bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ‘oestrogen hypothesis’– where do we stand now?1
Authors: Sharpe Richard M. 
Published: March 2003

SummaryThe original ‘oestrogen hypothesis’ postulated that the apparent increase in human male reproductive developmental disorders (testis cancer, cryptorchidism, hypospadias, low sperm counts) might have occurred because of increased oestrogen exposure of the human foetus/neonate; five potential routes of exposure were considered. This review revisits this hypothesis in the light of the data to have emerged since 1993. It addresses whether there is a secular increasing trend in the listed disorders and highlights the limitations of available data and how these are being addressed. It considers whether new data has emerged to support the suggestion that increased oestrogen exposure could cause these abnormalities and reviews new data on potential routes via which such increased exposure could have occurred. Secular trends: The disorders listed above are now considered to represent a syndrome of disorders (testicular dysgenesis syndrome, TDS) with a common origin in foetal life. Testicular cancer has increased in incidence in Caucasian men worldwide and lifetime risk is 0.3–0.8%. Secular trends in cryptorchidism are unclear but it is by far the commonest (2–4% at birth) congenital abnormality in either sex. Secular trends for hypospadias are not robust, although most studies suggest a progressive increase; registry data probably under‐estimates incidence, but based on this data hypospadias is the second most common (0.3–0.7% at birth) congenital malformation. Retrospective analyses of sperm count data show a global downward trend but this is inconclusive – prospective studies using standardized methodology show significant differences between countries and very low sperm counts in the youngest cohort of men. For all disorders, other then testis cancer, standardized prospective studies are the best way forward and are in progress across Europe. Oestrogen effects: Evidence that foetal exposure to oestrogens can induce the above disorders has strengthened. New pathways via which such changes could be induced have been identified, including suppression of testosterone production by the foetal testis, suppression of androgen receptor expression and suppression of insulin‐like factor‐3 (InsL3) production by foetal Leydig cells. Other evidence suggests that the balance between androgen and oestrogen action may be important in induction of reproductive tract abnormalities. Oestrogen exposure: Although many new environmental oestrogens have been identified, their uniformly weak oestrogenicity excludes the possibility that they could induce the above disorders. However, emerging data implicates various environmental chemicals in being able to alter endogenous levels of androgens (certain phthalates) and oestrogens (polychlorinated biphenyls, polyhalogenated hydrocarbons), and the former have been shown to induce a similar collection of disorders to TDS. Other mechanisms via which increased fetal exposure to pregnancy oestrogens might occur (increasing trend in obesity, dietary changes) are also discussed.
Bond strength and interfacial micromorphology of compomers in primary and permanent teeth
Authors: El‐Kalla Ibrahim H , García‐Godoy Franklin 
Published: March 2003

Objectives. To (1) test and compare the shear bond strength of compomers (Compoglass, Dyract, Hytac) to primary and permanent dentin, (2) compare the values to those obtained with a resin‐modified glass ionomer (Vitremer), and (3) evaluate the material–dentin interfacial morphology.Sample and methods. The facial and lingual surfaces of 32 primary and 32 permanent teeth were used. The manufacturers’ instructions were followed for the bonding procedures. After bonding, the teeth were thermocycled and sheared.Results. ANOVA and Student‐Newman‐Keuls test revealed that the shear bond strength for Dyract was significantly higher than for the other restorative systems tested, both for primary (P<0·001) and permanent (P<0·01) teeth. Compoglass bond strength was significantly lower than Vitremer for the primary teeth dentin (P<0·01). The shear bond strength for Compoglass to permanent dentin was significantly lower than for all other restorative systems (P<0·001). There was a significantly higher shear bond strength for Compoglass (P<0·05) and Dyract (P<0·01) restorative systems for prim‐ary compared to permanent teeth. For all products tested, all samples revealed cohesive failures. The highest frequency of cohesive failure was reported with Compoglass in both primary and permanent teeth and for Hytac and Vitremer in permanent teeth. Micromorphologically, all restorative systems revealed good adaptation to the underlying dentin; however, there was no evidence of the formation of a hybrid layer or deep resin penetration inside the dentinal tubules. There was no difference in the interfacial morphological adaptation between the primary and permanent teeth.Conclusions. The compomers tested had shear bond strength values between those of resin‐modified glass ionomers and resin composites.
Dental findings in three siblings with Morquio’s syndrome
Authors: Rølling I. , Clausen N. , Nyvad B. , Sindet‐Pedersen S. 
Published: March 2003

Three siblings with Morquio’s syndrome are described. Cultured fibroblasts from the youngest sibling demonstrated a total absence of N‐acethylgalactosamine‐6‐sulphate‐sulphatase whereas β–galactocidase activity was normal, thus verifying the diagnosis of MPS‐IV A. Dental features such as pointed cusps, spade‐shaped incisors, thin enamel and pitted buccal surfaces were observed in all three children. Furthermore, in all three siblings the TMJ was affected with severe resorption of the head of the condyle.Histological examination of exfoliated primary molars showed a band of increased porosity following the striae of Retzius in the outer part of the enamel. These developmental disturbances were occasionally associated with minor localized defects in the enamel surface.The importance of close monitoring of dental development and regular dental care in order to prevent attrition of the teeth, loss of vertical face height and subsequent risk of TMJ dysfunction is emphasized.
Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre‐school children – a 30‐month evaluation
Authors: Lo E.C.M. , Holmgren C.J. 
Published: March 2003

Summary.
Objectives. The objectives of this study were: to provide restorations using the ART approach to pre‐school children in Southern China in a kindergarten environ‐ment, using a high‐strength glass‐ionomer restorative material; to assess the accept‐ability of this approach and to evaluate on a longitudinal basis the restorations placed. Sample and methods. A total of 170 ART restorations were placed in 95 children, aged 5·1 ± 0·7 years, by seven final‐year dental students using standard ART procedures and hand instruments. The restorations were evaluated every six months thereafter by two calibrated independent examiners using explorers and mouth‐mirrors. Results. 93% of the children reported that they did not feel pain during treatment and 86% were willing to receive ART restorations again. The cumulative 12‐ and 30‐month survival rates of Class I restorations were 91% and 79%, respectively. The corresponding figures for Class V restorations were 79% and 70%, while those for Class II restorations were 75% and 51%. The failure rates of Class III and IV restor‐ations were high with more than half of them scored as missing within the first year. Conclusions. The ART approach was shown to be acceptable to Chinese pre‐school children for providing restorative dental care outside the traditional clinical setting. The success rates were high for Class I and V restorations in primary teeth, modest for Class II, and low for Class III and IV restorations.
Effectiveness of a caries preventive program in pregnant women and new mothers on their offspring
Authors: Gomez S.S. , Weber A.A. 
Published: March 2003

Objective. The medical centre at Almirante Nef Naval Hospital, Vina del Mar, Chile, operates a mother and child preventive dental program (PDP) which includes women from their fourth month of pregnancy and mothers with their offspring. The aim was to evaluate the effectiveness of this prenatal and postnatal prevention program after the first four years. Methods. The prevalence of early childhood caries of 180 1‐ to 3·5‐year‐old children enrolled in the PDP was compared with 180 non‐participating children. The control group was randomly selected from the rolls of the healthy child system of the Valparaiso‐San Antonio Health Service and was comparable by age, socio‐economic status and level of fluoride in the drinking water (1·0 p.p.m. F) with the PDP group. Clinical caries examinations were conducted by two calibrated examiners using the WHO visual criteria. Results. In the PDP group, 97% of the children were caries free compared with the 77% in the control group. The dft (mean ± SD) of the PDP children was 0·11 ± 0·78 versus 0·66 ± 1·55 for the control children, a difference of 83·3%. The differences between the groups in caries‐free status and caries prevalence were both statistically significant (P < 0·05). Conclusions. The preventive dental program was effective in inhibiting caries in pre‐school children, even in a population already receiving the benefits of community water fluoridation.
Multifactorial analysis of the aetiology of craniomandibular dysfunction in children*
Authors: Vanderas A. P. , Papagiannoulis L. 
Published: March 2003

Summary. Objectives. It is generally accepted that the aetiology of craniomandibular dysfunction (CMD) is multifactorial. Different types of malocclusion, oral parafunctions especially bruxism, trauma of the mandible or temporomandibular joint (TMJ) and emotional stress are known aetiologic factors. Research has been conducted into the relationship between each of these aetiologic factors and the signs and symptoms of CMD. However, such an approach does not control for the simultaneous effect of other factors responsible for the development of the dysfunction. The purpose of this study was to investigate the effect of each aetiologic factor on the signs and symptoms of CMD in children, controlling for the effect of all other known factors by means of a multifactorial analysis.Methods. A sample of 314 children, aged 6–8 years, was examined clinically for signs of CMD and morphologic and functional malocclusion. Symptoms of CMD and oral parafunctions were recorded by the same investigator in an interview. Emotional stress was measured through urinary catecholamines including epinephrine, norepinephrine and dopamine, detected in a 24‐h urine sample, using high performance liquid chromatography. A questionnaire was distributed to the parents to collect information regarding socioeconomic factors and the history of dentofacial injuries. A logistic multiple regression was carried out to estimate the partial effect of each aetiologic factor. A 95% probability level was used.Results. Posterior crossbite with lateral shift significantly affected the probability of child developing deviation of the mandible on opening. Similarly, posterior crossbite and epinephrine had a significant impact on TMJ tenderness, overjet had an effect on clicking, clenching and biting of objects had an effect on muscle tenderness, and lip/cheek biting influenced dysfunctional opening. Of the symptoms reported, pain on wide opening was affected significantly by lip/cheek biting.Conclusion. On the basis of these results, it can be suggested that parafunctional and some structural and psychological factors may increase the probability of the child developing the signs and symptoms of CMD.
Fluoride intake in children living in a high‐fluoride area in Ethiopia – intake through beverages
Authors: Malde M. K. , Zerihun L. , Julshamn K. , Bjorvatn K. 
Published: March 2003

Summary. Introduction. The present study was conducted in Wonji Shoa, a sugar estate in the Ethiopian Rift Valley. Drinking water in the area is provided either by the Awash River or by high‐fluoride ground water wells. Defluoridation plants have been installed, but are not in regular use, and fluorosis, dental as well as skeletal, is endemic. The aim of this study was to assess daily fluoride intake from drinking water and beverages in children from neighbouring villages with varying fluoride concentration in the drinking water.Subjects and methods. Thirty families were selected from two of the plantation villages (A and K). The criterion for being included in the project was the presence in the household of at least one child, fully weaned and below the age of 5 years. For sampling of beverages, the duplicate portion technique was used. The fluoride concentration in the beverage samples was determined using standard methods, using a fluoride ion‐selective electrode.Results. Ten of the selected households in Village A fetched water from the Awash River (1·8 mg F−/L) while five relied upon water from a local well (2·1 mg F−/L). All 15 households in Village K used water from a local well with fluoride concentration of 14·4 mg/L. The mean daily fluoride intake from drinking water and beverages during the four days, varied from 1·2 to 1·5 mg and 5·9 to 8·8 mg in Village A and K, respectively. Low variety in types of beverages consumed was reported both during the study period and through the questionnaire. Only local water was used for beverage preparation. Children who consumed milk had a reduced fluoride intake. Tea, which was part of the children's diet, was not found to be a main source of fluoride.Conclusion. A2n effective defluoridation of the drinking water or a change of water source would seem to be the only options for avoidance of dental and possibly skeletal fluorosis.
Quality indicators in clinical nursing: a review of the literature
Authors: Idvall Ewa , Rooke Liselotte , Hamrin Elisabeth 
Published: March 2003

The purpose of the present study was, by means of a literature review, to describe and analyse the characteristics of clinical indicators used to assess and promote quality improvement in nursing care.It was found that a generally accepted definition of a clinical indicator is a ‘quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities’. By the seriousness of the event and the degree to which it can be avoided, clinical indicators are described as sentinel event or rate‐based indicators. They can measure structure, process or outcome of care. Authors have had different approaches in focus when selecting and developing indicators viz. specific aspects of care/nursing diagnosis, medical diagnosis, generic aspects of care and clinical areas. These different points of departure were influenced by research knowledge, theories/frameworks, or by the opinions of patients or staff.The threshold of an indicator is essential when measuring the quality of care as it describes a critical level between what is considered good or not.Thresholds should be dynamic, realistic, and improve over time. However, the literature on how to establish specific thresholds is limited.The review has also revealed that there is an uncertainty regarding the use of terms such as indicators, standards, norm, criteria and aspects of care.
Observations on the neglected concept of intervention in nursing research
Authors: Johnson Martin 
Published: March 2003

In this paper I will examine the concept of researcher intervention in nursing research. In will suggest that the concept is essentially problematic for both positivist and qualitative researchers, which may have some bearing upon its relative neglect as an area for discussion.I will examine the redundancy of the more popular moral frameworks in dealing with the problems raised by intervention and suggest that nursing research, being ‘messy’, requires the articulation of a more reflexive and contextual approach. This applies both to moral justification and to more pragmatic methodological issues. In the paper I suggest that humanistic action research, informed by recent feminist thinking, has potential to produce a more creative and clinically relevant future for nursing research than is currently so.
An analysis of nursing in context: the effects of current health policy
Authors: Antrobus Sue 
Published: March 2003

This paper intends to analyse the effects of recent health policy changes in the United Kingdom upon nursing, examining some of the anomalies raised by the rhetoric of the politics and the actualities of the change process and exploring and analysing nursings’presence within that change process. Specific reference will be paid to the philosophy and ideology of the reforms and comparisons made with some of the original factors underpinning the purpose and functioning of the British National Health Service and professional groups within it.In particular, this paper considers the functioning of nursing as an holistic, intuitive, humanistic, and caring act within the context of the scientific, rational, performance and outcomes‐orientated new public management ideology presently sweeping the health service. The resultant tensions this apparent dichotomy is causing nursing will be tentatively explored. Lastly, an agenda for change will be proposed which will identify ways in which nursing can respond and, more importantly, be proactive within the contextual changes highlighted.
Family‐centred care: a concept analysis
Authors: Hutchfield Kay 
Published: March 2003

Family‐centred care: a concept analysis Family‐centred care would seem to be a central element of children's nursing, but there is no consensus about its meaning. This paper uses a combination of Rodgers' evolutionary model of concept analysis and Schwartz‐Barcott and Kim's hybrid model of concept development to facilitate a dispositional approach to analysing this concept. Data from a qualitative survey undertaken during 1994/1995 was used in conjunction with data obtained through a questionnaire, to provide the field‐work element for the process of analysis. The process resulted in the identification of the antecedents and attributes of family‐centred care, and the identification of a lack of clarity related to the consequences of family‐centred care. Two alternative models of family‐centred care emerged, both of which demonstrate strong associations with the concepts of partnership with parents, parental participation and care by parents. The paper does not conclude with any definition of family‐centred care, but rather explores its usefulness in practice and considers how the concept might be operationalized. The tentative proposals for a hierarchy of family‐centred care will require exploration, testing and evaluation by practitioners in the real world of children's nursing.
Critical reflective inquiry for knowledge development in nursing practice
Authors: Kim Hesook Suzie 
Published: March 2003

Critical reflective inquiry for knowledge development in nursing practiceThis paper presents a method of inquiry which uses nurses' situated, individual instances of nursing practice as the basis for developing knowledge for nursing and improving practice. This method of inquiry is founded upon the ideas in action science and reflective practice, and critical philosophy. Nursing practice is viewed as a rich source of new knowledge as practitioners are engaged in creating as well as modifying knowledge to respond to specific clinical situations. At the same time, practitioners may be in practice without recognizing deficiencies or ineffectiveness. As a method to tap these two aspects of practice, the inquiry is designed to encompass three phases, i.e. descriptive, reflective and critical/emancipatory, and is oriented to provide understanding to practitioners of the nature and meaning of their own practice, to correct and improve practice through self‐reflection and critique, and to generate models of `good' practice and theories of application as well as to discover processes of practice as played out in clinical situations. This method of inquiry can be used by nurses and nursing students in collaboration with researches or mentors to develop nursing knowledge about practice, improve individual practice, and engage in shared learning.
A longitudinal study into the perceptions of caring and nursing among student nurses
Authors: Watson Roger , Deary Ian J. , Lea Amandah 
Published: March 2003

A longitudinal study into the perceptions of caring and nursing among student nurses A longitudinal study of a cohort of student nurses was undertaken in order to investigate whether changes in perceptions of nursing and caring take place and how perceptions of nursing and caring are related. The Caring Dimensions Inventory (CDI) and the Nursing Dimensions Inventory (NDI) were employed for data collection at entry to nurse education and after 12 months. There were significant changes in the scores of a range of items in both inventories which suggested that student nurses lose some of their idealism about nursing and caring after 12 months in nurse education. While the overall ranking of items in the inventories was very similar, it was possible to distinguish between the inventories at entry to training and to observe a change, particularly in the CDI, over time by means of Mokken scaling. Nursing and caring would appear to become more synonymous to the student nurses after 12 months in nurse education. Factors scores, for factors identified in the CDI in a previous study, were used to investigate whether these scores changed at 12 months into nurse education compared with entry. No significant changes were detected.
A content analysis of staff nurse descriptions of job satisfaction and dissatisfaction
Authors: McNeese‐Smith Donna K. 
Published: March 2003

A content analysis of staff nurse descriptions of job satisfaction and dissatisfaction Job satisfaction of nurses has been studied, using quantitative methodology, but hospital staff nurse descriptions of the source of their job satisfaction and job dissatisfaction have rarely been examined. This study collected information from 30 staff nurses through semistructured, taped interviews. Using content analysis, interviews were coded and categories and themes were identified. Findings indicate that job satisfaction was derived from the following categories: patient care, environment, balanced workload, relations with coworkers, personal factors, salary and benefits, professionalism, cultural background of the nurse and career stage of the nurse. Themes related to patient care, the pace and variety in an acute care environment, relationships with coworkers and meeting personal and family needs were cited as particularly relevant to job satisfaction. Job dissatisfaction was primarily influenced by patient care, factors that interfere with the job and patient care, feeling overloaded, relations with coworkers, personal factors, organizational factors and the career stage of the nurse. Themes related to the following categories have the greatest influence on job dissatisfaction: feeling overloaded, factors that interfere with patient care, coworkers who do not provide good care and situations that feel unfair. The actual words of nurses were included to provide depth and substance to the categories and themes. A discussion was presented of the relationship of these findings to theory and to outcomes of quantitative research. These findings have implications for nursing practice, administration and education as the profession considers organizational and individual factors influencing nurses’ feelings about their job and prepares for future nursing shortages.