bluuebunny/crossref_metadata_2025 huggingface dataset:
EMG activity of the masseter muscle in implant supported overdenture wearers during chewing of hard and soft food
Authors: Karkazis H. C.
Published: March 2003

summary  The influence of texture of food on the surface electromyographic (EMG) activity of the masseter muscle was investigated in a sample of mandibular implant overdenture wearers. Six experienced denture wearers (mean age 57·8 years) with mandibular overdentures supported by two implants, consented to participate in this study. Fresh raw carrots and peeled apples of similar size and weight were chosen as representing hard and soft food, respectively. The findings were in line with those earlier reported in dentate subjects and complete denture wearers in that harder foods require higher chewing rates, higher EMG activity and higher relative contraction times, accompanied by shorter cycle durations. It was also concluded that rehabilitation with implant retained mandibular dentures may result in more regular chewing patterns with higher electrical activity of the masseter muscles, thus providing improved chewing function and comfort.
Surface treatment of dentin with GLUMA and iron compounds for bonding indirect restorations
Authors: Baba N. , Taira Y. , Matsumura H. , Atsuta M.
Published: March 2003

SUMMARY  The purpose of this study was to evaluate five dentin bonding systems simulating indirect restorations. The surface of bovine and human dentin was primed with a glutaraldehyde agent (GLUMA) and placed in a humidor at 37 °C for 168 h. In an experimental bonding system (GLUMA/CY/SB), the surfaces were etched with phosphoric acid, primed with cytochrome c, and then bonded to an acrylic rod with a self‐curing resin (4‐META/MMA‐TBB). Specimens using two commercially available bonding systems [All‐Bond 2 (AB2) and Super‐Bond C & B (10–3/SB)] and two controls with and without GLUMA (GLUMA/10–3/SB and CY/SB) were also prepared. Tensile testing revealed that the bond strengths were influenced by the bonding system, 168 h dentin exposure and their interaction, but not by the tooth origin. AB2 showed the lowest bond strength. With the 10–3/SB system, exposing the dentin to humidity resulted in a decrease in bond strength. After 168 h of exposure, no significant differences were observed between 10–3/SB and CY/SB. The most effective bonding was obtained with the bonding systems of GLUMA/10–3/SB and GLUMA/CY/SB. Improved outcome is expected with these bonding systems when building up abutment teeth with indirect restorations.
Denture stomatitis and salivary Candida in Brazilian edentulous patients
Authors: Pires F. R. , Santos E. B. D. , Bonan P. R. F. , De Almeida O. P. , Lopes M. A.
Published: March 2003

SUMMARY  Denture stomatitis (DS) is frequently associated with high levels of Candida in saliva and deficient denture hygiene. In order to analyse the incidence of DS and its pre‐disposing factors, we evaluated 77 edentulous patients before and 6 months after the placement of new complete dentures. Denture stomatitis was observed in 50·6 and 18·2% of the patients at the first and second evaluation, respectively. Salivary flow, Candida counts in saliva and Candida species were similar in both evaluations. Denture stomatitis and Candida in saliva were more common in females. Our results showed that denture replacement and denture hygiene improvement were useful for DS resolution, particularly types I and II. However, oral and denture hygiene must be continuous, inasmuch as salivary Candida counts remained high and it is considered an important pre‐disposing factor for DS.
Changes in chewing ability with ageing: a 7‐year study of older adults
Authors: Locker D.
Published: March 2003

SUMMARY  One of the most important consequences of oral diseases and disorders is a reduction in the ability to chew. This paper reports the results of a study of changes in chewing ability in a population of community‐dwelling older adults who were aged 50 years and over when first recruited. Data were collected at baseline, and at 3 and 7‐year follow‐ups using an index of chewing capacity consisting of six indicator foods, a four‐item measure of the psychosocial impact of chewing dysfunction and a single‐item rating of satisfaction with chewing ability. The percentage of subjects who reported a problem chewing increased from 24·0% at baseline to 25·2% at 3 years and 33·8% at 7 years. The increase in prevalence over 7 years was 5·3% in dentate subjects aged 64 years and under at baseline and 26·1% in edentulous subjects aged 65 years and over. Overall, there were increases in the proportion reporting some psychosocial impact and the proportion reporting dissatisfaction with their ability to chew. Patterns of change with respect to these variables differed across groups defined by age and dental status. Change scores computed from baseline and the 7‐year follow‐up indicated considerable within‐subject change, with some individuals improving and some deteriorating. However, they confirmed that overall there was a decline in oral functioning in this population and that older edentulous subjects showed the greatest propensity to change. Factors which predict the patterns of change identified by this study need to be explored in order to enhance our understanding of changes in the chewing ability of this population as it ages.
Eccentric anterior wear facets in the diagnosis of temporomandibular disorders
Authors: KIRVESKARI P. , JÄMSÄ T.
Published: March 2003

The present study aimed at testing whether eccentric anterior bruxing facets are associated with clinical signs from the temporomandibular joints and with palpatory tenderness of the muscles of mastication. Wear facets in the canine and incisor areas were assessed by inspecting dental stone casts made at baseline and at the end of a 4‐year clinical trial involving 129 adolescents and young adults. The subjects who showed distinct increase in wear were divided into three groups: (i) wear pattern indicating an anterior thrust of the working side mandible, (ii) wear pattern indicating a posterior thrust of the working side mandible and (iii) other wear patterns. The assessment of wear patterns was made without knowledge of clinical signs of temporomandibular disorders (TMD). The eventual change in muscular or joint signs of TMD from baseline to the final examination was then obtained from the records, and the association with wear pattern was calculated.

There was no significant evidence of an association between eccentric anterior wear and signs of TMD. The direction of the mandibular thrust generated by bruxing was also unassociated with the presence of TMJ and muscular signs. In conclusion, the predictive value of eccentric anterior wear facets in young subjects is too low to be helpful in the diagnosis of TMD.
In vivo horizontal forces on implants depending on the type of occlusion
Authors: MORNEBURG T. , PROESCHEL P.
Published: March 2003

Minimizing horizontal forces on implants is one of the important aims of an occlusal design. Therefore, several proposals have been made in literature, e.g. flat cuspal slopes or narrow occlusal surfaces. Our aim was to test how these occlusal designs would influence horizontal forces.

Ten healthy subjects with unilateral partially edentulous arches were provided with fixed partial dentures (FPD) on two ITI‐implants. The opposing jaw was fully dentate. After an adaptation of 6 month measurement setups with a measuring FPD were put into the mouth. The sensoring device, which consisted of two abutments equipped with strain gauges, evaluated the forces in three dimensions. For each person three FPDs were made with a different design of the occlusal surface. The first FPD exhibited cusps with steep slopes (S), the second showed flat cusps (F) and the third had a narrow occlusal surface (N). The peak forces of the chewing cycles of each patient were evaluated. While chewing wine gum the average values of the vertical forces of the three different FPDs showed no significant differences and amounted to between 253·8 N (s.d. 85·7 N) and 273·9 N (s.d. 63·7 N). With the first FPD (S) mean horizontal forces of 47·9 N (s.d. 34·8 N) were found whereas with the flat surface an average force of 47·4 N (s.d. 37·1 N) was measured. The narrow occlusal surface was associated with an average reduction of the horizontal forces of about 50·9% to a mean value of 24·4 N (s.d. 10·6 N) (P < 0·005).

The inclination of occlusal slopes did neither affect vertical nor horizontal forces significantly. However, narrowing of the occlusal surface in the oro‐vestibular direction by 30% showed a significant reduction of the lateral forces exerted on the implants by more than 50%. A reduced oro‐vestibular width of the occlusal surface is recommended especially for diameter‐reduced implants, in case of an unfavourable relationship between implant and crown length or for implants that are strongly inclined to the occlusal plane.
Maximal bite force and EMG during bilateral and unilateral clenching
Authors: VAN DER BILT A. , ABBINK J. H. , FONTIJN‐TEKAMP F. A. , BOSMAN F.
Published: March 2003

The observed maximal bite force is known to depend on the measuring method employed. Bite position, bite rise and unilateral or bilateral biting influence the observed bite force. The maximal bite force obtained when clenching unilaterally is smaller than the bite force summed for the two sides of a bilateral measurement (Bakke et al., 1989). We determined bite force and muscle activity of the masseter and temporal muscles during maximal voluntary contraction in a group of 81 dentate subjects. The bite force was measured between the first molars both bilaterally and unilaterally. The summed bite force obtained from the bilateral measurement was 569 ± 170 N. The bite force obtained for unilateral clenching was significantly lower: 430 ± 142 N. No significant differences in bite force between the right and left side for both the bilateral and unilateral measurements were observed. The muscle activity of the masseter and temporal muscles obtained from bilateral clenching did not differ significantly (masseter: 248 ± 149 μV and temporalis: 232 ± 105 μV). Also no significant differences were observed in muscle activity between the right and left side during bilateral clenching. We observed a significantly lower muscle activity in both masseter and temporalis for unilateral clenching as compared with bilateral clenching. The results of unilateral clenching showed no differences in muscle activity between the ipsi‐ and contralateral side for the masseter muscle (186 ± 127 μV). However, the muscle activity at the ipsilateral side of the temporal muscle (197 ± 127 μV) was significantly higher than at the contralateral side (150 ± 81 μV). We may conclude that bilateral clenching yields bite forces that are over 30% larger than those obtained during unilateral clenching. The muscle activity during unilateral clenching is symmetrical in the masseter muscles, but asymmetrical in the temporal muscles.
Validation of diagnostic criteria for sleep bruxism
Authors: BABA K. , HAKETA T. , AKISHIGE S. , FUEKI K. , OHYAMA T.
Published: March 2003

Several diagnostic criteria for bruxism can be taken from the literature; however, most of them have never been validated. This study examined whether predictor variables taken from physical examinations and questionnaires were related to the actual bruxism levels.

Fifty dental students agreed to participate in this study and eight examination variables and seven questionnaire variables were collected from them. The subjects measured their nocturnal EMG activity from the right masseter muscle for six consecutive nights in their home by means of a portable EMG device. Off‐line analysis was performed on data from second to sixth nights. By using a custom made software, all EMG activity elevations above a minimum threshold of 50% of each subject's individually established maximum voluntary contraction (MVC) level were quantified with regard to the duration and number of elevations and then three outcome variables, which were event number per hour (number/h), event duration per hour (duration h−1), and duration per event (duration/event), were calculated. A multiple stepwise regression (MSR) analysis was conducted to assess the 15 predictor variables and the three outcome variables.

These MSR analyses revealed that the joint sound score remained in the regression equation as a predictor (n=50, P < 0·05) of the likelihood that a subject would exhibit longer bruxism events (duration h

−1

and number h

−1

). It must be noted that the self‐awareness and tooth attrition status were found not to be strong predictors and even for the above variable where significant association was found, the likelihood ratio between the variable and predicted outcomes was not robust.
Interactions between swallowing centre, chewing centre and supramedullary region during elicitation of swallows by superior laryngeal nerve (SLN) stimulation
Authors: YAMADA Y. , YAMAMURA K. , TAKAGI M. , AMARASENA J. K. C.
Published: March 2003

Swallowing centre (swl‐c) which controls motor behaviour of swallowing receives inputs from other regions including respiratory center, chewing center (chw‐c) and supramedullary region. However, interactions between them are unclear. The objective of this study was to elucidate such interactions using freely behaving six domestic male rabbits. Swallows were elicited by superior laryngeal nerve (SLN) stimulation. The electromyographic activities (EMGs) of masticatory and swallowing muscles and the jaw movement orbits were recorded for 30 s with and without SLN stimulation at rest and during chewing. Decerebration was performed to investigate the influence of supramedullary region. Although there was a significant increase (P < 0·001) in the number of swallows between with and without SLN stimulation at rest and during chewing, the absolute increase in the number of swallows was same. After decerebration, the number of swallows was decreased significantly (P < 0·05). There were no significant differences in the latency of thyrohyoid EMG onset and cycle durations between with and without SLN stimulation.

It is concluded that (i) swallows induced by SLN stimulation may be identical to those induced by food bolus, (ii) generation of swallows by swl‐c might be controlled by chw‐c, (iii) swl‐c might affect the rhythm generator in chw‐c and (iv) supramedullary region might send a tonic excitatory input to swl‐c and maintains its excitability.

Supported by Japan grants – in‐aid #1470389 and #12771102.
Possible gender‐related differences in a jaw reflex evoked by stimulation of the human lip
Authors: LYONS M. F. , OKDEH A. M. , CADDEN S. W.
Published: March 2003

It has been reported that the latency of the jaw jerk reflex in symptom‐free human female subjects is significantly shorter than in male subjects (Kossioni et al., 1994). In the present study, we have begun to investigate whether there are any gender‐related differences in other jaw reflexes. The EMG recordings were made from an active masseter muscle in 16 young adult age‐matched subjects (eight male, eight female; aged 20–43 years). Inhibitory reflexes were evoked in the muscle by applying stimuli through bipolar electrodes clipped over the lower lip with the cathode placed intraorally on the oral mucosa. While the stimuli were being applied, the subjects maintained the EMG level at around 10% of maximum with the aid of visual feedback. The presence or absence of reflex responses was determined as previously described (Louca et al., 1996). Wilcoxon Rank Sum tests were used to compare the properties of the short‐ (∼10–15 ms) and long‐ (∼40–50 ms) latency inhibitory reflexes evoked by the stimuli in the two groups. There was no significant difference between the male and female groups in the threshold or latency of either reflex. However, the duration of the long‐latency inhibition was significantly shorter in females than in males (median values: 29·0 versus 44·0 ms, P=0·015). These preliminary findings suggest that, at least in young human subjects, there is a gender‐related difference in the strength but not in the presence of long‐latency inhibitory jaw reflexes.
Effect of finishing and polishing procedures on the surface roughness of new tooth‐coloured restoratives
Authors: Özgünaltay G. , Yazici A. R. , Görücü J.
Published: March 2003

summary  The purpose of this study was to evaluate the effect of various finishing and polishing procedures on the surface roughness of three new tooth‐coloured restorative materials. The materials included a hybrid composite resin (Filtek Z250), a packable composite resin (Filtek P60), and an ormocer (organically modified ceramic) (Definite). Thirty‐two specimens of each material were prepared and randomly divided into four finishing and polishing groups (n=8): (i) diamond bur/silicone polishers, (ii) diamond bur/Sof‐Lex discs, (iii) carbide bur/silicone polishers, (iv) carbide bur/Sof‐Lex discs. Average surface roughness (Ra) in micrometers was measured with a Mitutoyo Surftest‐402 Surface Roughness Tester and the data compared using anova, at P≤0·05. Surface topography was also assessed using the scanning electron microscope (s.e.m) from samples of each group. The Mylar strip produced the smoothest surface and finishing/polishing procedures; (ii) and (iv) were significantly smoother than (i) and (iii). The lowest variability in initial surface roughness between materials was also observed with ormocer group.
Peplau and professionalism: the emergence of the paradigm of professionalization
Authors: Sills
Published: March 2003

We asked Dr Grayce Sills, a long‐time collegue and friend of Dr Hildegard Peplau, to write a historical paper to assist in understanding the contributions of Dr Peplau to the professionalization of nursing. This historical reflection reveals insights into Dr Hildegard Peplau as a person, her leadership and her scholarly abilities. Dr Peplau's theorizing is largely inductive and based on keen observations of her clinical work and her environment. This insight into her inductive curiosity is further revealed in the papers that follow.
The ideal role of the nurse teacher in the clinical area: a comparison of the perspectives of mental health, learning difficulties and general nurses
Authors: Brown  , Forrest  , Pollock
Published: March 2003

This paper reports findings from a study that explored trained nurses' and student nurses' perceptions of the nurse teachers' ideal role in the clinical area. Findings demonstrate a dichotomy of opinion regarding the ideal role of the nurse teacher in the clinical area that relates to the nursing specialities in which trained nurses work. Trained nurses working in general nursing areas favoured a product‐focused, inspectorate supervisory role for nurse teachers. Conversely, trained nurses working in mental health and learning difficulties areas favoured a supportive, supervisory role for the nurse teacher that emphasized the learning process and encouraged reflection. The consequence of the different models used for student nurses' experience of supervision are discussed and the issue of nurse teachers' clinical credibility is explored. It is suggested that trained nurses, nurse teachers and student nurses should be involved in negotiating and constructing the role that nurse teachers play in the clinical area.
The application of Peplau's theory to group psychotherapy
Authors: Lego
Published: March 2003

This paper illustrates the application of Hildegard Peplau's Interpersonal Theory of Nursing to group psychotherapy. The phases of the nurse‐patient relationship, including orientation, identification, exploitation and resolution, are described as they relate to group psychotherapy, and clinical examples are presented. The clinical examples also demonstrate the patient's movement in group therapy through the steps of the learning process: observation, description, analysis, formulation, validation, testing, integration and utilization. Finally, the roles of the nurse including stranger, resource person, teacher, leader, surrogate and counsellor are described as they occur in group psychotherapy.
The differences between health professionals in assessing levels of caregiver burden
Authors: MacInnes
Published: March 2003

This study examined the ways in which 44 different health professionals appraised a series of comments from those relatives who were the main caregivers of people with schizophrenia. The comments reflected different dimensions of caregiver burden, and were used to develop a questionnaire. The respondents were given 60 different quotes from caregivers, and asked to rate the burden severity of each burden quoted, in three different scenarios that could apply: the burden happening once, the burden happening on a regular basis, and the burden happening in conjunction with other problems. The results were analysed in relation to the question as to whether there were differences in the ratings of different demographic groups within the professional sample undertaking the questionnaire. The results showed that there were wide areas of agreement between the different demographic groups in the study. However, there were a number of differences in burden ratings relating to caregivers' concerns over patients' thoughts and behaviours, and also to the caregivers' annoyance with health services. There were also some specific areas of difference between male and female professionals, nursing and non‐nursing professionals, and between those with five years experience or less, and those professionals with over five years experience.
Discourses on empowerment
Authors: Tilley  , Pollock  , Tait
Published: March 2003

The discourse community of British psychiatric and mental health nursing is a contested realm. The ‘Big Stories’ of policy and planning of services are clearly articulated in disputes in journals, but the ‘Little Stories’ of nurses’ work and patients’ or users’ experiences may be ignored or under‐valued. This paper illustrates how the Big Story of a central theme in current policy – empowerment – is articulated in the realm of research funding and design, and how it is articulated by practitioners. The paper focuses attention on the responsibilities faced by researchers, in relating the Little Stories of practice and the Big Story of policy. It reports early and tentative findings from a study of community psychiatric nurses’ empowerment of people with enduring mental disorders. The paper suggests ways in which strategies for analysis of qualitative data from interviews with CPNs may be informed by ideas drawn from the field of discourse analysis; reflexively examining how researchers’ discourses relate to those of policy makers and mental health nursing practitioners.

This paper is based on a presentation at the Network for Psychiatric Nursing Research Conference, Napier University, Edinburgh, 17 September 1997.
The psychiatric nurse and the ‘appropriate adult’
Authors: Southcott J. L.
Published: March 2003

This paper identifies a role for the mental health nurse in the ‘Appropriate Adult Scheme’. It discusses how the unique skills of the mental health nurse could be utilized in this role but also the problems and objections associated with this potential development.
General practitioners’ perceptions of community psychiatric nurses in primary care
Authors: Badger F. , Nolan P.
Published: March 2003

The management of and responsibility for the care of people with mental health problems in the community is increasingly being assumed by general practitioners (GPs) and primary care personnel. As primary care groups (PCGs) evolve, so must their expertise in managing people with a wide range of mental health problems. It is expected that all mental health professionals will participate in this development, although it is likely that community psychiatric nurses (CPNs) will be the largest professional group involved, with a significant part to play in the shaping, management and delivery of mental health services. To date, there has been little research into how CPNs are perceived by other primary health care professionals. This study seeks to provide an insight into how GPs assess the contribution of CPNs in primary care. Overall, the results of the study suggest that GPs view CPNs favourably and consider that they have an important role to play. Greater involvement in primary care raises issues about the education and preparation of CPNs, their professional development and supervision needs.
An exploration of the application of social role valorization in special hospitals
Authors: Davis Bryn , Williams P.
Published: March 2003

The set of ideas known as ‘social role valorization’ (SRV) has been highly influential in services for some client groups, but has rarely been applied in contexts of security. A framework of questions was designed to assist the application of the theory and principles of SRV in work with patients in special hospitals. Small‐scale exercises in its use were introduced to explore the relevance and usefulness of SRV ideas in special hospital work. Evaluation indicated potential usefulness in a variety of contexts, especially when allied to consideration of values issues. No attempt was made in these exercises to incorporate SRV in the operational structures of the hospitals, a task that would require much more thought and work at an organizational level.
Nurse education yesterday? A memoir of experiments in mental health nurse education (1987–96)
Authors: Davis Bryn , Keen T. M.
Published: March 2003

After a decade of community mental health care, the time is ripe for critical evaluation not only of the policy itself, but also of appropriate nurse education. This paper fills some gaps in the historical record of the early years of community care by describing some educational innovations within one of the earliest services to abandon mental hospitals. Whilst it is accepted that the libertarian, experimental nature of the courses described may be accused of contributing to the alleged early failings of community care, it is also suggested that such educational experiences may assist the establishment of positively therapeutic nursing relationships. Current modular courses are generally more tightly structured, highly assessed, research‐based and technical. Recent claims suggest that whilst nurses are more highly educated, there may be a reduction in the quality of the caring relationships they establish. This account of largely unreported, process‐based courses implicitly suggests that mental health nurse education might be better as a creative synthesis of such theoretical principles with today's more science‐based, content‐driven courses.
Hearing voices and listening to those that hear them
Authors: Martin P. J.
Published: March 2003

This paper is concerned with the experience of service users of a mental health Trust. The shared experience of the particular service user group is that of auditory hallucinations. The paper argues that mental health practitioners have, traditionally, not listened effectively to the subjective experience of voice hearing. By creating an environment in which service users can discuss their shared experience, the mental health practitioner can facilitate learning from experience and the development of ‘common‐sense’ management strategies. Such strategies do not demand, or require, text book answers from health care professionals, but emerge from service users, through living with voice hearing. The work is interpreted through Parse’s theory of human becoming and Marius Romme’s work with ‘Hearing Voices’.
The first nurse–patient encounter in a psychiatric context: an initial study in an action research process
Authors: Sjöstedt E. , Hällström T. , Lützén K.
Published: March 2003

This paper presents an initial study undertaken as the first step in action research concerning the first encounter between the nurse and the patient on psychiatric admission. The specific aim was to identify obstacles and possibilities of starting an ongoing learning process with mutual agreement upon goals and a good working relationship between the principal investigator and the participating nurses. Participant observation and questionnaires, completed by nurses and patients, were used in the data collection. The main finding was the identification of parallel processes concerning patients and nurses as to experiences of the abandonment and the lack of confirmation and autonomy. This initial study confirms the need and satisfies the requirements for continuing the action research process.
Burnout in community mental health nurses: findings from the all‐Wales stress study
Authors: Hannigan B. , Edwards D. , Coyle D. , Fothergill A. , Burnard P.
Published: March 2003

Stress and its outcomes are significant problems for mental health workers. Questionnaires were sent to 614 community mental health nurses (CMHNs) in Wales. Three hundred and one responded (49%). Of these, 283 completed the Maslach Burnout Inventory (MBI) (Maslach et al. 1996). Half of those who responded indicated that they were emotionally overextended and exhausted by their work. One quarter of respondents were found to possess negative attitudes towards their clients, and approximately one in seven experienced little or no sense of satisfaction with their work. Working in an urban environment and lacking a supportive line manager were indicators for higher emotional exhaustion. CMHNs were significantly more likely to have negative attitudes towards their clients if they: were male; worked with an elderly care caseload; lacked job security; and had an unsupportive line manager. However, CMHNs who had worked longer within the field of community mental health were more likely to have positive attitudes towards their clients. Those CMHNs who had not completed a specialist postqualifying education course and those who did not hold a supervisory or management position were found to have a lowered sense of personal satisfaction in their work. Those CMHNs who reported that they drank alcohol were more satisfied with their sense of personal accomplishments achieved in their work.
Community mental health nurses in Wales: self‐reported stressors and coping strategies
Authors: Burnard P. , Edwards D. , Fothergill A. , Hannigan B. , Coyle D.
Published: March 2003

There is evidence to suggest that community mental health nurses experience stress and burnout related to their work. Previous research has been limited by a number of methodological problems. One of the problems is that studies have tended to have small or unrepresentative samples, and many researchers have only examined mental health nurses as a subset within their research, which limits the generalizability of the findings. The All‐Wales Community Mental Health Nurse (CMHN) Stress Study was set up in order to address this issue. The total population of CMHNs in Wales was surveyed (N = 614) and 301 (49%) responded. The questionnaire booklet contained a number of validated instruments to measure stress, burnout, and coping, together with a demographic questionnaire. The demographic questionnaire included three open ended‐questions. These questions were asked in order in determine the CMHNs' own views of the sources of stress in the workplace, and to investigate which methods they use to cope. This paper reports the findings from the content analysis of the three questions. The results from the other measures are reported in the companion paper (Edwards et al. 2000). The most frequently cited stressors included perceived workload, excessive paperwork and administration, and a broad spectrum of client‐related issues. Coping strategies that CMHNs reported using included peer support, a range of personal strategies such as relaxation, and belief in self and supervision. It appears from the findings that a range of factors such as organizational pressures and factors related to working with patients are important in determining stress levels, and that informal rather than formal support networks are the preferred methods of coping.
Temporary confusion: a fearful experience
Authors: Fagerberg I. , Jönhagen M. E.
Published: March 2003

Older people admitted to hospital often develop acute temporary confusion. Earlier studies have focused on problems in providing care to the confused, causes of the confusion and the key aspects of caring. The aims of this study were to describe, from a nursing perspective, how older people experienced the phenomenon of temporary confusion and to describe the older peoples’ reasoning when they described their experiences. Interviews with five older informants who had recovered from their confusional state were conducted and analysed using the phenomenological method. Two phenomena were studied, ‘being temporarily confused’ and ‘reasoning about experiences of temporary confusion’, each was found to be represented by four inter‐related constituents. The phenomena can be understood as aspects of suffering and power imbalance between staff and older people.
A comparison of behaviour in two differing psychiatric long‐stay rehabilitation environments
Authors: Mcgonagle I. M. , Allan S.
Published: March 2003

This study compares aspects of behaviour in two long‐stay resident groups with residual psychiatric difficulties. One group was residing on traditional psychiatric hospital wards and the other group was based in a newly built bungalow complex set within the hospital grounds. This study compares behavioural profiles between these two resident groups. Results indicate that bungalow residents showed significantly lower levels of psychiatric difficulty than their ‘ward‐based’ counterparts. To explore this result further we conducted an examination of possible selection bias at the time of initial assessment. Historical data on both groups were obtained from case notes and analysed to seek possible explanations for this result. These results are discussed with respect to the provision of mental health care in smaller retained hospital facilities and nursing practice, which emphasizes the provision of effective philosophies of care accentuating choice, a sense of autonomy and involvement in care.
Sleep bruxism based on self‐report in a nationwide twin cohort
Authors: HUBLIN CHRISTER , KAPRIO JAAKKO , PARTINEN MARKKU , KOSKENVUO MARKKU
Published: March 2003

The relative roles of genetic and environmental factors in bruxism are not known. In 1990 a questionnaire sent to the Finnish Twin Cohort yielded responses from 1298 monozygotic and 2419 dizygotic twin pairs aged 33–60 years. We used structural equation modelling to estimate genetic and environmental components of variance in the liability to bruxism. There was a significant gender difference both in childhood (P =0.001) and adult (P =0.007) bruxism. Females compared to males reported childhood bruxism ‘often’ 5.2% vs 4.1% and ‘sometimes’ 17.4% vs 17.3%, and as adults ‘weekly’ 3.7% vs 3.8% and ‘monthly’ 3.9% vs 4.6%, respectively. Bruxism in childhood and adulthood is highly correlated (0.86 in males and 0.87 in females). The proportion of total phenotypic variance in liability to bruxism attributed to genetic influences in childhood bruxism was 49% (95% CI 37–60%) in males and 64% (55–71%) in females, and for adults 39% (27–50%) among males and 53% (44–62%) among females. The correlation between the genetic effects on childhood bruxism and the genetic effects on adult bruxism was estimated in a bivariate model to be 0.95 (95% CI 0.94–0.96) in males and 0.89 (0.88–0.90) in females. Bruxism appears to be quite a persistent trait. There are substantial genetic effects on bruxism both in childhood and as adults, which appear to be highly correlated.
Differences in brain gene expression between sleep and waking as revealed by mRNA differential display and cDNA microarray technology
Authors: Cirelli  , Tononi
Published: March 2003

The consequences of sleep and sleep deprivation at the molecular level are largely unexplored. Knowledge of such molecular events is essential to understand the restorative processes occurring during sleep as well as the cellular mechanisms of sleep regulation. Here we review the available data about changes in neural gene expression across different behavioural states using candidate gene approaches such as in situ hybridization and immunocytochemistry. We then describe new techniques for systematic screening of gene expression in the brain, such as subtractive hybridization, mRNA differential display, and cDNA microarray technology, outlining advantages and disadvantages of these methods. Finally, we summarize our initial results of a systematic screening of gene expression in the rat brain across behavioural states using mRNA differential display and cDNA microarray technology. The expression pattern of ≈ 7000 genes was analysed in the cerebral cortex of rats after 3 h of spontaneous sleep, 3 h of spontaneous waking, or 3 h of sleep deprivation. While the majority of transcripts were expressed at the same level among these three conditions, 14 mRNAs were modulated by sleep and waking. Six transcripts, four more expressed in waking and two more expressed in sleep, corresponded to novel genes. The eight known transcripts were all expressed at higher levels in waking than in sleep and included transcription factors and mitochondrial genes. A possible role for these known transcripts in mediating neural plasticity during waking is discussed.
Respiratory‐related evoked potentials during the transition from alpha to theta EEG activity in Stage 1 NREM sleep
Authors: Gora John , Colrain Ian M. , Trinder John
Published: March 2003

It has been argued previously that evoked potential components during Stage 1 sleep in response to both auditory and respiratory stimuli are intermediate between those of wakefulness and Stage 2 sleep. However, state fluctuations in the EEG between alpha and theta during Stage 1 sleep have been linked to changes in a number of respiratory functions including ventilation, upper airway resistance and chemical drive. It was therefore hypothesized that if respiratory related evoked potentials (RREP) were averaged separately for alpha and theta EEG periods during Stage 1 sleep, the alpha RREP would resemble wakefulness and the theta RREP would resemble Stage 2 sleep. RREPs were produced by 250 ms occlusions in 10 subjects. EEG was recorded from 29 scalp sites, referenced to linked ears, together with EOG and EMG. The N1 component was not specifically associated with alpha vs. theta activity, but appeared to be sensitive to any decrease in arousal level, suggesting that it was more related to attention than to changes in the EEG. The late N2 and P300 components were present during wake and Stage 1 alpha. However, in Stage 1 theta, different late components emerged (N300 and P450) that differed in latency, amplitude or topographical distribution from those seen in wakefulness. The P2 proved difficult to interpret, whereas the N550 did not appear until Stage 2 sleep, and as such, was not dependent on alpha/theta state. The results indicate that RREP components are differentially affected by the transition into sleep.
The effect of clustered versus regular sleep fragmentation on daytime function
Authors: Martin Sascha E. , Brander Pirkko E. , Deary Ian J. , Douglas Neil J.
Published: March 2003

Previously, we found that regular sleep fragmentation, similar to that found in patients with sleep apnoea/hypopnoea syndrome (SAHS), impairs daytime function. Apnoeas and hypopnoeas occur in groups in patients with REM or posture related SAHS. Thus, we hypothesised that clustered sleep fragmentation would have a similar impact on daytime function as regular sleep fragmentation. We studied 16 subjects over two pairs of 2 nights and 2 days. The first night of each pair was for acclimatisation. On the second night, subjects either had their sleep fragmented regularly every 90 s, or fragmented every 30 s for 30 min every 90 min, the remaining 60 min being undisturbed. We fragmented sleep with tones to produce a minimum 3 s increase in EEG frequency. During the days following each pair of nights we tested subjects daytime function. Total sleep time (TST) and microarousal frequency were similar on both study nights. We found significantly less stage 2 (55 SD 4, 62±7%; P=0.001) and more slow wave sleep (21 SD 3, 12±6%; P < 0.001) on the clustered night. Mean sleep onset latency was similar on MSLT (clustered 10 SD 5, regular 9±4 min; P=0.7) and MWT (clustered 32 SD 7, regular 30±7 min; P=0.2). There was no difference in subjects mood or cognitive function after either study night. These results suggest that although there is more slow wave sleep (SWS) on the clustered night, similar numbers of sleep fragmenting events produced similar daytime function whether the events were evenly spaced or clustered.
Prevalence of insomnia in a survey of 12 778 adults in France
Authors: Leger Damien , Guilleminault Christian , Dreyfus Jean Pierre , Delahaye Chantal , Paillard Michel
Published: March 2003

This study was an epidemiological questionnaire survey of a representative sample of the French population that included 12 778 individuals and in which adapted DSM‐IV criteria for the definition of insomnia were used. Our goals were not only to assess the prevalence of ‘insomnia’ using these criteria, but also to compare the results obtained with those of prior studies using different definitions of ‘insomnia’. The aim of this study was also to identify where areas of agreement and disaggreement existed, as we believe that it is important to emphasize these points because DSM‐IV recommendations are supposedly reflected in clinical practice. Seventy‐three per cent of the individuals surveyed complained of a nocturnal sleep problem, but only 29% reported at least one sleep problem three times per week for a month, and 19% (2428 subjects) had at least one sleep problem three times per week for a month and complained of daytime consequences (DSM‐IV criteria). Only 9% had two or more nocturnal sleep problems with daytime consequences and were classified as ‘severe insomniacs’. Our study indicates that if DSM‐IV criteria are used, the diagnosis of ‘insomnia’ is lower than in other epidemiological studies. The DSM criteria have an advantage in that they emphasize the daytime consequences of nocturnal sleep disturbances, which seem to be responsible for the most important socio‐economic costs of the problem.
Prevalence of sleepiness and its relation to autonomic evidence of arousals and increased inspiratory effort in a community based population of men and women
Authors: Stradling J. R. , Barbour C. , Glennon J. , Langford B. A. , Crosby J. H.
Published: March 2003

Degrees of sleep apnoea and daytime sleepiness are quite common in community populations. However the relationship between the two is poor, although sleepiness does correlate better with a history of snoring. It has been suggested that sleep can be fragmented by upper airways obstructive events, short of full apnoeas or hypopnoeas, and that these events may not provoke full cortical arousal, but be detectable through activation of the autonomic system. Failure to detect both these could mask a relationship between ‘sleep apnoea’ and daytime sleepiness. We have therefore measured sleepiness (Epworth Sleepiness Scale) in addition to both autonomic ‘arousals’ and inspiratory effort (using pulse transit time) in 473 men and women at home. Although sleepiness was related to a history of snoring, it was not significantly predicted by the measures of autonomic ‘arousal’, or inspiratory effort. Reported snoring and objectively measured snoring correlated poorly. As in other studies, nocturnal hypoxic dips were correlated with obesity, age, alcohol consumption, drug usage and a history of snoring. These data make it unlikely that sleep fragmentation from subtle variants of sleep apnoea and ‘autonomic’ (or ‘subcortical’) arousals are an important source of daytime sleepiness in the community.
Effect of infant sleeping position on sleep spindles
Authors: Horne Rosemary S. C. , Egodagamage Chamali , Cranage Susan M. , Adamson T. Michael
Published: March 2003

Sleep spindles play an active role in inducing and maintaining sleep and may affect arousal by blocking the transmission of external stimuli through the thalamus to the cortex. Previously we have demonstrated that sleeping in the prone position impairs arousal in infants at 2–3 months of age, but not at 5–6 months. We aimed to examine if sleeping position and postnatal age affected duration and/or density of sleep spindles. Twenty‐one healthy term infants were studied using daytime polysomnography at 2–3 months and 16 were again studied at 5–6 months. Infants slept both prone and supine at each study. The mean duration of non‐rapid eye movement (NREM) sleep was not different between the two studies in either position. At 2–3 months both spindle density (P < 0.001) and proportion of NREM sleep (P < 0.025) with spindles were significantly greater in the supine than in the prone position. At 5–6 months spindle duration was longer in the supine than in the prone position (P < 0.03). Spindle density in the supine position was not different between the two studies, however, when infants slept prone, it was significantly increased at 5–6 months compared with 2–3 months (P < 0.001). Arousal threshold was not correlated with either spindle density or percentage of NREM sleep with spindles in either position at either study. In this study spindle density and the percentage time spent with spindles were not well correlated with infant arousability, and hence may not be able to be used as markers of depressed arousal responses in infants.
Pharmacological and pathophysiological modulation of food intake and forestomach motility in small ruminants
Authors: Van Miert  , Van Duin
Published: March 2003

I Introduction

II Pharmacological modulation of food intake and forestomach motility

II 1. Orexigenic agents

1.1 glutamate

1.2 benzodiazepines

1.3 opioid receptor agonists and antagonists

4 neuropepetides Y (NPY)

II 2. Anorectic agents

2.1 cholecystokinin (CCK) agonists and antagonists

2.2 serotonin receptor agonists and antagonists

2.3 dopamine receptor agonists and antagonists

2.4 alpha‐2 adrenoceptor agonists and antagonists

III Anorexia and ruminal stasis during the Acute Phase Response to infections

1. cytokines

2. prostaglandins

3. hormones

4. nitric oxide

IV Conclusions

V References
A comparison of the haemodynamic effects of propofol and isoflurane in pregnant ewes
Authors: Gaynor  , Wertz  , Alvis  , Turner
Published: March 2003

The purpose of this study was to compare the effects of inhaled isoflurane and a constant infusion of propofol on maternal haemodynamics and uterine arterial and umbilical venous flows in pregnant ewes. Late term pregnant ewes (n = 5) were randomly assigned to receive either inhaled isoflurane or an intravenous infusion of propofol for 1 h, each on separate occasions. Maternal systemic arterial, right atrial and pulmonary arterial blood pressures, cardiac index, systemic vascular resistance index, stroke volume index, heart rate, and uterine arterial and umbilical venous flows were determined over the 1 h period of each treatment. Data were analysed using an univariate analysis of variance for repeated measures performed on the ranks of the data. Propofol anaesthetized ewes had significantly higher heart rate (P = 0.0040), mean arterial pressure (P = 0.0003) and cardiac index (P = 0.0475) compared to isoflurane anaesthetized ewes. There were no significant differences in uterine arterial flows, umbilical venous flows, or other measured variables. Continuous propofol infusions maintain maternal haemodynamics at significantly higher levels than does inhaled isoflurane, while uterine arterial and umbilical venous flows do not differ significantly.