Protecting children from sexual exploitation

Child sexual exploitation has been a largely hidden but significant issue for many years. Nurses need to be aware of its effects on health so they can identify children and young people affected and work with colleagues from other disciplines and agencies to provide treatment and care.

Reversal of the substrate specificity of CMP N-glycosidase to dCMP

MilB is a CMP hydrolase involved in the early steps of biosynthesis of the antifungal compound mildiomycin. An enzyme from the bacimethrin biosynthetic pathway, BcmB, is closely related to MilB in both sequence and function. These two enzymes belong to the nucleoside 2'-deoxyribosyltransferase (NDT) superfamily. NDTs catalyze N-glycosidic bond cleavage of 2'-deoxynucleosides via a covalent 2-deoxyribosyl-enzyme intermediate. Conservation of key active site residues suggests that members of the NDT superfamily share a common mechanism; however, the enzymes differ in their substrate preferences. Substrates vary in the type of nucleobase, the presence or absence of a 2'-hydroxyl group, and the presence or absence of a 5'-phosphate group. We have determined the structures of MilB and BcmB and compared them to previously determined structures of NDT superfamily members. The comparisons reveal how these enzymes differentiate between ribosyl and deoxyribosyl nucleotides or nucleosides and among different nucleobases. The 1.6 Å structure of the MilB-CMP complex reveals an active site feature that is not obvious from comparisons of sequence alone. MilB and BcmB that prefer substrates containing 2'-ribosyl groups have a phenylalanine positioned in the active site, whereas NDT family members with a preference for 2'-deoxyribosyl groups have a tyrosine residue. Further studies show that the phenylalanine is critical for the specificity of MilB and BcmB toward CMP, and mutation of this phenylalanine residue to tyrosine results in a 1000-fold reversal of substrate specificity from CMP to dCMP.

Current Oncology: It All Started 20 Years Ago

As Current Oncology approaches its 20th year of publication, the time is right to share with our readers a brief history of its humble beginnings. [...]

Pedestrian and motorized mobility scooter safety of older people

OBJECTIVES

After driving, walking is older adults' second most preferred mode of transport and preferred recreational activity. This leads to greater exposure to traffic, increasing their risk of pedestrian-vehicle crashes, with older adults being more likely to die as a pedestrian compared to when using other modes of transport. However, less focus has been placed on this particularly vulnerable group. This review summarizes issues associated with older adult pedestrian and motorized mobility scooters (MMS) safety and interventions that have been conducted.

METHODS

A literature search was undertaken from PubMed, MUARC publications, the Curtin University Library Catalogue, and Google Scholar. Keywords included older pedestrians, older adult road injury, mobility scooter injury, and injury prevention. Publications from 2000 and later were used, unless an earlier publication had significant relevance and worth.

CONCLUSION

Maintaining older adults' mobility and independence during a time of decreasing physical and mental capacity is a priority. Walking provides a key mode of transport that needs to be given higher priority within the road environment by policy makers, transport planners, and drivers. Therefore, governments need to consider appropriate and comprehensive urban planning and road safety policies that accommodate active aging to provide pedestrians and MMS users with environments that facilitate active living and safe transport. In addition, there is a need for community programs that raise awareness about safe road crossing for this growing vulnerable age group.

Surgical management of chronic ruptures of the Achilles tendon remains unclear: a systematic review of the management options

BACKGROUND

Chronic ruptures of the Achilles tendon cause marked functional impairment. Given the different repair techniques used, there is a need for a systematic review of the literature to investigate whether these procedure are comparable with one another when performed by experienced surgeons.

SOURCES OF DATA

A systematic literature search using the Medline (Pubmed), EMBASE and CINHAL databases.

AREAS OF AGREEMENT

Provided there are no contraindications, surgery is regarded the best management option.

AREAS OF CONTROVERSY

Most reports are case series with small sample sizes using non-validated measures.

GROWING POINTS

Long-term results of surgical repair procedures are now available.

AREAS TIMELY FOR DEVELOPING RESEARCH

The current literature does not allow clinicians to definitively determine the optimal management modality for chronic rupture of the Achilles tendon. There is a need for randomized controlled trials which use validated functional outcome measures.

The Ethics of Deactivating a Pacemaker in a Pacing-Dependent Patient

The decision to deactivate a pacemaker in a pacing-dependent patient is troubling for some health professionals who may regard such interventions as hastening death and therefore ethically impermissible. This may be especially concerning in situations where a patient is unable to clearly state what their preferences may be and the decision—were it to be made—will almost certainly result in the patient’s immediate death. In this discussion, we reflect on some of the ethical aspects that arise when JP, a 75-year-old woman who is pacing dependent, suffers a significant brain injury, and the family request that her pacemaker be deactivated. Taking into account the clinical reality of her situation, the united wishes and loving concern of her husband and family, and their substituted judgment regarding her likely preferences, we claim that the decision to deactivate her pacemaker was ethically sound.

Popcorn is more satiating than potato chips in normal-weight adults

BACKGROUND

Strategies that may increase compliance to reduced energy intakes are needed to reduce the health burden of obesity. Conflicting evidence exists regarding the effects of snacking on satiety and energy intake.

METHODS

This study compared short-term satiety from two common snack foods, low fat popcorn or potato chips. Using a counterbalanced within-subject design, 35 normal weight non-smoking participants (17 men, 18 women) ages 20-50 years (mean age 33 ± 11, BMI 23 ± 2 kg/m²) consumed four conditions each: 200 mL of water (control), one cup (4 g, 15 kcal) popcorn, 6 cups (27 g, 100 kcal) popcorn, and one cup (28 g, 150 kcal) potato chips, each with 200 mL water. Participants rated their hunger, satisfaction, prospective consumption, and thirst on 100 mm visual analogue scales 30 minutes after commencement of snack consumption. In addition, post-snack energy intake from an ad libitum meal (amount served less amount remaining) was measured, and the test food and meal combined energy intake and energy compensation were calculated.

RESULTS

Participants expressed less hunger, more satisfaction, and lower estimates of prospective food consumption after six cups of popcorn compared to all other treatments (P < 0.05). Energy compensation was 220% ± 967%, 76% ± 143% and 42% ± 75% after one cup popcorn, six cups popcorn and one cup potato chips, respectively. Combined energy intake was significantly greater (P < 0.01) during the potato chips condition (803 ± 277 kcal) compared to control (716 ± 279 kcal) or popcorn conditions (698 ± 286 kcal for one cup and 739 ± 294 kcal for six cups). Combined energy intakes from both popcorn conditions were not significantly different than control (p > 0.05).

CONCLUSION

Popcorn exerted a stronger effect on short-term satiety than did potato chips as measured by subjective ratings and energy intake at a subsequent meal. This, combined with its relatively low calorie load, suggests that whole grain popcorn is a prudent choice for those wanting to reduce feelings of hunger while managing energy intake and ultimately, body weight.

Effect of post-brushing mouthwash solutions on salivary fluoride retention--study 2

OBJECTIVE

This study evaluated the effects of three post-brushing mouthwashes containing 0 ppm F, 225 ppm F, and 500 ppm F, respectively, on salivary fluoride retention after brushing with 1450 ppm fluoride (as NaF) toothpaste and rinsing with water immediately after brushing.

METHODS

In this three-phase, randomized, cross-over study, an ion-specific electrode was used to measure salivary F levels in thirty trial participants before brushing (Time 0), and after brushing, rinsing with water, and then rinsing with one of the three mouthwashes. Time points evaluated after brushing were one, three, five, 10, 20, 30, 45, and 60 minutes. For saliva sample collections, subjects were asked to pool saliva in their mouths for 10 seconds before spitting out into a container for each of the time points.

RESULTS

The AUC0-60 means for F in saliva were 554, 252, and 20 for the 500, 225, and 0 ppm F mouthwash groups, respectively. The 500 ppm F mouthwash resulted in a 2660% increase in total fluoride salivary retention over 60 minutes when compared with the 0 ppm F group, and a 120% increase when compared with the 225 ppm F group. A significant difference (p < 0.001) in the AUC0-60 means between the three groups was observed using analysis of variance (ANOVA). Paired t-tests also showed significant differences in the mean fluoride retention over 60 minutes for all three pair-wise group comparisons (p < 0.001).

CONCLUSION

Use of a fluoride mouthwash containing 225 ppm F or 500 ppm F produced a significant increase in salivary fluoride retention following brushing with a 1450 ppm F toothpaste and rinsing with water compared to rinsing without fluoride. The use of the 500 ppm F mouthwash may be of particular benefit to those at high caries risk.

Psychotropic medications and crash risk in older drivers: a review of the literature

OBJECTIVE

. An extensive review of Australian and international literature was undertaken, examining the association between psychotropic medications and crash risk involving older drivers.

METHODS

. The review summarizes the findings in experimental and epidemiological studies related to (a) prevalence of psychotropic medication use among older drivers; (b) side effects of driving under the influence of psychotropic medications; and (c) association between psychotropic medications and crash risk for older drivers.

RESULTS

. Current evidence indicates that several types of psychotropic medications have the potential to impair driving ability and increase the risk of crash involvement. A major limitation is that few studies have specifically examined the effects on older drivers, despite the fact that the majority of the population using psychotropic medications are older. Discussion. More knowledge about the safety of therapeutic use of psychotropic medications is needed. Large-scale, whole-population, epidemiological studies, such as data linkage studies, may be the optimal study design.