bluuebunny/crossref_metadata_2025 huggingface dataset:
Too early to dismiss Yersinia enterocolitica infection in the aetiology of Graves’ disease: evidence from a twin case–control study
Authors: Brix Thomas H. , Hansen Pia S. , Hegedüs Laszlo , Wenzel Björn E.
Published: February 2008

Background  Yersinia enterocolitica (YE) infection has long been implicated in the pathogenesis of Graves’ disease (GD). The association between YE and GD could, however, also be due to common genetic or environmental factors affecting the development of both YE infection and GD. This potential confounding can be minimized by investigation of twin pairs discordant for GD.

Aim  To examine whether YE infection is associated with GD.

Design  We first conducted a classical case–control study of individuals with (61) and without (122) GD, and then a case–control study of twin pairs (36) discordant for GD.

Methods  Immunoglobulin (Ig)A and IgG antibodies to virulence‐associated Yersinia outer membrane proteins (YOPs) were measured.

Main outcome measures  The prevalence of YOP IgA and IgG antibodies.

Results  Subjects with GD had a higher prevalence of YOP IgA (49%vs. 34%, P = 0·054) and YPO IgG (51%vs. 35%, P = 0·043) than the external controls. The frequency of chronic YE infection, reflected by the presence of both IgA and IgG YOP antibodies, was also higher among cases than controls (49%vs. 33%, P = 0·042). Similar results were found in twin pairs discordant for GD. In the case–control analysis, individuals with GD had an increased odds ratio (OR) of YE infection: IgA 1·84 (95% CI 0·99–3·45) and IgG 1·90 (95% CI 1·02–3·55). In the co‐twin analysis, the twin with GD also had an increased OR of YE infection: IgA 5·5 (95% CI 1·21–24·81) and IgG 5·0 (95% CI 1·10–22·81).

Conclusion  The finding of an association between GD and YE in the case–control study and within twin pairs discordant for GD supports the notion that YE infection plays an aetiological role in the occurrence of GD, or vice versa. Future studies should examine the temporal relationship of this association in more depth.
Could shelling in the First World War have increased copper concentrations in the soil around Ypres?
Authors: Van Meirvenne M. , Meklit T. , Verstraete S. , De Boever M. , Tack F.
Published: February 2008

In the First World War, the region around Ypres (West‐Flanders, Belgium) was a battlefield where millions of copper‐containing shells were fired. To investigate the consequences of this shelling, we analysed statistically data on the copper (Cu) content in the topsoil (0–0.5 m) of the province of West‐Flanders, an area of 3144 km2. The measurements had been made on the fine earth (< 2 mm) fraction of 2786 samples. A preliminary screening of the data revealed larger concentrations of Cu in a region of approximately 625 km2around Ypres. These concentrations were estimated by ordinary block kriging on the logarithms of the Cu concentration with separate variograms for the battlefield area and the rest of the province and mapped. The median concentration in the battlefield area was 18.0 mg Cu kg−1compared with 12.0 mg Cu kg−1elsewhere. We conclude that the current Cu enrichment in the soil around Ypres is the legacy of the millions of shells that were fired in the First World War.
Fish abundance and community composition in native and non‐native plants following hydrilla colonisation at Lake Izabal, Guatemala
Authors: BARRIENTOS C. A. , ALLEN M. S.
Published: February 2008

Abstract  Fish community composition was assessed among six macrophyte habitats, including hydrilla, Hydrilla verticillata (L.F.) Royle, common native species (bulrush, Scirpus spp., muskgrass, Chara spp., eelgrass, Vallisneria americana Michx. and Illinois pondweed, Potamogeton illinoensis Morong) and no‐plants, to assess potential impacts of recent hydrilla colonisation on the littoral fish community at Lake Izabal, Guatemala. Fish biomass was significantly different among habitats, with hydrilla supporting the highest fish biomass. Fish density did not differ significantly among habitats. Total fish species richness was similar (12‐15 species) among habitats, but community composition changed with macrophyte presence. Biomass of mojarra, Cichlasoma maculicauda Regan, which supported the most important subsistence fishery at the lake, was significantly different among habitats and had the greatest biomass in the hydrilla habitat. Although hydrilla may adversely affect native plants, lake access and other uses, it provided useful fish habitat and likely was not detrimental to the Lake Izabal fish community composition.
Diabetes self‐management experience: a focus group study of Taiwanese patients with type 2 diabetes
Authors: Lin Chiu‐Chu , Anderson Robert M , Hagerty Bonnie M , Lee Bih‐O
Published: February 2008

Aims and objectives.  The purpose of this study was to understand and document the perspectives of Taiwanese patients with type 2 diabetes regarding the processes and strategies used to self‐manage their chronic condition.

Background.  The importance of patients learning self‐management through self‐regulation has been recognized in the literature, but little of this research has focused on skills to manage symptoms. Besides, studies about how patients self‐manage their diabetes in term of patients’ perspectives have been scant. Sociocultural context is also an influencing factor in disease management.

Methods.  Focus groups were used to collect data from 41 adult participants with type 2 diabetes at three teaching hospitals located in southern Taiwan. The five focus groups ranged in size from six to ten people. The focus groups were recorded, transcribed and analysed.

Results.  Three themes and ten subthemes were revealed. The first theme ‘the impact of the illness’ includes three subthemes: facing the predicament of stigmatization, concern about inheritance of diabetes and seeking alternative therapy for hope. The second theme ‘self‐regulation process’ includes four subthemes: struggling for diet control, adjusting to psychological barriers, identifying body response and developing strategies for dealing with diabetes. The third theme ‘transformation process’ includes three subthemes: resuming conventional illness, support from families and fellow patients and learning to live with the disease.

Conclusions.  Findings obtained from the themes of the study illustrated that self‐management of patients with diabetes is highly related to their own sociocultural environment and experiences. Understanding the cultural features and the meaning of illness can help in the development of interventions tailored to the needs of this cultural group.

Relevance to clinical practice.  The findings have important implications for healthcare providers to consider individuals’ sociocultural backgrounds in which they make choices about their treatment and manage their illness. This recognition will enhance patients with diabetes to transform being active in self‐management through the skills of self‐regulation.
Using snowball sampling method with nurses to understand medication administration errors
Authors: Sheu Shuh‐Jen , Wei Ien‐Lan , Chen Ching‐Huey , Yu Shu , Tang Fu‐In
Published: February 2008

Aims and objectives.  We aimed to encourage nurses to release information about drug administration errors to increase understanding of error‐related circumstances and to identify high‐alert situations.

Background.  Drug administration errors represent the majority of medication errors, but errors are underreported. Effective ways are lacking to encourage nurses to actively report errors.

Methods.  Snowball sampling was conducted to recruit participants. A semi‐structured questionnaire was used to record types of error, hospital and nurse backgrounds, patient consequences, error discovery mechanisms and reporting rates.

Results.  Eighty‐five nurses participated, reporting 328 administration errors (259 actual, 69 near misses). Most errors occurred in medical surgical wards of teaching hospitals, during day shifts, committed by nurses working fewer than two years. Leading errors were wrong drugs and doses, each accounting for about one‐third of total errors. Among 259 actual errors, 83·8% resulted in no adverse effects; among remaining 16·2%, 6·6% had mild consequences and 9·6% had serious consequences (severe reaction, coma, death). Actual errors and near misses were discovered mainly through double‐check procedures by colleagues and nurses responsible for errors; reporting rates were 62·5% (162/259) vs. 50·7% (35/69) and only 3·5% (9/259) vs. 0% (0/69) were disclosed to patients and families. High‐alert situations included administration of 15% KCl, insulin and Pitocin; using intravenous pumps; and implementation of cardiopulmonary resuscitation (CPR).

Conclusions.  Snowball sampling proved to be an effective way to encourage nurses to release details concerning medication errors. Using empirical data, we identified high‐alert situations. Strategies for reducing drug administration errors by nurses are suggested.

Relevance to clinical practice.  Survey results suggest that nurses should double check medication administration in known high‐alert situations. Nursing management can use snowball sampling to gather error details from nurses in a non‐reprimanding atmosphere, helping to establish standard operational procedures for known high‐alert situations.
Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study
Authors: Wårdh Inger , Paulsson Gun , Fridlund Bengt
Published: February 2008

Aims and objectives.  The aim of this study was to evaluate long‐lasting changes in the nursing staff's understanding of oral health care for cancer patients after an oral health care intervention. The study also assessed whether there were changes between registered nurses and auxiliary nurses.

Background.  The maintenance of good oral health care in cancer patients is essential for nutrition, recovery and wellbeing and requires the involvement of nursing staff. However, several studies reveal that the need to prioritize oral health care has not been made sufficiently clear.

Methods.  The nursing staff (registered nurses, n = 133 and auxiliary nurses, n = 109) on five wards at different hospitals providing cancer care took part in a four‐hour oral healthcare training session, including the use of an oral assessment guide and answered a questionnaire initially and after this intervention. The data were statistically analyzed.

Results.  Several aspects of implementation opportunities improved, but they did not include attitudes to oral health care. Knowledge of oral diseases decreased, more for auxiliary nurses than for registered nurses.

Conclusions.  A four‐hour oral health training session and subsequent activities improve the nursing staff's understanding of oral health care for patients with cancer diagnoses in some respects but not in terms of attitudes to oral health care or specific oral knowledge.

Relevance to clinical practice.  Oral healthcare education and training activities for nursing staff can produce some improvements in the understanding of oral health care for cancer patients but not in attitudes and specific oral knowledge. These areas must be covered during the basic education period or/and by a routine oral healthcare programme for nursing staff, probably including an oral healthcare standard.
Relationship between organizational empowerment and job satisfaction perceived by nursing assistants at long‐term care facilities
Authors: Kuo Huai‐Ting , Yin Teresa Jeo‐Chen , Li I‐Chuan
Published: February 2008

Aim.  The purpose of this study was to understand the relationships between organizational empowerment and job satisfaction among nursing assistants at long‐term care facilities in Taiwan.

Background.  Nursing assistants are the major manpower at long‐term care facilities. The responsibilities of nursing assistants are complex and numerous and affect their job satisfaction. We assumed that a well‐organized and pleasant work environment is an important characteristic of organizational empowerment and ought to enhance the nursing assistants’ job satisfaction. However, little information exists that can be used by long‐term care facilities managers when they strive to increase the nursing assistants’ job satisfaction by modifying the regulations or interventions from an organizational perspective.

Methods.  We used a cross‐sectional design with a descriptive correlation approach to understand the relationship between organizational empowerment and job satisfaction among nursing assistants at long‐term care facilities in Taiwan. A total of 28 long‐term care facilities and 114 nursing assistants participated in the study.

Results.  The results indicated that, where there was a moderate level of organizational empowerment, a higher level of job satisfaction was found. Organizational empowerment was significantly associated with total job satisfaction (r = 0·366, p < 0·01). The variables of nationality (Vietnamese), resources, opportunity and informal power were significant predictors of job satisfaction (R2 = 0·318, F = 12·24, p < 0·001).

Conclusion.  Organizational empowerment is significantly associated with job satisfaction among nursing assistants in this study.

Relevance to clinical practice.  Nursing assistants need to receive more assistance and resources from their co‐workers to enhance their job satisfaction. The manager should initiate regular meetings and activities for staff who work in long‐term care facilities that will allow sharing, communication and support among the staff in terms of ideas, information and feelings.
Patients’ perceived care needs whilst waiting for a heart or lung transplant
Authors: Yorke Janelle , Cameron‐Traub Elizabeth
Published: February 2008

Aim.  To explore the perceptions of caring and expectations of nursing care in patients on a heart and/or lung transplant waiting list.

Background.  The waiting period for a heart or lung transplant can be very stressful and demanding for patients and their families. Care during the waiting period needs to be aimed at treating the symptoms and complications of patients’ underlying condition and also specific issues related to organ transplant candidacy.

Method.  A qualitative research design, using semi‐structured interviews with 22 patients on a heart and/or lung transplant waiting list was used. Participants were interviewed on three separate occasions.

Findings.  Qualitative analysis of the data revealed five major themes related to the nursing care needs of heart and lung transplant candidates. The themes were identified as information giving, maintenance of regular contact, familiarity, positive thinking and compassionate manner. These were five key aspects of communication within the nurse–patient relationship and formed the essence of caring as perceived by patients awaiting heart and/or lung transplantation.

Conclusion.  Transplant candidates often experience prolonged waiting times for a transplant which is often laden with uncertainties and stress. This study provided an in‐depth description of patients’ perceptions of caring and their nursing care needs whilst on a heart and lung transplant waiting list.

Relevance to clinical practice.  The findings provide useful advice to nurses about ways they can improve care and enhance caring for patients waiting for an organ transplant. Key elements of nursing care that foster the nurse–patient relationship that can be incorporated into nursing care pathways have been highlighted.
Quality of life in elders living alone in Taiwan
Authors: Lin Pao‐Chen , Yen Miaofen , Fetzer Susan Jane
Published: February 2008

Aims and Objectives.  The aim of this study was to identify and describe predictors of QOL of elders who live alone in Taiwan.

Background.  Despite a growing population of elders who live alone, research on their quality of life, important for policy decisions and health care provider interventions is virtually absent.

Methods.  A descriptive correlational design surveyed 192 Taiwanese elders living alone, selected at random from urban and rural areas. During home visits elders completed the WHO‐QOL‐BREF, Social Support Scale and Center for Epidemiological Studies Depression Scale (CES‐D) in addition to providing demographic data.

Results.  Multiple linear regressions showed that six variables predicted physical health and the psychological wellbeing QOL domains, accounting for 74·5 and 60·1% of the variance, respectively. Four variables predicted 46·7 and 34·3% of the environmental and the social relationship QOL domains, respectively.

Conclusions.  Elders who live alone in rural areas and suffer from depression are at high risk for a low quality of life. However, elders living alone reported a better quality of life than their institutionalized counterparts. Interventional research and policy decisions focused on treatment for depression and providing social support networks, as these elders age, will be particularly important.

Relevance to clinical practice.  By understanding variables associated with elders' quality of life, nurses can coordinate interventions to improve their quality of life. Poorly educated rural women who live alone are particularly vulnerable. Nursing assessment of quality of life indicators and implementation of strategies for increased social support are needed for high‐risk elders.
Living with a spinal cord injury: a grounded theory approach
Authors: Chen Hsiao‐Yu , Boore Jennifer RP
Published: February 2008

Aims.  This paper reports a study which examined patients’ experiences of suffering a spinal cord injury.

Background.  Spinal cord injury has major bio‐psycho‐social and spiritual implications for patients. However, very limited research exists regarding the experience of patients with spinal cord injury in Taiwan or other countries worldwide.

Method.  Grounded theory was used to explore the psychosocial implications for patients of spinal cord injury.

Data collection and analysis.  Data were collected from October 2002 – March 2003 through tape‐recorded, semi‐structured interviews and complete observation of a group discussion focusing on patients with tetraplegia, in a rehabilitation hospital in Taiwan. The number of patients with spinal cord injury interviewed for this study was 15, involving 18 interviews. Data collection and analysis occurred concurrently.

Results.  The findings resulted in the core category ‘living with a spinal cord injury’ and identify the experiences of suffering a spinal cord injury. Three stages were identified as the individual experience, including four categories: stage 1 A catastrophic life event, stage 2 Confront challenges and stage 3 Moving forward or Withdraw from society.

Conclusions.  This study shows that patients suffering a spinal cord injury have to find their own way and learn to live with their disability. Patients who did better in living with spinal cord injury point could move forward, otherwise, they may withdraw from society.

Relevance to clinical practice.  Health professionals need to recognize patients’ experiences, perceptions and needs, to provide better nursing care.
A Health Need Satisfaction Instrument for Taiwan's single‐living older people with chronic disease in the community
Authors: Shih Shaw‐Nin , Gau Meei‐Ling , Tsai Jen‐Chen , Li I‐Chuan , Liou Ying‐Mei , Shih Fu‐Jin
Published: February 2008

Aims.  The aims of this study were to explore health needs and need satisfaction of Taiwan's single‐living older people with chronic disease in the community, develop a culturally sensitive Health Need Satisfaction Instrument and examine the relationships between health needs and need satisfaction.

Background.  Until now, there has been no reliable instrument for health professionals to assess, comprehensively, health needs and needs satisfaction for Chinese single‐living older people with chronic disease in the community.

Design.  Between‐method triangulation design was used. The first phase explored the contextual content of health needs from the perspectives of a purposive sampling (n = 44) using the explorative qualitative method. The second phase developed the Health Need Satisfaction Instrument and established its reliability and validity. The final phase implemented the instrument in a cohort study (n = 110) and examined the relationship between the respective/overall health needs and need satisfaction.

Results.  A Health Need Satisfaction Instrument with good validity and reliability encompassing tangible, psychospiritual and informational needs was developed. A significant correlation between tangible and psychospiritual needs (r = 0·238, p < 0·05) and between tangible and informational needs (r = 0·306, p < 0·01) was found. Three types of need satisfaction were inter‐related (p < 0·01). A negative correlation between global health needs and need satisfaction (r = −0·223, p < 0·05) was found. Each domain of need satisfaction was negatively correlated with that particular type of health needs (p < 0·01), except for psychospiritual need (r = 0·339, p < 0·01). A measurement model between health needs and need satisfaction was established.

Conclusion.  This study set a successful example of a rigorous, cross‐cultural instrument development process for community‐based Taiwan's single‐living older people.

Relevance to clinical practice.  Using Health Need Satisfaction Instrument, the less satisfied multidimensional health needs of community‐based Taiwan's single‐living older people with chronic disease can be more accurately assessed and met.
Patients’ illness perception four months after a myocardial infarction
Authors: Alsén Pia , Brink Eva , Persson Lars‐Olof
Published: February 2008

Aims and objectives.  The aim of this study was to explore patients’ illness perception of myocardial infarction four months after a myocardial infarction.

Background.  An important task for research on recovery from myocardial infarction is to understand the factors that influence an individual's adherence to secondary preventive strategies. Perceptual, cognitive and motivational factors have been found to influence adherence to a secondary preventive regimen.

Method.  Twenty‐five patients were interviewed four months after a myocardial infarction. In accordance with grounded theory methodology, data collection and analysis were carried out simultaneously.

Results.  The findings can be understood in light of two core categories: ‘trust in oneself ’ vs. ‘trust in others’; belief in one's own efforts to control the illness; and ‘illness reasoning’, lines of thought about illness identity. In searching for relationships, six categories describing variation in illness perceptions of a myocardial infarction emerged: (i) ‘sign of a chronic condition – feasible to influence’; (ii) ‘sign of a chronic condition – uncontrollable’; (iii) ‘acute event that can recur – feasible to influence’; (iv) ‘acute event that can recur – uncontrollable’; (v) ‘unthinkable acute event’; and (vi) ‘non‐recurring acute event’.

Conclusion.  The more reflective patients perceived the heart attack as a sign of a chronic condition; they also devoted time for reasoning about the possible causes of their illness. This is in contrast to patients who were less reflective and viewed their myocardial infarction as an acute event, which they avoided thinking about. The findings contribute to our understanding of variation in illness perceptions.

Relevance to clinical practice.  The examination of how individuals perceive myocardial infarction may help health‐care professionals individualize secondary preventive strategies, thereby improving adherence to health‐care regimens. Nurse–patient discussions could begin with identification of the patient's variations of reflectiveness concerning his/her illness.
How do older people experience their management of medicines?
Authors: Westerbotn Margareta , Fahlström Elin , Fastbom Johan , Agüero‐Torres Hedda , Hillerås Pernilla
Published: February 2008

Aim.  The aim of this study was to describe how older people living at home in Stockholm, Sweden, experienced the management of their own medication regimen from their own perspective.

Background.  Very old people tend to use more medicines, and without proper medication, many of them would not function well and would not be able to remain in their own homes.

Methods.  This qualitative study involved audiotaped interviews with 25 very old persons. Inclusion criteria: aged ≥85 years, mini‐mental state examination ≥24, living at home, taking medicines regularly. Data collected May–June 2005, analysed using content analysis.

Design.  Descriptive study.

Results.  Findings revealed that most participants managed their medicines by themselves and were very content with this. Older people who received some help with their medicines were also very pleased with that help. The most important components for older people were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back up.

Conclusion.  Our results indicate that most of the participants were very pleased with their medicine management, either on their own or they were able to get some help. There was, however, a need for assistance in delivering the medicines to their homes.

Relevance to clinical practice.  Understanding how older people experience their management of medicines and to reveal the components which may affect them in this situation is important to improve nursing care. To observe the life of an older person as a whole is important in nursing care, so that the person's behaviour can be understood, as how older people manage to handle their medicines may have an impact on their autonomy and on health‐care resource use.
The influence of culture on diabetes self‐management: perspectives of Gujarati Muslim men who reside in northwest England
Authors: Fleming Elizabeth , Carter Bernie , Pettigrew Judith
Published: February 2008

Aim. To present the findings of a study which explored the influence of culture on (type 2) diabetes self‐management in Gujarati Muslim men who reside in northwest England.

Background. This study was informed by an embodied perspective of culture, in which culture is grounded in the body and self. This contrasts with some contemporary health research and policy which adopts an oversimplified perspective, portraying culture as static and deterministic and being responsible for non‐adherent self‐management behaviours.

Method. A case‐study approach was used, which combined interview and participant observation methods. Data were collected from Gujarati Muslim men about their lived experiences of diabetes self‐management. These accounts, along with further narrative data from ‘significant other’ participants, were analysed over several cycles.

Results. Two central concepts guide the results: embodied culture and dynamic culture. These concepts reflect the subjective and contextual nature of culture and are illustrated in the themes ‘past experiences and socio‐economic factors’, ‘social and gendered roles’ and ‘personal choice and contextual factors’. The findings highlight that the complexity of life means that culture never exists in isolation, but is one of the many factors that a man negotiates to inform his diabetes self‐management.

Conclusion. We draw attention to the dissonance between the way culture is presented in some government policy and research, and the way it is understood in an embodied approach. TheNational Service Framework for Diabetesadvocates the provision of individualized culturally appropriate care, and in this paper, we make suggestions as to how an embodied approach can be incorporated within the framework.

Relevance to clinical practice. Nurses have an integral role in implementing the National Service Framework for Diabetes. This paper contributes to the debate about how nurses can best deliver this framework to a diverse patient population.
Toward a trajectory of adjustment in women with end‐stage renal disease on haemodialysis
Authors: Tanyi Ruth A , Werner Joan Stehle
Published: February 2008

Aims.  To examine the lived experiences of community‐dwelling women with end‐stage renal disease undergoing haemodialysis treatment.

Background.  End‐stage renal disease is a chronic progressive disease with renal transplantation as a major treatment option. However, the majority of patients choose haemodialysis as their primary treatment. In this disease, many changes occur in the body that demand adjustment in every aspect of these patients’ lives. The turbulent trajectory of adjusting to this disease and treatment has been under‐researched. Given the increased number of patients requiring haemodialysis, a fuller understanding of the experienced disease course is essential in guiding clinical efforts.

Method.  Descriptive phenomenology was used as it suited the purpose of this study.

Design.  Sixteen adult women from two large haemodialysis centres in a large Midwestern city in the USA were interviewed. All data were analysed using Colaizzi's methodological interpretation.

Findings.  Three major themes emerged supporting a possible adjustment trajectory: initiation‐the initial phase of adjustment; appreciation‐the middle phase of appreciating haemodialysis treatment; and grappling‐the later phase of dealing with adverse effects from haemodialysis. The findings, however, suggest that experiences in the adjustment trajectory are interwoven, circular and ongoing, rather than linear.

Conclusion.  More research is needed in this under‐researched area to guide practice for meeting the demands of this growing patient population.

Relevance to clinical practice.  These results provide knowledge that can assist nurses to implement care that is tailored to support adjustment, thus minimizing setbacks and improving patients’ well‐being.
Determining caseloads in the community care of frail older people with chronic illnesses
Authors: Williams Allison , Cooper Brad
Published: February 2008

Aims and objectives.  The purpose of this paper is to discuss and critique the literature related to the measurement of caseloads by sociomedical case managers in the context of community care for frail older people.

Background.  As a result of reduced mortality rates, there is an ageing, chronically ill population in need of long‐term continuity of care. Case management is a model of care designed to maintain the quality of life of frail older people living in the community whilst constraining the associated costs of care.

Method.  A review of the literature was undertaken to examine methods of determining caseloads for frail older people in the community setting to identify where investigations are absent or not robust.

Conclusions.  An absence of empirically tested approaches to determining caseloads and the wide variability in caseloads in caring for frail older people was evident. Predictors of variations in case management resources have been described at both the programme and client level, although controversy about the validity of these predictors, such as age and functional status, has been reported.

Relevance to clinical practice.  The ageing population is a vulnerable group, and is entitled to live out their lives in the comfort and familiarity of their own homes where possible. Coordinated and supportive healthcare organizations and health system policies are critical to support empirically tested caseload indexes. These findings have implications for quality of care, planning and workforce policy development for our increasingly aged society. Recommendations for further research conclude this paper.
Asymptomatic hypoesthesia of the maxillary alveolar ridge in complete denture wearers
Authors: KIMOTO S. , OGURA K. , FEINE J. S. , SASAI H. , YAMAGUCHI H. , SAITO T. , MATSUMARU Y. , KOBAYASHI K.
Published: February 2008

Summary  This study was carried out to investigate the effect of compression induced by complete dentures on the function of the nerves underlying the dentures. The influence of compression induced by complete dentures on nerve function was analysed using current perception threshold (CPT) in 33 complete denture wearers aged 50–80 at Nihon University School of Dentistry (Matsudo, Japan). Based on the age range of the complete denture group, dentate subjects were selected as a control. Because the group characteristics (such as subject age, gender, body mass index) and oral mucosal thickness were not matched, a multiple regression analysis was used to adjust for the influence of heterogeneous characteristics on the CPT. Statistically significant differences were found between subject groups for the nasopalatine and the greater palatine nerve. The results of the study were that complete denture wearers experience asymptomatic hypoesthesia mainly affecting the nasopalatine and greater palatine nerves, but not the infraorbital nerve.
The small GTPase Rac and the p21‐activated kinase Cla4 in Claviceps purpurea: interaction and impact on polarity, development and pathogenicity
Authors: Rolke Yvonne , Tudzynski Paul
Published: February 2008

Claviceps purpurea, the ergot fungus, is a highly specialized pathogen of grasses; its colonization of host ovarian tissue requires an extended period of strictly polarized, oriented growth towards the vascular tissue. To understand this process, we study the role of signalling factors affecting polarity and differentiation. We showed that the small GTPase Cdc42 is involved in polarity, sporulation and in planta growth in C. purpurea. Here we present evidence that the GTPase Rac has an even stronger and, in some aspects, inverse impact on growth and development: Δrac mutants form coralline‐like colonies, show hyper‐branching, loss of polarity, sporulation and ability to penetrate. Functional analyses and yeast two‐hybrid studies prove that the p21‐activated kinase Cla4 is a major downstream partner of Rac. Phosphorylation assays of MAP kinases and expression studies of genes encoding reactive oxygen species (ROS)‐scavenging and ‐generating enzymes indicate a function of Rac and Cla4 in fungal ROS homoeostasis which could contribute to their drastic impact on differentiation.
A temperature‐regulated Campylobacter jejuni gluconate dehydrogenase is involved in respiration‐dependent energy conservation and chicken colonization
Authors: Pajaniappan Mohanasundari , Hall Johanna E. , Cawthraw Shaun A. , Newell Diane G. , Gaynor Erin C. , Fields Joshua A. , Rathbun Kimberly M. , Agee Willie A. , Burns Christopher M. , Hall Stephen J. , Kelly David J. , Thompson Stuart A.
Published: February 2008

Campylobacter jejuni is a gastrointestinal pathogen of humans but can asymptomatically colonize the avian gut. C. jejuni therefore grows at both 37°C and 42°C, the internal temperatures of humans and birds respectively. Microarray and proteomic studies on temperature regulation in C. jejuni strain 81–176 revealed the upregulation at 42°C of two proteins, Cj0414 and Cj0415, orthologous to gluconate dehydrogenase (GADH) from Pectobacterium cypripedii. 81–176 demonstrated GADH activity, converting d‐gluconate to 2‐keto‐d‐gluconate, that was higher at 42°C than at 37°C. In contrast, cj0414 and cj0415 mutants lacked GADH activity. Wild‐type but not cj0415 mutant bacteria exhibited gluconate‐dependent respiration. Neither strain grew in defined media with d‐gluconate or 2‐keto‐d‐gluconate as a sole carbon source, revealing that gluconate was used as an electron donor rather than as a carbon source. When administered to chicks individually or in competition with wild‐type, the cj0415 mutant was impaired in establishing colonization. In contrast, there were few significant differences in colonization of BALB/c‐ByJ mice in single or mixed infections. These results suggest that the ability of C. jejuni to use gluconate as an electron donor via GADH activity is an important metabolic characteristic that is required for full colonization of avian but not mammalian hosts.
The biosynthesis and biological role of 6‐deoxyheptose in the lipopolysaccharide O‐antigen of Yersinia pseudotuberculosis
Authors: Ho Nathan , Kondakova Anna N. , Knirel Yuriy A. , Creuzenet Carole
Published: February 2008

Yersinia pseudotuberculosis O:2a harbours 6‐deoxy‐d‐manno‐heptose in its O‐antigen. The biological function of 6‐deoxyheptose and its role in virulence is unknown and its biosynthetic pathway has not been demonstrated experimentally. Here, we show that dmhA and dmhB are necessary for 6‐deoxyheptose biosynthesis in Y. pseudotuberculosis. Their disruption resulted in the lack of 6‐deoxyheptose in the O‐unit and its replacement by d‐glycero‐d‐manno‐heptose, thus indicating relaxed specificity of the glycosyltransferases, polymerase and ligase involved in lipopolysaccharide synthesis. The dmhB mutant exhibited a lower content in ketooctonic acid (Ko)‐containing core molecules and reduced ligation and polymerization of the O‐unit. We also show that Tyr128 is essential for activity of DmhB, and that DmhB functions as an oligomer, based on the dominant negative effect of overexpression of DmhB Y128F in dmhA. Moreover, we demonstrate that 6‐deoxyheptose is important for virulence‐related functions of the outer membrane and its appendages in vitro, such as barrier function against bile salts, polymyxin and novobiocin, and flagella‐mediated motility. Although both mutants colonized the mouse ceacum as well as the wild type, the dmhB mutant was impaired for colonization of the liver, suggesting that DmhB represents a potential therapeutic target.
Cleavage of mRNAs and role of tmRNA system under amino acid starvation in Escherichia coli
Authors: Li Xia , Yagi Mieko , Morita Teppei , Aiba Hiroji
Published: February 2008

We have shown previously that ribosome stalling during translation caused by various reasons leads to mRNA cleavage, resulting in non‐stop mRNAs that are eliminated in a tmRNA‐dependent manner. Amino acid starvation is a physiological condition in which ribosome stalling is expected to occur more frequently. Here we demonstrate that mRNA cleavage is induced by amino acid starvation, resulting in accumulation of truncated mRNAs in cells lacking tmRNA. The truncated mRNAs are eliminated in wild‐type cells, indicating that the tmRNA system rapidly degrade the truncated mRNAs. The cleavage pattern of model mRNAs in which serine codons were replaced with threonine codons indicated that mRNA cleavage occurs near serine codons in response to serine starvation. Cells lacking all of the five known toxin loci were proficient in mRNA cleavage, showing that toxin–antitoxin systems are not responsible for the cleavage. A mild serine starvation caused a significant growth inhibition in cells lacking tmRNA but not in wild‐type cells. The ribosome‐mediated mRNA cleavage along with the tmRNA system is an important mechanism that enables cells to adapt to amino acid starvation conditions.
FliL is essential for swarming: motor rotation in absence of FliL fractures the flagellar rod in swarmer cells of Salmonella enterica
Authors: Attmannspacher Ursula , Scharf Birgit E. , Harshey Rasika M.
Published: February 2008

fliL is the first gene in a flagellar operon that specifies members of the switch complex and type III export system in Salmonella enterica and Escherichia coli, but no function has been ascribed to this gene thus far. Here we report that a fliL mutant is slightly impaired for swimming but completely defective in swarming in both organisms, and have studied this phenotype further in S. enterica. We have found that on swarm agar, mutant cells release or ‘eject’ their flagellar filaments. The released filaments are attached to the hook and part of the rod structure; we have identified the distal rod protein FlgG but not the proximal rod protein FlgF in these filaments. Rod fracture was not observed if flagellar rotation was prevented by removal of proteins that supply proton flow through the motor. Based on these and other results, we propose that motors experience a higher torque on swarm agar owing to an increased proton motive force, and that FliL allows the rod to withstand the increased torsional stress. The flagella‐release phenotype of the S. enterica fliL mutant has a bearing on FliL‐dependent flagellar ejection during the swimmer‐ to stalk‐cell transition in the developmental cycle of Caulobacter crescentus.
Bicarbonate‐mediated transcriptional activation of divergent operons by the virulence regulatory protein, RegA, from Citrobacter rodentium
Authors: Yang Ji , Hart Emily , Tauschek Marija , Price G. Dean , Hartland Elizabeth L. , Strugnell Richard A. , Robins‐Browne Roy M.
Published: February 2008

Regulation of virulence gene expression plays a central role in the pathogenesis of enteric bacteria as they encounter diverse environmental conditions in the gastrointestinal tract of their hosts. In this study, we investigated environmental regulation of two putative virulence determinants adcA and kfc by RegA, an AraC/XylS‐like regulator, from Citrobacter rodentium, and identified bicarbonate as the environmental signal which induced transcription of adcA and kfc through RegA. Primer extension experiments showed that adcA and kfc were divergently transcribed from σ70 promoters. In vivo and in vitro experiments demonstrated that bicarbonate facilitated and stabilized the binding of RegA to an operator located between the two promoters. The interaction of RegA with its DNA target resulted in the formation of a nucleosome‐like structure, which evidently displaced the histone‐like proteins, H‐NS and StpA, from the adcA and kfc promoter regions, leading to transcriptional derepression. In addition, our results indicated that RegA also behaved as a Class I activator by directly stimulating transcription initiation by RNA polymerase. This is the first report to describe the molecular mechanism by which an environmental chemical stimulates transcription of virulence‐associated genes of an enteric pathogen through an AraC/XlyS‐like activator.
GLP‐1 suppresses gastrointestinal motility and inhibits the migrating motor complex in healthy subjects and patients with irritable bowel syndrome
Authors: Hellström P. M. , Näslund E. , Edholm T. , Schmidt P. T. , Kristensen J. , Theodorsson E. , Holst J. J. , Efendic S.
Published: February 2008

Abstract  Glucagon‐like peptide‐1 (GLP‐1) is released after food intake to act as an incretin. GLP‐1 also inhibits gastric emptying and increases satiety. In rats, GLP‐1 inhibits small bowel motility. Our aim was to study the effects of GLP‐1 on gastrointestinal motility in healthy subjects and patients with irritable bowel syndrome (IBS). Antro‐duodeno‐jejunal manometry was carried out during a 4‐h control period with saline, followed by a 4‐h period with intravenous GLP‐1 (healthy: 0.7 and 1.2 pmol kg−1 min−1 (n = 16); IBS, 1.2 and 2.5 pmol kg−1 min−1 (n = 14). Plasma was analysed for GLP‐1 and gut hormones, and gut tissue expression of GLP‐1 receptor was studied. In healthy subjects, GLP‐1 0.7 pmol kg−1 min−1 reduced the migrating motor complexes (MMCs) from a median of 2 (range 2–3) to 0.5 (0–2), and motility index from 4.9 ± 0.1 to 4.3 ± 0.3 ln ∑(mmHg*s min−1) in jejunum, while GLP‐1 1.2 pmol kg−1 min−1 diminshed MMCs from 2 (2–3) to 1.5 (1–2.5), and motility index from 5.2 ± 0.2 to 4.4 ± 0.2. In IBS patients, GLP‐1 1.2 pmol kg−1 min−1 reduced the MMCs from 2.5 (2–3.5) to 1 (0–1.5) without affecting motility index. At 2.5 pmol kg−1 min−1 GLP‐1 decreased MMCs from 2 (1.5–3) to 1 (0.5–1.5), and motility index from 5.2 ± 0.2 to 4.0 ± 0.5. Motility responses to GLP‐1 were similar in antrum and duodenum. Presence of the GLP‐1 receptor in the gut was verified by reverse transcriptase PCR. In conclusion, the gut peptide GLP‐1 decreases motility in the antro‐duodeno‐jejunal region and inhibits the MMC in healthy subjects and IBS patients.
Multichannel electrogastrography under a magnifying glass – an in‐depth study on reproducibility of fed state electrogastrograms
Authors: Krusiec‐świdergoł B. , Jonderko K.
Published: February 2008

Abstract  We checked on reproducibility of parameters of a multichannel electrogastrogram in adults after intake of typical, applied in electrogastrography, test meals. Recordings of multichannel electrogastrograms were accomplished in four blocks comprising 18 subjects (nine healthy volunteers and nine patients with functional GI disorders) each. Every subject had two examinations taken 1‐2 days apart, and a third one was accomplished at least 2 weeks before or after the two other sessions. The registration involved a 30‐min fasted and a 2‐h postprandial period after one of the meal stimuli tested within a given block: 400 mL water, 400 g yoghurt (378 kcal), a scrambled eggs sandwich (370 kcal), a pancake (355 kcal). From among the parameters reflecting the propagation of the gastric slow waves, the average percentage of slow wave coupling (APSWC) exhibited a good (coefficient of variation for paired examinations CVp ≤ 10%) to moderate (10< CVp ≤30%) reproducibility. On the other hand, the reproducibility of the maximum dominant frequency difference and the spatial dominant power difference was found to be unsatisfactory. The reproducibility of the multichannel electrogastrographic parameters did not differ between healthy volunteers and patients with functional GI disorders. Gender or the kind of a test meal did not affect the reproducibility of the electrogastrographic parameters either. The medium‐term reproducibility was not any worse than the short‐term one. From among the parameters of a multichannel electrogastrogram intended to quantify the propagation of slow waves, only the APSWC offers a reproducibility potentially good enough for clinical applications.
Distribution and expression levels of somatostatin and somatostatin receptors in the ileum of normal and acutely Schistosoma mansoni‐infected SSTR2 knockout/lacZ knockin mice
Authors: Van Op Den Bosch J. , Lantermann K. , Torfs P. , Van Marck E. , Van Nassauw L. , Timmermans J.‐p.
Published: February 2008

Abstract  We recently described the widespread expression of somatostatin (SOM) receptors (SSTRs) in the non‐inflamed and inflamed murine ileum. Surprisingly, no significant changes were observed in the SSTR2 expression during intestinal inflammation. These data, combined with several recent independent lines of investigation, raised some question about the long presumed central role of SSTR2 in the SOM‐mediated effects in the physiological and pathological activity of the gastrointestinal (GI) tract. To further unravel the role of SSTR2 in GI physiology, we studied the expression of SOM and SSTRs in the normal and inflamed SSTR2 knockout/lacZ knockin (SSTR2−/−) ileum. The SSTR2−/− ileum was characterized by a widespread distribution of multiple SSTR subtypes in non‐inflamed and inflamed conditions. Moreover, the absence of SSTR2 did not induce any compensatory effect in the distribution pattern or expression level of any of the other SSTR subtypes. In contrast, the amount of SOM mRNA was significantly lower in SSTR2−/− ileum than that in wild type animals. Quantitative analysis revealed a decreased number of SOM‐expressing neurons in both enteric plexuses of the knockout animals, implying a possible link between the number of SOM‐expressing enteric neurons and the expression of SSTR2 in the enteric nervous system. In conclusion, these data show that a reconsideration of the role of SSTR2 in the GI somatostatinergic effects is in order and further corroborate recent data on the role of other SSTR subtypes in the inflammatory effects of SOM during intestinal inflammation.