Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial.

AIM: To increase maintenance of breastfeeding through improved primary care support. METHOD: A cluster randomised controlled trial recruited 15 rural family doctor's offices and 330 women who were currently breastfeeding took part. Eight practices formed the intervention group (154 women) and seven formed the control group (176 women). The practice nurses who provided the intervention used a specially designed motivational flowchart to speak to the mothers when they brought their child for immunisation at 2, 4 and 6 months. The nurses also attended preparatory workshops on breastfeeding management, counselling skills, motivational interviewing and reflective practice and were given resources and support. Breastfeeding rates were measured at 4 and 6 months. RESULTS: Randomisation equally distributed all measured variables except prenatal intentions to rejoin employment within 12 months (70% intervention, 56% control, p < 0.05). After adjustment, the 4-month figures showed significantly higher rates of exclusive breastfeeding (OR 1.88; 95%CI 1.01-3.50; p = 0.047) and full breastfeeding (water/juice allowed) (OR 1.95; 95%CI 1.03-3.69; p = 0.04) in the intervention group. There were no differences at 6 months. CONCLUSION: A motivational interviewing intervention by primary care health professionals who have undertaken a replicable training programme is feasible and effective in increasing exclusive breastfeeding and full/predominant breastfeeding at 4 months.

Electrorheological phenomena in polyhedral silsesquioxane cage structure/PDMS systems.

It is shown, for the first time, that mixtures of sulfonated polyhedral silsesquioxane cage structures (sPOSS) and poly(dimethyl siloxane) (PDMS) with silicone oil exhibit significant electrorheological (ER) activity. At low sPOSS concentrations, less than 10 wt %, the viscosity is enhanced by approximately 100, which is comparable to the viscosity enhancements exhibited by conventional ER fluids, under the influence of comparable applied electric fields, E = 2 kV/mm. Measurements of the shear stress, sigma, dependencies on E, the conductivities, and relative permittivities reveal that the properties of these POSS/PDMS systems cannot be reconciled with theory developed to explain the behavior of conventional ER fluids.

Combinations of the FLT3 inhibitor CEP-701 and chemotherapy synergistically kill infant and childhood MLL-rearranged ALL cells in a sequence-dependent manner.

Mixed lineage leukemia (MLL) rearrangements occur in 80% of infants and 5% of older children with acute lymphoblastic leukemia (ALL). These cases have a poor prognosis with current therapy. The FLT3 kinase is overexpressed and constitutively activated in MLL-rearranged ALL cells. The FLT3 inhibitor CEP-701 selectively kills these cells, but is unlikely to be curative if used as monotherapy. To identify potentially synergistic combination strategies, we studied CEP-701 and six standard chemotherapeutic agents in three sequences of exposure (S1: chemotherapy followed by CEP-701, S2: simultaneous exposure to both; and S3: CEP-701 followed by chemotherapy) using MLL-rearranged ALL cell lines and patient bone marrow samples. MTT cytotoxicity and annexin V binding apoptosis assays were used to assess antileukemic effects. Combination indices (CI) were calculated for each combination (CI<0.9 - synergistic; CI 0.9-1.1 - additive; CI>1.1 - antagonistic). A striking pattern of sequence-dependent synergy was observed: S1 was markedly synergistic (mean CI=0.59+/-0.10), S2 was additive (mean CI=0.99+/-0.09) and S3 was antagonistic (mean CI=1.23+/-0.10). The sequence dependence is attributable to the effect of CEP-701 on cell cycle kinetics, and is mediated specifically by FLT3 inhibition, as these effects are not seen in control cells without activated FLT3.

Cultured muscle cells from insulin-resistant type 2 diabetes patients have impaired insulin, but normal 5-amino-4-imidazolecarboxamide riboside-stimulated, glucose uptake.

Impaired insulin action is a characteristic feature of type 2 diabetes. The study aims were to investigate whether after prolonged culture skeletal muscle cultures from insulin-resistant, type 2 diabetic patients (taking >100 U insulin/d) displayed impaired insulin signaling effects compared with cultures from nondiabetic controls and to determine whether retained abnormalities were limited to insulin action by studying an alternative pathway of stimulated glucose uptake. Studies were performed on myotubes differentiated for 7 d between passages 4 and 6. Insulin-stimulated glucose uptake (100 nm; P < 0.05) and insulin-stimulated glycogen synthesis (1 nm; P < 0.01) were significantly impaired in the diabetic vs. control cultures. Protein kinase B (PKB) expression and phosphorylated PKB levels in response to insulin stimulation (20 nm) were comparable in the diabetic and control cultures. 5-Amino-4-imidazolecarboxamide riboside (AICAR) mimics the effect of exercise on glucose uptake by activating AMP-activated protein kinase. There was no difference in AICAR (2 mm)-stimulated glucose uptake between diabetic vs. control myotube cultures (P = not significant). In conclusion, diabetic muscle cultures retain signaling defects after prolonged culture that appear specific to the insulin signaling pathway, but not involving PKB. This supports an intrinsic abnormality of the diabetic muscle cells that is most likely to have a genetic basis.

Genetics of type 2 diabetes and insulin resistance: knowledge from human studies.

Both type 2 diabetes mellitus (T2DM) and insulin resistance are complex traits in which multiple gene effects and metabolic and environmental factors combine to contribute to the overall pathogenesis of these conditions. This complexity has complicated the search for susceptibility genes and has led to different but complementary approaches being used for the detection of gene effects. These include the study of monogenic cases of insulin resistance and T2DM, association studies of candidate genes and genome-wide scans. The peroxisome proliferator-activated receptor gamma (PPARgamma) and calpain-10 (CAPN10) genes have recently been identified as T2DM susceptibility genes, and the lessons learnt from these studies are helping to shape future strategies to search for additional susceptibility genes in T2DM and insulin resistance.

Sequential chemotherapy by CHOP and DHAP regimens followed by high-dose therapy with stem cell transplantation induces a high rate of complete response and improves event-free survival in mantle cell lymphoma: a prospective study.

Mantle cell lymphoma (MCL) is a distinct clinico-pathological entity with a poor prognosis. We have conducted a prospective study in patients with MCL to evaluate a therapeutic strategy in which CHOP polychemotherapy was followed by DHAP if CHOP failed to induce complete remission. Responding patients then proceeded to an intensification therapy with autologous peripheral blood stem cell transplantation (APBSCT). Twenty-eight consecutive patients with newly diagnosed aggressive MCL were included. After four cycles of CHOP regimen, two complete responses (CR) were obtained (7%) and 14 (50%), five (18%) and seven (25%) patients achieved partial (PR), minor (MR) and no response, respectively (one patient died from septic complications during CHOP induction). The two patients in CR after CHOP underwent intensification with TBI, high-dose cyclophosphamide-etoposide and APBSCT. The other twenty-five patients received DHAP and in this group a response rate of 92% (21 CR (84%), two PR (8%)) was observed. Two patients had progressive disease. The twenty-three responding patients received high-dose therapy (TAM8 regimen: TBI-cytarabine-melphalan) followed by APBSCT. One of the two partial responding patients achieved CR after TAM8. After a median follow-up of 47.6 months (range, 14-70), seven patients have relapsed. Our data confirm that: (1) CHOP regimen induces a low CR rate in MCL; (2) CHOP plus DHAP appears to be much more efficient and allows a large proportion of patients to proceed to high-dose therapy in CR; (3) consolidation therapy including TBI and high-dose Arac-C followed by APBSCT may improve event-free survival.

Attitudes towards infant feeding among adults in a low socioeconomic community: what social support is there for breastfeeding?

An analysis of the role of social support in influencing breastfeeding in a low socioeconomic area in South Australia was undertaken by examining infant feeding attitudes and experiences of mothers, fathers and grandmothers as well as the general community. A random telephone survey of over 3,400 adults (including a more extensive survey of 373 mothers, fathers and grandmothers in the sample) in this area indicated that there was little support for breastfeeding compared to bottle-feeding with similar barriers to breastfeeding found in all target groups as well as the general community. These included breastfeeding in public, the convenience of bottle-feeding, maternal discomfort of breastfeeding, the support required for breastfeeding, fathers' involvement with feeding, and a mother's previous experience of breastfeeding. Strategies promoting and supporting breastfeeding should address these issues and should be directed at the community in general rather than specific groups within the community.

Community attitudes to infant feeding.

A cross-sectional study was designed to describe the social context in which breastfeeding occurs by examining experiences of and attitudes toward infant feeding within the general community. Of the 2500 randomly selected adults who participated in the telephone survey, 61% had been breastfed, the youngest child of 52% of participants (who were also parents) had been mainly breastfed but 58% of babies seen by participants were bottle-fed. The attitudes examined in this survey suggest there was little support for breastfeeding, particularly outside the home. Over 80% of participants agreed that bottle-feeding was more acceptable in public places and 70% agreed there was not always a place to breastfeed when outside the home. In addition, bottle-feeding was considered easier and more convenient indicating the social environment was not very breastfeeding friendly. Interventions to enhance environmental support for breastfeeding need to focus on reducing these barriers so that breastfeeding in public is more acceptable and breastfeeding in general is easier and more convenient.

Serum S-100beta protein is a potential biochemical marker for cerebral oedema complicating severe diabetic ketoacidosis.

CASE REPORT: A 39-year-old man with Type 1 diabetes mellitus was hospitalized with severe diabetic ketoacidosis (DKA). Sixteen hours after admission he suddenly deteriorated having a respiratory then cardiac arrest. A brain computed tomography scan performed 2 h after the respiratory arrest showed severe cerebral oedema. Serial serum samples were stored and analysed for S-100beta protein. The S-100beta protein concentration was initially normal (0.12 microg/l) then rose significantly before the onset of the respiratory arrest (8.5 h = 0.61 microg/l, 14.5 h = 0.9 microg/l, 18 h = 1.6 microg/l, 25.5 h = 3.1 microg/l, 34 h = 4.6 microg/l and44 h = 19.5 microg/l). CONCLUSIONS: In this case of DKA, serum S-100beta concentration rose coinciding with the onset of cerebral oedema, before it became clinically evident. Monitoring serum S-100beta may have a useful role in the management of DKA.

Breastfeeding in public places.

This study reports the results of a survey of restaurant and shopping center managers concerning breastfeeding in their facilities. Managers from 66 restaurants and 27 shopping centers were interviewed by telephone. One-third of the restaurant managers and 48% of the shopping center managers stated that a mother could breastfeed anywhere in their facility regardless of what other customers might say. The remaining managers would either discourage breastfeeding anywhere in their facility, suggest a mother move to a more secluded area if she wished to breastfeed, or were unsure how they would react. The variability in support for breastfeeding by managers of restaurants and shopping centers will continue to create uncertainty for mothers wishing to breastfeed in these public places.

Determinants of infant feeding practices in a low socio-economic area: identifying environmental barriers to breastfeeding.

OBJECTIVE: To identify environmental barriers to breastfeeding. METHOD: Focus groups were conducted with young women, parents-to-be, mothers, fathers and grandmothers in 1996 in northern Adelaide, South Australia (a low socio-economic area). RESULTS: Seven focus groups (4-8 participants per group) were conducted. Breastfeeding was seen as being embarrassing to do in public, and not possible to combine with paid employment. While fathers were not supportive of their partners breastfeeding in public, health professionals were seen as strong advocates of breastfeeding. Bottle feeding was perceived to be more convenient for the mother, more acceptable in public but not as good as breastfeeding for the baby. CONCLUSION: An environmental that enables women to breastfeed is far from being achieved in this low socio-economic area, particularly in relation to breastfeeding in public. IMPLICATIONS: Breastfeeding promotion should have a public health focus, concentrating on creating a supportive breastfeeding environment through a multi strategy approach aimed not just at mothers but also at the community.

Suitability of breastfeeding facilities outside the home: an audit of baby change rooms in shopping centres.

In an attempt to identify and audit breastfeeding facilities (baby care rooms) outside the home, this study considered their presence and suitability for breastfeeding in major shopping centres in a low socio-economic area. Only 48% of the shopping centres had baby care rooms, all of which were located either in or next to toilets and were indicated by a range of symbols and terms. The baby care rooms were audited for breastfeeding suitability using the NMAA (Nursing Mothers' Association of Australia) Baby Care Room criteria as an assessment procedure. Only 43.7% of the baby care rooms met all of the 8 NMAA Baby Care Room criteria. Reliability of this assessment process was moderate with a kappa of 0.52. In reviewing these criteria, it was found that more specific clarification of some of the criteria should be undertaken to improve the assessment process. Mothers need to be reassured if they wish to breastfeed in public places by using baby care rooms, that these rooms are suitable for breastfeeding. If breastfeeding is to be encouraged, since it is a healthy choice, it needs to be an easy choice--easy to do outside the home because there are suitable places to breastfeed.

A diffuse T lymphocytic gastrointestinal mucosal infiltration associated with Sjögren's syndrome resulting in a watery diarrhea syndrome and responsive to immunosuppressive therapy.

We report the case of a 45-yr-old white man, investigated for chronic diarrhea, malabsorption and weight loss associated with sicca syndrome. Endoscopic and x-ray examinations showed normal macroscopic mucosa in gastrointestinal tract (GIT). Immunohistochemistry showed diffuse polyclonal T cell lymphocytes infiltrating either epithelium and lamina propria in GIT. There was no villous atrophy in the jejunum and ileum. Corticosteroids, azathioprine, and cyclosporine failed to improve symptoms. Monthly intravenous cyclophosphamide administered over 1 yr, stopped the diarrhea and weight loss. The patient is free of symptoms up to a 5-yr follow-up.

Diagnostic utility of specific microbiological markers for periodontal diseases.

Specific detection of marker organisms Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans with an immunoassay provided 2 types of useful information directly into private clinical practice: 1) persistence of P. gingivalis in patients undergoing regular treatment allowed rapid identification of pockets requiring further treatment without waiting for measurable progression of lesions and 2) presence of A. actinomycetemcomitans in adults at any stage of diagnosis or treatment identified patients who may prove to have difficult-to-manage periodontitis. We made these findings in 253 patients (234 in specialist periodontal practices [F-ME 55; MHM 179] and 19 in general dental practice [EWM]). The search for useful diagnostic markers overlaps only partly with the search for periodontal pathogens. The P. gingivalis marker and the A. actinomycetemcomitans marker identify 2 different patterns of infection that appear to reflect 2 different underlying problems. Demonstration of pocket-dependent infection with P. gingivalis in treated patients provides an outcome marker for sites not converting to marker-negative sites at detection levels of the immunoassay. This information facilitates selection of sites and patients requiring adjustment of treatment regimens. Detection of A. actinomycetemcomitans in adult patients is significantly associated with periodontitis characterized as refractory. Positive identification of A. actinomycetemcomitans with the immunoassay supports clinical decision-making by drawing attention to adult patients who require closer monitoring and intensive persistent treatment. Successful application of immunoassay detection of microbiological markers is based on continuous patient monitoring to support clinical decisions; it does not replace careful clinical judgment.