Experiences of family caregivers of the older people with limitations in activities: A qualitative study.

Functional disabilities increase with ageing and limitations in daily living activities (ADLs) occurred as a consequence. Older people living at home may therefore become dependent on family members in managing activities in daily living. As the informal caregivers' role is known to be challenging, their experiences need to be explored to strengthen their new roles as family caregivers. This study aimed at exploring family caregivers' experiences of providing care for older people living at home with limited ADLs in Sri Lanka. Caregivers caring for older people with limitations in activities at home were purposively selected. Limitations in ADL were determined using the Sinhala-validated Barthel Index. Data were collected through in-depth interviews with 20 caregivers who cared for older people with several basic self-care limitations. Data were analysed using thematic analysis. The results consist of three themes related to caring for older people with limited ADLs: committed to providing compassionate care for the activity-limited older person, trapped in one's own home by caring for the activity-limited older person and in need of respite and support in caring for older persons with limitations of activity. Motivated to care, adapting to care-giving challenges, changed life pattern, neglecting one's own health, emotional suffering, lack of knowledge and skills and wanting assistance in care-giving and with financial support were resultant subthemes. Family caregivers of older people with limited activities living at home, face many challenges to their own health. Supporting interventions will therefore be necessary. An introduction of educational training programmes for informal caregivers would promote the health and well-being of functionally disabled older people and their caregivers. Developing home-based care will be a future solution since the availability of informal caregivers will be at risk due to a rapid increase in older people and social changes related to the family structure.

Algae-based antioxidant containing selenium yeast (Economase®) enhanced the growth performance, oxidative stability, and meat quality of broiler chickens.

OBJECTIVE: An experiment was conducted to determine the effect of algae-based antioxidant containing Se yeast (EconomasE®) on the growth performance, visceral organ weight, meat quality, and oxidative stability of broiler chickens. METHODS: Nine hundred sixty, day-old male broiler chickens (Cobb, 43.97±0.55 g) were divided into three dietary treatments and allocated into 12 deep litter pens in a completely randomized design giving 4 replicate cages for each treatment. Three dietary treatments were: i) control (CON, basal diet with sufficient nutrient), ii) vitamin E (VitE, basal diet supplemented with 100 IU VitE), and iii) Algae-based antioxidant containing Se yeast (EcoE, basal diet supplemented with 0.2% algae-based antioxidant containing Se yeast: EconomasE®). Maize soybean meal based basal diets were formulated to meet or exceed the nutrition requirement for broiler chickens. Chickens were fed ad-libitum experimental diets during the 42 days experiment period. On days 21 and 42, body weight and feed intake were measured to calculate the feed conversion ratio of the chickens. Intestine and visceral organs were measured together with meat quality and oxidative stability on days 14 and 42. RESULTS: Chickens fed with EcoE showed improved (p<0.05) growth performance, meat quality, and higher (p<0.05) oxidative stability compared to the chicken fed on CON. Moreover, broiler chickens fed with EcoE showed similar (p<0.05) growth performance with better (p<0.05) meat quality and higher oxidative stability compared to the broiler chickens fed VitE (p<0.05). CONCLUSION: The algae-based antioxidant containing Se yeast can be supplemented into commercial broiler diets as a substitution of VitE while maintaining growth performance with enhancing meat quality and oxidative stability of the broiler chickens.

Menopause is a natural stage of aging: a qualitative study.

BACKGROUND: Menopause is a biopsychosocial phenomenon encompassing the transition in a woman's life from being fertile to infertile. Although menopause may result in extremely unpleasant physical symptoms there is evidence of a low rate of reported menopausal symptoms amongst women in Asian cultures. Women's experiences, views, and responses to menopause which influences women's daily life and well-being, may vary between different societies and cultures. This study aimed to explore and describe menopausal experiences among women in Sri Lanka. METHODS: A qualitative exploratory research was conducted among postmenopausal women of 46-55 years of age in the western province of Sri Lanka. Individual interviews with a purposive sample of 20 women were conducted, and data analysis was done using manifest and latent content analysis. RESULTS: The results consist of an overall theme, "Menopause is a natural stage of aging" and three categories "Entering a new stage", "Managing menopause" and "Not the end of life" which emerged from 34 codes. The overall theme highlights that changes in menopause were experienced as a natural change in life, with health problems that are normal for this change and handled with different self-care practices. The category "Entering a new stage" describes the women becoming aware of menopause and its bodily changes. The category "Managing menopause" describes women's experiences of being able to find their own remedies to ease the menopausal symptoms and by engaging in religious activities and focusing on interaction with people. The category, "Not the end of life" describes women's views of themselves as still valuable because menopause was experienced as a natural part of their lives. CONCLUSION: Women in Sri Lanka managed menopausal problem mainly on their own as they viewed the menopause as a natural stage of aging risking unnecessary suffering and failure to detect preventable complications. Enabling support groups for menopausal women and improving on their health-seeking behaviour by encouraging them to take part in screening for cervical and breast cancer would improve their condition. Further information on additional hormone therapy with a, subsequent follow-up and evaluation by community health nurses and/or midwives, would facilitate Sri Lankan women's transition to menopause.

Could Anthropometric and Lipid Parameters Reflect Susceptibility to Breast Cancer? Comparison of Newly Diagnosed Breast Cancer and Apparently Healthy Women

Objectives: To determine and compare the serum lipid profiles and anthropometric parameters of newly diagnosed BC patients and healthy women. Methods: Serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), triglyceride (TG) and TC: HDL-C were measured in consent obtained newly diagnosed BC patients (n=155) and age matched apparently healthy females (n=75). Weight (W), height (H), waist circumference (WC), hip circumference (HC) and mid upper arm circumference (MUC) of each women were recorded. Cut off values for each parameter was found by receiver operative characteristic (ROC) curves and risk associated with was calculated using SPSS version 16. Results: Majority (67%) of BC women were postmenopausal. The mean TC, HDL-C, LDL-C, VLDL-C, TC: HDL-C, TG concentrations of BC patients who were not on cholesterol lowering drugs (n= 126) were 234 mg/dL (±51), 43 mg/dL (±10), 164 mg/dL (±44), 27 mg/dL (±14), 5.7(±1.7) and 135 mg/dL (±69) respectively. TC, LDL-C and TC: HDL-C of BC patients were significantly elevated when compared with healthy females. Significant difference in serum lipid profile parameters was not observed (p> 0.05) according to the menopausal status of BC and healthy women. One third (30.3%) of BC patients were overweight and 45% were obese. Majority had elevated WC (72%), W: H ratios (89%) and MUC (89%). BMI, W: H and MUC of BC women were significantly higher (p<0.05) when compared with healthy females. Conclusions: The lipid parameters TC, LDL-C and TC: HDL-C above 203 mg/dL, 139 mg/dL and 3.9 respectively were risk factors. Among anthropometric measures, BMI>25 kg/m2 showed the highest risk while elevated W:H and MUC were also significant risk factors among the study group.

Detection of clarithromycin-resistant Helicobacter pylori strains in a dyspeptic patient population in Sri Lanka by polymerase chain reaction-restriction fragment length polymorphism.

AIM: The aim of this study was to investigate the proportion of common clarithromycin-resistant mutation types present in the 23S ribosomal ribonucleic acid (rRNA) gene of H. pylori strains in Sri Lanka. SETTINGS AND DESIGN: The study was a cross-sectional, descriptive study where 76 dyspeptic patients who were required to undergo endoscopy examination were included. The study was carried out at a Teaching Hospital in Sri Lanka. SUBJECTS AND METHODS: In-house urease test and polymerase chain reaction (PCR) amplification of the glmM gene of H. pylori was performed to confirm the H. pylori infection. Analysis of point mutations in 23S rRNA gene strains were performed by PCR-restriction fragment length polymorphism (RFLP). RESULTS: Of the 16 urease-positive biopsies, 94% (n=15) were positive by PCR using the glmM primer. All H. pylori strains yeilded a point mutation at A2142G site of the 23S rRNA gene, while A2143G mutation was not detected. CONCLUSIONS: For the first time in Sri Lanka, we reported predominance of A2142G point mutation associated with claritromycin resistance of H. pylori in a Sri Lankan population.

Anti-inflammatory activity of dried flower extracts of Aegle marmelos in Wistar rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Almost all part of the plant Aegle marmelos (Bael tree) has been used in the traditional medicine systems of Asian countries to treat various diseases over many centuries. The water extract of the dried flowers of Aegle marmelos is a commonly used beverage among Sri Lankan population in rural areas. Although extensive investigations done on many parts of the plant there are no experimental data available on the extracts of flowers. Anti-inflammatory effect of the water extract of dried flowers of Aegle marmelos (WEAM) was evaluated in the present study. MATERIALS AND METHODS: The anti-inflammatory effect of the WEAM was evaluated by inhibition of the rat paw oedema, induced by carrageenan. The mechanism of the anti-inflammatory effect was assessed by the inhibition of production of nitric oxide (NO) by rat peritoneal cells, infiltration of rat peritoneal cells, anti-histamine effect, membrane stabilization activity, the antioxidant capacity and inhibition of lipid peroxidation by the WEAM. RESULTS: The maximum percentage inhibition of paw oedema was exhibited by the dose of 200 mg/kg at 2 h. The WEAM showed a significant increment of rat peritoneal cell infiltration, inhibition of NO production by rat peritoneal cells and inhibition of wheal formation on the skin of the rat after injection of histamine. The WEAM protected the erythrocyte membrane from heat-induced lysis in a dose-dependent manner and showed a significant anti-oxidant effect and lipid peroxidation inhibition activity. CONCLUSION: The WEAM possesses significant anti-inflammatory effect by multiple mechanisms in Wistar rats.

Sulphoxythiocarbamates modify cysteine residues in HSP90 causing degradation of client proteins and inhibition of cancer cell proliferation.

BACKGROUND: Heat shock protein 90 (HSP90) has a key role in the maintenance of the cellular proteostasis. However, HSP90 is also involved in stabilisation of oncogenic client proteins and facilitates oncogene addiction and cancer cell survival. The development of HSP90 inhibitors for cancer treatment is an area of growing interest as such agents can affect multiple pathways that are linked to all hallmarks of cancer. This study aimed to test the hypothesis that targeting cysteine residues of HSP90 will lead to degradation of client proteins and inhibition of cancer cell proliferation. METHODS: Combining chemical synthesis, biological evaluation, and structure-activity relationship analysis, we identified a new class of HSP90 inhibitors. Click chemistry and protease-mass spectrometry established the sites of modification of the chaperone. RESULTS: The mildly electrophilic sulphoxythiocarbamate alkyne (STCA) selectively targets cysteine residues of HSP90, forming stable thiocarbamate adducts. Without interfering with the ATP-binding ability of the chaperone, STCA destabilises the client proteins RAF1, HER2, CDK1, CHK1, and mutant p53, and decreases proliferation of breast cancer cells. Addition of a phenyl or a tert-butyl group in tandem with the benzyl substituent at nitrogen increased the potency. A new compound, S-4, was identified as the most robust HSP90 inhibitor within a series of 19 derivatives. CONCLUSION: By virtue of their cysteine reactivity, sulphoxythiocarbamates target HSP90, causing destabilisation of its client oncoproteins and inhibiting cell proliferation.

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.

Apoptosis in subicular neurons: A comparison between suicide and Addison's disease.

BACKGROUND: Stress and depression shows possible links to neuronal death in hippocampus. Subiculum plays a prominent role in limbic stress integration and direct effect of corticosteroids on subicular neurons needs to be defined to assess its subsequent impact on hippocampal plasticity. AIM: This study was intended to assess apoptosis in subicular neurons of a young depressed suicide victim, where presumably stress induced excess of corticosteroids and a case of young Addison's disease with low level of corticosteroids. MATERIALS AND METHOD: Both bilateral adrenal glands (Addison's) and subiculum (both cases) were initially stained with hematoxylin and eosin; subicular neurons of both cases were examined for the degree of apoptosis using 'ApopTag Kit'. Apoptotic cell counts were expressed as average number of labeled cells/mm 2 and the results were analysed statistically using a non-parametric Mann-Whitney U test. RESULT: Apoptotic neurons were detected in the subicular region of both suicide and Addison victims, and it is statistically significant in both right and left between the cases (P < 0.05). In suicide victim, the neuronal apoptosis is considerably significant between the two hemispheres (P < 0.05), in contrast to Addison disease where the number of neuronal cell death between right and left was statistically insignificant (P > 0.05). CONCLUSION: The present study confirms the vulnerability of the subicular neurons to apoptosis, possibly due to corticosteroids in both ends of spectrum.

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.

Activity of supplemental enzymes and their effect on nutrient utilization and growth performance of growing chickens as affected by pelleting temperature.

Activity of supplemental enzymes in a barley-soybean-maize based diet at 60, 75 and 90 degrees C pelleting temperatures was studied using feed viscosity, in-vitro enzyme activity and broiler performance data. High pelleting temperatures increased feed viscosity but supplemented enzymes reduced the viscosity at all three temperatures levels by 11, 14 and 17%, respectively. Water intake and losses in excreta of birds were found to be affected by feed viscosity. Activity of cellulase enzyme, measured using the radial diffusion method, was unaffected at 60 and 75 degrees C, but reduced by 73% in feed processed at 90 degrees C. Enzymes increased the weight gain of broilers by 11.1% at 90 degrees C, but no effect could be seen at low pelleting temperatures possibly due to high dietary protein and energy contents. Feed intake was unaffected by enzymes. Birds consumed 6% more feed and grew 9% faster when the pelleting temperature was increased from 60 to 75 degrees C. Reduced feed intake and daily weight gain observed at 90 degrees C could be fully compensated by the enzyme supplementation. High pelleting temperature reduced energy metabolizability (3.2%) and nitrogen utilization (4%) but enzyme almost compensated them (by 3.3% and 2.6%, respectively). No interaction could be detected between the pelleting temperatures and enzymes. It is concluded that pelleting temperatures as high as 90 degrees C drastically reduce cellulase activity, energy and nitrogen utilization thus lowering broiler performance. Either the remaining activity of cellulase or other thermostable enzymes can prevent the losses.