium perborate. The specimens were submitted to disinfection twice, simulating when dentures come from the patient and before being returned to the patient. Ten specimens were made for each group. The transverse strength was evaluated by a 3‐point bend test. The flexural strength of the two denture base acrylic resins evaluated remained unaffected after immersion in the three solutions evaluated. In general, the QC 20 resin specimens exhibited lower transverse strength than the Lucitone 550 resin specimens, regardless of immersion solutions.