Common feeding problems in babies and children: 1.
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Child Nutritional Physiological Phenomena↗
Biomedical subjects
P Gilbert
Publications and source records attributed to P Gilbert.
Nurse triage for house call requests in a Tyneside general practice: patients' views and effect on doctor workload.
BACKGROUND: Demand for consultations in primary care has risen recently, necessitating a change in working practices. As part of this process, the possible contribution of practice nurses in the telephone assessment of home visit requests merits attention. AIMS: To survey the views of our patients encountering our nurse triage system for home visit requests, set up in June 1995, and to plot its effect on the routine visiting workload of our doctors and thus their availability at the surgery. METHOD: The outcome of each request was categorized as: doctor to visit (DV), surgery consultation with doctor (SC), nurse advice given and accepted (NA), or call passed to doctor for advice (DA). Frequency data from September 1995 to December 1996 were recovered. Questionnaires for self-completion were sent to all those requesting a routine weekday house call during two four-week periods in 1995 and 1996. RESULTS: Analysable activity data revealed 1764 house call requests, with 41% DV, 18% SC, 24% NA, and 8% DA. In the first survey, 121 questionnaires were sent out and 84 returned (69% response rate) and, in the second, the corresponding figures were 113, 85, and 75%. About 80% of responders reported that they were satisfied with the help received from the nurse. CONCLUSIONS: Nurse triage of house call requests has led to more efficient care for our patients, as we have increased the availability of surgery consultations by reducing the number of house calls made by our general practitioners.
Family Practice↗
Common feeding problems in babies and children: 2.
Weaning is the cause of much concern among first-time mothers. A milk-only diet is advised until 3-4 months of age. Health professionals should ensure the baby receives a sufficient and balanced diet during the weaning period, to meet the needs for energy and growth. Breast milk or infant formula should continue up to the age of at least one year. The weaning period is a good time to educate parents in good nutrition. A wide variety of foods should be the aim in child nutrition, but each different type needs to be started separately during weaning. Care is needed to ensure vegetarian babies receive enough proteins, vitamins and minerals (especially iron). Failure to thrive has a multitude of causes, and treatment must be that of the cause. Strictly vegan children who eat no dairy products will need added synthetic vitamin B12. Failure to thrive may be due to physical problems (eg choanal atresia), infection, vomiting, diarrhoea, anorexia, parental ignorance or poverty. Other causes include coeliac disease, cow's milk protein allergy, cystic fibrosis, severe eczema or asthma, or diabetes.
Child Nutrition Sciences↗
Skin problems in children: 1. Infections in the early years.
The skin is an organ which has many important functions for body maintenance and health. The condition of the skin is a good indicator of health and disease. A rash has many diagnostic features. Bacteria, virus and fungi all give rise to specific effects on the skin. Some skin infections are localised, affecting only a small area of skin, while others cover extensive areas of the body. Some skin infections are systemic, ie affect the body as a whole, often producing both internal and external symptoms. A sound knowledge of skin infections will enable the nurse or midwife to give the parents appropriate advice and reassurance, and to make appropriate referrals.
Child↗
Skin problems and parasites in children: 2. Parasitic worms.
The skin is an organ which has many important functions for body maintenance and health. Infestation by a wide variety of worms is a worldwide public health problem. Threadworms are believed to infect up to 50% of London school children. Dogs and other pets have much to teach children but regular care of pets should include attention to hygiene. Nurses and midwives can help to educate the public about worms and their advice can help prevent toxocara infections.
Adult↗
The development of a small-scale biofilm model suitable for studying the effects of antibiotics on biofilms of gram-negative bacteria.
A method for the study of membrane-associated biofilm populations of Escherichia coli ATCC 8739 using modified Swinnex filter units was developed. Biofilms were established under carbon limitation in a chemically defined simple salts medium. Cells, pressure filtered on to cellulose nitrate membranes in situ, were perfused from the sterile side. Steady-state conditions were attained at which the growth rate of the sessile cells could be demonstrated to be proportional to the flow rate of medium. The antibiotic susceptibility of these biofilms was examined by including ciprofloxacin within the perfusing medium. Susceptibility of the biofilms to ciprofloxacin was found to be affected not only by its concentration, but also by the growth rate of the bacteria.
Anti-Infective Agents↗
In-vitro studies of the activity of glycopeptide combinations against Enterococcus faecalis biofilms.
Perfused biofilms of Enterococcus faecalis reached a pseudo-steady state, with respect to bioburden and the numbers of cells liberated within the perfusates. Biofilm growth rate was slow (approximately 0.006 doublings/h) relative to batch culture (approximately 0.01 doublings/h). MICs were determined for vancomycin (0.12 mg/L) and teicoplanin (1.2 mg/L) in batch culture. Steady-state biofilms (24 h and 48 h) were perfused continuously for 96 h with medium containing antibiotic at 4 X MIC. Susceptibility was assessed as cfu in the perfusate, indicating growth inhibition, and as cfu for the parent biofilm. Vancomycin at these levels had little or no effect on either parameter, whilst teicoplanin produced a temporary (30 h) reduction in growth rate (99.99% for 24 h biofilms, 50% for 48 h biofilms). Antibiotic concentrations were raised to therapeutic (trough) levels (vancomycin, 5 mg/L; teicoplanin, 12 mg/L) and applied continuously to 24 h old biofilms. Neither agent affected viability of the biofilm over 96 h. Biofilm growth rate, however, was decreased markedly over the first 8-10 h of antibiotic treatment and was maintained at the reduced level for approximately 40 h. Thereafter growth of the biofilms gradually returned to pre-exposure levels. The pattern of recovery was different for the two agents suggesting that different mechanisms might be involved. Accordingly biofilms were exposed to successive and concurrent 24 h treatments with vancomycin (5 mg/L) and teicoplanin (12 mg/L). This led not only to a further 2-3 log reduction in the growth rate but also to a 3 log reduction in the viability of the parent biofilm. Such synergy between the glycopeptide agents might have therapeutic implications for the treatment of E. faecalis infection.
Anti-Bacterial Agents↗
Submissive behaviour and psychopathology.
OBJECTIVES: A variety of behaviours have been identified as submissive (Buss & Craik, 1986). These are believed to be associated with vulnerability to psychopathology. This paper explores the construct and measurement of submissive behaviours and their association with psychopathology. DESIGN: Two self-report scales were designed to measure the frequencies of (a) typical submissive behaviours (SBS) and (b) passive/withdrawal and affiliative strategies focused on conflict de-escalation (CDS). The association of these scales with psychopathology was explored in a series of questionnaire studies. METHODS: Study 1 assessed the SBS using a student sample (N = 332) and a mixed clinical group (N = 136). Of these, 177 students and 66 patients also completed the SCL-90-R. In Studies 2 and 3, the CDS and its association with depressive symptoms were assessed using a student sample (N = 154) and a depressed patient group (N = 60). RESULTS: The SBS and CDS appeared reliable. There was a positive relationship between the SBS and the SCL-90-R, including interpersonal sensitivity and unexpressed hostility. The passive/withdrawal subscale of the CDS was associated with depressive symptoms. Evidence was obtained for sex differences with the affiliative subscale. CONCLUSIONS: Some forms of submissive behaviour, especially those associated with passive/withdrawal and inhibition, are associated with a wide range of psychological problems.
Adult↗
The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy.
This paper suggests that humans have innate needs to be seen as attractive to others. These needs form the basis for shame and mediate evaluations of social standing (status), social acceptance and social bonds. Shame and humiliation are associated with attacks on, and losses of, social attractiveness. The internal experiences of shame are derived from submissive strategies where one seeks to signal to others awareness of loss of social standing and limit possible damage. However, it is suggested that shame and humiliation differ from each other in a number of ways. For example, in shame the focus is on the self, while in humiliation the focus is on the harm done by others. Variations in the defensive strategies of shame and humiliation (e.g. avoidance, escape versus aggression and revenge) can pose particularly difficult problems in therapy. A focus on the role of social attractiveness in shame also allows for important distinctions to be drawn between shame and guilt.
Attention↗
Biofilm susceptibility to antimicrobials.
Microbial biofilms, where organisms are intimately associated with each other and a solid substratum through binding and inclusion within an exopolymer matrix, are widely distributed in nature and disease. In the mouth, multispecies biofilms are associated not only with dental plaque and tooth decay but also with soft tissues of the buccal cavity and with most forms of periodontal disease. Organization of micro-organisms within biofilms confers, on the component species, properties which are not evident with the individual species grown independently or as planktonic populations in liquid media. While many of these properties relate to the establishment of functional, mixed-species consortia within the exopolymeric matrices, others relate to the establishment of physico-chemical gradients, within the biofilm, that modify the metabolism of the component cells. A consequence of biofilm growth that has profound implications for their control in the environment and in medicine is a markedly enhanced resistance to chemical antimicrobial agents and antibiotics. Mechanisms associated with such resistance in biofilms will form the substance of the present review. While some aspects of biofilm resistance are yet only poorly understood, the dominant mechanisms are thought to be related to: (i) modified nutrient environments and suppression of growth rate within the biofilm; (ii) direct interactions between the exopolymer matrices, and their constituents, and antimicrobials, affecting diffusion and availability; and (iii) the development of biofilm/attachment-specific phenotypes.
Anti-Bacterial Agents↗
Impact of caregivers on the symptoms of dementia.
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Caregivers↗
Overconfidence and personal evaluations of social rank.
Research on confidence judgements suggests that people are often overconfident. However, some studies have found that depressed mood reduces this positive bias. To date this has been explained as a mood phenomenon. In this study we explore an alternative theory which suggests that confidence is related to internal judgements of social rank and status. This theory suggests that the lower one perceives oneself to be in status and rank the less one can afford to be overconfident. Data from a student population suggests that confidence judgements are associated with internal judgements of status.
Adolescent↗
A short measure of social and separation anxiety.
Separation and social anxiety have often been seen to relate to different social fears. This paper outlines a pilot study on a short separation and social anxiety scale in relationship to depression. Results suggest an acceptable factor structure and reliability. Both separation and social anxiety were found to be associated with depression and submissive behaviour. The association of social anxiety to depression was particularly strong in a depressed group.
Adult↗
A Novel Strategy for Control of Microbial Biofilms through Generation of Biocide at the Biofilm-Surface Interface.
Biofilms of a mucoid clinical isolate of Pseudomonas aeruginosa (24 h; ca. 10(sup6) CFU/cm(sup2)) were established by immersion of polymer discs in nutrient broth cultures at 37(deg)C. Biofilms exposed for 30 min to various concentrations (0 to 3 mg/ml) of hydrogen peroxide or potassium monopersulfate were rinsed and shaken vigorously in sterile saline to detach loosely associated cells, and the residual viable attached population was quantified by a blot succession method on agar plates. Incorporation of copper and cobalt phthalocyanine catalysts within the polymers significantly enhanced the activity of these oxidizing biocides towards biofilm bacteria by several orders of magnitude. Biofilms established on the control discs resisted treatment with concentrations of either agent of up to 3 mg/ml. Enhancement through incorporation of a catalyst was such that concentrations of potassium monopersulfate of as low as 20 (mu)g/ml gave no recoverable survivors either on the discs or within the washings. Catalysts such as these will promote the formation of active oxygen species from a number of oxidizing agents such as peroxides and persulfates, and it is thought that generation of these at the surface-biofilm interface concentrates the antimicrobial effect to the interfacial cells and generates a diffusion pump which further provides active species to the biofilm matrix. The survivors of low-concentration treatments with these agents were more readily removed from the catalyst-containing discs than from the control discs. This indicated advantages gained in hygienic cleansing of such modified surfaces.
Journal Article↗
Characteristics of pregnant substance abusers in two cities in the northeast.
This study examined the drug use patterns of pregnant women in two inner city sites, selected to overrepresent cocaine users. Women who used cocaine were much more likely to have used some combination of cigarettes, alcohol, and marijuana in addition to cocaine during pregnancy. There was little difference in the patterns of drug use in the two study sites, Trenton, New Jersey, and northwestern Philadelphia. A number of demographic and lifestyle variables of cocaine users, soft drug users (cigarettes, alcohol, and/or marijuana), and abstainers were compared. The cocaine-using group was significantly older and had more children, had less stable and more isolated living situations, was less likely to be employed and more likely to be receiving public assistance during pregnancy, and was more likely to have a higher drug- and alcohol-using social environment and family history than soft drug users or abstainers. Of significance was that many of the high-risk lifestyle factors exhibited by cocaine users were also seen, albeit to a lesser extent, among the soft drug users. These findings have implications for the timing of intervention strategies that would be most effective.
Adult↗
Micronodulation: ultrasonographic sign of Hashimoto thyroiditis.
The purpose of this work is to assess the validity of an ultrasonographic sign, micronodulation, in the diagnosis of Hashimoto thyroiditis. Among 101 patients found to have ultrasonographic features of micronodulation, 57 patients had autoantibody test results available. Fifty-four patients were positive and three were negative for the autoantibodies. Therefore, the positive predictive value for micronodulation in diagnosing Hashimoto thyroitis is 94.7%. The micronodules were 0.1 to 0.65 cm in size, hypoechoic, and surrounded by an echogenic rim. This corresponds to accentuated lobulation on the pathologic specimen. Although micronodulation is highly diagnostic of Hashimoto thyroiditis, the ultrasonographic features of eight biopsy-proved masses caused by Hashimoto thyroiditis varied and were not specific for the disease.
Adolescent↗
Quantification of the ease of removal of bacteria from surfaces.
This paper describes a technique which reproducibly quantifies the ease of removal of microorganisms from surfaces. Tiles (22 mm x 22 mm) of various materials were colonised with Staphylococcus epidermidis NCTC 11047, Escherichia coli K12 HB101 or Pseudomonas aeruginosa PaWH, by submersion, for various times (2 min-48 h), in inoculated Tryptone Soya broth (37 degrees C). Colonised tiles were blotted onto a Tryptone Soya agar plate for 1 min and the process was repeated through a succession of agar plates. The final plate contained tetrazolium salts (0.05% w/v) and was incubated in situ with the tile. Tetrazolium plates indicated that very few organisms remained on the tiles after 15 successive blots. In all instances, the number of recovered colonies per plate decreased exponentially with plate succession number, according to the relationship, CFU = A.10-kN, where CFU is the number of colonies transferred, k is the removal exponent, A is the intercept and N is the plate succession number. Removal exponents differed significantly between organisms (P > 0.95), depended on the nature of the test surface, and decreased as the inital attachment and colonisation time was increased from 2 min-48 h. Intercept values (A) but not the gradients were dependent upon the initial numbers of bacteria in suspension. These data indicate that the gradients derived from counting recoverable viable cells from successive blots of test tiles onto agar is a measure of the strength of attachment of the organisms to the surface.
Bacteria↗
Modification by surface association of antimicrobial susceptibility of bacterial populations.
In the majority of natural situations in which bacteria are found, they are associated with and attached to surfaces. In the presence of moisture and nutrients, they grow to form extensive bacterial films which are often enveloped within copius exopolymeric matrices. Biofilms are ubiquitous to many different situations in industry, the environment and medicine. Their presence can be either beneficial or more commonly detrimental to such systems. In this respect, biofilm populations possess physiological properties distinct from those of unattached, planktonic bacteria. Moreover, it is generally accepted that bacteria growing within a biofilm are more resistant to antimicrobial agents than their planktonic counterparts. However, although the consequences of attachment to antimicrobial resistance have been known for many years, the mechanistic bases for such effects have still to be fully elucidated. In this article the nature of different resistance mechanisms, including those of the exopolymeric matrix, environmental modulation, attachment-specific physiologies and quorum sensing are reviewed.
Bacteria↗