Nurses' health beliefs about paper face masks in Japan, Australia and China: a qualitative descriptive study.

AIM: To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks. BACKGROUND: The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID-19, but there appear to be differences in health beliefs of nurses within and between countries regarding these. METHODS: This qualitative descriptive study used content analysis with a framework approach. FINDINGS: There were major differences in nurse participants' beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts. CONCLUSION: Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: The COVID-19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence-based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide-reaching education campaign.

Epicardial adipose tissue volume in patients with coronary artery disease or non-ischaemic dilated cardiomyopathy: evaluation with cardiac magnetic resonance imaging.

AIM: To compare the amount of epicardial adipose tissue (EAT) in patients with coronary artery disease (CAD) or non-ischaemic dilated cardiomyopathy (NIDCM) with that in patients with negative cardiac magnetic resonance imaging (CMR). MATERIALS AND METHODS: One hundred and fifty patients (median age 57 years, interquartile range [IQR] 46-66 years) who underwent CMR were evaluated retrospectively: 50 with CAD, 50 with NIDCM, and 50 with negative CMR. For each patient, the EAT mass index (EATMI) to body surface area, end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume (SV), ejection fraction (EF) for both ventricles, and left ventricle (LV) mass index were estimated. Intra and inter-reader reproducibility was tested in a random subset of 30 patients, 10 for each group. Mann-Whitney U test, Kruskal-Wallis test, Spearman's correlation, and Bland-Altman statistics were used. RESULTS: The EATMI in CAD patients (median 15.7 g/m2, IQR 8.3-25.7) or in NIDCM patients (15.9 g/m2, 11.5-18.1) was significantly higher than that in negative CMR patients (9.1 g/m2, 6-12; p<0.001 both). No significant difference was found between CAD and NIDCM patients (p=1.000). A correlation between EATMI and LV mass index was found in NIDCM patients (r=0.455, p=0.002). Intra- and inter-reader reproducibility were up to 80% and 72%, respectively. CONCLUSION: Patients with NIDCM or CAD exhibited an increased EATMI in comparison to negative CMR patients. CMR can be used to estimate EAT with good reproducibility.

Implant insertion torque value in immediate loading: A retrospective study.

BACKGROUND: The aim of this study is to verify if the Insertion Torque Value (ITV) of 32 Ncm for immediate loading protocol (ILP), as indicated by literature, is still, with the advance in implant research, a real significant cut-off for long-term implant survival. MATERIAL AND METHODS: In this retrospective study, data from 224 patients that during three years of clinical practice, were submitted to the insertion of 322 implants with immediate loading protocol, have been recorded, pooled and analyzed. Data were organized based on Insertion Torque Value (ITV): > 32 Ncm (CG) and < 32 Ncm (LTG) and two different groups of equal sample size, 161 implants each, were distinguished. Crestal bone reabsorption, and the implant failure rate were evaluated after 2-years of follow-up. RESULTS: The bone reabsorption in LTG (0.49 ± 0.11 mm ) was significantly greater than CG (0.22 ± 0.04 mm), p<0.001. However, the survival rate after 2-years of follow-up was quite high and similar for both groups: 96.89% for LTG and 97.52% for CG and no statistically significant differences have been found among the two groups for the implant failure rate (p=0.455).The Odds Ratio (OR) of implant failure was of 1.258 (95% CI 0.332, 4.772), but results were not statistical significant, p=0.740. CONCLUSIONS: The present study showed that although implants with ITV> 32 Ncm are still characterized by a lower crestal bone resorption, there are no statistically significant differences among the two groups for what concerning the failure rate during the 2 years of follow-up and OR. These results permit us to suppose that the cut-off of ITV >32 Ncm for immediate loading implants, could be reduced to inferior values. However further studies are necessary to indicate precise clinical guidelines.

Experiences from Southeast Asia on nursing education, practice, mobility and influencing policy.

In this report from the field, we describe the challenges and opportunities for nursing practice and education, and ways to improve nurse mobility across Asia. We also explain the collaboration within the Southeast and East Asian Nursing Education and Research Network to influence policy development and review. The collaborative process was supported by evidence drawn from discussions at Network meetings, and with nursing and other leaders, an examination of literature and policy documents, and member surveys. We reviewed the region's regulatory statutes which all support diversity in the nursing workforce. The Southeast Asian Nursing Education and Research Network was established in 2015 to support policy development around the upgrading of nurse education, clinical competencies and research capacity, in hospital and primary health care; and facilitating the movement of nurses across national boundaries. Most countries have tried to address policy gaps and their efforts to implement changes are seen in policy expansion and development at the national level. We focus on two policies from the Association of Southeast Asian Nations from 2006 and 2012, that cover nurse mobility, information exchange, nurse capacity building and education and mutual professional recognition of nurses' credentials. However, we found significant variances in education, regulatory policies and clinical competencies that have restricted, and continue to restrict policy implementation. Nursing in South-East Asia has made significant progress in upgrading standards for education by increasing bachelor degree bridging programs, master and doctoral degrees. Participating countries have passed legislation on licensure, competencies and credentialing of internationally qualified nurses wishing to practice in various contexts. However, much work remains to be done. IMPLICATIONS FOR NURSING POLICY, EDUCATION AND PRACTICE: Governing bodies determine entry into practice law which requires dialogue to enhance policies for domestic and international practitioners for mutual exchange and recognition. Nursing practice and education are under government regulatory bodies but require new policies and laws to ensure adequate educational requirements for safe quality practice.

Nurses' perceptions of health beliefs and impact on teaching and practice: a Q-sort study.

AIM: To understand Chinese nurses' perceptions of health beliefs, their content, origin and the influence of sociocultural factors, as a basis of their evidence-based practice. This study contributes to a larger study to establish the health beliefs of Japanese, Australian, Chinese, South Korean and Thai nurses. BACKGROUND: Registered nurses teach patients and students about maintaining or attaining health are subject to the same range of influences and their health beliefs may be antithetical to current health evidence. METHODS: Q-method design using q-sort and interview was used to explore the perspectives on a range of health beliefs of 60 nurses in four cities in China. FINDINGS: Three factors arose from the perceptions of the participants about health and accounted for 50.2% of the total variance: (1) social impact, (2) 'the importance of evidence', and (3) beliefs rooted in culture. DISCUSSION: Influence on nurses' health beliefs was explored in terms of the internalized and frequently unconscious beliefs, values and norms tying them to their communities, reflecting the need for nurses to be aware of their health beliefs and behaviours. CONCLUSIONS: Education for nurses in practice needs to acknowledge that individual practitioners' beliefs strongly influence health teaching for patients and families. In order to implement evidenced-based practice and teach in line with current evidence nurses need to critically examine and reflect on the impact of culture, society and the media on their own health beliefs. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Education policy needs to consider that culture and societal pressures affect nurses' health beliefs and practice. Critical thinking, reflective and evidence-based practice need to be emphasized in clinical training and nurse education. China also needs to develop policies to allow nurses to be able to assess the reliability of health information on the Internet and to make quality health research more available.

Correlation between halitosis, oral health status and salivary ß-galactosidases and time spent in physical activities in children.

AIM: The aim of this work was to evaluate the oral health status in children and to correlate it with time spent in physical activity per week. MATERIALS AND METHODS: Fifty children (mean age 9±2 years) attending the first visit at the Paediatric Dental Unit of the University of Rome "Tor Vergata" have been included in the study. The parents of all patients were interviewed about the medical history of the children and specific data, in particular, the time spent in physical activity per week. A trained dentist examined the oral cavity of the patients and the following clinical parameters were recorded: number of deciduous and permanent teeth, caries (on deciduous and permanent teeth), presence of gingivitis (0=no; 1=yes), tongue coating score (from 0=none to 3= > 2/3 tongue dorsum surface covered)", oral infections (0=no; 1=yes), oral hygiene index (0=insufficient, 1=sufficient, 2=good), presence of at least one incongruous restoration (0=no, 1=yes), oral breathing (0=no; 1=yes), fissured tongue (0=no, 1=yes), presence of aftous ulcers, herpetic lesions or candidiasis (0=no, 1=yes), food stagnation (0=no; 1=yes). The level of salivary ?-galactosidases activity was measured spectrophotometrically. The subjects were classified into "Group 0": children who did not practice any sports beside physical education class; "Group 2": 2 hours per week; "Group 3": 3 hours; and "Group 4": 4 hours. STATISTICS: Statistical analysis was performed using SPSS for Windows version 21 (IBM SPSS Inc., Chicago, IL, USA). The Pearson's correlation coefficient (P) was used to evaluate the linear relationship between continuous variables, and the Spearman's correlation coefficient (S) was calculated for ordinal variables. Analysis of variance (ANOVA) and the Fischer's Least Significant Difference (LSD) test were used to compare the parameters analysed in the study. Data were analysed using linear regression and descriptive statistics. The significance threshold was set at 0.05. RESULTS: A more physically active lifestyle was significantly associated with a better oral hygiene and a reduced level of salivary ?-galactosidases, halitosis, gingivitis and tongue coating. Results of the organoleptic evaluation of halitosis performed by the parents and sport hours/week practiced have shown that Group 0 and 2 were characterised by statistically significant higher scores with respect to the other groups (Group 0 vs. Group 3, p=0.014; Group 2 vs. Group 3, p=0.030; Group 0 vs. Group 4, p=0.001; Group 2 vs. Group 4, p=0.002) (P= -0.458). The spectrophotometric quantification of salivary ?-galactosidases has shown that increasing the hours of sports, the enzyme activity significantly decreases (S= -0,330); similar levels were found with 0 and 2 hours of sports, but an important decrease has been recorded with both 3 (Group 0 vs. Group 3, p=0,011; Group 2 vs. Group 3, p=0,006) and 4 hours of sports practiced (Group 0 vs. Group 4, p=0,014; Group 2 vs. Group 4, p=0,008). The level of significance between children who did not practice sport and those who did for 3 and 4 hours a week was 0.005 (Group 0 vs. Group 3) and 0.0018 (Group 2 vs. Group 4) with respect to tongue coating scores (P= -0,511) and 0.012 for both groups with respect to gingivitis (Group 0 vs. Group 3; Group 0 vs. Group 4) (P=-0,427). CONCLUSION: Children who practiced sport showed a better oral hygiene level and lower halitosis, with respect to those who did not.

Interdental plaque reduction after use of different devices in young subjects with intact papilla: A randomized clinical trial.

OBJECTIVES: To determine the efficacy of 4 different oral hygiene regimens involving adjunctive interdental cleaning devices in unsupervised young subjects with intact interdental papilla. MATERIAL AND METHODS: Sixty periodontally healthy subjects were randomly allocated to 4 groups following different oral hygiene regimens (T-7): use of manual toothbrush alone; manual toothbrush plus dental floss; manual toothbrush plus interdental brushes; and manual toothbrush plus rubber interdental picks. Oral hygiene instructions (OHI) were given. One week after (T0), professional supragingival scaling and polishing was performed, and subjects were then reseen every 2 weeks (T14 and T28). At T-7, T0, T14 and T28, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and angulated bleeding index (AngBI) were taken. RESULTS: During the first week (T-7/T0 unclean phase), FMPS decreased significantly in all groups except the group using dental floss. At T28, a significant decrease in FMPS (P < .001, all groups) and FMBS (P < .05, all groups except the group using flossing P < .001) was noted. Interdental FMPS showed significantly lower values in subjects treated with interdental brushes or rubber interdental picks vs toothbrushing alone (P < .05). The use of interdental picks was associated with reduced interdental FMBS when compared to flossing (P < .05). CONCLUSION: In young subjects, with no interdental attachment loss, toothbrushing or toothbrushing and adjunctive interdental cleaning devices such as dental floss, interdental brushes or interdental rubber picks can significantly reduce both plaque and gingival inflammation. Use of interdental brushes or rubber picks reduces more interdental plaque in comparison with toothbrushing alone.

Gold nanoparticles as scaffolds for poor water soluble and difficult to vehiculate antiparkinson codrugs.

We report the facile and non-covalent preparation of gold nanoparticles (AuNPs) stabilized by an antiparkinson codrug based on lipoic acid (LA). The obtained AuNPs appear stable in both dimethyl sulfoxide and fetal bovine serum and able to load an amount of codrug double the weight of gold. These NPs were demonstrated to be safe and biocompatible towards primary human blood cells and human neuroblastoma cells, one of the most widely used cellular models to study dopaminergic neural cells, therefore are ideal drug carriers for difficult to solubilize molecules. Very interestingly, the codrug-stabilized AuNPs were shown to reduce the accumulation of reactive oxygen species in SH-SY5Y cells treated with LD and did not change total oxidant status levels in cultured human blood cells, thus confirming the antioxidant role of LA although bound to AuNPs. The characterization of AuNPs in terms of loading and stability paves the way for their use in biomedical and pharmacological applications.

Effect of pre-operatory low-level laser therapy on pain, swelling, and trismus associated with third-molar surgery.

BACKGROUND: The extraction of impacted third molars is commonly associated to pain, edema, trismus, limited jaw opening and movements. The aim of this retrospective study is to verify if pre-surgical low-level laser therapy (LLLT) associated with the extraction of impacted lower third molars could add benefits to the postoperative symptoms respect LLLT performed only after surgery. MATERIAL AND METHODS: Data from 45 patients subjected to a surgical extraction of lower third molars were pooled and divided into three groups. Patients that received only routine management were inserted in the control group. Group 1, were patients that received LLLT immediately after surgery and at 24 hours. In group 2 were included patients treated with LLLT immediately before the extraction and immediately after the end of the procedure. Data were analyzed using linear regression and descriptive statistics. RESULTS: Both laser-treated groups were characterized by minor events of post-surgery complications of pain, edema, trismus. The use of NSAIDs in the first 24 hours was significantly inferior in Group 2. CONCLUSIONS: Pre-surgical LLLT treatment seems to increase the analgesic effect of LLLT. However, trismus and edema were reduced in both laser treated groups, independently from the period of irradiation.

Does cyclic guanosine monophosphate induce autophagy in thyroid malignant carcinoma through down-regulation of cyclic guanosine monophosphate phosphodiesterase?

The aim of this study was to evaluate whether or not the expression of cGMP- phosphodiesterases (cGMP-PDE) varies in different thyroid pathologies and to elucidate the relationship between the expression of cGMP-PDE, cGMP, and autophagy. Fifty-four thyroid biopsy samples, excised to perform the biopsy, were split into two parts and randomly assigned: one part was microscopically examined and histological classified, and the other was frozen and analysed in order to evaluate the cGMP-PDE activity. Intracellular cGMP was also measured. A strong expression of intracellular cGMP and cGMP-PDE activity was observed in carcinoma in respect to controls and benign pathologies. The level of cGMP-PDE in papillary carcinoma without lymph node involvement (N-) was approximately four-fold higher compared to those with lymph node invasion (N±). On the contrary, the cGMP was one and a half times higher in N± than N-. Our results are promising, although further epigenetical studies are needed to confirm this association. A correlation between the cGMP-degrading activity and the severity of thyroid pathology has been shown. The decrease of cGMP-PDE and the increase of cGMP in N± papillar carcinoma could be an autophagic stimulus, a defence mechanism of the body, against the cancer that is expanding and invading other tissues and organs.

Effect of low energy light irradiation by light emitting diode on U937 cells.

Photobiomodulation (PBM) can induce a set of different biological modulators either in vitro or in vivo. Experimental evidence has highlighted the role of light effects on the mechanisms related to inflammation, apoptosis and autophagy. The goal of this project was the evaluation of PBM on U937, an established cell line of histiocytic lymphoma origin. Several aspects of modulation of proinflammatory pathways were analyzed and autophagic and proapoptotic mechanisms related to low laser light exposure of cells were studied. As a source of low energy light emission, we used an NIR-LED device, characterized by an 880 nm-wavelength as light source. Flow cytometry analysis was performed on supernatants of controls and treated U937 cells to detect inflammatory cytokine levels. In order to evaluate NF-kB and caspase3 expressions, Western blot analysis was performed according to standard procedures. In this report, we show the effect of PBM on a monocyte/macrophage established tumor cell line (U-937). We demonstrate that LED exposure, in the presence or absence of lipopolysaccharide (LPS), activates cell degranulation, increased expression of Interleukin-8 (IL-8) and modulation of beta galactosidase activity. Evidence shows that the well-known pro-inflammatory nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) and the apoptotic marker (caspase3/cleaved-caspase3 ratio) are up-regulated in response to a proinflammatory biochemical pathway.

Alkaline phosphatase level in gingival crevicular fluid during treatment with Quad-Helix.

The aim of this work is to assess the level of the human alkaline phosphatase enzyme (ALP) during palatal expansion with Quad-Helix (QH) appliance. A total of twenty-two orthodontic patients characterized by contraction of the upper jaw, that needed application of a QH in order to treat their condition, were included in this study. Gingival crevicular fluid (GCF) was collected at four different times: before cementation (T0), after two weeks (T1), after four weeks (T2) and after one year (T3) from application of QH. In each patient maxillary first molars, right (UM-right) and left (UM-left), which were connected with bands to QH, were used for testing; first lower molars were used as Controls (LM-right, LM-left). Data show that ALP level in tension sites was proportional to the average increase of the inter-molar distance; on the contrary, the enzymatic level in compression sites was characterized by an inverse trend. The only exception to this phenomenon was recorded after one year (T3), when the increase of ALP level in both sites of tension and compression was ascribed to a mild inflammation due to bacterial plaque accumulation. The level of ALP in control sites was constant for the whole period of observation. The described ALP fluctuations in accordance with the inter-molar distance increment, shows that the main action of QH on bone remodelling was exerted during the fourth week (T2); for this reason, the monitoring of this enzyme could be used as a marker of effective function of the QH appliance.

Evaluation of family-centred services from parents of Chinese children with cerebral palsy with the Measure of Processes of Care.

BACKGROUND: Family-centred service (FCS) has become essential to parents of children with cerebral palsy (CP) and professionals in Chinese paediatric rehabilitation services. FCS practice meets the unique needs of the child and family, through facilitation of optimal service provision delivered by professionals, and ensures service systems to be flexible, appropriate and actively responsive to the family needs. Parents used the Measure of Processes of Care 20 (MPOC-20) questionnaire to evaluate and verify the efficacy of use in China. The aims of the present study were twofold: to assess the validity and reliability of the Chinese MPOC-20, and investigate the range of parents' satisfaction with service provision in an FCS practice using the MPOC-20. METHODS: The Chinese MPOC-20 was selected to assess parent satisfaction with service provision of professionals in FCS practice. Participants were parents of children under 8 years of age with CP, who had received rehabilitation services between May 2012 and May 2013, and were receiving rehabilitation services in May 2013 at a hospital outpatient department and a rehabilitation centre. RESULTS: The reliability and validity of the Chinese MPOC-20 were confirmed. Parents evaluated FCS practice with the MPOC-20 survey. Respectful and supportive care was rated with the highest score and providing general information the lowest. Parents according to the data were dissatisfied with the lack of information. CONCLUSIONS: Parents fairly evaluated service provision of professionals in FCS practice with the Chinese MPOC-20. Professionals received feedback reports of parents, summaries of the inadequacy of service delivery, and developed and implemented ameliorated measures in the FCS policy to strive to provide exemplary service.

Disaster nursing skills, knowledge and attitudes required in earthquake relief: Implications for nursing education.

BACKGROUND: Globally, nurses becoming more aware of getting better prepared for disaster relief, but in China, disaster nursing knowledge, courses and research are still limited. INTRODUCTION: China has long been prone to disasters, but disaster nursing education and training is in its infancy. AIM: This study explored the skills, knowledge and attitudes required by registered nurses from across China who worked in the aftermath of three large earthquakes to try to determine future disaster nursing education requirements. METHOD: The Questionnaire of Nurses' Disaster Nursing Skills at Earthquake Sites, assessing nursing skills, knowledge and attitudes, was distributed to 139 registered nurses in 38 hospitals in 13 provinces across China who had worked in one or more earthquake disaster zones. Descriptive statistics were used for quantitative data, and content analysis for qualitative data. RESULTS: Eighty-nine questionnaires were returned, a response rate of 68.3%. No respondent had ever received specific disaster nursing training prior to their post-earthquake nursing. Skills most often used by respondents were haemostasis bandaging, fixation, manual handling, observation and monitoring, debridement and dressing, and mass casualty transportation. Respondents identified that the most important groups of skills required were cardiopulmonary resuscitation; haemostasis, bandaging, fixation, and manual handling; and emergency management. They emphasized the need for psychological care of victims as well as that of fellow health workers. CONCLUSION: No respondent had ever received disaster nursing training prior to engagement at the earthquake disaster sites. All believed that there were important gaps in their knowledge and skills, and supported disaster nursing courses in the future. IMPLICATIONS FOR NURSING AND HEALTH POLICY: China urgently needs to develop disaster nursing courses, with the support of nurse leaders, educationalists and government, to implement training using an all hazards approach in accordance with international best practice and trainees' background clinical experience and knowledge.

The c.480C>G polymorphism of hOCT1 influences imatinib clearance in patients affected by chronic myeloid leukemia.

The aim of the study was to investigate any possible influence of polymorphisms of transmembrane transporters human organic cation transporter 1 (hOCT1), ABCB1, ABCG2 on imatinib pharmacokinetics in 33 men and 27 women (median age and range, 56 and 27-79 years, respectively) affected by chronic myeloid leukemia. A population pharmacokinetic analysis was performed to investigate imatinib disposition in every patient and the role of transporter polymorphisms. Results showed that the α1-acid glycoprotein and the c.480C>G genotype of hOCT1 had a significant effect on apparent drug clearance (CL/F) being responsible, respectively, for a 20% and 10% decrease in interindividual variability (IIV) of CL/F (from 50.1 up to 19.6%). Interestingly, 25 patients carrying at least one polymorphic c.480 G allele had a significant lower CL/F value with respect to the 35 c.480CC individuals (mean±s.d., 9.6±1.6 vs 12.1±2.3 l h(-1), respectively; P<0.001). In conclusion, the hOCT1 c.480C>G SNP may significantly influence imatinib pharmacokinetics, supporting further analyses in larger groups of patients.

Samoan Philosophy of Nursing: a basis for culturally proficient care and policy.

AIM: To explore nurses' perspectives about the Samoan Philosophy of Nursing, and determine its feasibility for nursing care of Samoans internationally. BACKGROUND: This philosophy is the conceptual cultural framework for nursing law, practice, education and research in Samoa, and was developed by Samoan nurses who recognized the need for guidance to deliver quality, culturally competent and proficient health care. DESIGN: A mixed method study, employing a questionnaire and ethnographic methods. METHOD: The Samoan Philosophy of Nursing Questionnaire sought demographic data and aspects about the philosophy from 95 registered nurse clinicians, administrators and educators throughout Samoa during 2012. Descriptive statistics were used for data analysis. Additionally, 19 focus groups (5-6 participants each) and 19 in-depth interviews were held to further explore these aspects, as well as participant observations. Descriptive statistics were used to analyse quantitative data, and Spradley's ethnographic method was adopted for analysing the qualitative data. FINDINGS: Of 95 questionnaires analysed, 70% of participants reported using the philosophy all the time, and 30% most of the time. They placed a high satisfaction rate, value and importance on this philosophy. From the ethnography, six major themes emerged: valuable framework of learning; conceptual framework for holistic assessment; benchmark for regulating and monitoring practice improving interaction and culturally proficient practice; potential use for Samoans overseas; and maintaining quality health and the dignity of people. CONCLUSION: This first-time study evaluated the Samoan Philosophy of Nursing and adds to nursing knowledge. Findings confirmed its usefulness as a culturally based conceptual framework to facilitate, regulate and monitor education, research and practice for sustainable health outcomes in Samoa, and for Samoans living abroad. IMPLICATIONS FOR NURSING POLICY AND EDUCATION: It is important that Samoans living abroad receive culturally proficient care, but this requires the support of policymakers, nurse leaders and educators so that nurses internationally can access and competently utilize relevant aspects of this philosophy in practice.

Factors associated with post-natal anxiety among primiparous mothers in Nepal.

BACKGROUND: In Nepal, new mothers are fatigued by childcare responsibilities because of lack of knowledge and preparation for their new role. Knowledge deficit and adherence to traditional health practices place infants at risk. Some cultural practices for the care of newborns may cause tetanus, hypothermia or other life-threatening illnesses. Maternal education, previous experience of newborn care, economic status, relationship problems with husband or mothers-in-law and dissatisfaction with social relations are the variables of interest for this study. AIMS: To examine the association between socio-demographic variables and post-natal anxiety among primiparous mothers in Nepal. DESIGN: The study was designed as a correlational study. SETTING: A major maternity hospital in Kathmandu, Nepal. PARTICIPANTS: The sample were 216 primiparous mothers who were followed at 5-6 weeks after delivery. METHODS: Three instruments were used for data collection: a demographics questionnaire, the Newborn Care Knowledge Questionnaire and the State-Trait Anxiety Inventory for Adults. RESULTS: The mothers' knowledge of newborn care, general educational level and income were inversely related to maternal anxiety, that is, mothers with a lower educational level and socio-economic status demonstrated a higher level of post-natal anxiety. Poor relationships with husbands or mothers-in-law and low social support presented potential for the development of anxiety and depression during post-partum period. CONCLUSION: Maternal education, socio-economic status and knowledge of newborn care were major factors of post-natal anxiety. On the other hand, women with low income and education, poor relationships with their husbands or mothers-in-law, and insufficient social support are vulnerable to the development of moderate to severe anxiety. HEALTH POLICY: Policy implications from these results indicate the need for support and funding from the Ministry of Health for education for women at hospitals, which must work together to offer newborn care education during the ante-natal and post-natal periods.

Association between the organoleptic scores, oral condition and salivary ß-galactosidases in children affected by halitosis.

OBJECTIVES: The goal of this work is to evaluate the association between organoleptic scores, oral condition and salivary ß-galactosidases, to facilitate the differential diagnosis of halitosis in children. METHODS: Fifty systemically healthy children with a primary complaint of oral malodour were included in this cross-sectional study. The organoleptic evaluation was carried out by two judges, evaluating the intensity of malodour of the air exhaled 5 s through the mouth of the patients, at a distance of approximately 10 cm from their noses; the level of salivary ß-galactosidases was quantified spectrophotometrically after a chromatic reaction between a salivary sample of each patient and a specific chromatic substrate of the enzyme. Clinical conditions, such as visible plaque and gingival bleeding index, tongue coating score, localized food stagnation and other oral parameters, were evaluated by qualified dentists through an oral check-up. RESULTS: The ß-galactosidase level was significantly related to the organoleptic scores and clinical parameters, such as the tongue coating score and the visible plaque index. Stratifying results with respect to the different phase of the day at which parents complained halitosis in their children, statistical analysis showed that the organoleptic scores and the level of ß-galactosidases were significantly higher in children who suffered of halitosis during the whole day, A = 40%, with respect to those without this problem, N = 20% (P = 0.001 and P = 0.006, respectively). CONCLUSIONS: Certain oral parameters such as halitosis during the whole day, high tongue coating score and high visible plaque index were particularly associated with an increase in the salivary ß-galactosidase level.