Predictors of need for help with weight loss among overweight and obese men and women in the Netherlands: a cross-sectional study.

BACKGROUND: Need for help is perceived as an important first step towards weight related health-care use among overweight and obese individuals and several studies have reported gender as an important predisposing characteristic of need for help. Therefore, the goal of the current study is to gain insight into factors that might determine need for help for weight loss in men and women. METHODS: In the current study, data from the Dutch cross-sectional survey Health Monitor 2012 was used. Overweight and obese men (N = 2218) and women (N = 2002) aged 19-64 years were selected for the current study. Potential predictors of need for help were age, ethnicity, marital status, educational level, perceived health, weight status, comorbidities, physical activity level, and income. Multiple logistic regression analyses were conducted separately among men and women to establish prediction models of need for help for weight loss. RESULTS: The mean age of the adult women in this study population was 47.7 years and 68% was medium educated, whereas the mean age of men was 49.0 years and 63.0% was medium educated. Of the respondents, 24.9% indicated they either felt a need for help for weight loss, 6.4% already received help and 68.7% felt no need for help. Women were more likely to indicate a need for help than men (OR = 2.17). Among both genders, need for help was significantly predicted by obesity (ORmen = 3.80, ORwomen = 2.20) and "poor" perceived health (ORmen = 2.14, ORwomen = 1.94). Besides, "unmarried" (ORmen = 1.57) and suffering from comorbidities (ORmen = 1.26) predicted need for help among men. Whereas among women, need for help was predicted by younger age (i.e. 19-34 years (ORwomen = 2.07) and 35-49 years (ORwomen = 1.35)). CONCLUSION: The current study revealed specific predictors of need for help for weight loss for men and women. Among men, the strongest predictors were obesity and poor perceived health, whereas among women need for help was most strongly predicted by obesity and young age. Insight into these specific predictors enables health professionals to reach overweight individuals with a need for help for weight loss by connecting their need to available support.

Social frailty in older adults: a scoping review.

Social frailty is a rather unexplored concept. In this paper, the concept of social frailty among older people is explored utilizing a scoping review. In the first stage, 42 studies related to social frailty of older people were compiled from scientific databases and analyzed. In the second stage, the findings of this literature were structured using the social needs concept of Social Production Function theory. As a result, it was concluded that social frailty can be defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span. Moreover, the results of this scoping review indicate that not only the (threat of) absence of social resources to fulfill basic social needs should be a component of the concept of social frailty, but also the (threat of) absence of social behaviors and social activities, as well as (threat of) the absence of self-management abilities. This conception of social frailty provides opportunities for future research, and guidelines for practice and policy.

On the appropriateness of modelling brain parenchyma as a biphasic continuum.

Computational methods originally developed for analysis in engineering have been applied to the analysis of biological materials for many years. One particular application of these engineering tools is the brain, allowing researchers to predict the behaviour of brain tissue in various traumatic, surgical and medical scenarios. Typically two different approaches have been used to model deformation of brain tissue: single-phase models which treat the brain as a viscoelastic material, and biphasic models which treat the brain as a porous deformable medium through which liquid can move. In order to model the brain as a biphasic continuum, the hydraulic conductivity of the solid phase is required; there are many theoretical values for this conductivity in the literature, with variations of up to three orders of magnitude. We carried out a series of simple experiments using lamb and sheep brain tissue to establish the rate at which cerebrospinal fluid moves through the brain parenchyma. Mindful of possible variations in hydraulic conductivity with tissue deformation, our intention was to carry out our experiments on brain tissue subjected to minimal deformation. This has enabled us to compare the rate of flow with values predicted by some of the theoretical values of hydraulic conductivity from the literature. Our results indicate that the hydraulic conductivity of the brain parenchyma is consistent with the lowest theoretical published values. These extremely low hydraulic conductivities lead to such low rates of CSF flow through the brain tissue that in effect the material behaves as a single-phase deformable solid.

Nurse managers in Australia: mentoring, leadership and career progression.

Identification of those leadership qualities which nurses believe led to their successful attainment of a nursing management position may help in understanding how to identify and foster leadership potential amongst nursing staff. This study asked nurse managers to indicate the important factors which influenced and facilitated their entry to management positions with a particular reference to the development of leadership characteristics. The results suggest that the leadership qualities we expect nurse managers to display evolve in a largely random way. Additionally, there is evidence that the development of leadership skills and attainment of management positions remains fragmented and random in nature. Because of this, individual nurse managers develop leadership skills almost by default using informal strategies to learn and develop. These findings should provide direction to educational providers and senior managers who seek to develop future leaders and managers.

The regrowth of axons within tissue defects in the CNS is promoted by implanted hydrogel matrices that contain BDNF and CNTF producing fibroblasts.

In this study we demonstrate the potential for combining biocompatible polymers with genetically engineered cells to elicit axon regrowth across tissue defects in the injured CNS. Eighteen- to 21-day-old rats received implants of poly N-(2-hydroxypropyl)-methacrylamide (HPMA) hydrogels containing RGD peptide sequences that had been infiltrated with control (untransfected) fibroblasts (n = 8), fibroblasts engineered to express brain-derived neurotrophic factor (BDNF) (n = 5), ciliary neurotrophic factor (CNTF) (n = 5), or a mixture of BDNF and CNTF expressing fibroblasts (n = 11). Fibroblasts were prelabeled with Hoechst 33342. Cell/polymer constructs were inserted into cavities made in the left optic tract, between thalamus and superior colliculus. After 4-8 weeks, retinal projections were analyzed by injecting right eyes with cholera toxin (B-subunit). Rats were perfused 24 h later and sections were immunoreacted to visualize retinal axons, other axons (RT97 antibody), host astrocytes and macrophages, donor fibroblasts, and extracellular matrix molecules. The volume fraction (VF) of each gel that was occupied by RT97(+) axons was quantified. RT-PCR confirmed expression of the transgenes prior to, and 5 weeks after, transplantation. Compared to control rats (mean VF = 0.02 +/- 0.01% SEM) there was increased ingrowth of RT97(+) axons into implants in CNTF (mean VF = 0.33 +/- 0.19%) and BDNF (mean VF = 0.62 +/-0.19%) groups. Axon growth into hydrogels in the mixed BDNF/CNTF group (mean VF = 3.58 +/- 0.92%) was significantly greater (P < 0.05) than in the BDNF or CNTF fibroblast groups. Retinal axons exhibited a complex branching pattern within gels containing BDNF or BDNF/CNTF fibroblasts; however, they regrew the greatest distances within implants containing both BDNF and CNTF expressing cells.

Profile of first-line nurse managers in New South Wales, Australia, in the 1990s.

AIMS: To determine a demographic profile, employment history and career plans of a sample of nursing unit managers (first-line managers) in New South Wales (NSW), Australia in 1999. To compare the profile of first-line nurse managers in 1999 with those in 1989. BACKGROUND: This study replicates another undertaken a decade earlier (see Duffield 1992). Tracking the changes to nurse manager positions is important, given changes to the educational preparation of nurses and restructuring within hospitals which have occurred in the past decade. METHOD: The same questionnaire was used in both studies, with minor amendments and the addition of two items to reflect changes to organizational structures, whereby nurse managers are now responsible for non-nursing staff. In 1999 all first-line nurse managers in the largest health service in NSW were invited to participate in the study. RESULTS: A response rate of 77% was achieved. There were few differences of note in the demographic profile from 1989 to 1999. However educationally, first-line nurse managers in 1999 were more highly qualified. A greater proportion had higher degrees and increasingly, in the management discipline. CONCLUSION: Perhaps reflecting these qualifications, more managers in 1999 indicated their intention to move to more senior management positions in the next decade. The mode for experience in this role of 1 year in both 1989 and 1999 reflects a worrying trend of high turnover and inexperience amongst this group of managers. While maternity relief might account for this result, further research needs to determine more precise reasons. The ad hoc bases on which expert clinicians (clinical nurse specialists) act as the manager in his/her absence need to be critically examined. Alternative strategies such as introducing a formal second- in-charge position may ensure more successful recruitment and retention of staff to these critical management positions.

Errors in the assessment of tympanic membrane perforations.

It is commonly stated that operative closure of large perforations of the tympanic membrane is less successful than closure of small perforations. Few authors mention the exact size of the perforations studied, and fewer still give their method of measuring perforations. We describe a photographic method of assessing the size of perforations relative to the total drumhead, measuring them with a computerized digitizing pad. Thirteen temporal bones were selected at random. Perforations of different sizes, shapes and at different sites were fashioned in the tympanic membranes. These were assessed by clinicians of all grades, who were asked to draw the perforations and give estimates of the perforation size as a percentage of the total drumhead. Visual estimates and drawings were compared with a photographic objective method. Gross errors (some in excess of 100%) were apparent in both estimates and drawings. There was a highly significant statistical difference between the objective method and visual estimates and drawings (P < 0.001). Greater clinical experience was not correlated with better performance in estimating the size of perforations.

An examination of the evidence for the existence of preformed pathways in the neural tube of Xenopus laevis.

We have examined the neural tube in Xenopus laevis tadpoles to investigate the anatomical guidance elements which may be present in the presumptive marginal zone. With appropriate fixation protocols the neuroepithelial cells appeared in contact; electron microscopic observations failed to show any specialized intercellular spaces preceding the growing axons. The first fibres were found in the intercellular clefts between the neuroepithelial cells near the surface of the neural tube. Reconstructions of the neural tube from examination of serial 1 micron sections showed that the intercellular clefts are non-aligned at this stage and branching. Scanning electron microscopy of the surface of the neural tube confirmed that the intercellular spaces are non-aligned and often branch caudal to the growing front of descending axons. Thus to grow in a consistent direction the developing axons may have to make consistent and selective (specific) selections of pathway at numerous branch points if their growth is restricted to these intercellular clefts. As more axons grow along the neural tube, the intercellular clefts become wider, and the neuroepithelial cells bounding the clefts become indented. At later stages many fibres were observed with both scanning and transmission electron microscopy to grow along the surface of the neural tube. These changes in neuroepithelial cell morphology and fibre pathway allow axons to form bundles which take a fairly straight course in contrast to the winding path which must be taken by the first axons to grow through the intercellular clefts.

Selection of pathways by regenerating spinal cord fiber tracts.

We have traced fiber tracts in the regenerating teleost spinal cord and have found that the regenerative capabilities of fiber tracts coming from different parts of the CNS vary considerably. Some descending tracts can regenerate up to 5.6 mm beyond a transection, while other fiber tracts cannot even penetrate the scar tissue. In spite of a great disturbance of their normally ordered pathways as they grow through the lesion site, those tracts which can regenerate can find their appropriate funiculi in the distal spinal cord.

Evidence for an orderly arrangement of optic axons within the optic nerves of the major nonmammalian vertebrate classes.

The pathways of selected optic axons were traced in representative urodele, anuran, teleost, reptile, and avian species by filling the fibers with HRP or by tracing, at the light and electron microscopic (EM) level, the degeneration caused by focal retinal or optic nerve lesions. In all species it was shown that fibers retain retinotopic neighborhood relationships throughout their transit of the optic nerve. Additionally, in anurans, it was found that a subset of large diameter, myelinated fibers take up a random arrangement in the nerve. It is argued that retinotopic fiber organisation is a reflection of contact guidance of axons during fiber outgrowth in the embryo and that this organisation could account for the arrival of fibers in orderly arrays at central nuclei during normal embryonic development.

Prenatal development of the optic projection in albino and hooded rats.

The development of retinofugal projections has been examined in albino and hooded rat embryos from embryonic day 16 to birth (E21.5). Horseradish peroxidase (HRP) was injected intraocularly through the uterine wall and its anterograde transport revealed with TMB and DAB. The retrograde transport of HRP or the fluorescent dyes Nuclear yellow, Fast blue and propidium iodide from optic tract, superior colliculus (SC) or lateral geniculate body (LG) injections was used to demonstrate the origin of the projections. Superficial projections to the contralateral SC were first identified at E16. A light projection to the entire medio-lateral extent of the ipsilateral SC could be detected a day later. The optic axons grow over the surface of the diencephalon at E16 and it was only at later stages that the fibers were observed to invade successively deeper parts of the LG. A superficial projection to the ipsilateral LG could first be detected at E17. Both the ipsilateral and contralateral projections grew through the entire dorso-ventral extent of the lateral geniculate body: some restriction of the axons to their normal adult termination zones could be detected by E21. No difference in the distribution of projections could be detected between the albino and pigmented rats although the projections were lighter, and possibly because of this were detected later, in the albino rats. At all the ages examined in this study labeled retinal ganglion cells were observed in the non-injected eyes after injection of label into the contralateral eye. The use of persistent fluorescent dyes showed that these retinal ganglion cells did not survive for more than 5 days postnatally. The projection to the uninjected eye came preferentially from ganglion cells in the lower nasal retina while the ipsilateral central projections came predominantly but not exclusively from the lower temporal retina of the injected eye. It appears, therefore, that the initial projections of optic axons in the rat are not limited to their normal termination zones and that the choice of pathway at the chiasm appears to be only loosely controlled.

Retinotopic and temporal organization of the optic nerve and tracts in the adult goldfish.

In order to investigate the role of the different factors controlling the pathways and termination sites of growing axons, selected optic fibers were traced from the eye to the tectum in adult goldfish either by filling them with HRP, or by severing a group of fibers and tracing their degeneration in 2 micrometers plastic sections stained with toluidine blue. Some fish received more than one lesion and others received both lesions and HRP applications. Two major rearrangements of the optic fibers were identified, one at the exit from the eye, the other within the optic tracts. Near the eye the optic fibers appear to be guided by the conformation of the underlying tissue planes that they encounter. The most recently added fibers, from the peripheral retina, grow over the vitread surface of the older fibers toward the blood vessel in the center of the optic nerve head. Behind the eye the fibers follow this blood vessel until it leaves the side of the optic nerve, and the fibers from peripheral retina are left as a single group on the ventral edge of the optic nerve cross section. As a consequence of this pattern of fiber growth the fibers form an orderly temporal sequence in the optic nerve, with the oldest fibers from the central retina on one side of the nerve and the youngest from peripheral retina on the other. In addition, the fibers are ordered topographically at right angles to this central-to-peripheral axis, with fibers from ventral retina on each edge of the nerve, dorsal fibers in the center, and nasal and temporal fibers in between. This arrangement of the optic fibers continues with only a little loss of precision up to the optic tracts. A more radical fiber rearrangement, seemingly incompatible with the fibers simply following tissue planes occurs within the optic tracts. Each newly arriving set of fibers grows over the surface of the optic tracts so that the older fibers come to lie deepest in the tracts. This segregation of fibers of different ages ensures that the rearrangement is limited to each layer of fibers. The abrupt reorganization of the fibers occurs as the tracts split around the nucleus rotundus to form the brachia of the optic tracts. The fibers are then arranged with temporal fibers nearest the nucleus rotundus and nasal fibers on the opposite edges of the brachia. From this point the fibers grow out over the tectal surface to their termination sites with only minimal rearrangements. Therefore the optic fiber rearrangements show evidence of several different sorts of constraints acting on the fibers at separate points in the optic pathway, each contributing to the final orderly arrangement of the fibers on the optic tectum.

Development of a transient retino-retinal pathway in hooded and albino rats.

Intraocular HRP injections in E16-21 embryos show that during the normal development of the central optic projections in hooded and albino rats many optic axons grow through the chiasm into the contralateral eye. This retino-retinal projection disappears shortly after birth. This suggests that an initial, imprecise guidance of growing axons is followed by a selective elimination of axons taking aberrant pathways and failing to make appropriate synapses.