Characterization of casein-derived peptide bioactivity: Differential effects on angiotensin-converting enzyme inhibition and cytokine and nitric oxide production.

Lactic acid bacteria (LAB) are used as starter cultures in the production of fermented dairy products and have the potential to confer bioactivity relevant to cardiovascular health, as they possess extensive proteolytic systems that liberate small bioactive peptides from larger milk proteins. Certain casein-derived peptides released by various LAB strains during fermentation have been shown to reduce hypertension and to modulate the immune system. We investigated the growth and peptide production of 2 LAB strains, Lactobacillus helveticus R0389 and Lactocaseibacillus rhamnosus R0011, their immunomodulatory activities, as well as their abilities to inhibit the angiotensin-converting enzyme (ACE). Peptide fractions collected from the cell-free supernatant of both medium-grown and milk fermentation cultures were assessed for ACE-inhibitory activity and their effects on the production of proinflammatory and regulatory cytokines by human THP-1 monocytes. Cultures were grown in medium, with or without supplementation with 0.1% casein, or in 3.25% milk fermented with each LAB strain. Casein supplementation increased the growth rate of both LAB strains, and significantly increased ACE-inhibitory activity of peptide fractions collected from both L. helveticus R0389 and L. rhamnosus R0011 cultures grown for 12 h. Fermentation peptide fractions of L. rhamnosus R0011 showed comparable ACE-inhibitory activity to known ACE inhibiting peptides Val-Pro-Pro and Ile-Pro-Pro (up to 79% inhibition) with a significant difference between culture peptide fractions and acidified and nonacidified control fractions collected after 6 d of fermentation. Many milk and casein-derived peptides reported in previous studies have been identified as part of a larger bioactive fraction. We synthesized a group of these peptides to individually assess both ACE-inhibitory and immunomodulatory activity. The known ACE inhibitors Val-Pro-Pro and Ile-Pro-Pro showed similar ACE inhibition to previously published results, while also inducing the production of the regulatory cytokine IL-10 by monocytes in the presence and absence of a proinflammatory stimulant. These synthesized peptides could also induce the production of nitric oxide (NO), a potent vasodilator, in human endothelial cell cultures. Investigating the relationships among these bioactive properties could improve the use of probiotic organisms and their secreted products in the food industry.

Self-disgust mediates the relationship between dysfunctional cognitions and depressive symptomatology.

Disgust has been linked to several psychopathologies, although a role in depression has been questioned. However, it has recently been proposed that rather than general disgust sensitivity, disgust directed toward the self (self-disgust) may influence the development of depression, providing a causal link between dysfunctional cognitions and depressive symptomatology. This possibility was examined by developing a scale to measure self-disgust (the Self-Disgust Scale; SDS) and then using mediator analysis to determine if self-disgust was able to explain the relationship between dysfunctional cognitions (measured with the use of the Dysfunctional Attitudes Scale) and depressive symptomatology (measured with the use of the Beck Depression Inventory and the Depression, Anxiety and Stress Scale). The developed SDS was found to exhibit a high level of internal consistency, test-retest reliability, and concurrent validity. Principal-components analysis revealed two factors to underlie responses to SDS items: the 'Disgusting self,' concerned with enduring, context independent aspects of the self, and 'Disgusting ways,' concerned with behavior. Self-disgust was found to mediate the relationship between dysfunctional cognitions and depressive symptomatology, demonstrating for the first time that self-disgust plays a role in depression.

A study of bone mineral density in women with forearm fracture in Northern Ireland.

A group of Northern Ireland women aged 40-75 years of age with low-trauma forearm fracture were studied to determine the incidence of such fractures and the prevalence of osteoporosis in this fracture population. A total of 1,147 subjects were identified in 1997 and 1998 throughout Northern Ireland following low-trauma forearm fractures, as well as 699 residents in the Eastern Health and Social Services Board (EHSSB), enabling calculation of the annual incidence rate of new low-trauma forearm fractures at 2.69/1,000 population aged 40-75. A total of 375 participants consented to have bone mineral density (BMD) measurements undertaken at the femoral neck, spine, and forearm using a Lunar Expert bone densitometer. Osteoporosis at the femur was present in 14% of women, at the spine in 29%, and at the forearm in 32%. A total of 45% were osteoporotic at one or more measured sites, but only 18% were on treatment for osteoporosis. Additional significant risk factors identified included an early menopause in 24.5% and current or previous corticosteroid use in 13%. Only 1.6% received information on treatment of osteoporosis at the time of fracture. Increased awareness is needed in both primary and secondary care including fracture services to improve treatment of women with low-trauma fracture.

Do the COL1A1 and Taq 1 vitamin D receptor polymorphisms have a role in identifying individuals at risk of developing osteoporosis?

The distribution of the Taq 1 polymorphism in the vitamin D receptor (VDR) gene and the MSc 1 polymorphism in the collagen 1 alpha 1 (COL1A1) gene were studied in 266 female and 55 male patients attending an osteoporosis clinic. Allele frequency in control (T- or Z-score >-1.0) and osteoporotic (T- or Z-scores <-2.5) groups were compared using Chi squared tests. No differences were found between the 2 groups with either of the polymorphisms. When allele frequency was compared in patients with and without history of fracture, no differences were found in the frequency of the COL1A1 alleles. However there were significantly more fracture patients, who had been previously treated with corticosteroids for other conditions, carrying the T allele of the VDR polymorphism (X2 = 5.65, p>0.01<0.02). In conclusion, neither of these polymorphisms aid in the prediction of osteoporosis but the VDRT allele may carry an increased fracture risk in patients who require corticosteroid treatment.

How reliable is a radiological report in osteoporosis in diagnosing low bone density?

Patients are often referred to osteoporosis clinics with a radiological diagnosis of osteoporosis. Previous studies attempting to ascertain risk of osteoporosis from radiographs have been conflicting. The aim of our study was to determine how reliable spinal radiographs were at detecting low bone density compared with Dual Energy X ray Absorptiometry (DXA). We retrospectively measured the Bone Mineral Density (BMD) at the spine in 130 patients with a radiological diagnosis of osteopenia or osteoporosis in the absence of vertebral fractures. They were compared with a group of 119 age and sex matched patients with one or more low trauma vertebral fractures. There was a statistically significant difference in the mean BMD between these two groups. 12.7%, of the x-ray group with osteopenia reported, had a normal bone density, 49.2% had osteopenia (T-score -1 to -2.5) and 38.1% had osteoporosis (T-score <-2.5). Of those with a radiological report of osteoporosis, 12.8% had a normal bone density, 44.7% had osteopenia and 42.6% had osteoporosis. We conclude that a radiological report of low bone density is a strong predictor of osteopenia or osteoporosis by BMD measurement.

Tolerability and compliance with risedronate in clinical practice.

The purpose of this study was to determine compliance with dosing instructions, and the prevalence of possible adverse events, when risedronate is used in clinical practice. 219 patients were studied. We found that despite counseling one in four patients were non-compliant with dosing instructions. Those patients who did not stay upright after taking risedronate were more likely to have an adverse event and to discontinue the drug. Adverse events were experienced by 38% of patients, the commonest being gastrointestinal. Upper GI adverse events occurred in 21% of patients. A previous history of upper GI symptoms applied to 44% of patients and significantly more of them experienced upper GI adverse events than those with no history of GI problems. Forty two (19%) of patients taking risedronate stopped therapy due to adverse events, but only ten of these patients had contacted the Osteoporosis Unit about these symptoms. Approximately one third of the patients who experienced adverse events in this study had attempted a rechallenge with the drug. This was worthwhile, however, as in almost 50% of these patients their symptoms settled and they continued with therapy. This study has highlighted the importance of following up patients on long-term osteoporosis medication to ensure optimal compliance. The use of specialized osteoporosis nurses in clinics or primary care to follow up patients needs to be addressed.

Rehabilitation after a hip fracture. Special needs of the elderly.

Hip fractures are one of the most common and potentially devastating injuries in the geriatric population. The incidence, morbidity, and health care costs associated with hip fracture among older persons are well recognized. Because of the complex health care needs of the elderly, rehabilitation after a hip fracture can present a challenge at a time when the nursing workforce and health care funding are declining. Aggressive rehabilitation focusing on continuity of care and attention to the cognitive as well as physiologic status results in effective and cost-effective rehabilitation.

Self-reported benefits of t'ai chi practice by older women.

Self-rated health is a powerful and consistent predictor of self-care capability and health outcomes including mobility, morbidity, and mortality. Exercise is important for health and functioning of older adults. Although daily physical activity is advocated for reducing many health risks and maintaining mobility, older women are generally not heeding the message. Exercise interventions for older women should be age appropriate. T'ai chi, an ancient Chinese martial art, involves an integration of the mind and body in slow, circular movements and changes in the center of gravity. Although there is a growing body of literature on the health benefits of t'ai chi exercises, few studies focus on the self-assessment of health benefits of t'ai chi for older women. This within-participants, single-factor study of women aged 72 to 96 years resulted in statistically significant improvement in self-assessed health as well as numerous self-reported benefits after 3 months of t'ai chi exercise participation.

Case management model for a community-based multiple sclerosis clinic.

This article describes the process from inception to successful operation of a case management model of a community-based multiple sclerosis clinic. The article includes information regarding the pathophysiology, diagnosis, and clinical manifestations of multiple sclerosis. The assessment, planning, and intervention stages of the process are explained, and a case study of one clinic patient is provided.

Creating an effective poster presentation.

One way to build knowledge in nursing is to share research findings or clinical program outcomes. The dissemination of these findings is often a difficult final step in a project that has taken months or years to complete. One method of sharing findings in a relaxed and informal setting is a poster presentation. This method is an effective form for presenting findings using an interactive approach. The milieu of a poster presentation enables the presenters to interact and dialogue with colleagues. Guidelines for size and format require that the poster is clear and informative. Application of design helps to create visually appealing posters. This article summarizes elements of designing and conducting a poster presentation.

Multiple sclerosis update.

Multiple sclerosis (MS) is the most common central nervous system disease among young adults and the third leading cause of disability in the United States. It is estimated that 400,000 Americans have this disorder of the brain and spinal cord, which causes disruption in the smooth flow of electrical messages from the brain to nerves throughout the body. The clinical manifestations vary more in MS than any other neurologic disease. Because of the complexity of MS, a collaborative approach to care of these clients and their family is ideal. This article provides an update on the diagnosis, pharmacologic management, and collaborative care for patients and families.

Orthopaedic nursing research priorities: a replication and extension.

PURPOSE: This study identified current orthopaedic nursing research priorities that should be investigated to advance the practice of orthopaedic nursing. The study was accomplished by the National Association of Orthopaedic Nurses' (NAON) Research Committee via a national survey of selected NAON members. DESIGN: A descriptive design was used to determine research priorities. SAMPLE: The sample consisted of a random sample of 133 NAON members. The sample was stratified for either graduate degrees (> or = master's), other than a graduate degree (< or = bachelor's) (to insure representation from "frontline" practicing nurses), and registrants in the NAON Researcher Database and recipients of NAON Foundation or American Academy of Orthopaedic Surgeons (AAOS)/NAON grants. METHOD: A three round Delphi survey technique was used to build consensus by systematically generating, synthesizing, and analyzing opinions of a group of experts while maintaining confidentiality of the individuals. MAIN RESEARCH CLASSIFICATIONS: Nursing research priorities, Delphi method, Orthopaedic nursing. FINDINGS: The nine target research questions for orthopaedic nursing identified as high priority were grouped into the following categories: patient acuity, care delivery models, staffing issues, patient complications, pain management (in the elderly and those with altered mental status), and patient mobility. These research priority items are intended to direct the orthopaedic nurse researcher to study specific questions within these categories. CONCLUSION: Results reflect the dramatic changes occurring in orthopaedic nursing practice. Research priorities reveal the need for more research on pain and patient complications (e.g., deep vein thrombosis (DVT)) despite a preponderance of existing, published research on these topics. IMPLICATIONS FOR NURSING RESEARCH: This study identified target research questions for orthopaedic nursing. These questions may be used by orthopaedic nurses to develop nursing research proposals as well as collaborative research endeavors with other members of the orthopaedic health care team. An ongoing and wider dissemination of results of existing research to the NAON membership needs to be implemented.

Long-term efficacy of cyclical etidronate therapy in postmenopausal osteoporosis.

Sixty-two women (mean age 68.7 +/- 0.9 yr) with postmenopausal spinal osteoporosis were treated with cyclical etidronate therapy (400 mg for 2 weeks alternating with 12 weeks of 1 gm elemental calcium and 400 IU Vitamin D3) for a minimum of 2 yr. Bone mineral density (BMD) of the lumbar spine (g/cm2) increased significantly (p < 0.0001) after yr 1 (4.1 +/- 0.5 per cent) and yr 2 compared with yr 1 (2.2 +/- 0.5 per cent). The response rate was 89 per cent after yr 1 and 84 per cent after yr 2. BMD of the hip (30 patients) increased by 1.5 +/- 0.9 per cent after yr 1 and 5.5 +/- 1.1 per cent (p < 0.0001) after yr 2 when compared with baseline. The response rate was 63 per cent after yr 1 and 80 per cent after yr 2. Smaller numbers of patients continued with treatment up to 4 yr with no adverse long-term effects.

The relation of exercise habits to health beliefs and knowledge about osteoporosis.

The relation of exercise habits of 113 female college students to their knowledge about osteoporosis and their health beliefs was investigated, using the health belief model to determine why some people participate in self-care preventive actions but others do not. Age was positively correlated with the level of osteoporosis knowledge, awareness of personal susceptibility, and motivation for general health behaviors. Older participants, however, perceived more barriers to exercise as an osteoporosis-prevention measure than did the younger respondents. The authors' conclusions support the importance of early osteoporosis education and lifetime physical activities to prevent osteoporosis.