Experiences and needs concerning health related information for newly arrived refugees in Sweden.

BACKGROUND: Owing to communication challenges and a lack of knowledge about the health care system, refugees may be at risk of having limited health literacy, meaning that they will have problems in achieving, understanding, appraising and using health information or navigating in the health care system. The aim of this study was to explore experiences and needs concerning health related information for newly arrived refugees in Sweden. METHODS: A qualitative design with a focus group methodology was used. The qualitative content analysis was based on seven focus group discussions, including 28 Arabic and Somali speaking refugees. RESULTS: Four categories emerged. 'Concrete instructions and explanations' includes appreciation of knowledge about how to act when facing health problems. 'Contextual knowledge' comprises experienced needs of information about the health care system, about specific health risks and about rights in health issues. 'A variation of sources' describes suggestions as to where and how information should be given. 'Enabling communication' includes the wish for more awareness among professionals from a language and cultural point of view. CONCLUSION: Concrete instructions and explanations are experienced as valuable and applicable. Additional information about health issues and the health care system is needed. Information concerning health should be spread by a variety of sources. Health literate health organizations are needed to meet the health challenges of refugees, including professionals that emphasize health literacy.

Small-scale agricultural grassland management can affect soil fungal community structure as much as continental scale geographic patterns.

A European transect was established, ranging from Sweden to the Azores, to determine the relative influence of geographic factors and agricultural small-scale management on the grassland soil microbiome. Within each of five countries (factor 'Country'), which maximized a range of geographic factors, two differing growth condition regions (factor 'GCR') were selected: a favorable region with conditions allowing for high plant biomass production and a contrasting less favorable region with a markedly lower potential. Within each region, grasslands of contrasting management intensities (factor 'MI') were defined: intensive and extensive, from which soil samples were collected. Across the transect, 'MI' was a strong differentiator of fungal community structure, having a comparable effect to continental scale geographic factors ('Country'). 'MI' was also a highly significant driver of bacterial community structure, but 'Country' was clearly the stronger driver. For both, 'GCR' was the weakest driver. Also at the regional level, strong effects of MI occurred on various measures of the soil microbiome (i.e. OTU richness, management-associated indicator OTUs), though the effects were largely regional-specific. Our results illustrate the decisive influence of grassland MI on soil microbial community structure, over both regional and continental scales, and, thus, highlight the importance of preserving rare extensive grasslands.

A platform for phenotypic discovery of therapeutic antibodies and targets applied on Chronic Lymphocytic Leukemia.

Development of antibody drugs against novel targets and pathways offers great opportunities to improve current cancer treatment. We here describe a phenotypic discovery platform enabling efficient identification of therapeutic antibody-target combinations. The platform utilizes primary patient cells throughout the discovery process and includes methods for differential phage display cell panning, high-throughput cell-based specificity screening, phenotypic in vitro screening, target deconvolution, and confirmatory in vivo screening. In this study the platform was applied on cancer cells from patients with Chronic Lymphocytic Leukemia resulting in discovery of antibodies with improved cytotoxicity in vitro compared to the standard of care, the CD20-specific monoclonal antibody rituximab. Isolated antibodies were found to target six different receptors on Chronic Lymphocytic Leukemia cells; CD21, CD23, CD32, CD72, CD200, and HLA-DR of which CD32, CD200, and HLA-DR appeared as the most potent targets for antibody-based cytotoxicity treatment. Enhanced antibody efficacy was confirmed in vivo using a patient-derived xenograft model.

The Conceptions of Pain and Rehabilitation Questionnaire (CPRQ): development and test of face validity and stability over time.

The heterogeneity of diagnoses included in the concept of chronic pain, as well as differences in adaptation to the situation involving chronic illness, imply the need for a variety of rehabilitation forms. Despite evidence concerning the success of multidisciplinary behaviour-orientated rehabilitation programmes, not all participants experience the expected change. The aim of the present study was to develop and test the face validity and the stability over time of a Swedish self-administered questionnaire: the Conceptions of Pain and Rehabilitation Questionnaire (CPRQ) for persons with chronic pain. The questionnaire is to be used as a guiding tool in planning for rehabilitation. Its purpose is to distinguish between individuals with expectations of and motivation for active rehabilitation and those with expectations of more supportive forms of therapy. The face validity was mainly obtained by target-group discussions including persons with chronic pain and rehabilitation staff with experience in the rehabilitation of persons with chronic pain. The test-retest stability analysis was performed using a model for identifying occasional and systematic disagreement. The questionnaire in its final form showed face validity and reliability in terms of stability over time. Further steps in the development process will include laying down the guiding principles for the questionnaire, based on new focus-group discussions, and completing work on the manual by including information about the origin of the questionnaire and instructions for its administration. Thereafter, the next step in the development process will be a test of responsiveness, i.e. to examine the degree to which the questionnaire really serves its purpose.

Occupational life trajectories in the context of chronic pain and immigration.

BACKGROUND: Persons with chronic pain report a range of occupational problems. The specific health needs of immigrants are judged to be poorly understood, and health systems are not prepared to respond adequately. Being an immigrant is regarded as a risk factor for the progression of chronic widespread pain into a state of disability. OBJECTIVES: To explore occupational life trajectories among immigrant women with chronic pain. MATERIAL AND METHODS: A qualitative content analysis was used to capture the latent meaning of experiences in individual interviews of eight women with immigrant background and chronic pain. RESULTS: An overarching theme, 'making the best of a conditional situation', representing the women's occupational life trajectories, covers the content of two categories: 'being controlled', including affected self-perception, social relations, and future prospects, and 'trying to deal with challenges', comprising a focus on resources, having trust in one's own judgements and getting help from others. CONCLUSION AND SIGNIFICANCE: The experiences demonstrate an occupational life controlled by internal and external factors and may be understood as a disrupted occupational life trajectory. This knowledge may be helpful to occupational therapists supporting immigrant women's attempts to regain a structured life despite the constant presence of pain.

Role of an evolutionarily invariant serine for the stability of human carbonic anhydrase II.

There are several evolutionarily invariant amino acids in the primary structures of all known isoenzymes of carbonic anhydrase. One of these is Ser-29 which is situated in the peripheral part of the active site interacting by hydrogen bonds with amino acids located nearby in the tertiary structure. Furthermore, the neighbourhood of Ser-29, composed of Gln-28, Pro-30, Tyr-194, Ser-197 and Trp-209, has a totally invariant structure. The structural role of Ser-29 was investigated by site-directed mutagenesis. The stability of two enzyme mutants, where Ser-29 was replaced by alanine and cysteine, towards denaturation by guanidine-HCl was studied. Changing Ser-29 to Ala resulted in a destabilization by 2.6 kcal/mol, corresponding to the loss of 2-3 hydrogen bonds. Interestingly, Ser-29 is within hydrogen bond distance to Tyr-194, Ser-197 and Trp-209 in the tertiary structure. Therefore, rupture of these interactions caused by the Ser-29----Ala substitution could explain the observed destabilization of this enzyme variant. Substituting cysteine for Ser-29 gives rise to a drastic decrease in the stability of the protein (change in midpoint concentration of denaturation from 0.96 M to less than 0.1 M guanidine-HCl) despite the minor structural change (O----S atom). This destabilization corresponds to approx. 7-8 kcal/mol and cannot be explained by changes in hydrogen bond pattern only, but must also include unfavourable conformational changes to avoid van der Waals collisions originating from the somewhat larger thiol group.

Folding around the C-terminus of human carbonic anhydrase II. Kinetic characterization by use of a chemically reactive SH-group introduced by protein engineering.

We are characterizing the process of refolding of the enzyme human carbonic anhydrase II from the denatured state in guanidine hydrochloride. To describe the folding in defined parts of the protein we use protein engineering to introduce cysteine residues as unique chemically reactive probes. The accessibility of the cysteine SH-group to the alkylating reagent iodoacetate, at different stages during refolding, is used to give a kinetic description of the folding process. The structuration of the C-terminal part of the polypeptide chain, which is involved in a unique 'knot' topology, was investigated. Our results show that the structure around the C-terminal, composed of the outermost beta-strands in a dominating beta-structure that extends through the entire protein, is formed relatively late during refolding. In contrast, it was found that beta-strands located in the interior of the protein were structured very rapidly. The final native structure is formed in a process that is slower than those observed for formation of beta-structure.

Cis-trans isomerization is rate-determining in the reactivation of denatured human carbonic anhydrase II as evidenced by proline isomerase.

The refolding of human carbonic anhydrase II is a sequential process. The slowest step involved is the recovery of enzymic activity (t1/2 = 9 min). Kinetic data from 'double-jump' measurements indicate that proline isomerization might be rate determining in the reactivation of the denatured enzyme. Proof of this is provided by the effect of proline isomerase on the reactivation kinetics: the presence of isomerase during reactivation lowers the half-time of the reaction to 4 min, and inhibition of proline isomerase completely abolishes this kinetic effect. A similar acceleration of the refolding process by proline isomerase is also observed for bovine carbonic anhydrase II, in contrast to what has previously been reported. In human carbonic anhydrase II there are two cis-peptidyl-Pro bonds at Pro30 and Pro202. Two asparagine single mutants (P30N and P202N) and a glycine double mutant (P30G/P202G) were constructed to investigate the role of these prolines in the rate limitation of the reactivation process. Both in the presence and absence of PPIase the P202N mutant behaved exactly like the unmutated enzyme. Thus, cis-trans isomerization of the Pro202 cis-peptidyl bond is not rate determining in the reactivation process. The mutations at position 30 led to such extensive destabilization of the protein that the refolding reaction could not be studied.

Iloprost attenuates trauma-related pulmonary sequestration of leucocytes and platelets.

The purpose of this study was to investigate the effects of iloprost, a synthetic prostacyclin analogue, on the pulmonary cellular trapping after a standardized soft tissue trauma. In two groups 1 and 2 iloprost was given in doses of 100 ng/kg/min commencing 30 and 20 min respectively prior to trauma and ceasing 10 min after trauma. 111Indium-oxine was used to label neutrophils in 6 animals from each group. Platelets were labelled in 6 and 7 animals respectively. A third group of 11 pigs served as a control and did not receive iloprost. The pulmonary sequestration of platelets and neutrophils was studied dynamically with a gamma camera and directly after trauma was significantly less in group 1 when compared to the control group. A rise in pulmonary vascular resistance and pulmonary arterial pressure was seen in the control group immediately after trauma but this was not evident in the iloprost groups. PaO2 decreased significantly in group 1 and 2 during the iloprost infusion. The results indicate that iloprost attenuates the pulmonary cellular sequestration and changes in central hemodynamics during trauma in this model.

Melatonin together with noradrenaline augments contractions of human myometrium.

The hormone melatonin is known to influence the circadian rhythm, and it probably also mediates some of the physiological changes that occur in the body at night. Inasmuch as uterine activity is greater during darkness, we investigated whether melatonin could modulate uterine contractility. Biopsies were performed during caesarean sections to obtain uterine tissue from women who had reached full term. The obtained samples were mounted in organ baths, and spontaneous contractions were recorded. Melatonin alone did not change myometrial contractility, whereas melatonin in combination with noradrenaline potentiated contractions. These results may indicate that melatonin plays a role in the timing of labour, since labour often begins late in the evening.

Effect of terbutaline sulphate on ovarian, uterine and maternal placental blood flow in the anesthetized guinea pig.

The effect of terbutaline sulphage, a beta-adrenergic agonist, on uteroplacental blood flow was studied in the guinea pig during late pregnancy. Organ blood flows and cardiac output were assessed by the radioactive microsphere technique. Infusion of terbutaline at a rate of 2nmol min-1 kg-1 body weight caused a significant increase in cardiac output and in the perfusion of the uterus and ovaries, but there was no significant alteration in maternal placental blood flow. When the infusion rate was increased tenfold, there was also a significant rise in the blood supply to the bronchi, urinary bladder, kidneys, and adrenal glands. Maternal placental blood flow was not adversely affected even by this large dose of the drug, although there was a significant reduction in the placental share of the cardiac output.

Noradrenaline-induced pigment aggregating response of melanophores in normal, denervated and reinnervated cichlid skin.

The present study examines noradrenaline (NA) effects on melanophore pigment aggregation in normal, denervated and reinnervated teleost skin in vitro. Many axons were present in the melanophore-containing layer of normal skin. One week after a nerve crush lesion the skin was devoid of axons. By 1 month the skin was partly reinnervated. One day after nerve crush NA-sensitivity was markedly increased compared to controls. Sensitivity then approached normality but it remained elevated for at least one month. We conclude that melanophore supersensitivity develops very rapidly upon denervation and then gradually fades away during reinnervation.

Phase memory relaxation times of spin labels in human carbonic anhydrase II: pulsed EPR to determine spin label location.

Phase memory relaxation times (T(M) or T(2)) of spin labels in human carbonic anhydrase II (HCA II) are reported. Spin labels (N-(1-oxyl-2,2,5,5-tetramethyl-3-pyrrolidinyl)iodoacetamide, IPSL) were introduced at cysteines, by site-directed mutagenesis at seven different positions in the protein. By two pulse electron paramagnetic resonance (EPR), electron spin echo decays at 45 K are measured and fitted by stretched exponentials, resulting in relaxation parameters T(M) and x. T(M) values of seven positions are between 1.6 micros for the most buried residue (L79C) and 4.7 micros for a residue at the protein surface (W245C). In deuteriated buffer, longer T(M) are found for all but the most buried residues (L79C and W97C), and electron spin echo envelop modulation (ESEEM) of deuterium nuclei is observed. Different deuterium ESEEM patterns for W95C and W16C (surface residue) indicate differences in the local water concentration, or accessibility, of the spin label by deuterium. We propose T(M) as a parameter to determine the spin label location in proteins. Furthermore, these systems are interesting for studying the pertaining relaxation mechanism.

A melatonin binding site modulates the alpha 2-adrenoceptor.

The melanophores of the cuckoo wrasse (Labrus ossifagus L., a teleost fish) can aggregate and disperse their pigment granules. This migration is controlled by sympathetic nerves and a postsynaptic alpha 2-adrenoceptor. Melatonin was discovered because of its ability to aggregate pigment granules, hence we used the cuckoo wrasse melanophore as a model for studying the effect of melatonin at a cellular level. We found that melatonin had no aggregating effect; instead the hormone enhanced the actions of several alpha 2-agonists, such as noradrenaline, medetomedine and clonidine. When the melanophores were pre-aggregated in vitro by use of the alpha 2-agonist B-HT 920, the aggregation was not augmented after the addition of melatonin. Instead the pre-aggregated granules were dispersed. This suggests that melatonin has affinity for an alpha 2-adrenoceptor site that can modulate the effect of alpha 2-adrenoceptor agonists.

Is Ca2+ the second messenger in the response to melatonin in cuckoo wrasse melanophores?

Pigment aggregation in melanophores of Labrus ossifagus is controlled by an alpha2-adrenoceptor and is somehow modulated by melatonin. The signal transduction mechanisms seem to involve both an attenuation of cAMP and an increase in intracellular Ca2+, inhibiting protein kinase A or activating a phosphatase, respectively. These effects result in dephosphorylation, which in turn induces aggregation. Various alpha2-adrenoceptor agonists attenuate cAMP levels or increase the concentration of intracellular Ca2+. Noradrenaline, for example, lowers cAMP but does not affect the calcium signal whereas B-HT 920, an alpha2-adrenoceptor specific agonist, does not induce a cAMP decrease but does appear to induce an increase in intracellular Ca2+. This later inference is drawn from experiments with BAPTA/AM, an intracellular calcium chelator, which counteracts the aggregation induced by B-HT 920. Interestingly, the very potent alpha2-adrenoceptor agonist medetomidine apparently activates both signal transduction pathways, which could explain its high efficacy in producing aggregation. Melatonin itself does not cause pigment aggregation, but it potentiates noradrenaline-induced aggregation. It has been suggested that melatonin receptors and alpha2-adrenoceptors follow the same signal transduction pathway, i.e. an attenuation of cAMP. In our experiments, melatonin did not reduce cAMP levels; instead it appears to increase Ca2+ concentration, since melatonin-potentiated aggregation was inhibited by BAPTA/AM. Thus, aggregation amplified by melatonin is probably not mediated by a further decrease in cAMP, but by the same signal transduction mechanism as B-HT 920, i.e. an increase in Ca2+. This further strengthens the suggestion that melatonin and B-HT 920 bind to the same site, but it is unclear if that particular site is on the melatonin receptor or the alpha2-adrenoceptor.

Changes in plasma levels of vasoactive substances during routine acetate and bicarbonate hemodialysis.

Hemodynamic stability is better preserved during bicarbonate hemodialysis compared to acetate. We have studied the effects of bicarbonate (HDB) and acetate hemodialysis (HDA) on plasma levels of vasoactive substances. The treatments were performed for 270 min. A cuprophan plate dialyzer was used. The ultrafiltration volume and the ultrafiltration rate were identical in the individual patients during the two treatments. In the case of vasoconstrictors there was an increase in neuropeptide Y (NPY) (20%, p < 0.01) during HDB and arginine vasopressin (AVP) was unchanged. Unlike this was the response during HDA when there was no change in NPY and a decrease in AVP (38%, p < 0.01). An increase in noradrenaline (NA) (41%, p < 0.05) occurred during HDA different from what was the case during HDB. There was a gradual increase in renin (PRA) during both HDB (141%, p < 0.05) and HDA (148%, p < 0.01). With respect to vasodilators there were no differences between the two regimes regarding calcitonin gene-related peptide (CGRP) and motilin (MOT). The change in substance P (SP) during the treatments was also similar but somewhat more pronounced during HDB. Thus, an initial rise occurred (HDB, 81%, p < 0.01; HDA, 36%, p < 0.05) followed by a decrease (HDB, 26%, p < 0.05) or a tendency to decrease (HDA, 12%, p = 0.058) during the remaining part of the treatment. A rise in beta-endorphin (beta-END) occurred during HDB (10%, p < 0.05) but not during HDA. An increase in vasoactive intestinal peptide (VIP) occurred during HDB (27%, p < 0.05) different from the decrease during HDA (11%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of sham hemodialysis on plasma levels of vasoactive peptides in patients with uremia.

Changes in plasma levels of vasoactive peptides during hemodialysis have mainly been attributed to changes in plasma volume and osmolality. This study investigated the effect of the extracorporeal circulation on plasma levels of vasoactive peptides, noradrenaline, and renin. Eleven stable hemodialysis patients were studied during sham dialysis for 60 min using a Cuprophan dialyzer (Alwall GFE11, Gambro AB, Lund, Sweden). With regard to vasoconstrictors, there was an increase in noradrenaline (NA) (13%, p < 0.05) and renin (PRA) (32%, p < 0.05), while arginine vasopressin and neuropeptide Y remained unaltered. Concerning vasodilators, an increase in substance P (SP) (23%, p < 0.05) and vasoactive intestinal peptide (VIP) (15%, p < 0.01) was observed, while a decrease in atrial natriuretic peptide (ANP) (17%, p < 0.05) and motilin (MOT) (24%, p < 0.01) occurred. Calcitonin gene related peptide and beta endorphin were unaltered. A decrease in blood pressure was observed, while heart rate remained unchanged. The authors conclude that the extracorporeal circulation, per se, affects plasma levels of vasoactive substances and influences vascular stability. The decrease in ANP and MOT might be due to adsorption to the dialysis membrane. The increase in some vasoconstrictors (NA, PRA) and vasodilators (SP, VIP) might be induced by the blood-artificial surface contact, or by other factors, e.g., heparin or cooling of the blood during the procedure.

Dialysis fluid temperature and vasoactive substances during routine hemodialysis.

Blood pressure stability is better during cold hemodialysis (HD). This has mainly been attributed to a more pronounced sympathetic activation during cold than during warm HD. The authors studied the effect of dialysate temperature on vasoactive peptides, noradrenaline (NA), and renin (PRA). Ten hemodynamically stable patients were dialyzed for 240 min with each of two dialysate temperatures: 38.5 degrees C (warm HD = WHD) and 34.5 degrees C (cold HD = CHD). A decrease (P < 0.05) in blood pressure occurred during WHD; however, during CHD, blood pressure was stable. There were no differences in vasoconstrictors between the two regimens. There was a decrease in NA (P < 0.05), a tendency of PRA to increase (NS owing to a large statistical spread), while arginine vasopressin was unchanged. During CHD, there was a small increase in neuropeptide Y (NPY); however, during WHD, NPY only tended to increase. However, the relative NPY levels (percent of baseline levels) after WHD and CHD did not differ. The vasodilator response was similar during both treatments. Calcitonin gene related peptide was unaltered. Motilin tended to decrease initially, but then increased (P < 0.05) to baseline levels. An increase occurred in beta-endorphin (P < 0.05) and substance P(P < 0.01). There was an initial rise (P < 0.05) in vasoactive intestinal peptide (VIP), followed by a tendency to decrease during the remainder of treatment. The authors concluded that blood pressure stability was better during CHD. However, this was not reflected by differences in plasma levels of the vasoactive peptides, nor did they find any difference in the sympathetic drive between the two regimens.

Spherical aberration in relation to visual performance in contact lens wear.

INTRODUCTION: The aim of the present study was to evaluate changes in spherical aberration and their effect on visual quality (visual acuity and contrast sensitivity) in both distance and near with different non-custom-made contact lenses. METHODS: A wavefront analyser was used to measure the aberrations in each subject's eyes uncorrected and with the contact lenses: a standard lens and two aspherical contact lenses. High-contrast visual acuity at distance was measured with Test-Chart 2000 (100% contrast) and at near with Sloan ETDRS Near Point chart (100% contrast). Low-contrast visual acuity at distance was measured with Test-Chart 2000 (10% contrast) and contrast measurements at near with Mars letter contrast sensitivity chart. RESULTS: Mean spherical aberration was positive for all pupil sizes in the uncorrected eye, residual spherical aberration was close to zero with the standard lens for all pupil sizes, whereas the two aspheric contact lenses over-corrected spherical aberration. The changes in aberration were statistically significant (p < 0.05) with all lenses. No significant difference could be detected between trial frame correction, spherical and aspherical soft contact lens designs with respect to visual quality. This was the case for both distance and near. CONCLUSION: The results are in line with previous studies and indicate that non-custom-made spherical aberration control contact lenses have little effect on visual quality as defined in this study.

Filter-based treatment of leachate from an industrial landfill containing shredder residues of end-of-life vehicles and white goods.

A pilot plant was set up to treat leachate from an industrial landfill containing shredder residues of end-of-life vehicles and white goods. The treatment plant consisted of aeration and sedimentation steps for pre-treatment, and a filter. The plant was designed to simultaneously remove various types of pollutants. The efficiencies of pre-treatment and of the main treatment step were investigated over a period of 3 years at the landfill site. By continuous aeration of the leachate the concentrations of Fe and Mn were reduced by 55% and 49%, respectively. By prolonged sedimentation suspended solid content was noticeably reduced (72%). In the filter, consisting of a mixture of peat and carbon-containing ash as a treatment medium, very high reduction of polar organic compounds, e.g. phenol (74%), o-and p-cresol (91%), and 2,4-dimethylphenol (73%), high average reduction of metals, e.g. Pb (78%), Fe (74%), Cu (73%), Mn (56%), Sn (55%), and Zn (47%), and good average reduction of DOC (26%), Tot-N (23%) and NH4-N (46%) were achieved. Sixty non-polar compounds in the leachate, identified by GC-MS screening, occurred at trace level. Most of them were considerably reduced in the filter.