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Selected Abstracts


The mental health of female sex workers

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010
W. Rössler
Rössler W, Koch U, Lauber C, Hass A-K, Altwegg M, Ajdacic-Gross V, Landolt K. The mental health of female sex workers. Objective:, There is limited information available about the mental health of female sex workers. Therefore, we aimed to make a comprehensive assessment of the mental status of female sex workers over different outdoors and indoors work settings and nationalities. Method:, As the prerequisites of a probability sampling were not given, a quota-sampling strategy was the best possible alternative. Sex workers were contacted at different locations in the city of Zurich. They were interviewed with a computerized version of the World Health Organization Composite International Diagnostic Interview. Additional information was assessed in a structured face-to-face interview. Results:, The 193 interviewed female sex workers displayed high rates of mental disorders. These mental disorders were related to violence and the subjectively perceived burden of sex work. Conclusion:, Sex work is a major public health problem. It has many faces, but ill mental health of sex workers is primarily related to different forms of violence. [source]


Reliability of Intraoperative Transesophageal Echocardiography During Tetralogy of Fallot Repair

ECHOCARDIOGRAPHY, Issue 4 2000
JAMES J. JOYCE M.D.
There is limited information available concerning the accuracy of intraoperative transesophageal echocardiography (TEE) in predicting the extent of residual abnormalities after recovery from surgical repair of tetralogy of Fallot. Therefore, we investigated differences between the results of final postbypass TEE and those of postrecovery (mean, 6 days after surgery) transthoracic echocardiography in a total of 28 consecutive pediatric patients who underwent repair of tetralogy of Fallot with biplane or multiplane TEE. Both postbypass and postrecovery echocardiographic examinations included measurements of the right ventricle (RV)-main pulmonary artery (PA) and the main PA-branch PA peak instantaneous gradients, the degree of pulmonary valvar insufficiency, and color Doppler interrogation of the ventricular septum for residual defects. The RV-main PA gradient did not change significantly: 15 ± 13 vs 18 ± 14 mmHg (postbypass versus postrecovery, mean ± SD). None of the patients had a decrease of , 10 mmHg; and only one patient had an increase of ,: 15 mmHg. There also was no change in the degree of pulmonary insufficiency (3.0 ±1.2 versus 3.1 ± 1.1, using a scale of 0 to 4). Only one of the seven very small (, 2 mm) residual ventricular septal defects was not discovered during postbypass TEE. However, postrecovery transthoracic echocardiography detected significant branch PA stenosis (peak gradient, , 15 mmHg) in five patients (18%) that was not detected during postbypass TEE (P < 0.03). Of the branch PA stenoses that were not detected during TEE, four were left and one was right. Conclusions: Postbypass TEE after tetralogy of Fallot repair reliably predicts residual postrecovery hemodynamic abnormalities, except for branch PA stenosis. [source]


What level of effect is a no observed effect?

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 2 2000
Mark Crane
Abstract The no observed effect concentration (NOEC) is currently a major summary statistic in ecotoxicity testing. Its use is heavily criticized, partly because it is a poor estimator of "safe" chemical concentrations. In this short communication, we review the limited information available on the percentage effect that corresponds with the NOEC, a value designated the ECNOEC, and calculate ECNOEC values for fish growth data. The average ECNOEC for different test protocols was found to vary widely, with values for chronic studies ranging from 10 to 34%. Individual results varied even more widely. This analysis suggests that the NOEC is neither a consistent summary statistic nor an indicator of safe concentrations of toxic chemicals. [source]


A literature review of principles, policies and practice in extended nursing roles relating to UK intensive care settings

JOURNAL OF CLINICAL NURSING, Issue 20 2008
Namita Srivastava
Aims., To provide an overview of the literature relating to the principles, policy and practice of extended nursing roles in UK intensive care settings to date; to review and critically assess evidence of impact, outcomes and effect on practice and provide suggestions for future research. Background., It is known that career development opportunities, new technologies, patient needs, as well as the reduction in junior doctors' hours, are driving the development of new roles for nurses. Policy initiatives aim to expand nursing roles to support professional substitution. In adult, neonatal and paediatric intensive care, specialist trained nurses and designated advanced nursing practitioners are increasingly taking on extended practice of clinical tasks previously undertaken by medical staff. As yet there are no statutory regulations on the perceived scope and definition of the role of extended and advanced roles. Design., Systematic review. Methods., Search of electronic databases and selection of policy and peer-reviewed reports and reviews of extended nursing roles or advanced nursing practitioners in UK intensive care settings. Results., Chronological review shows policy development proceeding in a relatively ad hoc way. There is limited information available about how extensively or effectively extended nursing roles are being implemented in intensive care settings in the UK, particularly in adult and paediatric intensive care. To test local initiative findings for reliability and generalisability, a more robust evidence base is required. Conclusions., More data are needed on definition and outcomes of extended nursing roles in intensive care and care process measures should be developed to better inform implementation of nurse role development in the UK. Relevance to clinical practice., The review of policy and research evidence in this paper may better inform clinicians working in adult, neonatal or paediatric intensive care, as they continue to be challenged by expansion and development of their role. It may also help to form a basis and evaluation for future research into extended and advanced nursing roles in intensive care settings. [source]


Effects of simvastatin on hepatic cholesterol metabolism, bile lithogenicity and bile acid hydrophobicity in patients with gallstones

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2000
Jeffery L Smith
Abstract Background and Aims: There is limited information available on the effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on hepatic and biliary cholesterol metabolism in patients with gallstones. The aims of this study were to determine the effect of simvastatin on the regulatory elements of cholesterol metabolism that determine the concentrations of cholesterol in plasma and bile. Methods: Thirty-one gallstone patients were enrolled in the study; 17 were treated with 20 mg simvastatin daily for 3 weeks prior to cholecystectomy and 14 served as controls. Samples of blood, liver, gall-bladder bile and bile from the common bile duct (CBD) were collected and analysed. Results: The plasma cholesterol (,30%), triacylglycerol (,23%) and low-density lipoprotein (LDL) cholesterol (,42%) concentrations were significantly lowered by simvastatin treatment, as was the plasma lathosterol : cholesterol (,70%), which reflects whole-body cholesterol synthesis. Despite these changes, the hepatic LDL receptor protein and LDL receptor activity in circulating mononuclear cells were similar in both groups. There were no differences in the plasma phytosterol : cholesterol, which reflects the intestinal cholesterol absorption capacity or in the activity of hepatic acyl-coenzyme A : cholesterol acyltransferase. There were however, lower cholesterol concentrations in CBD (,68%) and gall bladder (,41%) bile, and decreased lithogenic (,47%) and bile acid hydrophobicity (,22%) indices of CBD bile in the simvastatin group. Conclusions: These data indicate that simvastatin reduced plasma and biliary cholesterol levels primarily by reducing cholesterol synthesis. The reduction in CBD bile lithogenicity and bile acid hydrophobicity by simvastatin suggests that this agent may be useful for people who have early stages of cholesterol gallstone development and in whom a choleretic effect is required. [source]


Postoperative analgesic requirements , total laparoscopic hysterectomy versus vaginal hysterectomy

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005
Marcelo Carraro NASCIMENTO
Abstract Background:, There is limited information available on the requirement for postoperative analgesic drugs in patients submitted to total laparoscopic hysterectomy (TLH) compared with patients undergoing vaginal hysterectomy (VH). Aim:, To compare the postoperative analgesic requirements in patients who underwent a TLH with patients who had a VH. Methods:, Chart review of 53 patients who had TLH and 47 who had VH and were seen postoperatively by an acute pain management service in order to assess postoperative analgesic requirements. Patient controlled analgesia (PCA) was part of the standard protocol for postoperative pain management. Analgesic requirement was recorded as the mean doses of morphine and number of days that patients used non-steroidal anti-inflammatory drugs (NSAIDs), oxycodone and tramadol. Results:, The requirement for total morphine was approximately half the dose in patients who had a TLH (10.8 ± 12.6 mg) compared with patients who had a VH (19.4 ± 21.9 mg) (P 0.017). The length of use of NSAIDs was significantly reduced in patients who had undergone a TLH (2.0 ± 0.95 days) as compared with patients who had a VH (2.85 ± 1.1 days) (P < 0.0001). Conclusions:, Patients submitted to TLH require less postoperative analgesic drugs when compared with patients who had VH. Prospective randomised trials are warranted to compare analgesic requirements between patients submitted to TLH and VH. [source]


Successful treatment of profound hypothermia of the newborn

ACTA PAEDIATRICA, Issue 1 2009
P Konopova
Abstract We report a case of a profoundly hypothermic newborn with a core temperature of 25°C with a successful recovery and normal neurological outcome at 3 and 6 months. This term male infant had been exposed to a temperature of ,3°C for approximately 30 min. Slow re-warming, using external modalities was used in addition to volume expansion, heparinization, antibiotics and sedation. There is limited information available concerning the safest and most effective method of re-warming hypothermic newborns. Slow re-warming has been advocated as it replicates the normal physiological process in a neonate, which minimizes a negative therapy impact. Conclusion: The most significant decision regarding treatment is the identification of the most appropriate method and speed of re-warming. This report supports recommendations for gradual re-warming of a severely hypothermic newborn. Physiological cardiovascular mechanisms seemed to be intact during slow re-warming; this might be applicable to the treatment of profound hypothermia of the newborn. [source]