Slaying the Swiss Unicorn of Animal Dignity

In this article, we describe and analyse the Swiss legislation relating to animal dignity. We conclude that previous criticisms of the law do not go far enough: far from protecting animal dignity, the Swiss law not only undermines such dignity but itself serves as a means to ensure that animals can be used merely as a means, and not treated with respect. As such, the Swiss Animal Welfare Act is deeply unethical and undermines the constitutional requirement to treat animals with dignity.

Preoperative word-finding difficulties in children with posterior fossa tumours: a European cross-sectional study

PURPOSE

Posterior fossa tumour surgery in children entails a high risk for severe speech and language impairments, but few studies have investigated the effect of the tumour on language prior to surgery. The current crosslinguistic study addresses this gap. We investigated the prevalence of preoperative word-finding difficulties, examined associations with medical and demographic characteristics, and analysed lexical errors.

METHODS

We included 148 children aged 5-17 years with a posterior fossa tumour. Word-finding ability was assessed by means of a picture-naming test, Wordrace, and difficulties in accuracy and speed were identified by cut-off values. A norm-based subanalysis evaluated performance in a Swedish subsample. We compared the demographic and medical characteristics of children with slow, inaccurate, or combined slow and inaccurate word finding to the characteristics of children without word-finding difficulties and conducted a lexical error analysis.

RESULTS

Thirty-seven percent (n = 55) presented with slow word finding, 24% (n = 35) with inaccurate word finding, and 16% (n = 23) with both slow and inaccurate word finding. Children with posterior fossa tumours were twice as slow as children in the norming sample. Right-hemisphere and brainstem location posed a higher risk for preoperative word-finding difficulties, relative to left-hemisphere location, and difficulties were more prevalent in boys than in girls. The most frequent errors were lack of response and semantically related sideordinated words.

CONCLUSION

Word-finding difficulties are frequent in children with posterior fossa tumours, especially in boys and in children with right-hemisphere and brainstem tumours. Errors resemble those observed in typical development and children with word-finding difficulties.

Russell and Burch's 3Rs then and now: The case of Switzerland

Since Russell and Burch introduced and defined the 3Rs, i.e., the replacement, reduction, and refinement of animal use in research, in 1959, different definitions have emerged and been implemented in guidelines and policies. Switzerland is known for having some of the most restrictive legislation regarding the use of animals, in which the 3Rs are also defined and implemented. To our knowledge, the purpose and definitions of the 3Rs used in the Swiss Animal Welfare Act, Animal Protection Ordinance, and Animal Experimentation Ordinance have never been compared with Russell and Burch’s original purpose and definitions. In this paper we make this comparison with two aims: to reveal ethically relevant departures from the original purpose and definitions, and to provide an ethical evaluation of the current Swiss law regarding the 3Rs. In doing so, we first expose the similarity of purposes. We then identify one risky departure from the original definition of replacement in Swiss law, which shows a problematic focus on species. Finally, we address Swiss law’s failure to apply the 3Rs in the most effective way. With respect to this last point, we discuss the need for 3R conflict resolution, the timing of application of the 3Rs, problematic prioritizations and choices of convenience as well as a solution to apply the 3Rs more effectively using Russell and Burch’s concept of total sum of distress.

"What If It Was Your Dog?" Resource Shortages and Decision-Making in Veterinary Medicine-A Vignette Study with German Veterinary Students

The here presented vignette study was part of a survey on ethical judgement skills among advanced veterinary students at the University of Veterinary Medicine Hannover, Foundation. The vignette describes a fictitious dilemma in veterinary practice due to medication supply shortages. First, the students should make an ethically justified decision: who of the two patients in the waiting room gets the last dosage of a medication. Important factors were the animal patients' characteristics (age, state of health, life expectancy), the patient owners' wellbeing, and context-related criteria. Second, the students were asked for decisional changes if one of the patients was their own dog. They reacted in four different ways: (1) for a professional, this should not make a difference; (2) most likely being "egoistic" and preferring their own dog; (3) giving the medication to the other dog; and (4) avoiding a decision. Finally, the students judged a list of possible solutions to the dilemma on a 9-point scale. They preferred patient-related criteria to patient-owner-related criteria in this task. In the overall results, it became obvious that no "gold standard" or guidelines for situations of medication shortages exist, yet, which presents an important subject for future research and veterinary ethics teaching.

End-of-life decisions: A focus group study with German health professionals from human and veterinary medicine

Introduction

At first glance, human and (companion animal) veterinary medicine share challenging processes in end-of-life (EOL) decision-making. At the same time, treatment options in both professions are substantially different. The potential of an interdisciplinary exchange between both fields has been neglected by empirical research so far.

Methods

In this qualitative study, professionals from both fields were brought together in interdisciplinary focus groups to investigate the ethical aspects of convergences and divergences in EOL situations in human and veterinary medicine. The authors present and discuss an innovative mix of materials and methods as stimuli for discussion and for generating hypotheses.

Results

The results point toward a general convergence of issues, challenges, and judgements in EOL situations in both fields, such as professional ethos, communication with the family and the role thereof as well as the ideals of death, clearly exceeding the expectations of study participants. At the same time, the study highlights a few prominent differences such as the access to patients' preferences or legal and practical constraints.

Discussion

The findings suggest that using social science methods in empirical interdisciplinary biomedical-veterinary ethics could help to shed more light on this new area. Animal as well as human patients can potentially benefit from this mutual, scientifically accompanied exchange and the resulting identification and corrections of misconceptions.

Killing Kira, Letting Tom Go?—An Empirical Study on Intuitions Regarding End-of-Life Decisions in Companion Animals and Humans

Simple Summary

End-of-life decisions present challenges in both human and veterinary medicine. Legally, the options are clearly defined in the respective fields. The legal differences, however, are not necessarily mirrored in personal judgements by different stakeholder groups involved in the decision-making processes. In this study, veterinary and medical professionals as well as a control group of laypersons were asked to choose treatment options in six different fictional end-of-life scenarios for human and for animal patients, differing in age, gender, and, in case of the human patients, in terms of their state of consciousness. Interesting differences and congruencies—within and between stakeholders but also animal and human patients—can be found in the results, especially with regard to the reasons study participants gave for their choices.

Abstract

Veterinary and human medicine share the challenges of end-of-life decisions. While there are legal and practical differences, there might be parallels and convergences regarding decision-making criteria and reasoning patterns in the two disciplines. In this online survey, six variants of a fictitious thought experiment aimed at pointing out crucial criteria relevant for decision-making within and across both professional fields. The six variants introduced four human and two animal patients with the same disease but differing in age, gender and, in case of the human patients, in terms of their state of consciousness. Participants could choose between four different treatment options: euthanasia, continuous sedation, a potentially curative treatment with severe side effects and no intervention. Study participants were human and veterinary medical professionals and an additional control group of lay people. Decisions and justifications for the six variants differed but the three groups of participants answered rather homogeneously. Besides the patient’s “suffering” as a main criterion, “age”, “autonomy” and, to a lesser extent, “species” were identified as important criteria for decision-making in all three groups. The unexpected convergences as well as subtle differences in argumentation patterns give rise to more in-depth research in this cross-disciplinary field.

Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine

Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be 'put to sleep', while veterinarians have begun to integrate principles and practices from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the (dis)analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the (animal and human) patients' wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care.

Strategies to prevent sexual harassment in the hospitality workplace in Sweden

Background

Sexual harassment is a problem at workplaces, particularly in the hospitality business. These workplaces are known for having a lot of challenges for the psychosocial work environment such as working hours, leadership and the relation to alcohol, but also being workplaces with a high risk for being exposed to sexual harassment, from managers, coworkers as well as from guests. Sexual harassment is a kind of gendered violence and a work environmental problem that needs to be prevented in order to reduce work-related stress. The aim of this study was to analyze strategies to prevent sexual harassment in the hospitality business. A second aim was to analyze factors in these kind of workplaces that constitute barriers to effective prevention strategies.

Methods

Twenty-five employees and managers in the hotel and restaurant business were interviewed individually about their experiences of sexual harassment and what kind of strategies they use to cope, prevent and counteract sexual harassment at their work places.

Results

The preliminary results indicate a broad range of preventive measures that employers and managers deploy, stretching from the arrangement of the physical environment to team-building activities and onto efforts aimed at creating a common value-system. Workers, on their part, strategize collectively for instance by close communication with each other regarding “difficult” customers. Furthermore, individual workers use their bodily resources and clothing, to counteract harassment and threatening situations.

Conclusions

There are several conflicting aims and contradictions inherent in this industry, e.g. in terms of profit and the expectations of service and hospitality towards guests, no matter of their behavior. There are also gendered expectations on staff that increases the risk for sexual harassment from managers, coworkers as well as guests that make preventive work more challenging than in other types of businesses.

Key messages

Sexual harassment in the hospitality business is more challenging than in other work places, and thus need specific prevention strategies in order to promote a healthy psychosocial work environment. As gendered hierarchies in the hospitality business put women at risk for sexual harassment to a higher degree than men, there is a need for increased gender awareness in the preventive work.

Finding of increased caudate nucleus in patients with Alzheimer's disease

OBJECTIVES

A recently published study using an automated MRI volumetry method (NeuroQuant®) unexpectedly demonstrated larger caudate nucleus volume in patients with Alzheimer's disease dementia (AD) compared to patients with subjective and mild cognitive impairment (SCI and MCI). The aim of this study was to explore this finding.

MATERIALS & METHODS

The caudate nucleus and the hippocampus volumes were measured (both expressed as ratios of intracranial volume) in a total of 257 patients with SCI and MCI according to the Winblad criteria and AD according to ICD-10 criteria. Demographic data, cognitive measures, and APOE-ɛ4 status were collected.

RESULTS

Compared with non-dementia patients (SCI and MCI), AD patients were older, more of them were female, and they had a larger caudate nucleus volume and smaller hippocampus volume (P<.001). In multiple linear regression analysis, age and female sex were associated with larger caudate nucleus volume, but neither diagnosis nor memory function was. Age, gender, and memory function were associated with hippocampus volume, and age and memory function were associated with caudate nucleus/hippocampus ratio.

CONCLUSIONS

A larger caudate nucleus volume in AD patients was partly explained by older age and being female. These results are further discussed in the context of (1) the caudate nucleus possibly serving as a mechanism for temporary compensation; (2) methodological properties of automated volumetry of this brain region; and (3) neuropathological alterations. Further studies are needed to fully understand the role of the caudate nucleus in AD.

Pericardial Effusion and Pericardial Compartments after Open Heart Surgery

Thirty-three patients with pericardial effusion after open heart surgery were investigated with computed tomography (CT). Twelve of the 33 patients also underwent echocardiography prior to pericardiocentesis. The effusions were typed according to the results of the CT investigation. Because of postoperative adhesions, typical patterns of localized pericardial effusions were found in 16 patients. The localized compartments were seen on the right and left side of the heart and around the aorta and the pulmonary artery. CT was therefore shown to be of value for selecting the approach for drainage with catheter pericardiocentesis.

Role of Mfa5 in Expression of Mfa1 Fimbriae in Porphyromonas gingivalis

Fimbriae are protein-based filamentous appendages that protrude from the bacterial cell surface and facilitate host adhesion. Two types of fimbriae, FimA and Mfa1, of the periodontal pathogen Porphyromonas gingivalis are responsible for adherence to other bacteria and to host cells in the oral cavity. Both fimbrial forms are composed of 5 proteins, but there is limited information about their polymerization mechanisms. Here, the authors evaluated the function of Mfa5, one of the Mfa1 fimbrial accessory proteins. Using mfa5 gene disruption and complementation studies, the authors revealed that Mfa5 affects the incorporation of other accessory proteins, Mfa3 and Mfa4, into fibers and the expression of fimbriae on the cell surface. Mfa5 is predicted to have a C-terminal domain (CTD) that uses the type IX secretion system (T9SS), which is limited to this organism and related Bacteroidetes species, for translocation across the outer membrane. To determine the relationship between the putative Mfa5 CTD and the T9SS, mutants were constructed with in-frame deletion of the CTD and deletion of porU, a C-terminal signal peptidase linked to T9SS-mediated secretion. The ∆CTD-expressing strain presented a similar phenotype to the mfa5 disruption mutant with reduced expression of fimbriae lacking all accessory proteins. The ∆porU mutants and the ∆CTD-expressing strain showed intracellular accumulation of Mfa5. These results indicate that Mfa5 function requires T9SS-mediated translocation across the outer membrane, which is dependent on the CTD, and subsequent incorporation into fibers. These findings suggest the presence of a novel polymerization mechanism of the P. gingivalis fimbriae.

Sample and data sharing barriers in biobanking: consent, committees, and compromises

The ability to exchange samples and data is crucial for the rapidly growth of biobanking. However, sharing is based on the assumption that the donor has given consent to a given use of her or his sample. Biobanking stakeholders, therefore, must choose 1 of 3 options: obtain general consent enabling multiple future uses before taking a sample from the donor, try to obtain consent again before sharing a previously obtained sample, or look for a legally endorsed way to share a sample without the donor's consent. In this study, we present the results of 36 semistructured qualitative interviews with Swiss biobanking stakeholders regarding these options and the role of ethics committees in the process of authorizing sharing. Our results show that despite a lack of legal or guideline-based barriers to general consent, some stakeholders and ethics committees have reservations about this method of consent. In most cases, however, a general consent form is already in use. Many interviewees describe processes involving the ethics committees as time-consuming and cumbersome and their requirements as too demanding for donors/patients. Greater awareness of donors' opinions and preferences and the content of guidelines and recommendations could therefore be helpful for a better justified perspective of biobanking stakeholders and ethical committee members, equally. Finally, it may be necessary to differentiate between procedures governing future samples, where general consent is clearly desirable, and the use of old yet still relevant samples, where the option of using them without consent can be highly beneficial for research.

Trends in out-of-hospital ischaemic heart disease deaths 1992 to 2003 in southern Sweden

Aims:

In western countries out-of-hospital ischaemic heart disease (IHD) deaths account for approximately 50–70% of all IHD deaths. The objective was to examine the trends in out-of-hospital IHD deaths in the Region of Skåne in southern Sweden, in different sex- and age-groups.

Methods:

All 14,347 persons (range 24–110 years) in Skåne who died out-of-hospital between 1992 and 2003 from IHD (I410–I414; I20–I25) as the underlying cause of death. Subjects with previous admission for IHD since 1970 were excluded. Data were retrieved from the Swedish National Cause of Death and Patient Register. Age-standardized IHD mortality rates and trends were calculated using Poisson regression analysis.

Results:

Age-standardized annual out-of-hospital IHD mortality rates from 1992–2003 decreased in men from 177±13 to 103±9/100,000 inhabitants (−4.7%; p<0.001) and in women from 142±11 to 96±9/100,000 (−2.7%; p<0.001). In men, the annual change in age-standardized IHD mortality rates were −5.3 % ( p<0.001), −4.0 % ( p<0.001) and −4.7 % ( p<0.001), respectively, in the age groups 20–64 years, 65–74 years and ≥75 years. Corresponding figures in women were −4.4 % ( p<0.001), −2.4 % ( p=0.003) and −2.5 % ( p<0.001). The proportion of IHD deaths occurring out-of-hospital was in these age groups 50%, 40% and 35% respectively.

Conclusions:

In Skåne, out-of-hospital mortality in IHD deaths decreased significantly between 1992 and 2003. The decrease is more pronounced in men than women, and at the end of the study period in 2003, rates were almost equal. The proportion of IHD deaths occurring outside hospital was higher in younger people than in older people.

Gender-specific association of the plasminogen activator inhibitor-1 4G/5G polymorphism with central arterial blood pressure

BACKGROUND

The functional plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism has previously been associated with hypertension. In recent years, central blood pressure, rather than brachial has been argued a better measure of cardiovascular damage and clinical outcome. The aim of this study was to investigate the possible influence of the 4G/5G polymorphism on central arterial blood pressure in a cohort of elderly individuals.

METHODS

We studied 410 individuals, 216 men and 194 women, aged 70-88. Central pressures and pulse waveforms were calculated from the radial artery pressure waveform by the use of the SphygmoCor system and a generalized transfer function. Brachial pressure was recorded using oscillometric technique (Dinamap, Critikon, Tampa, FL). PAI-1 antigen was determined in plasma.

RESULTS

The results showed that central pressures were higher in women carrying the PAI-1 4G/4G genotype compared to female carriers of the 5G/5G genotype, (P = 0.025, P = 0.002, and P = 0.002 for central systolic-, diastolic-, and mean arterial pressure, respectively). The association remained after adjustment for potentially confounding factors related to hypertension. No association of the PAI-1 genotype with blood pressure was found in men. Multiple regression analysis revealed an association between PAI-1 genotype and plasma PAI-1 levels (P = 0.048).

CONCLUSIONS

Our findings show a gender-specific association of the PAI-1 4G/5G polymorphism with central arterial blood pressure. The genotype effect was independent of other risk factors related to hypertension, suggesting that impaired fibrinolytic potential may play an important role in the development of central hypertension in women.

Impaired abdominal aortic wall integrity in elderly men carrying the angiotensin-converting enzyme D allele

OBJECTIVE

A polymorphism in the angiotensin-converting-enzyme gene (ACE I/D) has been associated with abdominal aortic aneurysm and a link between aortic aneurysm and aortic stiffness has been suggested. This study aimed to explore the links between ACE I/D polymorphism, circulating ACE and abdominal aortic wall integrity as reflected by abdominal aortic wall stiffness.

MATERIAL

A total of 212 men and 194 women, aged 70-88 years, were studied.

METHODS

Mechanical properties of the abdominal aorta were determined using the Wall Track System, ACE genotype using the polymerase chain reaction (PCR) and circulating ACE level by enzyme-linked immunosorbent assay (ELISA).

RESULTS

In men, pulsatile diameter change differed between genotypes (II 0.70, ID 0.55 and DD 0.60 mm, P = 0.048), whereas a tendency was seen for distensibility coefficient (DC) (II 10.38, ID 7.68 and ID 8.79, P = 0.058). Using a dominant model (II vs. ID/DD), men carrying the ACE D allele had lower pulsatile diameter change (P = 0.014) and DC (P = 0.017) than II carriers. Multiple regression analyses showed additional associations between the D allele and increased stiffness β, and reduced compliance coefficient.

CONCLUSION

Men carrying the ACE D allele have stiffer abdominal aortas compared with II carriers. Deranged abdominal aortic stiffness indicates impaired vessel wall integrity, which, along with other local predisposing factors, may be important in aneurysmal disease.

The association between Mycoplasma genitalium and pelvic inflammatory disease after termination of pregnancy

The prevalence and complications of Mycoplasma genitalium and Chlamydia trachomatis infections among women undergoing termination of pregnancy were studied in this nested case-control study at Malmo University Hospital, Sweden, during 2003 to 2007. The study comprised 2079 women presenting for termination of pregnancy. Forty-nine women with M. genitalium infection and 51 women with C. trachomatis infection, together with 168 negative control women, were evaluated. The prevalences of M. genitalium and C. trachomatis were 2.5% and 2.8%, respectively. The M. genitalium was strongly associated with post-termination pelvic inflammatory disease (odds ratio 6.29, 95% CI 1.56-25.2). The increased risk for pelvic inflammatory disease associated with M. genitalium infection after termination of pregnancy suggests a causal relationship.

C-reactive protein, C3, C4 and properdin during the Jarisch-Herxheimer reaction in early syphilis

The occurrence of plasma CRP during the febrile response after the first injection of penicillin was followed in 10 patients with early syphilis. An increase in CRP was noted after 12 hours, with a maximum after 24 hours. The appearance of this acute phase protein could not be correlated to cutaneous reaction, increased body temperature or leukocytosis, nor were baseline values of CRP correlated to clinical or serological activity of the infection. Patients with high levels of CRP prior to treatment suffered the most intense systemic reactions. No activation of the complement system during the Jarisch-Herxheimer reaction was detected from sequential determinations of C3, C4 and properdin.

Monitoring oral health and dental attendance in an outpatient psychiatric population

Impaired mental health has been associated with an increased need for dental care. Population surveys have indicated that people with enduring mental health problems make less frequent planned visits to the dentist and report a greater number of missing teeth than the general population. The study aims to examine oral health status, attendance to dental care, and medication in an outpatient psychiatric sample. A descriptive study combining a structured interview with a visual oral examination carried out in 113 outpatients under psychiatric care. Dental health was described in terms of sound, missing and/or filled teeth, and showed a relation between these categories and types of psychiatric diagnosis, age and numbers of antidepressant and neuroleptic drugs. Oral hygiene was found to be more neglected among men and in patients with the diagnosis of schizophrenia. The need of dental treatment was widespread, although regular dental visits were commonly reported. In order to maintain good oral health, regular dental check-ups should be encouraged for patients under psychiatric care. Further studies are required to reveal contributory causes for/to decreased oral health. The difficulty such individuals have in maintaining additional self-efficacy raises questions about the necessity for oral health interventions in outpatient psychiatric services.

Association of genetic variation on chromosome 9p21.3 and arterial stiffness

OBJECTIVES

Genome wide association studies have consistently reported associations between a region on chromosome 9p21.3 and a broad range of vascular diseases, such as coronary artery disease (CAD), aortic and intracranial aneurysms and type-2 diabetes (T2D). However, clear associations with intermediate phenotypes have not been described so far. To shed light on a possible influence of this chromosomal region on arterial wall integrity, we analysed associations between single nucleotide polymorphisms (SNPs) and degree of stiffness of the abdominal aorta in elderly individuals.

METHODS AND RESULTS

A total of 400 subjects, 212 men and 188 women, aged 70-88 years were included. Arterial stiffness was examined at the midpoint between the renal arteries and the aortic bifurcation. Two CAD- and aneurysm-associated SNPs (rs10757274 and rs2891168) and one T2D-associated SNP (rs1081161) within the 9p21.3 region were genotyped. Aortic compliance and distensibility coefficients were higher in carriers of the rs10757274G and rs2891168G alleles in men reflecting a decrease in aortic stiffness. Adjustment for age and mean arterial pressure had no effect on these associations. The two SNPs were not associated with intima-media thickness or lumen diameter of the abdominal aorta. There were no associations between the rs10811661 SNP and any measure of aortic stiffness.

CONCLUSIONS

Impaired mechanical properties of the arterial wall may explain the association between chromosome 9p21.3 polymorphisms and vascular disease.

Deficits in motor co-ordination and attention at 3 years of age predict motor deviations in 6.5-year-old children who needed neonatal intensive care

BACKGROUND

A total of 189 children without major impairments who needed neonatal intensive care (NIC) were followed up at ages 3 and 6.5 years.

AIM

To determine the prevalence of different motor deviations at age 6.5 years and the co-occurrence of attention deficits; also, to analyse the predictive ability of motor co-ordination and attention assessments at age 3 years for motor deviations at 6.5 years.

METHOD

A combined assessment of motor performance and behaviour (CAMPB) was used at the 3-year examination. The Test of Motor Impairment (TOMI) and the Motor-Perceptual Development (MPU) were used together with the criteria of the diagnostic and statistical manual of mental disorders (DSM-IV-TR) to define motor deviations.

RESULTS

At 6.5 years 64% of the children showed a motor deviation either as a delay according to MPU, a problem according to TOMI or Developmental Coordination Disorder (DCD) according to DSM-IV-TR. Higher proportions of children with attention deficit (50%) were found in the DCD group. The predictive ability of CAMPB was analysed in two ways: when all children with either a co-ordination or attention deficit, or both, at 3 years were considered to be at risk for motor deviations at 6.5 years, the sensitivity reached 78% and the specificity was 42%. But when only the 3 year olds with a combined deficit were considered to be at risk, the sensitivity was 37% and the specificity 89%; however, a positive predictive value of 86% was reached.

CONCLUSION

At 6.5 years of age a majority of NIC children with no major impairments showed motor deviations. To fulfil the DCD criteria in DSM-IV-TR, a strict definition of motor deviations is recommended. Attention deficits are more prevalent among children with DCD. Deficits in motor co-ordination and/or attention in 3-year-old children are strong predictors of motor deviations and, especially, of DCD at 6.5 years of age.

Friction of fatty acids in nanometer-sized contacts of different adhesive strength

The effects of adhesion, contact area, and pressure on the lubricating properties of self-assembled monolayers on steel have been investigated with friction force microscopy. The adsorbed molecules were fatty acids with varying degrees of unsaturation (0-2 double bonds; stearic, oleic, and linoleic acid) and a rosin acid (dehydroabietic acid), adsorbed from n-hexadecane solution. The friction of these loose-packed monolayers was studied in dry N2 gas and in ethanol. Low adhesion (in ethanol) resulted in a linear increase in friction force at low loads, that is, F = muL, whereas higher adhesion (in N2 gas) gave an apparent area-dependence at low loads of the form F = S(c)A, where S(c) is the critical shear stress. A recent model for the contact mechanics of a compliant elastic film confined between stiffer substrates was applied to the data obtained in dry N2. Using this approach, we obtained interfacial energies of the compliant monolayers in good agreement with van der Waals-Lifshitz theory. With a low monolayer elastic modulus of E'(1)=0.2 GPa, we obtained a slightly higher value of Sc for stearic acid than that established for more close-packed stearic acid monolayers. An increase of mu and S(c) was found with increasing degree of unsaturation of the fatty acid.

An outbreak of cryptosporidiosis at a day-care centre in Sweden

In mid-August, several children at a day-care centre in a suburb to Stockholm developed diarrhoea. Faecal samples showed presence of cryptosporidia.

A fault‐tolerant distributed formation protocol for Bluetooth scatternets

A Bluetooth scatternet is a network topology that is formed by inter‐connecting piconets. A piconet is a starshaped ad‐hoc networking unit that can accommodate eight Bluetooth devices, a master and up to seven slaves. By designating certain piconet nodes as bridges, or gateways, we can interconnect piconets by forcing the bridge nodes to interleave their participation in multiple piconets. Bridge nodes form an auxiliary relay connection between adjacent piconet masters and are fundamental for establishing scatternets. In this paper we present a new fault‐tolerant approach to scatternet formation that is selfhealing and operates in a multi‐hop environment. Our Bluetooth Distributed Scatternet Formation Protocol (BTDSP) establishes a flat scatternet topology, allows incremental node arrival, and automatically heals scatternet partitions by re‐incorporating disconnected nodes. By maintaining neighbor associations in soft state, existing links can also be re‐established quickly upon disconnection due to intermittent wireless connectivity. By only using slave/slave bridges, the algorithm is resilient to both node failure and wireless interference. It also prevents time‐slot waste due to master/slave bridges being away from their piconets.

Experiences with the new genetic variant of Chlamydia trachomatis in Orebro county, Sweden - proportion, characteristics and effective diagnostic solution in an emergent situation

A Chlamydia trachomatis variant that contains a 377 bp deletion in the cryptic plasmid was recently reported in Sweden. This deletion includes the targets for Cobas Amplicor, Cobas TaqMan48, and Abbott m2000. We examined the proportion and characteristics of this variant in Orebro county, Sweden and developed an effective diagnostic solution. In total, 2,401 consecutive C. trachomatis culture samples and 536 PCR samples from symptomatic and asymptomatic patients and screened females were included. Culture, Cobas Amplicor, and LightMix 480HT were used for diagnosis. A mutant-specific PCR, plasmid sequencing, omp1 sequencing and multilocus sequence typing (MLST) were used to identify and characterise mutants. In total, 162 (6.7%) of the cultured samples were positive for C. trachomatis. However, 61 (38%) of those were negative when using Cobas Amplicor, and 60 of these were subsequently confirmed as the new variant. 13 of these mutant isolates were further characterised genetically, and all were of identical genotype E and the unique MLST sequence type: 21, 19, 1, 2, 1. Of all culture-positive samples, 161 of 162 were positive in the LightMix 480HT assay. The single negative sample was only weakly positive in culture, and negative in all PCRs. Of the 536 PCR samples, 37 were positive in both Cobas Amplicor and LightMix 480HT, 13 were only positive in LightMix 480HT (mutants), and two were only positive in Cobas Amplicor. Mutated C. trachomatis were prevalent in Orebro county in the period from October 2006 to February 2007, and it appeared to be a single clone. LightMix 480HT seemed sensitive, specific, and enabled high throughput diagnostics. However, rare low positive samples may be false-negative. Frequent surveillance and evaluations of diagnostic methods worldwide are crucial.

Associations of motor co-ordination and attention with motor-perceptual development in 3-year-old preterm and full-term children who needed neonatal intensive care

BACKGROUND

Children who have needed neonatal intensive care (NIC) are considered to be at risk for deficits such as developmental co-ordination disorder and attention-deficit/hyperactivity disorder. By assessing motor-perceptual development, motor co-ordination and attention already at 3 years of age, it might be possible to identify such deficits earlier than they are today.

AIM

To investigate the motor-perceptual development in a group of 202 NIC children but had no major impairments, to describe associations of deficits in co-ordination and attention with motor-perceptual delays, and to estimate the prevalence of NIC children with combined deficits together with a motor-perceptual delay.

METHOD

Co-ordination and attention in children born very preterm (n = 57), moderately preterm (n = 75) and full-term (n = 70) were observed according to a model for Combined Assessment of Motor Performance and Behaviour while they were assessed using a developmental scale, Motor-Perceptual Development, 0-7 years, MPU.

RESULTS

In two out of 14 MPU areas, a larger proportion of very preterm than of moderately preterm and full-term children had marked developmental delay. Overall, the proportion of NIC children having a motor-perceptual delay increased with increasing incoordination and especially increasing lack of attention. Twenty-one (11%) of the NIC children had different motor-perceptual delays combined with pronounced incoordination and pronounced lack of attention.

CONCLUSION

Deficits in co-ordination and attention were associated with motor-perceptual delays in areas important for daily living and development of academic skills. Therefore, to find children at risk for developmental co-ordination disorder and attention-deficit/hyperactivity disorder, assessments of co-ordination and attention should be added to assessments of motor-perceptual development in 3-year-old NIC children.

Measles outbreak in the Øresund region of Denmark and Sweden

Since late January, 18 laboratory confirmed cases of measles have been reported in the Scandinavian region of Øresund; nine in Denmark and nine in Sweden.

Chlamydia Pneumoniae Infection: An Additional Factor for Chronic Allograft Rejection

INTRODUCTION

Chronic rejection (CHR) of organ allografts, one of the most significant problems in modern transplantation, is not fully understood. This study sought to evaluate the influence of selected parameters on late kidney transplant function.

PATIENTS AND METHOD

The studied group consisted of eighty-six patients who received allogeneic transplants between 1988 and 1999 for leukocyte Chlamydia pneumoniae-DNA, immunoglobulin (Ig)A/IgG anti-C pneumoniae, blood lipids, ischemic damage in the donor and during organ preservation, HLA mismatch, and acute rejection episodes.

RESULTS

Eighty-six patients were segregated as 26 patients (30%) with histologically proven chronic graft rejection (CHR[+]) and 59 patients (70%) without (CHR[-]). The presence of C pneumoniae-DNA in peripheral blood leukocytes was significantly more frequent in CHR(+) than CHR(-) group (46% vs 20%). Patients with leukocytes positive for C pneumoniae-DNA more frequently (50%) had CHR than patients negative for C pneumoniae-DNA (22%). CHR(+) patients showed significantly lower HDL levels (47 mg/dL vs 58 mg/dL) and higher triglyceride levels (193 mg/dL vs 148 mg/dL). To study the cumulative effect of differences between the CHR(+) and CHR(-) groups, we applied a multiple binary logistic regression analysis. An econometric model enabled us to calculate the probability of CHR for a given patient taking into account covariates chosen by means of stepwise selection: the presence of C pneumoniae-DNA in blood leukocytes, the use of continuous pulsatile perfusion in hypothermia, myocardial infarction occurrence, and triglyceride concentrations.

CONCLUSION

The presence of C pneumoniae-DNA in peripheral blood leukocytes increased the risk of CHR, which may be predicted by a multifactor analysis of chosen parameters.

Quality of motor performance in preterm and full-term 3-year-old children

BACKGROUND

A combined assessment of motor performance and behaviour (CAMPB) was introduced previously for use in a longitudinal study of children who needed neonatal intensive care (NIC) and were born very preterm (n = 68), moderately preterm (n = 81) and full-term (n = 77) and in a reference group of neonatally healthy full-term children (n = 72). Aim To follow up the quality of motor performance at 3 years of age in the above groups of children.

METHOD

A detailed assessment of motor performance and an assessment of co-ordination were performed according to the CAMPB protocol. The results were compared between the different groups of children, and the relation between the two ways of assessing quality of motor performance was examined.

RESULTS

The detailed assessment showed that the very preterm children had a significantly higher total score of deviations than any of the other gestational age groups of children. Also, some types of deviations were much more frequently observed in the very preterm children than in the other three groups. Some types of deviations were more often seen in children with pronounced incoordination than in children with no incoordination. The results from the two ways of assessing motor performance were strongly correlated.

CONCLUSION

At 3 years of age, NIC children born very preterm have a lower quality of motor performance than NIC children born at a higher gestational age and healthy children born at term. The two ways of assessing quality of motor performance proved useful in identifying children with deviations indicating minor motor impairments.

The effects of tropospheric ozone and elevated carbon dioxide on potato (Solanum tuberosum L. cv. Bintje) growth and yield

An open-top chamber experiment with field grown potato (Solanum tuberosum L. cv. Bintje) was performed in the south-west of Sweden in 1998. The experiment was aimed to investigate individual and interactive impacts of elevated ozone (O(3)) and carbon dioxide (CO(2)) on potato growth and yield. Treatments were ambient and elevated CO(2) with or without the addition of 20 nmol mol(-1) O(3). In addition, plants were grown in ambient air plots. Plants grown in elevated CO(2) and O(3) had a reduced tuber yield, compared to control, by 2% and 8%, respectively. These effects were, however, not statistically significant. Elevated CO(2) caused a significantly larger number of tubers of lower average size, while elevated O(3) induced significantly lower tuber dry matter content. The number of tuber initials (tubers <15 mm) found at harvest was significantly lower in elevated O(3). Visible O(3) leaf injury appeared earlier and the number of yellow leaves 89 days after emergence was significantly larger in elevated O(3). In elevated CO(2), haulm dry weight was significantly (15%) lower at harvest and the haulm/tuber ratio was significantly reduced. There were significant interactive effects of O(3) and CO(2) on the final number of leaves and on stem height. Plants in elevated CO(2) reached final stem height earlier than in the other treatments. In summary, it was concluded: (a) that anticipated future O(3) levels are likely to have a negative impact on potato growth, although tuber yield effects may be hard to demonstrate experimentally in this plant due to large variation; (b) that whether any possible beneficial effect of elevated CO(2) on the magnitude of tuber yield will be expressed, depend on the climatic conditions prevailing; and (c) that potato growth responses to CO(2) and O(3) are not simply additive.

Preschool children with developmental coordination disorder: a short-term follow-up of motor status at seven to eight years of age

At a population-based screening of 5-6-y-old children, 37 children were identified as having definite or borderline motor difficulties consistent with developmental coordination disorder. When 7-8 y old they were re-examined to determine their current motor status and to compare it with that at the age of 5-6 y. The motor status was investigated from three perspectives: by a motor test, by the use of a self-perceived motor competence scale, and from the parents' descriptions. On a group level the children had not changed their motor status when 7-8 y old, according to the total scores in the Movement ABC motor test and the Perceived Motor Competence scale. On an individual level most children with definite motor difficulties remained in their category regarding motor difficulties at the follow-up, while most children with borderline motor difficulties did not. The parents' descriptions indicated an association between willingness to engage in physical activities and degree of motor difficulties.

CONCLUSION

Over a period of 1.5 y most children with definite motor difficulties continued to have such difficulties. The parents' descriptions of their children's motor status and development were in agreement with the children's motor status as measured by a motor test, but were not in total accordance with the children's self-perceived competence.

Expression of nitric oxide synthase in bladder smooth muscle cells: regulation by cytokines and L-arginine

PURPOSE

The expression and regulation of the different isoforms of nitric oxide synthase (NOS) in bladder smooth muscle cells are controversial and to our knowledge have not yet been studied systematically. Therefore, the expression and regulation of NOS were studied in rat bladder smooth muscle cells after stimulation with cytokines, lipopolysaccharide and L-arginine.

MATERIALS AND METHODS

Primary cell cultures were prepared from rat bladders. The expression of NOS mRNA was examined by reverse transcriptase-polymerase chain reaction and inducible NOS (iNOS) protein expression was studied by Western blot analysis and immunohistochemistry. Nitrite accumulation in the culture medium was determined by the Griess assay. The expression of iNOS was also studied immunohistochemically in whole bladder strips stimulated by cytokines.

RESULTS

NOS mRNA expression was not detected in unstimulated cells. Stimulating bladder smooth muscle cells with a cytokine mixture of interferon-gamma, tumor necrosis factor-alpha and interleukin-1beta induced iNOS mRNA and protein expression. The combination of interleukin-1beta plus tumor necrosis factor-alpha appeared to be crucial for iNOS induction in bladder smooth muscle cells. Exposing bladder smooth muscle cells to lipopolysaccharide did not induce iNOS. Adding L-arginine increased nitrite accumulation in cytokine mixture stimulated bladder smooth muscle cells, while iNOS positive cells were detected in the smooth muscle layer of cytokine mixture stimulated bladder strips.

CONCLUSIONS

NOS was not detected in unstimulated bladder smooth muscle cells. However, bladder smooth muscle has the potential to express iNOS when exposed to cytokines known to be produced during urinary tract infection.

Expression of nitric oxide synthase in bladder smooth muscle cells: regulation by cytokines and L-arginine

PURPOSE

The expression and regulation of the different isoforms of nitric oxide synthase (NOS) in bladder smooth muscle cells are controversial and to our knowledge have not yet been studied systematically. Therefore, the expression and regulation of NOS were studied in rat bladder smooth muscle cells after stimulation with cytokines, lipopolysaccharide and L-arginine.

MATERIALS AND METHODS

Primary cell cultures were prepared from rat bladders. The expression of NOS mRNA was examined by reverse transcriptase-polymerase chain reaction and inducible NOS (iNOS) protein expression was studied by Western blot analysis and immunohistochemistry. Nitrite accumulation in the culture medium was determined by the Griess assay. The expression of iNOS was also studied immunohistochemically in whole bladder strips stimulated by cytokines.

RESULTS

NOS mRNA expression was not detected in unstimulated cells. Stimulating bladder smooth muscle cells with a cytokine mixture of interferon-gamma, tumor necrosis factor-alpha and interleukin-1beta induced iNOS mRNA and protein expression. The combination of interleukin-1beta plus tumor necrosis factor-alpha appeared to be crucial for iNOS induction in bladder smooth muscle cells. Exposing bladder smooth muscle cells to lipopolysaccharide did not induce iNOS. Adding L-arginine increased nitrite accumulation in cytokine mixture stimulated bladder smooth muscle cells, while iNOS positive cells were detected in the smooth muscle layer of cytokine mixture stimulated bladder strips.

CONCLUSIONS

NOS was not detected in unstimulated bladder smooth muscle cells. However, bladder smooth muscle has the potential to express iNOS when exposed to cytokines known to be produced during urinary tract infection.

Clinical manifestations of atherosclerosis in an elderly population are related to plasma neopterin, NGAL and endothelin-1, but not to Chlamydia pneumoniae serology

BACKGROUND

Inflammatory mediators secreted by leukocytes are implicated in atherogenesis. Chlamydia (C.) pneumoniae infection has been suggested as a trigger of this process. We investigated relationships between C. Pneumoniae serology, inflammatory mediators and symptomatic cardiovascular disease in old age.

METHODS

In a cross-sectional study at baseline with a prospective 4 year follow-up, intraplatelet cyclic 3'-5'adenosine monophosphate (cAMP) and cyclic 3'-5'guanosine monophosphate (cGMP), plasma neutrophil gelatinase associated lipocalin (NGAL), plasma soluble tumor necrosis factor receptor-1 (TNFR-1) plasma neopterin and plasma endothelin-1 (ET-1) were analysed together with IgG and IgA antibodies for C. Pneumoniae in an elderly reference population (n=140, median age 71 years, 71 females). Twenty-one subjects had clinical manifestations of cardiovascular disease at baseline and another 21 were diagnosed with cardiovascular disease during follow-up.

RESULTS

In age adjusted logistic regression, subjects with cardiovascular disease showed higher plasma levels of neopterin (p=0.02), NGAL (p=0.04), and ET-1 (p<0.01). If subjects with cardiovascular disease at baseline were excluded from the analysis, higher plasma neopterin (p=0.01) and lower serum HDL cholesterol (p=0.03) predicted cardiovascular disease during follow-up. The presence of IgG or IgA against C. pneumoniae was not associated with cardiovascular disease. Neither were there any associations between inflammatory or endothelial parameters and C. pneumoniae serology.

CONCLUSIONS

The inflammatory mediators neopterin and NGAL and endothelial derived vasoconstrictive ET-1 were increased in elderly subjects with symptomatic cardiovascular disease. Increased plasma neopterin predicted cardiovascular disease during follow-up. No relationships were found between C. Pneumoniae serology and cardiovascular disease.

Extent and patterns of RAPD variation in landraces and cultivars of rye (Secale cereale L.) from northern Europe

Little is known about the extent and patterns of distribution of RAPD diversity in outcrossing species. This study is the first step in using RAPD markers to quantify the amount and distribution of genetic variation within and between accessions of 9 landraces and 3 cultivars of cultivated rye from Northern Europe. A high level of RAPD variation was detected, demonstrating the utility of RAPDs for genetic characterisation in rye. The results show that: (1) landraces and improved cultivars maintain roughly the same high levels of RAPD variation, (2) landraces from Norway, Germany and Finland showed the lowest level of variation, probably because of a small amount of seeds from the original samples, (3) most of the RAPD variation was found within rather than between the accessions, which is consistent with the pattern expected for a cross pollinated crop. Both the cluster and the principal coordinates analyses displayed the same pattern of genetic relationship among the accessions studied.

Syphilis, gonorrhoea and chlamydial infection among women undergoing legal or illegal abortion in Maputo

Our objectives were to compare the prevalence of sexually transmitted infections (STIs) in 103 women undergoing induced legal abortion (LA) and in 101 women with confirmed, recent illegal abortion (IA), in Maputo, Mozambique. For the purpose of this study, LA was considered the abortion provided in the Maputo Central Hospital with the approval of the Ministry of Health, and IA the one not provided through the approved facility, mentioned above. Women with IA were recruited in the outpatient gynaecology ward and women with LA in the emergency gynaecology ward in the Maputo Central Hospital, during the same time period. Serological tests for syphilis (rapid plasma reagin, ELISA-IgG and fluorescent treponemal antibody absorption), gonorrhoea (indirect haemagglutination) and chlamydia (microimmunofluorescence) were carried out. Direct immunofluorescence for detection of Chlamydia trachomatis antigen was done on endocervical smears from all the women. The prevalence of syphilis seropositivity in IA women is twice that of LA women (odds ratio [OR] 2.13; 95% confidence interval [CI] 0.55-9.95), with 10.9% and 4.9%, respectively. Exposure to gonorrhoea in these 2 groups is similar (OR 1.18; 95% CI 0.63-2.20), with seroprevalence of 31.1% in the LA and 34.7% in the IA group. The high titres are also similar in both groups. Serology findings for C. trachomatis indicate prevalence of seropositivity of 40.6% in the LA and 44.4% in the IA group with no significant difference (OR 1.17; 95% CI 0.64-2.13). In conclusion, STIs are highly prevalent in both IA and LA groups in Maputo. Urgent interventions are needed to reduce their prevalence and consequently their adverse consequences.

The neuropeptide PACAP contributes to the glucagon response to insulin-induced hypoglycaemia in mice

The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) is a neuropeptide in the autonomic nerves innervating the pancreatic islets and previous studies have shown that it stimulates insulin and glucagon secretion. It is known that autonomic nerve activation contributes to the glucagon response to hypoglycaemia. In the present study, we evaluated whether PACAP is involved in this glucagon response by examining the glucagon response to insulin-induced hypoglycaemia in mice genetically deleted of the specific PACAP receptor, the PAC1 receptor. We found that insulin (1 U kg-1 ip) reduced circulating glucose to a hypoglycaemic level of approximately 2.5 mmol L-1 in PAC1R-/- mice and their wild-type counterparts with no difference between the groups. However, the glucagon response to this hypoglycaemia was markedly impaired in the PAC1R-/- mice. Thus, after 120 min, plasma glucagon was 437 +/- 79 ng L-1 in wild-type mice vs. only 140 +/- 36 ng L-1 in PAC1R-/- mice (P=0.004). In contrast, the glucagon response to intravenously administered arginine (0.25 g kg-1) was the same in the two groups of mice. We conclude that PACAP through activation of PAC1 receptors contribute to the glucagon response to insulin-induced hypoglycaemia. Therefore, the glucagon response to hypoglycaemia is dependent not only on the classical neurotransmitters but also on the neuropeptide PACAP.

Motor performance and behaviour in preterm and full-term 3-year-old children

AIM

To compare the motor performance and behaviour at 3 years of age of very preterm, moderately preterm and full-term children (n = 221), who needed neonatal intensive care (NIC), and of 72 neonatally healthy full-term children (reference group).

METHOD

A model for combined assessment of motor performance and behaviour (CAMPB) was used. The children's performance was assessed on the basis of observations and documentation of categories of co-ordination, attention and social behaviour included in CAMPB.

RESULTS

Significantly more very preterm children showed deviations in co-ordination than children in the other groups, and this difference was most evident in comparison with the reference group. No differences were found between the groups regarding attention and social behaviour during the assessment.

CONCLUSION

Very preterm children differ from moderately preterm and full-term children in their motor performance at 3 years of age. By means of CAMPB, individual children with pronounced incoordination were identified in all groups, and some of them also showed pronounced lack of attention.

Interleukin-1 receptor antagonist is detectable in human carotid artery plaques and is related to triglyceride levels and Chlamydia pneumoniae IgA antibodies

OBJECTIVES

To investigate whether the interleukin-1 receptor antagonist (Il-1ra) and interleukin-1beta (Il-1beta) can be detected in human carotid artery tissue, and whether their presence is related to evidence of Chlamydia pneumoniae infection, risk factors for atherosclerosis, and clinical data.

SETTING

Departments of Vascular Diseases and Surgical Pathophysiology, University Hospital, Malmö, Sweden.

SUBJECTS

A total of 66 patients undergoing carotid endarterectomy (median age 74, range 53-89 years, 26 women). Il-1beta and Il-1ra were studied in carotid artery plaques and in Il-1ra in serum.

RESULTS

Interleukin-1 receptor antagonist was detected in mononuclear cells in plaques from 37/66 (56%) patients. Patients with Il-1ra in plaques showed higher [2.04 (1.70-3.14) mmol x L(-1) vs. 1.69 (1.09-1.99) mmol x L(-1); P < 0.05] serum(s-)triglyceride(tg) levels, and a higher frequency of IgA seropositivity for C. pneumoniae (76% vs. 52%; P < 0.05) than those without. S-Il-1ra levels correlated with s-tg levels (r=0.38; P=0.047). There were no differences between patients with and without Il-1ra in plaques concerning s-Il-1ra, blood(b-)haemoglobin or leucocyte count, s-cholesterol, b-glucose, blood pressure, IgG seropositivity for C. pneumoniae, prevalence of neurological symptoms preceding operation, smoking, or diabetes mellitus. There were no differences in frequency of Il-1ra in plaques or in s-Il-1ra levels between patients with symptomatic and asymptomatic stenosis, between smokers and nonsmokers, or between diabetic and nondiabetic patients. Il-1beta was not detected in plaques in the current study.

CONCLUSION

Interleukin-1 receptor antagonist can be detected in human atherosclerotic carotid artery plaques, and is related to s-triglyceride levels and IgA seropositivity for C. pneumoniae, but not to prevalence of neurological symptoms related to embolization.