A community-based intervention study involving family gardens with aromatic herbs on changes in dietary and urinary sodium.

OBJECTIVE: To measure dietary and urinary changes in sodium (Na) intake and excretion through the implementation of family gardens with aromatic herbs and workshops for cooking, using the herbs as a substitute for salt and seasoning powder. METHODS: Thirty-five participants from a neighborhood of Mexico City were included. A general questionnaire was administered to collect information on sociodemographic factors. At baseline and 3 months later, a dietary evaluation was conducted, and 24-hour urine samples were collected. Food items reported were classified according to the NOVA classification. Visits to participants´ houses were conducted to measure the amount of salt and seasoning powder added to food during the preparation of meals as well as a home food inventory. All participants were given a family garden with 6 aromatic herbs and a recipe book. The intervention included 7 cooking and 3 garden care workshops. Qualitative information on the experience was also collected. Linear regression models were run in order to estimate the contribution of each NOVA group, salt, and seasoning powder to total dietary Na intake. RESULTS: Participants were 44 years old on average and were mainly women (91.4%). The participation compliance in the workshops was 69.5%. After 3 months, there was a Na intake mean reduction of 976 mg. There was also a reduction in the excreted urinary Na of 325 mg per day. CONCLUSION: A positive level of involvement in this program had a direct influence on dietary habits to lower Na consumption.

High-Power 365 nm UV LED Mercury Arc Lamp Replacement for Photochemistry and Chemical Photolithography.

Ultraviolet light emitting diodes (UV LEDs) have become widespread in chemical research as highly efficient light sources for photochemistry and photopolymerization. However, in more complex experimental setups requiring highly concentrated light and highly spatially resolved patterning of the light, high-pressure mercury arc lamps are still widely used because they emit intense UV light from a compact arc volume that can be efficiently coupled into optical systems. Advances in the deposition and p-type doping of gallium nitride have recently permitted the manufacture of UV LEDs capable of replacing mercury arc lamps also in these applications. These UV LEDs exceed the spectral radiance of mercury lamps even at the intense I-line at 365 nm. Here we present the successful exchange of a high-pressure mercury arc lamp for a new generation UV LED as a light source in photolithographic chemistry and its use in the fabrication of high-density DNA microarrays. We show that the improved light radiance and efficiency of these LEDs offer substantial practical, economic and ecological advantages, including faster synthesis, lower hardware costs, very long lifetime, an >85-fold reduction in electricity consumption and the elimination of mercury waste and contamination.

Molecular monitoring of inactivation efficiencies of bacteria during pulsed electric field treatment of clinical wastewater.

AIMS: The applicability of an alternative wastewater disinfection concept based on the pulsed electric field (PEF) treatment is tested with molecular biology techniques using clinical wastewaters. METHODS AND RESULTS: Hospital wastewater was treated with the PEF technology. The inactivation efficiencies of bacteria were successfully monitored with real-time polymerase chain reaction (PCR). As the differentiation between living and dead bacterial cells is important for the determination of the disinfection efficiency, propidium monoazide (PMA) was applied. PMA selectively penetrates cells with compromised membranes and intercalates into the DNA inhibiting a subsequent PCR amplification. The rates of reduction were examined for specific pathogens and wastewater populations using PCR-denaturing gradient gel electrophoresis. The results showed that the main part of the bacterial population could be inactivated efficiently with the PEF treatment. Moreover, it was demonstrated that naturally occurring nuclease activities were not affected by the PEF treatment in contrast to a thermal treatment. CONCLUSIONS: The results indicated that the PEF treatment is an appropriate alternative disinfection concept for the treatment of clinical wastewaters and surpass the disadvantages of other disinfection methods. SIGNIFICANCE AND IMPACT OF THE STUDY: With the use of propidium monoazide for live-dead distinction, a new concept could be developed for the evaluation of disinfection methods.

Shu 508 A (Levovist)-enhanced Doppler echocardiography improves the assessment of valvular heart disease.

OBJECTIVE: To investigate whether intravenous injection of SHU 508 A improves the diagnostic accuracy of Doppler echocardiography in the assessment of valvular pathologies. METHODS AND RESULTS: One hundred and twenty-five consecutive patients with valvular pathology (aortic stenosis, n = 48; aortic regurgitation, n = 20; mitral stenosis, n = 21; and mitral regurgitation, n = 36) and diagnostically insufficient Doppler signal were enrolled in this multicenter study. The severity of valvular pathology was graded on a four-point scale using unenhanced and contrast-enhanced Doppler echocardiography as well as cardiac catheterization. Agreement with cardiac catheterization findings increased from 63% using the unenhanced examination to 73% using the contrast-enhanced Doppler examination. Grading was possible in all patients using SHU 508 A, whereas the unenhanced Doppler examination remained inconclusive in six patients. The weighted kappa coefficient between contrast-enhanced Doppler and cardiac catheterization for all diagnoses was 0.76 as compared to 0.68 between unenhanced Doppler and cardiac catheterization. Agreement was especially improved in aortic stenosis (kappa 0.69 unenhanced vs 0.81 contrast-enhanced) and in aortic regurgitation (kappa 0.45 unenhanced vs 0.75 contrast-enhanced). Patients with mitral stenosis and mitral regurgitation experienced less improvement. CONCLUSIONS: In case of an inconclusive unenhanced Doppler echo study, the administration of a left heart contrast agent should be considered. SHU 508 A is especially useful in improving the severity grading of aortic stenosis and aortic regurgitation, while grading of mitral stenosis and mitral regurgitation is less improved.

The role of enhanced Doppler ultrasound in differentiation of benign vs. malignant scar lesion after breast surgery for malignancy.

AIM: To evaluate the benefit of echo-contrast-enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass. METHODS: Thirty-eight patients referred for biopsy of a palpable, suspicious scar lesion 1-15 years (mean 3.3 years) after surgery for breast cancer were examined. During baseline ultrasound examination a subjective scoring system of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound contrast agent (Levovist) the same scoring system was applied to the parameters together with enhancement kinetics, enhancement intensity and enhancement pattern. Any increase in the scoring level of two or more characteristics (vascularity, number of vessels, intensity of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periphery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesion. RESULTS: Of the 38 patients with a clinically-suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed no or slight vascularity on baseline sonography. After Echocontrast-enhancement a significant increase in tumor vascularity and the number of tumor vessels could be demonstrated in all 10 malignant lesions but in only one of the 28 benign scars. CONCLUSION: Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhancing agents showed improved diagnostic accuracy in the hands of an experienced examiner.

Contrast-enhanced colour Doppler ultrasonography in suspected breast cancer recurrence.

BACKGROUND: Postoperative scarring and radiotherapy changes in the conservatively treated breast often mimic breast cancer recurrence, resulting in many unnecessary biopsies. Local breast cancer recurrence may be detected more accurately with contrast-enhanced colour Doppler imaging. METHODS: Fifty-eight women with suspected local breast cancer recurrence were evaluated prospectively by means of conventional and contrast-enhanced colour Doppler imaging before surgical biopsy. RESULTS: Sensitivity for the detection of breast cancer recurrence using contrast enhancement was 94 per cent (specificity 67 per cent). Contrast enhancement significantly increased overall diagnostic accuracy, from 80 to 90 per cent (P < 0. 04). CONCLUSION: Contrast-enhanced colour Doppler imaging is a highly accurate method for detecting local breast cancer recurrence. Its adoption may substantially reduce biopsy rates.

Signal-enhanced color Doppler sonography of deep venous thrombosis in the lower limbs and pelvis.

Detection of Doppler signal tends to be more difficult in peripheral veins owing to low flow velocity. This can be caused by nonoccluding thrombosis, post-thrombotic wall changes, or a deep anatomic location of pelvic veins. The last-mentioned frequently is accompanied by interference by bowel gas. In addition, inappropriate insonation angles adversely affect the outcome of color-coded Doppler interrogation. The purpose of the present study was to evaluate the effectiveness of signal-enhanced color Doppler sonography on peripheral veins in 31 patients clinically suspected of having deep vein thrombosis. As a result of diagnostic uncertainty, additional enhanced studies were performed on 43 venous segments. The enhancement led to a decrease in false-positive results (from four patients to one patient) and false-negative results (from four patients to two patients) compared to unenhanced studies. Evaluation of the deeply located pelvic veins profited the most through signal enhanced Doppler sonography.

Ultrasound in the investigation of tubal patency. A meta-analysis of three comparative studies of Echovist-200 including 1007 women.

DESIGN: This study is a meta-analysis of the results of three clinical studies of the ultrasound echo-contrast agent Echovist-200 with transvaginal contrast sonography (HyCoSy) in the demonstration of tubal patency. Results from 1007 patients were included in the analysis, of whom 986 patients were examined for tubal patency. The HyCoSy findings were compared with those of chromolaparoscopy in 428 cases and with those of hysterosalpingography (HSG) in 202. RESULTS: The results of HyCoSy and chromolaparoscopy were identical in 294 of 428 patients (68.7%) or in 688 of 828 individual tubes (83.1%). HyCoSy showed "false" occlusion in 85 tubes (10.3%) and "false" patency in 55 (6.7%). The results of HyCoSy and HSG were identical in 138 of 202 patients (68.3%) or in 320 of 384 individual tubes (83.3%). HyCoSy showed "false" occlusion in 49 tubes (12.8%) and "false" patency in 15 (3.9%). The findings of chromolaparoscopy and HSG agreed in 49 of 77 patients (63.6%) or in 116 of 152 tubes (76.3%). HSG showed "false" occlusion in 19 (12.5%) tubes and "false" patency in 17 (11.2%). TOLERANCE: Echovist-200 was well tolerated. The most frequent adverse event was pain, which was mild in 42.3% of patients and severe in 10.1%. Pain was clearly related to tubal occlusion. Other adverse events such as vasovagal reactions or nausea occurred in 7.0% of patients, but the events required treatment in only 1.9%.

Sequelae of abuse. Health effects of childhood sexual abuse, domestic battering, and rape.

Violence against women is endemic in the United States. One third to one half of all women will experience one or more types of abuse in their lifetime, most often at the hands of a family member or an intimate or formerly intimate partner. One in 12 women is battered during pregnancy. Abuse survivors are disproportionately frequent users of health care services because of acute and chronic physical, somatic, emotional, and behavioral sequelae of abuse. Health care practitioners are often the first contact abuse survivors have with a potentially helping professional. It is, therefore, essential that health care providers learn to identify and to intervene appropriately with survivors of abuse. This article reviews and compares the health effects of three of the most common types of violence against women: childhood sexual abuse, domestic battering, and rape. Sequelae are divided into six categories: physical/medical, somatic, emotional/ psychological, social/interpersonal, behavioral/sexual, and pregnancy-related effects. The health effects discussed in this article include research findings, as well as effects noted in clinical practice. Recommendations are made for routine screening of all women for past and current abuse, as well as for intervention strategies.

PIP: This paper reviews and compares the health effects of three common types of abuse against women: childhood sexual abuse, domestic battering, and rape. In the US, violence against women has become a serious problem. One half to one third of all women in the country experience abuse in their lifetime that is usually inflicted by a family member, or an intimate or formerly intimate partner. One out of 12 women experienced abuse during pregnancy. Victims of violence frequently seek medical care because of the acute and chronic health problems that result from abuse. Since health care practitioners are often the first contact abuse victims have, it is essential that they learn to assess and intervene appropriately with survivors of abuse. In this discussion, the health effects of abuse were categorized as physical/medical, somatic, emotional/psychological, social/interpersonal, behavioral/sexual, and pregnancy-related. Recommendations are made concerning the routine screening of all women for past or current abuse, as well as for effective intervention strategies.

A practical approach to clients who are survivors of childhood sexual abuse.

Approximately 30% of all women have experienced some form of sexual abuse in childhood or adolescence. This abuse may result in serious long-term sequelae for the survivor, such as depression, low self-esteem, post-traumatic stress disorder, and addictive behaviors. Nurse-midwives are uniquely equipped to provide health care to survivors of childhood sexual abuse because of their commitment to thorough, sensitive health education. This article draws on current literature and the clinical experience of a nurse-midwife who has cared for many survivors of sexual abuse. It offers suggestions for incorporating identification of survivors into the initial health assessment. Interventions are reviewed including how to approach the physical examination of a survivor and how to provide appropriate care in the intrapartum and postpartum period. Emphasis is given to the development of a referral network.

Outcomes of mature primiparas in an out-of-hospital birth center.

This is a retrospective chart review of perinatal outcomes of all primiparas over the age of 24 delivering at Maternity Center Associates, an out-of-hospital birth center, from January 1985 through May 1988 (N = 228). Chi-square analysis was used to determine whether mature primiparas, aged 35 to 43 (n = 27), had significantly more adverse outcomes than younger primiparas, aged 25 to 34 (n = 201). There was a significant difference between the groups in rate of transfer to hospital; however, there were no significant differences in rate of cesarean section, infant birth weight, apgar scores, and length of second stage labor. Implications for practice and future study are examined.