Self-care research: How to grow the evidence base? (reprint).

BACKGROUND AND OBJECTIVE: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. METHOD: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. RESULTS: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. CONCLUSION: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care.

An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals.

The aim of this paper is to investigate the perceptions of patients and family members with regard to care received for cancer cachexia. A qualitative study recruited 27 participants, of which 15 were patients with advanced cancer who had primary cachexia and 12 were family members. Participants were recruited from a regional cancer centre in the UK. All participants took part in a domiciliary interview, which was transcribed verbatim for analysis. A major finding from analysis was 'lack of response from health care professionals' in relation to cancer cachexia management. This finding illuminated that patients and their family members wanted three things from healthcare professionals. They wanted their profound weight loss acknowledged, they wanted information about it and why it was happening and they wanted interventions to deal with it. This paper provides powerful messages for healthcare professionals and highlights the needs of patients and their family regarding cancer cachexia management. Patients and their families want this problem addressed by healthcare professionals. This client group requires supportive healthcare interventions, so that they can understand the nature and impact of this syndrome.

Self-care research: How to grow the evidence base?

BACKGROUND AND OBJECTIVE: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. METHOD: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. RESULTS: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. CONCLUSION: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care.

Hepatitis B virus, hepatitis C virus and other blood-borne infections in healthcare workers: guidelines for prevention and management in industrialised countries.

The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in order to review and evaluate the epidemiology of blood-borne infections in healthcare workers, to evaluate the transmission of hepatitis B and C viruses as an occupational risk, to discuss primary and secondary prevention measures and to review recommendations for infected healthcare workers and (para)medical students. This VHPB meeting outlined a number of recommendations for the prevention and control of viral hepatitis in the following domains: application of standard precautions, panels for counselling infected healthcare workers and patients, hepatitis B vaccination, restrictions on the practice of exposure-prone procedures by infected healthcare workers, ethical and legal issues, assessment of risk and costs, priority setting by individual countries and the role of the VHPB. Participants also identified a number of terms that need harmonization or standardisation in order to facilitate communication between experts.

Cooperative mechanisms in the activation dependence of the rate of force development in rabbit skinned skeletal muscle fibers.

Regulation of contraction in skeletal muscle is a highly cooperative process involving Ca(2+) binding to troponin C (TnC) and strong binding of myosin cross-bridges to actin. To further investigate the role(s) of cooperation in activating the kinetics of cross-bridge cycling, we measured the Ca(2+) dependence of the rate constant of force redevelopment (k(tr)) in skinned single fibers in which cross-bridge and Ca(2+) binding were also perturbed. Ca(2+) sensitivity of tension, the steepness of the force-pCa relationship, and Ca(2+) dependence of k(tr) were measured in skinned fibers that were (1) treated with NEM-S1, a strong-binding, non-force-generating derivative of myosin subfragment 1, to promote cooperative strong binding of endogenous cross-bridges to actin; (2) subjected to partial extraction of TnC to disrupt the spread of activation along the thin filament; or (3) both, partial extraction of TnC and treatment with NEM-S1. The steepness of the force-pCa relationship was consistently reduced by treatment with NEM-S1, by partial extraction of TnC, or by a combination of TnC extraction and NEM-S1, indicating a decrease in the apparent cooperativity of activation. Partial extraction of TnC or NEM-S1 treatment accelerated the rate of force redevelopment at each submaximal force, but had no effect on kinetics of force development in maximally activated preparations. At low levels of Ca(2+), 3 microM NEM-S1 increased k(tr) to maximal values, and higher concentrations of NEM-S1 (6 or 10 microM) increased k(tr) to greater than maximal values. NEM-S1 also accelerated k(tr) at intermediate levels of activation, but to values that were submaximal. However, the combination of partial TnC extraction and 6 microM NEM-S1 increased k(tr) to virtually identical supramaximal values at all levels of activation, thus, completely eliminating the activation dependence of k(tr). These results show that k(tr) is not maximal in control fibers, even at saturating [Ca(2+)], and suggest that activation dependence of k(tr) is due to the combined activating effects of Ca(2+) binding to TnC and cross-bridge binding to actin.

Exercise capacity of rats remains unaffected by a chronic pressure overload.

OBJECTIVE: The aim was to determine if the adaptive responses of the myocardium to a chronic pressure overload affected cardiovascular performance when evaluated under conditions of increased functional demand. METHODS: Selected female rats were made hypertensive by abdominal aortic constriction. After eight weeks of aortic constriction, cardiovascular responses and work performance were measured during a maximal treadmill exercise bout. RESULTS: Aortic constriction increased mean arterial pressure and the relative quantity of the slow ATPase myosin isoform, V3, relative to untreated controls (p < 0.05). Both groups had similar oxygen consumptions (VO2), heart rates (HR), and oxygen pulses (VO2/HR) at rest and throughout the exercise test. Both groups reached their VO2 max at the same exercise duration and exercise intensity (40.4 m.min-1). Soleus citrate synthase activity was not different between the groups. CONCLUSIONS: These similarities in work capacity, VO2, oxygen pulse, and muscle oxidative capacity suggest (1) that cardiovascular and exercise capacity can both be maintained in spite of the presence of a chronic pressure overload; (2) that after two months of aortic constriction the heart appears to be in a compensated stage of adaptation; and (3) that the cardiac myosin isoenzyme profile may have little direct effect on cardiovascular functional capacity.

Myocardial functional correlates of cardiac myosin light chain 2 phosphorylation.

In vitro and in situ studies have proposed a potentiation of submaximal force production after myosin light chain 2 (P-light chain) phosphorylation in mammalian striated muscle. The purpose of this study was to ascertain the relationship between the augmentation in left ventricular pressure development and cardiac myosin P-light chain phosphorylation at different times during and after submaximal treadmill exercise involving adult female Sprague-Dawley rats. In vivo hemodynamic measurements were monitored with an indwelling high-fidelity solid-state pressure transducer. Exercise heart rate, peak left ventricular (LV) pressure, and rate of LV pressure development/relaxation (LV +/- dP/dt) were significantly elevated compared with a normal sedentary group (P less than 0.001). Peak LV pressure remained significantly elevated throughout 20 min of postexercise recovery (P less than 0.01), and heart rate, LV end-diastolic pressure, and LV +/- dP/dt returned rapidly to preexercise values. Corresponding to these in vivo hemodynamic changes, increased levels of P-light chain phosphorylation were observed during both exercise (16%, P less than 0.01) and subsequent recovery periods (14%, P less than 0.02) compared with the NC group. A quasi-temporal relationship was observed between postexercise peak LV pressure potentiation and P-light chain phosphorylation. These results demonstrate that cardiac myosin P-light chain phosphorylation is associated, in part, with the augmentation of peak LV pressure observed during both exercise and recovery.

Isomyosin distributions in rodent muscles: effects of altered thyroid state.

In this study we examined the effects of 6-8 wk of thyroid hormone manipulation on striated muscle isomyosin expression in adult female rats. Animals were randomly assigned to one of three groups: 1) euthyroid controls, 2) thyroid deficient (propylthiouracil treated), and 3) hyperthyroid (triiodothyronine treated). Thyroid deficiency resulted in a marked increase in the low-adenosinetriphosphatase V3 isoform by 20- and 49-fold in the left and right ventricle, respectively. Conversely, hyperthyroidism induced a modest (3-11%) but significant increase in the high-adenosinetriphosphatase V1 isoform in both ventricles. The thyroid-deficient rats exhibited significant increases in slow myosin in both soleus (8%) and red gastrocnemius (24%), with concomitant reductions in intermediate myosin in both muscles. Interestingly, while the slow-myosin isoform was decreased in both the soleus (-19%) and the red gastrocnemius (-43%) of the hyperthyroid group, the intermediate-myosin isoform was affected differentially in the two muscles, with a fivefold increase in the former vs. a 16% decrease in the latter. Furthermore, hyperthyroidism increased the fast myosins in the red gastrocnemius while exerting no effect on the same isoforms in the white gastrocnemius. Collectively these data suggest both different specificity and sensitivity among the myosin genes of different striated muscle types in response to thyroid hormone.

Phosphorylation of rodent cardiac myosin light chain 2: effects of exercise.

The purpose of this study was to ascertain whether the degree of cardiac myosin light chain 2 (P-light chain) phosphorylation occurs as a function of changes in cardiovascular functional state as induced by 1) treadmill exercise (20-27 m/min, 0% grade for 20, 30, 45 min) (phase I) and 2) pharmacological intervention (phase II) in adult female Sprague-Dawley rats. It was hypothesized that cardiac myosin phosphorylation is regulated in accordance with time-dependent sustained elevations in myocardial work demands requiring alterations in either heart rate or left ventricular pressure development. Exercise heart rates (HR) and double products (HR x DP) were equivalent among the three exercise groups and were significantly elevated in comparison with the normal-rest (NR) group (P less than 0.05). In phase II, isoproterenol elicited higher HR, although the atenolol group exhibited a marked reduction in HR, mean arterial pressure, and double product relative to NR (P less than 0.05). Percent myosin P-light chain phosphorylation exhibited both a HR- and a work load-dependent modulation in P-light chain levels (-9% to +23% change) in the two phases of the study (P less than 0.05). These data are consistent with the view that the above responses are associated with modulations in intracellular calcium concentrations commensurate with the alterations in HR and left ventricular pressure. Also, elevations in P-light chain phosphorylation could serve to augment left ventricular pressure development under these functional states.

Effect of thyroid state on cardiac myosin P-light chain phosphorylation during exercise.

This study ascertained the effects of thyroid deficiency (TD) and hyperthyroidism (H) on in vivo cardiovascular functional capacity in the context of cardiac myosin light chain 2 phosphorylation [P-LC(P)], a proposed modulator of myocardial function, at rest and during exercise. Compared with normal controls (NC), Ca2(+)-regulated myofibril adenosinetriphosphatase was reduced by 39% in TD and increased by 9% in H rats. This response was associated with a 20-fold increase in the V3 isoform and an 11% increase in the V1 isoform in TD and H rats, respectively. Submaximal treadmill exercise elicited significant elevations in all myocardial functional indexes examined in H rats compared with the NC group, whereas the opposite occurred for the TD group. Despite the marked contrast in cardiac function among the three groups, intrinsic levels of P-LC(P) were similar at rest among the groups and were significantly reduced in both TD and H groups relative to controls during exercise. These data suggest that although thyroid state exerts a profound impact on intrinsic myocardial functional state, it exerts little control over cellular processes regulating P-LC(P) during rest and exercise.

Effects of endurance exercise on isomyosin patterns in fast- and slow-twitch skeletal muscles.

Although endurance training has been shown to profoundly affect the oxidative capacity of skeletal muscle, little information is available concerning the impact of endurance training on skeletal muscle isomyosin expression across a variety of muscle fiber types. Therefore, a 10-wk running program (1 h/day, 5 days/wk, 20% grade, 1 mile/h) was conducted to ascertain the effects of endurance training on isomyosin expression in the soleus, vastus intermedius (VI), plantaris (PLAN), red and white medial gastrocnemius (RMG and WMG), and red and white vastus lateralis muscles (RVL and WVL). Evidences of training were noted by the presence of a resting and a submaximal exercise bradycardia, as well as an enhancement in peak O2 consumption in the trained rodents relative to the nontrained controls. No evidence for skeletal muscle hypertrophy was observed subsequent to training when muscle weight was normalized to body weight. Shifts in the isomyosin profile of the trained VI, RMG, RVL, and PLAN were seen relative to the nontrained controls. Specifically, training affected the slow myosin (SM) composition of the VI by decreasing the relative content of the SM2 isoform by 14% while increasing that of the SM1 isoform (P less than 0.05). In addition, training elicited various degrees of a fast to slower myosin transformation in the RMG, RVL, and PLAN. All three muscles showed a significant reduction in the fast myosin 2 isoform (P less than 0.05), with significant increases in intermediate myosin in the RVL and PLAN along with elevations in SM2 in the RMG and PLAN (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac biochemical and functional adaptations to exercise in sympathectomized neonatal rats.

This study was undertaken to examine the influence of guanethidine monosulfate-induced sympathectomy on exercise-induced adaptations of cardiac contractile protein and on acute hemodynamic responses to exercise involving female neonatal rats. Four groups of rats were studied: 1) normal sedentary (NS), 2) normal trained (NT), 3) sympathectomized sedentary (SS), and 4) sympathectomized trained (ST). The 9-wk running program, which began at 20 days of age, induced increases in whole-body maximal O2 consumption and skeletal-muscle citrate synthase activity in both NT and ST groups compared with NS (P less than 0.05). Submaximal exercise tests demonstrated circulatory adaptations for NT, SS, and ST groups compared with NC; however, the ST group demonstrated the greatest degree of altered cardiac function (decreased heart rate, left ventricular pressure, and contractility index) during exercise. Also, significant reductions in both myosin- and Ca2+-regulated myofibril adenosinetriphosphatase (ATPase) activity and increases in the relative content of the low ATPase myosin isozyme, V3, occurred in the hearts of the two trained groups (P less than 0.05). These findings suggest that chronic exercise involving normal and sympathectomized neonatal rats improves cardiac function without compromising maximal exercise capacity. Also, the exercise-related adaptation involving myosin isozyme shifts are exaggerated when involvement of the sympathetic nervous system is reduced during training.

Left ventricular functional capacity in the endurance-trained rodent.

Cardiac myosin P-light chain phosphorylation [P-LC(P)] has been proposed to augment myocardial force production. This study was undertaken to examine the potential for cardiac myosin P-LC(P) for both equivalent heart rate and work load in exercising endurance-trained and nontrained rodents. A 10-wk training protocol elicited a significant reduction in submaximal running O2 uptake while enhancing peak O2 uptake (-17 and 10%, respectively, P less than 0.05). Left ventricular functional index during submaximal exercise, obtained with a high-fidelity Millar ultraminiature pressure transducer, indicated that the trained animals were able to maintain peak left ventricular pressure (LVP) in comparison to their sedentary counterparts, even though both heart rate and rate of LVP development were significantly reduced (P less than 0.05). When expressed on the basis of equivalent submaximal heart rate, peak LVP was augmented in the trained animals. Cardiac myosin P-LC(P) was examined under two conditions known to produce disparate responses in trained vs. sedentary animals. For an equivalent work load, we observed parallel increases in P-LC(P) (20%) and systolic pressure (17%) in both groups, even though the trained animals exhibited significantly lower heart rates (P less than 0.05). For an equivalent heart rate, training evoked a significant increase in systolic pressure (26%, P less than 0.05) and caused a slight increase in P-LC(P) relative to the nontrained controls. Cardiac myosin adenosinetriphosphatase was reduced approximately 10% in the trained animals (P less than 0.05), commensurate with a 2.0-fold increase in the V3 (low adenosinetriphosphatase) isomyosin.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutrition and oral health guidelines for pregnant women, infants, and children.

Good oral health care and nutrition during pregnancy, infancy, and childhood are essential but often overlooked factors in the growth and development of the teeth and oral cavity. Pregnant women and parents and caregivers of infants and children often receive little guidance about proper preventive dental and oral health care, including fluoride and dietary measures. Pregnant women can maintain their health through proper diet, good oral hygiene, and appropriate use of fluoride. An adequate diet during gestation is important for optimal oral development of the fetus. To promote good oral health in infancy, caregivers need to provide the infant with appropriate amounts of fluoride in addition to a healthful diet. As the teeth erupt into the mouth, the caregiver needs to clean the teeth thoroughly on a daily basis. When solid foods are introduced in later infancy, it is also important to limit the frequency of caries-promoting fermentable carbohydrates between meals. Good oral hygiene habits and dietary practices that emphasize minimum exposure to retentive, fermentable carbohydrates; use of fluoridated water; and a varied, balanced diet should continue throughout childhood to set the stage for optimal oral health for a lifetime.

The filaricidal activity of some derivatives of N-[2-(4-thiazolyl)benzimidazol-5-yl]benzamide against Brugia pahangi adults.

A series of analogues of N-[2-(4-thiazolyl)benzamidazol-5-yl]benzamide with halogen substituents on the benzamide ring was tested for activity against adult Brugia pahangi in the peritoneal cavities of jirds. None of the chloro, bromo or iodo analogues was active at 5 x 100 mg/kg by subcutaneous injection. The 2-fluoro, 3-fluoro and 4-fluoro analogues showed greater activity than the parent compound and the 2,5-difluoro analogue had the same activity as the parent. The 3-fluoro, 4-fluoro and 2,5-difluoro analogues were not active in cats treated per os with 5 x 50 mg/kg.

Using research to improve infection control practice.

Research into nurses' knowledge of infection control provided the basis for a hospital training programme. A combined approach by occupational health and infection control specialists developed an appropriate needs-based programme.

Screening for obstructive sleep apnea in preschool children with cleft palate.

OBJECTIVE: The objective of this study was to explore the prevalence, range of reported symptoms, and clinical risk factors of obstructive sleep apnea in preschool children with cleft lip and/or palate. DESIGN: Questionnaires were distributed to parents/guardians of all children from birth to 5 years of age who were followed by the cleft clinic. RESULTS: Questionnaire data and cleft classification were available for 248 children, with a mean age of 33.4 months. Obstructive sleep apnea was identified in 31.4% of the children. Only 29.5% of children with obstructive sleep apnea had undergone an investigation of these symptoms. The three most common symptoms reported in children with a questionnaire diagnosis of obstructive sleep apnea were (1) "heavy or loud breathing," (2) "easily distracted," and (3) "on the go" or "driven by a motor." The only clinical risk factor associated with a questionnaire diagnosis of obstructive sleep apnea was the presence of a syndrome (chi(2) = 3.5, p = .05). There were no significant differences in risk of obstructive sleep apnea by age, cleft classification, and surgical status. CONCLUSION: Preschool children with cleft lip and/or palate have a risk of obstructive sleep apnea that is as much as five times that of children without cleft. Obstructive sleep apnea appears to be underrecognized in this group of children. Further research is needed to investigate important risk factors for obstructive sleep apnea in children with cleft lip and/or palate.