Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward.

BACKGROUND: Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. METHODS: The intervention consisted of six workshops, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Parental satisfaction with nursing care was measured with 288 parents before and six weeks after the workshops, by means of an adapted Picker questionnaire. Two focus-group discussions were held with the workshop participants six months after the intervention. RESULTS: During the workshops, nurses demonstrated awareness of poor relationships between themselves and mothers. To tackle this, they proposed measures including weekly meetings to solve problems, maintain respect and increase cooperation, and representation to administrative forces to request better working conditions such as equipment, salaries and staff numbers. The results of the parent satisfaction questionnaire showed some improvement in responsiveness of nurses to client needs, but overall the mean percentage of parents reporting each of 20 problems was not statistically significantly different after the intervention, compared to before it (38.9% versus 41.2%). Post-workshop focus-group discussions with nursing staff suggested that nurses felt more empathic towards mothers and perceived an improvement in the relationship, but that this was hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs. CONCLUSION: The intended outcome of the intervention was not met. The priorities of the intervention--to improve nurse-parent relationships--did not match the priorities of the nursing staff. Development of awareness and empathy was not enough to provide care that was satisfactory to clients in the context of working conditions that were unsatisfactory to nurses

Distinct transthyretin oxidation isoform profile in spinal fluid from patients with Alzheimer’s disease and mild cognitive impairment

BACKGROUND: Transthyretin (TTR), an abundant protein in cerebrospinal fluid (CSF), contains a free, oxidation-prone cysteine residue that gives rise to TTR isoforms. These isoforms may reflect conditions in vivo. Since increased oxidative stress has been linked to neurodegenerative disorders such as Alzheimer’s disease (AD) it is of interest to characterize CSF-TTR isoform distribution in AD patients and controls. Here, TTR isoforms are profiled directly from CSF by an optimized immunoaffinity-mass spectrometry method in 76 samples from patients with AD (n = 37), mild cognitive impairment (MCI, n = 17)), and normal pressure hydrocephalus (NPH, n = 15), as well as healthy controls (HC, n = 7). Fractions of three specific oxidative modifications (S-cysteinylation, S-cysteinylglycinylation, and S-glutathionylation) were quantitated relative to the total TTR protein. Results were correlated with diagnostic information and with levels of CSF AD biomarkers tau, phosphorylated tau, and amyloid β(1-42) peptide. RESULTS: Preliminary data highlighted the high risk of artifactual TTR modification due to ex vivo oxidation and thus the samples for this study were all collected using strict and uniform guidelines. The results show that TTR is significantly more modified on Cys(10) in the AD and MCI groups than in controls (NPH and HC) (p ≤ 0.0012). Furthermore, the NPH group, while having normal TTR isoform distribution, had significantly decreased amyloid β peptide but normal tau values. No obvious correlations between levels of routine CSF biomarkers for AD and the degree of TTR modification were found. CONCLUSIONS: AD and MCI patients display a significantly higher fraction of oxidatively modified TTR in CSF than the control groups of NPH patients and HC. Quantitation of CSF-TTR isoforms thus may provide diagnostic information in patients with dementia symptoms but this should be explored in larger studies including prospective studies of MCI patients. The development of methods for simple, robust, and reproducible inhibition of in vitro oxidation during CSF sampling and sample handling is highly warranted. In addition to the diagnostic information the possibility of using TTR as a CSF oxymeter is of potential value in studies monitoring disease activity and developing new drugs for neurodegenerative diseases

Bulk-Processed Plasmonic Plastic Nanocomposite Materials for Optical Hydrogen Detection

Conspectus Sensors are ubiquitous, andtheir importanceis only going to increaseacross many areas of modern technology. In this respect, hydrogengas (H-2) sensors are no exception since they allow mitigationof the inherent safety risks associated with mixtures of H-2 and air. The deployment of H-2 technologies is rapidlyaccelerating in emerging energy, transport, and green steel-makingsectors, where not only safety but also process monitoring sensorsare in high demand. To meet this demand, cost-effective and scalableroutes for mass production of sensing materials are required. Here,the state-of-the-art often resorts to processes derived from the microelectronicsindustry where surface-based micro- and nanofabrication are the methodsof choice and where (H-2) sensor manufacturing is no exception. In this Account, we discuss how our recent efforts to develop sensorsbased on plasmonic plastics may complement the current state-of-the-art.We explore a new H-2 sensor paradigm, established througha series of recent publications, that combines (i) the plasmonic opticalH(2) detection principle and (ii) bulk-processed nanocompositematerials. In particular, plasmonic plastic nanocomposite sensingmaterials are described that comprise plasmonic H-2-sensitivecolloidally synthesized nanoparticles dispersed in a polymer matrixand enable the additive manufacturing of H-2 sensors ina cost-effective and scalable way. We first discuss the concept ofplasmonic plastic nanocomposite materials for the additive manufacturingof an active plasmonic sensing material on the basis of the threekey components that require individual and concerted optimization:(i) the plasmonic sensing metal nanoparticles, (ii) the surfactant/stabilizermolecules on the nanoparticle surface from colloidal synthesis, and(iii) the polymer matrix. We then introduce the working principleof plasmonic H-2 detection, which relies on the selectiveabsorption of H species into hydride-forming metal nanoparticles that,in turn, induces distinct changes in their optical plasmonic signaturein proportion to the H-2 concentration in the local atmosphere.Subsequently, we assess the roles of the key components of a plasmonicplastic for H-2 sensing, where we have established that(i) alloying Pd with Au and Cu eliminates hysteresis and introducesintrinsic deactivation resistance at ambient conditions, (ii) surfactant/stabilizermolecules can significantly accelerate and decelerate H-2 sorption and thus sensor response, and (iii) polymer coatings acceleratesensor response, reduce the limit of detection (LoD), and enable molecularfiltering for sensor operation in chemically challenging environments.Based on these insights, we discuss the rational development and detailedcharacterization of bulk-processed plasmonic plastics based on glassyand fluorinated matrix polymers and on tailored flow-chemistry-basedsynthesis of Pd and PdAu alloy colloidal nanoparticles with optimizedstabilizer molecules. In their champion implementation, they enablehighly stable H-2 sensors with response times in the 2 srange and an LoD of few 10 ppm of H-2. To put plasmonicplastics in a wider perspective, we also report their implementationusing different polymer matrix materials that can be used for 3D printingand (an)isotropic Au nanoparticles that enable the manufacturing ofmacroscopic plasmonic objects with, if required, dichroic opticalproperties and in amounts that can be readily upscaled. We advertisethat melt processing of plasmonic plastic nanocomposites is a viableroute toward the realization of plasmonic objects and sensors, producedby scalable colloidal synthesis and additive manufacturing techniques

Pertussis in infants in Nordic countries

Aim: A life-course immunisation approach is required to prevent and control pertussis. We aimed at reviewing pertussis incidence among infants in Denmark, Finland, Norway and Sweden, and at putting these data in the context of national surveillance systems and vaccination schedules.Methods: We collected 2014-2018 data on pertussis incidence, on pertussis vaccination schedules and on coverage of the third dose of the diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine from publicly available sources. We gathered opinions on national surveillance systems from public health and paediatrics experts of the relevant countries.Results: The pertussis vaccination schedules and coverage in infancy were similar across countries. All countries except Denmark recommended an additional booster vaccine dose for adolescents. None of the countries had maternal immunisation recommendation. Mean pertussis incidence in Denmark, Sweden and Finland was 168, 76 and 35 per 100,000 infant-years, respectively. Data were insufficient to derive a mean incidence in Norway. There were no systematic differences in the national surveillance systems across the countries.Conclusion: The higher mean pertussis incidence in Denmark may be explained by the lack of recommendations for adolescent pertussis booster vaccination. Further investigations are warranted.</div

Recurrent lower respiratory illnesses among young children in rural Kyrgyzstan:overuse of antibiotics and possible under-diagnosis of asthma. A qualitative FRESH AIR study

Abstract Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers’ U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children’s recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication

Evaluation of a digital method to assess evening meal intake in a free-living adult population

Background: In recent years new applications of technologies, including digital images, to capture dietary behaviour in real time have been explored. Objectives: To validate a digital method for estimating evening meal intake in a free-living adult population, and to examine the feasibility of the method for recording evening meal intake over a prolonged period of time. Design: The digital method was compared against weighed records of 19 participants&#x2019; usual evening meals for five consecutive days. Two trained image analysts independently estimated the weight of individual foods within the meals into major food categories, and the nutrient content was calculated. A second study included interviews with 28 participants recording their evening meals on weekdays for three consecutive weeks to get their perspective on the feasibility of the method. Results: High correlation coefficients between the digital method and weighed records were found for all measured food categories and nutrients. Comparable means and acceptable limits of agreement (mean difference +/&#x2212; 2 SD) were found with regard to macronutrient distribution (e.g. fat content &#x2212;5 to 6 E%), energy density (&#x2212;75 to 91 kJ/100 g), and energy-adjusted foods (e.g. fruit and vegetable content &#x2212;241 to 236 g/10 MJ). The majority of the participants expressed satisfaction with the method and were willing to record their evening meals for 1 month or more using the digital method. Conclusion: The digital method is valid and feasible for evening meal estimation in real-time where a prolonged recording period of participants&#x2019; meals is needed