N-glycosylation of infectious bronchitis virus M41 spike determines receptor specificity.

Infection of chicken coronavirus infectious bronchitis virus (IBV) is initiated by binding of the viral heavily N-glycosylated attachment protein spike to the alpha-2,3-linked sialic acid receptor Neu5Ac. Previously, we have shown that N-glycosylation of recombinantly expressed receptor binding domain (RBD) of the spike of IBV-M41 is of critical importance for binding to chicken trachea tissue. Here we investigated the role of N-glycosylation of the RBD on receptor specificity and virus replication in the context of the virus particle. Using our reverse genetics system we were able to generate recombinant IBVs for nine-out-of-ten individual N-glycosylation mutants. In vitro growth kinetics of these viruses were comparable to the virus containing the wild-type M41-S1. Furthermore, Neu5Ac binding by the recombinant viruses containing single N-glycosylation site knock-out mutations matched the Neu5Ac binding observed with the recombinant RBDs. Five N-glycosylation mutants lost the ability to bind Neu5Ac and gained binding to a different, yet unknown, sialylated glycan receptor on host cells. These results demonstrate that N-glycosylation of IBV is a determinant for receptor specificity.

Systematic review: deployment length and the mental health of diplomats.

BACKGROUND: While there has been considerable research into the psychosocial consequences of tour length for military personnel, this subject has not been studied in other occupational groups who also deploy staff to high-threat areas. AIMS: To carry out a comprehensive review of relevant published literature to inform diplomatic organizations that deploy staff in high-threat postings (HTPs). METHODS: We searched appropriate scientific databases for studies relevant to deployment length, mental health and well-being for diplomats. A systematic review related to military personnel was found and used as the foundation for the literature review. Other relevant papers identified by the search have also been included. RESULTS: The majority of identified papers had examined military personnel. Results suggested that longer deployments were associated with poorer mental health including post-traumatic stress disorder, depression and alcohol problems and this was most likely to be a function of increased exposure to potentially traumatic events. Exceeding a threshold of 6-12 months within a 3 year period, for military personnel, appeared to elevate the risk of psychosocial problems. Furthermore, diplomats deploying on their first HTP, and those whose tour length is altered after deployment, could be especially vulnerable. CONCLUSIONS: While further research of this topic is required, this review provides an evidence-based insight into the increased risks of developing mental health problems when deployed to HTPs. This information is relevant to generating policies, which may reduce the impacts of adverse psychosocial effects on diplomatic staff and their families.

Deployment guidelines for diplomats: current policy and practice.

BACKGROUND: Diplomatic organizations routinely send staff to high-threat postings (HTPs) and consequentially have moral and legal obligations to protect their health as far as is reasonably practicable. AIMS: To carry out an international survey of diplomatic organizations that send personnel to HTPs to establish how they deal practically with their obligations to protect the mental health of their staff. METHODS: An online anonymous survey about their organizations' policies relating to HTPs completed by international diplomatic organizations. RESULTS: Fourteen of 30 organizations approached completed the questionnaire, with a response rate of 47%. Deployment length varied: no minimum (15%), a minimum of 2 years (39%) and a maximum of 2 (31%), 3 (15%) or 4 years (31%); one organization did not state any maximum. HTP and low-threat postings had the same policies in 46% of organizations. Additional care and support (66%), additional preparation (50%), enhanced leave (33%) and additional physical and mental health assessments were informally adopted to address psychosocial risks of deployment to HTPs. CONCLUSIONS: There was little consensus on policies and practice for HTP deployment. We suggest that formal, consistently written guidelines, based on available quality evidence, and associated training and quality assurance should be formulated to make international practice more consistent and equitable.

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males.

BACKGROUND: Hypogonadism is a worldwide problem among men causing sexual, physical and mental problems. Testosterone therapy is the first-choice treatment for male hypogonadism, with several side effects, that is, subfertility. Clomiphene citrate (CC) is an alternative off-label therapy for a certain group of hypogonadal males, especially for those with an active or future child wish. There is scarce literature in usage of CC for men with hypogonadism. The aim of this retrospective study was to evaluate the effectiveness and safety of CC for hypogonadal males. METHODS: In this single-centre study, men treated with CC for hypogonadism were evaluated retrospectively. Primary outcome was hormonal evaluation including total testosterone (TT), free testosterone (FT), luteinizing hormone (LH) and follicle stimulating hormone (FSH). Secondary outcomes were hypogonadal symptoms, metabolic and lipid parameters, haemoglobin (Hb), haematocrit (Ht), prostate specific antigen (PSA), side effects, the effect of a trial without medication and potential predictors for biochemical and clinical response. RESULTS: In total, 153 hypogonadal men were treated with CC. Mean TT, FT, LH and FSH increased during treatment. TT increased from 9 to 16 nmol/L, with a biochemical increase in 89% of the patients. In patients who continued CC treatment, an increased level of TT persisted after 8 years of treatment. With CC treatment, 74% of the patients experienced hypogonadal symptom improvement. LH at the lower normal range before CC treatment was predictive for better TT response. During CC therapy, few side effects were reported and no clinical important changes in PSA, Hb and Ht were found. CONCLUSION: Clomiphene citrate is an effective therapy on short and long term, improving both clinical symptoms and biochemical markers of male hypogonadism with few side effects and good safety aspects.

Principles for designing and delivering psychosocial and mental healthcare.

The development of the UK's military policy includes the potential for military organisations to deploy in support of humanitarian aid operations. This paper offers an overview of the risks to people's mental health of their exposure to emergencies, major incidents, disasters, terrorism, displacement, postconflict environments in which humanitarian aid is delivered, and deployments to conflict zones. It summarises the psychosocial approach recommended by many contemporary researchers and practitioners. It differentiates the extremely common experience of distress from the mental disorders that people who are affected may develop and introduces the construct of psychosocial resilience. The authors recognise the importance of trajectories of response in separating people who are distressed and require psychosocial care from those who require mental healthcare. Finally, this paper summarises a strategic approach to designing, planning and providing psychosocial and mental healthcare, provides a model of care and outlines the principles for early psychosocial interventions that do not require training in mental healthcare to deliver them.

Apparent coexistent valvular and subvalvular left ventricular outflow tract obstruction.

A patient is presented in whom coexisting bicuspid valvular aortic stenosis and asymmetrical septal hypertrophy were suggested by echocardiography. A focal area of hypertrophy noted at operation was excised. Subsequent histological examination did not reveal evidence to support the echographic and surgical observations. The necessity for careful intraoperative assessment of the degree and nature of subvalvular muscular hypertrophy is stressed. The absence of classic echographic findings in these patients is noted.

Multiple lead ECG submaximal treadmill exercise tests in angiographically documented coronary heart disease.

One hundred patients underwent submaximal exercise tolerance testing and coronary cineangiography. Sixty-six percent of the exercise tests were diagnostic including 48 positive and 18 negative tests; 34 patients had indeterminate test results. The occurrence of exercise induced ventricular premature beats was not related to significant coronary artery disease. Ventricular asynergy was significantly more frequent in patients with positive exercise tests (p less than .0001). Application of the age-adjusted target heart rate criterion recommended from Scandinavia and Myrtle Beach to patients with indeterminate results due to failure to reach target heart rate resulted in six false negative tests and lowered sensitivity. The number of positive diagnostic responses achieved using a multiple electrocardiographic lead system was compared with positive diagnostic responses detected in a single lead (V5) and the number of positive tests identified by the additional leads was highly significant (p less than .0001). A high incidence of indeterminate test results due to failure to achieve target heart rate is noted.

The psychosocial impact of a high-risk pregnancy on the family.

A conceptual model for guiding the nurse in assessing the psychosocial impact of a high-risk pregnancy on and planning care for the family is described. The model depicts four major concepts that the nurse must consider in determining how the family is integrating, interpreting, and adapting to the high-risk pregnancy: health status of the pregnancy, the family's perception of the high-risk pregnancy, support available to the family, and the family's adaptation to a high-risk pregnancy are discussed.

Maternal prenatal attachment in normal and high-risk pregnancies.

The purposes of this study were to compare maternal-fetal attachment in normal and high-risk pregnancies and to identify variables affecting the maternal attachment process during pregnancy. Fifty-three women experiencing normal pregnancies and thirty-two women with high-risk pregnancies completed Cranley's prenatal attachment tool and a questionnaire providing data specific to the current pregnancy during the third trimester. The results of a two-tailed, pooled t-test indicated no significant differences (at p less than or equal to .05) in the scores of the normal and high-risk groups on prenatal attachment. No significant correlations (at p less than or equal to .05) were found between the attachment scores and educational level, age, race, whether the pregnancy was planned, whether the women had a sonogram, or the ordinal position of the infant.

Health practices and anxiety in low-income, high and low-risk pregnant women.

OBJECTIVE: To evaluate anxiety and health-protective and health-promoting behaviors in low- and high-risk, low-income pregnant women. DESIGN: Nonrandomized descriptive study. SETTING: Low- and high-risk prenatal clinics at a tertiary-care center. PARTICIPANTS: Sixty-five black and white low-income women between 20 and 41 weeks of pregnancy. MAIN OUTCOME MEASURES: Anxiety and health-promoting behavior. RESULTS: No significant differences were found in anxiety levels. A significant difference was found between the two groups in overall Health-Promoting Lifestyle Profile (HPLP) scores. Women in the low-risk group scored higher on all HPLP subscales, with significant differences on self-actualization and health responsibility. CONCLUSION: Findings support the need for nurses to assess high-risk pregnant women for their health practices during pregnancy. Although a major focus on nursing care during pregnancy is teaching the promotion of health, only limited research exists on the effectiveness of such interventions.

[The optimization of the use of economic resources for vaccination against hepatitis B in professionals in the health area]. / Otimização do emprego de recursos econômicos para vacinação contra hepatite B em profissionais da área de saúde.

In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers, two different aspects were studied: the need of a pre-vaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost-minimization study) showed that when the prevalence of immune individuals is higher than 11% it is more cost-effective to perform pre-vaccination screening. This situation was observed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92% and 93%, respectively) and geometric mean titers of antiHBs (1278 UI/L and 789.6 UI/L) were similar, and both were different from group A (p < 0.05), showing that alternative vaccination schedules may be cost-effective.

A theoretical model for smoking prevention studies in preteen children.

The age of the onset of smoking is on a continual decline, with the prime age of tobacco use initiation being 12-14 years. A weakness of the limited research conducted on smoking prevention programs designed for preteen children (ages 10-12) is a well-defined theoretical basis. A theoretical perspective is needed in order to make a meaningful transition from empirical analysis to application of knowledge. Bandura's Social Cognitive Theory (1977, 1986), the Theory of Reasoned Action (Ajzen & Fishbein, 1980), and other literature linking various concepts to smoking behaviors in preteens were used to develop a model that may be useful for smoking prevention studies in preteen children.

Intervening with prenatal crack cocaine users.

Nurses in primary care, maternal child health, and community health practice settings are in a unique position to intervene with clients who are prenatal crack cocaine users. Clinical assessment is considered in both the context of the pregnancy and the crack cocaine use. A synthesis model of intervention related to both the pregnancy and the drug use are outlined to support a healthy baby and a healthy recovery.

[Evaluation of the immunological response to hepatitis B vaccine in health care professionals]. / Avaliação da resposta imunológica à vacina contra hepatite B em profissionais da área de saúde.

Clinical trials have shown the safety and efficacy of Hepatitis B (HB) vaccination, but it is well known that host and immunization factors can affect the response to HB vaccine. In order to assess the importance of some of these factors we evaluated the immune response of 86 health care workers who received three doses of H-B-Vax intramuscularly (deltoid), at days 0, 30 and 180. Serum samples were taken after each dose and anti-HBs antibodies were determined by quantitative radioimmunoassay. The results showed that males had a diminished immune response to the first dose of HB vaccine (31.7% x 53.3%, p < 0.05) and had geometric mean titers (GMT) of anti-HBs lower than females at the end of the vaccination program (2109.4 x 2453.8, p > 0.05). Smokers had a lower rate of seroconversion after the first dose (29.7% x 53.1%, p < 0.05) and reached lower GMT (2015.2 x 2453.8, p > 0.05) than non-smokers. There were no statistically significant differences between individuals younger or older than 35 years old, in either immunological response of level of anti-HBs.