Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Servicios de Salud del Trabajador , Salud Laboral , Servicios Preventivos de Salud , Lugar de Trabajo , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Humanos , Pronóstico , Medición de Riesgo , Factores de RiesgoAsunto(s)
Políticas Editoriales , Enfermeras Obstetrices , Investigación en Enfermería/organización & administración , Revisión de la Investigación por Pares/métodos , Publicaciones Periódicas como Asunto , Rol Profesional , Humanos , Enfermeras Obstetrices/organización & administración , Sesgo de Publicación , Proyectos de InvestigaciónRESUMEN
The Chilean isopod Excirolana hirsuticauda is a marine benthic brooder with wide distributional range and low potential for long-distance dispersal. Eleven microsatellite markers were developed for E. hirsuticauda using enriched libraries. Characterization of those loci in 35 individuals from Playa Blanca beach showed high allelic diversity with a mean of 10.9 alleles per locus. The average expected and observed heterozygosities were 0.65 and 0.41. These microsatellite loci are the first published for any Excirolana species and should be useful to study the genetic structure of E. hirsuticauda.
RESUMEN
Products containing mesalazine have been used in the treatment of inflammatory bowel disease for many years. Many of the oral, modified-release products are reaching the point of patent expiration, and it is expected that several new 'generic' versions will be developed. As mesalazine acts topically, the drug needs to be available at the site of inflammation to be effective. For this reason, the currently available products have been developed with individual formulations so that physicians have a choice when matching the different release profiles to the site and extent of disease. As such, the current guidelines state that oral, delayed-release mesalazine formulations are not interchangeable and should be prescribed by their proprietary (brand) name. The standard regulatory assessment process for generic or 'copy' products, using systemic bioequivalence data, does not appear to be sufficient when evaluating topically acting, oral, modified-release products. We therefore recommend that the regulatory bodies should require that new, oral mesalazine products should be assessed by a combination of dissolution, bioequivalence and (a minimum of one) adequately powered, comparative trial to determine therapeutic equivalence. Of most importance here is that the assessment of new modified-release products is sufficiently rigorous to allow patients and physicians to be confident in their use.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacocinética , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Mesalamina/farmacocinética , Administración Oral , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Colitis Ulcerosa/metabolismo , Enfermedad de Crohn/metabolismo , Medicamentos Genéricos/administración & dosificación , Medicamentos Genéricos/efectos adversos , Humanos , Enfermedades Inflamatorias del Intestino/metabolismo , Mesalamina/efectos adversos , Equivalencia TerapéuticaRESUMEN
OBJECTIVE: to explore current policies and practices in maternity units that aim to identify, assess and support women experiencing domestic violence. DESIGN AND SETTING: a postal survey, conducted between June and October 1999, of all NHS Trusts in England and Wales that provided maternity services. PARTICIPANTS: Heads of Midwifery or the midwife with expertise or interest in domestic violence in each Trust. MAIN OUTCOME MEASURES: use of written policies and agreed practices for identifying and referring women experiencing domestic violence, such as availability of information, routine questioning of all women and offering women an appointment without their partner. RESULTS: 87% (183) of the 211 NHS Trusts providing maternity care participated in the survey. Twelve per cent of units had written policies for identifying women experiencing domestic violence, and a further 30% had some form of agreed practice. Less than half of maternity units routinely offered women an appointment without their partner, and just over half displayed material about domestic violence in places where women receive maternity care. Only three units had undertaken audit on their domestic violence practices. CONCLUSIONS: there is considerable variability around England and Wales in policies and practices related to domestic violence. It is evident that clear guidelines for identification and referral, training, audit and the integration of domestic violence policies with child protection and other policies are necessary to fully address the issues.
Asunto(s)
Política de Salud , Servicios de Salud Materna/organización & administración , Enfermeras Obstetrices/organización & administración , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/prevención & control , Maltrato Conyugal/diagnóstico , Maltrato Conyugal/prevención & control , Educación Continua en Enfermería , Inglaterra , Femenino , Humanos , Capacitación en Servicio , Enfermeras Obstetrices/economía , Auditoría de Enfermería , Investigación en Evaluación de Enfermería , Política Organizacional , Guías de Práctica Clínica como Asunto , Embarazo , Derivación y Consulta/organización & administración , Medicina Estatal/organización & administración , Encuestas y Cuestionarios , GalesRESUMEN
The predominant microflora recovered from infected dentine of 52 carious teeth from 14 children with nursing caries was determined using both selective and non-selective media for the isolation of specific genera and acidified media (pH 5.2) to isolate the predominant aciduric microorganisms, and compared with the microflora of sound enamel surfaces in caries-free children. Streptococcus mutans formed a significantly greater proportion of the lesion flora while Streptococcus oralis, Streptococcus sanguis and Streptococcus gordonii formed a significantly greater proportion of the plaque flora from sound tooth surfaces. The proportions of Actinomyces naeslundii and Actinomyces odontolyticus were significantly greater in the plaque samples than in the lesion samples. Actinomyces israelii formed 18.2% of the flora from the lesions, but was not isolated from the plaque samples. The proportions of Candida albicans, Lactobacillus spp. and Veillonella spp. were also significantly greater in the carious dentine than in the plaque samples. The most frequently isolated lactobacilli were Lactobacillus casei, Lactobacillus fermentum and Lactobacillus rhamnosus. The predominant aciduric flora was S. oralis, S. mutans and A. israelii and these taxa were also isolated from a similar proportion of the lesions at pH 7.0. Strains of S. mutans, L. casei, L. fermentum and L. rhamnosus isolated from individual carious teeth were genotyped using PCR-based methods. Each species was genotypically heterogeneous and different genotypes were recovered from different carious teeth in the same child. These data indicate that the microflora of lesions in the same child is microbiologically diverse and support a non-specific aetiology for nursing caries in which the physiological characteristics of the infecting flora, not its composition, is the major determinant underlying the disease process.
Asunto(s)
Alimentación con Biberón/efectos adversos , Caries Dental/microbiología , Bacterias Grampositivas/clasificación , Actinomyces/clasificación , Técnicas Bacteriológicas , Candida albicans/crecimiento & desarrollo , Distribución de Chi-Cuadrado , Preescolar , Recuento de Colonia Microbiana , Medios de Cultivo , Esmalte Dental/microbiología , Placa Dental/microbiología , Dentina/microbiología , Variación Genética/genética , Genotipo , Humanos , Concentración de Iones de Hidrógeno , Lactobacillus/clasificación , Lactobacillus/genética , Lacticaseibacillus casei/crecimiento & desarrollo , Reacción en Cadena de la Polimerasa , Estadísticas no Paramétricas , Streptococcus/clasificación , Streptococcus mutans/genética , Streptococcus mutans/crecimiento & desarrollo , Streptococcus oralis/crecimiento & desarrollo , Streptococcus sanguis/crecimiento & desarrollo , Diente Primario/microbiología , Veillonella/clasificaciónRESUMEN
Although women who experience domestic violence seek healthcare services frequently, screening and counseling rates remain low, and healthcare professionals report feeling inadequately trained to care for abused women. The English language literature from 1989 to 1999 was searched to identify and evaluate published assessments of the education of healthcare providers in domestic violence toward women. Major deficiencies in program evaluation were found. They included the use of a historical comparison group, lack of an experimental design, selection of nonstandardized outcomes without clinical performance measures, short-term follow-up, limited documentation of course content and theory, and lack of focus on the impact of programs on abused women. Educational programs generally consisted of a single session of limited duration (1-3 hours). Based on published reports, it appears that few rigorously designed evaluations have been conducted of training programs for healthcare providers in the detection and treatment of women affected by domestic violence.
Asunto(s)
Violencia Doméstica/prevención & control , Educación Médica Continua , Educación Continua en Enfermería , Servicios de Salud para Mujeres , Curriculum , Educación/normas , Femenino , Humanos , Evaluación de Programas y Proyectos de Salud , Estados UnidosAsunto(s)
Enfermería Maternoinfantil/métodos , Evaluación en Enfermería/métodos , Palpación/métodos , Palpación/enfermería , Atención Posnatal/métodos , Periodo Posparto/fisiología , Trastornos Puerperales/enfermería , Recuperación de la Función , Hemorragia Uterina/enfermería , Útero/anatomía & histología , Útero/fisiología , Femenino , Humanos , Enfermería Maternoinfantil/normas , Enfermeras Obstetrices , Evaluación en Enfermería/normas , Investigación en Evaluación de Enfermería , Palpación/normas , Periodo Posparto/psicología , Valor Predictivo de las Pruebas , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/psicología , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/psicologíaAsunto(s)
Partería/métodos , Palpación/enfermería , Periodo Posparto/fisiología , Hemorragia Uterina/enfermería , Útero/anatomía & histología , Estudios de Casos y Controles , Continuidad de la Atención al Paciente , Documentación/métodos , Inglaterra , Femenino , Humanos , Atención Posnatal/métodos , Embarazo , Excreción Vaginal/enfermeríaRESUMEN
The objective of this study was to assess the pattern of change in salivary immunoglobulins and antibodies to S. mitis and S. oralis in 23 children following allogeneic bone marrow transplantation and their matched controls. To overcome the difficulty of obtaining a sufficient quantity of whole saliva from very young, sick children saliva was collected in a 5-ml oral rinse of sterile normal saline. It was not possible to measure the volume of whole saliva in each rinse and the concentration of the salivary immunoglobulins and bacterial antibodies were estimated from 1 ml of oral rinse. Despite these shortcomings a pattern of change in the mean concentrations of total salivary IgA, secretory IgA, antibodies to S. mitis and S. oralis and total IgG at specific event- related times during the transplantation period has been demonstrated. There was a significant increase in the concentration of salivary IgG 7 days post-transplantation, followed by significant decreases in total salivary IgA, secretory IgA and antibodies to S. mitis after recovery of the peripheral neutrophil count above 0.5 x 10(9). The concentrations of total IgA and antibodies to S. oralis was significantly greater in the transplant group 119 days post-transplantation.
Asunto(s)
Anticuerpos Antibacterianos/análisis , Trasplante de Médula Ósea , Inmunoglobulina A Secretora/análisis , Inmunoglobulina G/análisis , Saliva/inmunología , Streptococcus oralis/inmunología , Streptococcus/inmunología , Anticuerpos Antibacterianos/inmunología , Niño , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Huésped Inmunocomprometido , Inmunoglobulina A Secretora/inmunología , Inmunoglobulina G/inmunología , Control de Infecciones , Masculino , Boca/microbiología , Reproducibilidad de los Resultados , Manejo de Especímenes , Irrigación Terapéutica , Acondicionamiento PretrasplanteRESUMEN
OBJECTIVE: To describe the range of normal vaginal loss as reported by women from 24 hours after delivery until three months postnatally. SETTING: Two health districts in the south of England. METHODS: A prospective survey of women's experiences and expectations of the duration, amount and colour of vaginal loss after childbirth. The term vaginal loss includes all types of fluid loss from the vagina following childbirth. FINDINGS: Five hundred and twenty-four women were recruited to the survey in 1995. Vaginal loss, as reported by the women, was considerably more varied in duration, amount and colour than descriptions in current midwifery textbooks. The median number of days reported for the duration of vaginal loss was 21 days and the interdecile range (10th to 90th percentile) was 10-42 days. For colour of lochia, women overall reported their vaginal loss to be more predominantly red/brown in colour and the traditional descriptions of the timing and colour phases of lochia rubra, serosa and alba are not supported by the majority of the women's experiences. Primiparous women were significantly more likely to report feelings of surprise or shock about their experiences of vaginal blood loss after the birth (odds ratio 4 [95% Confidence Interval 2-9]). Seven primiparous women (2%) were unaware that they would have a blood loss at all after the birth. IMPLICATIONS FOR PRACTICE: The findings from this survey have been used to develop information leaflets for women and health professionals about vaginal loss following childbirth. These leaflets include descriptions of normal ranges for the colour, amount and duration of vaginal loss in the first three months after childbirth.
Asunto(s)
Actitud Frente a la Salud , Líquidos Corporales/fisiología , Periodo Posparto/fisiología , Periodo Posparto/psicología , Vagina/fisiología , Adolescente , Adulto , Color , Femenino , Humanos , Embarazo , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
To examine the influence of cytoplasmic morphology on the success rate of intracytoplasmic sperm injection (ICSI), the morphology of 837 metaphase II oocytes was assessed after cumulus stripping. The main abnormalities detected were excessive granularity, cytoplasmic inclusions such as vacuoles, smooth endoplasmic reticulum clustering and refractile bodies. Microinjection was performed in 538 oocytes with normal cytoplasm, 142 out of 161 with excessive granularity and 112 out of 138 with cytoplasmic inclusions. Very poor oocytes were not injected. No difference was found in fertilization rate. The embryos achieved cleaved normally and a similar number of good quality embryos among the three groups was noted. The outcome of transfer of embryos derived solely from normal oocytes (group A: 72 patients, 183 embryos) was compared with those from oocytes with cytoplasmic abnormalities (group B: 34 patients, 85 embryos). In group A, 17 clinical pregnancies (24% per patient, implantation rate 10%) were established. In group B, only one clinical pregnancy (3% per patient, implantation rate 1%) was established, from the transfer of embryos derived from oocytes with homogeneous granularity of the cytoplasm. No pregnancy resulted following the transfer of embryos from eggs with cytoplasmic inclusions. The difference was statistically significant. The outcome of ICSI is dependent on the quality of the oocytes retrieved. Normal fertilization and early embryo development were achieved in oocytes with abnormal cytoplasm morphology, but the resulting embryos failed to demonstrate the same implantation potential as those derived from oocytes with normal cytoplasm.
Asunto(s)
Fertilización In Vitro/métodos , Oocitos/ultraestructura , Espermatozoides , Adulto , Citoplasma/patología , Citoplasma/ultraestructura , Transferencia de Embrión , Desarrollo Embrionario y Fetal , Femenino , Humanos , Infertilidad Masculina/terapia , Masculino , Microinyecciones , Oocitos/patología , Embarazo , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Metallothionein is a ubiquitous low molecular weight metalloprotein with powerful protective properties against oxygen radical-mediated cytotoxicity associated with inflammatory processes. In rheumatoid arthritis, the inflammatory damage to the synovium appears to be mediated by free radicals released by the high concentration of neutrophils found in the synovial fluid of the inflamed joint. Synovial tissue obtained during routine surgery on rheumatoid and non-rheumatoid joints was subjected to an indirect immunoperoxidase protocol for the immunolocalization of metallothionein using mouse monoclonal anti-metallothionein antibody E9, reactive against the two major isoforms of mammalian metallothionein. A layer of large dendritic-like cells situated subsynovially in the rheumatoid synovium stained very positively for the metalloprotein, both cytoplasmically and in their nuclei. These cells were not found in non-rheumatoid osteoarthritic or in undamaged synovial tissue associated with traumatic joint injury. An attempt was made to investigate their lineage using a series of antibody markers against epithelial cells, endothelial cells, smooth muscle, mesothelial cells, fibroblasts, neutrophils, dermal dendrocytes, macrophages, low and high molecular weight cytokeratin as well as a cell proliferation marker. From our results, it is suggested that these metallothionein-positive cells are probably myofibroblasts similar to the highly motile cells present in granulation tissue. They may originate from perivascular areas of synovium and their movement into the inflamed synovium may reflect the cytoprotective role of metallothionein acting as a free radical scavenger against oxidative damage.
Asunto(s)
Artritis Reumatoide/patología , Metalotioneína/análisis , Membrana Sinovial/química , Antígenos CD/análisis , Antígenos CD/inmunología , Antígenos de Diferenciación Mielomonocítica/análisis , Antígenos de Diferenciación Mielomonocítica/inmunología , Artritis Reumatoide/metabolismo , Biomarcadores/análisis , Factor XIII/análisis , Factor XIII/inmunología , Humanos , Inmunohistoquímica , Osteoartritis/patologíaRESUMEN
Three and four-year-old Caucasian and Afro-Caribbean children (n = 641) attending childcare facilities in the London boroughs of Lambeth, Lewisham and Southwark were studied in order to determine the prevalence of caries and caries-associated micro-organisms and the interactions between these for each of the racial groups; dmft (decayed, missing or filled teeth) scores were recorded using British Association for the Study of Community Dentistry criteria. Saliva and plaque samples were taken from each child and the numbers of mutans streptococci, lactobacilli and yeasts per sample were determined. The mean dmft scores of the 3- and 4-year-old Afro-Caribbean children were 0.36 +/- 0.10 and 0.51 +/- 0.13, respectively, compared to 0.80 +/- 0.17 and 1.48 +/- 0.24 for the equivalent Caucasian children (p < 0.001). Mutans streptococci and lactobacilli were recovered less frequently from the Afro-Caribbean children than from the Caucasian, but in both groups there were significant correlations between the plaque and salivary levels of mutants streptococci and caries experience. In both groups, children from whom both mutans streptococci and lactobacilli were isolated had the greatest mean dmft scores and these were not significantly different. Multiple regression analyses demonstrated that, after controlling for age and dmft, there were still significant associations between race and salivary levels of mutans streptococci and lactobacilli, p = 0.0013 and p = 0.0167, respectively. These data indicate that Afro-Caribbean children had lower levels of dental caries than Caucasian children living in the same London boroughs and attending the same preschool care facilities and, after controlling for age and caries experience, they also had lower salivary levels of mutans streptococci and lactobacilli.
Asunto(s)
Población Negra , Caries Dental/epidemiología , Placa Dental/microbiología , Etnicidad , Lactobacillus/aislamiento & purificación , Saliva/microbiología , Streptococcus mutans/aislamiento & purificación , Población Blanca , África/etnología , Factores de Edad , Región del Caribe/etnología , Preescolar , Recuento de Colonia Microbiana , Índice CPO , Caries Dental/microbiología , Restauración Dental Permanente/estadística & datos numéricos , Humanos , Londres/epidemiología , Prevalencia , Análisis de Regresión , Pérdida de Diente/epidemiología , Levaduras/aislamiento & purificaciónRESUMEN
OBJECTIVE: To evaluate the effect of NG-monomethyl-L-arginine (L-NMMA) on sperm motility. DESIGN: Controlled study using motile sperm suspensions obtained by the swim-up technique. SETTING: Endocrine Laboratory, Department of Obstetrics and Gynaecology, University College London Medical School. PATIENTS: Men attending the Reproductive Medicine Unit at University College London Hospitals, Obstetric Hospital, for routine fertility investigations. INTERVENTIONS: Motile sperm suspensions were incubated with either culture medium (control) or L-NMMA (test) for 24 hours at 37 degrees C. MAIN OUTCOME MEASURE: Motion characteristics were assessed manually and by computer-assisted sperm motility analyzer. RESULTS: In all 23 preparations either equivalent or significantly higher percentage total motility and percentage rapidly motile sperm were observed in the test compared with the control samples at 24 hours. There were no significant differences in motion characteristics between test and control specimens at 6 hours. CONCLUSIONS: NG-monomethyl-L-arginine inhibits the formation of nitric oxide; its ability to prevent sperm motility decline indicates that the arginine-nitric oxide pathway may play a role in modulating sperm motility and motility survival.
Asunto(s)
Inhibidores Enzimáticos/farmacología , Óxido Nítrico Sintasa/antagonistas & inhibidores , Motilidad Espermática/efectos de los fármacos , omega-N-Metilarginina/farmacología , Humanos , Masculino , Recuento de EspermatozoidesRESUMEN
A prospective randomized study was designed to compare gamete intra-Fallopian transfer (GIFT) and in-vitro fertilization (IVF) and embryo transfer in the treatment of couples who have failed to conceive after at least three cycles of ovarian stimulation and intrauterine insemination (IUI). A total of 69 couples with primary unexplained infertility of at least 2 years' duration plus at least three failed cycles of ovarian stimulation and IUI were randomly allocated to either GIFT or IVF/embryo transfer. The clinical pregnancy rate was 34% after GIFT treatment and 50% after IVF/embryo transfer. This difference was not statistically significant. The twin rate in the IVF/embryo transfer group was higher than in the GIFT group (53 versus 17%, P = 0.005). We conclude that patients with unexplained infertility and failed ovarian stimulation and IUI can still achieve encouraging pregnancy rates with IVF/embryo transfer or GIFT. Since IVF/embryo transfer is the least invasive of the two procedures and may yield diagnostic information, we would favour this therapy; however, the number of embryos transferred should be reduced to two to reduce the risk of twin pregnancy.
Asunto(s)
Buserelina/uso terapéutico , Gonadotropina Coriónica/uso terapéutico , Fertilización In Vitro , Transferencia Intrafalopiana del Gameto , Técnicas Reproductivas , Adulto , Transferencia de Embrión , Femenino , Humanos , Inseminación Artificial Homóloga , Masculino , Inducción de la Ovulación/métodos , Embarazo , Resultado del Embarazo , Índice de Embarazo , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento , Gemelos , ÚteroRESUMEN
Information about postnatal home visiting is presented from a postal survey of all directors of midwifery in English NHS districts, carried out in April and May 1991. The main finding was that almost all districts had changed from the traditional policy of daily home visits up to the tenth postnatal day to selective home visits by midwives. What was meant by 'selective' varied greatly, however, and the study highlighted the need to carry out audits of postnatal midwifery visiting.