bluuebunny/crossref_metadata_2025 huggingface dataset:
Bayes' Theorem to estimate population prevalence from Alcohol Use Disorders Identification Test (AUDIT) scores
Authors: Foxcroft David R. , Kypri Kypros , Simonite Vanessa
Published: May 2009

Aim  The aim in this methodological paper is to demonstrate, using Bayes' Theorem, an approach to estimating the difference in prevalence of a disorder in two groups whose test scores are obtained, illustrated with data from a college student trial where 12‐month outcomes are reported for the Alcohol Use Disorders Identification Test (AUDIT).

Method  Using known population prevalence as a background probability and diagnostic accuracy information for the AUDIT scale, we calculated the post‐test probability of alcohol abuse or dependence for study participants. The difference in post‐test probability between the study intervention and control groups indicates the effectiveness of the intervention to reduce alcohol use disorder rates.

Findings  In the illustrative analysis, at 12‐month follow‐up there was a mean AUDIT score difference of 2.2 points between the intervention and control groups: an effect size of unclear policy relevance. Using Bayes' Theorem, the post‐test probability mean difference between the two groups was 9% (95% confidence interval 3–14%). Interpreted as a prevalence reduction, this is evaluated more easily by policy makers and clinicians.

Conclusion  Important information on the probable differences in real world prevalence and impact of prevention and treatment programmes can be produced by applying Bayes' Theorem to studies where diagnostic outcome measures are used. However, the usefulness of this approach relies upon good information on the accuracy of such diagnostic measures for target conditions.
A meta‐analysis of marijuana, cocaine and opiate toxicology study findings among homicide victims
Authors: Kuhns Joseph B. , Wilson David B. , Maguire Edward R. , Ainsworth Stephanie A. , Clodfelter Tammatha A.
Published: May 2009

Aim  To synthesize the results of marijuana, cocaine and opiate drug toxicology studies of homicide victims and examine variation in results across person and setting characteristics.

Methods  A meta‐analysis of 18 independent studies identified from an extensive review of 239 published articles that met the inclusion criteria of reporting marijuana, cocaine and/or opiate toxicology test results for homicide victims. A total of 28 868 toxicology test results derived from 30 482 homicide victims across five countries were examined.

Results  On average, 6% of homicide victims tested positive for marijuana, 11% tested positive for cocaine, and 5% tested positive for opiates. The proportion of homicide victims testing positive for illicit drugs has increased over time. Age had a strong curvilinear relationship with toxicology test results, but gender differences were not apparent. Hispanic and African American homicide victims were more likely to test positive for cocaine; Caucasians were most likely to test positive for opiates. Cocaine use appeared to be related to increased risk of death from a firearm and was a greater risk factor for violent victimization in the United States than in Newfoundland and Scandinavia.

Conclusion  There are relatively few studies of illicit drug toxicology reports from homicide victims that allow for cross‐cultural comparisons. This study provides a basis for comparing future local toxicology test results to estimates from existing research.
The importance of drinking frequency in evaluating individuals' drinking patterns: implications for the development of national drinking guidelines
Authors: Paradis Catherine , Demers Andrée , Picard Elyse , Graham Kathryn
Published: May 2009

Aims This paper examines the relationship between frequency of drinking, usual daily consumption and frequency of binge drinking, taking into consideration possible age and gender differences.

Participants and design Subjects were 10 466 current drinkers (5743 women and 4723 men) aged between 18 and 76 years, who participated in the GENACIS Canada (GENder Alcohol and Culture: an International Study) study.

Setting Canada.

Measurements The independent variable was the annual drinking frequency. The dependent variables were the usual daily quantity consumed, annual, monthly and weekly frequency of binge drinking (five drinks or more on one occasion).

Findings Logistic regressions show (i) that those who drink less than once a week are less likely than weekly drinkers to take more than two drinks when they do drink; (ii) that the usual daily quantity consumed by weekly drinkers is not related to their frequency of drinking; but that (iii) the risk and frequency of binge drinking increase with the frequency of drinking.

Conclusions Given that risk and frequency of binge drinking among Canadians increases with their frequency of drinking, any public recommendation to drink moderately should be made with great caution.
Meta‐analysis: incidence of endoscopic gastric and duodenal ulcers in placebo arms of randomized placebo‐controlled NSAID trials
Authors: YUAN Y.‐H. , WANG C. , YUAN Y. , HUNT R. H.
Published: May 2009

Background  The safety of NSAIDs is often evaluated by comparison with placebo in clinical trials.

Aim  To investigate the incidence of gastric and duodenal ulcers (GDU) in placebo arms in NSAID trials over the last three decades.

Methods  Randomized placebo‐controlled trials of oral NSAIDs from 1975 to 2006 were systematically reviewed. The pooled incidence of GDU in placebo arms was calculated and compared. Meta‐regression was used to identify risk factors related to the incidence of the placebo ulcer at the study level.

Results  Thirty‐six studies met inclusion criteria (duration of 6.5 days to 24 weeks). In total, 3.29% GDUs were reported in 36 placebo arms. The incidence of GDU in placebo arms was 0, 4.20% and 3.03% in the studies from 1975–1989, 1990–1999 and 2000–2006 respectively (P > 0.05). Eligible subjects with previous GI events and eligible subjects on co‐therapy with low‐lose aspirin/corticosteroids were associated with the increase in placebo ulcer incidence after adjusting for other factors.

Conclusions  The incidence of GDU in placebo arms has not changed significantly over the last three decades, although has decreased in the past 10 years. Studies show that previous GI events and co‐therapy with low‐dose aspirin/corticosteroids were associated with increasing GDU in placebo arms.
Recent advances in molecular gynaecological pathology
Authors: Herrington C Simon
Published: May 2009

This review gives an overview of recent advances in our understanding of the molecular basis of gynaecological malignancy, including cervical, vulval, endometrial and ovarian tumours. These advances are beginning to influence clinical practice, perhaps most notably with the introduction of human papillomavirus vaccination for the prevention of anogenital neoplasia, but are likely to have broader clinical implications as further details emerge.
Molecular assessment of sentinel lymph node in breast cancer management
Authors: Douglas‐Jones Anthony G , Woods Victoria
Published: May 2009

Sentinel lymph node biopsy (SLNB) is becoming accepted as standard of care for axillary staging in breast cancer. World Health Organization (WHO) re‐classification of axillary metastases into macrometastases, micrometastases and individual tumour cells has highlighted the issues of sampling and further histological examination of the initially negative SLNB. Molecular detection of metastatic breast cancer cells in lymph nodes is now available as a commercial kit for intraoperative use and can resolve the sampling issue. Semiquantitative assessment of axillary lymph node tumour burden can now be made using two separate technologies (histology and reverse transcriptase–polymerase chain reaction). The clinical implications of low metastatic axillary lymph node tumour burden are not clear, and future trials need to include molecular data. The consequences of the availability of molecular assessment are reviewed.
Stage‐dependent predation on competitors: consequences for the outcome of a mosquito invasion
Authors: Alto Barry W. , Kesavaraju Banugopan , Juliano Steven A. , Philip Lounibos L.
Published: May 2009

1.Predator‐mediated coexistence occurs when predation allows competitors to coexist, due to preferential consumption of a superior competitor relative to an inferior competitor. Differences between the native treehole mosquito (Aedes triseriatus) and the co‐occurring Asian tiger mosquito (Aedes albopictus) in anti‐predatory larval behaviours account, in part, for the greater vulnerability of this invasive species to native predatory midge (Corethrella appendiculata). We test the hypothesis that stage‐dependent differences in the sizes ofA. albopictusandA. triseriatuslarvae, relative to the size‐limitedC. appendiculata, contribute to differential consumption and the likelihood of predator‐mediated coexistence of these competitors.

2.In all instars, larvae ofA. triseriatuswere larger thanA. albopictusof the same stage. Third and fourth instarC. appendiculataselectively consumed late‐stageA. albopictusin preference to same‐stageA. triseriatus. Small, early‐stage prey larvae did not differ in vulnerability to predation, but large, late‐stage larvae differed significantly in vulnerability to predation, probably owing to size‐limited predation by fourth instarC. appendiculata.This effect was less pronounced for third instarC. appendiculata.

3.Prey size, in conjunction with anti‐predatory behavioural responses, alters the probability of predator‐mediated coexistence. A stage‐structured predation model showed that equally vulnerable early stages reduce the range of environmental conditions (productivities) in which predator‐mediated coexistence is possible, increasing the likelihood of both competitive exclusion of the resident species or failure of the invasive to establish. These results underscore the importance of stage‐dependent interspecific differences in predator–prey interactions for determining how predators may affect community composition.
Variation in the chloroplast DNA of Swiss stone pine (Pinus cembraL.) reflects contrasting post‐glacial history of populations from the Carpathians and the Alps
Authors: Höhn Maria , Gugerli Felix , Abran Peter , Bisztray György , Buonamici Anna , Cseke Klara , Hufnagel Levente , Quintela‐Sabarís Celestino , Sebastiani Federico , Vendramin Giovanni Giuseppe
Published: May 2009

Aim To characterize the genetic structure and diversity ofPinus cembraL. populations native to two disjunct geographical areas, the Alps and the Carpathians, and to evaluate the rate of genetic differentiation among populations.

Location The Swiss Alps and the Carpathians.

Methods We screened 28 populations at three paternally inherited chloroplast simple sequence repeats (cpSSRs) for length variation in their mononucleotide repeats. Statistical analysis assessed haplotypic variation and fixation indices. Hierarchical analysis of molecular variance (AMOVA), Mantel test, spatial analysis of molecular variance (SAMOVA) andbarrieranalyses were applied to evaluate the geographical partitioning of genetic diversity across the species’ range.

Results Haplotypic diversity was generally high throughout the natural range ofP. cembra, with the mean value substantially higher in the Carpathians (H = 0.53) than in the Alps (H = 0.35). The isolated Carpathian populations showed the highest haplotype diversity among the populations originating from the High Tatras (Velka Studena Dolina) and South Carpathians (Retezat Mountains). AMOVA revealed that only 3% of the total genetic variation derived from genetic differentiation between the two mountain ranges. Differentiation among Carpathian populations was higher (FST = 0.19) than among Alpine populations (FST = 0.04). Low, but significant, correlation was found between the geographical and genetic distances among pairs of populations (r = 0.286,P < 0.001). SAMOVA results revealed no evident geographical structure of populations.barrieranalysis showed the strongest differentiation in the eastern part of the species’ range, i.e. in the Carpathians.

Main conclusions The populations ofP. cembrawithin the two parts of the species’ range still share many cpDNA haplotypes, suggesting a common gene pool conserved from a previously large, continuous distribution range. Carpathian populations have maintained high haplotypic variation, even higher than Alpine populations, despite their small population sizes and spatial isolation. Based on our results, we emphasize the importance of the Carpathian populations of Swiss stone pine for conservation. These populations comprise private haplotypes and they may represent a particular legacy of the species’ evolutionary history.
The experiences of primary caregivers raising school‐aged children with attention‐deficit hyperactivity disorder
Authors: Lin Mei‐Jue , Huang Xuan‐Y , Hung Bai‐Jin
Published: May 2009

Aims and objectives.  To understand the experiences of primary caregivers who are bringing up school‐aged children with attention‐deficit hyperactivity disorder. The research findings will help address the problems related to caring for school‐aged children with attention‐deficit hyperactivity disorder.

Background.  In Taiwan, the rate of school‐aged children diagnosed with attention‐deficit hyperactivity disorder ranges from 7·9–11·7%. This study is the first, which tries to understand the experiences of primary caregivers who are bringing up school‐aged children with attention‐deficit hyperactivity disorder in Taiwan.

Design.  The study used a qualitative phenomenological approach to explore the experiences of caregivers raising school‐aged children with attention‐deficit hyperactivity disorder.

Methods.  Purposive sampling and in‐depth, face‐to‐face interviews were used to collect data. The unstructured interview guide allowed the major caregivers to express their experiences of raising school‐aged children with attention‐deficit hyperactivity disorder. When data saturation was reached, the sample size comprised 12 major caregivers. Narratives were analysed according to Colaizzi’s seven‐step method.

Results.  Three themes and seven sub‐themes emerged from this study: the burdens of caring (parenting burdens, emotional burdens and family conflicts), the lack of adequate support systems (lack of support from professionals, spouses and other family members) and the mechanisms of coping (cognitive coping strategies and social coping strategies). Furthermore, several other factors that affected the caregivers of children with attention‐deficit hyperactivity disorder are also revealed in the study.

Conclusion.  The findings of the study demonstrate the importance of understanding the experiences of primary caregivers, bringing up school‐aged children with attention‐deficit hyperactivity disorder. Improving professional services in family care should be a major concern for all healthcare professionals.

Relevance to clinical practice.  The recommendations that have been made based on the findings of this research can be used as a guide to improve the delivery of caring by people who have school‐aged children with attention‐deficit hyperactivity disorder and by the wider family.
Hospital pressure ulcer prevalence rates and number of raters
Authors: Kottner Jan , Tannen Antje , Dassen Theo
Published: May 2009

Aim.  The purpose of this study was to evaluate the influence of different numbers of nurse raters conducting skin inspection (one or two) on observed pressure ulcer prevalence rates.

Background.  Pressure ulcer prevalence and incidence rates are important outcome measures for the quality of care. To ensure reliability and comparability of such rates standardisation of study methods is recommended. It is assumed that data accuracy can be improved if skin inspection is conducted by a team of two raters.

Design.  A secondary data analysis of pressure ulcer prevalence data was conducted.

Method.  Groups of hospital patients which were examined by one (n = 2420) or two raters (n = 15,009) were compared regarding demographic characteristics, pressure ulcer risk and pressure ulcer prevalence. Logistic regressions were conducted to examine the association between the number of raters (one or two) and the outcome pressure ulcer (yes/no).

Results.  Groups of one and two raters were comparable regarding demographic characteristics. There was no statistically significant difference regarding pressure ulcer prevalence between both groups (p = 0·222). There was no relation between the number of raters and the probability of identifying a pressure ulcer patient (p = 0·060).

Conclusions.  Pressure ulcer prevalence rates in the analysed studies were not affected by the number of raters. There seems to be no relation between the numbers of nurses conducting skin inspection and observed prevalence rates.

Relevance to clinical practice.  Conducting pressure ulcer prevalence studies require a lot of effort and personal costs. Provided that one nurse alone or a team of two nurses rate the existence of pressure ulcers equally it is no longer obligatory to have two raters. This would save resources. However, when patients are restricted in their mobility two nurses are recommended to provide assistance in patient turning.
A randomised controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers
Authors: Edwards Helen , Courtney Mary , Finlayson Kathleen , Shuter Patricia , Lindsay Ellie
Published: May 2009

Aims and objective.  The negative impact of chronic leg ulcers on quality of life is well documented. The aim of this study was to determine the effectiveness of a new community nursing model of care on quality of life, morale, depression, self‐esteem, social support, healing, pain and functional ability of clients with chronic venous leg ulcers.

Background.  Venous leg ulcers are slow to heal, frequently recur and are associated with pain, restricted mobility and decreased quality of life. Although chronic wound care consumes a large proportion of community nursing time and health care resources, there is little evidence available on the effectiveness of differing models of community care for this population.

Design.  Randomised controlled trial.

Methods.  We recruited a sample of 67 participants with venous leg ulcers referred for care to a community nursing organisation in Queensland, Australia after obtaining informed consent. Participants were randomised to either the Lindsay Leg Club® model of care (n = 34), emphasising socialisation and peer support; or the traditional community nursing model (n = 33) consisting of individual home visits by a registered nurse. Participants in both groups were treated by a core team of nurses using identical research protocols based on short‐stretch compression bandage treatment. Data were collected at baseline, 12 and 24 weeks from commencement.

Results.  Participants who received care under the Leg Club model demonstrated significantly improved outcomes in quality of life (p = 0·014), morale (p < 0·001), self‐esteem (p = 0·006), healing (p = 0·004), pain (p = 0·003) and functional ability (p = 0·044).

Conclusion.  In this sample, the evaluation of the Leg Club model of care shows potential to improve the health and well‐being of clients who have chronic leg ulcers.

Relevance to clinical practice.  These results suggest further evaluation and implementation of this model is warranted by community health organisations involved in the care of this population.
The lived experience of Dupuytren’s disease of the hand
Authors: Pratt Anna L , Byrne Geraldine
Published: May 2009

Aims.  To describe patients’ experiences of living with Dupuytren’s disease.

Background.  Dupuytren’s disease is a chronic, progressive deformity of the hand which limits active extension of the fingers due to advancing and irreversible flexion deformity. It is estimated that two million people are affected by the condition in the UK. Nurses may frequently encounter patients with this condition in a wide range of settings. However, the disease is neglected in the nursing literature and little is known about patients’ experience of living with the condition.

Design.  A phenomenological approach, using Coliazzi’s method, was employed.

Method.  Semi‐structured interviews were conducted with six men and one woman diagnosed with Dupuytren’s disease.

Results.  Four interlinking themes emerged. Theme 1: Awareness of Dupuytren’s disease describes participants’ experiences of recognising and acknowledging the disease, which often did not occur until functional ability was restricted. Theme 2: Living with Dupuytren’s disease describes how patients coped with the disease and adapted their activities to maintain independence. Theme 3: Deciding on treatment illuminates how patients decided on treatment and highlights a lack of information and support from health professionals. Theme 4: Receiving treatment articulates participants’ experience of surgical treatment and post surgical rehabilitation.

Conclusions.  The findings revealed that people living with Dupuytren’s disease receive little information about their condition and possible treatment from health professionals yet high quality and accurate information is required for patients to understand their condition and the treatment options available.

Relevance to clinical practice.  People with Dupuytren’s disease do not always recognise their condition until it has significantly progressed. Following diagnosis they need accurate and up‐to‐date information about their condition and treatment options. Nurses have an important role to play in raising awareness of the disease, educating patients about its features and progression and enabling them to become active partners in decisions about treatment.
The impact of stroke consequences on spousal relationships from the perspective of the person with stroke
Authors: Thompson Hilary S , Ryan Assumpta
Published: May 2009

Aims and objectives.  This paper aims to provide a subjective insight into the experience of stroke recovery within spousal relationships. The aftermath of stroke and its impact on the physical, emotional, psychological and social effects of spousal relationships are explored.

Background.  Many studies have examined observable functional recovery following stroke from the perspective of health care professionals. Longer‐term effects of stroke such as changes in role and perception of self can alter significantly the dynamics of spousal relationships. Despite this, little attention has been given to the subjective impact of stroke on spousal relationships.

Design.  A qualitative study design was adopted. Individual, audio‐taped interviews were carried out over three months.

Methods.  A convenience sample of 16 stroke survivors was recruited from the Stroke Nurse Specialist Register. All participants were over 18 years old and had been discharged from hospital following a diagnosis of stroke. Transcribed interviews were analysed using content data analysis to code and categorise emerging themes.

Results.  Poststroke, spousal relationships altered significantly in terms of sexuality, sexual desire and sexual functioning. Within their role of husband or wife, stroke survivors described a lack of control and dramatic changes in their perception of self.

Conclusions.  Survivors of stroke experience profound, complex and multi‐faceted difficulties in many areas of their spousal relationships, which are distressing to both them and their spouses. These have a significant impact on each individual’s quality of life particularly in the longer term.

Relevance to clinical practice.  Health care professionals and service providers need to understand and recognise the subjective experience of stroke and the complex difficulties that stroke survivors experience within their spousal relationships. It would appear that current service provision does not adequately address the range of needs that the stroke survivors described in this study.
The culture of a Taiwanese nursing home
Authors: Chuang Yeu‐Hui , Abbey Jennifer
Published: May 2009

Aim. To explore and understand the culture of nursing home life for older residents in Taiwan.

Background. The environment, the care providers and the residents all influence how the nursing home operates and performs. The literature has shown that there has been a move from understanding nursing home culture to changing it. However, there is no literature illustrating nursing home culture in Taiwan. It is appropriate to understand the phenomenon before making any changes.

Design. Ethnographic methodology was used to understand this phenomenon.

Methods. Three methods, participant observation, in‐depth interviews and examination of related documents, were used to collect information from July 2005–February 2006. All the data were recorded in either field notes or verbatim transcripts and were analysed concurrently.

Results. Three themes have been generated including collective life, care rituals and embedded beliefs. ‘Living in a public area’, ‘mealtime is the highlight’, ‘every day is the same’, and ‘the ceiling is my best mate’ are used to explain the collective life. Under care rituals, there are ‘the perception of inadequate staffing in spite of legal requirements being met’ and ‘task‐oriented care’. The embedded beliefs can be described by the notions of ‘patients and hospitalisation’ and ‘compromise’.

Conclusions. A tedious, monotonous, idle and lonely life is experienced by the residents, and insufficient staffing is obvious, despite the legal staffing requirements being met. This is exacerbated by the provision of care that is task‐oriented rather than individual driven. The residents, whether consciously or not, consider themselves to be the patients of a hospital. They easily compromise to maintain harmony and balance in the nursing home life.

Relevance to clinical practice. The findings contribute to the understanding of Taiwanese nursing home culture and filling the gaps in nursing knowledge for the purpose of improving care of residents.
Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units
Authors: Cho Sung‐Hyun , June Kyung Ja , Kim Yun Mi , Cho Yong Ae , Yoo Cheong Suk , Yun Sung‐Cheol , Sung Young Hee
Published: May 2009

Aim. To examine the relationship between nurse staffing and nurse‐rated quality of nursing care and job outcomes.

Background. Nurse staffing has been reported to influence patient and nurse outcomes.

Design. A cross‐sectional study with a survey conducted August–October 2007.

Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four‐point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes.

Results. The average patient‐to‐nurse ratio was 2·8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3·26; 95% confidence interval, 1·14–9·31) or 2·0–2·5 patients (odds ratio, 2·44; 95% confidence interval, 1·32–4·52), compared with having more than three patients. Perceived adequate staffing was related to a threefold increase (odds ratio, 2·97; 95% confidence interval, 2·22–3·97) in the odds of nurses’ rating high quality and decreases in the odds of dissatisfaction (odds ratio, 0·30; 95% confidence interval, 0·23–0·40), burnout (odds ratio, 0·50; 95% confidence interval, 0·34–0·73) and plan to leave (odds ratio, 0·40; 95% confidence interval, 0·28–0·56).

Conclusions. Nurse staffing was associated with quality of care and job outcomes in the context of Korean intensive care units.

Relevance to clinical practice. Adequate staffing must be assured to achieve better quality of care and job outcomes.
Evaluating the effects of an Internet education programme on newborn care in Taiwan
Authors: Kuo Su‐Chen , Chen Ya‐Shan , Lin Kuan‐Chia , Lee Tzu‐Ying , Hsu Chi‐Ho
Published: May 2009

Aim. The objectives of this study were to evaluate an Internet education programme provided to primigravida in the third trimester of pregnancy with the aim of enhancing mothers’ knowledge about newborn care and increasing their maternal confidence.

Background. Shorter hospital stays have had an impact on the traditional role of mother–baby nurses in providing education about parenting to their parturient women. Internet education is an efficient way to provide nursing instruction.

Design. A randomised controlled trial was used. A total of 118 women receiving prenatal care in a hospital clinic who met study criteria and who consented were assigned randomly to intervention and control groups. The study was conducted at a hospital in Taiwan.

Methods. The target population was women at 32–34 weeks gestation, using the Internet on a regular basis. The primigravida were randomly assigned to either the control group (n = 57) or the experimental group (n = 61). Two primary outcome measures were newborn‐care knowledge and maternal confidence.

Results. The changes in newborn‐care knowledge were 7·21 for the experimental group, compared with 1·95 for the control group; the difference between the least‐squares means computed byancovawas 5·73 and statistically significant (p < 0·001). The changes in maternal confidence were 8·46 for the experimental group and 3·05 for the control group; the difference between the least‐squares means computed byancovawas 5·94 and statistically significant (p < 0·001).

Conclusion. Results suggest that Internet education about newborn care may contribute to greater care knowledge and maternal confidence.

Relevance to clinical practice. Internet newborn‐care education programmes can achieve success in promoting newborn care and provide health professionals with evidence‐based intervention.
Living with type 1 diabetes: perceptions of children and their parents
Authors: Marshall Marie , Carter Bernie , Rose Karen , Brotherton Ailsa
Published: May 2009

Aim.  To explore and describe the experiences of children and their parents living with type 1 diabetes mellitus from diagnosis onwards.

Background.  Type 1 diabetes mellitus is a psychologically and behaviourally demanding chronic condition that necessitates children and their parents taking extensive responsibility for managing the condition. Diabetes management involves maintaining a highly effective level of treatment to reduce the risks of short‐ and long‐term complications. Treatment is carried out in the context of daily life, but little research evidence is available about this experience.

Design.  A phenomenological study using conversational interview.

Method.  A purposive sample of 10 children, (aged 4–17) living with type 1 diabetes mellitus and their parents participated in this study. Participants were from different ethnic backgrounds and at differing lengths of time since diagnosis. Data were generated through conversational interviews and analysed using thematic analysis.

Results.  The central theme that was identified was ‘normal’. This was underpinned by four subthemes: transition, attachment, loss and meaning. The notion of ‘normal’ is dominant in the lives of these children and their parents because diabetes not only makes these families different, but also makes their pursuit of ‘normal’ more visible.

Conclusion.  These findings highlight that, despite different cultures, ages and lengths of time since diagnosis, families living with diabetes share very similar experiences. Understanding how children and parents create meaning and how this meaning influences their actual and potential health problems, is important if the provision of healthcare is to be effective in meeting their needs.

Relevance to clinical practice.  Conducting child‐ and parent‐centred qualitative research allows exploration of the perceptions and understanding of type 1 diabetes mellitus and the meaning ascribed by children and their parents who live with the condition. Diabetes is a lifelong, life‐threatening condition that has a significant impact on children’s and parents’ lives. Developing a deeper understanding of their lives and experiences will enable the delivery of nursing care to meet their specific needs.
Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review
Authors: Ho Simone SM , Yu Winnie WM , Lao Terence T , Chow Daniel HK , Chung Joanne WY , Li Yi
Published: May 2009

Aims.  This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low back pain during pregnancy, to identify future research directions.

Background.  Lumbar/pelvic support belts are frequently recommended for the prevention and treatment of low back pain during pregnancy.

Design.  Systematic review.

Methods.  MEDLINE, CINAHL, the Cochrane Library and patents databases were electronically searched.

Results.  Maternity support belts belong to one of the four main types of maternity support garments, which are widely commercially‐available. Current research showed limited evidence in support of the commercial maternity products regarding the effectiveness in the prevention and/or treatment of low back pain during pregnancy, other than that from the manufacturers. However, potential stabilisation effect of maternity support belt was demonstrated in some studies. Adverse effects reported include increased pain, fetal heart rate changes, skin irritation and discomfort.

Conclusions.  There is insufficient scientific evidence to conclude that wearing maternity support belts reduces pregnancy‐related low back pain and/or pelvic girdle pain. Future research directions in the area of biomechanics and physiology are recommended.

Relevance to clinical practice.  This review provides comprehensive understanding of the effectiveness of maternity support belts for the relief of low back pain during pregnancy which will facilitate healthcare professionals in providing evidence‐based advice to their patients.
Placental position and late stillbirth: a case‐control study
Authors: Warland Jane , McCutcheon Helen , Baghurst Peter
Published: May 2009

Aims and objectives.  The aim of this study was to determine whether there is a relationship between placental position and stillbirth with the objective of establishing if placental position impacted on stillbirth risk.

Background.  Whilst there has been extensive research on low placental implantation because of the importance of detecting placenta praevia, little research has been undertaken on other aspects of placental position and possible impact on pregnancy outcome.

Design.  A matched case‐control study of stillbirth and placental position was conducted using case‐notes from two tertiary obstetric referral centres.

Methods.  Notes were retrospectively examined and Placental position as documented in the case‐notes at the routine mid‐trimester (20 week) ultrasound was identified. Placental position for a total of 124 pregnancies culminating in stillbirth was compared with placental position in 243 (matched) pregnancies resulting in a live born baby.

Results.  Women who had a posterior located placenta were statistically more likely to suffer a stillbirth than women who had a placenta in any other position OR 1·64 (95%CI 1·02–2·65 p = 0·04).

Conclusion.  Posterior located placenta may be a contributory risk factor for stillbirth. Further research is warranted.

Implications for practice.  Nurses and midwives should be aware of this potential risk factor to monitor foetal well‐being closely.
A decade of stigma and discrimination in mental health: plus ça change, plus c'est la même chose (the more things change, the more they stay the same)
Authors: LYONS C. , HOPLEY P. , HORROCKS J.
Published: May 2009

In recent years, efforts to combat stigma and discrimination experienced by mental health service users have ranged from small local initiatives to national and international campaigns. Success has been mixed, with significant, lasting benefits appearing to be elusive. This paper explores the current nature and extent of stigma and discrimination in an area of the north of England and compares findings with those from a study undertaken a decade previously in 1997. Qualitative responses to a postal questionnaire received in 2007 were thematically analysed and compared and contrasted with findings from the 1997 study. Four broad categories of discrimination – (1) employment; (2) professional; (3) communities; and (4) family and friends – arose from the 2007 data, the most common being discrimination in employment. There were close similarities in both sets of data. Stigma and discrimination remain largely as strong, damaging and enduring as they were a decade ago. A range of pre‐emptive interventions that support people prior to the escalation of mental health crises could limit the impact of stigma.
Service users' experiences of a therapeutic group programme in an acute psychiatric inpatient unit
Authors: O'DONOVAN A. , O'MAHONY J.
Published: May 2009

Psychiatric nurses have been facilitating therapeutic groups in acute psychiatric inpatient units for many years; however, there is a lack of nursing research related to this important aspect of care. This paper reports the findings of a study which aimed to gain an understanding of service users' experiences in relation to therapeutic group activities in an acute inpatient unit. A qualitative descriptive study was undertaken with eight service users in one acute psychiatric inpatient unit in Ireland. Data were collected using in‐depth semi‐structured interviews and analysed using Burnard's method of thematic content analysis. Several themes emerged from the findings which are presented in this paper.
Hardship, dedication and investment: an exploration of Irish mothers commitment to communicating with their children with cerebral palsy
Authors: POWER R. , MCMANUS V. , FOURIE R.
Published: May 2009

This qualitative study investigated the experiences of mothers who have a child with communication difficulties resulting from cerebral palsy (CP). There is a dearth of information about parents' experiences of having a child with CP and communication difficulties. Three participants, whose children had moderate or severe CP and communication difficulties, were recruited from a voluntary organization. Participants were interviewed using an in‐depth, semi‐structured interview guide. Interviews were audio‐recorded, then transcribed and subsequently analysed using Grounded Theory methods. Five main themes emerged, combining to form the core category of mothers dedicating their attention to their children. The information gleaned from this study could have important implications for nurses involved in facilitating communication, including speech and language therapists, occupational therapists and registered nurses. By becoming more aware of the experiences of parents with a child with CP and communication disorders, nurses may be better able to plan and implement therapy and also support communication aims. The study concludes with a discussion of further research avenues, suggesting that a study investigating the experiences of parents of children with other types of physical disabilities affecting communication should be conducted to determine the similarities and differences of parents of children with other kinds of disability. A similar study with a larger sample could be conducted to validate the findings of the current study.
Knowledge and attitudes of mental health professionals in Ireland to the concept of recovery in mental health: a questionnaire survey
Authors: CLEARY A. , DOWLING M.
Published: May 2009

Recovery is the model of care presently advocated for mental health services internationally. The aim of this study was to examine the knowledge and attitudes of mental health professionals to the concept of recovery in mental health. A descriptive survey approach was adopted, and 153 health care professionals (nurses, doctors, social workers, occupational therapists and psychologists) completed an adapted version of the Recovery Knowledge Inventory. The respondents indicated their positive approach to the adoption of recovery as an approach to care in the delivery of mental health services. However, respondents were less comfortable in encouraging healthy risk taking with service users. This finding is important because therapeutic risk taking and hope are essential aspects in the creation of a care environment that promotes recovery. Respondents were also less familiar with the non‐linearity of the recovery process and placed greater emphasis on symptom management and compliance with treatment. Multidisciplinary mental health care teams need to examine their attitudes and approach to a recovery model of care. The challenge for the present and into the future is to strive to equip professionals with the necessary skills in the form of information and training.
Quality of life for patients with schizophrenia living in the community in Greece
Authors: DIMITRIOU P. , ANTHONY D. , DYSON S.
Published: May 2009

Several quality of life instruments were considered for use in a Greek mental health environment. Subjective Quality of Life Profile was chosen as it was easy to complete and covered the issues raised by patients with schizophrenia through interviews. Confirmatory factor analysis gave credence to the four‐dimensional structure identified by the original authors. Patients with schizophrenia were generally satisfied with their quality of life, found the items in the instrument important and were optimistic about expectations for change. Age, gender, education, marital status and years of sickness were not statistically significant in a general linear model with quality of life as the outcome for the 27 core questions. There were some statistically significant results for the three disease‐specific questions; positive expectation was correlated positively with education and negatively with years of sickness.
Intracellular excision and reintegration dynamics of the ICEclc genomic island of Pseudomonas knackmussii sp. strain B13
Authors: Sentchilo Vladimir , Czechowska Kamila , Pradervand Nicolas , Minoia Marco , Miyazaki Ryo , Van Der Meer Jan Roelof
Published: May 2009

Genomic islands are DNA elements acquired by horizontal gene transfer that are common to a large number of bacterial genomes, which can contribute specific adaptive functions, e.g. virulence, metabolic capacities or antibiotic resistances. Some genomic islands are still self‐transferable and display an intricate life‐style, reminiscent of both bacteriophages and conjugative plasmids. Here we studied the dynamical process of genomic island excision and intracellular reintegration using the integrative and conjugative element ICEclc from Pseudomonas knackmussii B13 as model. By using self‐transfer of ICEclc from strain B13 to Pseudomonas putida and Cupriavidus necator as recipients, we show that ICEclc can target a number of different tRNAGly genes in a bacterial genome, but only those which carry the GCC anticodon. Two conditional traps were designed for ICEclc based on the attR sequence, and we could show that ICEclc will insert with different frequencies in such traps producing brightly fluorescent cells. Starting from clonal primary transconjugants we demonstrate that ICEclc is excising and reintegrating at detectable frequencies, even in the absence of recipient. Recombination site analysis provided evidence to explain the characteristics of a larger number of genomic island insertions observed in a variety of strains, including Bordetella petri, Pseudomonas aeruginosa and Burkholderia.
Dimerization of the quorum‐sensing transcription factor TraR enhances resistance to cytoplasmic proteolysis
Authors: Pinto Uelinton M. , Winans Stephen C.
Published: May 2009

TraR is a LuxR‐type quorum‐sensing protein encoded by the tumour‐inducing plasmid of Agrobacterium tumefaciens. TraR requires the pheromone N‐3‐oxooctanoyl‐l‐homoserine lactone (OOHL) for biological activity, and is dimeric both in solution and when bound to DNA. Dimerization is mediated primarily by two α‐helices, one in the N‐terminal OOHL binding domain, and the other in the C‐terminal DNA binding domain. Each of these helices forms a parallel coiled coil with the identical helix of the opposite subunit. We have previously shown that OOHL is essential for resistance to proteolysis, and here we asked whether dimerization is also required for protease resistance. We constructed a series of site‐directed mutations at the dimer interface, and tested these mutants for activity in vivo. Alteration of residues A149, A150, A153, A222 and I229 completely abolished activity, while alteration of three other residues also caused significant defects. All mutants were tested for dimerization as well as for specific DNA binding. The cellular abundance of these proteins in A. tumefaciens was measured using Western immunoblots and OOHL sequestration, while the half‐life was measured by pulse‐chase radiolabelling. We found a correlation between defects in in vivo activity, in vitro dimerization, DNA binding and protein half‐life. We conclude that dimerization of TraR enhances resistance to cellular proteases.
Mid‐Cretaceous hydrothermal vents and authigenic carbonates in a transform margin, Basque‐Cantabrian Basin (western Pyrenees): a multidisciplinary study
Authors: AGIRREZABALA LUIS M.
Published: May 2009

A comprehensive study of authigenic carbonates and associated fauna in Late Albian organic‐rich, deep‐water deposits (the Black Flysch Group) reveals that carbonate precipitation was a by‐product of the anaerobic oxidation of hydrocarbon‐rich hydrothermal fluids. The authigenic carbonates are exposed along the Kardala and Alkolea sea cliffs in the western Pyrenees. The two vent carbonates occur 1 km apart adjacent to the synsedimentary, right‐reverse Mutriku fault, but in contrasting structural domains: the Kardala carbonates occur on a structural ridge (hangingwall) and the Alkolea carbonates are positioned at the base of an erosional scarp (folded downward footwall). The similarity in pattern of the carbonate phases and complex paragenetic events for both vent precipitates implies that hydrothermal fluid generation processes and pore‐water evolution during early and late diagenesis were similar. Nevertheless, a comparison of the geochemistry, fossil fauna and morphology of carbonate structures of both precipitates suggests that the vented hydrocarbon type, flow intensity and temperature of hydrothermal fluids were different. At the Kardala vent, intense focused flow of hot (up to 109 °C), oil‐rich fluids were generated, allowing the development of a relatively abundant chemosynthesis‐based fauna. In contrast, at the Alkolea vent, diffuse flows of warm, thermogenic methane‐rich fluids were expelled to the sea floor and no chemosynthetic fauna developed. These differences are related to the contrasting structural setting of each locality. Similar δ13Corg values for both pyrobitumen‐fills and host unit organic matter suggest that the hydrocarbon source was the Black Flysch Group. Contact alteration of these organic‐rich sediments by syndepositional hydrothermal fluids generated hydrothermal petroleum (oil and gas hydrocarbons) which probably migrated updip to the sea floor by contemporary compression tectonics.