Epidemiologie und Hautpflege

Einleitung. Aktuell sind etwa 11,5% der Weltbevölkerung älter als 60 Jahre. Aufgrund von altersbedingten Veränderungen der Haut ist diese Population besonders vulnerabel für die Entwicklung dermatologischer Erkrankungen. Es wurden die Epidemiologie von Hauterkrankungen, die Zusammenhänge von Pflegebedürftigkeit, Hautphysiologie und dem Auftreten von Hauterkrankungen untersucht. Weiterhin wurde die Wirksamkeit standardisierter Hautpflegeregimes im Vergleich zur nicht-standardisierten Hautpflege bei Pflegeheimbewohnern in der institutionellen Langzeitversorgung untersucht. Methoden. Es wurde eine systematische Übersichtsarbeit zur Epidemiologie von Hauterkrankungen erstellt. Eine deskriptive Querschnittstudie und eine multizentrische, randomisierte, kontrollierte, prüferverblindete klinische Studie wurden in zehn vollstationären Pflegeheimen durchgeführt. Neben der Erhebung und Messung demographischer Variablen und hautphysiologischer Funktionsparameter (transepidermaler Wasserverlust, Stratum Corneum Hydratation, pH-Wert), wurden dermatologische Untersuchungen durchgeführt. Die Zuteilung der Pflegeheimbewohner zu einer von drei Gruppen für ein achtwöchiges Hautpflegeregime erfolgte randomisiert. Der Endpunkt Hauttrockenheit wurde anhand des Overall Dry Skin Scores diagnostiziert. Die Auswertung der Ergebnisse erfolgte deskriptiv mittels der Darstellung bi- und multivariater Zusammenhänge. Gruppenvergleiche erfolgten mittels Kruskal-Wallis Test und einem Post-hoc-Paarvergleich (Mann-Whitney U-Test). Ergebnisse. Die systematische Literaturrecherche ergab 74 Volltexte, welche Prävalenzund/ oder Inzidenzdaten von mehr als 20 Hautproblemen oder Erkrankungen berichteten. In der Querschnittstudie nahmen n = 223 Pflegeheimbewohner (67,7% weiblich; mittleres Alter 83,6 Jahre (SD 8,0)) teil. Insgesamt wurden 60 dermatologische Diagnosen, darunter Xerosis cutis (99,1%, 95% KI 97,7%-100,0%), identifiziert. Wenige bivariate Assoziationen zwischen Hauterkrankungen und demographischen Charakteristiken konnten dargestellt werden. An der klinischen Studie nahmen n = 133 Pflegeheimbewohner (65,4% weiblich; mittleres Alter 83,8 Jahre (SD 8,3)) teil. Die Hauttrockenheit nahm in allen drei Gruppen ab. Im Gruppenvergleich konnten statistisch signifikante Unterschiede gezeigt werden. Im Vergleich mit den Ausgangswerten waren die hautphysiologischen Funktionsparameter geringfügig verändert. Diskussion. Die Ergebnisse deuten darauf hin, dass Hauterkrankungen in der älteren Bevölkerung sehr häufig sind. Die dermatologischen Befunde reichen von stark prävalenter Xerosis cutis über kutane Infektionen bis hin zu Hautkrebs. Nicht alle Erkrankungen erfordern eine sofortige dermatologische Behandlung. Ein strukturiertes Hautpflegeregime ist effektiv zur Behandlung von Xerosis cutis bei Pflegeheimbewohnern. Pflegekräfte sollten das nötige Wissen und diagnostische Fähigkeiten besitzen, um angemessene klinische Entscheidungen treffen zu können, da eine umfassende, spezialisierte, dermatologische Versorgung im wachsenden Langzeitpflegesektor unwahrscheinlich ist.Introduction. About 11.5% of the world's population is older than 60 years. This population is particularly vulnerable to the development of dermatological diseases. The epidemiology of skin diseases, the relationships between care dependency, skin physiology and skin diseases, as well as the efficacy of standardized skin care regimens compared to non-standardized skin care in nursing home residents were examined. Methods. A systematic review of the epidemiology of skin diseases was conducted. An observational, descriptive, cross-sectional study and a multi-center, randomized, controlled, investigator blinded study were conducted in ten nursing homes. Demographic variables and skin physiology (transepidermal water loss, stratum corneum hydration, and pH) were measured and dermatological examinations were performed. Nursing home residents were randomized to one of three groups with an eight-week skin care regimen. The endpoint skin dryness was diagnosed using the Overall Dry Skin Score. The results were described descriptively. Bi- and multivariate correlations were performed to detect possible associations. The Kruskal-Wallis test with post-hoc pairwise twosample Mann-Whitney U-test was performed to detect group differences. Results. The systematic literature search resulted in 74 analyzed full texts, which reported prevalence and/or incidence data of more than 20 skin diseases. In the descriptive cross-sectional study, n = 223 nursing home residents (67.7% female, mean age 83.6 years (SD 8.0)) participated. Sixty dermatological diseases were diagnosed,including xerosis cutis (99.1%, 95% CI 97.7% to 100.0%). Only few bivariate associations between skin disease and demographic characteristics have been detected. N = 133 nursing home residents (65.4% female, mean age 83.8 years (SD 8.3)) participated in the clinical study. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. The skin physiological function parameters showed slightly changed values compared to the baseline values. Discussion. Results indicate that skin diseases are highly frequent in the elderly population. Dermatological findings range from highly prevalent xerosis cutis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment. A structured skin care regimen is effective in reducing skin dryness in aged nursing home residents. Caregivers should have the needed knowledge and diagnostic skills to make appropriate clinical decisions, since it is unlikely that specialized dermatological care will be delivered widely in the growing long-term care sector

The modification, implementation, and evaluation of an HIV/AIDS education programme for students in year 10

This research addresses the issue of HIVIAIDS education for Year 10 students. The purpose of this study was twofold: to provide baseline data on students’ knowledge, beliefs, and attitudes about HIV and AIDS (Phase 1), and to evaluate the effect of an education intervention on possible determinants of behaviour (Phase 2), Previous studies have Indicated that improved knowledge may influence risk-reducing behaviour. In addition, adolescents have numerous misconceptions about the cause and transmission of HIV. However, there has been no known assessment of AIDS knowledge, attitudes, beliefs, and behaviours of high school students in Western Australia. The study was guided by the Health Belief Model (HBM), which attempts to explain preventative health behaviour in terms of attitudes, values, and beliefs. Using a descriptive, quasi-experimental design, the study drew a non-random convenience sample of 269 students aged 14-15 years from two senior high schools in Perth, Western Australia. One school received the education intervention, and the other school was used as the control group. Phase 1: A questionnaire was administered to gather baseline data on AIDS knowledge, attitudes, perceived risk, and intention to change risk behaviours. Students were also asked to identify sources of HIV/AIDS information. Results revealed that students knew most about the prevention of HIV/AIDS, and least about its transmission. Understanding of the severity of the disease was poor, students reported high levels of fear, and varying degrees of willingness to practice risk-reducing behaviours. There was a significant relationship between knowledge of HIV/AIDS and perceived severity, perceived barriers, and perceived pressure. Schools, television and magazines were major sources of AIDS information. Phase 2: a pre-test was administered to both groups to gather data on existing AIDS knowledge, attitudes, perceived risk, and intention to change risk behaviours. The data gathered in Phase 1 also served as the pre-test data in Phase 2. Following the pre-test, students in the experimental group were given as HIV/AIDS education programme and tested immediately following its completion. Six weeks later, both groups were evaluated using a questionnaire identical to the pre-test and intervention test to allow comparison of data between the groups, and to evaluate the effect of the intervention of the following HBM variables: knowledge of HIV/ADIS, knowledge of HIV/AIDS prevention, perceived severity, perceived susceptibility, preventive intentions, perceived barriers and perceived pressures. Data from the intervention test and post-test were used to evaluate knowledge retention rates in students in the experimental group. To allow for pre-test differences, post-test scores were subtracted from pre-test scores. Using these difference scores, !-test analyses were conducted to test the hypotheses. Results indicated support for hypotheses investigating the effect of the intervention on adolescents\u27 knowledge about HIV/AIDS, perceived severity, and perceived pressures. However, differences in responses relating to knowledge of prevention, preventive intentions, and perceived barriers, were not statistically significant. At post-test, the experimental group maintained knowledge levels, felt less threatened and less susceptible to AIDS, acknowledged fewer pressures, and were less inclined to practice preventive health behaviours. Study findings have implications for nursing practice, health education, planning, and research

Open-source, commercial, non-profit, for-profit: what power have you got?

A previous Impact Blog post expressed the view that scholarly communications shouldn’t just be open but non-profit too. Mark Hahnel responds to that contention, highlighting the technical and financial considerations that render many of the academic-led, grant-funded initiatives unsustainable. Moreover, the non-profit vs. for-profit dichotomy itself may be too simplistic; non-profit is not synonymous with good, and for-profit is not synonymous with exploitation. Provided it is on the right terms, universities should be encouraged to seek help from outside of academia, especially in areas not in their direct area of expertise. With a healthy blend of open-source, commercial, non-profit and for-profit, a democratic marketplace can drive innovation in the academic space

The relationship between diet and exercise and the occurrence of headaches in adolescents aged 12 to 15 years

Headaches in adolescents present school nurses with a challenge. Al though separate research has focussed on headaches in children, and on dietary and exercises practices of adolescents, little attention has been paid to the relationship between the two. The purpose of this study was to investigate whether adolescents\u27 dietary and exercise practices affect the occurrence of their headaches. The randomly selected sample consisted of 97 adolescents, aged 12 to 15 years, from a Perth metropolitan high school. Males accounted for 28%. Of respondents, and females 72%.. The average age was 13.5 years. All students taking part in the study were required to complete an 18-item questionnaire, which surveyed frequency of headaches, dietary knowledge and behaviour, and exercise knowledge and behaviour. The data, collected between class times, showed that a large number of students reported headaches; dietary knowledge and behaviour were poor; and exercise knowledge and behav1our were good. All responses were anonymous. The study showed no evidence of a relationship between headaches and diet, or between headaches and exercise. The major implication for nursing practice is that the school nurse should carefully document all assessment data relating to headaches in order to build a comprehensive information base from which to deduce hypotheses for study. Future research which follows from the study should address the development of headaches as a consequence of varying levels of exercise and dietary intake, as well as the relationship between perceived stress and headaches

Trafficking of mesenchymal stem cells

In adult life mesenchymal stem cells (MSCs) reside primarily in the bone marrow and are defined according to their ability to self-renew and differentiate into tissues of mesodermal origin. Due to their immuno-modulatory properties and ability to form cartilage and bone, MSCs have clinical potential, for the treatment of autoimmune diseases and tissue repair. This project determines the chemokine receptor profile on murine bone marrow MSCs at early and late passage and on human MSCs derived from a range of fetal tissues including fetal blood, bone marrow, amniotic fluid and placenta. The overwhelming result from this analysis is the consistency across species and tissue source with respect to chemokine receptor profiles. In addition it is clear that expression of specific chemokine receptors defines sub-populations of MSCs. Currently, clinical trials using MSCs have relied on continued in vitro culture in order to obtain sufficient numbers for treatment. Here, MSCs have been shown to lose external chemokine receptor expression and associated chemotactic ability, whilst growing in size upon continued culture. All cultured MSCs investigated in this thesis were shown to be a heterogeneous population of stem cells and progenitors that contained ‘true’ MSCs within its number. This thesis investigates a pharmacological approach to mobilise endogenous MSCs from the bone marrow, increasing their numbers in the blood. It has previously been reported that administration of VEGF-A over 4 days followed by a single dose with a CXCR4 antagonist (AMD3100) causes selective mobilisation of MSCs into blood. The VEGF biology of this response has been interrogated. MSCs were shown to express high levels of VEGFR-1 and lower levels of VEGFR-2 on the cell surface but do not express VEGFR-3. By blocking VEGFR-1 with mAbs during VEGF-A165 treatment, a ten-fold increase in MSC mobilisation in response to AMD3100 was recorded, while treating with VEGFR-2 blocking mAbs had no effect. Using VEGF isoforms specific for VEGFR-1 and VEGFR-2 (PlGF and VEGF-E respectively), it was determined that MSC mobilisation was dependant on activation of VEGFR-2 and not VEGFR-1. PαS cells are a subset of MSCs found in the murine bone marrow that are PDGFRα+, Sca-1+, CD45-, Ter119-. Further characterisation of mobilised mMSCs by flow cytometric analysis of PαS cells, now provides a way to investigate the biology of MSCs, both in their steady state in vivo and in models of injury and inflammation. Molecular mechanisms lying downstream of VEGFR-2 have been explored and it has been shown that MMPs play a critical role in mobilisation. The use of drugs to mobilise MSCs into the blood may provide a cost effective, non-invasive treatment to promote tissue repair

The state of open data 2019 - what are the key issues in open data for researchers?

s mandates and policies encouraging open data are becoming more widely established and enforced, the use of and sharing of data is becoming more central to scholarly communication. This has resulted in data sharing becoming increasingly entangled with the prestige economy of academia. In this post, Mark Hahnel presents findings from the largest continuous survey of academic attitudes to open data and suggests that as well promoting data sharing, it may also have inadvertently fed into the publish or perish culture of research

An Analysis of Performance Claims in Athleisure

The purpose of this research was to evaluate performance claims in athleisure, in order to confirm or refute their authenticity. Aesthetic properties and functional claims were evaluated initially, and after repeated home laundering. A convenience (nonprobability) sample of activewear with performance features consisted of ninety garments that are currently on the market and commonly used by consumers. The garments included men’s and women’s t-shirts, polos, leggings, windbreakers, hoodies, sweatpants, and warm-up pants of various fiber contents and performance chemistries. The focus of the garment selection was on garments with performance properties relating to moisture management. Performance claims listed on the hang tags included moisture management, wicking, quick dry, stay cool, breathable, water resistant and wind resistant. Garments in the sample were a combination of natural, synthetic and blended fiber contents. The garments were tested initially, after one, five, ten, fifteen and twenty laundry cycles. The garments were evaluated for smoothness, dimensional stability, color change, pilling, horizontal wicking of textiles, water repellency- spray test, water resistance- impact penetration, water resistance- hydrostatic pressure, absorbency of textiles, aqueous liquid repellency and air permeability. All testing was performed in accordance with AATCC and ASTM standard test methods and was conducted under controlled laboratory settings

Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study

Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer