bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory syncytial virus decreases the capacity of myeloid dendritic cells to induce interferon‐γ in naïve T cells
Authors: Bartz H. , Türkel Ö. , Hoffjan S. , Rothoeft T. , Gonschorek A. , Schauer U.
Published: December 2004

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants under 6 months of age. Since an RSV infection does not necessarily prevent a reinfection, we asked whether RSV might subvert an effective immune response by interfering with the function of dendritic cells (DCs). Immature DCs cultured from cord blood stem cells and infected with RSV reduced the rate of interferon‐γ (IFN‐γ) production in co‐cultured autologous naïve T cells stimulated with the superantigen TSST‐1. Maturation of DCs in response to poly(IC) but not to CD40 ligand did overcome the inhibitory effect of RSV. Further experiments demonstrated that induction of apoptosis, a selective increase in CD86 expression and lack of release of pro‐inflammatory cytokines were associated with inhibition of IFN‐γ generation. In addition, RSV replication seemed to be essential for modulation of IFN‐γ production because a virus preparation inactivated by UV irradiation had no effect. Hence, one reason for multiple reinfections by RSV might be the subversion of antiviral immune responses by interference of RSV with DC function.
Apoptotic cell death in conjunction with CD80 costimulation confers uveal melanoma cells with the ability to induce immune responses
Authors: Carlring Jennifer , Shaif‐Muthana Munitta , Sisley Karen , Rennie Ian G. , Murray Anna K.
Published: December 2004

Uveal melanoma is a rare malignancy with a poor prognosis despite current therapeutic intervention. The current investigation focuses on the immunogenicity of uveal melanoma cells genetically modified with recombinant adenovirus encoding CD80 (AdCD80) in contrast to their parental counterpart. We demonstrate that costimulation provided by uveal melanoma cells improved immune responses in vitro as determined by mixed lymphocyte tumour cell cultures and cytotoxic T‐cell assays using lymphocytes from healthy donors and uveal melanoma patients. Flow cytometry revealed T‐cell stimulation by activated CD4+ and CD8+ T cells. Additionally, autologous lymphocytes proliferated in response to CD80‐expressing primary uveal melanomas, indicating that this patient group is suitable for immunotherapy. Moreover, this study utilized AdCD80 modified and parental apoptotic tumour cells, loaded onto immature dendritic cells, as a source of tumour antigen. The ability of live or apoptotic tumour cells to stimulate lymphocyte proliferation and activation was determined. Apoptotic uveal melanoma cells expressing CD80 were efficient at inducing an immune response and served as a potent immunogen. The use of apoptotic uveal melanoma cells in combination with expression of costimulatory molecules could prove a novel adjuvant therapy for the treatment of this disease.
Heavy‐chain only antibodies derived from dromedary are secreted and displayed by mouse B cells
Authors: Nguyen Viet Khong , Zou Xiangang , Lauwereys Marc , Brys Lea , Brüggemann Marianne , Muyldermans Serge
Published: December 2004

Whereas functional heavy (H)‐chain antibodies devoid of light (L)‐ chains account for about half of the circulating immunoglobulins in Camelidae, H‐chain only antibodies (HCAbs) are not produced in other healthy mammals including rodents and humans. To test the feasibility of expressing single chain antibodies in the mouse, which on account of their small size and antigen‐recognition properties would have a major impact on antibody engineering strategies, we constructed a rearranged dromedary H‐chain gene encoding the immunoglobulin G2a (IgG2a) isotype with specificity for hen‐egg lysozyme (HEL). This IgG2a H‐chain gene was introduced into mouse myeloma cells not expressing endogenous immunoglobulin H‐ or L‐chains. Unexpectedly the mouse cells processed and expressed the introduced H‐chain as naturally occurring dromedary antibody. For this the first constant (C) region exon was proficiently removed from the recombinant H‐chain transcript. This resulted in specific H‐chain antibodies of the correct molecular weight (2 × 50 000 MW) secreted as disulfide‐linked homodimers and displayed on the mouse cell surface as glycosyl‐phosphatidyl‐inositol‐linked B‐cell receptor. The results indicate that antibody expression and maturation without immunoglobulin L‐chain is feasible and paves the way for the generation of transgenic single chain antibody repertoires.
The influence of macrophage inflammatory protein‐1α on protective immunity mediated by antiviral cytotoxic T cells
Authors: Jones Emma , Price David A. , Dahm‐Vicker Michaela , Cerundolo Vincenzo , Klenerman Paul , Gallimore Awen
Published: December 2004

Macrophage inflammatory protein 1α (MIP‐1α), a member of the CC‐chemokine subfamily, is known to induce chemotaxis of a variety of cell types in vivo. Although the role of MIP‐1α in inflammatory responses generated following primary infection of mice with many different pathogens has been characterized, the influence of this chemokine on the generation of antigen‐specific T‐cell responses in vivo is less well understood. This is important, as virus‐specific CD8+ T lymphocytes (CTL) play a crucial role in defence against viral infections, both acutely and in the long term. In this study, we compared the ability of wild‐type and MIP‐1α‐deficient (MIP‐1α−/−) mice to mount CTL responses specific for the immunodominant epitope derived from influenza nucleoprotein (NP366–374). Influenza‐specific CTL responses were compared with respect to frequency, cytotoxic activity and ability to clear subsequent infections with recombinant vaccinia viruses expressing the influenza NP. The results indicate that antiviral CTL generated in MIP‐1α−/− mice are slightly impaired in their ability to protect against a subsequent infection. However, impaired in vivo CTL‐mediated antiviral protection was found to be associated with reduced cytotoxicity rather than with a failure of the CTL to migrate to peripheral sites of infection.
Innate immune responses induced by CpG oligodeoxyribonucleotide stimulation of ovine blood mononuclear cells
Authors: Mena Angelo , Nichani Anil K. , Popowych Yurij , Godson Dale L. , Dent Donna , Townsend Hugh G. G. , Mutwiri George K. , Hecker Rolf , Babiuk Lorne A. , Griebel Philip
Published: December 2004

Examples exist in the literature that demonstrate that treatment with immunostimulatory cytosine–phosphate–guanosine (CpG)‐DNA can protect mice against infection by intracellular pathogens. There are, however, few studies reporting that CpG‐DNA offers similar disease protection in other species. In this study, we assessed the potential of a class A and class B CpG oligodeoxynucleotide (ODN) to induce innate immune responses in sheep, an outbred species. Using peripheral blood mononuclear cells, we have for the first time demonstrated CpG‐ODN‐induced innate immune responses, including natural‐killer‐like activity [non‐major histocompatibility complex (MHC)‐restricted cytotoxicity], interferon‐α secretion and 2′‐5′A oligoadenylate synthetase activity, that could contribute to immune protection in sheep. The type and magnitude of these responses were dependent on ODN class and non‐MHC‐restricted killing was not associated with interferon‐γ production. The latter observation is in contrast with observations reported for mice and humans. These observations support the conclusion that differences in CpG‐ODN‐induced responses exist among species and that specific ODN sequences can significantly influence innate immune responses.
Senescence and age‐related reproduction of female Columbian ground squirrels
Authors: Broussard D. R. , Risch T. S. , Dobson F. S. , Murie J. O.
Published: December 2004

Three hypotheses have been proposed to explain age‐structured patterns of reproductive investment and somatic investment: residual reproductive value, senescence and evolutionary restraint. We evaluated these hypotheses for female Columbian ground squirrels (Spermophilus columbianus) by examining age‐related patterns of somatic and reproductive investment. Females were designated as successful (those that weaned litters) and unsuccessful (those that did not wean litters).

Somatic investment varied among both successful and unsuccessful females of different ages, with yearlings having the highest investment. Considering all females, reproductive investment varied among age classes with yearlings and the oldest (6–9‐year‐olds) having the lowest investments. However, when only successful females were considered, reproductive investment was lowest in the yearlings and not significantly different among older females.

The highest proportion of successful females occurred in the middle adult age classes, while yearlings and the oldest females displayed the lowest proportion of successful females. During the breeding season, somatic investments of successful and unsuccessful females differed significantly only in the yearling age class, with unsuccessful females having the highest investment.

Evolutionary restraint or constraint explained patterns of reproduction in the yearling age class, where both reproductive investment and proportion of reproductive females were low. There was evidence for senescence of reproduction by some of the oldest females.
Dispersal pattern of domestic cats (Felis catus) in a promiscuous urban population: do females disperse or die?
Authors: Devillard Sébastien , Say Ludovic , Pontier Dominique
Published: December 2004

The domestic feral cat (Felis catusL.) is a good model for studying intraspecific variability of dispersal patterns in mammals because cats live under a large diversity of socio‐ecological conditions. We analysed both the natal and breeding dispersal patterns of domestic cats in a promiscuous urban population and tested whether or not it differed from the male‐biased natal dispersal pattern observed for polygynous rural populations.

During an 8‐year study we recorded the exact date ofin situdeath for 148 marked cats and the exact date of disappearance from the population for 99 other cats. Because undiscovered deaths might over‐estimate dispersal probabilities when considering only disappearance probabilities, we made an novel application of multistrata capture–recapture methods in order to disentangle dispersal from true mortality.

We showed that mature females dispersed, both before and after their first reproduction, at 1 and 2 years old. Contrary to females, no dispersal seemed to occur in males. Before sexual maturity, females that disappeared at 1 and 2 years old were in worse body condition than females that stayed in the population area after 2 years old. However, they did not reproduce less successfully before their disappearance than females that died later in the population area.

The female‐biased and low natal dispersal pattern in this population was atypical compared to other promiscuous/polygynous mammals and differed from that observed in rural polygynous populations of domestic cat. Neither local mate competition nor inbreeding avoidance appeared to be sufficient pressures to counterbalance ecological constraints on dispersal in an urban environment. However, local resource competition for den sites between potential matriarchies could lead to the breeding dispersal of less competitive females.
Spatial refugia and the coexistence of a diurnal raptor with its intraguild owl predator
Authors: Sergio Fabrizio , Marchesi Luigi , Pedrini Paolo
Published: December 2004

Intraguild predation (IGP) has been studied extensively in predatory fish, amphibians and mammals, but less so in top avian predators. We studied the impact of IGP by large eagle owlsBubo buboLinnaeus (body mass ∼1·5–4 kg) on diurnal black kitesMilvus migransBoddaert (∼0·5–1 kg) in eight populations located in the Italian Alps. Eagle owls preyed on both adult and nestling kites, especially when kites nested within 2 km of an owl nest. Food overlap was low as kites preyed mainly on fish and owls on mammals. Eagle owls were absent from two study areas, bred very close to another area and were present at medium–high densities in the other five. Within‐population effects varied and were most severe in areas with high owl densities. Overall, kites responded to predation risk through predator spatial avoidance, being concentrated in interstitial predation‐refugia bordering the core home range of owl pairs.

Kite productivity declined steeply with increasing predation risk; no nestling fledged within 1 km of an owl nest. Brood predation was higher in an area with medium owl density than in an area lacking eagle owls.

The abandonment of kite territories increased near owl nests, but close coexistence was maintained by new kite territories being established occasionally in areas of high predation risk and high food abundance, which probably functioned as ecological traps. Compared to a random nest dispersion, colonial nesting was avoided within 1 km of an owl pair and peaked in conditions of medium predation risk.

At the population level, kite density and productivity were related to a complex interaction of IGP risk and food abundance, and were probably shaped by a mixture of top‐down and bottom‐up effects. These results may apply to many other vertebrate mesopredators, whose individual decisions and population responses are probably the result of a trade‐off between predator avoidance and food acquisition.

At the community level, the density of different diurnal avian predators responded differently to IGP risk, some of them even increasing with this risk. The diversity of the assemblage peaked at medium–high eagle owl density. Future studies of top vertebrate predators need to take more account of IGP effects. Their conservation management needs to be highly case‐specific and framed within a broader ecosystem perspective.
Bill dimorphism and foraging niche partitioning in the green woodhoopoe
Authors: Radford Andrew N. , Du Plessis Morné A.
Published: December 2004

Cooperatively breeding green woodhoopoes, Phoeniculus purpureus, forage mainly as close‐knit groups, creating opportunities for intrasexual and intersexual foraging competition.

Adult males foraged on wider branches than adult females, probably as a consequence of their larger body size (5–8%). Moreover, adult males spent more time scaling bark and probing the ends of broken branches, while adult females preferred pecking. There was no intersexual difference in the use of hole probing or surface gleaning.

Intersexual differences in foraging technique probably resulted from morphological differences: adult male bills were 36% longer than those of females, with no overlap between the sexes. In support of the specialization hypothesis: (a) birds were more likely to forage in close proximity to a member of the opposite sex; (b) there was more intrasexual than intersexual aggression during foraging; (c) lone females did not change their foraging behaviour from when in close proximity to a male; (d) the niche breadth of both sexes was similar; and (e) juveniles foraged in ways predicted from their bill lengths. On fledging, bills of juvenile males and females were the same length as those of adult females, and all juveniles fed like adult females. After 4 months, the bills of juvenile males exceeded those of adult females, and they began to forage like adult males.

Adult males brought different invertebrate taxa and heavier prey to the nest than females. These differences were a consequence of the different foraging techniques used, because both sexes collected the same types of prey when using the same technique.

When all group members foraged together, dominant adults spent more time hole probing than subordinates of the same sex. This intrasexual difference probably resulted from interference competition, as dominants and subordinates did not differ in bill length, and dominants excluded subordinates from prime feeding areas.

To compensate, subordinate adults did not increase their foraging time or collect larger prey items than dominants, but more often left the group to forage alone. When alone, subordinates spent more time hole probing and experienced higher foraging success than when in a group.
The effects of an exotic fish invasion on the prey communities of two lakes
Authors: Beisner Beatrix E. , Ives Anthony R. , Carpenter Stephen R.
Published: December 2004

We examined changes in prey (zooplankton) communities resulting from the invasion of an exotic predator, the rainbow smelt (Osmerus mordax Mitchill), using long‐term data sets from two lakes in Wisconsin, USA.

Food webs in the two lakes differed originally both in the dominant native planktivorous fish species and in relative biomasses of major zooplankton groups.

Zooplankton communities in each lake changed dramatically, coinciding with the exotic predator invasion. The communities in the two lakes became more similar to each other, with cyclopoid copepods becoming dominant.

Time‐series analyses demonstrated that the long‐term responses of the two lake prey communities were driven primarily by direct predation effects of planktivorous fish. Indirect effects acting through competitive interactions among zooplankton were present but were comparatively small in the long term.

Results suggest that zooplankton populations were subject to both predator and resource limitation but that the composition (relative species abundance) of the zooplankton community was dictated in the long term by predation.
Sex differences in the seasonal patterns of energy storage and expenditure in a phocid seal
Authors: Beck Carrie A. , Bowen W. Don , Iverson Sara J.
Published: December 2004

Sex differences in the timing and magnitude of energy expenditure for reproduction may result in sex‐specific seasonal patterns of energy storage and utilization, particularly among capital‐breeding species. We studied the seasonal patterns of energy storage in adult grey seals, Halichoerus grypus, a capital‐breeding, marine carnivore, to test the prediction that males and females differ in their seasonal pattern of energy storage and expenditure.

We measured body mass and composition in 135 (67 males, 68 females) adult grey seals at five key points throughout the annual cycle. Longitudinal changes in body composition were also measured in 73 individuals (35 males, 38 females) to examine individual variability.

There were significant sex differences in seasonal patterns of total body energy, with females exhibiting greater energy content (after accounting for body mass) throughout the year. Females gained body energy following both the spring moult and the breeding season, whereas males only gained body energy following an extended period of loss that included both breeding and moulting, a period of some 6 months.

Mass loss of females during the breeding season was similar in magnitude and composition to that gained during the 7‐month pre‐breeding foraging period. In contrast, mass loss of males during the breeding season was more similar to that gained during the last three months of the pre‐breeding foraging period.

Our results suggest that the balance of costs and benefits of storing body energy for reproduction differs between males and females. Females appear to be risk‐averse, committing themselves to, and preparing for, reproduction at a much earlier stage in the annual cycle compared to males. As a result, females accumulate body energy stores earlier and carry a higher level of insurance against environmental uncertainty leading up to the breeding season relative to males.
Variable performance of individuals: the role of population density and endogenously formed landscape heterogeneity
Authors: Pfister Catherine A. , Peacor Scott D.
Published: December 2004

Individuals can show positive correlations in performance (e.g. growth and reproduction) through time beyond the effects of size or age. This ‘performance autocorrelation’ has been attributed previously to traits that differ among individuals or to extrinsic generators of environmental heterogeneity.

A model of mobile consumers on a dynamic resource showed that consumer foraging gave rise to resource heterogeneity that in turn generated autocorrelation in growth in consumers.

Resource heterogeneity and growth autocorrelation were most pronounced when consumers were poorer foragers, moving locally and with an imperfect ability to identify the highest resource cells.

The model predicted that lowered population density enhanced resource heterogeneity and the strength of growth autocorrelation.

Consistent with model predictions, an experiment with tidepool limpets demonstrated that autocorrelation in growth changed with population density, with individuals in lower density tidepools showing stronger temporal correlations in growth.

Our model and empirical results contrast with those of previous studies with plants, where dominance and suppression increases with increasing density.

Our results suggest that growth autocorrelation can occur without invoking size‐dependent advantages, intrinsic trait differences or extrinsic generators of environmental heterogeneity.
Differential species‐specific ectoparasitic mite intensities in two intimately coexisting sibling bat species: resource‐mediated host attractiveness or parasite specialization?
Authors: Christe Philippe , Giorgi Maud S. , Vogel Peter , Arlettaz Raphaël
Published: December 2004

The mechanisms underlying host choice strategies by parasites remain poorly understood. We address two main questions: (i) do parasites prefer vulnerable or well‐fed hosts, and (ii) to what extent is a parasite species specialized towards a given host species?

To answer these questions, we investigated, both in the field and in the lab, a host–parasite system comprising one ectoparasitic mite (Spinturnix myoti) and its major hosts, two sibling species of bats (Myotis myotis and M. blythii), which coexist intimately in colonial nursery roosts. We exploited the close physical associations between host species in colonial roosts as well as naturally occurring annual variation in food abundance to investigate the relationships between parasite intensities and (i) host species and (ii) individual nutritional status.

Although horizontal transmission of parasites was facilitated by the intimate aggregation of bats within their colonial clusters, we found significant interspecific differences in degree of infestation throughout the 6 years of the study, with M. myotis always more heavily parasitized than M. blythii. This pattern was replicated in a laboratory experiment in which any species‐specific resistance induced by exploitation of different trophic niches in nature was removed.

Within both host species, S. myoti showed a clear preference for individuals with higher nutritional status. In years with high resource abundance, both bat hosts harboured more parasites than in low‐resource years, although the relative difference in parasite burden across species was maintained. This pattern of host choice was also replicated in the laboratory. When offered a choice, parasites always colonized better‐fed individuals.

These results show first that host specialization in our study system occurred. Second, immediate parasite choice clearly operated towards the selection of hosts in good nutritional state.
Evaluation of qualitative research
Authors: Horsburgh Dorothy
Published: December 2004

• It is necessary to subject published research to critical scrutiny, in order to evaluate the robustness of the findings.

• The criteria used in evaluation require to be appropriate for the research paradigm, i.e. quantitative or qualitative. Quantitative conceptualizations of reliability and validity are unsuitable for evaluation of qualitative research as they were not devised for this purpose.

• The use of quantitative criteria to evaluate qualitative research may create the impression that the latter is not academically rigorous.

• Evaluation criteria which are specific to qualitative research require identification and application, in order to provide a formalized and rigorous approach to critical appraisal.

• A formalized framework for evaluation will help to ensure that the contribution of qualitative studies, with specific reference to health services research, receives optimum recognition.

• The work of a number of writers is used in this paper to examine the features which distinguish qualitative research and the following are discussed:

• the need for researcher reflexivity;

• the use of the ‘first person’ in academic work;

• the context in which research takes place;

• the selection of research participants;

• the interpretation of participants' accounts;

• the active acknowledgement of ‘lay’ knowledge;

• researcher flexibility within the research process;

• the generalizability of findings.

• It is concluded that academically rigorous criteria, which are appropriate for evaluation of qualitative research, exist and are available for use by practitioners and researchers.
Do they practise what we teach? A survey of manual handling practice amongst student nurses
Authors: Swain Jane , Pufahl Eric , R. Williamson Graham
Published: December 2004

• Experience of training students of nursing in manual handling suggested that they did not practise the techniques they had been taught. A search of the literature revealed that there was indeed a theory‐practice gap.

• The aim of the project was to answer three questions: do students know what they should be doing, do they do what they should be doing, and if not, why not.

• A survey design was used, with questionnaires designed specifically for the study. Self report questionnaires were distributed to students of nursing (n = 148) on the adult branch in one higher education institution in England. One hundred and thirty‐nine completed questionnaires were returned.

• Results showed that students' knowledge of whether particular techniques were ‘recommended’ was fair. They indicated however, that they were frequently unable to use recommended techniques in practice. The most frequent explanation given was the influence of other nurses. Results of this small study indicated that male students and younger students were more susceptible to socialization into poor ward practice than others. Other reasons for not using recommended techniques were unavailability of manual handling aids, lack of time and patient needs.

• The complexity of relationships within the nursing team emerged, with students ever aware of the impression they were making with regard to their assessment of practice, and their need to be accepted as a member of the team. Changes to training are suggested, to help reduce the theory‐practice gap.
Older South Asian patient and carer perceptions of culturally sensitive care in a community hospital setting
Authors: Clegg Angie
Published: December 2004

• This study describes the application of grounded theory to establish older, south Asian patient and carer views of service delivery in the UK. The purpose of the study was to inform the development of culturally sensitive services by defining the concept of cultural sensitivity from a user/carer perspective.

• The study took place in two community hospitals providing nurse‐led intermediate care to a culturally diverse inner city population. Fifty‐five per cent of the inner city population is of south Asian origin. Admissions to intermediate care, however, do not reflect the demography.

• Recent reports commissioned by the Department of Health highlight the failure of the National Health Service in England to provide culturally sensitive services to black and Asian patients. The Department of Health is trying to redress this inequality providing policy guidance for improving access and cultural sensitivity in the British health care system. There is little existing empirical evidence, however, to clarify the concept of culturally sensitive care.

• Patients and carers in this study described culturally appropriate care as that which respects individuality, creates mutual understanding, caters for spiritual need and maintains dignity. Older south Asian patients and their carers identified respect, understanding, spirituality and dignity as central to their conceptualization of cultural sensitivity. Their focus was on the nature of human relationships and their ability to interact in a positive way with staff.

• The findings of this small piece of empirical research are limited by the sample size (four patients and three carers), but illustrate that cultural sensitivity, although complex, can be defined. This then provides a basis for developing appropriate care strategies.

• One universal principle explicit in this research was that to be sensitive to culture staff must challenge their own assumptions and develop an understanding of the many layers of culture and subculture with which they are dealing. The starting point for any service is to understand the expectations of its users and to seek out and manage areas of conflict between organizational values and individuals' cultural requirements.
Unsatisfied basic needs of older patients in emergency care environments – obstacles to an active role in decision making
Authors: Nydén Kristoffer , Petersson Martin , Nyström Maria
Published: December 2004

• Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people.

• The aim of this study was thus to analyse older people's basic needs in the emergency care environment.

• The study was carried out with a life‐world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality.

• Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non‐urgent health‐related problems, were interviewed about their experiences of ECU care.

• Their basic needs at the lower levels of Maslow's hierarchy were well‐represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation.

• Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.
Developing user involvement in research
Authors: Maslin‐Prothero Sian
Published: December 2004

• User involvement is central to the UK government's modernization agenda for the National Health Service (NHS).

• This paper represents work undertaken for the NHS National Cancer Research and Development Programme and NHS Executive Trent.

• It includes reflection on the experience of user involvement in health care research drawing on current UK health policy documents and an examination of the factors affecting recruitment to breast cancer clinical trials, and contributes to the debate on recruitment to clinical trials.

• Reference to UK policy documents is made throughout as well as real life experience of involving users in research.

• It summarizes key issues that nurses and midwives must consider to ensure effective user participation in research and practice.
‘Relatives are a resource, but…’: Registered Nurses' views and experiences of relatives of residents in nursing homes
Authors: Hertzberg Annika , Ekman Sirkka‐Liisa , Axelsson Karin
Published: December 2004

• Registered Nurses (RNs) working in nursing homes in Sweden have obligations towards the residents' relatives, besides the care of residents. Relatives' involvement and satisfaction with the care partly depend on their contacts and communication with the staff.

• This study aimed to explore and describe RNs' views and experiences of relatives of residents who live in nursing homes.

• Open interviews were conducted with 19 RNs at three nursing homes. The verbatim‐transcribed interviews were subjected to qualitative content analysis.

• Relatives were seen as a resource (with some restrictions) and nice, although demanding. The RNs saw relatives as part of their work – a part that could be time‐consuming and had low priority.

• Interviewees noticed a difference between young and old relatives, and between female and male relatives.

• A large proportion of accounts could be related to issues about communication and interpersonal relationships with relatives.

• Building a trusting relationship with relatives may result in them being involved in residents' care and thus giving the nurses time rather than consuming time.
Caregivers’ experiences of interaction with families expecting a fetally impaired child
Authors: Maijala Hanna , Paavilainen Eija , Väisänen Leena , Åstedt‐Kurki Päivi
Published: December 2004

Background. On the basis of earlier research, caregivers’ actions when interacting with clients should be developed. However, nursing research has focused little attention on the interaction between caregivers and families expecting a fetally impaired child.

Aim. The study aimed at generating a practical family nursing theory of caregivers’ interaction with families expecting a malformed child.

Methods. A grounded theory study was undertaken at Tampere University Hospital in Finland in 1999–2000. Data consisted of semi‐structured interviews with 22 (n = 22) nurses and doctors. The data were analysed using the constant comparative method.

Results. The interaction process starts when a caregiver informs the parents of the fetal impairment. The process is influenced by caregivers’ attitude towards issues related to the family's life situation. Caregivers’ views of their job, and of human coping and cultural attitudes towards these issues are also of importance. These factors account for their goals in the interaction, which, in turn, underlie their actions. When the caregiver's interpretation is that the family accepted the help provided, the outcome of the interaction is satisfaction with having been able to help. Correspondingly, in the case of an opposite interpretation, the caregiver experiences strain caused by inadequacy of the help he/she is providing. The core of interaction consists of two dimensions: gaining strength and losing strength in relation to impairment issues.

Conclusions. Caregivers’ views of helpful interaction were consistent with earlier research on the subject, but the findings of this study showed that more attention should be focused on the family as a whole. Furthermore, caregivers rarely criticized their own actions, thus their interaction skills should be upgraded by focusing on systematic self‐assessment through training. Nursing research deepening our understanding of why interaction fails is warranted.

Relevance to clinical practice. The study results can be used in the family nursing practice as tools in reinforcing the caregivers’ ability to helpful interaction with families expecting a fetally impaired child. The results may enhance caregivers’ systematic self‐evaluation and conscious use of the self.
Meeting patient and relatives’ information needs upon transfer from an intensive care unit: the development and evaluation of an information booklet
Authors: Paul Fiona , Hendry Charles , Cabrelli Louise
Published: December 2004

Background.  Transfer from the intensive care unit to a ward is associated with a significant degree of relocation stress for patients and relatives. This can be stressful for ward nurses due to the dependency levels of patients and the ensuing increased workload. Furthermore the patient may require care, not normally undertaken in that clinical area, e.g. tracheostomy care. Patients may forget the verbal information given to them at the time of transfer and often have limited or no memory of the intensive care unit experience. This can cause anxiety and compound the feelings of stress associated with transfer. Many patients suffer psychological and physiological problems after intensive care unit, which can affect their recovery and quality of life.

Aims.  The aim of the study was to develop an evidence‐based information booklet for patients and relatives preparing for transfer from intensive care units.

Design.  This collaborative study used an exploratory design with elements of the action research cycle. The study, conducted in three phases, involved identifying patients’ and relatives’ information needs around the time of transfer; designing and developing an information booklet; and the introduction and evaluation of the booklet into practice.

Methods.  Semistructured interviews were used to elicit the views of patients and relatives regarding their information needs. Members of the multidisciplinary team were involved in identifying and reviewing booklet content.

Results.  Evaluation identified positive outcomes relating to patients’ and relatives’ satisfaction with the information and enhanced communication with other wards and health care professionals. The study also highlighted the need for more staff education in relation to patients and relatives needs when transferring to a ward.

Conclusions.  This study has demonstrated the value of providing patients and relatives with written information regarding transfer from intensive care units. Furthermore the study confirmed the feasibility and importance of including patients and relatives in the process of booklet development to ensure that their needs for information are being met.

Relevance to clinical practice.  Providing written information as part of a structured discharge plan is recommended. It provides patients and relatives with a resource that they can refer to at any time and that enhances verbal communication. The purpose of this information is to inform and empower patients so that they are better prepared for the transfer and recovery period.
Environmental elements affecting the decision‐making process in nursing practice
Authors: Hedberg Berith , Larsson Ullabeth Sätterlund
Published: December 2004

Background. In their practice nurses constantly make decisions in a dynamic context including complex situations. Besides affecting elements related to the decision‐maker and the task itself, the setting where the decision‐making process takes place are of decisive importance to the quality of the decision‐making outcome.

Aim. The aim of this study was to explore environmental elements related to the decision‐making process in nursing practice.

Methods. Six expert nurses, from three Swedish nursing settings, participated voluntarily in the study, which were designed of participated observations in everyday nursing practice. Permission to carry out the study was given by the clinics and an ethical committee. A content analysis was used to analyse the field notes where themes emerged which were found to be environmental elements affecting decision‐making process of nurses.

Conclusions. The most striking theme, environmental elements, included the sub‐themes interruptions and the work procedures are presented in this report. The implications of environmental elements, are discussed from a perspective of nurses' competence, where the elements could be seen as a facilitator or as a hindrance to developing nursing competence. It were concluded that environmental elements have to be well considered before knowledge can be reached about decision‐making in practice.

Relevance to clinical practice. Interpersonal and technological interruptions were features highlighted in the study, features which could jeopardize the decision‐making outcome. Therefore, it is of greatest importance that nurses learn to use decision‐making strategies to guarantee patient care security and patient care quality.
Nutritional management of rheumatoid arthritis: a review of the evidence
Authors: Rennie K. L. , Hughes J. , Lang R. , Jebb S. A.
Published: December 2004

Rheumatoid arthritis (RA) is a debilitating disease and is associated with increased risk of cardiovascular disease and osteoporosis. Poor nutrient status in RA patients has been reported and some drug therapies, such as nonsteroidal anti‐inflammatory drugs (NSAIDs), prescribed to alleviate RA symptoms, may increase the requirement for some nutrients and reduce their absorption.

This paper reviews the scientific evidence for the role of diet and nutrient supplementation in the management of RA, by alleviating symptoms, decreasing progression of the disease or by reducing the reliance on, or combating the side‐effects of, NSAIDs. Supplementation with long‐chain n‐3 polyunsaturated fatty acids (PUFA) consistently demonstrates an improvement in symptoms and a reduction in NSAID usage. Evidence relating to other fatty acids, antioxidants, zinc, iron, folate, other B vitamins, calcium, vitamin D and fluoride are also considered. The present evidence suggests that RA patients should consume a balanced diet rich in long‐chain n‐3 PUFA and antioxidants. More randomized long‐term studies are needed to provide evidence for the benefits of specific nutritional supplementation and to determine optimum intake, particularly for n‐3 PUFA and antioxidants.
Promoting healthy diet and exercise patterns amongst primary school children: a qualitative investigation of parental perspectives
Authors: Hart K. H. , Herriot A. , Bishop J. A. , Truby H.
Published: December 2004

Parents represent a potentially powerful intermediary in behaviour change strategies aimed at improving the lifestyle behaviours of young children. However, to fulfil this role, parents need to have the necessary knowledge and motivation to assimilate dietary guidelines. This study aimed to assess these psychosocial constructs, and subsequent parental receptiveness to nutrition education, through investigation of the barriers and benefits perceived by parents to the provision of a healthy diet and adequate exercise for their children. A qualitative methodology was employed and 41 parents took part in seven focus groups separated by socio‐economic status (SES).

Across the groups, a combination of reported external barriers and unconscious internal barriers, stemming from high optimistic bias, low perceived control and unrealistic health expectations, were observed. SES differences were suggested in restrictive feeding practices, the responsibility attributed to the school and in the level and format of desired nutrition education. Overall a demand for interventions focusing on behavioural techniques rather than fact transmission was uncovered, in particular the promotion of parental self‐awareness to reduce negative influences within the family food environment. Providing realistic definitions of appropriate behaviour and empowering parents to tackle children's weight issues were indicated as important targets for future education programmes.
Nurses' knowledge of current guidelines for infant feeding and weaning
Authors: Williams A. , Pinnington L. L.
Published: December 2004

Background  Poor infant feeding practices are common causes of nonorganic failure to thrive and may exacerbate the effects of many chronic conditions. It is important therefore that parents receive correct and consistent feeding advice from health professionals. The aim of this study was to determine whether hospital paediatric nursing staff are familiar with the recommendations of the Department of Health (DOH) Weaning Report (DOH, 1994).

Methods  A total of 127 members of nursing staff (79%) at Derbyshire Children's Hospital were interviewed. Knowledge of recommended practices for the introduction and use of cow's milk, gluten, milk products, mashed foods, vitamin supplements and drinks was assessed.

Results  Overall, 42 people (33%) answered all questions correctly. In each clinical area, six outpatient (64%), 19 special care baby unit (61%) and 17 ward (20%) staff provided correct answers to all questions. No significant difference was found between staff at each grade in the number of questions answered correctly.

Conclusions  Knowledge of national infant feeding and weaning guidelines was limited suggesting that DOH recommendations are not widely understood or recognized. Further nutrition education and local dissemination of information is required if nurses are to continue to advise parents on aspects of infant feeding.
Survival and trends of occurrence of left ventricular hypertrophy, gender differences, 1967–92: The Reykjavik Study
Authors: Thrainsdottir I. S. , Hardarson Th. , Thorgeirsson G. , Sigvaldason H. , Sigfusson N.
Published: December 2004

Abstract.  Thrainsdottir IS, Hardarson Th, Thorgeirsson G, Sigvaldason H, Sigfusson N (National University Hospital, Reykjavik, Iceland). Survival and trends of occurrence of left ventricular hypertrophy, gender differences, 1967–92: The Reykjavik Study. J Intern Med 2003; 253: 418–424.

Objective.  We estimated the prevalence, incidence and risk factors of left ventricular hypertrophy (LVH) in a prospective cohort study of 26 489 participants.

Material and methods.  The LVH was defined as Minnesota Code 310 on electrocardiogram (ECG). Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. The comparison cohort were all other participants in the Reykjavik Study stages I–V.

Results.  A total of 297 men and 49 women were found to have LVH of 3.2% and 0.5%, respectively. The incidence was 25 per 1000 per year amongst men and six per 1000 per year amongst women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure [odds ratio (OR) per mmHg 1.02; 95% confidence interval (CI): 1.01–1.03], age (OR per year 1.04; 95% CI: 1.02–1.05), silent myocardial infarction (MI) (OR 3.18; 95% CI: 1.39–7.27) and ST‐T changes (OR 3.06; 95% CI: 2.14–4.38) amongst men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure [incidence ratio (IR) 1.01; 95% CI: 1.01–1.02] and angina with ECG changes (IR 2.33; 95% CI: 1.08–5.02) amongst men and systolic blood pressure amongst women (IR 1.03; 95% CI: 1.01–1.04). The risk for coronary mortality was significantly increased amongst women with hypertrophy [hazard ratio (HR) 3.07; 95% CI: 1.5–6.31] and their total survival was poorer with increasing time from diagnosis of LVH (HR 2.17; 95% CI: 1.36–3.48).

Conclusions.  We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure amongst both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischaemic heart disease.
Plasma oxidized LDL: a predictor for acute myocardial infarction?
Authors: Nordin Fredrikson G. , Hedblad B. , Berglund G. , Nilsson J.
Published: December 2004

Abstract.  Nordin Fredrikson G, Hedblad B, Berglund G, Nilsson J (Malmö University Hospital, Lund University; and Biomedical Laboratory Science, Malmö University, Sweden). Plasma oxidized LDL: a predictor for acute myocardial infarction? J Intern Med 2003; 253: 425–429.

Objectives.  Oxidized LDL has been attributed a key role in the development of atherosclerosis. Previous studies have demonstrated increased plasma levels of oxidized LDL in patients with established coronary artery disease. The aim of the present study was to investigate if plasma oxidized LDL also predicts risk for development of coronary heart disease (CHD).

Design.  We used a nested case–control design to study the association between plasma levels of oxidized LDL and risk for development of acute myocardial infarction (AMI) and/or death by CHD.

Subjects.  Oxidized LDL was analysed by ELISA in cases (n = 26), controls (n = 26) and controls with LDL cholesterol >5.0 mmol L−1 (n = 26).

Results.  Oxidized LDL correlated with total plasma and LDL cholesterol in both cases (r = 0.72, P < 0.01, r = 0.69, P < 0.01, respectively) and controls (r = 0.71, P < 0.01, r = 0.77, P < 0.01, respectively). The oxidized LDL/plasma cholesterol ratio was higher amongst cases (13.5, range 10.7–19.8) than in controls (12.6, range 9.5–15.8, P < 0.05) and hypercholesterolaemic controls (12.2, range 8.0–16.0, P < 0.01).

Conclusions.  These findings identify high plasma oxidized LDL/total cholesterol ratio as a possible indicator of increased risk for AMI.