Primary health care nurses' promotion of involuntary migrant families' health.

BACKGROUND: Involuntary migrant families in cultural transition face a number of challenges to their health and to family cohesion. Primary health care nurses (PHCNs) therefore play a vital role in the assessment and promotion of their health. AIM: The aim of this study was to describe the promotion of health in involuntary migrant families in cultural transition as conceptualized by Swedish PHCNs. METHOD: Interviews were conducted with 34 strategically chosen PHCNs covering the entire range of the primary health care sector in two municipalities of Southern Sweden. A contextual approach with reference to phenomenography was used in interpreting the data. FINDINGS: There are three qualitatively different descriptive categories epitomizing the characteristics of the PHCNs' promotion of health: (1) an ethnocentric approach promoting physical health of the individual, (2) an empathic approach promoting mental health of the individual in a family context, and (3) a holistic approach empowering the family to function well in everyday life. CONCLUSIONS: For nurses to promote involuntary migrant families'health in cultural transition, they need to adopt a holistic approach. Such an approach demands that nurses cooperate with other health care professionals and community authorities, and practise family-focused nursing; it also demands skills in intercultural communication paired with cultural self-awareness in interacting with these families. Adequate knowledge regarding these skills should therefore be included in the education of nurses, both at under- and at post-graduate level.

Physical performance and muscular characteristics in different stages of COPD.

This study has examined exercise capacity and muscle morphology in patients with different severities of chronic obstructive pulmonary disease (COPD). Twenty-three patients and 12 healthy matched controls were recruited. Based on the severity of airflow obstruction, patients were divided into two subgroups. Exercise capacity was determined using a 6-min walk test. Muscle fiber composition, fiber area and number of satellite cells/muscle fiber were determined in muscle biopsies using immunohistochemistry. A progressive decline in exercise capacity was noted with ascending disease severity. Furthermore, a correlation between reduction in exercise capacity and changes in muscle fiber composition was observed in COPD. The group with severe and very severe COPD had a lower proportion of type I and a higher proportion of type IIa fibers compared with the other groups. In severe and very severe COPD, a reduction in fiber area of type IIa fibers was also seen. The number of satellite cells/muscle fiber did not differ between the groups. In conclusion, a decline in exercise capacity occurs already in mild and moderate COPD, indicating that the 6-min walk test is a reliable indicator of disease severity. Furthermore, changes in skeletal muscle morphology are associated with disease severity while muscle regenerative capacity is not altered.

Construct validity of a health questionnaire intended to measure the subjective experience of health among patients in mental health services.

Mental health services have been lacking systematic health-promoting activities, and health is often perceived as the absence of disease from a biomedical perspective. It is vital to develop methods to assess perceived health among patients in a broader perspective. The aim of the study was to investigate construct validity of a newly developed health questionnaire intended to measure subjectively experienced health among patients in mental health services. A cross-sectional study, including a randomly selected sample of 139 outpatients in contact with the mental health services, was performed in order to explore the relationship between perceived health and self-reported levels of self-esteem, symptoms, empowerment, quality of life and experiences of stigmatization. Self-esteem, symptoms, empowerment and quality of life altogether accounted for 70% of the variation in overall perceived health. Overall perceived health showed positive associations to self-esteem, empowerment and quality of life and negative associations to psychiatric symptoms, discrimination and rejection experiences. The findings suggest that perceived health as measured by the health questionnaire can be a meaningful and valid construct that may be useful for measuring health in clinical mental healthcare practice and in mental health services research.

The construct validity of a self-report questionnaire focusing on health promotion interventions in mental health services.

Health promotion has become a widespread concept, although little empirical research as to its importance and outcome has been performed in the mental health field. The aim of the present study was to investigate the construct validity of a newly developed Health Promotion Intervention Questionnaire, intended to measure patients' subjectively experienced health-promoting interventions within mental health services. A total of 135 participants responded to the questionnaire and to validation measures assessing psychiatric symptoms, empowerment, helping alliance and satisfaction with care. Bivariate correlations showed that overall perceived health-promoting interventions were positively correlated to, helping alliance, client satisfaction with care and empowerment. Stepwise multiple regression analysis showed that the strongest relationship was found between perceived health promotion intervention and helping alliance. In conclusion, the construct validity of the scale was satisfactory, except for one of its subscales where further investigations are needed.

Primary Health Care Nurses' conceptions of involuntarily migrated families' health.

BACKGROUND: Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care. AIM: To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs. METHOD: Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data. FINDINGS: Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from society, and (4) a stable and well-functioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family. CONCLUSION: Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Characterization of human urinary metabolites of the antimalarial piperaquine.

Five metabolites of the antimalarial piperaquine (PQ) (1,3-bis-[4-(7-chloroquinolyl-4)-piperazinyl-1]-propane) have been identified and their molecular structures characterized. After a p.o. dose of dihydroartemisinin-piperaquine, urine collected over 16 h from two healthy subjects was analyzed using liquid chromatography (LC)/UV, LC/tandem mass spectrometry (MS/MS), Fourier transform ion cyclotron resonance (FTICR)/MS, and H NMR. Five different peaks were recognized as possible metabolites [M1, 320 m/z; M2, M3, and M4, 551 m/z (PQ + 16 m/z); and M5, 567 m/z (PQ + 32 m/z)] using LC/MS/MS with gradient elution. The proposed carboxylic M1 has a theoretical monoisotopic molecular mass of 320.1166 m/z, which is in accordance with the FTICR/MS (320.1168 m/z) findings. The LC/MS/MS results also showed a 551 m/z metabolite (M2) with a distinct difference both in polarity and fragmentation pattern compared with PQ, 7-hydroxypiperaquine, and the other 551 m/z metabolites. We suggest that this is caused by N-oxidation of PQ. The results showed two metabolites (M3 and M4) with a molecular ion at 551 m/z and similar fragmentation pattern as both PQ and 7-hydroxypiperaquine; therefore, they are likely to be hydroxylated PQ metabolites. The molecular structures of M1 and M2 were also confirmed using H NMR. Urinary excretion rate in one subject suggested a terminal elimination half-life of about 53 days for M1. Assuming formation rate-limiting kinetics, this would support recent findings that the terminal elimination half-life of PQ has been underestimated previously.

Interferon-beta affects the tryptophan metabolism in multiple sclerosis patients.

Tryptophan and its metabolites are of great interest in understanding the pathogenesis of multiple sclerosis (MS). The total levels of tryptophan and its metabolites, kynurenine and kynurenic acid were determined in plasma by capillary liquid chromatography electrospray ionisation tandem mass spectrometry. This is the first report of the plasma levels of these analytes in healthy controls and relapsing-remitting MS patients receiving long-term and acute interferon-beta (IFN-beta) treatment. Twenty-four hours post-administration increased kynurenine levels (first IFN MS versus healthy, P = 0.042) and kynurenine/tryptophan ratio (K/T; first IFN MS versus healthy, P =0.027; first IFN MS versus long-term IFN MS, P = 0.036) were found. The long-term IFN MS group had higher K/T ratios at 4 and 12 h post-administration (P = 0.015 and 0.009, respectively). The increase of K/T ratio in the first IFN MS group indicate an induction of the enzyme indolamine-2,3-dioxygenase (IDO), as reported earlier in experimental allergic encephalomyelitis. As IDO is participating in both inflammatory and neurodegenerative processes, further knowledge of its involvement in the pathogenesis of MS is of great importance.

Body composition and bone mineral density in long-standing type 1 diabetes.

OBJECTIVES: To study body composition and bone mineral density (BMD) in adult patients with long-standing type 1 diabetes mellitus. RESEARCH DESIGN AND METHODS: In a population-based study, body composition and BMD were evaluated by dual energy X-ray absorptiometry in 38 patients with type 1 diabetes since childhood, compared with 38 age- and sex-matched controls. The mean age was 43 years (range 33-55 years) and the mean duration of diabetes was 33 years (range 28-37 years). RESULTS: Besides a tendency to a reduced abdominal fat mass in diabetic males, no difference was observed in fat mass, muscle mass, or BMD between the groups. Significant correlations were found between insulin dosage and whole body fat mass in diabetic females and between serum cholesterol levels and abdominal fat mass in diabetic males. CONCLUSION: Patients with long-standing type 1 diabetes with onset in childhood and adolescence seem to show only minor differences in body composition and no difference in BMD compared with closely matched healthy controls.

Nurses' conceptions of how health processes are promoted in mental health nursing.

The health and well-being of the individual is a central goal in nursing, and health promotion seeks to enable people to increase control over and improve their health. In mental health care, health is often described in negative terms such as the absence of mental illness, which may create hopelessness and constitute a barrier to a policy of health promotion. The aim of this study was to describe nurses' conceptions of how health processes are promoted in mental health nursing. Twelve nurses working in mental health care were interviewed and the data were analysed using a phenomeographic approach. The nurses expressed 11 different conceptions of the phenomenon, which were summarized into three descriptive categories: presence, balance of power, and focus on health. The findings show that the nurses expressed ambiguous attitudes towards meeting the patient in mental health care. It is suggested that the goal of nursing care should be clarified for nurses in practice, otherwise they may adopt the perspectives of other mental health professionals.

Patients' conceptions of how health processes are promoted in mental health nursing. A qualitative study.

The most important goal of nursing care is to promote the subjective experience of health. The health promoting efforts of mental health care nurses must be aimed at creating encounters where the patient will be confirmed both existentially and as an individual worthy of dignity. The patient in mental health care is often viewed by the nurse as nothing more than a passive recipient of care and the belief in the patient's potential is minimal. This can lead to a situation where the patient loses control in the caring situation and feels unable to improve his/her health, which conflicts with the goal of the nursing care. The aim of the study was to describe patients' conceptions of how health processes are promoted in mental health nursing. Twelve patients with experience of mental health nursing were interviewed, and the data material was analysed using a phenomenographic approach. The results show 13 different conceptions of the phenomenon, and these were summarized into four descriptive categories: interaction, attention, development and dignity. The conceptions described show that the patients need to be treated as equals and that the nurse must trust the patient's ability to make decisions and to promote his/her health process. It is suggested that mental health nursing should be built on humanistic science and its view that every individual has the ability to grow and develop. This view is one of the most important preconditions for the promotion of health processes in mental health nursing.

Bone mineral content and collagen metabolites in children receiving steroid treatment for nephrotic syndrome.

UNLABELLED: Bone mineral density (BMD) and content (BMC) were measured in nine children treated with corticosteroids for nephrotic syndrome and in age-matched controls, using dual-energy X-ray absorptiometry (DEXA). The urinary excretion of cross-linked N-telopeptide (NTx) released from collagen type I as a specific marker of bone resorption was also measured. There were no significant differences in body size, BMD results or NTx urinary concentrations between patients and controls, nor could any significant differences be found when the six patients given a cumulative corticosteroid dose of >15 g were analysed separately. The lack of significant differences could be due to the small number of patients included in the study. But when the measured BMD and BMC were analysed according to methods that corrected for body size and puberty stage, values well within the normal range were found in patients as well as in controls. There was, however, a significant, negative correlation between the urinary excretion of NTx and the cumulative dose of corticosteroids. CONCLUSION: Despite treatment for long periods with high, cumulative doses of corticosteroids, the skeletons of the patients had a normal mineral content, which is encouraging for all those in need of steroids for nephrotic syndrome. A negative correlation between urinary collagen degradation products and the cumulative steroid dose might point to a reduced growth velocity in patients on high doses of steroids earlier than an effect on bone mineralization.

Psychiatric nurses' conceptions of how a group supervision programme in nursing care influences their professional competence: a 4-year follow-up study.

AIM: The aim of the study was to describe, after 4 years, psychiatric nurses' conceptions of how a 2-year group supervision programme within nursing care had influenced their professional competence. BACKGROUND: The intention of group supervision in nursing care is to understand nurses' experiences within real care settings and to structure these in a professional and personal context. METHODS: Ten psychiatric nurses participated in a 2-year group supervision programme. They were interviewed 4 years after the group supervision was ended. Data were analysed according to the phenomenographic method. FINDINGS: Six description categories emerged: a feeling of job satisfaction; gaining knowledge and competence; gaining a sense of security in nursing situations; a feeling of personal development; realizing the value of supervision; and a sense of professional solidarity. CONCLUSIONS: The findings of the 4-year follow-up showed that a group supervision programme in nursing care had lasting influences on the psychiatric nurses' professional competence in the form of a pronounced professional identity and an integrated nursing care perspective. Group supervision contributes to maintaining the strength and energy needed to carry on working, which makes continuing supervision necessary. IMPLICATIONS: An important research implication could be to investigate the type of knowledge that ought to be developed within group supervision in nursing care.

Specific effects of eccentric and concentric training on muscle strength and morphology in humans.

The purpose of this study was to compare pure eccentric and concentric isokinetic training with respect to their possible specificity in the adaptation of strength and morphology of the knee extensor muscles. Ten moderately trained male physical education students were divided into groups undertaking eccentric (ETG) and concentric (CTG) training. They performed 10 weeks of maximal isokinetic (90 degrees x s(-1)) training of the left leg, 4x10 repetitions - three times a week, followed by a second 10-week period of similar training of the right-leg. Mean eccentric and concentric peak torques increased by 18% and 2% for ETG and by 10% and 14% for CTG, respectively. The highest increase in peak torque occurred in the eccentric 90 degrees x s(-1) test for ETG (35%) whereas in CTG strength gains ranged 8%-15% at velocities equal or lower than the training velocity. Significant increases in strength were observed in the untrained contra-lateral leg only at the velocity and mode used in ipsilateral training. Cross-sectional area of the quadriceps muscle increased 3%-4% with training in both groups, reaching statistical significance only in ETG. No major changes in muscle fibre composition or areas were detected in biopsies from the vastus lateralis muscle for either leg or training group. In conclusion, effects of eccentric training on muscle strength appeared to be more mode and speed specific than corresponding concentric training. Only minor adaptations in gross muscle morphology indicated that other factors, such as changes in neural activation patterns, were causing the specific training-induced gains in muscle strength.

Food supply for settling male rock pipits affects territory size

Theory predicts that abundant food may favour larger breeding territories, provided that males could gain some important benefit, such as improved mating success or breeding performance, from keeping a large territory. The time saved when food is easy to find may be used to defend more space, unless increased defence costs offset the savings in foraging time. A previous experiment with concealed food addition close to laying did not reveal any effects on rock pipit, Anthus petrosusterritories. In this study the food intake rate of males was manipulated at the time of arrival from the winter quarters, by providing a concealed food source at the centre of each territory. The aim was to reduce foraging time, without attracting intruders, in order to isolate any effects of food abundance. Fed males had larger territories and tended to defend longer stretches of shoreline than control males. The difference in territory size was not related to male age or order of arrival. These results suggest that males settling at concentrated food sources may be able to establish large territories, and that keeping a large territory confers some advantage. We discuss possible reasons why food intake rate later during the breeding season did not affect territory size.

Cancer incidence after radiotherapy for skin haemangioma during infancy.

An infant cohort treated for skin haemangioma with 226Ra between 1930 and 1965 (n = 11,807) was studied. The median age at treatment was 5-months and 88% were treated before 12 months of age. This cohort was followed up in the Swedish Cancer Registry during the years 1958 to 1989, giving 370,517 person-years at risk. A total number of 248 malignancies have been observed and the standardized incidence ratio (SIR) was 1.21 (confidence interval (CI) 95%, 1.06-1.37). Significantly increased numbers of cancers were found in the central nervous system, 34 cases (SIR = 1.85, CI 95% 1.28-2.59), the thyroid, 15 cases (SIR = 1.88, CI 95% 1.05-3.09) and other endocrine glands, 23 cases (SIR = 2.58, CI 95% 1.64-3.87). The absorbed dose in 11 specified risk organs has been estimated using a phantom of the size of a 5-6-month-old child. The mean absorbed dose in the thyroid was 0.12 Gy and the excess relative risk (ERR) for thyroid cancer was 7.5 per Gy (CI 95% 0.4-18.1). The mean dose in the central nervous system was 0.077 Gy and the ERR for brain tumours was 10.9 per Gy (CI 95% 3.7-20.5). This cohort gives a unique opportunity to analyse long-term effects of low-dose irradiation during infancy.

Iron prophylaxis in menorrhagia.

Heavy menstrual bleedings frequently lead to iron deficiency. Iron supplementation is usually given to cover the increased losses. In the present study one tablet containing 100 mg of iron (Duroferon R, Durules R) was given daily for 10 days in connection with the menstrual period in 15 women with menorrhagia. The tablets contained 59 Felabelled FeSO4 and the total absorption was measured in a whole-body counter. The mean menstrual blood loss was 117 ml (range 46-259 ml), corresponding to 53 mg of iron (range 21-117 mg). The mean absorption was 81 mg (range 49-145 mg). Individually, 14 of 15 subjects absorbed more iron from the tablets than was lost by the menstrual bleedings. Thus, the iron prophylaxis as applied in the present study seems to be sufficient in most women with menorrhagia.

Body composition. Prediction of normal body potassium, body water and body fat in adults on the basis of body height, body weight and age.

In 134 males and 242 females, aged 20-70 years, most of them randomly selected from population studies, the body composition was estimated from the measurements of body height (BH), body weight (BW), total body potassium (TBK) and total body water (TBW). TBK was measured with isotope dilution technique using 42K or determined as 40K in a whole body counter. TBW was determined with an isotope dilution technique using tritiated water, assayed in urine or plasma. From these data, body cell mass (BCM), intra- and extra-cellular water (ICW and ECW, resp.) and body fat (BF) were calculated for each individual. Significant correlations were found between age versus TBK, ECW, BF and ECW/ICW; between BW versus TBK, TBW, ECW, BF and ECW/ICW; (females only) and between BH versus TBK, TBW, ECW (females only) and ECW/ICW. For the prediction of TBK, TBW and BF, multiple regression equations based on BW, BH and age are given. These equations are also presented diagrammatically. The problems with the methods used are considered as well as the applicability of the formulas for the calculation of BCM etc. The predictive value of the results when both TBW and TBK are used for the calculation of body composition data is discussed and compared with similar results, based on TBW or TBK only. It is concluded, that the most reliable method for calculation of BF is to estimate both TBW and TBK.