bluuebunny/crossref_metadata_2025 huggingface dataset:
A Longitudinal Examination of Racial Identity and Racial Discrimination Among African American Adolescents
Authors: Seaton Eleanor K. , Yip Tiffany , Sellers Robert M.
Published: May 2009

This study tested the longitudinal association between perceptions of racial discrimination and racial identity among a sample of 219 African American adolescents, aged 14 to 18. Structural equation modeling was used to test relations between perceptions of racial discrimination and racial identity dimensions, namely, racial centrality, private regard, and public regard at 3 time points. The results indicated that perceived racial discrimination at Time 1 was negatively linked to public regard at Time 2. Nested analyses using age were conducted, and perceptions of racial discrimination at Time 2 were negatively linked to private regard at Time 3 among older adolescents. The findings imply that perceived racial discrimination is linked to negative views that the broader society has of African Americans.
Heterogeneity and Change in the Patterning of Adolescents’ Perceptions of the Legitimacy of Parental Authority: A Latent Transition Model
Authors: Cumsille Patricio , Darling Nancy , Flaherty Brian , Loreto Martínez María
Published: May 2009

Changes in the patterning of adolescents’ beliefs about the legitimate domains of parental authority were modeled in 2,611 Chilean adolescents, 11–16 years old. Transitions in adolescents’ belief patterns were studied over 3 years. Latent transition analysis (LTA) revealed 3 distinct patterns of beliefs—parent control, shared control, and personal control—that differed in the extent to which adolescents believed that parents had legitimate authority over personal, prudential, and multidomain issues. Younger adolescents with fewer problem behaviors, higher self‐efficacy, and more parental rules were more likely to espouse the parent control belief pattern. Adolescents’ patterning of beliefs was relatively stable over time. Older adolescents with more problem behaviors and fewer parental rules were most likely to move away from the parental control status.
Children’s Moral Motivation, Sympathy, and Prosocial Behavior
Authors: Malti Tina , Gummerum Michaela , Keller Monika , Buchmann Marlis
Published: May 2009

Two studies investigated the role of children’s moral motivation and sympathy in prosocial behavior. Study 1 measured other‐reported prosocial behavior and self‐ and other‐reported sympathy. Moral motivation was assessed by emotion attributions and moral reasoning following hypothetical transgressions in a representative longitudinal sample of Swiss 6‐year‐old children (N = 1,273). Prosocial behavior increased with increasing sympathy, especially if children displayed low moral motivation. Moral motivation and sympathy were also independently related to prosocial behavior. Study 2 extended the findings of Study 1 with a second longitudinal sample of Swiss 6‐year‐old children (N = 175) using supplementary measures of prosocial behavior, sympathy, and moral motivation. The results are discussed in regard to the precursors of the moral self in childhood.
The Development of Gendered Interests and Personality Qualities From Middle Childhood Through Adolescence: A Biosocial Analysis
Authors: McHale Susan M. , Kim Ji‐Yeon , Dotterer Aryn M. , Crouter Ann C. , Booth Alan
Published: May 2009

This study charted the development of gendered personality qualities and activity interests from age 7 to age 19 in 364 first‐ and secondborn siblings from 185 White, middle/working‐class families, assessed links between time in gendered social contexts (with mother, father, female peers, and male peers) and gender development, and tested whether changes in testosterone moderated links between time use and gender development. Multilevel models documented that patterns of change varied across dimensions of gender and by sex and birth order and that time in gendered social contexts was generally linked to development of more stereotypical qualities. Associations between time with mother and expressivity and time with father and instrumentality were stronger for youth with slower increases in testosterone.
Resilience Among Children Exposed to Domestic Violence: The Role of Risk and Protective Factors
Authors: Martinez‐Torteya Cecilia , Anne Bogat G. , Von Eye Alexander , Levendosky Alytia A.
Published: May 2009

Individual and family characteristics that predict resilience among children exposed to domestic violence (DV) were examined. Mother–child dyads (n = 190) were assessed when the children were 2, 3, and 4 years of age. DV‐exposed children were 3.7 times more likely than nonexposed children to develop internalizing or externalizing problems. However, 54% of DV‐exposed children maintained positive adaptation and were characterized by easy temperament (odds ratio [OR] = .39, d = .52) and nondepressed mothers (OR = 1.14, d = .07), as compared to their nonresilient counterparts. Chronic DV was associated with maternal depression, difficult child temperament, and internalizing or externalizing symptoms. Results underscore heterogeneous outcomes among DV‐exposed children and the influence of individual and family characteristics on children’s adaptation.
Harsh Parenting and Child Externalizing Behavior: Skin Conductance Level Reactivity as a Moderator
Authors: Erath Stephen A. , El‐Sheikh Mona , Mark Cummings E.
Published: May 2009

Skin conductance level reactivity (SCLR) was examined as a moderator of the association between harsh parenting and child externalizing behavior. Participants were 251 boys and girls (8–9 years). Mothers and fathers provided reports of harsh parenting and their children’s externalizing behavior; children also provided reports of harsh parenting. SCLR was assessed in response to a socioemotional stress task and a problem‐solving challenge task. Regression analyses revealed that the association between harsh parenting and externalizing behavior was stronger among children with lower SCLR, as compared to children with higher SCLR. SCLR may be a more robust moderator among boys compared to girls. Results are discussed with regard to theories on antisocial behavior and multiple‐domain models of child development.
The Cognitive and Behavioral Characteristics of Children With Low Working Memory
Authors: Alloway Tracy Packiam , Gathercole Susan Elizabeth , Kirkwood Hannah , Elliott Julian
Published: May 2009

This study explored the cognitive and behavioral profiles of children with working memory impairments. In an initial screening of 3,189 five‐ to eleven‐year‐olds, 308 were identified as having very low working memory scores. Cognitive skills (IQ, vocabulary, reading, and math), classroom behavior, and self‐esteem were assessed. The majority of the children struggled in the learning measures and verbal ability. They also obtained atypically high ratings of cognitive problems/inattentive symptoms and were judged to have short attention spans, high levels of distractibility, problems in monitoring the quality of their work, and difficulties in generating new solutions to problems. These data provide rich new information on the cognitive and behavioral profiles that characterize children with low working memory.
REAL EXCHANGE RATE, DISTRIBUTION AND MACRO FLUCTUATIONS IN EXPORT‐ORIENTED ECONOMIES
Authors: La Marca Massimiliano
Published: May 2009

The paper investigates the emergence of alternative growth, distribution and real exchange rate patterns as outcomes of institutional and socio‐economic interactions between broadly defined actors in an export‐oriented economy. The focus is on both the long‐run configuration and short‐run dynamics of the real exchange rate, the profit and wage shares, output growth, capacity utilization, and net foreign asset accumulation in a stock‐flow consistent framework with fiscal polices affecting the internal and external equilibrium. Fluctuations in output and distribution between income shares and the real exchange rate are obtained via Structuralist‐Goodwin dynamics.
Sub‐optimal CD4 recovery on long‐term suppressive highly active antiretroviral therapy is associated with favourable outcome
Authors: Önen NF , Overton ET , Presti R , Blair C , Powderly WG , Mondy K
Published: May 2009

Objectives
To examine risk factors for sub‐optimal CD4 recovery on suppressive highly active antiretroviral therapy (HAART) and assess long‐term clinical and immunological outcomes.

Methods
Retrospective analysis of 286 HIV‐positive patients from a university clinic who initiated HAART with CD4 count <350 cells/μL between January 1996 and July 2006 and achieved ≥52 weeks of viral suppression (VS). Sub‐optimal and optimal CD4 count recovery were defined by gains of <150 and ≥150 cells/μL during the first year of VS, respectively. Risk factors were analysed by multivariate logistic regression and markers of immune maturation and activation were evaluated prospectively for a sub‐group of patients with prolonged (>5 years) VS.

Results
One hundred and two (36%) patients had sub‐optimal CD4 recovery. Male gender, lower pre‐HAART viral load, HAART toxicity and use of opportunistic infection (OI) prophylaxis were independent risk factors on multivariate analysis (P<0.05). Outcomes of duration of VS on HAART (4 years), new OI events (1%) and mortality (5%) were similar between groups. Markers of immune maturation and activation were higher among patients with sub‐optimal CD4 recovery (P<0.05).

Conclusions
Among HIV‐positive patients with long‐term VS, sub‐optimal CD4 recovery was common but morbidity and mortality remained low. In addition, persistent CD4 T‐cell activation appeared to blunt long‐term CD4 gains.
Cryptogenic liver disease in HIV‐seropositive men
Authors: Dinh MH , Stosor V , Rao SM , Miller FH , Green RM
Published: May 2009

Objectives
In the era of highly active antiretroviral therapy (HAART), liver disease has become a leading cause of morbidity and mortality in HIV‐seropositive individuals. Although liver disease is commonly caused by viral co‐infection, it has also been described in patients without viral hepatitis. In this study, we determined clinical factors associated with the development of cryptogenic liver disease in HIV‐infected individuals.

Methods
HIV‐seropositive and ‐seronegative patients undergoing evaluation for liver transplantation were selected if they met clinical criteria for cryptogenic liver disease. Clinical data were collected retrospectively, and radiological and histological data were reviewed separately.

Results
Nine HIV‐seropositive individuals were compared with 41 HIV‐seronegative patients with cryptogenic liver disease. Only one HIV‐seropositive patient (11%) had cirrhosis, compared to 39 HIV‐seronegative patients (93%) (P<0.001). Three HIV‐infected patients (33%) had histological evidence of nodular regenerative hyperplasia. HIV‐seropositive patients had significantly lower body mass indices, and lower Child–Pugh–Turcotte and Model for Endstage Liver Disease scores than HIV‐seronegative patients (P<0.05).

Conclusions
Advanced cryptogenic liver disease in HIV‐infected patients is infrequently caused by cirrhosis, and more frequently by nodular regenerative hyperplasia. This disease entity may become more common in the HAART era, and may contribute to an increased morbidity in HIV‐infected individuals.
Long‐term follow‐up of nevirapine‐treated patients in a single‐centre cohort
Authors: Colafigli M , Di Giambenedetto S , Bracciale L , Fanti I , Prosperi M , Cauda R , De Luca A
Published: May 2009

Objectives
We reviewed the safety and efficacy of nevirapine (NVP)‐based therapy in all patients initiating NVP‐containing combined antiretroviral therapy [cART (≥3 drugs)] in our clinic since 1994.

Methods
Patient characteristics and laboratory values from the start of the NVP‐based cART regimen to the last available follow‐up or to NVP discontinuation were retrieved from an observational database.

Results
Five hundred and seventy‐three patients were treated with NVP‐based cART for a median of 18.4 (range 0.1–128.8) months. The 1‐year cumulative estimated probability of discontinuing NVP‐containing regimens for toxicity was 0.203. Only 1.9% developed a grade 3 alanine aminotransferase (ALT) elevation. Significant increases in high‐density lipoprotein cholesterol were observed up to month 12 except in treatment‐naïve patients, where the increase was limited to 3 months. Discontinuation because of cutaneous reaction was predicted independently by female gender [Hazard Ratio (HR) 3.21, P<0.001] and Centers for Disease Control class C (HR 0.50, P=0.012). Discontinuation because of liver toxicity was predicted independently by anti‐hepatitis C virus positivity (HR 3.84, P<0.001). In patients starting NVP‐containing cART with undetectable viral loads, the 5‐year estimated probability of viral load >400 HIV‐1 RNA copies/mL was 0.34.

Conclusions
Long‐term follow‐up with an NVP‐containing cART showed a low rate of discontinuation caused by liver toxicity and the maintenance of virological suppression in patients switched with undetectable viral loads.
Tenofovir‐associated renal and bone toxicity
Authors: Woodward CLN , Hall AM , Williams IG , Madge S , Copas A , Nair D , Edwards SG , Johnson MA , Connolly JO
Published: May 2009

Objectives
The aims of the study were to describe the clinical presentation and renal and bone abnormalities in a case series of HIV‐infected patients receiving treatment with tenofovir (TDF), and to recommend appropriate screening for toxicity related to TDF.

Methods
Patients were identified from referrals to a specialist HIV renal clinic. Patients were included if treatment with TDF was assessed as the primary cause of the renal function impairment and clinical data were available prior to and following discontinuation of TDF treatment. Data were collected from case note review and clinic databases.

Results
Twenty‐two patients (1.6% of all those who received TDF) were identified with TDF‐associated renal toxicity. All had normal serum creatinine prior to TDF therapy. All presented with proteinuria. On stopping TDF, renal function improved. Eight patients had confirmed Fanconi syndrome. Twelve patients presented with bone pain and osteomalacia was confirmed on an isotope bone scan in seven of these patients. The findings (in those patients tested) of tubular proteinuria, reduced tubular transport maximum of phosphate (TmP), and glycosuria were all consistent with the proximal tubule being the site of toxicity.

Conclusion
Renal toxicity remains a concern in patients treated with TDF. Clinical presentation may be with renal dysfunction, Fanconi syndrome or osteomalacia. Our investigations suggest proximal tubular toxicity as a common pathogenic mechanism.
Trends in mortality and antibiotic resistance among HIV‐infected patients with invasive pneumococcal disease
Authors: Grau I , Ardanuy C , Liñares J , Podzamczer D , Schulze MH , Pallares R
Published: May 2009

Objectives
The aim of the study was to describe trends and risk factors for mortality and changes in antibiotic resistance, serotypes and clones among HIV‐infected patients with invasive pneumococcal disease (IPD).

Methods
A prospective study of 199 episodes of IPD occurring in a cohort of 4011 HIV‐infected patients was carried out. Predictors of mortality included clinical and microbiological data. The 7‐valent pneumococcal conjugate vaccine (PCV7) for children was introduced in late 2001. Time periods were classified for mortality studies as pre‐ (1986–1996), early (1997–2001) and late (2002–2007) highly active antiretroviral therapy (HAART) era, and for serotype studies as pre‐PCV7 (1986–2001) and PCV7 (2002–2007) era.

Results
Of 199 IPD episodes, 71 (36%) occurred in HIV‐infected patients with associated comorbidities (mainly liver cirrhosis; 52 of 71), which increased in recent years. The incidence of IPD decreased from the pre‐HAART era to the early HAART era and then remained stable in the late HAART era (24.1, 8.4 and 7.4 episodes per 1000 patient‐years, respectively). Rates of 30‐day mortality have risen over the three periods (8, 19 and 25%, respectively; P=0.017). In multiple logistic regression analysis, predictors of mortality were shock at presentation [odds ratio (OR) 7.01; 95% confidence interval (CI) 2.05–23.87] and associated comorbidities (OR 4.27; 95% CI 1.53–11.92). In the PCV7 era, IPD caused by non‐PCV7 serotypes increased, and resistance to betalactams decreased. The most frequent genotypes were Spain9V‐ST156, Spain23F‐ST81, ST8819F, Sweden1‐ST304 and Spain6B‐ST90.

Conclusions
In the late HAART era, the incidence of IPD has not significantly decreased. Mortality from IPD has risen in association with an increase in comorbidities such as liver cirrhosis. New vaccination strategies are needed to diminish the burden of IPD in the HIV‐infected population.
Effects of feature types on proportion discrimination
Authors: TOKITA MIDORI , ISHIGUCHI AKIRA
Published: May 2009

Abstract:  We investigated the effects of feature types on statistical description of relative frequency by testing the accuracy and precision in a proportion discrimination task. We used search symmetry pairs and search asymmetry pairs as the elements for comparison. In Experiment 1, we used sets of red and green dots and sets of parallel lines and converging lines as search symmetry pairs, and we used sets of circles and circles with lines as a search asymmetry pair. The results demonstrated that the proportion of pop‐out elements in the asymmetry pair was overestimated and that precision of proportion discrimination differed between pairs. In Experiment 2, to eliminate the possibility that the overestimation found in Experiment 1 was due to quantitative dominance, we used sets of circles with gaps and circles. In Experiment 3, we tested the effect of the exposure duration on the performance of proportion discrimination to determine the source of bias and of difference in precision. Overall, the findings show that the performance of the proportion discrimination depended on the types of features being compared.
Culture and visual perception: Does perceptual inference depend on culture?1,2
Authors: ISHII KEIKO , TSUKASAKI TAKAFUMI , KITAYAMA SHINOBU
Published: May 2009

Abstract:  Some perceptual cues carry information about the overall pattern of an object (holistic cues), whereas others carry information about the distinct parts of an object (part cues). Drawing on recent work on culture and cognition, the authors predicted that people with European‐American cultural backgrounds would be more capable of using part cues in perceptual inference than those with Asian backgrounds. No such cross‐cultural difference was expected for the ability to use holistic cues. In two studies, participants were presented with either one of the two types of cues and asked to infer the identity of the original objects. As predicted, in the part‐cue condition European‐American participants performed better than did Japanese (Study 1) and Asian‐American participants (Study 2). Also as predicted, there was no cultural difference in the holistic‐cue condition. The results were interpreted with reference to other related studies documenting reliable cross‐cultural differences in cognition.
Biogenic volatile organic compounds in the Earth system
Authors: Laothawornkitkul Jullada , Taylor Jane E. , Paul Nigel D. , Hewitt C. Nicholas
Published: May 2009

Biogenic volatile organic compounds produced by plants are involved in plant growth, development, reproduction and defence. They also function as communication media within plant communities, between plants and between plants and insects. Because of the high chemical reactivity of many of these compounds, coupled with their large mass emission rates from vegetation into the atmosphere, they have significant effects on the chemical composition and physical characteristics of the atmosphere. Hence, biogenic volatile organic compounds mediate the relationship between the biosphere and the atmosphere. Alteration of this relationship by anthropogenically driven changes to the environment, including global climate change, may perturb these interactions and may lead to adverse and hard‐to‐predict consequences for the Earth system.

Contents

Summary
27

I.
Introduction
27

II.
Regulation of BVOC emission
30

III.
Roles of BVOCs in the Earth system
32

IV.
BVOCs in a changing global environment
36

V.
Synthesis
44

Acknowledgements
44

References
44
Family decision‐making in advanced dementia: narrative and ethics
Authors: Elliott Barbara A. , Gessert Charles E. , Peden‐McAlpine Cynthia
Published: May 2009

Background:  Traditionally, family members become decision‐makers for ageing parents with cognitive impairment. Our understanding of how families negotiate the ethical issues in this decision‐making is still developing.

Aim:  To describe and understand the ethical thinking used in end‐of‐life decision‐making by family surrogates on behalf of their cognitively impaired elders.

Methods:  Qualitative research with eight focus groups that included 39 family members of severely impaired nursing home residents in Minnesota. Transcripts were analysed using a thematic approach.

Findings:  The family surrogates described their decision‐making as a process based in the families’ stories and as extensions of the elders’ identities. Four themes emerged from the analysis of the families’ decision‐making: (i) acquisition of decision‐making authority, (ii) decision‐making for short‐term or long‐term time frames, (iii) justifying the decisions and (iv) advocacy for the elders.

Conclusions:  The families in these focus groups used the elders’ life stories to frame their decisions for care. Providers working in primary care settings who work with families in making care decisions for cognitively impaired elderly patients may find narrative ethics more pertinent than principle‐based ethics in understanding families’ perspectives and priorities, while also recognizing their decision‐making transition from using the principle of autonomy to that of beneficence.
A difficult mission to work as a nurse in a residential care home – some registered nurses’ experiences of their work situation
Authors: Karlsson Inger , Ekman Sirkka ‐ Liisa , Fagerberg Ingegerd
Published: May 2009

The aim of the study was to describe Registered Nurses’ (RNs) experiences of their work environment in residential care homes for older persons. Twelve RNs were interviewed and latent content analysis was used for analysing the data. The data were collected in the spring of 2006. The findings revealed that these RNs experienced a paradoxical work environment: feeling appreciated and valuable, whilst at the same time feeling underestimated and frustrated. They felt appreciated and valuable when they provided nursing care and trust and support to others. The RNs experienced a positive work environment when the border between social and nursing care were clear. They also felt frustrated when they were expected to ‘be everywhere and to know everything’, but at the same time they felt invisible and underestimated. They experienced themselves as ‘lonely fixers’, having the ability to solve practical problems when the older persons were discharged from hospital and expected to be able to provide specialist nursing care without having specialised competence and specialist staff team members. In conclusion, it is important that the RNs can identify the border for nursing care. When these are clear, the nursing care objectives are apparent and the RNs become more autonomous, visible and listened to. The manager should listen to and support the RNs, with continuous supervision and competence development being mandatory elements. It is a difficult task for RNs working in residential care homes to meet all of the expectations placed on them, resulting in a risk of moral distress, making mistakes and developing illnesses caused by stress.
Nursing students’ attitudes towards HIV/AIDS patients in Finland, Estonia and Lithuania
Authors: Suominen Tarja , Koponen Niina , Staniuliene Vida , Istomina Natalja , Aro Ilme , Kisper‐Hint Ima‐Riina , Vänskä Maj‐Lis , Välimäki Maritta
Published: May 2009

This paper presents baseline data on attitudes towards HIV/AIDS patients and homophobic levels among nursing students in three Baltic Sea countries: Finland, Estonia and Lithuania. The aim is to describe and compare nursing students’ attitudes in these three countries and to explore how attitudes towards HIV/AIDS correlate with background variables. The total sample comprised 471 nursing students. The respondents demonstrated average attitude scores towards patients with HIV/AIDS and rather positive attitudes towards homosexually oriented patients. Significant country differences were found, with Finnish nursing students showing the most positive attitudes towards HIV/AIDS patients and homosexually oriented patients. Previous experience of HIV/AIDS patients was the single factor with the greatest positive impact on nursing students’ attitudes. Nursing students’ willingness to provide care for an HIV/AIDS patient was associated with a positive attitude towards these patients. Length of employment experience correlated negatively with general attitude, and older nursing students with more work experience showed a more negative attitude towards homosexual patients. Proper education to achieve a sound knowledge base and good nursing skills promotes a more positive attitude to HIV/AIDS. It is important that nursing students are sensitive and show respect for the patient’s human dignity. There is need for greater harmonization of education in the three countries.
Primacy of existential pain and suffering in residents in chronic pain in nursing homes: a phenomenological study
Authors: Gudmannsdottir Gudrun Dora , Halldorsdottir Sigridur
Published: May 2009

The study’s rationale: Chronic pain is a major health problem among the elderly, both in the community and within nursing homes.

Aims and objectives: The purpose of the study was to examine the essentials of the experience of residents in chronic pain in nursing homes.

Methodological design and methods: The research approach was interpretive phenomenology. Data were collected in 23 dialogues with 12 residents, ages 74–97. Mean age was 86 years.

Results: The main finding is theprimacy of existential pain and sufferingin residents in chronic pain in nursing homes. Indeed they recounted aculminationof existential pain and suffering, e.g. loss of loved ones, loss of former home, health and independence, as well as loss of connectedness. Many seemed to be in some kind of grief and theirwork towards reconciliationto their life and circumstances seemed an ongoing process with successful results while others seemed more haltering or even stuck. Living with chronic pain in a nursing home is indeeda challengeand manyblocks to successful pain managementwere identified. The main sources of strength were loved ones who were seen aslifelines. Nurses seemed distant in their narratives of pain management.

Study limitations: Frailty of residents is a limitation as a few were starting to forget from one interview to the other and some were actually in pain at the time of our dialogue.

Conclusions: It is important to support ahealthy process of grieving and reconciliationin elderly people who live with chronic pain in nursing homes. Those who suffer in silence with their pain and discomforts and do not seek help should be identified and cared for. The residents’ own sources of strength should be identified and supported. Multi‐professional collaboration with educational thrust is needed towards quality pain management of elderly people in nursing homes where existential pain and suffering is not excluded.
Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment – a survey in a Swedish healthcare setting
Authors: Källman Ulrika , Suserud Björn‐Ove
Published: May 2009

The aim of this study was to investigate (i) attitudes among Registered Nurses (RNs) and Nursing Assistants (NAs) regarding pressure ulcer prevention, (ii) knowledge among RNs and NAs of pressure ulcer prevention and treatment, (iii) practice of risk assessment and documentation regarding pressure ulcers among RNs and NAs and (iv) to identify perceived possibilities and barriers in pressure ulcer prevention and treatment. In this cross‐sectional study, a total of 230 questionnaires were distributed to an equal number of RNs and NAs in both municipality as well as hospital care settings. The response rate was 67% (n = 154). In general, all respondents displayed good knowledge on prevention and treatment of pressure ulcers and demonstrated a positive attitude towards this area of care. However, answers provided to some questions indicate that recent research findings and guidelines have not succeeded in reaching out to these occupational groups. Furthermore, only 37% (n = 55) of the participants said that they have an agreed strategy for the prevention of pressure ulcers in their unit. These shortcomings may affect the quality of care provided to the patient and lead to pressure ulcers developing as a consequence. Today, evidence‐based methods for risk assessment are available but are not adopted and used in practice. The study highlights the need to further reduce the gap between research and practice.
Elderly people’s perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden
Authors: Harrefors Christina , Sävenstedt Stefan , Axelsson Karin
Published: May 2009

Many countries encounter a demographic change where the number of elderly people will increase. As a result, the number of very old people needing care, services and medical assistance will increase. Care in the private home is often described as providing the best alternative for many elderly people. The aim of this study was to describe elderly people’s perceptions of how they wanted to be cared for, from a perspective of becoming in need of assistance with personal care, in the future. Twelve couples of healthy elderly people living in a couple hood participated in an interview study. They were all 70 years and older and received no kind of professional care or social support. Open individual semi‐structured interviews were conducted with the support of written vignettes. The vignettes were formed as scenarios that described three levels of caring needs where the elderly people would become ill. A qualitative content analysis was used to analyse the interviews. The findings were interpreted in one main theme: maintaining the self and being cared for with dignity to the end. The theme was built from three categories: at home as long as possible, professional care at nursing home when advanced care is needed and fear of being abandoned. The categories reflect the perception that when minimum help was needed, care and support by the partner and nursing staff were preferred. As the scenarios changed to being totally dependent on care, they preferred care in a nursing home. There was a pervading concern of the risk of not being seen as an individual person and becoming a nobody with no meaningful relations. Thus, there must be a singular goal to support old people, in all stages of their lives, through the recognition and affirmation of self, and providing care with dignity to the end.
The nature of nursing research: dissertations in the Nordic countries, 2003
Authors: Lundgren Solveig M. , Valmari Gudrun , Skott Carola
Published: May 2009

Nursing and caring research has followed various paths in different countries and there are diverse views regarding the central phenomena in nursing science. An overview of Nordic nursing and caring science from 1974 to 2000 revealed that conceptualizations and design of enquiry differed. It therefore was of interest to investigate the overall picture regarding more recent and present doctoral dissertations on this subject. The aim of this study was to investigate the locus of interest and the content of current nursing and caring research in Nordic doctoral dissertations within the field presented during 2003. A total of 26 doctoral dissertations were read and studied. The analysis was inspired by Kim’s metaparadigmatic typology of four domains for structuring nursing knowledge. The investigation shows that the research in these dissertations, with some exceptions, was oriented towards phenomena belonging to the client domain (18 dissertations). Less knowledge has been gained in the client–nurse (two dissertations); four dissertations were categorized within the practice domain and environment domain includes two dissertations. The research conducted was primarily oriented towards pragmatic aspects and the practical application of knowledge, whereas basic research aiming at defining an autonomous science is exceptional. This means that scientific knowledge regarding and forming the discipline’s unique perspective and value system could still be in evolution. A combination of a carefully and well‐designed research practice, reflecting the need to further research and investigate new theoretical regions would appear to constitute the direction forward.
Sense of coherence and psychiatric morbidity in terms of anxiety and depression in patients with major depression before and after electric convulsive treatment
Authors: Langius‐Eklöf Ann , Samuelsson Mats
Published: May 2009

The specific aim of this study was to explore if the Sense of Coherence (SOC) Scale reflects and overlaps with standardized psychiatric assessments of depression and anxiety leading to the main hypothesis that the degree of depression decreases while the SOC scores remain stable. Fifteen patients with a diagnosis of major depression according to Axis I in DSM‐IV and planned electric convulsive treatment (ECT) participated in the study. The clinician‐rated instruments, Montgomery Åsberg Depression Rating Scale (MADRS) and Global Assessment of Function (GAF), and the self‐assessment instruments such as SOC and the Comprehensive Psychopathological Rating Scale‐Self Rating Scale for Affective Syndromes (CPRS‐S‐A) were used before and after the treatment. The patients showed statistically significant improvements in clinician‐rated depression (p < 0.001) and functional status (p < 0.001), and in self‐rated anxiety (p = 0.001) and depression (p = 0.003). There was no significant improvement in SOC (p = 0.213). No significant correlations were found between the SOC scores and any of the measures except for GAF after treatment (r = 0.57, p = 0.039); the lower the SOC scores the greater was the functional dysfunction. In conclusion, the SOC Scale seems not to be a measure of psychopathology in terms of depression or anxiety merely.
Practice Location Choice by New Physicians: The Importance of Malpractice Premiums, Damage Caps, and Health Professional Shortage Area Designation
Authors: Chou Chiu‐Fang , Lo Sasso Anthony T.
Published: May 2009

Objective. To understand the factors affecting the choice of initial practice location by new physicians.

Data Sources/Study Setting. A unique survey of exiting medical residents in New York State from 1998 to 2003.

Study Design. We estimate conditional logit models to examine the factors affecting the choice of initial practice location by new physicians.

Data Collection/Extraction Methods. We identify all physicians completing their training in obstetrics/gynecology or surgery and primary care physicians (PCPs) (general internal medicine, pediatrics, and family medicine) who had accepted a job in patient care and who provided the location (zip code) of their job. This resulted in 3,758 physicians in our sample.

Principal Findings. Our results indicate that malpractice insurance premiums are a significant deterrent for surgeons, but they do not appear to deter OB/GYNs or PCPs from locating in particular areas. In addition, caps on malpractice damage awards attract surgeons to areas. Shortage area designations attract PCPs without education debt yet deter PCPs with debt, suggesting that subsidies do not outweigh the perceived costs of locating in underserved areas.

Conclusions. In general our results highlight that new physicians are sensitive to the characteristics of the locations in which they could potentially locate when beginning their careers in patient care.
Racial Segregation and Disparities in Health Care Delivery: Conceptual Model and Empirical Assessment
Authors: Vaughan Sarrazin Mary S. , Campbell Mary E. , Richardson Kelly K. , Rosenthal Gary E.
Published: May 2009

Objective. This study examines two dimensions of racial segregation across hospitals, using a disease for which substantial disparities have been documented.

Data Sources. Black (n=32,289) and white (n=244,042) patients 67 years and older admitted for acute myocardial infarction during 2004–2005 in 105 hospital markets were identified from Medicare data. Two measures of segregation were calculated: Dissimilarity (i.e., dissimilar distribution by race across hospitals), and Isolation (i.e., racial isolation within hospitals). For each measure, markets were categorized as having low, medium, or high segregation.

Study Design. The relationship of hospital segregation to residential segregation and other market characteristics was evaluated. Cox proportional hazards regression was used to evaluate disparities in the use of revascularization within 90 days by segregation level.

Results. Agreement of segregation category based on Dissimilarity and Isolation was poor (κ=0.12), and the relationship of disparities in revascularization to segregation differed by measure. The hazard of revascularization for black relative to white patients was lowest (i.e., greatest disparity) in markets with low Dissimilarity, but it was unrelated to Isolation.

Conclusions. Significant racial segregation across hospitals exists in many U.S. markets, although the magnitude and relationship to disparities depends on definition. Dissimilar distribution of race across hospitals may reflect divergent cultural preferences, social norms, and patient assessments of provider cultural competence, which ultimately impact utilization.
Characterization of ZK 245186, a novel, selective glucocorticoid receptor agonist for the topical treatment of inflammatory skin diseases
Authors: Schäcke H , Zollner TM , Döcke WD , Rehwinkel H , Jaroch S , Skuballa W , Neuhaus R , May E , Zügel U , Asadullah K
Published: May 2009

Background and purpose: Glucocorticoids are highly effective in the therapy of inflammatory diseases. Their value, however, is limited by side effects. The discovery of the molecular mechanisms of the glucocorticoid receptor and the recognition that activation and repression of gene expression could be addressed separately opened the possibility of achieving improved safety profiles by the identification of ligands that predominantly induce repression. Here we report on ZK 245186, a novel, non‐steroidal, low‐molecular‐weight, glucocorticoid receptor‐selective agonist for the topical treatment of inflammatory dermatoses.

Experimental approach: Pharmacological properties of ZK 245186 and reference compounds were studied in terms of their potential anti‐inflammatory and side effects in functional bioassaysin vitroand in rodent modelsin vivo.

Key results: Anti‐inflammatory activity of ZK 245186 was demonstrated inin vitroassays for inhibition of cytokine secretion and T cell proliferation.In vivo, using irritant contact dermatitis and T cell‐mediated contact allergy models in mice and rats, ZK 245186 showed anti‐inflammatory efficacy after topical application similar to the classical glucocorticoids, mometasone furoate and methylprednisolone aceponate. ZK 245186, however, exhibits a better safety profile with regard to growth inhibition and induction of skin atrophy after long‐term topical application, thymocyte apoptosis, hyperglycaemia and hepatic tyrosine aminotransferase activity.

Conclusions and implications: ZK 245186 is a potent anti‐inflammatory compound with a lower potential for side effects, compared with classical glucocorticoids. It represents a promising drug candidate and is currently in clinical trials.

This article is part of a themed issue on Mediators and Receptors in the Resolution of Inflammation. To view this issue visithttp://www3.interscience.wiley.com/journal/121548564/issueyear?year=2009
Effects of indomethacin‐loaded nanocapsules in experimental models of inflammation in rats
Authors: Bernardi A , Zilberstein ACCV , Jäger E , Campos MM , Morrone FB , Calixto JB , Pohlmann AR , Guterres SS , Battastini AMO
Published: May 2009

Background and purpose:  The effects of systemic treatment with indomethacin‐loaded nanocapsules (IndOH‐NC) were compared with those of free indomethacin (IndOH) in rat models of acute and chronic oedema.

Experimental approach:  The following models of inflammation were employed: carrageenan‐induced acute oedema (measured between 30 min and 4 h), sub‐chronic oedema induced by complete Freund's adjuvant (CFA) (determined between 2 h and 72 h), and CFA‐induced arthritis (oedema measured between 14 and 21 days).

Key results:  IndOH or IndOH‐NC produced equal inhibition of carrageenan‐elicited oedema. However, IndOH‐NC was more effective in both the sub‐chronic (33 ± 4% inhibition) and the arthritis (35 ± 2% inhibition) model of oedema evoked by CFA, when compared with IndOH (21 ± 2% and 14 ± 3% inhibition respectively) (P < 0.01). In the CFA arthritis model, treatment with IndOH‐NC markedly inhibited the serum levels of the pro‐inflammatory cytokines tumour necrosis factor α and IL‐6 (by 83 ± 8% and 84 ± 11% respectively), while the levels of the anti‐inflammatory cytokine IL‐10 were significantly increased (196 ± 55%). The indices of gastrointestinal damage in IndOH‐NC‐treated animals were significantly less that those after IndOH treatment (58 ± 16%, 72 ± 6% and 69 ± 2%, for duodenum, jejunum and ileum respectively).

Conclusions and implications:  IndOH‐NC produced an increased anti‐inflammatory efficacy in long‐term models of inflammation, allied to an improved gastrointestinal safety. This formulation might represent a promising alternative for treating chronic inflammatory diseases, with reduced undesirable effects.

This article is part of a themed issue on Mediators and Receptors in the Resolution of Inflammation. To view this issue visit http://www3.interscience.wiley.com/journal/121548564/issueyear?year=2009
Detection of exhaled hydrogen sulphide gas in rats exposed to intravenous sodium sulphide
Authors: Insko Michael A , Deckwerth Thomas L , Hill Paul , Toombs Christopher F , Szabo Csaba
Published: May 2009

Background and purpose:  Sodium sulphide (Na2S) disassociates to sodium (Na+) hydrosulphide, anion (HS‐) and hydrogen sulphide (H2S) in aqueous solutions. Here we have established and characterized a method to detect H2S gas in the exhaled breath of rats.

Experimental approach:  Male rats were anaesthetized with ketamine and xylazine, instrumented with intravenous (i.v.) jugular vein catheters, and a tube inserted into the trachea was connected to a pneumotach connected to a H2S gas detector. Sodium sulphide, cysteine or the natural polysulphide compound diallyl disulphide were infused intravenously while the airway was monitored for exhaled H2S real time.

Key results:  Exhaled sulphide concentration was calculated to be in the range of 0.4–11 ppm in response to i.v. infusion rates ranging between 0.3 and 1.1 mg·kg−1·min−1. When nitric oxide synthesis was inhibited with Nω‐nitro‐L‐arginine methyl ester the amount of H2S exhaled during i.v. infusions of sodium sulphide was significantly increased compared with that obtained with the vehicle control. An increase in circulating nitric oxide using DETA NONOate [3,3‐bis(aminoethyl)‐1‐hydroxy‐2‐oxo‐1‐triazene] did not alter the levels of exhaled H2S during an i.v. infusion of sodium sulphide. An i.v. bolus of L‐cysteine, 1 g·kg−1, and an i.v. infusion of the garlic derived natural compound diallyl disulphide, 1.8 mg·kg−1·min−1, also caused exhalation of H2S gas.

Conclusions and implications:  This method has shown that significant amounts of H2S are exhaled in rats during sodium sulphide infusions, and the amount exhaled can be modulated by various pharmacological interventions.
Socioeconomic deprivation independent of ethnicity increases status epilepticus risk
Authors: Chin Richard F.M. , Neville Brian G.R. , Peckham Catherine , Wade Angie , Bedford Helen , Scott Rod C. ,   for the NLSTEPSS Collaborative Group
Published: May 2009

Background:  A higher incidence of convulsive status epilepticus (CSE) has been reported in nonwhite compared to white populations. Socioeconomic factors can be intricately involved in observed ethnic “effects,” and the importance of socioeconomic status on health conditions is widely recognized. Understanding the effect of socioeconomic factors on CSE would provide insights into etiology and management, leading to the development of novel prevention strategies.

Methods:  From a population‐based UK study on childhood CSE, we tested the hypothesis that socioeconomic deprivation independent of ethnicity increases the risk of childhood CSE. Home postal codes were used to measure the socioeconomic status of the neighborhood in which patients lived relative to that of the borough in which the neighborhood was located. The child’s ethnicity was reported by parent(s). Relationships between socioeconomic status, ethnicity, and incidence were investigated using Poisson regression analysis.

Results:  A total of 176 children were enrolled. The incidence of CSE in nonwhite children [18.5, 95% confidence interval (CI) 13.7–23.3/100,000/year] was 1.8 (95% CI 1.3–2.4) times greater than for white children (10.5, 95% CI 7.9–13.1/100,000/year) (p < 0.0005). Socioeconomic deprivation and Asian ethnicity were independently associated with increased incidence. For each point increase in Index of Multiple Deprivation (IMD) 2004, there was a 1.03 cumulative increased relative risk (95% CI 1.01–1.06, p = 0.007). Asian children were 5.7 times (95% CI 1.7–18.9) more likely than white children to have a first‐ever episode of CSE (p = 0.004). Socioeconomic and ethnicity effects were related to etiology of CSE.

Interpretation:  Ethnic and socioeconomic factors independently affect risk for prolonged febrile seizures and acute symptomatic CSE, but not for other types of childhood CSE.
The role of titration schedule of topiramate for the development of depression in patients with epilepsy
Authors: Mula Marco , Hesdorffer Dale C. , Trimble Michael , Sander Josemir W.
Published: May 2009

Purpose:  To determine whether a fast titration schedule of topiramate (TPM) has different effects on the occurrence of depression, in relation to other risk factors for TPM‐induced depression, including history of depression (HxDEP), febrile seizures (FS), and hippocampal sclerosis (HS).

Methods:  Using data from a large case registry of patients prescribed TPM, two models were constructed: Model 1 examined the independent effect of rapid TPM titration after separate adjustment for FS, HxDEP, and HS. Model 2 examined effect of the cooccurrence of rapid titration on the development of depression with each of these risk factors.

Results:  A total of 423 patients were included (51.8% females), mean age (SD) 35.5 (11.8) years, mean duration of epilepsy of 22.2 (11.5) years. Forty‐four patients (10.4%) developed depression during TPM therapy. A rapid TPM titration was associated with 5‐fold increased risk of depression that increased to 12.7‐fold in the presence of both FS and rapid TPM titration, 23.3‐fold in the presence of both HxDEP and rapid TPM titration, and 7.6‐fold in the presence of both HS and rapid TPM titration schedule.

Conclusions:  Our study suggests that a rapid titration schedule is associated with an increased risk of developing depression during TPM therapy. HxDEP and FS are major contraindications to the use of a rapid titration, with a 23.3‐fold and 12.7 fold increased risk, respectively.