Exploring the association between oral health literacy and alexithymia.

UNLABELLED: Low health literacy and alexithymia have separately been emphasized as barriers to patient-practitioner communication, but the association between the two concepts has not been explored. OBJECTIVE: To test the hypothesis that low oral health literacy and alexithymia are associated. METHOD: Adults (n=127) aged 21-80 years (56% women) participated in this cross-sectional study. Oral health literacy was assessed using the interview-based Adult Health Literacy Instrument for Dentistry (AHLID) with scores from 1-5. The self-administered Toronto Alexithymia Scale (TAS-20) was used to assess three distinct TAS-20 factors and TAS-20 total score. RESULTS: Significant negative correlations between AHLID scores and TAS-20 factors 2, 3 and TAS-20 total score were found. Regression analyses showed that TAS-20 factor 3, externally-oriented thinking (ß=-0.21, SE=0.02, p=0.017), and TAS-20 total score (ß=-0.18, SE=0.01, p=0.036) were significant predictors of AHLID level. CONCLUSION: The hypothesis that low oral health literacy is associated with alexithymia was supported. This finding proposes that alexithymia may be considered as a possible factor for low oral health literacy. However, the correlations are not strong, and the results should be regarded as a first step to provide evidence with additional research on this topic being needed.

MRI reveals the in vivo cellular and vascular response to BEZ235 in ovarian cancer xenografts with different PI3-kinase pathway activity.

BACKGROUND: The phosphoinositide-3 kinase (PI3K) pathway is an attractive therapeutic target. However, difficulty in predicting therapeutic response limits the clinical implementation of PI3K inhibitors. This study evaluates the utility of clinically relevant magnetic resonance imaging (MRI) biomarkers for noninvasively assessing the in vivo response to the dual PI3K/mTOR inhibitor BEZ235 in two ovarian cancer models with differential PI3K pathway activity. METHODS: The PI3K signalling activity of TOV-21G and TOV-112D human ovarian cancer cells was investigated in vitro. Cellular and vascular response of the xenografts to BEZ235 treatment (65 mg kg(-1), 3 days) was assessed in vivo using diffusion-weighted (DW) and dynamic contrast-enhanced (DCE)-MRI. Micro-computed tomography was performed to investigate changes in vascular morphology. RESULTS: The TOV-21G cells showed higher PI3K signalling activity than TOV-112D cells in vitro and in vivo. Treated TOV-21G xenografts decreased in volume and DW-MRI revealed an increased water diffusivity that was not found in TOV-112D xenografts. Treatment-induced improvement in vascular functionality was detected with DCE-MRI in both models. Changes in vascular morphology were not found. CONCLUSIONS: Our results suggest that DW- and DCE-MRI can detect cellular and vascular response to PI3K/mTOR inhibition in vivo. However, only DW-MRI could discriminate between a strong and weak response to BEZ235.

Beliefs about medications: measurement and relationship to adherence in patients with severe mental disorders.

OBJECTIVE: To determine if the Beliefs about Medicines Questionnaire (BMQ) has satisfactory psychometric properties in patients with severe mental disorders and if their scores differ from those of patients with severe medical disorders. To investigate if the scores are related to medication adherence. METHOD: Two hundred and eighty psychiatric patients completed the BMQ and reported how much of their medication they had taken the past week. Serum concentrations of medications were analyzed. BMQ scores were compared with those of patients with chronic medical disorders. RESULTS: Cronbach's alpha was satisfactory for all subscales. The psychiatric group scored lower on the necessity of taking medication than the medical group. Non-adherent patients felt medication to be less necessary and were more concerned about it than adherent patients. The necessity subscale predicted adherence fairly well. CONCLUSION: The BMQ has satisfactory psychometric properties for use in patients with severe mental disorders. The constructs measured by the BMQ are related to adherence in these patients.

Effects of binding of ligand (FVIIa) to induced tissue factor in human endothelial cells.

The tissue factor protein is structurally related to the cytokine receptors and ligand binding (factor VIIa) has been reported to give an intracellular calcium signal, thus indicating that tissue factor is a true receptor. In view of the attempts to use recombinant factor VIIa as a therapeutic agent in hemophilia, its binding effects may be of clinical interest. We have studied the effect of ligand binding to human endothelial cells that were stimulated with interleukin-1 to express tissue factor. Human umbilical cord vein endothelial cells produce and release a wide variety of proteins that participate in coagulation and fibrinolysis, and we have investigated whether binding of recombinant factor VIIa to tissue factor altered the release of some of these compounds. Three main findings are reported. (1) After an initial increase, the measurable tissue factor activity in endothelial cells decreased more rapidly in the presence of factor VIIa (half-life 3.7+/-0.7 hours) than in its absence (half-life 7.4+/-1.5 hours). This difference was not seen when tissue factor antigen was measured, indicating that ligand binding did not increase the degradation of the protein. (2) Tissue factor pathway inhibitor was detected on the cell surface, in cell homogenates, and in cell medium. When recombinant factor VIIa was added to the cells there was a significant decrease in the release of tissue factor pathway inhibitor to the medium. Four hours after recombinant factor VIIa was added, the levels were 7.5-fold higher in the medium of untreated cells compared to the medium of cells treated with recombinant factor VIIa. (3) We observed increased release of von Willebrand factor (vWF). After 1 and 6 hours with recombinant FVIIa the release was significantly greater than in controls without FVIIa. We did not detect significant differences in the release of tissue plasminogen activator or tissue factor pathway inhibitor.

[PS-RESKVA (Patient Satisfaction, Results and Quality)--patient satisfaction in hospitals]. / PS-RESKVA--pasienttilfredshet i sykehus.

The reliability and acceptability of a 39-question patient-satisfaction questionnaire (PS-RESKVA) for use in hospitals is assessed. Postal questionnaires were sent to 19,395 patients, aged between 15 and 100 years, who were discharged from the medical, surgical, gynaecological, and neurological wards of two Norwegian hospitals; they were followed up with one reminder. The response rate was 59% for all patients, and 71% among those who were considered medically capable of answering. Six underlying factors were identified in the PS-RESKVA profile, which contained 11 different aspects satisfaction. The PS-RESKVA satisfied the psychometric criteria for internal consistency. Results indicate that the PS-RESKVA is a possible measure of patient satisfaction after discharge from hospital. It seems acceptable to patients in general, and is a reliable measure of satisfaction for a wide range of patients. Further studies on its validity are warranted.

[Patients' stories about their hospital stay. "Of course one special physician was responsible for me--what a question?"]. / Pasientfortellinger om sykehusopphold. "Selvfølgelig var det én lege som hadde hovedansvaret for meg--hvordan skulle det ellers ha gått?"

Data on patients' experiences are usually collected by questionnaires with fixed response categories. An analysis of 3,600 questionnaires showed that almost every fifth responder elaborated on his/her multiple choice answers by writing additional comments. Nearly all the comments were related to topics in the questionnaire. However, the number of comments relating to each of the questions varied. The patients' additional comments may give a clearer indication of what experiences they were anxious to provide feedback on than their multiple choice answers. Additional comments to the questionnaires provide the health service with supplementary information on which its quality assurance efforts can be based.

[Hospital infections as quality indicators. DRG-based financing, did it change therapeutic quality?]. / Sykehusoppståtte infeksjoner som kvalitetsindikator. DRG-basert stykkprisfinansiering, endret behandlingskvalitet?

In 1991, four Norwegian hospitals switched from 100% global budgeting to a combination of 40% DRG-based per case payment and 60% fixed grant financing. In order to monitor quality of care, the prevalences of infections acquired in hospital were registered in medical and surgical departments during the two first years after changing the system of financing. The total cumulative prevalence of hospital acquired infections was 6.3%. There was no change in the occurrence of hospital acquired infections during the observation period. The prevalence of nosocomial infection was significantly higher among patients receiving long-term care than among other patients (18.9% vc. 4.2%, p < 0.0001).

[Myocardial infarction as indicator in a time study. DRG-based financing, did it change therapeutic quality?]. / Hjerteinfarkt som markørtilstand i en tidsstudie. DRG-basert stykkprisfinansiering, endret behandlingskvalitet?

In Norway, four hospitals switched from 100% global budgeting to a combination of 40% DRG-based per case payment and 60% fixed grant financing in 1991. In order to assess changes in the quality of care in acute medicine during the two first years after changing the system of financing, delays before initiation of thrombolytic therapy in patients with acute myocardial infarction were registered. The time from arrival in hospital to initiation of thrombolytic therapy was unchanged, median time was 50 minutes in the first registration period and 55 minutes in the second. 45% of the patients in the intensive care unit/coronary care unit with acute myocardial infarction received thrombolytic therapy.

Age-related discrimination in the use of fibrinolytic therapy in acute myocardial infarction in Norway.

Age-related use of fibrinolytic therapy in acute myocardial infarction was studied for patients admitted to the intensive care unit in four hospitals comprising 10% of the national hospital bed capacity in Norway. Altogether, 446 patients were included. All had validated acute myocardial infarction or acute ischaemic coronary heart disease treated with fibrinolytic medication. The fibrinolytic treatment rate decreased linearly from 74% among patients younger than 50 years to 15% among those older than 80 (p < 0.0001). In a multiple logistic regression, low age, short pre-hospital time and no previous myocardial infarction strongly predicted use of fibrinolytic therapy (p < 0.0001), and male sex was a significant predictor for use of fibrinolytic therapy (p = 0.01).

When time is precious--time lags as indicators of quality of care in acute myocardial infarction.

Intravenous thrombolytic therapy is known to reduce mortality in acute myocardial infarction. The effect is highly time dependent and is uncertain 12 hours or more after onset of major symptoms. In order to assess aspects of quality of care for the initial treatment of acute myocardial infarction, pre- and in-hospital time lags were recorded in four Norwegian hospitals for patients admitted to the intensive care unit with acute myocardial infarction and for patients who received thrombolytic therapy for acute ischemic coronary heart disease. Four hundred and forty-six patients were included, of whom 45% (199) received thrombolytic medication, 159 after the initial assessment and 40 after observation and reassessment. All patients receiving thrombolytic therapy had a history of pain, and 94% (187) had significant ECG-changes. Median pre-hospital time was 240 (1. and 3. quartil 120, 519) min for the total sample and 155 (91, 280) min for those who received thrombolytic medication after the primary assessment. Median in-hospital time before thrombolysis was 55 (35, 75) min for the latter group, and 177 (111, 335) for those who were observed and reassessed. We conclude that there is considerable potential for reducing the time lag for initiation of thrombolytic medication in acute myocardial infarction. Audits, written guidelines and standards are necessary to reduce in-hospital time.

Induction of tissue factor synthesis in human umbilical vein endothelial cells involves protein kinase C.

Incubation of human umbilical vein endothelial cells with one of the following compounds: endotoxin, recombinant interleukin-1 beta, recombinant tumor necrosis factor alpha, allogenic lymphocyte subpopulations or phorbol ester resulted in significant induction of tissue factor synthesis. Diacylglycerol had the same effect and also enhanced synergistically the induction caused by endotoxin and interleukin-1 beta. Two different inhibitors of protein kinase C, H7 and sphingosine, inhibited tissue factor synthesis at concentrations which did not depress protein synthesis in general, suggesting that protein kinase C is involved in the processes leading to tissue factor synthesis. Cells down-regulated for the tissue factor response to TPA responded essentially normally to endotoxin and interleukin-1 with regard to tissue factor synthesis.

Toxicity of sitosterol to human umbilical vein endothelial cells in vitro.

The pathogenesis of the early development of atherosclerosis in sitosterolaemia is unknown. The effect of sitosterol on vascular endothelial cells in vitro was investigated by culturing human umbilical vein endothelial cells in the presence of up to 0.7 mmol l-1 of sitosterol. Liposomes were used to supply the high sterol concentrations. Exposure to 0.7 mmol l-1 of sitosterol for 72 h caused contraction of the endothelial cells and increased release of intracellular lactate dehydrogenase. After 96 h incubation the cells were partly detached from the substrate. At this time-point 0.35 mmol l-1 of sitosterol also caused perturbation of the endothelial cells. However, we could not confirm previous reports that tissue plasminogen activator production was enhanced by sitosterol.

Toxicity of oxygenated cholesterol derivatives toward cultured human umbilical vein endothelial cells.

Human umbilical vein endothelial cells were cultured in the presence of several oxygenated cholesterol derivatives that are known to affect the viability of other cell lines. 5-Cholestene-3 beta,7 beta-diol (7 beta-hydroxycholesterol) caused a time- and concentration-dependent perturbation of the endothelial cells. Exposure to 50 mumol/l of this compound for 18 hours resulted in marked contraction of the cells, followed by increasing cell detachment from the substrate and Trypan Blue uptake in detached cells. Concomitantly release of lactate dehydrogenase from the cells reached about 80% at 24 hours. The release of tissue plasminogen activator and tissue plasminogen activator inhibitor-1 antigens decreased at a concentration of 7 beta-hydroxycholesterol lower than that required for reducing general protein synthesis. 7 beta-Hydroxycholesterol at 50 mumol/l first increased the release and then (at 100 mumol/l) inhibited the synthesis of von Willebrand factor. Incubation with 100 mumol/l of 5-cholestene-3 beta, 7 alpha,22(R)-triol (7 alpha,22-dihydroxycholesterol)e and the isomeric 5-cholestene-3 beta, 7 beta, 22(R)-triol (7 beta, 22-dihydroxycholesterol) caused formation of intercellular gaps and some detachment of the cells after 24 hours. Cell injury was slightly more pronounced for the 7 alpha, 22-dihydroxycholesterol than for the 7 beta-isomer. Incubations with cholesterol under the same conditions gave no sign of cell injury.

Observations on the cell biology of tissue factor in endothelial cells.

Human umbilical vein endothelial cells (HUVEC) are inducible for tissue factor (TF) activity in culture. Based on experiments using ECGF (4-20 micrograms/ml) with heparin (90 micrograms/ml), we obtained the following results: 1) In confluent HUVEC cultures, ECGF had essentially no influence on the levels of inducible TF. 2) In growing HUVEC cultures, ECGF reduced the TF response shortly after seeding but full response was regained when cells were kept confluent for 2-3 days. 3) Although secondary cultures responded best to TF induction in the absence of ECGF, the response was essentially equal over at least 8 passages in the presence of ECGF. 4) Of total cellular TF induced in HUVEC, about 25% was available on the surface, and less than 4% was released with the shed plasma membrane vesicles. The proportion of total TF activity available on the surface of intact cells was not influenced by the presence of ECGF. 5) T1/2 for the decay of TF activity induced was 8.3-9.5 h, whereas in HUVEC when protein synthesis was blocked after TF induction a T1/2 of about 30 h was found.

Allogenic induction of thromboplastin synthesis in monocytes and endothelial cells. Biphasic effect of cyclosporin A.

Monocytes and endothelial cells were stimulated in co-culture with allogeneic lymphocytes to produce thromboplastin (TPL). The induction was biphasic, an early response (8-24 h) was greatly augmented by cyclosporin A (CS) (0.5-5 micrograms/ml) whereas the late response (day 3-4) was inhibited. Prednisolone inhibited both responses. Both drugs inhibited lymphocyte proliferation. Interferon-gamma decreased MLC TPL activity but increased thymidine incorporation. CD4+ cells were instrumental in inducing the early TPL peak in monocytes, whereas CD8+ cells decreased the TPL effect. With endothelial cells both T cell classes were equally effective. Conditioned medium from MLC as well as from co-cultures of endothelial cells and lymphocytes induced early TPL synthesis in endothelial cells. Upon allogeneic stimulation monocytes, but not endothelial cells, produced a significant amount of F-VII, most of which was apparently undercarboxylated.

Synthesis of thromboplastin (tissue factor) by endothelial cells.

Molecular genetics, biochemistry, and cell biology of thromboplastin are briefly reviewed with special emphasis on its biosynthesis by endothelial cells.

Size of breast carcinomas at operation related to tumour growth rate.

The mean nuclear area (MNA) of breast carcinoma cells, previously shown to be related to prognosis, is here presented as a potential overall measure of tumour growth rate prior to operation. Recording of tumour diameter and MNA in 340 infiltrating breast carcinomas demonstrated that tumours of low MNA tended to present at a lower diameter that those of high MNA. The former have thus remained 'small' over a longer period, giving the woman more time to report them at this stage. It is suggested that mass screening from breast carcinoma may pick up these slow growing tumours, missing those of high growth rate unless the screening interval is correspondingly short.

Isolation of Bacillus subtilis in connection with bovine mastitis.

Bacillus subtilis has only seldom been associated with pathological conditions in mammals. As the organism is considered to be ubiquitous in the environment, care has to be taken not to put too much emphasis on the pathogenicity of the organism, even in cases where it is isolated in pure culture. Bacillus subtilis was isolated from 17 cases of bovine mastitis in which it was considered to be the etiological factor.