bluuebunny/crossref_metadata_2025 huggingface dataset:
In vitro fibroblast populated collagen lattices are not good models of in vivo clinical wound healing
Authors: Kuhn M. Ann , Smith Paul D , Hill Donald P , Ko Francis , Meltzer Dessie D , Vande Berg Jerry S , Robson Martin C
Published: March 2003

In chronic wounds, the healing process is prolonged and incomplete, proceeding in an uncoordinated manner, and resulting in poor anatomical and functional outcome. There have been numerous attempts to discover models that mimic human wound healing processes. The fibroblast populated collagen lattice is one such model that has been proposed. This study evaluated whether the fibroblast populated collagen lattice can be a model of chronic wound healing using the pressure ulcer as a paradigm. Fibroblast cultures of wound biopsies and wound volume measurements were obtained serially during a four arm blinded, placebo‐controlled sequential cytokine clinical trial of pressure ulcers. Fibroblasts obtained from study patients were added to collagen lattices and contraction was determined daily for 10 days. Collagen gel‐area measurements were converted to reflect percentage of gel contraction. These data of both edge and base wound biopsies on days 0, 10, and 36 were categorized into treatment groups and one‐way analysis of variance showed no significant differences in contraction among these groups. When considering all fibroblast populated collagen lattices, there was significantly greater contraction at days 10 and 36 for cells from both edge and base biopsies compared to day 0 (p < 0.05). The Spearman Rank Correlation test comparing all patients with fibroblast populated collagen lattice results from fibroblasts obtained at the edge or base of the wound at days 0, 10, and 36 and clinical pressure ulcer healing on day 36 showed no correlation. This lack of correlation not only persisted for each of the four treatment arms but also for responder status based on decrease in wound volume over the 35 day trial period. In conclusion, chronic wound healing is a complex process that is not modeled by in vitro fibroblast populated collagen lattices.
KERATINOCYTE‐DRIVEN CONTRACTION OF RECONSTRUCTED HUMAN SKIN
Authors: Chakrabarty Kaushik H , Heaton Martin , Dalley Andrew J , Dawson Rebecca A , Freedlander Eric , Khaw Peng T , Mac Neil Sheila
Published: March 2003

We have previously reported that reconstructed human skin, using deepidermized acellular sterilized dermis and allogeneic keratinocytes and fibroblasts, significantly contracts in vitro. Contracture of split skin grafts in burns injuries remains a serious problem and this in vitro model provides an opportunity to study keratinocyte/mesenchymal cell interactions and cell interactions with extracted normal human dermis. The aim of this study was to investigate the nature of this in vitro contraction and explore several approaches to prevent or reduce contraction. Three different methodologies for sterilization of the dermal matrix were examined: glycerol, ethylene oxide and a combination of glycerol and ethylene oxide. While the nature of the sterilization technique influenced the extent of contraction and thinner dermal matrices contracted proportionately more than thicker matrices, in all cases contraction was driven by the keratinocytes with relatively little influence from the fibroblasts. The contraction of the underlying dermis did not represent any change in tissue mass but rather a reorganization of the dermis which was rapidly reversed (within minutes) when the epidermal layer was removed. Pharmacological approaches to block contraction showed forskolin and mannose‐6‐phosphate to be ineffective and ascorbic acid‐2‐phosphate to exacerbate contraction. However, Galardin, a matrix metalloproteinase inhibitor and keratinocyte conditioned media, both inhibited contraction.
Heparin‐like inhibitory activity to fibroblast growth factor‐2 in wound fluids of patients with chronic skin ulcers and its modulation during wound healing
Authors: Landau Zvi , David Magda , Aviezer David , Yayon Avner
Published: March 2003

Fibroblast growth factors are potent mitogens and angiogenic factors which play a critical role in wound healing. Fibroblast growth factors require heparan sulfates as cofactors in order to activate their cognate receptors and exert their cellular and biological effects. Heparan sulfates were extracted from wound fluids of 5 patients with chronic diabetic foot ulcers or chronic venous stasis ulcers and tested for their capacity to modulate fibroblast growth factor‐receptor binding, during the course of the ulcers' resolution, until complete healing (3–8 months). Total heparan sulfates concentration measured as iduronic acid equivalents, decreased in wound fluids from 1.1 ±0.3 μg/ml to 0.26 ±0.1 μg/ml as wound healing progressed. These heparan sulfates exhibited a predominant inhibitory effect on fibroblast growth factor‐2 binding to fibroblast growth factor receptor‐1, when tested in cells deficient in cell surface heparan sulfates. During wound healing, there was a marked decrease in the relative inhibitory activity of the extracted heparan sulfates on fibroblast growth factor‐2‐receptor binding. Heparan sulfates extracted from chronic skin ulcers of different etiologies such as diabetic foot or chronic venous stasis ulcers showed the same pattern of alternating balance in heparan sulfates mediated activity. The presence of fibroblast growth factor inhibitory factors which possess heparin‐like activity in fluids of chronic skin ulcers and their ability to modulate fibroblast growth factor‐receptor activity throughout the process of wound healing, may significantly contribute to the mechanism of chronicity. Treatments to counter this inhibition may offer new possibilities for healing chronic wounds.
Expression of heat shock proteins in a linear rodent wound
Authors: Keagle Jennifer Newman , Welch William J , Young David M
Published: March 2003

Heat shock proteins (hsps) are ubiquitous and known to be expressed in all organisms. These stress proteins are likely to be induced in the wound environment and may play a critical role in the overall process of wound repair. Linear incisions were made in Sprague‐Dawley rats. Serial skin biopsies were taken, the dermis and epidermis were separated and a protein lysate made. The expression of hsp 72, 47, and 32 were analyzed by Western blotting and immunohistochemistry. There were distinct patterns of expression of hsp 72, 47, and 32 in the wound. In unwounded dermis, there was no constitutive expression of any of the heat shock proteins studied. In the epidermis, there was constitutive expression of hsp 32 and 72, but not hsp 47. With wounding, all hsps exhibited increased expression both in the dermis and epidermis. These patterns of protein expression are suggestive of the individual heat shock proteins' molecular function, such as hsp 72's role as an indicator of cellular stress and injury, hsp 47's role in collagen synthesis, and hsp 32's role as an antioxidant.
Stem cells in regenerative biology and medicine
Authors: STOCUM DAVID L.
Published: March 2003

Embryonic stem cells of the mammalian blastocyst give rise to all the tissue lineages that begin to emerge at gastrulation. They are pluripotent cells and can be propagated in vitro without loss of pluripotency. Many adult tissues harbor cells that do not complete their differentiation program. These cells serve as self‐renewing stem cells whose normal fate is to regenerate site‐specific tissue, in response to either physiological cell turnover or damage inflicted by injury or disease. Neural, muscle, and bone marrow stem cells possess developmental potency far greater than their normal lineage‐restricted fate. The understanding of the biology of stem cells is leading us into an era of regenerative medicine. The growth potential and pluripotency of embryonic stem cells and the developmental plasticity of adult stem cells, particularly those of bone marrow, make them potentially useful for replacing tissues, via transplantation or construction of bioartificial tissues, that either do not regenerate naturally or are damaged beyond their natural capability for regeneration. In addition to these two ways of replacing tissue, a third strategy of regenerative medicine is to stimulate regeneration in vivo from resident stem cells. Before these approaches become clinical reality, however, a number of basic research issues must be resolved, including the revision of our concept of a regeneration‐competent cell.
Metallothioneins: potential therapeutic aids for wound healing in the skin
Authors: Lansdown Alan B. G.
Published: March 2003

Metallothioneins are a family of low molecular weight proteins containing approximately 30 % cysteine. Expression of the metallothionein gene is up‐regulated in the skin following topical application of zinc and copper, and in wound margins particularly in regions of high mitotic activity. This induction of metallothionein in the wound margin may reflect its role in promoting cell proliferation and reepithelialiation. The action of metallothioneins in these processes may result from the large number of Zinc‐dependent and copper‐dependent enzymes required for cell proliferation and matrix remodeling. In addition, selected growth factors may modulate metallothionein gene expression and hence the ability of cells to proliferate. Recent studies suggest that metallothioneins may be an attractive target for development as vulnerary agents. (WOUND REP REG 2002;10:)
Fibroblast subpopulations in intra‐oral wound healing
Authors: Van Beurden Hugo E. , Snoek Patricia A.M. , Von Den Hoff Johannes W. , Torensma Ruurd , Kuijpers‐Jagtman Anne‐Marie
Published: March 2003

The objective of this study was to characterize fibroblasts at sequential time points during intra‐oral wound healing in the rat. Experimental wounds were made at several time points in the mucoperiosteum of the palate of 35‐day‐old Wistar rats. Fibroblasts were cultured from the biopsies under standard conditions for the same number of passages. The expression of the integrin subunits α1, α6, and β1; and the intermediate filaments α‐smooth muscle actin and vimentin were analyzed by flow cytometry. Western blot analysis was performed at 0, 8, and 60 days postwounding to confirm the expression of both intermediate filaments. The phenotypic profiles of fibroblasts cultured from subsequent stages in the wound healing process differed considerably. We conclude that distinct fibroblast phenotypes can be isolated from different stages in wound healing. These phenotypes remained stable during in vitro culturing. In addition, cryosections of the wound areas were made at identical time points and were immunohistochemically stained for the same antigens. The immunohistochemical staining correlated well to the flow‐cytometric data. These results suggest the occurrence of multiple subpopulations of fibroblasts with a specialized function during wound healing. We hypothesize that undesirable consequences of wound healing might be prevented through the modulation of specific fibroblast subpopulations. (WOUND REP REG 2003;11:55–63)
Multi‐stage pseudomorphic replacement of garnet during polymetamorphism: 2. Algebraic analysis of mineral assemblages
Authors: Cesare
Published: March 2003

Chemical relationships among four metapelites have been studied by investigation of mineral and bulk chemistry data and by singular value decomposition analysis of single and composite assemblage matrices. Bulk rock compositions cluster close together in an AFM diagram, all within the intersection space defined by the four sample assemblages. The similarity of bulk compositions normalized on a silica‐free, anhydrous basis indicates that sample chemistries differ mainly as a result of inhomogeneous distribution of quartz layers. The existence of mass balance relationships among samples indicates that assemblages also overlap in the Si–Ti–Al–Fe–Mg–Mn–Ca–Na–K multisystem. Analysis of single and composite matrices helps in defining possible mass balances linking sample mineral facies to one another during progressive contact metamorphism. The assemblage in sample A can form as the result of the model reaction 5.000 Ky+0.269 Grt+0.965 Bt+0.314 Pl=0.049 Ilm+1.115 Ms+0.849 Chl+0.306 St and react to assemblage B via reaction 0.97 Chl+0.52 Grt+0.66 Ms+0.14 Ilm+1.26 Ky=0.42 St+0.63 Bt+0.22 Pl coupled with the Ky→And transition. Assemblage B can transform into C by initial progress of Ky+Ilm+Chl+Grt+Ms=And+St+Bt+Pl followed by 0.142 Ilm+0.175 St+1.089 Chl+1.533 Ms+0.003 Grt=5.000 And+1.266 Bt+0.551 Pl Matrix analysis cannot satisfactorily model the C–D transition, because it predicts a net production of staurolite, which is in disagreement with petrographic evidence. All mass balances in the C–D composite matrix indicate net consumption of muscovite; this is integrated with the contrasting evidence of prograde pseudomorphs of muscovite after staurolite, observed in the nodules of sample D, within a model involving the progress of ionic reaction cycles.
Dissolution and precipitation processes in deformed amphibolites: an example from the ductile shear zone of the Ryoke metamorphic belt, SW Japan
Authors: Imon R. , Okudaira T. , Fujimoto A.
Published: March 2003

The granitic mylonite zone in the Cretaceous Ryoke metamorphic belt contains deformed amphibolites as thin layers. The amphibolite layers do not exhibit pinch‐and‐swell or boudinage structures, even when contained in a high‐strain granitic mylonite. This mode of occurrence suggests that they were deformed as much as the surrounding granite mylonite. In the highly deformed zone, strongly foliated amphibolites contain Ti‐rich brown amphibole porphyroclasts rimmed by Ti‐poor green amphibole, titanite and chlorite. These porphyroclasts are elongated, forming shear surfaces defined by preferential distribution of the chlorite and titanite. Porphyroclastic plagioclase in the strongly foliated amphibolites consists of two components: an anorthite‐rich core and an anorthite‐poor rim. Based on these observations, the mass‐balanced reaction occurring during deformation is defined as

As the reaction products form a weak interconnected matrix, the strain rate of the amphibolites may be controlled by the rate of dissolution–precipitation through fluids. Weakly foliated amphibolites in the low‐strain zone exhibit cataclastic microstructures, whereas the strongly foliated amphibolites do not exhibit such features. These microstructural and chemical changes suggest that high‐strain amphibolites were initially deformed by cataclasis, followed by deformation through metamorphic reactions. During the metamorphism/deformation, old plagioclase grains with high Xan were not stable and dissolved, and new plagioclase grains with low Xan crystallized at the old plagioclase rim. Dissolution of old plagioclase and precipitation of new plagioclase occurred normal to and parallel to the foliation, respectively, reflecting incongruent pressure solution due to differential stress and changes in P–T–H2O conditions. The development of incongruent pressure solution is attributed to increased fluid flux in the strongly foliated amphibolites, as evidenced by the greater abundance of hydration‐reaction products in the strongly foliated amphibolites than in the weakly foliated ones.
Future Directions in Dialysis Quantification
Authors: Lindsay Robert M. , Sternby Jan
Published: March 2003

The influence of dialysis prescription on outcome is well established, and currently the amount of dialysis prescribed is based on small molecular weight toxin removal as represented by the clearance of urea. The “normalized dose of dialysis” (Kt/Vurea) concept is well established. Most techniques for dialysis quantification require that blood samples be taken at the beginning and after the completion of dialysis. The postdialysis sample, however, gives cause for concern because of the “rebound phenomenon” due to nonuniform distribution of urea among body compartments. Blood samples give “indirect” measures of dialysis quantification. Thus direct urea concentration measurements in dialysate may be superior in urea kinetic modeling and these may be made “real time” during dialysis.

It is with real‐time monitoring that future advances in dialysis quantification will take place. These will be of two types. The first will analyze blood water or dialysate samples for urea content multiple times throughout the treatment; the second will assess the on‐line clearance of urea using surrogate molecules such as sodium chloride, the clearance being determined by conductivity measurements. On‐line urea monitoring is based on the action of urease on urea in a water solution and measurement of the resultant ammonium ions, which are measured directly by a specific electrode or indirectly by conductivity changes. Differences in blood‐side versus dialysate‐side urea monitors exist which reflect the parameters they can provide, but with both, the standard urea kinetic measurements of Kt/V and nPCR (nPNA) are easily obtainable.

A range of additional parameters can be derived from dialysate‐side monitoring such as “whole‐body Kt/V,”“pretreatment urea mass” and “whole‐body urea clearance,” which are worthy of future studies to determine their roles in adequacy assessment. Conductivity clearance measurements are made by examining the conductivity differences between dialysate inlet and outlet measured at two different dialysate inlet concentrations. This allows for the calculation of the electrolyte (ionic) dialysance, which is equal to the “effective” urea clearance, that is, the clearance that takes into account recirculation effects that reduce hemodialysis efficiency. The continuous reading of effective ionic clearance will allow an average value for K to be obtained for that dialysis, and hence the parameter K×t as an indication of dialysis dose is easily and accurately obtained for every treatment. The conductivity technology is cheap and rugged, and thus expanded use can be expected. Urea monitors have an inherent cost and require maintenance, and perhaps will remain researchers' tools for the present. The methodologies can complement each other; the addition of an accurate and independent value for K to dialysate based urea monitoring is like having simultaneous blood‐ and dialysate‐side monitoring, and allows further increase in measurable parameters.
Central Venous Dialysis Catheters: Catheter‐Associated Infection
Authors: Saad Theodore F.
Published: March 2003

Tunneled dialysis catheters (TDC) are extensively used for long‐term venous hemodialysis access and their use is frequently associated with infectious complications. Catheter‐related bacteremia (CRB) is the most common and important infection associated with TDC use and may be caused by a wide variety of Gram‐positive or Gram‐negative organisms. Prevention of CRB can be difficult despite use of rigorous infection‐control techniques for catheter insertion and access. A number of antibacterial catheter‐packing solutions hold promise for reduction of CRB. Treatment of CRB with antibiotics alone yields poor results and may increase the risk for other infectious complications, especially endocarditis. In selected cases where initial infection control can be achieved with antibiotics, guidewire exchange of the TDC results in cure rates equivalent to those of TDC removal and subsequent replacement. Dialysis programs should monitor TDC infections with attention to incidence, bacteriology, and outcomes.
Imaging in the Dialysis Patient: Dialysis Therapies for End‐Stage Renal Disease
Authors: Gokal Ram , Hutchison Alastair
Published: March 2003

End‐stage renal disease (ESRD) has various causes that may differ according to country and racial group. Whatever the cause, unless the water, salt, electrolytes, and waste products excreted by normal kidneys are removed, their accumulation will result in death. Removal of these products can be variably achieved by either hemodialysis or peritoneal dialysis. The principles and outcomes of these techniques are described, as are their complications. It is important that these two different methods of treatment are not regarded as competitive, but areintegrated, together with renal transplantation where appropriate, into the management of patients with ESRD tooptimize both outcome and quality of life.
Review Articles: Approach to Patients with “Complex” Hemodialysis Access Problems
Authors: Huber Thomas S. , Seeger James M.
Published: March 2003

The approach to patients with “complex” permanent hemodialysis (HD) access problems remains poorly defined. The purpose of this review is to outline our current algorithm for patients presenting for dialysis access and to address the management of specific problems that complicate this objective of establishing permanent access. The key components of the algorithm include noninvasive imaging in the diagnostic vascular laboratory to determine all the possible access configurations and invasive imaging with both venography and arteriography to confirm the optimal choice. The specific access‐related problems addressed include inadequate ipsilateral vein, inadequate arterial inflow, central vein stenosis/occlusion, multiple previous access failures, and obesity. Despite the label of “complex” access problems, it is possible to construct native arteriovenous fistulas (AVFs) in almost all patients presenting for access using the standard principles of vascular surgery that are based on establishing adequate arterial inflow, adequate venous outflow, and selecting an appropriate conduit.
Ethical Issues in Dialysis Aaron Spital, Series Editor: Cardiopulmonary Resuscitation and Dialysis: Outcome and Patients' Views
Authors: Hijazi Fadi , Holley Jean L.
Published: March 2003

Cardiopulmonary resuscitation (CPR) was initially described as an intervention to be used in otherwise healthy individuals suffering acute cardiorespiratory arrest. Over the years, CPR has been extended to all hospitalized patients unless specific orders not to resuscitate have been written with the informed consent of the patient and/or surrogate. The 14–15% survival to hospital discharge reported for in‐hospital CPR has not changed over the past three decades. Compared with other diseases, chronic kidney disease reduces long‐term survival (more than 6 months) following CPR, and the functional status of the few who survive is often quite poor. Nevertheless, most dialysis patients want to be resuscitated. Unfortunately television shows portraying resuscitation imply that survival after CPR is much more common than it really is. Such misinformation contributes to the overwhelming choice for CPR despite the dismal prognosis. Dialysis unit staff need to educate patients and families about the expected success and complications of CPR as part of the advance care planning process that should now be routine.
Long‐Term Follow‐Up of Patients Treated with Intermittent Hormone Therapy for Advanced Prostate Cancer
Authors: Hruby George , Gurney Howard , Turner Sandra , Berry Martin , Harnett Paul , Gebski Val
Published: March 2003

Background: To determine the feasibility of long‐term use of intermittent hormone therapy (IHT) in patients with advanced prostate cancer.

Methods: Sixteen hormone‐naïve patients were commenced on IHT and prospectively reviewed. IHT consisted of goserelin acetate alone (two patients) or combined with an antiandrogen. When the serum prostate specific antigen (PSA) level had fallen to < 4 ng/ml for 3 months, IHT was stopped. When the PSA level rose to > 10 ng/ml, the same treatment was recommenced, constituting one complete cycle comprising both “on‐treatment” and “off‐treatment” phases. This was repeated until hormone independence (HI) occurred.

Results: The median length follow‐up was 49.9 months. Considering all patients, a mean of 41% of the total time was spent off hormone treatment, ranging from a median of 4.0 to 7.1 months for each cycle. Fifteen patients finished at least one complete cycle of IHT, and 7 patients completed two or more cycles. Nine patients became HI after a mean time period of 19.5 months. Six men remain on IHT; three are currently in their fourth or fifth cycle of treatment. For patients completing Cycles 1, 2, 3, 4, and 5, the median percentage time spent off treatment during each cycle was 41%, 54%, 58%, 53%, and 58%, respectively.

Conclusions: Based on this pilot study, IHT would seem to allow considerable time off therapy without obviously affecting the time to HI. If the current randomized trials of IHT against continuous therapy demonstrate equivalent relapse‐free survival, then quality of life and fiscal end points will be paramount in determining treatment options. An Australian intergroup study to examine these end points has already begun.
Lack of Effect of Aminoglutethimide and Hydrocortisone Added to High‐Dose Bicalutamide for Androgen‐Independent Prostate Cancer
Authors: Bubley Glenn J. , Balk Steven P. , Joyce Robin M. , Taplin Mary‐Ellen
Published: March 2003

Objectives: To determine whether hormones derived from the adrenal gland affected the progression of androgen‐independent (AI) prostate cancer for patients already receiving treatment with high‐dose bicalutamide. This was accomplished by using a sequential trial design in which medically or surgically castrated patients with AI prostate cancer whose cancers were progressing while receiving bicalutamide were treated with adrenolytic therapy in the form of aminoglutethimide (AM) and hydrocortisone (HC).

Materials and Methods: Sixteen patients with AI prostate cancer were enrolled into this trial. All patients had metastatic disease in the bone, and two patients had additional metastases at other sites. Using prostate specific antigen (PSA) level as an indicator of disease activity, patients initially received bicalutamide therapy, then AM and HC were added to the regimen, and then bicalutamide therapy was discontinued, with each documented PSA level increase (see Figure 1).

Clinical Trial Study Design: Patients were treated with sequential hormonal interventions according to the scheme depicted above.

image

Results: Four (25%) patients demonstrated PSA level reductions of at least 50% after the initiation of bicalutamide, 150 mg/day. No patient demonstrated a PSA or obvious clinical response to the addition of AM and HC to the regimen. This includes the four patients who were initially sensitive to bicalutamide. Therapy with AM and HC was associated with fatigue and skin rashes. These side effects persisted after the withdrawal of bicalutamide therapy and were therefore attributed to AM and HC therapy.

Conclusions: Bicalutamide at high doses seems to effectively block the androgen receptor (AR) from the growth stimulation derived from adrenal hormones. Therefore, the inhibition of adrenal hormone production by AM is not a useful therapeutic maneuver in this setting and is associated with moderate side effects. The activation of the AR pathway in these patients may occur by a mechanism other than stimulation by the androgens derived from the testes or adrenal gland.
The Development and Implementation of a Population‐Based Intervention Model for Public Health Nursing Practice
Authors: Kosidlak Janet Garzone
Published: March 2003

Mandatory enrollment of Medicaid recipients into Managed Care Organizations (MCOs) in 1994 resulted in a major reduction in primary medical care provided by the Peninsula Health District (PHD) in southeastern Virginia. This article describes how the PHD responded proactively by changing from a predominantly primary care clinic practice to a population‐based public health practice and changed the role of public health nursing. A participatory planning process involving all PHD employees carefully defined this new direction over several years. As public health care resources were redirected into preventive programs to serve the health needs of the entire community rather then the individual, a new intervention model evolved. The intervention model became the framework for program planning and implementation and has now been in use by the PHD for 3 years. The planning process used by the PHD to devise a population‐based intervention model is described in this article.
A Successful Approach to Immunizing Men Who Have Sex with Men Against Hepatitis B
Authors: Savage Robert B , Hussey Mary Jo , Hurie Marjorie B
Published: March 2003

This paper reports the success of outreach efforts to immunize adults at high risk of acquiring hepatitis B virus (HBV) infection. Local health department testers recruited clients when they sought anonymous HIV testing. Interested clients were serologically tested for HBV infection. Susceptibles were offered a free hepatitis B vaccine. Of 189 clients who were tested, 161 (86%) were susceptible to HBV infection and 140 (74%) were men who have sex with men (MSM). Of the susceptibles, 82 (51%) started the hepatitis B vaccine series. Sixty‐five (80%) received three doses of hepatitis B vaccine and an additional 10 (12%) received two doses. Completing the hepatitis B vaccine series was associated with being a MSM (odds ratio [OR] 8.8, confidence interval [CI] 1.5–56.0) and with not being an injection drug user (IDU) (OR 0.2, CI 0.02–1.0). One way to provide hepatitis B vaccine to MSM is to attach an immunization program to a successful anonymous HIV testing program. The feasibility of implementing such programs would increase if public vaccine policymakers made more federally purchased hepatitis B vaccine available for adults.
Home Care for the Frail Elderly Based on Urinary Incontinence Level
Authors: Shimanouchi Setsu , Kamei Tomoko , Hayashi Masayuki
Published: March 2003

Incontinence is a common problem in the frail elderly. We conducted interviews focusing on urinary incontinence with 249 elderly clients in the home care setting, and studied differences of the needs among three (mild, moderate, and catheter) groups based on incontinence level. The mild group had the highest number of professional care needs, although their problems were not as serious as the other two groups. The moderate group required the highest amount of daily care by caregiver. A similar need pattern was shown in the moderate and catheter groups, while more diversified needs were required in the mild group. Portable toilet, rehabilitation, and short‐stay services were frequently used in the mild group. The use of telephone consultation was the highest in the moderate group, and the use of doctor visit and bathing service were higher in the catheter group. The most important challenge was significantly different in each group: preventive efforts to maintain activities of daily living (ADL) in the mild group, interpersonal relationships in the moderate group, and infection control in the catheter group. Education was necessary for caregivers in all three groups. These findings help to project realistic care needs for each client based on his or her incontinence level.
Trumpets of Attack: Collaborative Efforts Between Nursing and Philanthropies to Care for the Child Crippled with Polio 1930 to 1959
Authors: Carter Kimberly Ferren
Published: March 2003

The purpose of this historical inquiry research was to explore (a) the relationship of nursing and foundations focusing on polio from 1930 to 1959; (b) the employment and educational opportunities arising from the polio epidemics for white and black nurses, as well as the obstacles encountered; (c) the role of nursing leaders in the care of the crippled child; and (d) the effects of the resolution of the polio epidemics resulting from the polio vaccine on public attitude and on the philanthropic organizations. Relevant journals, primary and secondary sources, and personal interviews were the methods used for data collection. Because of the extraordinary community support for work related to polio, nurses were able to obtain support from foundations. This support resulted in employment and educational opportunities for bedside nursing, primarily for white nurses. Middle and upper class fear of polio enabled the development of powerful and successful private organizations to supplement the available governmental services. This research illustrates the advances that nursing has made and reminds nurses to develop and maintain strong praxis relationships, alliances with philanthropies, referrals for clients with local organizations, and a strong voice in the planning arena.
Health Visiting in Scotland and Norway: Commonalties and Differences
Authors: Ellefsen Bodil
Published: March 2003

This investigation compared health visiting in Scotland and Norway by focusing on health visitors' influence on management matters, work tasks and work conditions. The data are based upon in‐depth interviews with nine health visitors from Scotland and 12 health visitors from Norway. The results showed more similarities than differences between the Scottish and Norwegian health visitors. Both groups experienced autonomy at work. The hardships of work were the lack of visibility for their work and an inability to demonstrate in measurable ways the effect of their work. Issues related to lack of time and priority of the newborn and young children were also similar as well as the experience of insecurity and strain at work. The differences were mostly within the area of organizational structure and its influence on management matters. While the Norwegian HV participated in plans for the service, employment and budget proposals, the Scottish HV was involved in these matters to a lesser degree. All in all, the similarity of the themes and the comparable units suggest the core of health visiting extends beyond the limits of cultural and national boundaries.
Perception of Risk by Administrators and Home Health Aides
Authors: Kendra Mary Agnes
Published: March 2003

Increasing numbers of persons over 65, decreased length of hospital stay, and need for chronic (custodial) health care have placed a strain on home health care agencies. The second largest group of persons providing care is home health aides (HHAs), who perform in‐home, nonskilled, technical procedures with little or no on‐site supervision. They are generally high school graduates or hold GEDs. The purpose of this study was to compare home health care administrators' (HHCAs) and HHAs' perceptions of risk involved in home visiting. Given HHAs' educational preparation and limited supervision, they are basically on their own for work performed. Although agencies provide orientation sessions for new workers, periodic in‐services often relate to tasks and competency testing and little attention directed toward protecting the self—specifically, strategies to decrease personal risk. In order to determine to what extent HHCAs and HHAs perceive risk, the Home Health Care Perception of Risk Questionnaire, a self‐report measure, was administered to a national random sample of 93 HHCAs and 227 HHAs. Findings suggest that these groups differ in perception of risk and level of agency support in making home visits. Suggestions for meeting the needs of this HHA provider group are offered.
A Plan for the Delegation of Epinephrine Administration in Nonpublic Schools to Unlicensed Assistive Personnel
Authors: Truglio‐Londrigan Marie , Macali Margaret K. , Bernstein Marilynn , Kaider Gina , Petersen Susannah , Tumino Maria Celeste
Published: March 2003

Abstract Professional nurses in nonpublic schools address variables in their practice that are different from nurses in a public school setting. These may include lack of funds for full‐time nursing, different educational requirements, incorporation of religious beliefs into the social milieu, and inadequate peer or union support. These variables are problematic when public law health statues require change in school/parent/student relationships. New Jersey's Public Law 1997, Chapter 368 (N.J.S.A. 18A:40‐12.5 and 12.6), hereafter referred to as P.L. 1997, c. 368, was enacted because school nurses may not always be available to assess students who are experiencing severe allergic reactions. Since allergies in the school population are common and can lead to anaphylaxis which is life threatening (Smith, 1999), P.L. 1997, c. 368, requires each educational board or chief school administrator/principal of public and nonpublic schools to develop a policy governing epinephrine administration. This article describes how public health nurses, the director of public health nursing, and a faculty consultant in the Bergen County Department of Health Services worked together to produce strategies for the safe implementation of this law. These strategies may provide a template for consideration by other public health nurses who serve the student population.
Development and Pilot Testing of a Bicycle Safety Questionnaire for Adult Bicyclists
Authors: McCoy Carrie A.
Published: March 2003

Abstract Most deaths associated with bicycle riding are reported in those over the age of 16 and the highest death rate per million trips is reported in those over the age of 50, yet most efforts to reduce deaths among bicycle riders have focused on children. The purpose of this study was to pilot test a new instrument designed to assess knowledge of bicycle laws and perception of risk related to specific host behaviors and agents of injury. A pilot study using a descriptive correlational design was conducted among a convenience sample of 104 adult bicycle riders. A 25‐item questionnaire was administered to participants (10 knowledge items, 15 belief items). There were no significant differences in total knowledge or belief score for gender, age group, riding frequency, education, or formal bicycle training. Significant differences were found for responses to individual items on both scales. Psychometric testing indicated that items on the knowledge scale were independent. Psychometric testing on the belief scale suggested three underlying constructs measuring beliefs about riding behavior, agents of injury, and user burden. Bicycle riders with previous safety training had significantly different scores on the riding behavior and user burden subscales.
Tinea Capitis: An Overview with Emphasis on Management
Authors: Gupta Aditya K. , Hofstader Sophie L. R. , Adam Paul , Summerbell Richard C.
Published: March 2003

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that now predominates over . With this transition the utility of the Wood's light for diagnosis has been reduced since infection is Wood's light negative. Griseofulvin has been the mainstay of therapy for the last 40 years. The newer antifungal agents—itraconazole, terbinafine, and fluconazole—appear to be effective and safe for the treatment of tinea capitis. When tinea capitis is due to or other endothrix species the following regimens have been used: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen with capsules (5 mg/kg/day for 1 week plus 1–3 pulses 3 weeks apart), and itraconazole pulse regimen with oral solution (3 mg/kg/day for 1 week plus 1–3 pulses 3 weeks apart). With terbinafine tablets the continuous regimen (>40 kg body weight, 250 mg/day; 20–40 kg, 125 mg/day; and <20 kg, 125 mg/day) is given for 2 to 4 weeks. Fluconazole tablets or oral suspension (6 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once‐weekly regimen may also be effective. When ectothrix organisms (e.g., ) are present, a longer duration of therapy may be required. The data suggest that the newer agents are effective, safe with few adverse effects, and have a high benefit:risk ratio. It remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection.
Stress and Family Satisfaction in Parents of Children with Facial Port‐Wine Stains
Authors: Miller A. Cate , Pit‐ten Cate Ineke M. , Watson Heather S. , Geronemus Roy G.
Published: March 2003

A cross‐sectional survey was employed to assess parenting stress, family satisfaction, and parental concerns and to determine predictors of stress in parents of children with port‐wine stains (PWSs). The participants were 46 parents of 24 children receiving treatment with pulsed dye laser photocoagulation for facial PWS at an outpatient dermatology clinic based at a university medical center. Outcome measures used were self‐report instruments assessing psychosocial adjustment (Parenting Stress Index, Family Satisfaction Scale, and Parental Concerns Questionnaire). As a group, parents scored in the average range on the stress and family satisfaction measures when compared with a normative sample; five parents (11%) scored in the clinical range for stress. Forty‐nine percent of the variance in parenting stress was accounted for by four variables: the child's age (β = 0.34; p = 0.031), the parents' degree of family satisfaction (β = −0.27; p = 0.077), the level of parental concern regarding the child's facial PWS (β = 0.45; p = 0.005), and the parents' satisfaction with staff communication (β = −0.51; p = 0.002). The data suggest that while, as a group, parents of children with a facial PWS report to be in the average range for psychological stress, some do not fare as well as others. Factors associated with lower stress include younger children, more family cohesion and adaptation, fewer parental concerns, and greater satisfaction with parent‐staff communication. The potential for the development of medical complications and psychological problems over time suggests the need for treatment of the PWS at an early age. Health care providers should be prepared to screen for clinical levels of distress and to refer parents for psychological intervention when needed.
Bronchogenic Cyst Presenting as a Nodular Lesion
Authors: Ramón R. , Betlloch I. , Guijarro J. , Bañuls J. , Alfonso R. , Silvestre J. F.
Published: March 2003

Abstract: We report a subcutaneous bronchogenic cyst in a 7‐year‐old girl with unusual presentation as a nodular lesion. The cyst was excised and no connection with deeper structures was found. Histologic examination showed the typical features of a bronchogenic cyst. The characteristic clinical and histologic features of bronchogenic cysts are reviewed. The problems of differential diagnosis are also discussed.
Pattern of Skin Disease at the Ethio‐Swedish Pediatric Hospital, Addis Ababa, Ethiopia
Authors: Shibeshi Dagnatchew
Published: March 2003

Abstract: Although skin diseases are common in children, only a very few prospective studies are available, in the literature, mainly from developed countries. This work reports the pattern of skin diseases in a tertiary referral hospital in Addis Ababa, Ethiopia, from June 1995 to July 1997. A total of 1000 consecutive new pediatric patients, ages 0–12 years, were studied. The male:female ratio was 1:1. Allergic skin diseases were most frequently found (55%), followed by infections (33%) and photodermatosis (8%). Of the allergic skin diseases, atopic dermatitis was the most prevalent (47%), followed by seborrheic dermatitis (17.4%).
Acute Generalized Exanthematous Pustulosis (AGEP), an Uncommon Condition in Children: Case Report and Review of the Literature
Authors: Meadows Kappa P. , Egan Conleth A. , Vanderhooft Sheryll
Published: March 2003

Abstract: Acute generalized exanthematous pustulosis (AGEP) is characterized by acute onset of a widespread pustular eruption in association with fever. It is usually seen as a medication reaction. We describe a 17‐month‐old boy with AGEP secondary to exposure to amoxicillin. This is an uncommon condition in children.
Staphylococcal Septicemia in Children with Atopic Dermatitis
Authors: Hoeger Peter H. , Ganschow Rainer , Finger Gerlinde
Published: March 2003

Abstract: Atopic dermatitis (AD) is frequently complicated by minor bacterial superinfections. Invasive infections such as osteomyelitis have rarely been reported. We describe two children with staphylococcal septicemia during an exacerbation of their AD. Cellulitis and underlying congenital heart disease, respectively, were considered predisposing factors for the development of bacteremia. Identical strains were isolated from the skin, and there was a significant increase in antibodies against Staphylococcus aureus capsular polysaccharide in one child. Our cases demonstrate the potential severity of bacterial skin infections in AD, especially when associated with an underlying condition that increases vulnerability to bacteremia. While their true incidence in children with AD is currently unknown, it is conceivable that systemic staphylococcal infections may be more common than previously thought. Staphylococcal bacteremia has to be considered in the differential diagnosis of fever in children with severe AD. Conversely, episodes of staphylococcal bacteremia should prompt a search for underlying predisposing factors.
A Comparative Study of Pediatric Onset Psoriasis with Adult Onset Psoriasis
Authors: Raychaudhuri Siba P. , Gross Jeffry
Published: March 2003

Abstract: Psoriasis in childhood is not uncommon. We report data collected from 223 pediatric onset and 484 adult onset psoriasis patients. In the pediatric onset psoriasis patients (POPPs), prevalence of family history was 68.2% compared to 54% in the adult onset psoriasis patients (AOPPs). Also we noticed that exacerbation of psoriasis induced by precipitating factors such as stress (50.4% in POPPs, 42.7% in AOPPs), pharyngitis (27.9% in POPPs, 12.2% in AOPPs), and trauma (49.6% in POPPs and 38.9% in AOPPs) were more frequent in POPPs. Our data show that the frequency of spontaneous remission in POPPs was 35.3% compared to 24.3% in AOPPs. A disfiguring skin disease in childhood may have profound emotional effects. Childhood psoriasis needs special attention. To achieve a prolonged remission it is essential that children with psoriasis and their parents have an understanding of the exogenous and endogenous factors responsible for the increased morbidity of psoriasis.
Topical Ivermectin: A New Successful Treatment for Scabies
Authors: Victoria Jairo , Trujillo Rodolfo
Published: March 2003

Abstract: Ivermectin is the only one of the avermectins that has been widely used in humans, since it is recommended as the treatment of choice for onchocerciasis, a filariasis that produces “river blindness,” a parasitic endemic infestation in countries of West Equatorial Africa and in some areas of Central and South America. Also, ivermectin has been used for treating human endo‐ and ectoparasites with effective results and with almost no side effects. To study the efficacy of ivermectin for scabies, which is very common in Colombia, a trial with this drug that could be easily administered, with fast application and high efficacy, was undertaken. For this purpose, six complete families with active scabies, consisting of 12 adults and 20 children ranging in age from 1 to 10 years, were treated with 1% ivermectin in a solution of propylene glycol applied topically to the affected skin. The dose employed was 400 μg/kg, repeated once the following week. All patients were cured, tolerated the medication well, and there were no side effects or signs of recurrence 2, 4, or 6 weeks after therapy. In addition to its efficacy, easy administration, and lack of side effects, ivermectin is a low‐cost medication.
Generalized Acanthosis Nigricans in Early Childhood
Authors: Skiljevic Dusan S. , Nikolic Milos M. , Jakovljevic Anica , Dobrosavljevic Danijela D.
Published: March 2003

Abstract: Acanthosis nigricans (AN) is a disorder often accompanied by internal malignancy in adult patients, but in children it is usually benign. Generalized forms of AN, especially in childhood, are extremely rare. We report a 5‐year‐old boy with a 3‐year history of AN who had generalized roughness and hyperpigmentation, numerous skin wrinkles, disseminated skin tags, tripe palms, and intensive pruritus. No clinical evidence of internal disorders, notably of an endocrinologic or neoplastic nature, have been detected thus far.