Influence of national culture and context on healthcare workers' perceptions of infection prevention in Greek neonatal intensive care units.

BACKGROUND: Healthcare-associated infections (HAIs) in neonatal intensive care units (NICUs) result in increased morbidity, mortality and healthcare costs. HAI rates in Greek NICUs are among the highest in Europe. There is a need to identify the factors that influence the transmission of HAIs and implementation of prevention interventions in this setting. AIM: To understand healthcare workers' perceptions about HAI prevention in Greek NICUs. METHODS: Qualitative interviews were conducted with NICU staff (physicians and nurses) and infection prevention stakeholders (infectious diseases physicians and infection control nurses) working in three hospitals in Athens. Interviews were conducted in Greek, transcribed and translated into English, and analysed using a modified grounded theory approach. FINDINGS: Interviews were conducted with 37 respondents (20 physicians and 17 nurses). Four main barriers to HAI prevention were identified: (1) resource limitations leading to understaffing and cramped space; (2) poor knowledge about HAI prevention; (3) Greek-specific cultural norms, including hierarchy-driven decisions, a reluctance for public workers to do more than they are paid for, a belief that personal experience trumps evidence-based knowledge, and reactive rather than proactive approaches to societal challenges; and (4) lack of a national infection prevention infrastructure. Respondents believed that these barriers could be overcome through organized initiatives, high-quality HAI performance data, interpersonal interactions to build engagement around HAI prevention, and leveraging the hierarchy to promote change from the 'top down'. CONCLUSION: Implementing HAI prevention interventions in Greek NICUs will require consideration of contextual features surrounding the delivery of care, with particular attention paid to national culture.

Transthoracic lung and pleura ultrasonography as a diagnostic tool of pulmonary edema in dogs and cats.

Despite the consensus on the role of lung and pleura ultrasound in human medicine, veteri- nary medicine questions credibility of the pulmonary evaluation in ultrasound examination, based on the analysis of artifacts in animals with clinical signs of respiratory failure and possibility of pulmonary edema diagnosis with recognition of the degree of its severity. The study was conduct- ed on 47 animals (29 dogs and 18 cats) of different breeds, age and sex. In all of animals prior to the transthoracic lung and pleura ultrasound examination (TLPUS), all animals were subjected to a clinical examination and hematological blood test as well as chest radiography examination in three projections. Ultrasound imaging of the chest in each animal was performed at designated four defined segments. TLPUS in dogs and cats based on an analysis of artifacts allows recogni- tion of pulmonary edema, to the degree comparable to chest X-ray examination. The number of depicted B-lines artifacts is proportional to the degree of pulmonary edema. These results allow to reduce the number of radiographs and allow the shortening of the diagnostic process for pa- tients in life-threatening condition.

Ultrasonography: a method used for pregnancy imaging of the fire salamander (Salamandra salamandra).

Ultrasound imaging has more frequently been used in veterinary medicine of amphibians and reptiles. In this study, we have verified the usefulness of ultrasound imaging in pregnancy determination of the fire salamander Salamandra salamandra. We have also undertaken to estimate the number of larvae and their developmental stage directly in the oviducts. Three gravid females from Lower Silesia (southern Poland) were examined. Due to the small size of the scanned animals, and the particular arrangement of embryos in the oviducts and ultrasound beams dispersal, the method proved to be inaccurate. Therefore, the minimum number of well-visualized larvae was determined. The maximum number of larvae was established on the basis of the visible fragments of embryos. After birth, we found that the number of larvae born was included in the "min-max" range in only one case. In the remaining two salamanders the number of larvae was higher than estimated in 3 to 7 individuals. The results showed that ultrasound imaging allows the minimum number of larvae in salamander; oviducts to be specified. However, total length measurements were possible only for single and clearly visible embryos.

Osteoprotegerin, RANKL, and bone turnover in primary hyperparathyroidism: the effect of parathyroidectomy and treatment with alendronate.

Receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL), and its decoy receptor osteoprotegerin (OPG) play key roles in regulating bone turnover. The OPG/RANKL/RANK system is regulated by many hormones and cytokines, among which parathormone (PTH) seems to be one of the most important. Primary hyperparathyroidism (PHPT) with chronic excess of PTH and enhanced bone resorption provides an opportunity to observe the relationships between PTH, OPG and RANKL. From a group of 63 patients with PHPT, 29 underwent effective parathyroidectomy (PTX) and 33 were treated with alendronate. After one year, bone mineral density (BMD) improved in both groups, but the biochemical disturbances and PTH returned to normal only after PTX. The baseline serum concentrations of OPG and RANKL were higher in PHPT patients than in healthy controls, whilst the OPG/RANKL-F ratio was lower. The mean OPG concentration did not change after PTX, and slightly increased after alendronate treatment despite the unchanged PTH. Twelve months after treatment, RANKL slightly declined in both groups and the ratio of OPG/RANKL consistently increased. Serum OPG and RANKL did not correlate with PTH before or after PTX or alendronate treatment. In conclusion, bone resorption in PHPT is accompanied by a high serum concentration of OPG and RANKL as well as a low OPG/RANKL ratio. Both parathyroidectomy and treatment with alendronate diminish bone resorption, and correct the OPG/RANKL ratio in favor of OPG, although the mechanisms of their actions are different. Serum OPG concentration does not depend directly on PTH.

Evaluation of sex hormone levels and some metabolic factors in men with coronary atherosclerosis.

BACKGROUND: Because of the great controversy over the role of androgens in the pathogenesis of atherosclerosis, we investigated the relationship between serum sex hormone levels and angiographically confirmed coronary artery disease in men. MATERIAL AND METHODS: We investigated 86 men aged 40-60 years, 56 with coronary artery disease and 30 healthy men, matched by age, as a control group. Body mass index and waist to hip ratio were calculated and total body fat mass and percentage of abdominal deposit were investigated by dual-energy X-ray absorptiometry (Dpx (+) Lunar, USA). The serum levels of sex hormones and insulin were measured using commercial radioimmunoassay and IRMA (by SHBG) kits (DPC, USA). The serum levels of lipids and glucose were assessed by means of enzymatic methods. RESULTS: Men with coronary artery disease had lower total testosterone levels (17.01+/-6.42 vs. 19.37+/-6.58 nmol/l; p < 0.05), testosterone/estradiol ratio (228.5+/-88.5 vs. 289.8+/-120.1; p < 0.05) and free androgen index (FAI) (59.49+/-14.79 vs. 83.03+/-25.81; p < 0.0001), and higher levels of estrone (49.5+/-27.7 vs. 36.6+/-12.7 pg/ml) than men in the control group. Moreover, men with coronary artery disease were more insulin-resistant than controls and had an atherogenic lipid profile. There was an inverse correlation (p < 0.05) between testosterone level and serum level of glucose (r = -0.29), triglycerides (r= -0.37), body mass index (r= -0.55), waist (r = - 0.43), total body fat mass (r = - 0.3) and fasting insulin resistance index. A significant positive association (p < 0.05) was found between testosterone and the quantitative insulin sensitivity check index and high density lipoprotein cholesterol level in serum (r = 0.26). CONCLUSIONS: Low levels of total testosterone, testosterone/estradiol ratio and free androgen index and higher levels of estrone in men with coronary artery disease appear together with many features of metabolic syndrome and may be involved in the pathogenesis of coronary atherosclerosis.

[Pseudohypoparathyroidism]. / Rzekoma niedoczynnosc przytarczyc.

The article presents data concerning pseudohypoparathyroidism (PH TP). It is an unusual disease, which is characterized by the resistance of bones and kidney to PTH, followed by hypocalcaemia, hyperphospha-taemia, glandulary hypertrophy and hypersecretion of PTH. Patients with PTHT clinically manifest tetany seizures, soft tissue calcifications and many congenital malformations. The disease has a genetic etiology, it is connected with chromosome X and more often found in women. Clinical symptoms may be different and depend on genetic defect or its selectivity with reference to the tissues. At present we can distinguish three types of PHPT and pseudo-pseudo-HPT. The disease usually appears in the infancy. Early diagnosis and vitamin D3 or calcium treatment seem to be the most important for patient's condition. Too late treatment threatens with brain calcification followed by neurological defects and mental retardation. The long-lasting effect of PTH in bones can lead to their destruction, if bone receptors are completely sensitive.

[Content of nitrates and nitrites in market vegetables in Wroclaw in the years 1996-1997]. / Zawartosc azotanów i azotynów w warzywach rynkowych we wroclawiu w latach 1996-1997.

The aim of analytical investigation included in this paper was the determination the nitrate and nitrite contents in 8 common vegetables: cabbage, carrot, parsley, potato, garden beet, cucumber, lettuce and radish in relation to the acceptable levels of nitrates. The samples of vegetables were taken from detail shops in Wroclaw in the years 1996-1997. A total of 151 samples of vegetables were analyzed. The nitrate and nitrite level was determined collorimetricaly with sulfanilic acid after previous reduction of nitrates to nitrites by means of cadmium column. The acceptable values of nitrates were exceeded in 82% of the samples of radish and in 65% samples of lettuce. The smallest amount of samples with excess of the acceptable nitrate levels were found in potato, carrot and cucumber. It was found, that the nitrate content in the greenhouse vegetables: lettuce, cucumber and radish was greater than in the field vegetables. The potato, cabbage and carrot investigated after winter storage comprised lower content of nitrates than in freshly harvested. Nitrite accumulation in investigated vegetables was low, but the highest concentrations were found in lettuce and radish form greenhouse.

Intratumoral levels of estrogens in breast cancer.

Breast cancer tissue is an endocrine organ and particularly the estrogen biosynthetic properties of this tissue have been well studied. The concentration of estradiol in breast cancer tissue from postmenopausal patients is considerably higher than that in the circulation and appears to depend largely on local production. Androgenic precursor steroids are abundantly present, but estrogen storage pools like fatty acid derivatives appear to be less important than initially thought. New, potent and highly specific aromatase inhibitors effectively inhibit peripheral conversion of androgens to estrogens (Cancer Res. 53: 4563, 1993) as well as intratumour aromatase, median aromatase activity being 89% lower in the tissue from patients pretreated with aromatase inhibitor 7 days prior to surgery (P < 0.001). Also the intratissue concentrations of estrogens were decreased (64% and 80% reduction, respectively for estrone and estradiol; P = 0.001 and <0.05; Cancer Res. 57: 2109, 1997). These results illustrate that intratissue estrogen biosynthesis is effectively inhibited by the new generation of aromatase inhibitors. The pathophysiological consequences of this finding are currently under study.

Concentration of sex steroids in adipose tissue after menopause.

Adipose tissue is a site of uptake, storage, action, and metabolism of sex steroids. After menopause aromatization of androgens to estrogens in adipose tissue is one of the most important sources of estrogen in the circulation and for peripheral tissues. The aim of this study was to estimate local sex steroid concentrations in breast and abdominal subcutaneous (s.c.) adipose tissue, to compare them with plasma concentrations and to investigate possible correlations with body mass index (BMI). The patients were postmenopausal women undergoing surgery for non-oncological reasons (Group A; n = 35) and breast cancer patients (group B; n = 19). The concentrations of estrone, 17 beta-estradiol, estrone sulfate, 17 beta-estradiol sulfate, androstenedione, androstenediol (androst-5-ene-3 beta, 17 beta-diol), testosterone and dehydroepiandrosterone were measured. The method was based on frozen tissue homogenization, extraction with ethanol: acetone, delipidation, extraction of estrogens with ether, and of androgens with iso-octane in toluene, followed by RIA. The mean levels of steroids were higher in fat than in plasma, apart from testosterone. Levels of sulfates of estrogens and androstenediol were higher in breast than abdominal adipose tissue, and levels of estradiol lower. Positive correlations were found between BMI and tissue and plasma concentration of both estrone and androstenedione.

Ectopic thyroid malignancy in the right ventricle of the heart.

In a 55-year-old woman (10 years after subtotal thyroidectomy for follicular adenoma) echocardiography revealed a 25 x 23-mm tumour in the right ventricular outflow tract. The successfully removed tumour appeared to be a follicular carcinoma. Subsequently, there has been no clinical and laboratory evidence for another site of metastasis or ectopic thyroid. The whole body 131I scan showed only correct radioiodine uptake in the place of cervical residual thyroid gland. We believe this is the first description of follicular carcinoma in cardiac ectopic thyroid.

A study of sleep in the European blackbird.

Sleep states in the blackbird, Turdus merula, were determined by recording the electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG), and heart rate (HR), and from behavioral observations and responses to auditory stimulation by natural calls. The presence of changes in slow wave activity was determined from the power spectra of the EEG. Spectral power density in the 0.5-4.0 Hz band during slow wave sleep (SWS) attained highest values in the first part of the night, then declined. This trend in EEG spectra, which occurred across the night, probably reflects a homeostatic process strikingly similar to that observed in mammals. The reactivity to natural calls during SWS episodes also decreased across the night. Episodes of interhemispheric EEG asymmetry, which typically lasted from 2 to 4 s, occurred when birds displayed the front sleep posture and they constituted 140-200 s of each night. Unihemispheric sleep episodes probably result from unilateral activation of the visual system, and they could be considered as an evolutionary adaptation. HR was highest in wakefulness and lower in sleep but, due to large variability, reliable discrimination between sleep and wakefulness could not be made. Comparison of the blackbird's behavior during 4 different nights revealed a strong effect of the first night on sleeping behavior. A significant reduction in back sleep posture occurred during the baseline night, when lead wires were connected.

Annual and weekly changes in the sleep-wake rhythm of school children.

Sleep-wake patterns in 10- and 14-year-old children were followed over a year using sleep diaries kept during 2-week periods every 5 weeks. The times of awakening and sleep duration closely followed the annual and weekly alternations of schooldays and holidays. During vacations, sleep duration increased considerably as compared to the school year. The clear decrease in sleep duration was observed in spring only for 14-year-olds. Weekly changes of sleep patterns during the school year disappeared during vacations. It was concluded that sleep duration in children is closely related to the school schedules and could be a result of sleep deprivation and recovery.

[Treatment of hyperandrogenic manifestations in polycystic ovary syndrome]. / Leczenie objawów hiperandrogenizmu w zespole wielotorbielowatych jajników.

Etiopathogenesis of the polycystic ovarian disease is not clarified. Therefore, optimum therapy of hyperandrogenic syndromes, menstrual and fertility disorders pose a difficult problem. Sequential therapy with estrogens and progestagens is of value in young women, who are not planning to conceive in order to reduce hirsutism and regulate menses. A reduction of hirsutism, acne and seborrhea is produced within 3 months. However, cessation of the treatment produces the symptoms of excessive androgen production. Another method is therapy with antiandrogens, especially cyproterone acetate. This drug inhibits androgens biosynthesis and has also peripheral activity. Spironolactone is another antiandrogen frequently used, but it is known as a primarily diuretic agent. It acts primarily at the androgen receptor sites. Other antiandrogens such as ketoconazole and flutamide are used less frequently. It has been shown, that cimetidine--known H2 receptor inhibitor--also decreases the symptoms of hyperandrogenism. However, cimetidine has not been used for the treatment of polycystic ovarian disease. In cases of enzymatic defects in adrenocortical steroido-synthesis glucocorticoids are used, mainly low doses of triamcinolone and dexamethasone. Other therapies are preferred in case of polycystic ovarian disease in women, who want to conceive. Clomiphene citrate and gonadotropins, mainly FSH, are used to induce ovulation. If pharmacotherapy does not produce ovulation, wedge resection of the ovaries must be performed.

Electrophysiological and behavioral correlates of sleep in the blackbird (Turdus merula).

Sleep in five blackbirds was investigated by continuous 24-h recordings of EEG, EOG, EMG, HR, and behavior. Because these recordings were similar in many respects to those obtained previously in other species, it was possible to define the electrophysiological correlates of active wakefulness (AW), quiet wakefulness (QW), slow wave sleep (SWS), and paradoxical sleep (PS). The time spent in SWS and PS was 32.2% and 5.7% of the 24-h period, respectively. The amount of SWS decreased during the course of the dark period, whereas PS exhibited an increasing trend. In addition, SWS always preceded PS, as in mammals. Thus, homeotherms may share common mechanisms of sleep regulation. Blackbirds turned their heads so that their beaks pointed backwards only during darkness. This back posture was usually associated with sleep. Head nodding, which occurred only when the beak pointed forward, was observed during 13% of PS episodes. Eye closure was a reliable behavioral index of sleep. Detailed behavioral observations alone do not provide sufficient information for the accurate assessment of sleep stages in blackbirds.

[Level of cadmium and lead in vegetables, fruit, cereal and soil from areas differing in the degree of industrial pollution and from greenhouses]. / Zawartosc kadmu i olowiu w warzywach, zbozach, owocach i glebie pochodzacych z terenów o zróznicowanym zanieczyszczeniu przemyslowym oraz ze szklarni.

The content of cadmium and lead was measured in vegetables, fruit, cereals and soil from areas exposed and non-exposed to industrial pollution and in vegetables and soil from greenhouses. The elements were measured after dry mineralization by atomic absorption spectrophotometry following extraction of complexes from APDS into the organic phase (MIBK). Lead and cadmium were determined in 482 samples of vegetables, 101 fruit samples, 132 cereal samples and 297 soil samples. In the vegetables from the areas not exposed to industrial pollution lead content was below the detectability range (< d.r.) to 576.1 micrograms/kg, and cadmium was from < d.r. to 73.5 micrograms/kg. In the vegetables from areas exposed to industrial pollution lead was from 9.3 to 1044.0 micrograms/kg and cadmium from < d.r. to 552.3 micrograms/kg and cadmium from 2.3 to 132.5 micrograms/kg. In the soil from greenhouses lead was found in amounts from 17.5 to 212.0 mg/kg of air dry mass (adm), and cadmium from 125 to 750 micrograms/kg of adm. In soil from vegetable gardens lead was from 3.3 to 15.3 mg/kg of adm., and cadmium from < d.r. to 385.0 mu/kg adm. In soil from orchards lead was from 2.8 to 141.3 mg/kg adm, and cadmium from < d.r. to 810.0 micrograms/kg adm. In the soil from fields of cereals lead was from 3.0 to 67.5 mg/kg amd, and cadmium from < d.r. to 295.0 micrograms/kg adm. In fruit lead was present in amounts from 12.8 to 144.0 micrograms/kg and cadmium from < d.r. to 42.0 micrograms/kg. In cereals lead was found in amounts from < d.r. to 760.0 micrograms/kg and cadmium from < d.r. to 200 micrograms/kg.

[Levels of copper and zinc in vegetables, fruit and cereal from areas differing in the degree of industrial pollution and from greenhouses]. / Zawartosc miedzi i cynku w warzywach, owocach i zbozach pochodzacych z terenów o zróznicowanym zanieczyszczeniu przemyslowym oraz ze szklarni.

The content of copper and zinc was determined in vegetables, fruit and cereals derived from areas exposed or non-exposed to industrial pollution and from greenhouses. The elements were determined after dry mineralization by atomic absorption spectrometry immediately from mineral solution. Copper and zinc were measured in 506 samples of vegetables, 101 fruit samples and 117 cereal samples. In the vegetables from areas not exposed to industrial pollution the copper content was from 0.10 to 6.69 mg/kg, and zinc content was from 1.10 to 27.90 mg/kg. In the vegetables from areas exposed to this pollution copper was found in amounts from 0.10 to 3.26 mg/kg and zinc from 0.88 to 27.90 mg/kg. In the vegetables from green-houses copper amounted to 0.14-1.20 mg/kg and zinc from 1.00 to 10.60 mg/kh. In fruit samples copper was found in amounts from 0.04 to 7.01 mg/kg and zinc from 0.60 to 17.30 mg/kg. In cereals copper ranged from 1.14 to 11.68 mg/kg and zinc from 7.20 to 72.07 mg/kg. Table I. Copper in vegetables, fruit and cereals from areas differing in the degree of industrial pollution and from greenhouses copper amounted to 0.14-1.20 mg/kg and zinc from 1.00 to 10.60 mg/kh. In fruit samples copper was found in amounts from 0.04 to 7.01 mg/kg and zinc from 0.60 to 17.30 mg/kg. In cereals copper ranged from 1.14 to 11.68 mg/kg and zinc from 7.20 to 72.07 mg/kg. Table I. Copper in vegetables, fruit and cereals from areas differing in the degree of industrial pollution and from greenhouses.

Estrogens in plasma and fatty tissue from breast cancer patients and women undergoing surgery for non-oncological reasons.

Breast cancer tissue is able to maintain the tissue estradiol level in spite of the massive decrease in plasma estradiol associated with menopause, whereas fatty tissue from breasts with malignancies more closely reflects the changes in plasma. In the present study estrone and estradiol levels in fatty tissues from different origins were compared to evaluate the capacity of distant fatty tissues to act as estrogen reservoirs. Abdominal fat was obtained from 25 premenopausal and 20 postmenopausal women who underwent surgery for non-oncological reasons. Estrone and estradiol levels in these tissues were compared to those in breast fatty tissue from breast cancer patients. Plasma estrogen levels were not different in the two groups. In both groups, median plasma estradiol levels dropped sharply with menopause (from 363 to 40 pmol/l in breast cancer patients; from 280 to 45 pmol/l in the non-oncological patients; p less than 0.002), whereas a significant decrease in plasma estrone was observed only in the breast cancer patients (from 238 to 140 pmol/l; p less than 0.02). In premenopausal women, median estrone and estradiol levels in breast fatty tissue (1135 and 375 fmol/g, respectively) and abdominal tissue (1390 and 470 fmol/g, respectively) were not different. In postmenopausal women, however, significantly higher estrone levels (663 vs. 508 fmol/g; p less than 0.01) and estradiol levels (245 vs. 187 fmol/g; p less than 0.02) were found in abdominal fatty tissue. In view of the absolute estrogen levels in breast and abdominal fatty tissue and in plasma, we conclude, however, that it is unlikely that remote fat contributes substantially to the maintenance of estrogen levels in breast cancer tissue.