The effect of long-term use of a dentifrice containing zinc citrate and a non-ionic agent on the oral flora.

The effect on the oral ecology of daily use, for seven months, of a dentifrice containing 0.5% (w/w) zinc citrate and a non-ionic agent, i.e., 0.2% (w/w) Triclosan (2,4,4'-trichloro-2'-hydroxydiphenyl ether), has been monitored on 13 adult volunteers. Plaque and saliva were sampled monthly and the bacterial flora analyzed. Twenty-six volunteers used a placebo dentifrice as part of their normal oral hygiene for four months to establish the baseline microbial flora. The volunteers were then split into two equal groups: One group continued to use the placebo dentifrice; the other used the dentifrice containing zinc citrate and Triclosan. There was no evidence that seven months' use of a dentifrice containing 0.5% zinc citrate and 0.2% Triclosan caused shifts in the oral microbial ecology, nor was there any evidence of developing bacterial resistance to Triclosan.

Control of gingivitis and calculus by a dentifrice containing a zinc salt and triclosan.

The effect of unsupervised brushing with a dentifrice containing two antiplaque agents, 0.5% zinc citrate and 0.2% triclosan, on gingival health, plaque, supragingival calculus, and the oral flora was compared to brushing with a non-active control dentifrice. Volunteers were given oral hygiene instruction and their teeth were professionally cleaned. They then used a placebo dentifrice for a pre-experimental phase of 1 month, before being stratified into two groups on the basis of their initial plaque, gingival bleeding, and calculus levels, sex, and age. Over the following 6 months, one group used the control while the other used the test dentifrice. Plaque levels, gingival bleeding, and calculus were assessed at baseline and at 3 and 6 months. Supragingival plaque was sampled for microbiological analysis at the initial examination, at 3 and 6 months (conclusion of study period) and 3 months after the study. Representative oral bacteria and the development of bacterial resistance to triclosan were monitored. Results showed that plaque was reduced and gingival health significantly improved during the 1-month pre-experimental period. During the experimental period, this improvement was not maintained by the control group as gingival bleeding and calculus increased. In contrast, gingival bleeding and calculus levels of the test group were maintained significantly below those of the placebo group. Plaque levels were lower in the test group after 3 and 6 months, but the groups were not significantly (P = 0.05) different. No shifts in oral flora or development of bacterial resistance to triclosan were detected.

Maternal perceptions of newborn umbilical cord treatments and healing.

OBJECTIVE: To determine mothers' cord care practices and perceptions of their newborns' cord treatment and healing. DESIGN: Exploratory, descriptive. SETTING: Urban teaching hospital providing care for children, women, and families in eastern Canada. PARTICIPANTS: A convenience sample of 30 women with healthy full-term infants. MAIN OUTCOME MEASURES: Mothers' concerns about newborn umbilical cord care and cord treatments using an 18-item questionnaire, the Cord Rating Scale. RESULTS: Mothers' concerns regarding their newborns' cord included bleeding at the time of cord separation and cord odor. Several mothers (20%) did not recall being given information on cord care, and others had received conflicting information. Although most other mothers did begin the recommended treatment, they did not follow the recommended schedule. There was a strong positive relationship between the mothers' and nurses' ratings of the newborns' cord condition. CONCLUSIONS: The findings suggest that mothers continue to have concerns about their newborn's cord and cord care after hospital discharge. These concerns have implications for nursing practice. The findings also support the role that a mother has in accurately reporting the condition of her newborn's cord.

Towards better nutrition: lip service or a realistic fight?

Progress towards the objective of the World Food Conference of 1974 that "no child should go to bed hungry" is reviewed. The low market price of primary products keeps developing countries poor. Yet in these countries industry rather than agriculture has been supported by governments. All regions are increasing total food production but population growth threatens to offset this increase. In some areas there is decrease in food production per head of population. In many countries the social situation of women affects the nutrition of families. Other causes of malnutrition are discussed and future policies are recommended.

PIP: The causes of chronic malnutrition worldwide can be reduced to rural poverty, exploding populations, and sociocultural factors; ineffective and successful solutions are listed. The majority of people in developing countries live in rural areas: 80% in Africa. Subsistence farmers are forced to work marginal land, and have little access to cash which is creamed off by middle-men and governments. The population explosion, despite advances in food production, has added one billion mouths and reduced the food available in the decade since the World Food Conference in 1974. By 2000, land and water will be limited 64 countries will need food aid, and 38 of them will need imports for over half their people. In cash economies, increased child survival will lead to greater poverty. A major sociocultural cause of hunger in many areas is the situation of women. Countries do not recognize women for their work in producing food, but consider the man the breadwinner according to outdated colonial notions. Cultural traditions such as purchasing brides, and excluding women from family decision-making, education, credit, co-op membership, cash crops and better land considered appropriate for men, compromise their ability to produce family food. Ignorance and poverty, poor home and time management lead to poor nutrition in dozens of ways, such as loss of food in storage, or feeding children only once daily after they are too tired to eat, or giving infants food that is too bulky and coarse. Many nonproductive attempts to improve nutrition are mentioned such as promoting infant formula, western high protein nutritional advice, inappropriate products, and dull educational materials. Some simple sugestions for mothers are: feeding children at least 4 meals daily, providing dry biscuits, making porridges sufficiently thick, giving each child his own plate, using some fat in cooking, preserving food effectively. Effective techniques include sincere government commitment, integrated programs pilot programs, clear objectives, influential leaders, studying local customs and conditions, market research, consistent follow-up, practical and locally relevant programs, tactful, trained staff, and good evaluation procedures.

Mothers of children with chronic conditions: supportive and stressful interactions with partners and professionals regarding caregiving burdens.

Ninety mothers appraised the specific sources and types of social support they received in relation to specific types of demands of caring for a child with a chronic condition. Qualitative data were collected during home interviews with the mothers of children with diabetes, spina bifida, or cystic fibrosis. Virtually all of the mothers described primary caregiver demands that were directly related to the child's condition, such as physical care, health care in illness situations, and the child's psychological and social development. Many mothers also reported secondary demands related to their own needs, family roles and relationships, and the mother's activities outside the home. Mothers experienced gaps in the support provided for specific caregiving burdens and encountered stressful interactions with their partners and health professionals in particular.

Social support in children with a chronic condition.

This study used a descriptive exploratory design to describe social support in children with a chronic condition and how children use social support in coping with everyday demands and demands related to their condition. Participants comprised 62 school-aged children (16 with diabetes, 16 with cystic fibrosis, 15 with spina bifida, and 15 with no chronic illness). Data were collected about their social-support networks, the support functions provided by the networks, and their satisfaction with support. The children also described the social support they received and their use of social support as a coping strategy in specific stressful situations. The healthy children had the largest support networks overall and the largest peer networks. Children with spina bifida had the smallest networks overall and the smallest number of peers in their networks. Healthy children reported more support overall than the children in the illness groups. Both the healthy children and the children with a chronic condition described academic issues as the main source of everyday stress. Children with a chronic condition identified restriction due to illness as the key illness-related stressor. Children with a chronic condition reported more stress and more support-seeking in everyday stressful situations than in illness situations. The results will guide the design of a future social-support intervention for children with a chronic condition.

Bridging the gap - some problems of communication and empathy in nutrition education.

Among the approaches needed for improving the nutritional status of children, an important one is helping families to develop and use their present resources better. This means, however, bridging the gap in understanding so that feasible advice is given and taken, and mutual trust established between rural people and those who try to serve them. The present paper discusses some of the reasons for this gap and possible ways in which it may be bridged.

Rectosigmoidal mucosal puckering and diverticulosis.

The association of diverticulosis with a thickened muscle wall in the pelvic colon is well known. There appeared to be a possibility that this muscular thickening might give rise to the rectosigmoidal mucosal puckering often seen through a sigmoidoscope. In 278 colonic motility studies, mucosal puckering was correlated with patient age, diverticulosis, and the symptomatology of the irritable colon syndrome. The prevalence of mucosal puckering increased with age at the same rate as that of diverticulosis, but the different percentage levels were reached some 25 years earlier in life. Mucosal puckering, which persisted in all subsequent examinations, showed no correlation with the clinical characteristics of irritable colon syndrome. Resistance of the bowel wall to distention was significantly greater in association with puckered rectosigmoidal mucosa than when the mucosa appeared smooth. It is concluded that rectosigmoidal mucosal puckering is probably caused by thickening of the underlying muscle; it is a precursor of diverticulois, and patients who have it should be kept on a high-residue diet.

The transport of colonic contents in the irritable colon syndrome.

The mean distance of travel and hourly incidence of propulsive and retropulsive movements of colonic contents have been assessed by means of time-lapse cinefluorography and compared in 98 patients with the irritable colon syndrome and in 90 control subjects.Net propulsion in patients with the irritable colon syndrome was less than in the controls at rest, similar to the controls after feeding, and greater than in the controls after an injection of carbachol. In both clinical groups, food and carbachol increased the incidence of propulsive and retropulsive movements but did not alter the average distance over which they travelled.The figures suggest that at least two-thirds of all net propulsion of colonic contents in the irritable colon syndrome takes place under circumstances not reproduced in the present study.

Movement of segmental constrictions in the human colon.

Changes in the segmental pattern of opaque contents in the transverse colon among patients with diverticulosis were observed by means of time-lapse cinefluorography after ingestion of barium sulphate suspension. In some of them the muscular constrictions separating the opaque masses of bowel contents were seen to relax and later to re-form in a different spatial relationship to fixed points on the bowel wall represented by the necks of diverticula. In other instances ring contractions moved progressively along the bowel wall, temporarily occluding the necks of any diverticula they passed. Bowel contents were seen to be transported ahead of the advancing constrictions at varying rates and in either direction.

Nurses' perceptions of their relationships with parents.

Twenty-five children's nurses were interviewed and asked to select and describe two relationships, one satisfying and one dissatisfying, that they had had with parents of hospitalized children. The data were analyzed using interpretive strategies, and five types of parent-nurse relationships were identified: negotiated, reciprocal, adversarial, asynchronous, and ineffective. It seemed that the nurses' relationships with parents were social rather than professional, and that the nurses had difficulty caring for certain parents. The nurses' descriptions indicated that they either did not have knowledge of communication skills, conflict management and family-centered care to provide therapeutic, goal-oriented care for parents, or had difficulty utilizing that knowledge in practice. Various factors in the environment may have contributed to these difficulties. This descriptive study was conducted to provide some understanding of the interpersonal difficulties that often exist in relationships between nurses and the parents of hospitalized children.

Caring for chronically ill children at home: factors that influence parents' coping.

This study examined 29 parents' perceptions of the stressfulness of copying with their chronically ill child's home care. The parents were primarily responsible for care regimes that represented a continuous range of caregiving burden. Data were obtained using the Clinician's Overall Burden Index (COBI) (Stein & Jessop, 1982), the Coping Health Inventory for Parents (CHIP) (McCubbin & Patterson, 1981), visual analogue scales, and home interviews with parents. Parents described many dimensions of caregiving burden. Increased caregiving burden was associated with greater stressfulness and the use of fewer helpful coping strategies. Three clusters of coping strategies were most helpful: (a) using family support, (b) maintaining a positive outlook, and (c) ensuring that care was performed. The need for a reconceptualization of caregiving burden is discussed.

School-aged children's interpretation of their experience with acute surgical pain.

This study examined the intensity of pain children experience following surgical procedures, the relationship between analgesic administration patterns and perceived level of pain, and children's affective, cognitive, and sensory interpretation of their experiences with pain. The sample included 24 children between 7 and 11 years of age who were hospitalized after abdominal, orthopedic, or urologic surgery. Children rated the intensity of their pain on a visual analog scale three times on the day after surgery. A chart review examined analgesic administration. On the third day after surgery, children were interviewed about their experiences with pain. The findings provide insight into the content of children's fears and concerns when they have postoperative pain, and how they interpret their responses and the responses of others in the management of their pain experience.

Home community cancer care: parents' perspectives.

This article reports on the results of a survey on the needs of parents of children with cancer and explores the needs of the parents, the parents' perceived importance of the needs, and whether the needs have been met. The study was designed to identify any differences in needs between parents whose children received all of their care at the major tertiary center (n = 16) and parents whose children received at least some of their care in their local community (n = 40). There were no significant differences between the two groups. Parents reported that their important needs for information were met, but other needs (financial assistance, time, and rest) were unmet. Findings indicate that health care providers who care for families of children with cancer need to perform careful individual assessments throughout the treatment period.

Treatment of irritable bowel syndrome with lorazepam, hyoscine butylbromide, and ispaghula husk.

A double-blind controlled therapeutic trial of factorial design was used to study the therapeutic effects of lorazepam, hyoscine butylbromide, and ispaghula husk in 12 randomised blocks of eight patients with the irritable bowel syndrome (IBS). Each of the three agents caused a sustained symptomatic improvement in some of the patients, although only with ispaghula was the difference between the real and dummy preparation statistically significant. When the eight possible combinations of treatment were analysed none of the 12 patients who received only dummy preparations of the three agents had maintained any improvement over the three months of the trial. Seven patients improved among the 12 who received potent preparations of all three agents, and between four and six patients improved in the groups receiving one or two of the potent preparations. These therapeutic results, though far from perfect, show that the types of drug commonly used to treat IBS are of some value and may be additive in their effects. Similar combinations of other therapeutic agents may be more effective, but it will be possible to determine this only by carrying out factorial therapeutic trials.