bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping with hospital‐related fears: experiences of pre‐school‐aged children
Authors: Salmela Marja , Salanterä Sanna , Aronen Eeva T.
Published: April 2010

salmela m., salanterä s. & aronen e.t. (2010) Coping with hospital‐related fears: experiences of pre‐school‐aged children. Journal of Advanced Nursing 66(6), 1222–1231.

Title.  Coping with hospital‐related fears: experiences of pre‐school‐aged children.

Aim.  This paper is a report of a study of how 4‐ to 6‐year‐old children cope with their fears associated with hospitalization and how they explain their experiences.

Background.  Pre‐school‐aged children are particularly vulnerable to the effects of stress and fear during hospitalization. Children cope with their fears through problem‐oriented, emotion‐oriented, and function‐oriented coping strategies. Even pre‐school‐aged children can express their emotions and expectations quite well orally. However, little is known about the coping strategies of 4‐ to 6‐year‐old children related to hospital fears and the meaning of coping for children.

Method.  A qualitative method was chosen using a purposive sample of 89 children. The data were gathered using semi‐structured interviews from 2004 to 2006. The data were analysed using Colaizzi’s method for phenomenological analysis.

Findings.  The children’s experiences of coping with hospital fears consisted of ten main clusters: pleasure, positive images, security, confidence, care, understanding the meaning of the situation, participating, asking for help, readjustment and protecting oneself. The coping strategies during hospitalization described by the children were familiar to them and part of their everyday lives.

Conclusion.  It is important to observe and support the child’s individual coping strategies. Pre‐school‐aged children need information and guidance to orientate themselves in unknown situations and to participate in decisions concerning their everyday life. Most of all, they need opportunities to play and experience pleasure. Children can also be taught coping strategies that give them an active, positive role.
Nursing care of prisoners: staff views and experiences
Authors: Powell Jane , Harris Francesca , Condon Louise , Kemple Terry
Published: April 2010

powell j., harris f., condon l. & kemple t. (2010) Nursing care of prisoners: staff views and experiences. Journal of Advanced Nursing 66(6), 1257–1265.

Title.  Nursing care of prisoners: staff views and experiences.

Aim.  This paper is a report of a study of the views and experiences of nurses and other prison healthcare staff about their roles and the nursing care they provide to prisoners.

Background.  Nurses have become the key providers of healthcare in prison settings in England, replacing the previous prison service‐run system. However, there is very little evidence about the health services they provide to meet the health needs of prisoners.

Method.  A ethnographic study was conducted. Participants were 80 healthcare staff working in 12 prisons of all security categories in England. Twelve individual interviews with general healthcare managers and 12 key informant focus group discussions with healthcare staff were undertaken in 2005 using a semi‐structured interview schedule. Issues investigated included participants’ thoughts and experiences of nursing roles and delivery of primary healthcare. The group discussions and interviews were analysed to identify emerging themes.

Findings.  Participants gave accounts of day‐to‐day processes and the healthcare routine. They saw their work as identifying and meeting the health needs of prisoners and maintaining their health, and identified major influences that shaped their daily work, including new ways of working in primary care. They identified how policy and organizational changes were affecting their roles, and acknowledged the conflict between the custody regime and healthcare delivery.

Conclusion.  The move towards a NHS‐led primary healthcare service within prisons, predominantly delivered by nurses, has made positive changes to healthcare. Healthcare managers have benefited from the involvement of the local NHS in improving the health of prisoners.
Dental hygiene education for nursing staff in a nursing home for older people
Authors: Kullberg Erika , Sjögren Petteri , Forsell Marianne , Hoogstraate Janet , Herbst Bertil , Johansson Olle
Published: April 2010

kullberg e., sjögren p., forsell m., hoogstraate j., herbst b. & johansson o. (2010) Dental hygiene education for nursing staff in a nursing home for older people. Journal of Advanced Nursing 66(6), 1273–1279.

Title.  Dental hygiene education for nursing staff in a nursing home for older people.

Aim.  This paper is a report of a study evaluating the effect of a repeated education programme for nursing staff in a home for older people.

Background.  A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. Thus, nursing staff need to be educated in oral hygiene measures.

Methods.  Forty‐three nursing home resident older people (12 men, 31 women, age range 69–99 years) were included in a dental hygiene and gingivitis evaluation using gingival bleeding scores and modified plaque scores. Evaluation was conducted before and 3 weeks after a repeated dental hygiene education for nursing staff at a nursing home in Sweden in 2008. Dental hygiene education had been given 1·5 years previously.

Findings.  Forty‐one residents (12 men and 29 women) were available for evaluation after the repeated dental hygiene education (one died, one had had teeth extracted). There was a reduction in gingival bleeding scores (P < 0·001), and in plaque scores (P < 0·001).

Conclusion.  Repeated dental hygiene education improves the dental hygiene among nursing home resident older people. In order to succeed it may be necessary to address attitudes and perceptions towards oral care in such a dental hygiene education programme for nursing staff. Improved oral hygiene contributes to reducing the incidence of healthcare‐associated pneumonia among nursing home resident older people, and thus to reduced healthcare costs.
Curriculum infusion to promote nursing student well‐being
Authors: Yearwood Edilma , Riley Joan B.
Published: April 2010

yearwood e. & riley j.b. (2010) Curriculum infusion to promote nursing student well‐being. Journal of Advanced Nursing 66(6), 1356–1364.

Title.  Curriculum infusion to promote nursing student well‐being.

Aim.  This paper is a report of a study of baccalaureate nursing students’ experiences with curriculum infusion of college health issues into academic courses and students’ well‐being.

Background.  Bringing Theory to Practice is an ongoing project at a number of colleges in the United States of America. Its goal is to use the academic classroom and campus community to engage students actively in self‐reflection on a variety of common college student health and well‐being issues.

Method.  This qualitative study was based on 159 students’ experiences with curriculum infusion in two undergraduate nursing courses at a university in the United States of America over a 2‐year period from 2006 to 2008. Student reflection papers, photo‐essays, narrative course evaluations, classroom engagement with educators and peers and student use of campus health resources were the data examined.

Findings.  As a result of the integration of personal wellness concepts into classroom pedagogy, students experienced a variety of feelings and needs including isolation, shock and anger, taking time, awareness and valuing.

Conclusion.  In light of the increasing rigour of baccalaureate nursing programmes, it is important for educators to be aware of the health‐related effects of stress and isolation on students. By increasing student self‐awareness and changing relational dynamics in the classroom, student well‐being can be supported.
Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost‐effective patient safety intervention?
Authors: Van den Heede Koen , Simoens Steven , Diya Luwis , Lesaffre Emmanuel , Vleugels Arthur , Sermeus Walter
Published: April 2010

van den heede k., simoens s., diya l., lesaffre e., vleugels a. & sermeus w.(2010) Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost‐effective patient safety intervention?Journal of Advanced Nursing 66(6), 1291–1296.

Title. Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost‐effective patient safety intervention?.

Aim. This paper is a report of a cost‐effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units.

Background. A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates.

Method. Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a ‘do nothing’ alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life‐year gained. The analysis used 2007 costing data.

Findings. The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to €1,211,022. Such nurse staffing levels would avoid an estimated number of 45·9 (95% confidence interval: 22·0–69·4) patient deaths per year and generate 458·86 (95% confidence interval: 219·93–693·79) life‐years gained annually. This corresponds with incremental cost‐effectiveness ratios of €26,372 per avoided death and €2639 per life‐year gained.

Conclusion. Increasing nurse staffing levels appears to be a cost‐effective intervention as compared with other cardiovascular interventions.
Unified Parkinson’s Disease Rating Scale‐Motor Exam: inter‐rater reliability of advanced practice nurse and neurologist assessments
Authors: Palmer Janice L. , Coats Mary A. , Roe Catherine M. , Hanko Shelly M. , Xiong Chengjie , Morris John C.
Published: April 2010

palmer j.l., coats m.a., roe c.m., hanko s.m., xiong c. & morris j.c. (2010) Unified Parkinson’s Disease Rating Scale‐Motor Exam: inter‐rater reliability of advanced practice nurse and neurologist assessments. Journal of Advanced Nursing 66(6), 1382–1387.

Title.  Unified Parkinson’s Disease Rating Scale‐Motor Exam: inter‐rater reliability of advanced practice nurse and neurologist assessments.

Aim.  This paper is a report of a study to establish the inter‐rater reliability of advanced practice nurse and neurologist neurological assessments which included ratings with the Unified Parkinson’s Disease Rating Scale‐Motor Exam.

Background.  Around the world, advanced practice nurses are performing tasks once completed only by physicians. To promote consumer and provider confidence, it is important to establish that nurse and physician ratings using assessment tools are similar. In addition in research settings, when different raters are used, establishment of inter‐rater reliability for study assessments is needed.

Method.  Advanced practice nurses and neurologists independently recorded findings on neurological examinations of 46 participants in a study conducted between August 2007 and January 2008. An intraclass correlation coefficient was calculated to estimate overall agreement between the nurse and neurologist ratings. Agreement for individual items measured on a dichotomous scale was assessed by calculating Cohen’s kappa.

Results.  There was substantial agreement between advanced practice nurses and neurologists on the mean Unified Parkinson’s Disease Rating Scale‐Motor Exam ratings (intraclass correlation coefficient = 0·65) and the U.S. National Alzheimer’s Coordinating Center Uniform Data Set neurological examination ratings of unremarkable findings (kappa = 0·74) and of gait disorder (kappa = 0·73). Moderate agreement (kappa = 0·53) was reached for the rating of whether all Unified Parkinson’s Disease Rating Scale‐Motor Exam items were normal.

Conclusion.  These findings are consistent with studies of the inter‐rater agreement of the Unified Parkinson’s Disease Rating Scale‐Motor Exam and support the conduct of neurological assessments by advanced practice nurses.
Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice
Authors: Apekey Tanefa A. , McSorley Gerry , Tilling Michelle , Siriwardena A. Niroshan
Published: April 2010

Background  Leadership and innovation are currently seen as essential elements for the development and maintenance of high‐quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice.

Method  Self‐administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12‐item scale to assess leadership behaviour, a seven‐dimension self‐rating scale for culture of innovation and questions on current use of quality improvement tools and techniques.

Results  Sixty‐three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices.

Conclusions  Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate.
Current treatment of chronic heart failure in primary care; still room for improvement
Authors: Bosch Marije , Wensing Michel , Bakx J. Carel , Van Der Weijden Trudy , Hoes Arno W. , Grol Richard P.T.M.
Published: April 2010

Rational and aims  In recent years, guidelines for treatment of patients with chronic heart failure (CHF) have been updated. Insight in current pharmacological and non‐pharmacological treatment of CHF in primary care, which was non‐optimal in earlier studies, is limited. We aim to describe current pharmacological and non‐pharmacological treatment of CHF in primary care.

Methods  In this cross‐sectional observational study, we included a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined medical record data with data from patient and doctor questionnaires.

Results  Mean age of patients was 75.7 years (SD 10.2), 53% were male, and 73% of patients had mild heart failure (New York Heart Association class I or II). 76.5% of patients received diuretics. Angiotensin‐converting enzyme inhibitors were prescribed in 40.6% and angiotensin‐II receptor blockers in 20.7%; β‐blockers were prescribed to 54.6%, while 24.9% received spironolactone. Patients with more severe heart failure had a lower probability of being treated according to guideline recommendations. Relevant lifestyle advice was given to 40–60% of the patients, depending on the specific lifestyle advice.

Conclusions  Implementation of evidence‐based pharmacotherapy for heart failure in primary care has improved since clinical guidelines have been updated; especially with respect to prescription of β‐blockers. However, there still seems ample room for improvement, as in the case for providing lifestyle advice.
Confined displacement algorithm determines true and random colocalization in fluorescence microscopy
Authors: RAMÍREZ O. , GARCÍA A. , ROJAS R. , COUVE A. , HÄRTEL S.
Published: April 2010

The quantification of colocalizing signals in multichannel fluorescence microscopy images depends on the reliable segmentation of corresponding regions of interest, on the selection of appropriate colocalization coefficients, and on a robust statistical criterion to discriminate true from random colocalization. Here, we introduce a confined displacement algorithm based on image correlation spectroscopy in combination with Manders colocalization coefficients M1ROI and M2ROI to quantify true and random colocalization of a given florescence pattern. We show that existing algorithms based on block scrambling exaggerate the randomization of fluorescent patterns with resulting inappropriately narrow probability density functions and false significance of true colocalization in terms of p values. We further confine our approach to subcellular compartments and show that true and random colocalization can be analysed for model dendrites and for GABAB receptor subunits GABABR1/2 in cultured hippocampal neurons. Together, we demonstrate that the confined displacement algorithm detects true colocalization of specific fluorescence patterns down to subcellular levels.
A Tale of Two Rhythms: The Emerging Roles of Oxytocin in Rhythmic Prolactin Release
Authors: Bertram R. , Helena C. V. , Gonzalez‐Iglesias A. E. , Tabak J. , Freeman M. E.
Published: April 2010

Hormone secretion often occurs in a pulsatile manner. In this review, we discuss two rhythms of in vivo prolactin release in female rats and the ongoing research that we and others have performed aiming to understand the mechanisms underlying them. The peptide hormone oxytocin appears to play an important role in both rhythms. One rhythm occurs during the first half of pregnancy, but can also be induced in ovariectomised rats. This is characterised by a circadian pattern with two prolactin surges per day. Two methods for triggering this rhythm are discussed, each utilising a unique physiological pathway that includes oxytocin action, presumably on pituitary lactotrophs. The second rhythm occurs during the oestrous cycle and is characterised by a surge of prolactin on the afternoon of pro‐oestrus. We discuss recent findings that oxytocin is more effective at stimulating prolactin release from lactotrophs taken from animals on the afternoon of pro‐oestrus than from those of animals on the morning of dioestrus 1, raising the possibility that this hormone plays a physiological role in the regulation of prolactin secretion during the oestrous cycle.
Transcriptomes of the desiccation‐tolerant resurrection plant Craterostigma plantagineum
Authors: Rodriguez Maria C. Suarez , Edsgärd Daniel , Hussain Syed S. , Alquezar David , Rasmussen Morten , Gilbert Thomas , Nielsen Bjørn H. , Bartels Dorothea , Mundy John
Published: April 2010

Studies of the resurrection plant Craterostigma plantagineum have revealed some of the mechanisms which these desiccation‐tolerant plants use to survive environments with extreme dehydration and restricted seasonal water. Most resurrection plants are polyploid with large genomes, which has hindered efforts to obtain whole genome sequences and perform mutational analysis. However, the application of deep sequencing technologies to transcriptomics now permits large‐scale analyses of gene expression patterns despite the lack of a reference genome. Here we use pyro‐sequencing to characterize the transcriptomes of C. plantagineum leaves at four stages of dehydration and rehydration. This reveals that genes involved in several pathways, such as those required for vitamin K and thiamin biosynthesis, are tightly regulated at the level of gene expression. Our analysis also provides a comprehensive picture of the array of cellular responses controlled by gene expression that allow resurrection plants to survive desiccation.
Outcome assessment of decentralization of antiretroviral therapy provision in a rural district of Malawi using an integrated primary care model
Authors: Chan Adrienne K. , Mateyu Gabriel , Jahn Andreas , Schouten Erik , Arora Paul , Mlotha William , Kambanji Marion , van Lettow Monique
Published: April 2010

Objective  To assess the effect of decentralization (DC) of antiretroviral therapy (ART) provision in a rural district of Malawi using an integrated primary care model.

Methods  Between October 2004 and December 2008, 8093 patients (63% women) were registered for ART. Of these, 3440 (43%) were decentralized to health centres for follow‐up ART care. We applied multivariate regression analysis that adjusted for sex, age, clinical stage at initiation, type of regimen, presence of side effects because of ART, and duration of treatment and follow‐up at site of analysis.

Results  Patients managed at health centres had lower mortality [adjusted OR 0.19 (95% C.I. 0.15–0.25)] and lower loss to follow‐up (defaulted from treatment) [adjusted OR 0.48 (95% C.I. 0.40–0.58)]. During the first 10 months of follow‐up, those decentralized to health centres were approximately 60% less likely to default than those not decentralized; and after 10 months of follow‐up, 40% less likely to default. DC was significantly associated with a reduced risk of death from 0 to 25 months of follow‐up. The lower mortality may be explained by the selection of stable patients for DC, and the mentorship and supportive supervision of lower cadre health workers to identify and refer complicated cases.

Conclusion  Decentralization of follow‐up ART care to rural health facilities, using an integrated primary care model, appears a safe and effective way to rapidly scale‐up ART and improves both geographical equity in access to HIV‐related services and adherence to ART.
Tracking a sample of patients lost to follow‐up has a major impact on understanding determinants of survival in HIV‐infected patients on antiretroviral therapy in Africa
Authors: Geng Elvin H. , Glidden David V. , Emenyonu Nneka , Musinguzi Nicolas , Bwana Mwebwesa Bosco , Neilands Torsten B. , Muyindike Winnie , Yiannoutsos Constantin T. , Deeks Steven G. , Bangsberg David R. , Martin Jeffrey N.
Published: April 2010

Objective  To date, data regarding the determinants of mortality in HIV‐infected patients starting antiretroviral therapy (ART) in Africa have been primarily derived from routine clinical care settings practicing the public health approach. Losses to follow‐up, however, are high in these settings and may lead to bias in understanding the determinants of mortality.

Methods  We evaluated HIV‐infected adults initiating ART between January 1, 2004 and September 30th, 2007 in an ART clinic in southwestern Uganda. Clinical and demographic characteristics were obtained through routine clinical care. In evaluating determinants of mortality, a ‘naïve’ analysis used only deaths known through routine processes. A ‘sample‐corrected’ approach incorporated, through probability weights, outcomes from a representative sample of patients lost to follow‐up whose vital status was ascertained through tracking in the community.

Results  In 3,628 patients followed for up to 3.75 years after ART initiation, the ‘naïve’ approach identified male sex and lower pre‐ART CD4 count as independent determinants of mortality. The ‘sample‐corrected’ approach found lower pre‐ART CD4 count, older age, lower weight and calendar year of ART initiation, but not male sex, to be independent determinants of mortality.

Conclusions  Analyses to identify determinants of mortality in HIV‐infected patients on ART in Africa that do not account for losses to follow‐up can identify spurious associations and miss actual relationships – both with the potential to mislead public health efforts. A sampling‐based approach to account for losses to follow‐up represents a feasible and potentially scalable method to strengthen the evidence available for implementation of ART delivery in Africa.
Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007–2009: systematic review
Authors: Fox Matthew P. , Rosen Sydney
Published: April 2010

Objectives  To estimate the proportion of all‐cause adult patient attrition from antiretroviral therapy (ART) programs in service delivery settings in sub‐Saharan Africa through 36 months on treatment.

Methods  We identified cohorts within Ovid Medline, ISI Web of Knowledge, Cochrane Database of Systematic Reviews and four conference abstract archives. We summarized retention rates from studies describing observational cohorts from sub‐Saharan Africa reporting on adult HIV 1‐ infected patients initiating first‐line three‐drug ART. We estimated all‐cause attrition rates for 6, 12, 18, 24, or 36 months after ART initiation including patients who died or were lost to follow‐up (as defined by the author), but excluding transferred patients.

Results  We analysed 33 sources describing 39 cohorts and 226 307 patients. Patients were more likely to be female (median 65%) and had a median age at initiation of 37 (range 34–40). Median starting CD4 count was 109 cells/mm3. Loss to follow‐up was the most common cause of attrition (59%), followed by death (41%). Median attrition at 12, 24 and 36 months was 22.6% (range 7%–45%), 25% (range 11%–32%) and 29.5% (range 13%–36.1%) respectively. After pooling data in a random‐effects meta‐analysis, retention declined from 86.1% at 6 months to 80.2% at 12 months, 76.8% at 24 months and 72.3% at 36 months. Adjusting for variable follow‐up time in a sensitivity analysis, 24 month retention was 70.0% (range: 66.7%–73.3%), while 36 month retention was 64.6% (range: 57.5%–72.1%).

Conclusions  Our findings document the difficulties in retaining patients in care for lifelong treatment, and the progress being made in raising overall retention rates.
Early loss to follow up after enrolment in pre‐ART care at a large public clinic in Johannesburg, South Africa
Authors: Larson Bruce A. , Brennan Alana , McNamara Lynne , Long Lawrence , Rosen Sydney , Sanne Ian , Fox Matthew P.
Published: April 2010

Objective  To estimate loss to follow up (LTFU) between initial enrolment and the first scheduled return medical visit of a pre‐antiretroviral therapy (ART) care program for patients not eligible for ART.

Methods  The study was conducted at a public‐sector HIV clinic in Johannesburg. We reviewed records of all patients newly enrolled in the pre‐ART care program and not yet eligible for ART between January 2007 and February 2008. Crude proportions of patients completing their first return medical visit stratified by patient characteristics were calculated. A modified‐Poisson approach was used to estimate directly relative risks of returning for their first return medical visit within 1 year adjusting for patient characteristics as potential confounders.

Results  A total of 356 patients were identified. Two‐thirds had a CD4 count > 350 cells/μl (median [IQR] CD4 = 458 [394, 585]) and were scheduled to return in 6 months for a first medical visit. Seventy‐four percent of these patients did not return within one year for this visit. The remaining 36% of all patients had a baseline CD4 count 251–350 cells/μl and were scheduled to return in 3 months. Only 6% of these patients returned within 4 months; 41% returned within one year. Relative risks were positively associated with a patient being employed and negatively associated with the baseline CD4 count.

Conclusions  Given the high rate of LTFU immediately after enroling in pre‐ART care, it is clear that care programs are not expediting the timely initiation of ART. Significantly improved adherence to pre‐ART care and monitoring for patients not yet eligible for ART is required for South Africa to achieve its AIDS strategy goals and reduce the problem of late presentation and initiation of ART.
Why are antiretroviral treatment patients lost to follow‐up? A qualitative study from South Africa
Authors: Miller Candace M. , Ketlhapile Mpefe , Rybasack‐Smith Heather , Rosen Sydney
Published: April 2010

Objectives  To better understand the reasons why patients default from antiretroviral treatment (ART) programmes to help design interventions that improve treatment retention and ultimately, patient outcomes.

Methods  Prospective cohort study at two treatment sites in South Africa followed by qualitative interviews with patients that had defaulted.

Results  Respondents overwhelmingly reported that ART improved their health status and quality of life. Nevertheless, despite improved health from taking ART and worse health when treatment is stopped, serious barriers to treatment remained: transport costs, time needed for treatment, and logistical challenges were barriers to treatment, whereas stigma around HIV/AIDS, and side effects associated with ART were less influential.

Conclusion  With a better understanding of the reasons for defaulting, interventions can be designed that improve treatment retention and ultimately, patient outcomes. This study argues for realistic interventions and policy changes designed to reduce the financial and time burden of ART and to reduce logistical barriers, such as simplifying the referral and transfer process, employing patient advocates, and adopting extended and weekend clinic hours.
CLINICAL STUDY: FULL ARTICLE: Immunomodulating properties of gamma‐hydroxybutyrate (GHB), flunitrazepam and ethanol in ‘club drugs’ users
Authors: Pichini Simona , Farré Magi , Abanades Sergio , Pacifici Roberta , Zuccaro Piergiorgio , Langohr Klaus , De La Torre Rafael
Published: April 2010

Despite the increasing concern about gamma‐hydroxybutyrate (GHB) toxicity in users, no studies have addressed GHB and other club drugs effects on the immune system under controlled administration. Lymphocyte subsets and functional responsiveness of lymphocytes to mitogenic stimulation were measured in 10 healthy male recreational users of GHB who participated in five experimental sessions within the framework of a clinical trial. The study was randomized, double blind, double dummy and cross‐over. Drug conditions were: a single oral dose of GHB (40 mg/kg or 60 mg/kg), ethanol (0.7 g/kg), flunitrazepam (1.25 mg) and placebo. Acute GHB produced a time‐dependent immune impairment in the first 4 hours after drug administration associated with an increase in cortisol secretion. Although total leukocyte count remained unchanged, there was a significant decrease in the CD4 T/CD8 T‐cell ratio, as well as in the percentage of mature T lymphocytes, probably because of a decrease in both the percentage and absolute number of T helper cells. A significant decrease was also observed in natural killer cells and in functional responsiveness of lymphocytes to mitogenic stimulation. Flunitrazepam administration did not produce any change in the immune system, while ethanol intake produced a decrease in B lymphocytes and in lymphocyte proliferative response to mitogens. These results provide the first evidence that GHB intake under a controlled environmental setting impairs the immunological status and confirms the alterations in the immune function caused by ethanol.
PRECLINICAL STUDY: FULL ARTICLE: The dopamine D3 receptor partial agonist CJB090 and antagonist PG01037 decrease progressive ratio responding for methamphetamine in rats with extended‐access
Authors: Orio Laura , Wee Sunmee , Newman Amy H. , Pulvirenti Luigi , Koob George F.
Published: April 2010

Previous work suggests a role for dopamine D3‐like receptors in psychostimulant reinforcement. The development of new compounds acting selectively at dopamine D3 receptors has opened new possibilities to explore the role of these receptors in animal models of psychostimulant dependence. Here we investigated whether the dopamine D3 partial agonist CJB090 (1–10 mg/kg, i.v) and the D3 antagonist PG01037 (8–32 mg/kg, s.c.) modified methamphetamine (0.05 mg/kg/injection) intravenous self‐administration under fixed‐ (FR) and progressive‐ (PR) ratio schedules in rats allowed limited (short access, ShA; 1‐hour sessions 3 days/week) or extended access (long access, LgA; 6 hour sessions 6 days/week). Under a FR1 schedule, the highest dose of the D3 partial agonist CJB090 selectively reduced methamphetamine self‐administration in LgA but not in ShA rats, whereas the full D3 antagonist PG01037 produced no effect in either group. Under a PR schedule of reinforcement, the D3 partial agonist CJB090 reduced the maximum number of responses performed (‘breakpoint’) for methamphetamine in LgA rats at the doses of 5 and 10 mg/kg, and also it produced a significant reduction in the ShA group at the highest dose. However, the D3 full antagonist PG01037 only reduced PR methamphetamine self‐administration in LgA rats at the highest dose of 32 mg/kg with no effect in the ShA group. The results suggest that rats might be more sensitive to pharmacological modulation of dopamine D3 receptors following extended access to methamphetamine self‐administration, opening the possibility that D3 receptors play a role in excessive methamphetamine intake.
REVIEW: Behavioral evidence for the significance of serotoninergic (5‐HT) receptors in cocaine addiction
Authors: Filip Małgorzata , Alenina Natalia , Bader Michael , Przegaliński Edmund
Published: April 2010

Cocaine addiction has somatic, psychological, psychiatric, socio‐economic and legal implications in the developed world. Presently, there is no medication approved for the treatment of cocaine addiction. In recent years, data from the literature (pre‐clinical studies and clinical trials) have provided several lines of evidence that serotonin (5‐HT) and 5‐HT receptors play a modulatory role in the mechanisms of action of cocaine. Here we review the contribution of 5‐HT receptor subtypes to cocaine sensitization, discrimination, conditioned place preference, self‐administration, reinstatement of seeking behavior and withdrawal symptoms in laboratory animals. Additionally, the consequences of chronic cocaine exposure on particular 5‐HT receptor‐assigned functions in pre‐clinical studies are presented.
Liver transplant from Anti‐HBc‐positive, HBsAg‐negative donor into HBsAg‐negative recipient: is it safe? A systematic review of the literature
Authors: Avelino‐Silva Vivian Iida , D′Albuquerque Luiz Augusto Carneiro , Bonazzi Patrícia Rodrigues , Song Alice Tung Wan , Miraglia João Luiz , De Brito Neves Alan , Abdala Edson
Published: April 2010

Avelino‐Silva VI, D′Albuquerque LAC, Bonazzi PR, Song ATW, Miraglia JL, de Brito Neves A, Abdala E. Liver transplant from Anti‐HBc‐positive, HBsAg‐negative donor into HBsAg‐negative recipient: is it safe? A systematic review of the literature.  Clin Transplant 2010: 24: 735–746. © 2010 John Wiley & Sons A/S.

Abstract: Introduction:  After liver transplant (LT) from Anti‐HBc+/HBsAg− donors into HBsAg− recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg− recipients of Anti‐HBc+/HBsAg− LT with respect to: (i) the recipients’ HBV serology and (ii) the type of preventive therapy adopted.

Methods:  A systematic review of the literature using the electronic database Medline.

Results:  Five hundred and fifty‐two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti‐HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption.

Discussion:  LT from Anti‐HBc+/HBsAg− donors into HBsAg− recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti‐HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow‐up and preventive therapies should be maintained for five yr or preferably throughout the recipients’ life span.
MINERAL DEFICIENCY STRESS: Reflectance Properties, Leaf Photosynthesis and Growth of Nitrogen Deficient Big Bluestem (Andropogon gerardii)
Authors: Kakani V. G. , Reddy K. R.
Published: April 2010

A pot‐culture experiment was conducted under outdoor conditions to determine effects of nitrogen (N) deficiency on big bluestem (Andropogon gerardiiVitman, cv Bonelli) growth, photosynthesis and leaf reflectance (R) properties. Big bluestem was seeded on 14 May 2004 and grown in 120 twelve‐litre pots filled with fine sand and irrigated with Hoagland’s nutrient solution (with 81 mg L−1as N). Treatments initiated at 60 days after sowing (DAS) included: (1) the control (100N) continued receiving the Hoagland’s nutrient solution; (2) reduced N to 20 % of the control (20N); and (3) withheld N from the solution (0N). Chlorophyll (Chl) and N, and reflectance of the uppermost fully expanded leaves were determined at 10‐d intervals from 60 to 115 DAS during the N treatments. Plant growth and developmental parameters were measured at the end of the experiment, 115 DAS. Nitrogen deficiency caused a reduction in leaf Chl content, rate of photosynthesis (A), and dry weight (DW) of biomass components. Deficit N increased leaf reflectance at 555 (R555) and 715 (R715) nm and caused a shift in red‐edge (685–745 nm) to shorter wavelengths. Leaf N and Chl concentrations were linearly correlated with not only the reflectance ratios of R545/R1605 (r2 = 0.82) and R555/R405 (r2 = 0.81), respectively, but also the first derivatives of the reflectance (dR/dλ) in red‐edge centred 690 or 700 nm (r2 = 0.74–0.83). Leaf and panicle DW had the greatest, while root DW had the smallest decrease under N deficiency. It was concluded that the specific reflectance ratios or dR/dλ may be used for rapid and non‐destructive estimation of leaf Chl and plant N status of big bluestem to detect changes in N for appropriate nitrogen management strategies during the growing season.
Membrane Lipids of the Stallion Spermatozoon in Relation to Sperm Quality and Susceptibility to Lipid Peroxidation
Authors: Macías García B , González Fernández L , Ortega Ferrusola C , Salazar‐Sandoval C , Morillo Rodríguez A , Rodríguez Martinez H , Tapia JA , Morcuende D , Peña FJ
Published: April 2010

Contents

Lipids were extracted from ejaculated spermatozoa from seven individual stallions to distinguish neutral lipids (NL) and polar lipids (PL) and determine their variation among stallions and their relationship with sperm quality and sperm susceptibility to lipid peroxidation. The isolated fatty acids were correlated with sperm quality (membrane integrity, mitochondrial membrane potential (ΔΨm) and expression of active caspases) and the sensitivity of the sperm plasma membrane to LPO. The miristic (C14: 0), palmitic (C16: 0), stearic (C18: 0) and oleic (C18: 1n9) acids were predominant among the NLs. Within the phospholipid fraction, the docosapentanoic acid (C22: 5n6) was dominant, albeit varying among stallions. Surprisingly, the percentage of polyunsaturated fatty acids was positively correlated with sperm quality and a low propensity for LPO, probably because these particular fatty acids provide a higher fluidity of the plasma membrane. The stallion showing the poorest sperm membrane integrity plus a high level of LPO in his ejaculate had a lower percentage (p < 0.05) of this fatty acid in his sperm plasma membranes.
Reproductive Features and Faecal Progesterone Metabolite Profile in Female Ferrets
Authors: Proháczik A , Kulcsár M , Glávits R , Driancourt MA , Huszenicza Gy
Published: April 2010

Contents

Elevated post‐partum progesterone metabolite (P4‐met) levels have been recently postulated to occur in lactating lynxes. The aims of this study were to monitor reproductive features in female ferrets, changes in the faecal P4‐met concentrations throughout the breeding season and ovarian activity in post‐partum lactating and non‐lactating (NL) female ferrets. Our results indicate that coinciding with the results described in the lynx, elevated faecal P4‐met concentrations occur in lactating ferrets, furthermore, that the duration of elevated secretion of P4 seems to be dependant on the duration of lactation (P4‐met at delivery, n = 47: <500 ng/g; 5–7 days after delivery, during lactation, n = 47: ≥500–800 ng/g; in females weaned at delivery, n = 4: baseline levels). Three days after ovariohysterectomy of lactating females, P4‐met concentrations decreased to baseline levels. In lactating females, the ovarian stroma is more active than that in NL ones implicating that the ovary is at least in part responsible for the elevated P4‐met concentrations. Ovaries of lactating females contained many luteinized cells either as luteinized granulose cells in the wall of late pre‐antral/early antral follicles or as corpus luteum (CL)‐like structures. Early resumption of the entire ovarian activity (developed follicles and oestrus) occurs in NL post‐partum females, while final follicular development is blocked (follicles stalls at antral stage) in the lactating ones (however, occasionally lactational oestrus may occur). We suppose that the elevated faecal P4‐met during lactation together with suckling and other hormonal effects may contribute to prevention of early returning to oestrus in nursing female ferrets.
Basement membrane zone and dermal extracellular matrix of the vulva, vagina and amnion: An immunohistochemical study with comparison with non‐reproductive epithelium
Authors: Chi Ching‐Chi , Wang Shu‐Hui , Prenter Andrew , Cooper Susan , Wojnarowska Fenella
Published: April 2010

Background/Objectives:  The basement membrane zone (BMZ) is an anatomically defined region present in all types of skin and mucosa, linking the epithelium to the mesenchyme with a complex structure to provide adhesion. Altered antigenic expression of the BMZ is implicated in interface dermatoses, and the BMZ is targeted by autoantibodies in subepidermal immunobullous dermatoses. This study aims to compare the antigenic expression of the BMZ and the dermal extracellular matrix in female genital skin and mucosa and amnion, with non‐reproductive skin and mucosa.

Methods:  An indirect immunofluorescence technique was used to compare the antigenic expression of hemidesmosome, lamina lucida, anchoring filaments, lamina densa, anchoring fibrils and extracellular matrix in samples of non‐reproductive skin (three), oral mucosa (three), vulval skin (two), vagina (three) and amnion (four).

Results:  Antigenic expression was similar in the stratified epithelium of reproductive and non‐reproductive skin and mucosa, but differed in the simple cuboidal epithelium of amnion, which had reduced expression of dermal‐associated antigens.

Conclusions:  The BMZ and dermal extracellular matrix of vagina and vulva are very similar to those of non‐reproductive skin and mucosa despite their various functions, but differs from amnion. Their antigenic expression does not fully account for the anatomical distribution of immunobullous and interface dermatoses.
Patient‐related violence against emergency department nurses
Authors: Pich Jacqueline , Hazelton Michael , Sundin Deborah , Kable Ashley
Published: April 2010

In a finding that reflects international experiences, nurses in Australia have been identified as the occupation at most risk of patient‐related violence in the health‐care sector. A search of the literature was undertaken to explore this concept, with a focus on the emergency department and triage nurses. Significant findings included the fact that nurses are subjected to verbal and physical abuse so frequently that, in many instances, it has become an accepted part of the job. This attitude, combined with the chronic under‐reporting of violent incidents, perpetuates the normalization of violence, which then becomes embedded in the workplace culture and inhibits the development of preventative strategies and the provision of a safe working environment. Nurses are entitled to a safe workplace that is free from violence under both the occupational health and safety legislation and the zero‐tolerance policies that have been adopted in many countries including Australia, the UK, Europe, and the USA. Therefore, policy‐makers and administrators should recognize this issue as a priority for preventative action.
Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance
Authors: Lee Kyu Sung , Han Deok Hyun , Jeong Jae Yong , Lee Young Suk , Ko Jae Wook
Published: April 2010

Objective:  To evaluate the outcome of endoscopic subureteral injection (ESI) in adults with vesicoureteral reflux (VUR) associated with decreased bladder compliance (D‐BC).

Methods:  We retrospectively reviewed the medical records of 46 consecutive patients who underwent ESI for VUR at a single tertiary academic center. Fourteen patients (17 ureter units) who had underlying neurological disease with decreased bladder compliance, as determined by filling cystometry, were grouped as D‐BC. Thirty‐two patients (47 units) who had no signs or symptoms that suggested neurogenic lower urinary tract dysfunctions were grouped as normal bladder compliance (N‐BC). We compared the cure rates for ESI between groups, defining cure as complete resolution of reflux on voiding cystourethrogram.

Results:  In 70.6% of the D‐BC group and 70.2% of the N‐BC group, VUR resolved completely after the first injection (P = 0.977). One failed unit of D‐BC was cured after second ESI, and seven failed units of N‐BC were cured after additional treatments (second ESI, two patients; ureteroneocystostomy, five patients). No additional treatments were applied to three units of D‐BC or seven units of N‐BC without symptoms. No complications related to the ESI were observed.

Conclusions:  The ESI was found to be effective in adults with VUR regardless of the bladder compliance. As a minimally invasive procedure with a favorable outcome, ESI may represent the first choice for treatment of VUR even in adults with D‐BC.