bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why immunization coverage fails to catch up in India? A community‐based analysis
Authors: Sahu D. , Pradhan J. , Jayachandran V. , Khan N. 
Published: September 2009

AbstractBackground  An effort has been made in this paper to examine the impact of community and household vis‐à‐vis individual‐level variables on immunization coverage among Indian children.Methods  National Family Health Survey‐2 data set has been used for the analysis. Multilevel regression analyses have been used to explore the relative effects of community‐, household‐ and individual‐level factors on immunization coverage. Three community‐level variables, i.e. availability of health facilities, availability of all‐weather roads and information, education and communication (IEC) activities conducted during last year, are included in this analysis.Results  Availability of health facility and information, education and communication activities plays a significant role in determining the level of immunization coverage among children. Even with community‐level variables in the model, individual‐level variables, i.e. parent's education, birth order of child and number of antenatal care visits, retain their predictive role for the potential immunization coverage.Conclusions  Universal immunization can be achieved by providing services at community level and information about the available services and their benefits to the community. There is a considerable, unexplained variation in the immunization coverage between different communities, even in the most complex model used in this study, which could explain the entire heterogeneity of immunization coverage among Indian states.
Influence of early gut microbiota on the maturation of childhood mucosal and systemic immune responses
Authors: Sjögren Y. M. , Tomicic S. , Lundberg A. , Böttcher M. F. , Björkstén B. , Sverremark‐Ekström E. , Jenmalm M. C. 
Published: September 2009

SummaryIntroduction
Among sensitized infants, those with high, as compared with low levels, of salivary secretory IgA (SIgA) are less likely to develop allergic symptoms. Also, early colonization with certain gut microbiota, e.g. Lactobacilli and Bifidobacterium species, might be associated with less allergy development. Although animal and in vitro studies emphasize the role of the commensal gut microbiota in the development of the immune system, the influence of the gut microbiota on immune development in infants is unclear.Objective
To assess whether early colonization with certain gut microbiota species associates with mucosal and systemic immune responses i.e. salivary SIgA and the spontaneous Toll‐like receptor (TLR) 2 and TLR4 mRNA expression and lipopolysaccharide (LPS)‐induced cytokine/chemokine responses in peripheral blood mononuclear cells (PBMCs).Methods
Fecal samples were collected at 1 week, 1 month and 2 months after birth from 64 Swedish infants, followed prospectively up to 5 years of age. Bacterial DNA was analysed with real‐time PCR using primers binding to Clostridium difficile, four species of bifidobacteria, two lactobacilli groups and Bacteroides fragilis. Saliva was collected at age 6 and 12 months and at 2 and 5 years and SIgA was measured with ELISA. The PBMCs, collected 12 months after birth, were analysed for TLR2 and TLR4 mRNA expression with real‐time PCR. Further, the PBMCs were stimulated with LPS, and cytokine/chemokine responses were measured with Luminex.Results
The number of Bifidobacterium species in the early fecal samples correlated significantly with the total levels of salivary SIgA at 6 months. Early colonization with Bifidobacterium species, lactobacilli groups or C. difficile did not influence TLR2 and TLR4 expression in PBMCs. However, PBMCs from infants colonized early with high amounts of Bacteroides fragilis expressed lower levels of TLR4 mRNA spontaneously. Furthermore, LPS‐induced production of inflammatory cytokines and chemokines, e.g. IL‐6 and CCL4 (MIP‐1β), was inversely correlated to the relative amounts of Bacteroides fragilis in the early fecal samples.Conclusion
Bifidobacterial diversity may enhance the maturation of the mucosal SIgA system and early intense colonization with Bacteroides fragilis might down‐regulate LPS responsiveness in infancy.
Diagnostic testing in suspected fluoroquinolone hypersensitivity
Authors: Seitz C. S. , Bröcker E. B. , Trautmann A. 
Published: September 2009

SummaryBackgroundBecause of their broad antibacterial activity in the gram‐negative and gram‐positive spectrum, high oral bioavailability, and good tissue penetration, fluoroquinolone antibiotics are widely used. Besides direct drug‐related side‐effects, fluoroquinolones may cause hypersensitivity reactions.ObjectiveThe aim of this retrospective analysis was to present the results of diagnostic testing in cases of clinically suspected fluoroquinolone‐induced immediate or delayed hypersensitivity.MethodsWe studied 101 patients with a history of immediate or delayed hypersensitivity symptoms in temporal relation to treatment with a fluoroquinolone antibiotic using standardized skin testing, followed by oral challenges. Patients with anaphylaxis symptoms were further evaluated within vitrotests.ResultsFluoroquinolone hypersensitivity was excluded in 71 patients by tolerated oral challenge tests. During positive challenge tests, six patients (three out of these had positive and three had negative skin prick tests) developed anaphylaxis symptoms but the presumed IgE‐mediated mechanism could not be confirmed byin vitrotests. Patch testing was constantly negative; however, in two patients a rash was induced by the challenge tests.ConclusionHistory alone leads clearly to a considerable over‐estimation of fluoroquinolone hypersensitivity. Moreover, skin orin vitrotests do not seem to be very useful in identifying hypersensitive patients. Challenge tests appear to be necessary for definitely confirming or ruling out fluoroquinolone hypersensitivity.
A review of the nursing role in central venous cannulation: implications for practice policy and research
Authors: Alexandrou Evan , Spencer Timothy R , Frost Steve A , Parr Michael JA , Davidson Patricia M , Hillman Kenneth M 
Published: September 2009

Aims and objectives.  The aim of this article is to review published studies about central vein cannulation to identify implications for policy, practice and research in an advanced practice nursing role.Design.  Modified integrative literature review.Methods.  Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, Embase, and the World Wide Web were undertaken using MeSH key words. Hand searching for relevant articles was also undertaken. All studies relating to the nurses role inserting central venous cannulae in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool.Results.  Ten studies met the inclusion criteria for the review, all reported data were from the UK. There were disparate models of service delivery and study populations and the studies were predominantly non experimental in design. The results of this review need to be considered within the methodological caveats associated with this approach. The studies identified did not demonstrate differences in rates of adverse events between a specialist nurse and a medical officer.Conclusions.  There were only a small number of studies found in the literature review and the limited availability of clinical outcome data precluded formal analysis from being generated.Relevance to clinical practice.  Central vein cannulation is potentially an emerging practice area with important considerations for policy practice and research. Training specialist nurses to provide such a service may facilitate standardising of practice and improving surveillance of lines, and possibly improve the training and accreditation process for CVC insertions for junior medical officers. For this to occur, there is a need to undertake well‐conducted clinical studies to clearly document the value and efficacy of this advanced practice nursing role.
The turning point: from self‐regulative illness behaviour to care‐seeking in patients with an acute myocardial infarction
Authors: Nymark Carolin , Mattiasson Anne‐Cathrine , Henriksson Peter , Kiessling Anna 
Published: September 2009

Aims and objectives.  To describe the care‐seeking process from interpretation of an initial symptom to the decision to seek medical care in patients with an acute myocardial infarction.Background.  Patients afflicted by symptoms of an acute myocardial infarction delay in seeking care far exceeding the desired time limits. This results in avoidable loss of life. There is thus a need to understand these patients’ initial discomfort, appraisal and behaviour to design interventions that could reduce delay in care‐seeking.Design.  Focus group discussions with patients who had had a recent acute myocardial infarction.Methods.  The analysis of the transcribed text was inspired by the self‐regulatory model of illness behaviour.Results.  Patients with acute myocardial infarction describe problems to identify the exact time of onset of often vague symptoms. Their experiences of symptoms did not match their expectations. These patients exhibit self‐regulatory illness behaviour that seems to cause a considerable delay in care‐seeking.Conclusions.  We found indications of a pertinent shift in appraisal and coping‐strategy when a patient changes from self‐regulative illness behaviour to seeking care – the turning point. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for a person to reach this stage. All aspects of the patients’ self‐regulative illness behaviour have to be considered if we want patients to seek medical care more rapidly.Relevance to clinical practice.  Our findings are important to consider in future design of public health and rehabilitation strategies to save patient lives. To identify the turning point is a profitable way to deepen the understanding of patient behaviour during the initial phase of an acute myocardial infarction.
Enhancing the efficacy of psychoeducational interventions for paediatric patients in a randomised controlled trial: methodological considerations
Authors: Li William HC , Chung Oi KJ 
Published: September 2009

Aim.  This paper described a case study of a randomised controlled trial with the aim to illuminate how the intervention described takes into account the important methodological considerations for enhancing the efficacy of psychoeducational interventions for paediatric patients.Background.  Many nursing intervention studies commit a Type II error despite the fact that the intervention is effective. Lack of attention given to the threats of validity of an intervention study may lead to inaccurate inference about the efficacy of the intervention study, thereby precluding any definitive conclusions being drawn.Design.  A case study of a randomised controlled trial was described.Method.  Two hundred and three Hong Kong Chinese children, admitted for elective surgery, were invited to participate in the study. By using a simple complete randomisation method, 97 children were assigned to the experimental group and received therapeutic play intervention and 106 children were assigned to the control group and received routine information preparation.Results.  Children received preoperative therapeutic play intervention experienced lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures.Conclusion.  This case study illustrates that the more a measure is sensitive to differentiate between the experimental and control groups, the greater the likelihood of documenting intervention efficacy. Besides, the timing of measuring a dependent variable that matches with peak response to an intervention is crucial in evaluating the efficacy of an intervention. Additionally, outcome measures that are sensitive enough to differentiate between the experimental and control groups are extremely important to ensure greater accuracy in evaluating the efficacy of psychoeducational interventions.Relevance to clinical practice.  It is anticipated that designing an effective psychoeducational intervention research design can facilitate the development of holistic and quality care in preparing children for hospitalisation.
An integrative review and meta‐synthesis of the scope and impact of intensive care liaison and outreach services
Authors: Endacott Ruth , Eliott Suzanne , Chaboyer Wendy 
Published: September 2009

Aim. To determine activities and outcomes of intensive care unit Liaison Nurse/Outreach services. The review comprised two stages: (1) integrative review of qualitative and quantitative studies examining intensive care liaison/outreach services in the UK and Australia and (2) meta‐synthesis using the Nursing Role Effectiveness Model as ana priorimodel.Background. Acute ward patients are at risk of adverse events and patients recovering from critical illness are vulnerable to deterioration. Proactive and reactive strategies have been implemented to facilitate timely identification of patients at risk.Design. Systematic review.Methods. A range of data bases was searched from 2000–2008. Studies were eligible for review if they included adults in any setting where intensive care unit Liaison Nurse or Outreach services were provided. From 1423 citations and 65 abstracts, 20 studies met the inclusion criteria.Results. Intensive care liaison/outreach services had a beneficial impact on intensive care mortality, hospital mortality, unplanned intensive care admissions/re‐admissions, discharge delay and rates of adverse events. A range of research methods were used; however, it was not possible to conclude unequivocally that the intensive care liaison/outreach service had resulted in improved outcomes. The major unmeasured benefit across all studies was improved communication pathways between critical care and ward staff. Outcomes for nurses in the form of improved confidence, knowledge and critical care skills were identified in qualitative studies but not measured.Conclusion. The varied nature of the intensive care liaison/outreach services reviewed in these studies suggests that they should be treated as bundled interventions, delivering a treatment package of care. Further studies should examine the impact of critical care support on the confidence and skills of ward nurses.Relevance to clinical practice. Advanced nursing roles can improve outcomes for patients who are vulnerable to deterioration. The Nursing Role Effectiveness Model provides a useful framework for evaluating the impact of these roles.
Diet, physical activity, sedentary behaviour and perceptions of the environment in young adults
Authors: Lake A. A. , Townshend T. , Alvanides S. , Stamp E. , Adamson A. J. 
Published: September 2009

AbstractBackground:  Few studies have explored both food behaviour and physical activity in an environmental context. Most research in this area has focused on adults; the aim of the present study was to describe perceptions of the environment, diet, physical activity and sedentary behaviour patterns in 16–20 year olds in full‐time education (Newcastle, UK).Methods:  Participants (n = 73) recruited from a college and sixth‐form college completed a UK version of the Youth Neighbourhood Environment Walkability Survey, which included measures of sedentary behaviour. A validated food frequency questionnaire was completed and a factor applied to produce an estimated mean daily frequency of intake of each item, which was converted to nutrient intakes. A rank for Index of Multiple Deprivation (IMD) was assigned to their home postcode. Analysis explored associations between sedentary behaviours and nutrient intake.Results:  In this descriptive cross‐sectional study, most participants reported being physically active for at least 1 h day−1 on 3–4 (n = 28) or 5–7 days (n = 31). There were no significant differences in nutrient intake according to sample quartile IMD position. Sedentary behaviours were significantly associated with less healthy eating patterns. Higher total energy (P = 0.02), higher fat (P = 0.005), percentage energy from fat (P = 0.035) and lower carbohydrate intakes (P = 0.004) were significantly associated with more time spent watching DVDs at the weekend.Conclusions:  This combination of sedentary behaviour and less healthy eating patterns has important implications for long‐term health (e.g. the tracking of being overweight and obesity from adolescence into adulthood). Understanding behaviour relationships is an important step in developing interventions in this age group.
The effect of including a conventional snack (cereal bar) and a nonconventional snack (almonds) on hunger, eating frequency, dietary intake and body weight
Authors: Zaveri S. , Drummond S. 
Published: September 2009

AbstractBackground:  With the increasing prevalence of being overweight and obesity, dietary strategies to curb hunger levels and increase satiety at lower energy intakes are sought. The frequency of eating and type of snack may influence total energy intake. The present study aimed to assess the impact of providing either a conventional snack (cereal bar) or a nonconventional snack (almonds) on eating frequency, hunger rating, dietary intake, body weight and blood lipids.Methods:  Forty‐five healthy men (aged 25–50 years, body mass index = 25–35 kg m−2) were recruited and allocated to a control, cereal bar or almond snack group. Two packets of cereal bars and almonds were introduced for 12 weeks to the cereal bar group and the almond snack group, respectively. Dietary intakes and eating frequency were assessed by 4‐day unweighed diet diaries; visual analogue scales were used to assess hunger ratings; and fasting blood parameters (i.e. glucose, insulin, total cholesterol, triglycerides, low‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol) were measured at baseline, 6 and 12 weeks. In addition, anthropometric measures (height, weight, skinfold thickness, waist and hip circumference) were measured at baseline, 6 and 12 weeks.Results:  The present study found no significant change in the eating frequency within groups at 12 weeks. However, the almond snack group had a significantly higher eating frequency than the control group (P ≤ 0.05) and cereal bar group (P ≤ 0.01). This did not result in higher energy intake, body weight or percentage body fat in the almond snack group.Conclusion:  The present study demonstrated that snacking on almonds, in comparison to cereal bars, promoted a higher eating frequency, but not a higher energy intake. Advice to snack on either almonds or cereal bars did not result in weight gain, suggesting that energy compensation took place.
Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians
Authors: Jeanes Y. M. , Barr S. , Smith K. , Hart K. H. 
Published: September 2009

AbstractBackground: Polycystic ovary syndrome (PCOS) is a common endocrine condition associated with hyperandrogenism, infertility and metabolic dysfunction. Weight management through diet and lifestyle modifications are fundamental to its management; however, presently, there are no official dietary guidelines. The present study aimed to explore the dietary and lifestyle strategies followed by women with PCOS and the contribution of dietitians to its management.Methods: A questionnaire was completed by 105 UK dietitians focused on the service provided and a patient questionnaire and 7‐day food diary were completed by women with PCOS (n = 206 andn = 196, respectively). Food diaries were analysed for energy and macronutrient intake and the questionnaire focused on the dietary advice received.Results: Advice provided by dietitians focused on a reduction in energy intake (78%) and dietary glycaemic index (77%), often in combination. Of the women with PCOS who were following a diet specifically for their PCOS (57%), regimes included a low glycaemic index (34%), weight loss diets (16%) or a combination (26%). Of interest, 73% of overweight women were not following a diet to promote weight loss. Nutritional information predominately came from books, with only 15% of women having seen a dietitian. Eighty‐four percent of women with PCOS who had increased physical activity (48%) self‐reported an improvement in their symptoms.Conclusions: Women with PCOS recognise the importance of diet, but few received dietary advice from a registered dietitian. The dietary information women with PCOS received was often from an unregulated source. A consensus statement of evidence‐based dietary advice for women with PCOS is needed and would be a useful resource for dietitians.
Iron deficiency and frequency of HFE C282Y gene mutation in Brazilian blood donors
Authors: Terada C. T. , Santos P. C. J. L. , Cançado R. D. , Rostelato S. , Lopreato F. R. , Chiattone C. S. , Guerra‐Shinohara E. M. 
Published: September 2009

summary.Limited data are available about iron deficiency (ID) in Brazilian blood donors. This study evaluated the frequencies of ID and iron‐deficiency anaemia (IDA) separately and according to frequency of blood donations. The protective effect of the heterozygous genotype for HFE C282Y mutation against ID and IDA in female blood donors was also determined.Five hundred and eight blood donors were recruited at the Blood Bank of Santa Casa in Sao Paulo, Brazil. Haemoglobin and serum ferritin concentrations were measured. The genotype for HFE C282Y mutation was determined by polymerase chain reaction followed by restriction fragment length polymorphism analysis. The ID was found in 21·1% of the women and 2·6% of the men whereas the IDA was found in 6·8 and 0·3%, respectively. The ID was found in 11·9% of the women in group 1 (first‐time blood donors) and the frequency increased to 38·9% in women of the group 3 (blood donors donating once or more times in the last 12 months). No ID was found in men from group 1; however the ID frequency increased to 0·9% in group 2 (who had donated blood before but not in the last 12 months) and 5·0% in group 3. In summary, the heterozygous genotype was not associated with reduction of ID or IDA frequencies in both genders, but in male blood donors it was associated with a trend to elevated ferritin levels (P = 0·060). ID is most frequent in Brazilian women but was also found in men of group 3.