bluuebunny/crossref_metadata_2025 huggingface dataset:
Myogenous temporomandibular disorder patients and the temporomandibular opening index
Authors: Miller V. J. , Karic V. V. , Myers S. L. , Exner H. V.
Published: March 2003

Limited mandibular movement is one of the cardinal signs of temporomandibular disorders, and is usually assessed by measurement of mouth opening. Linear measurement of mouth opening does not discriminate between diagnostic groups and has been shown to be influenced by gender, age and ramus length. A new temporomandibular opening index, however, can differentiate between diagnostic groups and is not influenced by the above variables. When patients with a myogenous temporomandibular disorder were examined, the temporomandibular opening index distinguished two subgroups, the first with values about the lower quartile and the second with values about the upper quartile. A similar identification of two subgroups was seen in electromyographic studies of myogenous temporomandibular disorder patients (Visser, A., Kroon, G.W., Naeije, M. & Hansson, T.L. (1995) Journal of Oral Rehabilitation, 22, 429)
Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part I. Occlusal interferences and occlusal adjustment
Authors: De Boever J. A. , Carlsson G. E. , Klineberg I. J.
Published: March 2003

This review, divided into two parts, evaluates the literature on the relationship between dental occlusion and temporomandibular disorders (TMD) and the need for occlusal therapy in the management of TMD. The first part of the review focuses on the aetiological importance of occlusal interferences and the place of occlusal adjustment in the management and prevention of signs and symptoms of TMD. This has long been a controversial issue, which has not yet been resolved. The literature does not give strong support for the role of occlusion in the aetiology of TMD. Experienced clinicians also repudiate the need for occlusal adjustment in the management of TMD, whereas (less experienced) general dentists adhere to a concept focusing on the occlusion in diagnosis and treatment of TMD. There is a consensus that generalized prophylactic occlusal adjustment is not justified. There is an obvious need for research with evidence‐based methods, to be able to answer the many remaining questions in this field.
The temporomandibular opening index (TOI) in patients with closed lock and a control group with no temporomandibular disorders (TMD): an initial study
Authors: Miller V. J. , Karic V. V. , Myers S. L. , Exner H. V.
Published: March 2003

Mandibular movement may be assessed by measuring maximum mouth opening. This is a linear measurement from the maxillary to the mandibular incisal edge and is affected by gender, age and ramus length. It cannot be used to classify patients. The temporomandibular opening index (TOI) appears to be independent of these variables and has been shown to differ for different categories of patients with temporomandibular disorders (TMD). This study examined the TOI in a group of 11 patients with closed lock and a control group of 11 individuals with no signs or symptoms of TMD. The group with closed lock had a significantly different TOI from that of the control group (P<0·001) according to the Mann–Whitney U‐test. This suggests that the TOI may have greater diagnostic value than linear mouth opening.
Relationship of third molar development and root angulation
Authors: Yamaoka M. , Furusawa K. , Hayama H. , Kura T.
Published: March 2003

Angled roots are seen in mandibular third molars, which have a high frequency of incomplete impaction. We examined the relationship between incomplete impaction and angled roots. We enrolled orthopantomographs to determine the prevalence of angled roots in 239 men and 222 women aged 21–35 years with bilateral mandibular third molars. Angled roots were more frequent in subjects in whom the third molars had a different status on each side than in those with the same status on both sides (men: P<0·05; women: P<0·01). The incidence of women with angled roots in those with bilateral incomplete impactions was higher than that in those with bilateral eruption (P<0·01). Angled roots among mandibular third molars are related to environmental factors. Angled roots occur more frequently in women with incomplete impaction than in those with full eruption.
Antibacterial properties of dentin bonding systems, polyacid‐modified composite resins and composite resins
Authors: Karanika‐Kouma A. , Dionysopoulos P. , Koliniotou‐Koubia E. , Kolokotronis A.
Published: March 2003

This study examined the antibacterial activities of the bonding systems Syntac, EBS and Scotchbond 1, the polyacid‐modified composite resins Hytac and Compoglass, and the composite resins Tetric, Z100 and Scalp‐it. They were evaluated using the cariogenic bacteria Streptococcus mutans, Lactobacillus salivarius, Streptococcus sorbinus and Actinomyces viscosusin vitro with a modified cylinder drop plate agar diffusion assay. All adhesives of the dentin bonding systems and the polyacid‐modified composite resins exhibited various degrees of antibacterial activity against all of the test bacteria. On the contrary, composite resins did not affect bacterial growth. The data suggest that the use of these adhesives and polyacid‐modified composite resins may reduce the consequences of microleakage owing to their antibacterial properties.
The relationship between selective sleep deprivation, nocturnal jaw‐muscle activity and pain in healthy men
Authors: Arima T. , Svensson P. , Rasmussen C. , Nielsen K. D. , Drewes A. M. , Arendt‐Nielsen L.
Published: March 2003

The relationship between nocturnal jaw‐muscle activity and temporomandibular disorders (TMD) is still controversial. The aim of this study was to investigate the effect of selective slow wave sleep (SWS = non‐rapid‐eye‐movement (NREM) stage 3 + 4) deprivation on jaw‐muscle activity using a new automatic system. Ten healthy men without signs of symptoms of TMD participated. The subjects slept in the laboratory for six continuous nights including one adjustment night, one baseline night, three nights with experimental sleep deprivation and one recovery night. Polysomnographic recordings of electroencephalography (EEG) and electromyography (EMG) were obtained for recognition of sleep stages and masseter muscle activity. During the three experimental nights, computer‐controlled sound stimulation (60–90 dB(A), 1000 Hz) were given as long as the subjects were in SWS. Maximum voluntary occlusal force (MVOF), pain pressure threshold (PPT) and visual analogue scales (VAS) were used to assess the state of the masseter muscles every morning and evening during the study period. The results showed that the time spent in SWS was significantly decreased during the first sleep deprivation night, but there were no significant effects on nocturnal EMG activity (i.e. the numbers of bruxism episodes per hour of sleep, bruxism bursts per episodes bruxism bursts per hour of sleep), MVOF, VAS or PPT. Furthermore, the automatic system only deprived the SWS in five subjects for the following two nights although the sound stimulation was given at the maximum intensity. These results suggest that deprivation of SWS may not interact immediately with nocturnal jaw‐muscle activity and jaw‐muscle pain.
Etching characteristics of dentin: effect of ferric chloride in citric acid
Authors: Saeki K. , Marshall S. J. , Gansky S. A. , Marshall G. W.
Published: March 2003

Citric acid etchants with ferric chloride (10‐3) promote adhesion and are effective etchants. We used atomic force microscopy (AFM) to determine the dentin etching characteristics of 10% citric acid etchant with various additions of ferric chloride. AFM was used to measure the surface recession and morphology of dentin etching for a variety of 10% citric + Fe‐Cl etchants. Commercial 10‐3 was used as the control. Dentin disks were prepared and partially masked during etching so that the unetched dentin served as a reference. AFM images of the same samples were taken at each of the seven experimental steps using 10% citric acid with various quantities of ferric chloride ranging from 0 to 3% (denoted 10‐0, 10‐1, 10‐1·8 and 10‐3, respectively) which altered the pH from 1·63 to 0·42. Changes in depth (nm) relative to the reference height for intertubular dentin were determined after etching 15 s; clinical air drying, rewet for 1–5 min; desiccation for 24 h; rehydration for 24 h. Differences of log(depth change) were tested with mixed effects cell mean models. Overall differences were significant (P < 0·001). Significant differences were found between etchants and the extent of collapse on drying was dependent on pH and Fe‐Cl content. Following long‐term rehydration, samples recovered, but those with 0 or 1% Fe‐Cl did not recover as completely (P < 0·01). Etching and collapse depended on Fe‐Cl content. The collapse was nearly reversed on rehydration. Ten per cent citric acid with ferric chloride did not prevent the collapse of etched dentin. Ferric chloride additions reduced pH and increased the collapse of dentin on drying for either brief or prolonged periods. Brief rewetting can reverse the effect of brief air drying. For fully desiccated samples the effect was not reversed after 30 s, but was largely or completely reversed at 24 h in solution depending on Fe‐Cl content.
The influence of fibre placement and position on the efficiency of reinforcement of fibre reinforced composite bridgework
Authors: Ellakwa A. E. , Shortall A. C. , Shehata M. K. , Marquis P. M.
Published: March 2003

The effect of placement of ultra‐high molecular weight polyethylene (UHMWPE) fibres on the flexural properties and fracture resistance of a direct dental composite was investigated. The UHMWPE fibres are increasingly being used for the reinforcement of laboratory fabricated resin composite crown and bridgework. The aim of this study was to assess the effect of a commonly used laboratory fabrication variable on the in vitro strength of beam shaped specimen simulating a three‐unit fixed bridge. Four groups (10 specimens per group) of Herculite XRV were prepared for flexural modulus and strength testing after reinforcement with UHMWPE fibres. Two groups of control specimens were prepared without any fibre reinforcement. Half the specimen groups were stored in distilled water and the other groups were stored dry, both at 37 °C for 2 weeks before testing. The results of this study showed that placement of fibre at or slightly away from the tensile side improved the flexural properties of the composite in comparison with the unreinforced control specimen groups whilst the mode of failure differed according to fibre position. Scanning electron microscope (SEM) investigation revealed that placement of the fibre slightly away from the tensile side favoured crack development and propagation within the resin bridging the interfibre spaces in addition to debonding parallel to the direction of fibre placement. Laboratory fabrication variables may effect the strength of fibre reinforced bridgework significantly.
Artificial saliva substitutes and mineral dissolution
Authors: Smith G. , Smith A. J. , Shaw L. , Shaw M. J.
Published: March 2003

The erosive potentials of a number of commercially available artificial saliva substitutes have been investigated using an in vitro hydroxyapatite powder dissolution assay. Most of the saliva substitutes examined did not show any appreciable erosive potential, although one product resulted in greater mineral dissolution levels. There appeared to be little correlation between pH and mineral dissolution levels for the different saliva substitutes examined. Whilst saliva substitutes may be of assistance in maintaining some physiological function in patients with impaired salivary flow, it is important to choose a product with low erosive potential where the natural dentition is present.
Long‐term cytotoxicity of resin‐based dental restorative materials
Authors: Bouillaguet S. , Shaw L. , Gonzalez L. , Wataha J. C. , Krejci I.
Published: March 2003

Highly filled composites, Ormocers (organically modified ceramics) and ‘smart’ materials have been developed to overcome the polymerization shrinkage problems of conventional composite materials. The purpose of the current study was to investigate the effect of longer‐term (up to 8 weeks) ageing of these resin‐based dental restorative materials and determine the effect of post‐curing on cytotoxicity. Twelve discs of each material (Colombus/IDR, Definite/Degussa, Ariston pHc/Vivadent) were either light‐cured (Lc) or light‐cured and post‐cured (Pc). For cytotoxicity testing, the discs were placed in contact with cell culture medium (DMEM) and incubated at 37 °C. Extracts from composite materials were collected after 24 h and weekly over a time period of 8 weeks. Cytotoxicity of the eluates to cultured fibroblasts (Balb/c3T3) were measured by the succinic dehydrogenase (SDH) activity (MTT assay) and the results expressed in percentage of negative controls (Teflon discs). The results showed that ageing significantly influenced the cytotoxicity of the materials. Except for Ariston pHc, materials were less cytotoxic after 8 weeks of ageing than they were in early intervals and post‐curing was not generally useful in reducing cytotoxicity. The Ariston pHc was initially moderately toxic, but then become highly cytotoxic for 5 weeks before returning to initial levels. The current study demonstrated the importance of assessing the cytotoxicity of resin composite materials at multiple times.
Adhesive bonding of composite material to cast titanium with varying surface preparations
Authors: Yanagida H. , Matsumura H. , Taira Y. , Atsuta M. , Shimoe S.
Published: March 2003

The purpose of the present study was to evaluate the surface preparation effects of eight metal conditioners and an adhesive system on bonding between a prosthodontic composite material and cast titanium. Eight primers designed for conditioning base metal alloys (Acryl Bond, All‐Bond 2 Primer B, Alloy Primer, Cesead II Opaque Primer, Eye Sight Opaque Primer, Metafast Bonding Liner, Metal Primer II, and MR Bond) as well as a surface modification technique (Siloc) were assessed. Disk specimens cast from titanium (T‐Alloy H) were either primed with one of the eight primers or treated with the Siloc system, and then bonded with a light‐activated composite material (Artglass). Bond durability was evaluated by thermocycling (4 and 60 °C, 1 min each, 20 000 cycles). After thermocycling, two groups either primed with the Cesead II Opaque Primer material or treated with the Siloc system exhibited significantly greater bond strength (20·0 and 19·0 MPa) than the other groups (0·2–12·6 MPa, P < 0·05). These two systems are considered to be useful for improving bonding between the titanium and the composite material tested.
Five years of aftercare of implant‐retained mandibular overdentures and conventional dentures
Authors: Visser A. , Geertman M. E. , Meijer H. J. A. , Raghoebar G. M. , Kwakman J. M. , Creugers N. H. J. , Van Oort R. P.
Published: March 2003

The purpose of this multicentre randomized clinical trial was to analyse surgical and prosthetic aftercare and clinical implant performance of edentulous patients with implant‐retained mandibular overdentures and of patients with conventional dentures, either or not after pre‐prosthetic vestibuloplasty and deepening of the floor of the mouth. The evaluation period was 5 years. The implant systems evaluated were the IMZ implant system, the Brånemark implant system and the Transmandibular Implant system. The centre in Groningen had five groups (n=149) and the centre in Nijmegen had three groups (n=86). The evaluation comprised of surgical and prosthetic aftercare, together with clinical implant performance (CIP). The highest implant loss (29%) is found in the Transmandibular Implant group. All groups had prosthetic revisions and complications according to the CIP‐scale. The majority of the patients in the endosseous implant groups were subject to minor complications. The CIP‐score of the Transmandibular Implant group is significantly higher than the scores of the other groups, because of the high number of lost posts. In 26˙1% of the patients in this group score 4 is given, which means failure of the implant system. From this study it can be concluded that the endosseous implant systems used in this study have less surgical aftercare and a better clinical implant performance than the Transmandibular Implant system and are therefore the systems of choice for the edentulous mandible.
Wear of three dental composites under different testing conditions
Authors: Hu X. , Shortall A. C. , Marquis P. M.
Published: March 2003

Summary Although a great effort has been made to date with research on in vitro wear simulation testing, it is difficult to identify the relationship between the results of in vitro testing and in vivo observations. An intensive study into wear mechanisms is necessary for wear testing simulation. The objective of this research was to study the wear behaviour of three selected dental composites under different wear conditions to provide a more rational explanation for their wear mechanisms. Two typical wear conditions, two‐ and three‐body wear, were conducted on the composites. The results showed that the wear losses had different rankings between two wear conditions. It is therefore unreliable to predict the clinical performance merely by wear loss ranking from in vitro wear testing. Further analysis on the wear surfaces indicated that three dental composites experienced different wear mechanisms under different wear conditions. It is concluded that in vitro analysis of wear mechanisms may lead to a better understanding of in vivo failure patterns. Similar wear mechanisms should be the premise for any correlation between the results of in vitro and in vivo studies.
Oral perception and oral motor ability in edentulous patients with stroke and Parkinson's disease
Authors: Leung K. C. M. , Pow E. H. N. , McMillan A. S. , Wong M. C. M. , Li L. S. W. , Hi S.‐L.
Published: March 2003

Oral perception and oral motor ability were assessed in edentulous patients with stroke, Parkinson's disease, and an age and gender matched control group. Standard stereognosis and oral motor ability tests were performed, with and without complete dentures in situ. Statistical comparisons were made using ANOVA, Levene's test and paired t‐tests. Stroke patients had significantly poorer stereognostic measures than Parkinson's disease patients and controls (P < 0·02). Stereognostic measures were better in all groups when dentures were worn. There were no differences in oral motor ability between groups. Oral stereognosis was significantly impaired in stroke patients. Oral stereognostic ability was better in all groups when dentures were worn. The oral motor ability test lacked the sensitivity to detect differences in motor ability between experimental groups. Edentulous patients with stroke should be encouraged to wear dentures during the rehabilitation phase as oral stereognosis is then less impaired.
The expression of cyclooxygenase‐2 in human temporomandibular joint samples: an immunohistochemical study
Authors: Yoshida H. , Fukumura Y. , Fujita S. , Nishida M. , Iizuka T.
Published: March 2003

summary  The aim of this investigation was to evaluate the immunohistochemical expression of cyclooxygenase‐2 (COX‐2) in the temporomandibular joint (TMJ) and to compare it with that control specimens. Expression of COX‐2 in the TMJ disc and the synovial membrane in 26 human TMJ samples (internal derangement of TMJ; n=16, and control; n=10) was measured by an immunohistological technique using paraffin‐embedded tissue and specific antihuman COX‐2 polyclonal antibody. There were obvious distinction of COX‐2 immunoreactivity between the control specimens and internal derangement cases, in the region of posterior and/or anterior loose connective tissues. In particular, intensive COX‐2 expression was detected in the synovial membrane of internal derangement cases. The findings of the present study suggest that COX‐2 might be an important mechanism regulating inflammation in the synovial membrane with internal derangement of TMJ.
Interfacial layer characterization in dental composite
Authors: Truffier‐Boutry D. , Place E. , Devaux J. , Leloup G.
Published: March 2003

summary  Nowadays, dental resins find increasing use by practitioners. However, photopolymerization of such resins is limited to a so‐called ‘depth of cure’. To face this problem, dentists superimpose resin layers of limited depth. This technique raises the problem of the quality of interlayer. This paper aims at screening different cases of adhesion at the interface. Shear strength of such interfacial layers is tested in shear mode in various conditions (with or without an oxygen‐inhibited layer, or contaminated by saliva or water). Unexpectedly, the presence of an oxygen‐inhibition on the first layer, as assessed using micro‐Raman spectroscopy, induces higher shear strength. In this case, a cohesive break occurs while an adhesive one is observed in all the other cases.
Influence of working side contacts on masticatory function for mandibular distal extension removable partial dentures
Authors: Sueda S. , Fueki K. , Sato S. , Sato H. , Shiozaki T. , Kato M. , Ohyama T.
Published: March 2003

summary  The aim of this study was to clarify the influence of working side contacts for masticatory function for a distal extension removable partial denture. Five subjects who had edentulous arches from second premolar to second molar opposing natural teeth participated. Working side contacts were altered by using three types of artificial teeth attached to the denture base. A‐form teeth made contact with opposite teeth while acting as the working side in a lateral excursion. The cusp angles of B‐ and C‐form teeth were decreased by 10° and 20°, respectively compared with A‐form teeth. B‐and C‐form teeth discluded with opposite teeth on the working side. Subjects were asked to perform two kinds of masticatory performance test. Obtained data were evaluated by the repeated‐measures anova and the Tukey test for multiple comparisons. Results revealed that there was a significant difference (P=0·001) in the three types of teeth in the mixing ability test and the value of A‐form teeth was statistically less value than those of the other teeth. However, there was no significant difference in the comminuting ability test. These results suggested that working side contacts between artificial teeth and opposite natural teeth influenced mixing ability, but not comminuting ability.
Influence of abrasion in clinical manifestation of human dental erosion
Authors: Amaechi B. T. , Higham S. M. , Edgar W. M.
Published: March 2003

summary  The influence of abrasion from oral soft tissues on softened enamel lesion remineralization and erosion development was investigated. Using orange juice, softened enamel lesions were produced on 20 human premolars assigned randomly to 10 volunteers. Sections used as control and two test slabs were cut from each tooth. One of the two slabs from each tooth had an appliance built on it, which protected the lesion from abrasion. The two slabs (with/without appliance) were bonded to the palatal surfaces of upper right and left lateral incisor teeth of the participants who chewed sugar‐free gum four times daily. After 28‐day intra‐oral exposure, mineral loss (ΔZ) and lesion depth (ld) in both control and test samples were quantified using transverse microradiography, and the data was analysed by paired t‐test. ΔZ was significantly lower in lesions with appliance (protected), but higher in lesions without appliance (unprotected) when compared with control (unexposed). Similar pattern was observed with lesion depth. In unprotected slabs the lesions were abraded resulting in eroded enamel lesions. It was concluded that erosion observed clinically is the combined effect of demineralization of the tooth surface by an erosive agent and abrasion of the demineralized surface by surrounding oral soft tissues and through food mastication. Abrasion from oral soft tissues can contribute to site‐specificity of dental erosion.
Therapeutic communication strategies used by Hong Kong mental health nurses with their Chinese clients
Authors: Arthur  , Chan  , Fung  , Wong  , Yeung
Published: March 2003

Therapeutic communication is central to mental health nursing and through this process nurse‐client relationships can be enhanced. In Hong Kong, mental health nurses are educated in ‘western’ theories and strategies in using therapeutic communication and the field of communication is predominantly Eurocentric. However, the majority of people in Hong Kong are Chinese and little research has been conducted into how Hong Kong nurses communicate with their Chinese clients.

This qualitative study focused on identifying the therapeutic communication strategies used by mental health nurses with Chinese clients in Hong Kong. Three case study vignettes with some of the characteristics of Chinese culture were developed to elicit information about the strategies that respondents used in therapeutic communication. The purposive sample of 20 comprised 10 admission ward nurses and 10 community nurses from two psychiatric hospitals. All participants had at least five years post­registration experience.

Content analysis revealed categories of communication and theme clusters for the nurses’ response to the vignettes. The result showed a unique cultural influence emerged in communication patterns. In view of the scant nature of existing literature and studies in this area, this research provided some valuable data for further studies. Implications for mental health nursing education and practice in Hong Kong are raised, as are implications for nurses working in multicultural countries such as Australia, the UK and the USA, where there are significant numbers of Chinese clients who would benefit from nurses practising with a deeper understanding of communication strategies which are culturally bound.
Service user involvement in care planning: the mental health nurse's perspective
Authors: Anthony P. , Crawford P.
Published: March 2003

A dissonance between espoused values of consumerism within mental health care and the ‘reality’ of clinical practice has been firmly established in the literature, not least in terms of service user involvement in care planning. In order to begin to minimize such dissonance, it is vital that mental health nurse perceptions of service user involvement in the core activity of care planning are better understood. The main findings of this qualitative study, which uses semistructured interviews, suggest that mental health nurses value the concept of user involvement but consider it to be problematic in certain circumstances. The study reveals that nurses hold similar views about the ‘meaning’ of patient involvement in care planning but limited resources, individual patient characteristics and limitations in nursing care are the main inhibiting factors. Factors perceived as promoting and increasing user involvement included: provision of accurate information, ‘user‐friendly’ documentation, mechanisms for gaining service user feedback, and high staff morale.
Peers and partners: working together to strengthen preceptorship in mental health nursing
Authors: Allen C. , Simpson A.
Published: March 2003

The Sussex Education Consortium commissioned a development project to identify the education and training needs of community mental health nurses (CMHNs). The project also afforded an opportunity to examine the CMHNs' perception of their role of preceptor with pre‐registration diploma nursing (PRDN) students following the mental health branch. Utilizing a ‘responsive evaluation’ methodology, stakeholders' views were captured. As a consequence of the issues and concerns raised, the Consortium commissioned a second project, following a similar methodology, to explore preceptorship in greater depth. This paper reports stakeholders' views on preceptorship arrangements expressed in semi‐structured interviews, focused group discussions and other fora during the two projects. Preceptor preparation and support arrangements did not meet the needs of preceptors. Many preceptors felt their role was neither valued nor acknowledged. The link lecturer role was perceived as important by preceptors; but lecturers were often unable to meet the expectations placed upon them. The volume of students and allocation arrangements caused problems for placement areas. Finding time to carry out the roles of the preceptor was a challenge for practitioners. Recommendations for improving preceptorship are discussed and developments described, illustrating how locally commissioned research may influence both education and practice in mental health nursing.
Long‐term illness and patterns of medicine taking: are people with schizophrenia a unique group?
Authors: Marland G. R. , Cash K.
Published: March 2003

Patients with schizophrenia relapse because of inadequate levels of medicine taking. Therefore, it seems logical to learn about the factors underpinning their medicine‐taking decisions. Further research is urgently needed to explore this area and thereby to refine models of practice, to promote therapeutic interactions with medicine. Existing research tends to share three common deficits.

It is grounded in the worldview of the psychiatrist not the patient.

It studies the influence of symptoms on compliance behaviour in isolation from other potential variables.

It overlooks the potential influence of the chronicity experience in general by examining schizophrenia outwith the context of other enduring illnesses.

Overall these deficits may combine to distort the influence of schizophrenic symptoms on medicine decision making and justify a coercive rather than an empowering approach. A pernicious self‐fulfilling spiral may be contributing to the problem of relapse in schizophrenia. Potentially the mental health nurse has a role in addressing this problem.
Implementing research findings into practice: improving and developing services for women with serious and enduring mental health problems
Authors: Owen S. , Milburn C.
Published: March 2003

This paper discusses the process that is currently being undertaken to improve and develop services for women with serious and enduring mental health problems in one specialist psychiatric service. The paper begins by highlighting the particular service needs of this group of women. The process of translating the research evidence into practice is then explored by highlighting the comprehensive preparatory work that was required, how a women’s special interest group was established, the choice of a model to guide change and development, and a review of progress to date. The paper concludes by arguing that one of the means of maintaining the current momentum for change will be the celebration and acknowledgement of success.
Using primary care‐based mental health registers to reduce social exclusion in patients with severe mental illness
Authors: Bonner L. , Barr W. , Hoskins A.
Published: March 2003

Reducing social exclusion and improving mental health are key themes within the government's modernization programme. Despite this, little is known about the social exclusion experienced by people with severe and enduring mental illness living in specific communities, apart from their over‐representation amongst various socially excluded groups. This paper describes a 3‐year research study that focused on the impact of introducing mental health registers into general practices in an English health district. The registers were expected to facilitate improvements in linking patients with appropriate services and so improve the healthcare they received. The overall result should have been reductions in the levels of social exclusion experienced by these patients; however, findings revealed a lack of change in unmet needs and quality of life, even amongst those in contact with a community mental health nurse.
Mental health nursing and the promotion of physical activity
Authors: FAULKNER G. , BIDDLE S.
Published: March 2003

Evidence and recent policy initiatives support the promotion of physical activity and exercise within acute inpatient settings. Mental health nurses may perform an important role in encouraging physical activity and legitimizing its incorporation within care planning. This exploratory study aimed to investigate perceptions of the role of exercise and physical activity as a therapeutic strategy within inpatient settings. Given the exploratory nature of the study, a qualitative design using semistructured interviews was considered most appropriate. As part of a larger study regarding the promotion of physical activity within one United Kingdom (UK) Mental Health Trust, 12 mental health nurses were interviewed. All participants identified a need for increasing opportunities for physical activity on inpatient wards. Three interrelated themes emerged that related to how physical activity and exercise was conceptualized by the participants. First, exercise and physical activity was seen as a potentially beneficial distracting strategy rather than an adjunctive strategy in its own right. Secondly, exercise was considered as a lifestyle choice and an individual responsibility. Thirdly, a difficulty in articulating a possible relationship between the ‘physical’ and the ‘mental’ was predominant. The implications of these perceptions are discussed in relation to developing a greater profile for physical activity and exercise on acute wards.
Swedish forensic nursing care: nurses’ professional contributions and educational needs
Authors: Rask Mikael , Aberg Jonas
Published: March 2003

Nurses (registered nurses, RN, and licensed mental nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data regarding how nursing care could contribute to improved care and the organizational changes needed and what knowledge the nurses need, in order to be able to meet the demands in the future, were analysed by means of content analysis. The salient findings were: (i) an interpersonal patient–nurse relationship based on trust, empathy, respect and responsibility for the patients’ personal resources and knowledge seems to be the essence of nursing care and a way to improve care; and (ii) the nurses’ educational needs emanate from different treatment modalities, how to perform different treatments, how to establish developing relationships and in‐service training adapted to the ward‐specific problems.
From information to knowledge: the meaning of information‐giving to patients who had experienced first‐episode psychosis
Authors: KILKKU N. , MUNNUKKA T. , LEHTINEN K.
Published: March 2003

The reform of mental health services in Finland signifies that besides the structural development of services, the development of new approaches in care is needed. Besides the other elements, information‐giving has an important role when supporting outpatients’ and their caregivers’ everyday lives. The aim of this study was to describe how patients with first‐episode psychosis experienced the information‐giving and the meaning of these experiences to these patients. The study was conducted by interviewing seven patients participating in the development of the combined model of psycho‐education and need‐adapted models. The data were gathered by open‐ended questions and analysed within the phenomenological tradition, focusing on the understanding of the patient's experiences. The results show that patients’ own understanding and acceptance of the psychotic experience affected their experiences of information‐giving as well as the way their experiences were met during their care. The meaning of information was experienced with feelings of worthlessness, relief, confusion or confidence and coping. The results of this study address the importance of recognizing, hearing and appreciating patients’ own experiences. Information‐giving should be based on the patients’ own experiences, appreciating them. With the information integrated into patients’ own experiences they can be helped to turn to the future after the psychotic experience.
Staff morale in the merger of mental health and social care organizations in England
Authors: GULLIVER P. , TOWELL D. , PECK E.
Published: March 2003

Following the closure of the last Victorian asylum in Somerset, the health authority and county council undertook a review of mental health services. A major outcome of this review was the creation of an integrated mental health and social care provider. The current paper explores the impact of this integration on the morale of staff members involved, using a conceptual model derived from the literature on organizational behaviour. During the year immediately following integration, the average ratings on all measures of role clarity and job satisfaction reduced. For staff members involved in the integration, by far the largest group of whom were mental health nurses, job satisfaction was related to team role clarity, team identification, emotional exhaustion and gender. These effects of the integration on staff morale are discussed in light of the wider research into the determinants of job satisfaction and the conditions for success in merging organizations. The study has significant implications for managerial and professional leadership during organizational change.
Segregation of HLA genes in multicase narcolepsy families
Authors: MAYER G , LATTERMANN A , MUELLER‐ECKHARDT G , SVANBORG E , MEIER‐EWERT K
Published: March 2003

In the past 15 years, 411 sporadic narcolepsy patients have been diagnosed in the Hephata Klinik, Schwalmstadt, Germany. They were explored for presence or absence of excessive daytime sleepiness and narcolepsy in their relatives. A subset of 39 patients were explored for presence or absence of parasomnias. Six patients had more than one relative affected by narcolepsy‐cataplexy. Forty‐seven family members were investigated with the Stanford Center for Narcolepsy Sleep Inventory and a standardized parasomnia questionnaire. Twenty‐four relatives had nocturnal polysomnographies and Multiple Sleep Latency Tests. HLA class I typing was performed in all sporadic and familial cases, class II and microsatellite typing was performed in all members of multicase families. Based on the Finnish prevalence study by Hublin et al., 1994, the relative risk for first degree relatives to develop narcolepsy‐cataplexy was in our sample 16.5, 34.2 for excessive daytime sleepiness and 426.9 for parasomnias. Cataplexy, excessive daytime sleepiness and single narcoleptic symptoms in the multicase families segregate with the DRB1*1501, CARII:200, CARI:103, DQB1*0602 haplotype. In two families, members with narcolepsy and isolated symptoms have inherited the DRB1*1501/DQB1*0602 haplotype from the non‐affected parent. The observed segregations in these two families may support the view that narcoleptic symptoms are expressed by DRB1*1501/DQB1*0602 carriers, independent of haplotype origin. Parasomnias do not segregate with a specific haplotype. The frequency of parasomnias in narcolepsy is much higher than in the general population. The empirical risk for first degree family members of narcolepsy patients to develop cataplexy seems to be low, whereas it is higher for EDS and highest for parasomnias.
Insomnia in an 80‐year‐old population: Relationship to medical, psychological and social factors
Authors: JENSEN ELMO , DEHLIN O. , HAGBERG B. , SAMUELSSON G. , SVENSSON T.
Published: March 2003

In this study, insomnia in 80‐year‐olds was related to medical, psychological and social factors. The data were based on examinations every year in people aged between 80 and 89 years. Of 333 people living in the city of Lund and born in 1908, 67% participated. Increased severity of insomnia was significantly associated with use of diuretics, other cardiovascular drugs, hypnotics and laxatives, and with nervousness, difficulty relaxing, anorexia, nausea, constipation, backache, feeling cold, sweating, loss of weight, dizziness, depression, general fatigue, exhaustion, angina pectoris, cardiac insufficiency, worsened objective and subjective health, presence of negative T‐waves on ECG, anxiety, total life satisfaction, neuroticism, disbelief in a just world, feeling lonely and lower survival rates. Thus insomnia has widespread associations with different aspects of life in 80‐year‐olds.
Obstructive sleep apnoea syndrome in hereditarygelsolin‐related amyloidosis
Authors: Kiuru Sari , Nieminen Tuula , Partinen Markku
Published: March 2003

Gelsolin‐related amyloidosis (AGel amyloidosis) is a rare autosomal dominant disorder, reported worldwide in kindreds carrying a G654A or G654T gelsolin gene mutation. The main clinical signs are cutis laxa, cranial and peripheral neuropathy, and corneal lattice dystrophy but heavy intermittent snoring also occurs. To evaluate whether sleep apnoea is present we performed nocturnal sleep recordings, cephalometric and spirometric analyses and multiple sleep latency tests (MSLT) in five snoring patients with a G654A gelsolin gene mutation. Four patients had obstructive sleep apnoea syndrome (OSAS) with redundant oropharyngeal and hypopharyngeal soft tissues, macroglossia and cranial neuromuscular dysfunction. The fifth patient had hypersomnia without obstructive sleep apnoea. Nasal continuous positive airway pressure (CPAP) was an effective treatment. This study presents the first evidence in favour of an association between AGel amyloidosis and OSAS, but further studies are needed to define the prevalence of OSAS and the pathogenetic roles of amyloid and variant gelsolin in its evolution.
Reversal of the sleep/wake cycle disorder of sleeping sickness after trypanosomicide treatment
Authors: Buguet Alain , Tapie Philippe , Bert Jacques
Published: March 2003

To determine whether the circadian disruption of the sleep/wake cycle observed in sleeping sickness, human African trypanosomiasis (HAT), can be reversed after trypanosomicide treatment, 10 Congolese patients infected by Trypanosoma brucei gambiense underwent 24‐h polysomnographic recordings before treatment with melarsoprol and after each of three weekly treatment sessions. Polysomnography consisted of a continuous recording of the electroencephalogram, electromyogram and electro‐oculogram on a Minidix Alvar polygraph. Sleep traces were analysed in 20‐sec epochs for wakefulness, REM sleep, and NREM sleep [stages 1, 2, 3, 4; stages 3 and 4 representing slow‐wave sleep (SWS)]. As previously described (Buguet et al. 1993), the 24‐h distribution of the sleep/wake cycle was disturbed proportionally to the severity of the illness. The overall amounts of each sleep/wake stage did not change after treatment. However, the patterns of occurrence of sleep episodes, REM sleep and SWS phases were determinant in the evaluation of treatment efficacy. The trypanosomicide action of melarsoprol led to a reduction in the number of sleep episodes, except in one patient whose health condition worsened during the third treatment session: sleep onset REM sleep phases (SOREMPs) decreased and the number of SWS episodes during a sleep episode increased. We conclude that in HAT, the reversibility of the sleep/wake cycle alteration and that of sleep structure constitute the basis for an evaluation of the healing process.
Scalp topography of the auditory evoked K‐complex in stage 2 and slow wave sleep
Authors: Cote Kimberly A. , De Lugt Duncan R. , Langley Susan D. , Campbell Kenneth B.
Published: March 2003

During NREM sleep a very large amplitude wave‐form, known as the K‐complex, may be elicited upon presentation of an external stimulus. The present study compared the scalp distribution of a prominent negative wave peaking at about 550 ms and a later positive wave peaking between 900 and 1300 ms in stage 2 and slow wave sleep (SWS). Nine subjects spent a single night in the laboratory. They were presented with an 80 dB SPL 2000 Hz auditory tone pip every 15 s. The EEG was recorded from 29 electrode sites and referenced to the nose. A K‐complex was elicited on 34% of trials in stage 2 and on 46% of trials in SWS. A negative wave peaking at 330 ms was larger on trials in which the K‐complex was elicited than on trials in which it was not. The large amplitude N550 was readily observable on trials in which the K‐complex was elicited but could not be observed on trials in which it was not. The N550 was bilaterally symmetrical and was maximum over fronto–central areas of the scalp in both stage 2 and SWS. It inverted in polarity at the mastoid and inferior parietal regions. The scalp distribution of N550 significantly differed between stage 2 and SWS. It showed a sharper decline in amplitude over parietal and posterior–inferior areas of the scalp in stage 2 compared to SWS. A later P900 was maximum over centro–frontal areas of the scalp and was also bilaterally symmetrical. It showed a significantly sharper decline in amplitude over widespread inferior areas during SWS. Because the scalp maps of the N550 and P900 are different in stage 2 and SWS, their intracranial sources must also be different.
Zolpidem and sleep deprivation: Different effect on EEG power spectra
Authors: Landolt Hans‐Peter , Finelli Luca A. , Roth Corinne , Buck Alfred , Achermann Peter , Borbély Alexander A.
Published: March 2003

To study the role of GABA‐ergic mechanisms in sleep regulation, the combined action of 40 h sleep deprivation and either 20 mg zolpidem or placebo on the sleep electroencephalogram (EEG) were investigated by quantitative EEG analysis in eight young men who participated in a positron emission tomography study. Compared with baseline, sleep deprivation increased low‐frequency (1.25–7.0 Hz) EEG power in non‐rapid eye movement (NREM) sleep in the placebo night. After administration of zolpidem, power in the 3.75–10.0 Hz range and 14.25–16.0 Hz band was reduced. The largest decrease was observed in the theta band. Comparison with placebo revealed that zolpidem attenuated power in the entire 1.75–11.0 Hz range. The plasma concentration of zolpidem at 4.5 h after intake showed a positive correlation with the drug‐induced difference in power from placebo in the 14.25–16.0 Hz band. Regional EEG analysis based on bipolar derivations along the antero‐posterior axis disclosed, for NREM sleep, a drug‐induced posterior shift of power in the frequency range of 7.75–9.75 Hz. Zolpidem did not affect rapid eye movemnt sleep spectra. We conclude that sleep deprivation and agonistic modulation of GABAA receptors have separate and additive effects on power spectra and that their effects are mediated by different neurophysiological mechanisms.
Daytime sleepiness in Parkinson’s disease
Authors: Rye David B. , Bliwise Donald L. , Dihenia Bhupesh , Gurecki Paul
Published: March 2003

We describe multiple sleep latency test (MSLT) results in 27 adult patients with idiopathic Parkinson’s disease (PD). Pathological sleepiness (i.e. mean sleep latency ≤5 min) was common (40 of 134 nap opportunities), and sleep‐onset REM periods were also observed (13 of 134 nap opportunities). These findings bore little relationship to disease specific variables (e.g. level of disability, medication use), or sleep architecture measures (e.g. total sleep time, sleep stage percentage’s). Our findings speak against a simple association of excessive sleepiness and the quality and quantity of prior night’s sleep, but rather, argue for primary impairments of waking arousal and REM‐sleep expression in a sizeable subpopulation of PD patients.