bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing nurses’ capabilities to deputize for ward sisters
Authors: PITKÄNEN A. , KURONEN M. , PUKURI T. , VÄLIMÄKI M.
Published: March 2004

In recent years there has been heated debate on how the training of ward sisters should be conducted in Finland. This is important as in the coming years a large proportion of nurses will be approaching retirement while dramatic changes in mental health organizations during the last two decades have also challenged the role of the ward sister. This paper describes an ongoing project to develop the managerial skills of those nurses working as deputy ward sisters. The project began with a survey of managerial skills, an evaluation of training needs and the necessity for administrative counselling of a group of deputy ward sisters. On the basis of the analysis, a training programme was planned integrating managerial training and administrative counselling in a systematically advancing process.
Pathways to care in first episode psychosis
Authors: ETHERIDGE K. , YARROW L. , PEET M.
Published: March 2004

In order to inform the development of appropriate local services for early intervention in psychosis, a survey was conducted of the experiences of service users and their carers at the time when signs of psychosis were first noted. Eighteen service users and 12 carers were surveyed by questionnaire and interview. Both service users and carers recognized early signs of psychosis, but were often frustrated in their attempts to find help, particularly by lack of knowledge of whom to approach and unhelpful responses from professionals. The consistent themes that emerged included the young age of onset (mean age 17.2 years), poor recognition and lack of appropriate treatment at an early stage in primary care, delay in treatment because of associated substance misuse, and the inappropriateness of admission to a general adult psychiatric ward. This survey has given a local context to findings from national and international research studies. This will enable us to set up a local service which is responsive to the views and needs of service users and carers in Rotherham.
‘Shared‐rhythm cooperation’ in cooperative team meetings in acute psychiatric inpatient care
Authors: VUOKILA‐OIKKONEN P. , JANHONEN S. , VÄISÄNEN L.
Published: March 2004

The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared‐rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed.
Family dynamics and postnatal depression
Authors: TAMMENTIE T. , TARKKA M.‐T. , ÅSTEDT‐KURKI P. , PAAVILAINEN E. , LAIPPALA P.
Published: March 2004

Research has shown that postnatal depression (PND) affects 10–15% of mothers in Western societies. PND is not easily identified and therefore it often remains undetected. Untreated depression has a detrimental effect on the mother and child and the entire family. The purpose of this study was to ascertain the state of family dynamics after delivery and whether the mother's PND was associated with family dynamics. The study used a survey covering the catchment area of one Finnish university hospital. Both primi‐ and multiparas took part and data were collected using the Edinburgh Postnatal Depression Scale (EPDS) for mothers and the Family Dynamics Measure II (FDM II) for both mothers and fathers. The data were analysed using SPSS statistical programme and frequency and percentage distributions, means and standard deviations were examined. Correlations were analysed using Spearman's correlation coefficients. The significance of any differences between mothers’ and fathers’ scores was determined with a paired t‐test. Of the families participating in the study (373 mothers and 314 partners), 13% of the mothers suffered from PND symptoms (EPDS score of 13 or more). As a whole, family dynamics in the families participating in the study were reported to be rather good. However, mothers having depressive symptoms reported more negative family dynamics compared with other families. With the exception of individuation, mothers having depressive symptoms reported more negative family dynamics than their partners. With the exception of role reciprocity, non‐depressed mothers reported more positive family dynamics than their partners. Knowledge of the association of mothers’ PND with family dynamics could help to develop nursing care at maternity and child welfare clinics and maternity hospitals. Depressed mothers and their families need support to be able to make family dynamics as good as possible.
Mental health triage nursing: an Australian perspective
Authors: SANDS N.
Published: March 2004

This paper presents the findings of a doctoral research project that involved a state‐wide investigation into mental health triage nursing in Victoria, Australia. Mental health triage is a specialized domain of nursing practice that has emerged within the context of wider mental health reform in the State. The overall aim of the study was to produce a comprehensive definition and description of psychiatric triage nursing in Victoria. Methodological triangulation was used in the design of the study to enable the use of both survey (n = 139) and semi‐structured interview (n = 21) data collection methods. Mental health triage nursing was found to be a complex, stressful role that involves high levels of responsibility, clinical decision making, and multiple role functions, many of which overlap into areas of practice previously the exclusive domain of medicine, such as assessment, diagnosis, and referral. The paper raises discussion on contemporary professional issues of concern to mental health triage nursing, and concludes with recommendations for the future development of the discipline.
Development and piloting of a multidisciplinary training course for detecting and managing depression in the older person
Authors: MAYALL E. , OATHAMSHAW S. , LOVELL K. , PUSEY H.
Published: March 2004

Depression is the most common psychiatric condition found in older people. It is associated with increased mortality and adversely affects quality of life. Although the majority of depressive episodes are seen and treated in primary care, studies suggest in primary care there is under‐detection and inadequate management of depression in older people. In line with national policy in the UK this paper argues that training needs to be multidisciplinary and multiagency, and meet the requirements of local needs. It outlines a course that meets the expectation that specialist mental health workers such as mental health nurses should provide training and advice for those providing care and treatment in primary care. The paper reports upon the design and evaluation of a pilot multidisciplinary training course for health professionals and voluntary sector workers in the detection and management of depression in the older person. The course consisted of three 1‐day workshops and four consecutive courses were offered, with a total of 40 health professionals and voluntary sector workers completing the training. The training was evaluated using a questionnaire examining knowledge and confidence and by a scenario using an older person whom was potentially depressed. Results found a significant difference between pre‐ and post‐test for knowledge of depression in the older person and confidence in both detecting and managing depression. Results of the scenario revealed that there was a significant change from pre‐ to post‐test training in the type of questions participants would ask the older person to detect and assess depression. There was also a significant increase in the ability to identify types of interventions and local services available, which would help an older person with depression. The implications, limitations and future directions for research are discussed.
Understanding the social context of violent and aggressive incidents on an inpatient unit
Authors: SECKER J. , BENSON A. , BALFE E. , LIPSEDGE M. , ROBINSON S. , WALKER J.
Published: March 2004

The English National Service Framework for Mental Health stipulates that the highest quality of health care should be provided for mental health service users. Incidents of aggression and violence militate against achieving that goal, yet such incidents are frequently reported in inpatient settings. Much research in this area reflects a dualistic, perpetrator/victim conceptualization of incidents. This study aimed to take a more systemic approach by treating violent and aggressive incidents as social interactions and by seeking to understand the social contexts in which they took place. In this paper we describe and discuss the main themes to emerge from 15 staff accounts of 11 incidents on one ward. A striking theme reflected throughout the interview data was the lack of staff engagement with clients, and particularly an inability to look at the world through clients’ eyes in interpreting their behaviour. We conclude that the ‘zero tolerance’ campaigns currently being conducted in the UK in relation to aggression towards NHS staff are unlikely to succeed without attention to understanding why aggressive behaviour arises and identifying features of the caring environment that may contribute to it. Rather than adopting a position of ‘zero tolerance’, we argue that three steps are required following an aggressive incident: emotional support; critical reflection and learning; and the pursuit of accountability.
The mental health assistant practitioner: an oxymoron?
Authors: WARNE T. , McANDREW S.
Published: March 2004

The United Kingdom is currently experiencing a recruitment and retention crisis in its nursing workforce. Mental health care is a particular problem area. Widening access to health and social care careers is a challenge for educational and health care organizations.

 This discussion paper examines the congruence between an educational programme aimed at developing Mental Health Assistant Practitioners’ and the organizational responses to the subsequent opportunities for practice innovation within mental health care services. Whilst the ‘learning while working’ philosophy of the educational programme has been enthusiastically embraced by many health care organizations, the change in management required for using these assistant practitioners in service innovation appears beset by organizational, cultural and professional concerns. Not least of which are the often ambiguous concepts of the role and purpose of being a mental health nurse. This paper argues that if current mental health nurses are unclear about their role it is oxymoronic to establish the mental health assistant practitioners.
Consultant nurses in mental health: a discussion of the historical and policy context of the role
Authors: HAYES J. , HARRISON A.
Published: March 2004

This paper provides a platform for the discussion of the recent development of the nursing leadership role of consultant nurse. It focuses on the implementation of this role in mental health. The discussion is partially informed by evidence from personal reflections from consultant nurses obtained from semistructured interviews undertaken as part of a pilot study aimed at explaining the influences and context of nursing leadership in mental health. The authors believe that more in depth consideration needs to be given to the interpretation and implementation of such professional policy initiatives in to mental health nursing. Further thought also needs to be given to how consultant nurses in mental health can operationalize their expert clinical practice.
A model for setting up interdisciplinary collaborative working in groups: lessons from an experience of action learning
Authors: DOUGLAS S. , MACHIN T.
Published: March 2004

There is a current policy emphasis within health services on collaborative interdisciplinary groupworking between professionals, exemplified by the increasing use of action learning sets in a health context. Most of the evaluative research into this type of group collaboration has concentrated on evaluating outcomes, whereas this project aimed to evaluate qualitatively the experiences of the professional group members. The research uses a grounded theory methodology to investigate their perceptions and to analyse the data collected through interview methods. The research addresses an emergent theoretical model that could be of use when planning multidisciplinary task groups. It aims to enhance the success of these groups using a theory based on the concept of project momentum.
Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation – part I
Authors: FORREST S. , MASTERS H.
Published: March 2004

A range of psychosocial interventions (PSI) have developed as approaches to the treatment and support of people with enduring mental health problems and their carers. The impact of training mental health workers in PSI has also been subject to extensive research and evaluation for the past decade. Most previous research in the PSI and PSI training arenas have tended to adopt quasi‐experimental designs and professionally defined outcomes‐focused approaches to judging the success of training. This paper offers a critique of such approaches and presents a rationale for the methodology used in a qualitative study that evaluated five short PSI courses. The study emphasized a stakeholder approach to evaluation, involving collaborative activities between service users, carers, lecturers and mental health workers. These activities were intended to define what outcomes should be used to judge the success of training and how these should be examined during the research process. This paper details the processes and findings of these stakeholder activities that suggested, for service users particularly, process rather than outcome issues were the most important determinants of the success of PSI. Additionally, if outcomes were used to judge the success of interventions these should be highly individualized to reflect the aspirations of the person receiving the intervention. On the basis of the findings presented, discussion explores a proposal for a different methodological direction to the evaluation of PSI training. Part II of this paper presents and discusses the findings from the evaluation of the courses.
Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation – part II
Authors: FORREST S. , MASTERS H. , MILNE V.
Published: March 2004

Part I of this article presented an examination of the methodology used in previous psychosocial interventions (PSI) research and the rationale for the collaborative, qualitative design used in this study. In this second article the findings from an evaluation of five short PSI training courses are presented. Findings demonstrated that while the training was positively evaluated by participants and seen to be relevant to practice, the actual dissemination of PSI training into practice was a complex and context dependent process. There was difficulty for course participants in using PSI in practice as discrete, formal interventions. Rather the predominant way participants used PSI in practice was via a process of modifying PSI. The course philosophy, content and mode of delivery impacted on how the respondents constructed PSI as an overall approach to care and working relationships. Participants reported other ‘hidden’ benefits of training, such as reaffirming practice, increasing confidence and perhaps most powerfully, a change in attitude linked to the importance and impact attached to the service user and carer involvement in delivering the courses. Discussion locates the findings within the findings from previous PSI training evaluations and recommendations are made for a reappraisal of approaches to PSI training and research.
Being an outsider: nurses’ statements about a vignette of an elderly resident with a schizophrenia diagnosis and dementia behaviour
Authors: HELLZÉN O. , KRISTIANSEN L. , NORBERGH K. G.
Published: March 2004

In an exploratory study of nurses’ approach to elderly people with a diagnosis of long‐term schizophrenia, the aim was to investigate nurses’ views of the care of an elderly fictitious person with long‐term schizophrenia. All the nurses in one municipality in northern Sweden working at seven different units were investigated. A vignette, which was based on a case description in a previous study of an 84‐year‐old woman with severe dementia and problematic behaviour, was used after a minor alteration. In this study, the woman's age in the case description was changed from 84 to 68 years and the diagnosis was changed from severe dementia to long‐term schizophrenia; otherwise, the description was the same as in the original case. The main finding was the nurses’ inability to see the resident as anything other than what the ‘label’, the diagnosis, said. The nurses are interpreted as being caught in a dilemma of loyalty – on the one hand, the loyalty to the organization with its traditional goals and means and, on the other hand, the loyalty to the resident with her wishes in the forefront of their minds.
An analysis of Roy's Adaptation Model of Nursing as used within acute psychiatric nursing
Authors: PATTON D.
Published: March 2004

This article examines the use of Roy's Adaptation Model of Nursing within acute psychiatric nursing. The analytical framework used to analyse the model was that of McKenna's (1997) framework. The author believed this framework would allow for analysis of an abstract nature to occur. After examining the model under different headings it was concluded that there exists a research gap in relation to the use of Roy's model within acute psychiatric nursing. It is recognized that Roy's model is well developed and therefore has the potential to positively effect nurse practice and patient outcomes within acute psychiatric nursing. However, it is also acknowledged that a greater level of research‐based evidence is required in order to fully justify the use of the model within acute psychiatric nursing.
Medication administration in inpatient psychiatric care – get control and leave control
Authors: HAGLUND K. , Von ESSEN L. , Von KNORRING L. , SIDENVALL B.
Published: March 2004

The aim of this mini‐ethnographic study was to describe medication administration (MA) in short‐time inpatient psychiatric care. MA was observed on two psychiatric wards. Field‐notes were taken and interviews were conducted with 15 voluntarily admitted patients and nine nurses. The data analysis was conducted as a dialectical and interactive process. Two central categories were generated: get control and leave control, and two subcategories: interpersonal contact and nurses’ knowledge. The patients left control over medication to the nurses and expressed gratefulness for the opportunity to do so. Interpersonal contact between patients and nurses and nurses’ knowledge were of importance for the possibility for the nurses to get control and for the patients to leave control. MA is a complex task with an importance beyond giving the right pill to the right patient, and provides patients with an opportunity to communicate with the nurses.
Psychiatric treatment and research unit for adolescent intensive care: the first adolescent forensic psychiatric service in Finland
Authors: KAHILA K. , KILKKU N. , KALTIALA‐HEINO R.
Published: March 2004

Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor‐made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper.
Familial hypercholesterolemia (Type IIb) in a child: a case report with interesting features
Authors: Prasad P. V. S. , Chidambaram N.
Published: March 2004

Familial hypercholesterolemia (FH) is the most commonly recognized disorder of lipoprotein metabolism in childhood. We report a case of FH in a 5‐year‐old boy with onset of jaundice since birth, and multiple planar, tuberous, palmar and intertrigenous xanthomas covering the trunk and limbs. His total cholesterol was 590 mg/dl and triglycerides were 171 mg/dl. Echocardiography revealed mild aortic stenosis as a result of premature atherosclerosis. He was diagnosed with homozygous FH, and is reported here because of the interesting clinical features.
Favre‐Racouchot disease
Authors: Patterson Wanda M. , Fox Michael D. , Schwartz Robert A.
Published: March 2004

Solar elastosis with comedones studding the central face is often referred to as Favre‐Racouchot disease. These open and cystically dilated comedones tend to appear in the periorbital region of the face. The clinical manifestations, pathogenesis and current treatment of this disorder are reviewed.
Evaluation of nail involvement in patients with chronic cutaneous graft versus host disease: A single‐center study from Turkey
Authors: Sanli Hatice , Arat Mutlu , Oskay Tugba , Gürman Günhan
Published: March 2004

Although graft versus host disease (GVHD) is associated with a myriad of cutaneous signs, nail involvement is rarely mentioned in the literature. This study was conducted at the Department of Dermatology and The Bone Marrow Transplantation Unit of Hematology. All patients were examined clinically for presence of nail abnormalities. Severity of nail involvement was assessed as mild or severe. Of 28 patients diagnosed with chronic cutaneous GVHD, 14 had nail manifestations. Longitudinal ridging was the most frequently observed nail change on both the fingernails and the toenails. Severe nail changes such as ptergyium and onicoatrophy were noted in a few patients. As a result we could not find any relationship between nail changes and clinical severity but there was a relationship between nail changes and duration of disease. Nail manifestations could be responsible for considerable morbidity.
Allergic contact dermatitis to mango flesh
Authors: Weinstein Sari , Bassiri‐Tehrani Shirley , Cohen David E.
Published: March 2004

A 22‐year‐old white female student presented to the Emergency Department with a 2‐day history of patchy pruritic erythema of the face, neck, and arms with periorbital edema. The eruption began as an isolated patch of nasal erythema, with subsequent extension to involve the entire face. Within 2 days, fine pinpoint papules were noted on the face, anterior chest, neck, and upper extremities. Periorbital edema was present without intraoral abnormalities or laryngeal changes. An erythematous, mildly lichenified plaque was noted on the ventral left wrist.

The past medical history was significant for two similar, milder episodes of allergic reactions of uncertain etiology occurring within the previous 2 months. The previous eruptions resolved after treatment with oral loratodine and topical fluocinonide cream 0.05%. The patient denied any history of contact urticaria or new household or personal hygiene contactants, although she did report frequent ingestion of peeled mangoes. Her brother had a history of eczematous dermatitis.

In the Emergency Department, the patient was administered intravenous diphenhydramine and a single 50 mg dose of oral prednisone. She continued treatment with a 5‐day course of prednisone, 50 mg daily, with loratodine, 20 mg daily, and diphenhydramine as needed; however, no symptomatic improvement was seen over 4 days. She was then advised to restart fluocinonide cream twice daily.

Patch testing was performed to the North American Contact Dermatitis Group Standard Series utilizing methods of the International Contact Dermatitis research group with Finn chambers. Mango skin and mango flesh harvested 5 mm below the skin surface were also placed in duplicate and tested under Finn chambers. Positive (1+) reactions were noted to nickel and p‐tertbutylphenol formaldehyde resin, and bullous reactions were found to mango skin and surface flesh in duplicate (Fig. 1). Complete avoidance of mango led to resolution of the initial eruption. The clinical relevance of nickel and p‐tertbutylphenol formaldehyde resin was thought to be associated with the wrist lesion immediately below a glued portion of a wristwatch strap and metal clasp.

Positive patch test reactions, in duplicate, to mango skin (left column) and mango flesh 5 mm below the skin (right column)

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Ibuprofen‐induced acute generalized exanthematous pustulosis
Authors: Yesudian P. D. , Penny M. , Azurdia R. M. , King C. M.
Published: March 2004

Acute generalized exanthematous pustulosis is a rare condition characterized by an acute pustular eruption involving most of the body, usually precipitated by drugs. It can occur after the use of a variety of medications but there have been no previous reports of ibuprofen as an etiological agent.
Severe rosacea associated with colon cancer recurrence
Authors: Margolin L.
Published: March 2004

An 80‐year‐old male, who had undergone orchiectomy because of prostatic cancer, presented with rosacea (for the first time in his life), weight loss and anemia, and was diagnosed with local recurrence of colon cancer. The hormonal disarrangement unbalance after orchiectomy and a paraneoplastic vasoactive substance may have contributed to the development of rosacea in this patient.
Painful spitz naevus sole of foot
Authors: Ezughah Francesca I. , Orpin Sid , Colloby Peter S.
Published: March 2004

A 21‐year‐old student of sports science presented with a 12‐month history of a painful nodule on the sole of her left foot, which severely constrained her sporting activities. She was otherwise well. On examination there was a bluish pink 7‐mm nodule on the arch of her left foot (Fig. 1). It was firm, exquisitely tender and she walked with a slight limp. The lesion was curetted and sent for histological diagnosis.

Pink dermal nodule, sole of left foot

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The specimen showed a symmetrical wedge‐shaped compound melanocytic lesion reaching the margins of the biopsy. The overlying epidermis was acanthotic and hyperkeratotic. Junctional nests were present and there was clefting between them and the epidermis (Fig. 2). Near the nests were eosinophilic globules (Kamino bodies) and pigment‐laden macrophages. The lesion consisted of a mixture of large spindle and epithelioid cells with abundant eosinophilic cytoplasm and plump nuclei with prominent nucleoli. There were a few mitoses but none was atypical. Single epithelioid melanocytes were present deep within the lesion (outlier cells) and there was maturation with depth in the dermis. The histological features were those of Spitz naevus.

Photomicrograph demonstrating functional nests with clefting. Pigment‐laden macrophages are shown, as are Kamino bodies (→ hematoxylin and eosin, original magnification × 20)

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There was significant reduction in the severity of her pain after curettage but the pain subsequently recurred. In view of this and possible incomplete excision, the scar was re‐excised with a narrow margin. Histology confirmed complete excision of the residual naevus. Her symptoms have since subsided.
Erythema dyschromicum perstans: Response to dapsone therapy
Authors: Bahadir Sevgi , Çobanoglu Ümit , Çimsit Gülseren , Yayli Savas , Alpay Köksal
Published: March 2004

Erythema dyschromicum perstans (EDP) is a rare disorder characterized by asymptomatic, slowly progressive, ash‐gray macular pigmentation of the skin, which usually occurs from age 5 years through adult life. Most cases reported to date are of Latin American and Indian patients. Rare cases has been reported from Turkey. No treatment of choice is presently available. Various therapies have been tried, including sun protection, chemical peels, antibiotics, corticosteroids, vitamins, isoniazid, griseofulvin, and chloroquine, without any benefit. Some authors have suggested the therapeutic efficacy of clofazimine and dapsone on EDP. We report a case of EDP that responded remarkably well to treatment with dapsone.
Dermatology in Nigeria: evolution, establishment and current status
Authors: George Adekunle O. , Daramola Olaniyi O. M.
Published: March 2004

The history of dermatology in Nigeria can be summarized by listing the “first events and people” who played major roles. The first dermatologist to work in Nigeria was George HV Clarke in the mid 1950s. He was based in Lagos. Organized training/teaching and research in dermatology was first established at the University of Ibadan in the western region of Nigeria, in collaboration with the Institute of Dermatology, London. The first set of dermatologists from the Institute on secondment who established dermatology as a discipline at the University of Ibadan were Roger RM Harman as lecturer and GC Wells as the Visitor/supervising consultant in 1962. The first indigenous dermatologist was Anezi Okoro. The first female dermatologist was Yetunde M Olumide. The first (and still the only) Department of Dermatology was at the Obafemi Awolowo University in Ile‐ife in the western region of Nigeria, started by a German trained dermatologist: F. Soyinka, the junior brother of Nigeria's first (and only) Nobel Laureate. The first leprologist in Nigeria was George Stanley Browne, a medical missionary. He worked briefly as an associate lecturer (1963–65) under Professor Alexander Brown at the University of Ibadan. Most of the events in Nigeria's dermatology history as well as the greatest concentration of dermatologists in the country have been around the south‐western part of the country: Lagos, Ibadan, and Ile‐ife. The military coup and the political events that occurred thereafter had a great negative impact on the development/growth of dermatology in Nigeria. The documentation by Ryan as of 1990 indicates that many African countries still do not have a single trained dermatologist.1
Disseminated granuloma faciale
Authors: Zargari Omid
Published: March 2004

A 40‐year‐old man presented in January 2001 with multiple purple plaques and nodules, which had been present on the back for approximately 3 years. The lesions had gradually extended over the face, trunk and proximal extremities. He had no symptoms except occasional mild pruritus. The patient was in good health and was on no medications. Physical examination revealed multiple violaceous to brown, indurated, 5–50‐mm, round to oval plaques on the face, arms, shoulders, and back (Fig. 1), as well as a solitary lesion on the right thigh. Surface telangiectases were noted, especially on the shoulder lesions. There was no scaling or ulceration. Routine laboratory tests were unremarkable.

Multiple reddish‐brown plaques on the back

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In April 1999, another medical center performed a biopsy of what they thought was sarcoidosis. The results were reported as “possible angiolymphoid hyperplasia with eosinophilia.” With the possibility of granuoma faciale (GF) in mind, another skin biopsy was obtained from a facial lesion. This revealed a diffuse, relatively dense infiltrate of neutrophils, eosinophils and mononuclear inflammatory cells in dermis with an obvious Grenz zone (Fig. 2). Pilar units were intact, and endothelial cell swelling was present (Fig. 3). Retrospective evaluation of the initial biopsy, taken from the back, revealed the same changes, and helped confirm the diagnosis of GF.

A diffuse, relatively dense mixed infiltrate, separated from a normal epidermis by a Grenz zone (hematoxylin and eosin, × 40)

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Polymorphous infiltrate containing eosinophils, neutrophils, and lymphocytes surrounding dilated dermal vessels with swollen endothelial cells (hematoxylin and eosin, × 400)

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The patient was treated with liquid nitrogen for 20 s followed immediately by intralesional triamcinolone acetonide (5 mg/ml). This treatment was repeated every 4 weeks for three courses, resulting in partial resolution of the lesions.
Pilot study of patient satisfaction with nonfluorinated topical steroids compared with a topical immunomodulator in atopiform dermatitis
Authors: Burkhart Craig N. , Burkhart Craig G.
Published: March 2004

Background  There is clinical uncertainty concerning the effectiveness of the new topical immunomodulators vs. the conventional use of topical steroids for the treatment of atopic dermatitis.

Objectives  To assess patient satisfaction with these two prescription topical remedies for atopic eczema.

Methods  In an open‐label, 2‐week, comparative study, 10 patients demonstrating atopiform dermatitis were given tacrolimus and 0.1% hydrocortisone butyrate in a 70% oil‐in‐water base to apply to the eczema on opposite sides of the body. After 2 weeks of applying the agents twice daily to their respective sides of the body surface, the study subjects completed a 12‐question survey to assess their opinions of the two products.

Results  There was a preference for the nonfluorinated topical steroid over tacrolimus in this cursory head‐to‐head study. There were no withdrawals from the study or side‐effects reported with either product.

Conclusions  Trials of short duration with small numbers of patients do not adequately inform practitioners regarding the use of these topical remedies. However, the higher satisfaction of patients with 0.1% hydrocortisone buyrate in a 70% oil‐in‐water base over tacrolimus certainly warrants further investigation.
Cutaneous onchocercoma
Authors: Okulicz Jason F. , Stibich Adam S. , Elston Dirk M. , Schwartz Robert A.
Published: March 2004

Onchocerciasis is a common, chronic multisystem disease with dermatologic, ocular, and systemic manifestations. Although the disease is endemic in Africa, Latin America, and Yemen, imported cases have been described in the United States. The causative organism, Onchocerca volvulus, is transmitted by the bite of a black fly of the genus Simulium. There are a number of cutaneous manifestations of the disease, including onchocercomas, which are subcutaneous bundles of worms. The antiparasitic agent ivermectin is the drug of choice for both prophylaxis and treatment of active disease.
Effect of acetaldehyde, arsenite, ethanol, and heat shock on protein synthesis and chilling sensitivity of cucumber radicles
Authors: Saltveit Mikal E. , Peiser Galen , Rab Abdur
Published: March 2004

Exposure to a chilling temperature of 2.5°C for 96 h inhibited the subsequent growth of cucumber seedling radicles at 25°C by 92%. Exposing seedling with 5 ± 1 mm long radicles to acetaldehyde vapour (275 µl l−1) or to an aqueous ethanol solution (0.6 M) for 2 h, or to 45°C for 10 min before chilling, increased chilling tolerance so that the chilling treatment reduced growth by only 47, 39 or 36%, respectively. All of these effective treatments induced the synthesis of a number of proteins, and suppressedde novoprotein synthesis (i.e. the incorporation of [35S]‐methionine) by about 70%. In contrast, treatment for 2 h with an aqueous arsenite solution (100 µM) had no effect on chilling sensitivity or the incorporation of [35S]‐methionine, yet it induced the synthesis of a complement of proteins that were similar to that induced by the effective heat‐shock treatment. A unique protein or set of proteins may be responsible for heat‐shock‐induced chilling tolerance, but none was detected. The ability of various abiotic stresses to suppress protein synthesis may be more important in increasing tolerance to chilling injury than their ability to induce the synthesis of specific proteins.
Copper effect on cytochrome b559 of photosystem II under photoinhibitory conditions
Authors: Bernal María , Roncel Mercedes , Ortega Jose María , Picorel Rafael , Yruela Inmaculada
Published: March 2004

Toxic Cu (II) effect on cytochrome b559 under aerobic photoinhibitory conditions was examined in two different photosystem II (PSII) membrane preparations active in oxygen evolution. The preparations differ in the content of cytochrome b559 redox potential forms. Difference absorption spectra showed that the presence of Cu (II) induced the oxidation of the high‐potential form of cytochrome b559 in the dark. Addition of hydroquinone reduced the total oxidized high‐potential form of cytochrome b559 present in Cu (II)‐treated PSII membranes indicating that no conversion to the low‐potential form took place. Spectroscopic determinations of cytochrome b559 during photoinhibitory treatment showed slower kinetics of Cu (II) effect on cytochrome b559 in comparison with the rapid loss of oxygen evolution activity in the same conditions. This result indicates that cytochrome b559 is affected after PSII centres are photoinhibited. The high‐potential form was more sensitive to toxic Cu (II) action than the low‐potential form under illumination at pH 6.0. The content of the high‐potential form of cytochrome b559 was completely lost; however, the low‐potential content was unaffected in these conditions. This loss did not involve cytochrome protein degradation. The results are discussed in terms of different binding properties of the heme iron to the protonated or unprotonated histidine ligand in the high‐potential and low‐potential forms of cytochrome b559, respectively.
Distance education is as effective as traditional education when teaching food safety§
Authors: Shanley Ellen L. , Thompson Colleen A. , Leuchner Lisa A. , Zhao Yanyun
Published: March 2004

A food safety and sanitation course was developed and administered using two different educational methods: traditional classroom style and distance education via CD‐ROM and the Internet. A research project studied the differences between participants taking the distance education course and those taking the traditional course. Success of the participants was evaluated using several different measures: comparison of pre‐/post‐test, pass/fail of a United States nationally recognized food safety examination, and test score of the United States national food safety examination. Fifty individuals participated in the study: n = 22 in the traditional group and n = 28 in the distance education group. Data were analyzed using Statistical Power for the Social Sciences (SPSS). All participants took the nationally recognized food safety examination. Bivariate analyses revealed no significant association between the method of education and the national examination score. The data indicate that more highly educated people may choose a distance education course. Number of years employed in food service significantly influenced test scores among all participants. Distance participants who passed spent more time using the CD‐ROM (57% spent > 10 h) compared to those who failed (25% spent > 10 h). The audio and Internet components were more useful to those who passed. Participants who passed in both groups were more likely to list English as their primary language (100%). Of those who failed, 26% listed a language other than English as primary. Data indicate that distance education is a viable method of training food service professionals in food safety and sanitation. The Distance Education Course is available through the University of Connecticut and may be accessed at http://www.team.uconn.edu/foodsafety_course/index.htm. Distance education courses in food safety are available in English, Spanish, and Vietnamese. The project was funded in part by a United States Department of Agriculture Integrated Food Safety Grant.
Culinary arts and meal science – a new scientific research discipline*
Authors: Gustafsson Inga‐Britt
Published: March 2004

A new scientific research discipline has been accepted at the Department of Restaurant and Culinary Arts at Örebro University. The subject area definition of Culinary Arts and Meal Science, as opposed to Culinary Science, was chosen. This is because Culinary Arts places great emphasis on practical skills, aiming to combine these with science as well as with working methods with an artistic content. Thus its scientific approach is a multidisciplinary one, joint efforts with other sciences being necessary, for instance by maintaining a scientifically varied tutorship. Research areas such as ethnology, sociology, anthropology, business economics, nutrition, domestic science and public health all constitute adjacent branches. These areas treat the meal from various aspects, which are examined in this paper. During the course of our educational endeavours at the department, we studied the meal from a five‐aspect viewpoint with the following main elements: the room, the meeting, the product, the atmosphere and the management control system, which also constitute the framework within which we formulate our issues and questions. First, this five‐aspect approach is a constructive and all‐inclusive aid for those who plan and produce meals, especially in restaurants – all with the ultimate aim to achieve maximum satisfaction among the guests in different meal situations. If, then, the guest/diner evaluates the meal with something like these five aspects in mind is the subject of our research! At present, seven PhD students have been admitted to the postgraduate course in Culinary Arts and Meal Science. These students will study the meal, or certain parts of it, and the importance of the various components are presented from a number of perspectives.
Prevention of food worker transmission of foodborne pathogens: risk assessment and evaluation of effective hygiene intervention strategies
Authors: Michaels Barry , Keller Cheryll , Blevins Matthew , Paoli Greg , Ruthman Todd , Todd Ewen , Griffith Christopher J.
Published: March 2004

The infected food handler can be responsible for the transmission of infectious intestinal diseases (IID) caused by foodborne pathogens. It is believed that personal hygiene practices with varying levels of complexity can help prevent foodborne pathogens from entering the food chain. Overall, it has been difficult to reach a consensus among stakeholders on precisely which intervention measures should be employed in food handling environments to effectively reduce IID rates. Through a study of over 300 reports of outbreaks attributed to ill or asymptomatic food handlers, hazards and contributory factors responsible for foodborne illness outbreaks were identified. With the use of the risk analysis software platforms of Analytica®, @Risk, and GoldSim®, models were created to explore measures of hygiene effectiveness. Through the use of appropriate models, results of various personal hygiene intervention measures were explored for the development of preventive management strategies, designed to improve food‐handling practices at various levels of the food chain. These included exclusion of ill food handlers, vaccination for hepatitis A virus, handwashing combined with drying, wearing of gloves, and use of instant hand sanitizers and fingernail brushes. This was accomplished by modeling pathogen transfer and transmission routes from food handler via foods, beverages and common contact surfaces using GoldSim® and Monte Carlo simulations. A lottery model was also created to understand risk as an interrelated overlapping extremes driven system, comprised of the three components of hygiene frequency, efficacy and cross‐contamination. Data gaps were identified with respect to areas where considerable variability and uncertainty exists in order to establish research priorities.
Influence of tobacco smoking on periodontal bone height. Long‐term observations and a hypothesis
Authors: Bergström Jan
Published: March 2004

Aim:  The aim of the investigation was to estimate the magnitude of the long‐term influence of chronic smoking on the periodontal bone height.

Methods:  The study population included 19 continuous smokers, 28 former smokers and 44 non‐smokers in the age range 20–60 years at baseline. The participants were examined at two points in time with an interval of 10 years. The height of the periodontal bone was determined from bite‐wing radiographs of the first and second premolars of the maxilla and the mandible and measured from the cemento‐enamel junction (CEJ) to the periodontal bone crest (PBC) mesially and distally to the preselected teeth.

Results:  The mean (SD) CEJ–PBC distance at baseline was 1.82 (1.01) mm for smokers, 1.65 (0.81) mm for former smokers, and 1.16 (0.59) mm for non‐smokers (p=0.016). The mean (SD) 10‐year bone height reduction was 0.74 (0.59) mm for smokers as against 0.26 (0.31) mm for former smokers and 0.27 (0.29) mm for non‐smokers. Controlling for age and baseline bone height level, the magnitude of the reduction was significantly dependent of smoking (p=0.000). The widening gap between smokers and non‐smokers over time suggested that the bone height reduction of smokers took place at an accelerated rate.

Conclusion:  On the basis of the observations it is hypothesized that smoking induces an acceleration of the periodontal bone height reduction rate and that smoking cessation results in a return towards non‐smoker rate.