Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (The PartoMa study)

OBJECTIVE

To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia.

DESIGN

Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice.

SETTING

Tanzanian low-resource referral hospital, Mnazi Mmoja Hospital.

POPULATION

Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention month (1 October 2015 until 31 January 2016) [corrected].

METHODS

Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi-randomly selected subgroups (n = 283 and n = 264, respectively).

MAIN OUTCOME MEASURES

Stillbirths and neonates with 5-minute Apgar score ≤5.

RESULTS

Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53-0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41-0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60-240) to 74 minutes (IQR 30-130) (Mann-Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37-0.81) and timely use improved.

CONCLUSION

Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. TWEETABLE ABSTRACT: #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low-resource hospital PLAIN LANGUAGE SUMMARY: PartoMa guidelines help birth attendants in Tanzania to save lives Every year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived. At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth. At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied. The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8-page pocket booklet providing locally achievable and simple decision support for care during birth. Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where birth attendants are welcomed after working hours to learn about the guidelines. The guidelines have been positively received, and seminar attendance remains high. Use of the PartoMa guidelines is associated with: A decrease by one-third in stillbirths (59 to 39 per 1000 total births) A nearly halving in the number of babies born in immediate poor medical condition (52 to 28 per 1000 live births) The results presented here derive from a comparison of births before using the PartoMa guidelines and during the 9th-12th month of use. Such a 'before-after' study cannot exclude the possibility of other causes of better survival at birth. However, the improved survival is consistent with improved care during birth, which is in line with the PartoMa guidelines.

Acupuncture for the induction of labour: a double-blind randomised controlled study

Objective

To investigate whether acupuncture is effective for the induction of labour in post-term pregnancies.

Design

A double-blind multicentre randomised controlled study.

Settings

Aarhus University Hospital and Herning Regional Hospital, Denmark.

Population

One hundred and twenty-five healthy women with uneventful pregnancies at gestational week 41⁺⁶ were randomised into two groups.

Methods

The intervention group was given acupuncture twice on the same day at acupuncture point GV20 and bilaterally at points BL67, LI4 and SP6. The control group received sham acupuncture at the same points.

Main outcome measures

At effect evaluation, which was carried out 24 hours after randomisation, the primary endpoint was labour or delivery.

Results

The primary endpoint was achieved in seven women (12%) in the acupuncture group and eight women (14%) in the control group (P = 0.79). Stratification for parity and fetal gender did not alter the results.

Conclusion

Under the treatment regimen investigated in this study, acupuncture for the induction of labour in post-term women at gestational age 41⁺⁶ weeks may not be effective.

Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial

OBJECTIVES

To study the effect of insulin treatment in combination with metformin or an insulin secretagogue, repaglinide, on glycaemic regulation in non-obese patients with type 2 diabetes.

DESIGN

Randomised, double blind, double dummy, parallel trial.

SETTING

Secondary care in Denmark between 2003 and 2006.

PARTICIPANTS

Non-obese patients (BMI </=27) with preserved beta cell function.

INTERVENTIONS

After a four month run-in period with repaglinide plus metformin combination therapy, patients with a glycated haemoglobin (HbA(1c)) concentration of 6.5% or more were randomised to repaglinide 6 mg or metformin 2000 mg. All patients also received biphasic insulin aspart 70/30 (30% soluble insulin aspart and 70% intermediate acting insulin aspart) 6 units once a day before dinner for 12 months. Insulin dose was adjusted aiming for a fasting plasma glucose concentration of 4.0-6.0 mmol/l. The target of HbA(1c) concentration was less than 6.5%. Treatment was intensified to two or three insulin injections a day if glycaemic targets were not reached.

MAIN OUTCOME MEASURE

HbA(1c) concentration.

RESULTS

Of the 459 patients who were eligible, 102 were randomised, and 97 completed the trial. Patients had had type 2 diabetes for approximately 10 years. At the end of treatment, HbA(1c) concentration was reduced by a similar amount in the two treatment groups (insulin plus metformin: mean (standard deviation) HbA(1c) 8.15% (1.32) v 6.72% (0.66); insulin plus repaglinide: 8.07% (1.49) v 6.90% (0.68); P=0.177). Total daily insulin dose and risk of hypoglycaemia were also similar in the two treatment groups. Weight gain was less with metformin plus biphasic insulin aspart 70/30 than with repaglinide plus biphasic insulin aspart 70/30 (difference in mean body weight between treatments -2.51 kg, 95% confidence interval -4.07 to -0.95).

CONCLUSIONS

In non-obese patients with type 2 diabetes and poor glycaemic regulation on oral hypoglycaemic agents, overall glycaemic regulation with insulin in combination with metformin was equivalent to that with insulin plus repaglinide. Weight gain seemed less with insulin plus metformin than with insulin plus repaglinide.

TRIAL REGISTRATION

NCT00118963.

Dilution rate increases production of plant cell-wall degrading enzymes by anaerobic fungi in continuous-flow culture

The gut anaerobic fungi,Neocallimastix hurleyensis and aOrpinomyces sp., were grown in 100 mL batch and continuous-flow cultures on wheat straw at a concentration of 80 g dry matter/L of culture liquid. In batch cultures,N. hurleyensis and Orpinomyces sp. degraded only ca. 9% and 5% of the wheat straw, respectively. In continuous-flow cultures, however, the two fungi degraded 52-56% of the apparent dry matter of wheat straw. Both fungi were able to produce greater quantities (up to x 30) of cell-wall degrading enzymes (CMCase, xylanase, beta-glucosidase and beta-xylosidase) in continuous-flow cultures than in the corresponding batch cultures. Increasing the dilution rate in continuous-flow culture resulted in the production of increased enzyme activity for all the measured cell-wall degrading enzymes, with proportional relationships between dilution rate and the cumulative activities of beta-glucosidase and beta-xylosidase. Dilution rates, however, had no consistent effect on the cumulative production of the fermentation end-products, acetate, formate, D- and L-lactate from both fungi. In addition to acetate and formate,N. hurleyens is produced D- and L-lactate in both batch and continuous-flow cultures, whereas only trace amounts of L-lactate were detected in the Orpinomyces sp. cultures.

Characteristics of antenatal care attenders in a rural population in Tamil Nadu, South India: a community-based cross-sectional study

The objectives of the study were to identify factors associated with utilisation of antenatal care facilities in a rural population in South India. A community-based, cross-sectional questionnaire study of 30 randomly selected areas was used. A total of 1254 women (95%) had at least one antenatal care visit. The median number of visits was four. High utilisation of antenatal care facilities was associated with low parity and adverse obstetrical history, short distance to healthcare facilities and literacy. It was concluded that antenatal care coverage was high. Information about the above few aspects can be used to target women who are at risk of getting inadequate antenatal care.

[A controlled trial of training in knee arthritis]

INTRODUCTION

The aim was to investigate the effectiveness and safety of a physical training programme in patients with severe osteoarthritis of the knees.

MATERIAL AND METHODS

Twenty-five patients participated in this randomised clinical trial with a blind observer. Intervention consisted in training twice a week for three months and focused on general fitness, balance, co-ordination, and muscle strength. Follow-up was performed at 3 and 12 months. The recorded parameters were muscle strength, algofunctional index, pain, walking speed, and clinical findings.

RESULTS

At three months follow-up, muscle strength had improved in the intervention group. By one year, pain at night had decreased, but the number of palpable knee joint effusions had increased.

CONCLUSION

A general physical training programme appears to be beneficial to patients with osteoarthritis of the knees, but further investigation of the safety of such a programme is called for.

The Children's Global Assessment Scale (CGAS) and Global Assessment of Psychosocial Disability (GAPD) in clinical practice--substance and reliability as judged by intraclass correlations

Studies on the inter-rater reliability on the Children's Global Assessment Scale (CGAS) and the Global Assessment of Psychosocial Disability (GAPD) involving different subgroups of 145 outpatients from 4 to 16 years of age showed fair to substantial intraclass correlations of 0.59 to 0.90. Raters of different training levels participated. Interrater reliability was dependent on number of ratings per rater, training, available data sources and experience. A more detailed description of anchor points resulted in higher inter-rater agreement by psychiatrists training in child and adolescent psychiatry, but did not influence the inter-rater reliability among more (widely) experienced raters. Both the CGAS and the GAPD seem to be sufficiently reliable tools in clinical practice. The CGAS seems to be more sensitive to inter-rater variation than the GAPD.

Crystallization and molecular-replacement solution of a truncated form of human recombinant tetranectin

The two C-terminal domains, TN23 (residues 17-181), of human recombinant tetranectin, a plasminogen kringle 4 binding C-type lectin, have been crystallized in two different space groups. Using PEG 8000 as precipitant and at a pH of 8.5, crystals belonging to the monoclinic space group C2 are obtained, with unit-cell parameters a = 160.4, b = 44.7, c = 107.5 A, beta = 127.6 degrees. Using sodium formate as precipitant and at a pH of 5.0, TN23 crystallizes in a rhombohedral space group, with unit-cell parameters a = b = c = 107.4 A, alpha = beta = gamma = 78.3 degrees. A full data set to 4.5 A has been collected from the monoclinic crystals. Using the structure of full-length tetranectin, a molecular-replacement solution has been obtained. The crystal packing shows that TN23 crystallizes as a trimer, with one trimer in the asymmetric unit.

[From valium to the happy pill?]

The National Health Insurance started to refund expenditure on selective serotonin reuptake inhibitors in 1994. Questions have been raised if a significant portion of benzodiazepine users would transfer to these new drugs when they were described in the literature as also being used for light anxiety, but not carrying the addiction risk associated with benzodiazepines. The study looks at changes over a four-year period in the prescription of benzodiazepines and selective serotonin reuptake inhibitors dispensed from two pharmacies in Vest-Agder County with a total customer base of 17,800. For four years we also followed the prescription of drugs in these two groups to 1,125 patients who had been prescribed benzodiazepines in 1994. Our data show that only 5% of those receiving benzodiazepines in 1994, whom we were able to track, changed to a selective serotonin reuptake inhibitor-only therapy. 18% used a combination of the two groups of drugs and 77% continued to use benzodiazepines as before. The increase in the number of patients receiving selective serotonin reuptake inhibitors during the study period is far greater than the increase measured by number of daily doses. Selective serotonin reuptake inhibitors seem to have little influence on the use of benzodiazepines in our pharmacies' area. Our findings indicate that instead of "from Valium to Prozac" the change during the years 1994-97 can be described as "from Valium to Valium and Prozac".

Structure of the C-type lectin carbohydrate recognition domain of human tetranectin

Tetranectin (TN) is a C-type lectin involved in fibrinolysis, being the only endogenous ligand known to bind specifically to the kringle 4 domain of plasminogen. TN was originally isolated from plasma, but shows a wide tissue distribution. Furthermore, TN has been found in the extracellular matrix of certain human carcinomas, whereas none or little is present in the corresponding normal tissue. The crystal structure of full-length trimeric TN (2.8 A resolution) has recently been published [Nielsen et al. (1997). FEBS Lett. 412, 388-396]. The crystal structure of the carbohydrate recognition domain (CRD) of human TN (TN3) has been determined separately at 2.0 A resolution in order to obtain detailed information on the two calcium binding sites. This information is essential for the elucidation of the specificity of TN towards oligosaccharides. TN3 crystallizes as a dimer, whereas it appears as a monomer in solution. The overall fold of TN3 is similar to other known CRDs. Each monomer is built of two distinct regions, one region consisting of six beta-strands and two alpha-helices, and the other region is composed of four loops harboring two calcium ions. The calcium ion at site 1 forms an eightfold coordinated complex and has Asp116, Glu120, Gly147, Glu150, Asn151, and one water molecule as ligands. The calcium ion at site 2, which is believed to be involved in recognition and binding of oligosaccharides, is sevenfold coordinated with ligands Gln143, Asp145, Glu150, Asp165, and two water molecules. One sulfate ion has been located at the surface of TN3, forming contacts to Glu120, Lys148, Asn106 of a symmetry-related molecule, and to an ethanol molecule.

Crystal structure of tetranectin, a trimeric plasminogen-binding protein with an alpha-helical coiled coil

Tetranectin is a plasminogen kringle 4-binding protein. The crystal structure has been determined at 2.8 A resolution using molecular replacement. Human tetranectin is a homotrimer forming a triple alpha-helical coiled coil. Each monomer consists of a carbohydrate recognition domain (CRD) connected to a long alpha-helix. Tetranectin has been classified in a distinct group of the C-type lectin superfamily but has structural similarity to the proteins in the group of collectins. Tetranectin has three intramolecular disulfide bridges. Two of these are conserved in the C-type lectin superfamily, whereas the third is present only in long-form CRDs. Tetranectin represents the first structure of a long-form CRD with intact calcium-binding sites. In tetranectin, the third disulfide bridge tethers the CRD to the long helix in the coiled coil. The trimerization of tetranectin as well as the fixation of the CRDs relative to the helices in the coiled coil indicate a demand for high specificity in the recognition and binding of ligands.

Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, south India: community based, cross sectional study

OBJECTIVES

To study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India.

DESIGN

Community based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres.

SETTING

Rural parts of Salem District, Tamil Nadu, South India.

SUBJECTS

1321 women and their offspring delivered in the 6 months before the interview.

MAIN OUTCOME MEASURES

Number of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates.

RESULTS

41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive).

CONCLUSIONS

In this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures.

Human plasminogen binding protein tetranectin: crystallization and preliminary X-ray analysis of the C-type lectin CRD and the full-length protein

The recombinant human plasminogen binding protein tetranectin (TN) and the C-type lectin CRD of this protein (TN3) have been crystallized. TN3 crystallizes in the tetragonal space group P4(2)2(1)2 with cell dimensions a = b = 64.0, c = 75.7 A and with one molecule per asymmetric unit. The crystals diffract X-rays to at least 2.0 A resolution. A complete diffraction data set has been collected to 2.7 A resolution. The crystals of TN, obtained by the vapour-diffusion reverse salting-in method at 280 K, are rhombohedral, space group R3, with the hexagonal axes a = b = 89.1, c = 75.8 A, and diffract to at least 2.5 A. A full data set has been collected to 3.0 A. The asymmetric unit contains one monomer of TN. Molecular replacement solutions for TN3 and TN have been obtained using the structure of the C-type lectin CRD of rat mannose-binding protein as search model. The rhombohedral space group indicates that trimers of TN are formed in accordance with the observation of trimerization in solution.

The three-dimensional structure of mammalian ribonucleotide reductase protein R2 reveals a more-accessible iron-radical site than Escherichia coli R2

The three-dimensional structure of mouse ribonucleotide reductase R2 has been determined at 2.3 A resolution using molecular replacement and refined to an R-value of 19.1% (Rfree = 25%) with good stereo-chemistry. The overall tertiary structure architecture of mouse R2 is similar to that from Escherichia coli R2. However, several important structural differences are observed. Unlike the E. coli protein, the mouse dimer is completely devoid of beta-strands. The sequences differ significantly between the mouse and E. coli R2s, but there is high sequence identity among the eukaryotic R2 proteins, and the identities are localized over the whole sequence. Therefore, the three-dimensional structures of other mammalian ribonucleotide reductase R2 proteins are expected to be very similar to that of the mouse enzyme. In mouse R2 a narrow hydrophobic channel leads to the proposed binding site for molecular oxygen near to the iron-radical site in the interior of the protein. In E. coli R2 this channel is blocked by the phenyl ring of a tyrosine residue, which in mouse R2 is a serine. These structural variations may explain the observed differences in sensitivity to radical scavengers. The structure determination is based on diffraction data from crystals grown at pH 4.7. Unexpectedly, the protein is not iron-free, but contains one iron ion bound at one of the dinuclear iron sites. This ferric ion is bound with partial occupancy and is coordinated by three glutamic acids (one bidentate) and one histidine in a bipyramidal coordination that has a free apical coordination position. Soaking of crystals in a solution of ferrous salt at pH 4.7 increased the occupancy on the already occupied site, but without any detectable binding at the second site.

Crystallization and crystallographic investigations of the small subunit of mouse ribonucleotide reductase

The R2 protein component of mouse ribonucleotide reductase has been obtained from overproducing Escherichia coli bacteria. It has been crystallized using NaCl as precipitant. The crystals are orthorhombic, space group C222(1), with cell dimensions a = 76.9 A, b = 108.9 A, c = 92.7 A and diffract to at least 2.5 A. The asymmetric unit of the crystals contains one monomer. Rotation and translation function searches using a model based on the weakly homologous E. coli R2 gave one significant peak. Rotation about a crystallographic 2-fold axis parallel to the a-axis produces an R2 dimer with dimer interactions very similar to those found for E. coli R2.

Perceptions of the mammography experience

The 1993 projections for breast cancer indicate a morbidity of 183,000 women with a mortality rate of 18%. Mammography is one of three approaches available for the early detection of breast cancer. However, underutilization has been reported and attributed to pain associated with the procedure, the expense to the consumer, and lack of referral by physicians. Other reasons for the low utilization rates include fears on the part of the woman of a positive diagnosis, radiation, and a possible mastectomy. This study provides an analysis of the responses of a convenience sample of 272 women, aged 30-90 years, to two open-ended questions about the mammography experience. The words and phrases women used to describe the mammography experience and the sensations experienced in their breasts during mammography were subjected to content analysis. The results of this study suggest that the word descriptors women use to describe their experience during mammography are highly individualistic and may not be totally captured by numeric or descriptive rating scales of pain intensity.

[Salmonella dublin]

Salmonella dublin's natural host is cattle; it may cause acute disease in calves, while adult animals may be asymptomatic carriers. In humans S. dublin is the most invasive of the zoonotic Salmonella-bacteria found in Denmark. It is much more frequently isolated from the blood than from the faeces and may give rise to serous metastatic infections in practically all organs. The number of registered human infections rose from zero to 46 per year during the period 1980-1988, but has now stabilized at a level of about 20 per year. Outbreaks have been described abroad as being caused by unpasteurised milk and cheese; in Denmark beef and cow's liver must be viewed as the dominant source of infection. The direct routes of infection are, however, unknown. Tightening of regulations for the slaughtering of animals from S. dublin infected herds, optimal hygiene in the slaughterhouses and increased cooperation between the veterinary and medical professions concerning investigation of routes of infection are necessary measures to be taken in order to reduce the number of human S. dublin infections.

[Alcohol-induced immunosuppression is reversible]

The aim of the study was to investigate to which degree and how fast cellular immunodepression may be reversed after cessation of alcohol intake. Delayed hypersensitivity was investigated in ten severe alcoholics and in seven moderate consumers. A group of eight previous drinkers was tested for comparison. The skin test responses were modest initially with a median area of response of 12 mm2 in the heavy alcoholics, and three mm2 in the moderate consumers. It improved significantly after two weeks of sobriety. The responses stabilized after eight to nine weeks at 63-74 mm2, corresponding to the response of 70 mm2 in the group of previous drinkers.

Reversibility of alcohol-induced immune depression

Alcohol abusers have suppressed cellular immune function. The aim of the study was to investigate the time of sobriety required to normalize immune function. Delayed hypersensitivity was investigated during disulfiram controlled abstinence in ten heavy alcoholics and in seven moderate drinkers without liver diseases. For comparison a control group of eight previous drinkers was tested. The skin test responses were modest initially with a median area of response of 12 mm2 (range 0-31) in the heavy alcoholics and 3 mm2 (0-15) in the moderate drinkers. It improved significantly in both groups after two weeks of sobriety. The responses stabilized after 8 weeks at 74 mm2 (54-102) in the heavy alcoholics and after 9 weeks at 63 mm2 (42-76) in the moderate drinking group. The control group had skin test responses of 70 mm2 (46-87), not different from the responses of the alcohol groups after two months of abstinence. The results suggest that while 2 weeks of abstinence from alcohol will improve the depressed cellular immunity, 2 months of sobriety is necessary to normalize it.

Mobile mammography: the technologist's role

This article discusses the role of the radiologic technologist in a mobile mammography screening program targeted at the economically disadvantaged in Dade County, Fla. It describes the development of process, structure and outcome standards used to guide and evaluate both the program and the radiologic technologist within this setting, highlighting the technologists' valuable contributions to the program.

Instruments that measure beliefs about cancer from a cultural perspective

Understanding beliefs about cancer from a cultural perspective is of great importance as the population mix of this country continues to shift and change. In order to assess the cancer beliefs held by diverse populations, culturally specific tools are needed. The purpose of this article is to identify and describe instruments that have been used to assess beliefs about cancer. Eight published and unpublished instruments were identified from a review of the literature. These tools address attitudes and beliefs toward cancer, cancer prevention, and cancer treatment within a variety of age groups and ethnic populations. One tool was related to adolescents, whereas the remainder focused on adults; three were translated into other languages; four tools involved questionnaire format and four interview format. Although it is encouraging to report that culturally specific tools are being developed, there is a demonstrated need to increase the expertise in developing such instruments.

Breast cancer screening

Screening for breast cancer is receiving increased emphasis with the development of modern technology. Health care providers must inform the public that screening for breast cancer may increase survival. Legislation must be enacted to ensure that a screening examination is affordable and can be readily obtained upon referral. The message to both health care professionals and the public must be positive. Early detection is the best protection in breast cancer.

Increasing the cancer screening of the medically underserved in south Florida

Diagnosis and treatment of cancers at advanced stages have contributed to a significantly lower survival rate among individuals of low socioeconomic status compared with those in higher brackets. In an effort to increase the accessibility and acceptability of cancer screening among such individuals in Dade County, Florida, the Cancer Control Division of the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine initiated a pilot early detection program in 1987. The program initially provided breast cancer screening for women, aged 40 and older, who attended ten community health care centers located in low-income neighborhoods. With the selection of Miami by the American Cancer Society as one of three sites for conducting a screening demonstration project for the socioeconomically disadvantaged, this program has recently been expanded to include pelvic screening for women, aged 40 and older, and prostate screening for men, aged 65 and older.

Isolation of a Salmonella-specific DNA hybridization probe

A Salmonella-specific DNA fragment of the Salmonella typhimurium LT2 chromosome has been isolated. The fragment (2.3 kilobases (kb)) was used as a probe in a colony hybridization assay, where 185 strains of 93 different Salmonella serovars were correctly identified as belonging to Salmonella. The specificity of the probe was evaluated in colony hybridization assays on pure cultures of non-Salmonella bacteria and on specimens with an indigenous flora. Sixty-three strains of 34 non-Salmonella Gram-negative species did not hybridize to the fragment. By DNA hybridization to faecal samples from calves, pigs and chickens, and samples of animal feed, three samples out of 10 positive by traditional culture methods gave negative results by hybridization, 45 samples were negative in both methods, while one sample was positive only in the hybridization assay. From this sample, Salmonella livingstone was isolated by a replica plate hybridization technique. The probe therefore proved 100% specific for the genus Salmonella. The 2.3 kb fragment may form the basis of hybridization assays for specific detection of Salmonella in food, environmental and clinical specimens.

The prevalence of plasmids in Danish bovine and human isolates of Salmonella dublin

Nine different plasmid profiles were demonstrated among 135 Danish isolates of Salmonella dublin, with 58% of the strains enclosed in the major profile group. Two strains did not carry any plasmids. The plasmid profiles of 129 strains (96%) were made up of one or more of only four plasmids of approximate sizes 98 kb, 80 kb, 4.0 kb, and 3.8 kb. There was no significant difference in the prevalence of different plasmid profile groups between isolates from cattle and man. The serovar-specific and virulence-associated 80 kb plasmid could be demonstrated in all plasmid carrying strains, but one strain carried this plasmid at a very low copy number. Five of 47 strains tested showed resistance to antibiotics (2 to sulphathiazole, 2 to streptomycin, and 1 to streptomycin and tetracycline). Only the combined streptomycin/tetracycline resistance was transferable by a 48 kb conjugative plasmid.

Fibroadenomatoid hyperplasia of the male breast

A 69-year-old man with congestive heart failure who had been treated with digoxin for 27 years and spironolactone for 4 years developed bilateral gynecomastia. Excised tissue contained multiple nodules. Histologically, the nodules showed a structural pattern corresponding to fibroadenoma of the female breast. This lesion, called "fibroadenomatoid hyperplasia," is probably caused by treatment with spironolactone. The lesion has not previously been described in tissue from the male breast.

Advances in breast cancer. Implications for nursing care

The role of the nurse in the care of patients with breast cancer is changing because of the many options available for medical management of the disease. Breast cancer is a treatable disease. Patients survive many years. Throughout the treatment process, patients and families may be faced with numerous decisions involving initial treatment and adjuvant therapy as well as the treatment of metastatic disease. Involvement of the patient and caregiver are crucial in this process, and they must be assisted and supported by nurses who are knowledgeable about the options and the rationale behind each of the treatment options. If this disease continues to occur in 1 out of 10 women, most nurses will be involved with some aspect of the disease either personally or professionally.

[Young men's knowledge of AIDS. Development from June 1987 to January 1989]

The changes in young men's knowledge about AIDS were investigated in January 1989 by means of questionnaires, and compared with a similar investigation in June 1987. The answers to the questionnaires were voluntary and anonymous. Three hundred and six persons took part in the 1989-investigation. The investigation shows improved knowledge of AIDS and improved knowledge of the symptoms of AIDS. A greater percentage had received information about AIDS in school. 71% had attempted to use a condom compared to 45% in 1987. Furthermore, 96% knew that condoms provide protection from AIDS.

The nurse's role in mammography screening

Black women in Dade Country have a substantially higher proportion of advanced breast cancer at diagnosis than white women. To shift the stage at diagnosis from later to earlier, a Cancer Early Detection Program was initiated in the fall of 1987. This program involves screening with low-cost mammography, physical breast examination, and instruction in self-breast examination as well as general cancer education about prevention, early detection, and health promotion. The educational programs are presented in conjunction with the local unit of the American Cancer Society. A mobile mammography van travels to Primary Health Care Centers to provide mammograms to a population with limited access to preventive health care. This article describes the development and implementation of the program. It focuses on the responsibilities of an oncology nurse who coordinates and directs the program. Recommendations are made for ways oncology nurses can assume expanded roles in cancer screening/early detection.

Applying Andragogy in Nursing Continuing Education

Andragogy, a philosophical orientation for adult education, receives little attention in the nursing continuing education literature. Yet, the tenets of andragogy form the organizing framework for programming. This article defines andragogy and provides selected results of a research study designed to test andragogical concepts in long-term oncology nursing continuing education programs. The results of the study suggest a new way of viewing the goals of nursing continuing education activities.

Abdominal abscess following asymptomatic pelvic osteomyelitis. Case report

In a 23-year-old woman, an intramuscular abscess of the ventral abdominal wall in the right iliac fossa was found to have an extraperitoneal fistula to a focus of asymptomatic osteomyelitis of the iliac ala. Pelvic osteomyelitis should be suspected in cases of abdominal wall abscess without pathologic intra-abdominal findings.

Adenosis tumour of the breast--a clinicopathological investigation of 27 cases

Twenty-seven cases of palpable and/or tumour-forming adenosis in the female breast, called adenosis tumour, have been investigated. It is a rare lesion, which most often presents as a breast mass that clinically and histologically is sometimes misinterpreted as carcinoma. The majority of patients were under the age of 45 years. Grossly, most tumours were firm or elastic and showed a grey or greyish-white cut surface. Furthermore, seven (26%) were granular and nine (34%) were microcystic, whereas none showed chalky streaks. Microscopically, 20 cases were poorly circumscribed and seven cases were well circumscribed. In contradistinction to the often uniform growth pattern of tubular carcinoma, the adenosis tumours characteristically showed adenosis arranged in a mixture of eight different growth patterns. The most frequent and also most extensive growth pattern was classical sclerosing adenosis and the least frequent was tubular adenosis. Another conspicuous feature in adenosis tumours was patchy growth in contrast to the stellate configuration of tubular carcinoma which is the most likely differential diagnosis. Other findings separating adenosis tumours from carcinomas were microcysts (93%), apocrine metaplasia (63%), luminal histiocytes (52%) and pseudopapillomas, called glomeruloid structures (48%). Epithelial changes that could cause anxiety about malignancy were frequently found and comprised epithelial hyperplasia (44%), epithelial atypia (26%) and fat or nerve infiltration (30%). Three patients were subjected to unnecessary mastectomy because of incorrectly diagnosed adenosis tumours. Adenosis tumours and non-infiltrating carcinoma were found together in five cases, but their association is probably over represented due to selection. None of 18 pure adenosis tumours solely treated by excision had recurred at follow-up 1-9 years later (mean 3.75 years).

Morphometric investigation of the human thyroid gland. With special reference to the methods and to nontoxic goiter

A study was carried out to (1) evaluate methods for the quantitative morphologic description of the human thyroid gland and (2) investigate the relationship between the morphology and the functional state of the gland in patients with nontoxic goiter. Analysis of sampling variance showed a high contribution of biologic variation between individuals, a low contribution from the variance within individuals and a negligible contribution from the stereologic procedure itself to the overall variation. The optimal numbers of sections per gland and fields of vision were found to be 2 and 17, respectively. The only constant relationship between the morphology and the functional state, either before or after resection, was a positive correlation between the epithelial cell volume left behind and the se-"free" thyroxine index 12 months postoperatively. It is concluded that quantitative morphologic description of the human thyroid gland is possible without being too time-consuming but that the value of such investigations is clinically doubtful in cases of nontoxic goiter.