BACKGROUND: In Manchester, approximately 120 women at > or = 1:4 lifetime risk of breast cancer have considered preventative surgery since 1992. Women treated within the Manchester protocol receive two genetic counselling sessions, a psychological assessment and a surgical consultation pre-operatively and annual follow-up post-operatively. The vast majority of women have breast reconstruction. METHODS: Since 1996, mental health and body image have been assessed in women attending annual follow-up using self-report questionnaires: the 28-item General Health Questionnaire (GHQ) and 10-item Body Image Scale (BIS). Women with high scores are assessed by clinical interview together with a proportion who have no significant problems. RESULTS: Between 1995 and 1999, 76 women completed surgery. Ten were awaiting post-operative review and 60 (91%) attended for follow-up of whom 45 (75%) were interviewed. Questionnaire data were available for 52 (79%) women, mean age 40.8 years (range 27-58). Six women were gene mutation carriers and of these three had had breast cancer. One additional patient was affected but had not been genetically tested. Eight (17%) of 47 women with assessments in the first post-operative year scored in the 'caseness' range on the GHQ: the mean GHQ score was 3.8 (S.D. 6.7), range 0-25. Results were comparable with those for women attending the Family History Clinic for risk assessment. The mean score on the BIS was 5.1 (S.D. 5.5), range 0-25, comparable with scores for women undergoing conservative surgery for breast cancer. Twenty-one percent of women reported no negative change in body image following surgery (i.e. zero questionnaire summary scores) and the majority of changes reported were of minor degree (item scores 0 or 1). The most frequently reported changes were in sexual attractiveness (55%), feeling less physically attractive (53%) and self-consciousness about appearance (53%): a third of women felt less feminine to a minimal degree. These results appeared stable over time. A minority of women had more serious psychological or body image concerns, usually in relation to surgical complications: they received further psychiatric intervention. CONCLUSIONS: For the majority of women there is no evidence of significant mental health or body image problems in the first 3 years following Bilateral Prophylactic Mastectomy (BPM), but women who have complications warrant additional psychological help. Careful pre-operative preparation and long-term monitoring are advocated in this new field of cancer prevention.

Adult↗

PubMedDate not supplied

Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy.

Material and fetal cardiovascular effects of position change were assessed in 20 women in late pregnancy. On changing from the left lateral to the supine position, there was a 45% reduction in leg blood flow, measured by strain guage plethysmography. Arterial resistance, measured with Doppler ultrasound in the femoral, brachial and uterine arteries, remained unchanged, confirming the absence of compensatory vasoconstriction. There was no change in blood pressure (BP) in the leg, indicating no significant aortic compression, but a rise in maternal heart rate in the supine position suggested the presence of inferior vena cava (IVC) compression. Neither the left or the right pelvic-tilt position was associated with a significant change in leg blood flow or maternal heart rate compared to the supine position. A possible 'sluice' effect in the placental circulation was not confirmed, as fetal heart rate and umbilical Doppler resistance did not change in any position. In the absence of active vasoconstriction and significant aortic compression, IVC compression is the likely cause of the decrease in leg blood flow, and also of the previously demonstrated decrease in uterine blood flow. Leg BP and Doppler ultrasound measurements of uterine artery resistance may not be adequate measures of the effect of posture on uteroplacental perfusion.

Analysis of Variance↗

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An in vitro comparative study of a reciprocating scaler for root surface debridement.

OBJECTIVES: A number of instruments are available for debriding periodontally involved root surfaces. The aim of this SEM study was to assess and compare the efficiency of the recently marketed EVA scaling system with that of ultrasonic (Cavitron-Dentsply) and hand instruments (Ash Dental Products). METHODS: Forty-five periodontally involved extracted teeth were divided into three equal groups for instrumentation. The teeth were mounted onto typodonts, set in phantom heads and instrumented to tactile smoothness and visual cleanliness. Replica specimens of the debrided roots were prepared for the SEM and views were recorded on video film. The efficiency of instrumentation was assessed using the Remaining Calculus Index (RCI) and the Roughness and Loss of Tooth Substance Index (RLTSI). Five original specimens from each group were prepared for light microscopy to confirm histologically the appearances seen under the SEM. RESULTS: Observations indicated that there were no statistically significant differences between the different instruments but the EVA system took significantly longer than either the ultrasonic (P < 0.0001) or hand instruments (P < 0.025) to achieve visual cleanliness. The results supported the view that no instrument removes all extraneous deposits and all were capable of cavity roughness and minor damage to root cementum. Only the hand and ultrasonic instruments left scratches after instrumentation, although the greater part of all the surfaces was surprisingly smooth and calculus free after root surface debridement. CONCLUSIONS: Recently marketed EVA inserts are comparable to ultrasonic and hand instruments for root planing, with respect to calculus removal and quality of the remaining root surface.

Debridement↗

PubMedDate not supplied

Intergenic suppression of stage II sporulation defects by a mutation in the major vegetative sigma factor gene (rpoD) of Bacillus subtilis.

The Bacillus subtilis intergenic suppressor mutations crsA and rvtA, previously shown to restore sporulation competence to a variety of strains containing stage 0 sporulation defects, also suppress lesions in the stage II sporulation genes spoIIF, spoIIN and spoIIJ. They do not rescue sporulation in other stage II through stage V sporulation mutations. Cells containing spoIIN, spoIIF96 and spoIIJ::Tn917 mutations fail to transcribe spoIID, a late stage II gene. Introduction of crsA47 into spoIINts279, spoIIF96, or spoIIJ::Tn917 mutant backgrounds circumvents the need for the spoIIF, IIN, and IIJ products, restoring both expression of spoIID, and sporulation competence.

Bacillus subtilis↗

PubMedDate not supplied

Immunogenicity and safety of Haemophilus influenzae type b polysaccharide-Neisseria meningitidis conjugate vaccine in 7.5 micrograms liquid formulation: a comparison of three lots with the 15.0 micrograms lyophilized formulation. Study Group for 7.5 micrograms Liquid PedvaxHIB.

We conducted a multicenter, single-blind, randomized comparisons of the immunogenicity and safety of three manufacturing-scale lots of 7.5 micrograms liquid Haemophilus influenzae type b polysaccharide- Neisseria meningitidis conjugate vaccine (PRP-OMPC) and a single lot of 15.0 micrograms lyophilized PRP OMPC. A total of 908 infants were entered into the study. Each infant received two primary injections intramuscularly 2 months apart beginning at age 2-6 months and a booster injection at 12-15 months. Blood samples for serology were obtained before each injection and 1 month after the second and the booster dose. Immune responses were measured by radioimmunoassay. Approximately 80% of the infants achieved a titer > 1.0 micrograms ml-1 after the second primary dose of all four lots tested: the geometric mean titer (GMT) was ca 3 micrograms ml-1 for each vaccine group. After the booster dose, more than 90% of infants from each vaccine group had a titer > 1.0 microgram ml-1;GMTs ranged from 8 to 10 micrograms ml-1. No serious vaccine-associated adverse reactions were reported. Thus the 7.5 liquid PRP OMPC vaccine was at least as immunogenic and well tolerated as the 15.0 micrograms lyophilized vaccine.

Bacterial Outer Membrane Proteins↗

PubMedDate not supplied

Gaulin homogenization: a mechanistic study.

Free radical-based oxidation has been detected in the normal operating regime of the Gaulin homogenizer, demonstrating that cavitation occurs in this important industrial bioprocessing equipment. Free radical generation is suppressed by imposition of back pressure, proving that such cavitation occurs in the impingement section. The calculated value of the cavitation number is consistent with submerged jet cavitation, wherein a high-speed jet exiting from the valve gap accelerates fluid in the impingement region, creating the vacuum conditions for cavitation. Using polysaccharides as a model shear-sensitive compound, their breakage pattern in the homogenizer was characterized by molecular size and polydispersity and compared to those of fluid shear flows in capillary tubes and cavitating flow from a sonic horn. The results indicate that breakage occurs primarily by fluid shear, although a contribution by cavitation is also apparent when back pressure is applied. Because biological molecules can readily react with free radicals and the alterations caused thereby are subtle in nature, a thorough evaluation of the impact of free radicals in upstream homogenization is warranted.

Biopharmaceutics↗

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Developing BSN leaders for the future: the Fuld Leadership Initiative for Nursing Education (LINE).

The Helene Fuld Leadership Initiative in Nursing Education (LINE) program was designed to enhance beginning leadership competencies of baccalaureate nursing students. Given the increasing need for strong and effective leadership throughout the health care system, and the demands new graduates encounter as they move into practice, the LINE program is built on the premise that leadership skills must be instilled at the undergraduate level. The program achieves its goal through an intensive 5-day institute focused on assessing and developing the leadership competencies of nurse educators and their clinical partners to enable them to be effective agents of curriculum change in their home institutions. The institute also assists participants to redesign their baccalaureate nursing (BSN) curricula to ensure that students learn to: (1) work effectively within and across complex, integrated organizational and institutional boundaries; (2) think and act from the perspective of a system; and (3) communicate, negotiate, lead, and facilitate change within health care organizations. D. Goleman's (1998) framework of emotional intelligence, which addresses both personal competence (managing oneself) and social competence (handling one's relationships with others) provides the framework for operationalizing leadership in the BSN curriculum. To date, 26 BSN programs and their clinical partners have participated in the LINE program, which has the potential to influence the beginning leadership development of more than 2,400 BSN students. Program outcomes reveal that education-practice collaboration, professional networking, individual leadership development of nurse educators and their clinical partners as change agents, and the integration of leadership experiences at all levels of the BSN curriculum are important in developing beginning leadership competencies in BSN students.

Communication↗

PubMedDate not supplied

Analysis of CARD15/NOD2 haplotypes fails to identify common variants associated with rheumatoid arthritis susceptibility.

OBJECTIVES: The CARD15/NOD2 gene product plays an important role in host response to bacterial lipopolysaccharides and bacterial muramyl dipeptide via activation of NF-kappaB in monocytes. Mutations in CARD15 are associated with Crohn's disease (CD), a chronic inflammatory bowel disease. In this study we sought to determine whether CD-associated mutations or any common variants of this gene might contribute to susceptibility to another chronic inflammatory disease, rheumatoid arthritis (RA). METHODS: We genotyped 376 Caucasian RA cases and 376 ethnically matched healthy controls for three CD-associated CARD15 mutations. We also genotyped these 752 individuals for 12 common CARD15 single nucleotide polymorphisms (SNPs), determined the linkage disequilibrium structure of the gene, and compared the frequencies of the common CARD15 haplotypes in the RA cases and controls. RESULTS: None of the CD-associated mutations or the CARD15 SNPs was associated with susceptibility to RA. We also found no significant difference in the frequencies of any of the common haplotypes of the CARD15 gene in RA patients and controls. Our haplotype analysis was consistent with earlier observations that all three CD-associated variants independently arose on the same ancestral haplotype. CONCLUSIONS: These data suggest that CARD15 variants are not associated with RA susceptibility.

Adolescent↗

PubMedDate not supplied

Psychiatric morbidity among adults living in private households, 2000.

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Adolescent↗

PubMedDate not supplied

Gastric colonization of the ferret with Helicobacter species: natural and experimental infections.

Helicobacter mustelae, isolated from the stomachs of adult ferrets, appears to have a world-wide distribution. Ferrets are colonized with H. mustelae at a young age, usually 5-6 weeks; in our experience 100% of adult ferrets are colonized in both the antrum and the fundus. Gastric infection correlates with elevation of serum IgG antibodies to H. mustelae. In the oxyntic mucosa the presence of superficial gastritis coincides closely with the presence of H. mustelae. In the distal antrum the organism is associated with chronic inflammation occupying the full thickness of the mucosa. In addition to lesions seen in the distal antrum, focal glandular atrophy and regeneration are noted in the proximal antrum and transitional mucosa. Antibiotics used to eradicate Helicobacter pylori in humans are also effective in eliminating H. mustelae from ferrets. H. mustelae-free ferrets do not become colonized with H. pylori when challenged orally; however, sparse colonization follows oral inoculation with a related gastric organism, "Helicobacter felis." Controlled studies of the pathophysiology of gastroduodenal disease induced by Helicobacter species can be performed in H. mustelae-infected ferrets and their H. mustelae-negative counterparts.

Age Factors↗

PubMedDate not supplied

Helicobacter pylori: causal agent in peptic ulcer. Microbiological aspects.

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Animals↗

PubMedDate not supplied

Images in Medicine. Dural venous sinus thrombosis.

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Adult↗

PubMedDate not supplied

Health status and satisfaction with health care: a longitudinal study among patients served by the Veterans Health Administration.

As the Veterans Health Administration (VHA) places high priority on becoming a performance-based organization, there is an increasing need to quantify and refine its outcome measurement system. Using panel data from VHA ambulatory care patients (1996-1998), we conducted cross-lagged correlations and ordinary least squares regression to examine the relationship between 2 VHA health care values: health status and satisfaction with care. The study results indicated that patients' health status was significantly associated with their satisfaction with care, indicating that patients with better health status were more likely to be satisfied with health care. Although satisfaction with care was both a consequence and a determinant of health status, the effects of health status on satisfaction seemed to be more important than the effects of satisfaction on health status. More research is needed for a better understanding of the dynamic relationship between health status and satisfaction with care.

Adult↗

PubMedDate not supplied

Health status in VA patients: results from the Veterans Health Study.

Recently, the Veterans Administration (VA) Under Secretary for Health has designated functional status as one of the domains of value for the system, given its increasing importance for clinical care. The Veterans Health Study (VHS) was designed to assist the VA in monitoring outcomes and measuring the case mix of patients who use the VA. The Veterans SF-36 (short form functional status assessment for veterans) was administered to 2425 veterans receiving ambulatory care. Measures of the Veterans SF-36 were strongly correlated with sociodemographics and morbidities of the veterans. Young veterans had poorer mental health status than older veterans. Veterans who used ambulatory care in the VHS reported lower levels of health status, reflecting more disease than a non-VA civilian population. These measures of health are important indicators of the disease burden or case mix of the patients and are pertinent to health systems such as the VA for resource allocation decisions and as outcomes of care.

Adult↗