Possibilities and hindrances for prevention of intimate partner violence: perceptions among professionals and decision makers in a Swedish medium-sized town.

BACKGROUND: Intimate partner violence (IPV) is a major public health problem, but few evidence-based prevention programs have yet been implemented. PURPOSE: This study explored the perceptions and beliefs of local-level decision makers, social and health-care professionals, and representatives from the police force regarding the possibilities and hindrances for prevention of IPV. METHOD: An explorative qualitative approach was used, and participants were strategically selected for focus group discussions. The participants, 19 men and 23 women, were professionals or decision makers within health-care services, social welfare, municipal administration, the police force, local industry, and local politicians in a Swedish town of 54,000 inhabitants. The focus group discussions were audio recorded, transcribed verbatim, and thematically analyzed. A manifest content analysis was performed on the text. RESULTS: Preschools, schools, sports associations, workplaces, and the mass media were suggested as possible arenas for prevention measures. The proposed activities included norm building and improved social support structures. Hindrances were conceptualized as societal beliefs and attitudes, shame, silence, gender inequality, the counteracting influence of the media, and lack of resources. The participants demonstrated closeness and distance to IPV, expressed as acceptance or referral of responsibility to others regarding where and by whom prevention measures should be executed. CONCLUSION: This study gave new insights in the prevailing perceptions of professionals and decision makers of a medium-sized Swedish town, which can be a useful knowledge in future preventive work and contribute to bridge the gap between research and practice.

Oral microbiota associated with hyposalivation of different origins.

We analysed and compared the oral microbial flora in four groups with hyposalivation caused by radiation therapy (RT), primary Sjögren's syndrome (pSS), medication or unknown factors (Unknown), or neuroleptic treatment (Neuro). A control group with normal salivary secretion was also included. The subjects included were 54 +/- 8 years old and had 25 +/- 4 teeth. We analysed their microflora in rinsing samples using a cultivation technique. A marked increase in Lactobacillus spp. and Candida albicans was characteristic of the RT group. In the pSS group, 85% of subjects had high numbers of mutans streptococci despite good oral hygiene, frequent dental visits and fluoride use. The Unknown group had an oral flora similar to that of the controls. In the Neuro group, with a stimulated secretion rate similar to that of the Unknown group, the numbers of aciduric and acidogenic microorganisms were close to those in the pSS group. The results indicate that changes in the oral microflora associated with hyposalivation are related to the reason for the hyposalivation rather than to the magnitude of the decrease in the salivary secretion rate.

A method for preparation and purification of 234Th.

An improved method to recover 234Th from depleted uranium has been developed. The method is based on solvent extraction and ion-exchange separations. The final thorium fraction has a high specific activity, about 1-3 PBq/mol Th, which makes it well suited for investigations, where a low thorium concentration is essential. The method is comparably fast, with a total processing time of 2 days. Another advantage is that the uranium fraction can be used as a 234Th generator for several years.

Preimplantation genetic diagnosis (PGD): the Gothenburg experience.

BACKGROUND: A program for preimplantation genetic diagnosis of pre-embryos from patients with hereditary disorders was set up in our unit at Sahlgrenska University Hospital in 1994. The majority of the patients were carriers of X-chromosome linked disorders; a few patients were translocation carriers. In this paper we describe our experiences of our first 36 cycles, 30 gender determinations and six analyses of embryos with possible translocations. METHODS: Conventional hormone replacement treatment with intracytoplasmic sperm injection to fertilize the eggs followed by blastomere biopsy and fluorescent in situ hybridization at the eight cell stage was used for sexing as well as detection of translocations. RESULTS: Out of the 30 cycles in 13 patients for gender determination, blastomere biopsies could be carried out in 25 cycles. Transfer of normal female embryos (XX) was performed in 18 cycles, resulting in five pregnancies (pregnancy rate 27.8%) and an implantation rate of 20% per transfer. Three girls have been born. Hence the take home baby rate was 16.7% per transfer and 10% per started cycle. Six cycles (three patients) for detection of translocations in embryos were performed. Diagnosis was possible in four cycles. Transfer of normal embryos was carried out in one cycle. No pregnancy was achieved. CONCLUSION: Successful PGD in its clinical application demands close collaboration between a large group of specialists. Even so, the success rate is considerably lower than after conventional IVF or ICSI procedures. Taking into account the stress caused to the parents facing late interruption of pregnancy following conventional prenatal diagnosis we are convinced that this technique is well worthwhile continuing and refining.

A controlled vocabulary for nursing and allied health in Norway.

Nursing and allied health libraries at educational institutions in Norway have generally indexed their book collections with uncontrolled terms. With the reorganization of higher education in 1994, the majority of these libraries joined BIBSYS, which is a joint library system for higher education and research in Norway. This has led to chaos when searching the joint catalogue for literature on nursing and related fields. A term such as 'behaviour problems' may have up to five synonyms. In an attempt to improve the quality of searching the health literature, BIBSYS appointed a working group in the Spring of 1999 to find a suitable controlled vocabulary for this subject area, and to see how this vocabulary could be integrated into BIBSYS. The group presented its recommendations in October 1999. The report has been well received by the BIBSYS Board and by user groups. There are no Norwegian vocabularies that are suitable for use in nursing and allied health, therefore it will be necessary to translate and combine existing thesauri. The group has looked at the Nordic Multilingual Thesaurus on Health Promotion, the Swedish Spriline Thesaurus, MeSH (Medical Subject Headings) and CINAHL Subject Heading List. Other relevant thesauri are AMED/CATS Thesaurus, Bioethics Thesaurus (Bioethicsline) and the RCN thesaurus. The group recommends the development of a Norwegian thesaurus based on a translation of parts of MeSH and CINAHL Subject Heading List.

Role of a new mammalian gene family in the biosynthesis of very long chain fatty acids and sphingolipids.

Whereas the physiological significance of microsomal fatty acid elongation is generally appreciated, its molecular nature is poorly understood. Here, we describe tissue-specific regulation of a novel mouse gene family encoding components implicated in the synthesis of very long chain fatty acids. The Ssc1 gene appears to be ubiquitously expressed, whereas Ssc2 and Cig30 show a restricted expression pattern. Their translation products are all integral membrane proteins with five putative transmembrane domains. By complementing the homologous yeast mutants, we found that Ssc1 could rescue normal sphingolipid synthesis in the sur4/elo3 mutant lacking the ability to synthesize cerotic acid (C(26:0)). Similarly, Cig30 reverted the phenotype of the fen1/elo2 mutant that has reduced levels of fatty acids in the C(20)-C(24) range. Further, we show that Ssc1 mRNA levels were markedly decreased in the brains of myelin-deficient mouse mutants known to have very low fatty acid chain elongation activity. Conversely, the dramatic induction of Cig30 expression during brown fat recruitment coincided with elevated elongation activity. Our results strongly implicate this new mammalian gene family in tissue-specific synthesis of very long chain fatty acids and sphingolipids.

Hypersecretion of ovarian androgens may be gonadotrophin dependent many years after menopause.

BACKGROUND: In fertile women both adrenals and ovaries contribute to androgen production, whereas after the menopause the ovarian contribution normally decreases. OBJECTIVE: The objective of this case study was to assess whether ovarian androgen secretion was responsive to decreased gonadotrophin stimulation and whether gonadotrophins were sensitive to negative feedback from sex steroids many years after the menopause. METHODS: In this uncontrolled case study a 72 years old slightly overweight woman with noninsulin-dependent diabetes mellitus presented with hirsuitism and elevated serum testosterone concentrations. The woman was reluctant to have an oophorectomy, and received an oral estradiol/progestagene preparation. Serum testosterone and gonadotrophin concentrations were measured before and after steroid hormone therapy. RESULTS: Serum gonadotrophin concentrations decreased and testosterone levels returned to normal during therapy. When the hormone therapy was stopped for 1 month the high testosterone concentrations returned, but were again normalized when the hormone therapy was reinitiated. CONCLUSION: The ovaries of this woman were apparently still responsive to pituitary stimulation and her hypothalamic pituitary ovarian feed-back system still seemed to be working after 70 years of age.

To see or not to see. Perceptions of equality in a Swedish university hospital.

In order to examine the perceptions of sex equality among medical doctors (MDs) and registered nurses (RNs), a survey was conducted in a Swedish University Hospital in May 1995. A questionnaire was sent to 475 MDs and RNs of three different age groups. The results showed that women tend to have similar opinions irrespective of occupation and age, which differed significantly from those of men. Men believed that equality in general exists in the hospital, while women think the values and conditions in the workplace mainly benefit men. No evidence was found to indicate a change in the sex hierarchy within the health care system. Rather, the status quo will be maintained and gender stereotypes reinforced from one generation to the next.

Increased prevalence of large bites in 12-lead vectorcardiograms of diabetic patients.

The vectorcardiographic (VCG) bites in diabetic patients were compared with those in nondiabetic control subjects using automated analysis of the conventional electrocardiogram (ECG). A 12-lead ECG was recorded from each of the 154 patients with non-insulin-dependent diabetes mellitus and 128 control subjects. The orthogonal leads X, Y, and Z were derived from the 12-lead ECG, from which a so-called 12-lead VCG was calculated for each of the 282 participants. A computer-based method for the detection and quantification of bites was applied to the 12-lead VCGs. Bite amplitudes in the horizontal loop had an average of 0.062 +/- 0.089 mV in the diabetic group, and 0.039 +/- 0.045 mV in the control group (P < .01). In the sagittal plane, the mean bite amplitude was also greater in the diabetic group than in the control group: 0.095 +/- 0.084 versus 0.069 +/- 0.058 mV, respectively (P < .01). A bite greater than 0.1 mV in the horizontal or sagittal planes was found in 56 diabetic patients (36%) and 27 control subjects (21%) with (P < .05) considered significant. In conclusion, the results of this study suggest that automated analysis of the 12-lead VCG can be valuable in diagnosing diabetic cardiomyopathy.

The outcome of intracytoplasmic sperm injection is unrelated to 'strict criteria' sperm morphology.

Sperm morphology was assessed according to the 'strict criteria' established for in-vitro fertilization treatment in the semen samples used for 354 consecutive treatment cycles for intracytoplasmic sperm injection (ICSI). The semen samples were classified according to the three predictive categories of the Tygerberg strict criteria: excellent prognosis (>14% morphologically normal spermatozoa), good prognosis (4-14%) and poor prognosis (<4%). It was found that 37 (10.5%) of the ICSI cycles belonged to the excellent prognosis category, 197 (55.6%) to the good prognosis category, and 120 (33.9%) to the poor prognosis category. The outcomes of the ICSI treatments were evaluated and compared with the sperm morphology classification in order to determine whether the strict criteria could aid in predicting the outcome of ICSI. The fertilization rates in the three categories were 61.6, 66.8, and 61.9%, the pregnancy rates per oocyte retrieval 18.9, 24.9, and 28.3%, and the implantation rates 9.9, 13.0, and 14.9% respectively. No significant differences were found in fertilization, pregnancy, or implantation rates between the three prognosis categories, i.e. the poor prognosis category had an equal chance of obtaining pregnancy compared with the good prognosis category. The results indicate that strict sperm morphology is not related to the outcome of ICSI.

Spatial and temporal evaluation of locally induced skin trauma recorded with laser Doppler techniques.

The single-fiber laser Doppler flowmetry (SF-LDF) technique has been used to study perfusion within tissues. The insertion of the SF-LDF probe into human skin locally alters microcirculation for more than 70 min after positioning. In this study the SF-LDF and a newly developed laser Doppler imager (LDI) were used to describe the spatial distribution, the intensity, and the temporal course of the trauma following intracutaneous insertion of the probe. The LDI scanned a human skin area of 6 x 6 cm (36 x 36 pixels). A flexible SF-LDF probe was inserted intradermally in the same measuring region. Recordings were performed for 120 min with the two techniques simultaneously. With the SF-LDF probe maximal hyperemia was recorded after 5-30 min. After a gradual and slow decrease most of the subjects reached a steady-state level within 80-100 min. A 3-min tourniquet occlusion test was performed 120 min after SF probe positioning. A significant hyperemic response was recorded, indicating that almost no posttraumatic activity was present at this time. The area of increased perfusion recorded with the LDI had an oval to circular configuration with a maximal extension after 5-10 min (radius 1.5-2 cm, area 8.9 cm2). The zone of maximal hyperemia was distributed adjacent to the intradermal probe, gradually decreasing toward the periphery. No significant hyperemia was shown with LDI after 100 min. There was a concordance between the time courses of the hyperemic response obtained with the two techniques.

Fluorescent in situ hybridization analysis of chromosomally normal gametes and abnormal arrested embryos.

OBJECTIVE: The purpose of the present study was to investigate if the arrested embryos from a couple with several previously failed IVF treatments were chromosomally normal. Probes for chromosomes X, Y and 18 were used. RESULTS: A couple had undergone 7 in vitro fertilization treatments over a 2 1/2-year period without achieving a pregnancy. In each cycle, where fertilization was obtained, the development of the embryos was arrested. Fluorescent in situ hybridization probes for chromosomes X and Y (and 18) was carried out on gametes and on embryos in 2 separate cycles. Sperm and oocytes were normally haploid X0 or Y0. The nuclei of the blastomeres were fragmented and mosaic for X or Y, or monosomic X0, despite the fact that 2 pronuclei had been assessed on day 1 following intracytoplasmic sperm injection. CONCLUSION: Chromosomally normal gametes can result in abnormal embryos manifested by arrested development and unexplained infertility.

Human chorionic gonadotrophin self-administered by the subcutaneous route to induce oocyte maturation in an in-vitro fertilization and embryo transfer programme.

This study was initiated to evaluate oocyte maturation and the outcome of in-vitro fertilization (IVF) cycles following the s.c. administration of human chorionic gonadotrophin (HCG) by the patient herself or her partner. A group of 104 women who entered our IVF embryo transfer programme were prospectively randomized to have 5000 IU or 10,000 IU HCG s.c. or i.m. The HCG was administered for induction of the final oocyte maturation in cycles with pituitary down-regulation with a gonadotrophin-releasing hormone agonist according to a long protocol and where ovarian stimulation had been achieved with pure follicle stimulating hormone. The mean concentration of HCG in serum 12 and 36 h after the HCG injection was significantly higher in the women receiving 5000 IU i.m. compared to the s.c. route. However, in women receiving 10,000 IU HCG there were no significant differences in the mean concentrations 12 and 36 h after the injection, irrespective of the route of administration. Furthermore, there were no significant differences in the relative numbers of retrieved mature oocytes between the groups. When comparing the clinical outcome in the different groups, no significant differences were found between those receiving 5000 IU or 10,000 IU HCG, i.m. or s.c. Our data indicate that HCG can be given s.c. without reducing the chance of retrieving a mature oocyte and that the clinical outcome with regard to pregnancies is not negatively affected.

Factors of importance for the establishment of a successful program of intracytoplasmic sperm injection treatment for male infertility.

OBJECTIVE: To establish an intracytoplasmic sperm injection treatment program for couples with male infertility and to determine those factors important for success. DESIGN: A retrospective analysis of 171 consecutive cycles of intracytoplasmic sperm injection concerning 145 infertile couples. SETTING: Infertility clinic in a private hospital associated with a university hospital. PATIENTS: Couples with infertility in the male partner whose sperm parameters were unacceptable for conventional IVF or in whom fertilization by conventional IVF failed repeatedly. INTERVENTIONS: One hundred seventy-one transvaginal oocyte retrievals were completed after superovulation with GnRH agonist and gonadotropins. MAIN OUTCOME MEASURES: The parameters evaluated included fertilization, cleavage, implantation, pregnancy, and spontaneous abortion in relation to patient indications and improved procedures. RESULTS: After intracytoplasmic sperm injection, normal fertilization occurred in 45% of the oocytes (n = 1,499). Of 171 treatment cycles, 93% of the couples had fertilization and 86% had ET. Thirty-six pregnancies were achieved. During the period studied, the mean fertilization rate increased from 21.3% during the first 17 weeks to 67.8% during the last 13 weeks, and the pregnancy rate (PR) per started cycle increased from 12.8% to 31.3%. CONCLUSIONS: Technical factors critical for achieving high rates of fertilization and pregnancy were the use of standardized intracytoplasmic sperm injection pipettes, the immobilization of sperm before injection, and the aspiration of a minimal amount of ooplasm before reinjection with the sperm. Intracytoplasmic sperm injection appears to be superior to other micromanipulation methods for alleviating male infertility.

Microfertilization techniques--the Swedish experience.

Intracytoplasmic sperm injection (ICSI) has been studied in this animal research programme since 1990. In 1993, the technique was first applied clinically and up to the present time (September 1994), a total of 456 couples have been studied in 538 cycles. The principal indication for the use of ICSI has been severe male sub-fertility as judged by a semen analysis. In addition, men with high titres of antisperm antibodies, blockage of the vas deferens and neurological disorders such as spinal cord lesions have been included in the programme. Men with genetic disorders such as cystic fibrosis and acrosome-deficient spermatozoa have also been treated successfully. The overall fertilization rate using ICSI was 59%, which is similar to the conventional in vitro fertilization (IVF) programme in Göteborg, however, the pregnancy rate per embryo transfer (29%) and the ongoing pregnancy rate per transfer (22%) were slightly lower. The total number of pregnancies was 144 with 111 of the pregnancies either ongoing or already delivered. To date, 36 healthy children have been born following 29 deliveries and no major malformations have been diagnosed. Being the first programme in Scandinavia to perform ICSI, this unit has experienced long waiting lists which indicates that severe male sub-fertility will be one of the major groups for treatment with assisted reproductive technologies in the future.

Endotoxin is angiogenic.

The formation of new blood vessels, angiogenesis, is an important event in inflammation, wound healing and tumour growth. Mediators produced by various cells when exposed to endotoxin include cytokines (tumour necrosis factor, interleukins 1 and 6, and basic fibroblast growth factor) which, it has been suggested, stimulate angiogenesis. The angiogenic effect of endotoxin (lipopolysaccharide, LPS) was studied in rats using the quantitative mesenteric window assay. Adult rats were injected intraperitoneally with Escherichia coli LPS (5 pg/ml-20,000 ng/ml) twice daily for 4.5 consecutive days and were sacrificed 14 days after the start of this treatment. An angiogenic response was observed at concentrations of > 2 ng/ml in a dose-dependent manner. No inflammatory cellular exudate was seen in the test tissue at the time of angiogenesis analysis. Suppressed body-weight gain, a marker of the systemic effect of LPS in the rat, was significant only at the highest dose tested. The data suggest that endotoxin-mediated neovascularization could be a component of inflammation and wound healing.

A morphometric method to evaluate angiogenesis kinetics in the rat mesentery.

The mesenteric window angiogenesis assay permits the objective determination of a number of angiogenesis parameters in peritoneal connective tissue. The time-course of the angiogenic response that follows activation of endogenous connective tissue mast cells in situ in normal adult rats was investigated using a set of quantitative variables. A method developed to quantify angiogenesis kinetics by evaluation of microvascular ramification and elongation is presented. The angiogenic process was found to proceed long after the termination of the inducing selective mast-cell activation and was thus to a large extent self-perpetuating. The angiogenesis also continued long after the maximum level of the ingrowth of vessels from adjacent tissues, the vessel density, and ramification within the vascularized areas was reached. The whole angiogenic phase lasted as long as 5-6 weeks and the total vessel density, i.e. the vascular area multiplied by the vessel density, remained elevated over controls throughout the course of the 99-day experiment. It appears that angiogenesis kinetics based on truly quantitative assessment of relevant parameters, as in the present study, will be a useful means in elucidating how positive and negative angiogenic factors, individually or in combination, influence the microvascular arborization.

Subzonal insemination (SUZI) or in vitro fertilization (IVF) in microdroplets for the treatment of male-factor infertility.

PURPOSE: The results of subzonal insemination (SUZI) and in vitro fertilization with microdroplet insemination used in couples with male-factor infertility are presented. RESULTS: The total fertilization rate was 17.4% for SUZI (n = 89) and 49.3% for microdroplet IVF (n = 100). The fertilization rate for standard IVF (n = 510), not including any male-factor infertility and performed during the same period, was 73.2%. The "take-home baby rate" per started cycle and per embryo transfer (ET), respectively, was 10 and 17.6% for SUZI and 20 and 24.7% for microdrop IVF. For standard IVF these figures were 27 and 31.7%. CONCLUSION: It was concluded that microdroplet IVF can be used with good results in cases of moderate male-factor infertility. The normal (2PN) fertilization rate with the SUZI technique was only 15.1%. However, despite the low fertilization rate, SUZI should be considered when dealing with severe male-factor infertility.

Angiogenesis induced by mast cell secretion in rat peritoneal connective tissue is a process of three phases.

In the present study methods for morphometric evaluation of angiogenesis in the mesenteric window model were developed and used to assess kinetics of angiogenesis induced by either ip saline or the mast cell secretagogue 48/80. Morphometric variables included vessel density (VD), vessel luminal diameter (VLD), vessel luminal surface area (VSA), vessel luminal volume (VLV), vascularized area (VA), and number of circumferential vessels (CV). The kinetic pattern induced by 48/80 consisted of three phases. The first phase was characterized by a pronounced increase of CV, VD, VSA, and VLV and a decrease of VLD on Day 9. The second protracted phase (Day 9 to Day 37) was characterized by a continuing increase of VA together with remodeling of the vascular network (decrease of CV, VD, VSA, VLV and normalization of VLD). In the third phase (Days 37-65) no further expansion of the vascular network was present. Following saline injections ip, the characteristic kinetic pattern was a transient initial expansion of the vessel trees with significant increases of CV, VSA, and VLV on Day 9, while VD and VLD were unchanged, followed by a continuous regression. The results, including a protracted distinguishing second angiogenesis phase after 48/80 injections, strongly argues against short-lived mediators released from mast cells as decisive for the process but rather indicate that other factors, possibly related to macrophage infiltration are important.