Future directions for the concept of salutogenesis: a position article.

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one's movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky's original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal's work to strengthen salutogenesis as a theory base for health promotion.

Long-term Data from the Swedish National Environmental Monitoring Program of Pesticides in Surface Waters.

Environmental monitoring is essential for assessing the impact of human activities on the environment. Monitoring data are used to ascertain that environmental standards are met, to inform policy making, to determine trends, and to provide parameterization data for prediction models. The design of monitoring programs depends on what is being monitored, for what purpose, and available resources. Here we describe the strategy and design of the Swedish environmental monitoring program for chemical pesticides in surface waters and provide data generated within this program since 2002 (). We include examples of how the data can be used for toxicity assessments, trend analyses, and comparison between sampling strategies. Our goal is to increase awareness of this dataset and provide detailed information about the data so that it may be incorporated into meta-analytical research, comparison studies, model validation, and other scientific efforts.

Urethral instillations of clobetasol propionate and lidocaine: a promising treatment of urethral pain syndrome.

PURPOSE: To evaluate topical treatment with clobetasol propionate and lidocaine in women with urethral pain syndrome (UPS) in a retrospective pilot study. MATERIALS AND METHODS: Urethral instillations of two ml clobetasol propionate cream and two ml lidocaine gel in 30 Caucasian women age 15-74 years with UPS between 1999 and 2006 were evaluated retrospectively. Instillations were given ap- proximately once a week until the patient improved. Between one and 15 (median three) instillations were given. In substudy I a review was undertaken of the medical records to register the treatment effect at the end of the treatment (the last instillation) and any relapses six months thereafter. Substudy II was a follow-up at least five years after last instillation based on medical records and a written ques- tionnaire. RESULTS: Substudy I (n=30): By the end of the treatment 18 women had no symptoms and 12 were improved. Five patients had relapsed within six months. Substudy II (n=28): Twenty-eight women responded to the questionnaire. Four women remained with no symptoms, 18 remained improved, and six had the same symptoms as before treatment. Twenty women thought the treatment was very effective, five rather effective, and three women reported poor effect. Twenty-six women would ask for retreatment if a relapse oc- curred, two patients would not. No side effects, except transient pain, were reported. CONCLUSIONS: This retrospective study and long- term follow-up suggests that urethral instillation of clobetasol propionate and lidocaine is effective in treating women with UPS. Randomized control studies are warranted.

Characterization of pulmonary function in Duchenne Muscular Dystrophy.

Decline in pulmonary function in Duchenne Muscular Dystrophy (DMD) contributes to significant morbidity and reduced longevity. Spirometry is a widely used and fairly easily performed technique to assess lung function, and in particular lung volume; however, the acceptability criteria from the American Thoracic Society (ATS) may be overly restrictive and inappropriate for patients with neuromuscular disease. We examined prospective spirometry data (Forced Vital Capacity [FVC] and peak expiratory flow [PEF]) from 60 DMD patients enrolled in a natural history cohort study (median age 10.3 years, range 5-24 years). Expiratory flow-volume curves were examined by a pulmonologist and the data were evaluated for acceptability using ATS criteria modified based on the capabilities of patients with neuromuscular disease. Data were then analyzed for change with age, ambulation status, and glucocorticoid use. At least one acceptable study was obtained in 44 subjects (73%), and 81 of the 131 studies (62%) were acceptable. The FVC and PEF showed similar relative changes in absolute values with increasing age, i.e., an increase through 10 years, relative stabilization from 10-18 years, and then a decrease at an older age. The percent predicted, FVC and PEF showed a near linear decline of approximately 5% points/year from ages 5 to 24. Surprisingly, no difference was observed in FVC or PEF by ambulation or steroid treatment. Acceptable spirometry can be performed on DMD patients over a broad range of ages. Using modified ATS criteria, curated spirometry data, excluding technically unacceptable data, may provide a more reliable means of determining change in lung function over time.

Increased prefrontal activity and reduced motor cortex activity during imagined eccentric compared to concentric muscle actions.

In this study we used functional magnetic resonance imaging (fMRI) to examine differences in recruited brain regions during the concentric and the eccentric phase of an imagined maximum resistance training task of the elbow flexors in healthy young subjects. The results showed that during the eccentric phase, pre-frontal cortex (BA44) bilaterally was recruited when contrasted to the concentric phase. During the concentric phase, however, the motor and pre-motor cortex (BA 4/6) was recruited when contrasted to the eccentric phase. Interestingly, the brain activity of this region was reduced, when compared to the mean activity of the session, during the eccentric phase. Thus, the neural mechanisms governing imagined concentric and eccentric contractions appear to differ. We propose that the recruitment of the pre-frontal cortex is due to an increased demand of regulating force during the eccentric phase. Moreover, it is possible that the inability to fully activate a muscle during eccentric contractions may partly be explained by a reduction of activity in the motor and pre-motor cortex.

Imbalance of the autonomic nervous system at night in women with gestational diabetes.

AIMS: Autonomic nervous system dysfunction is observed in Type 2 diabetes. As gestational diabetes is a potent risk factor of later Type 2 diabetes, we set out to determine whether autonomic nervous system imbalance could already be observed in women with this condition. Because activity of the sympathetic nervous system tends to be relatively stable in the nocturnal hours, we performed the study at night. RESEARCH DESIGN AND METHODS: We studied 41 women with gestational diabetes, 22 healthy pregnant controls and 14 non-pregnant controls. We assayed plasma noradrenaline at 24.00, 04.00 and 07.00 h and performed an overnight Holter recording for heart rate variability analysis. In addition, we assayed plasma adrenomedullin, a cardiovascular protective hormone. RESULTS: Compared with non-pregnant controls, plasma noradrenaline levels were increased at 04.00 and 07.00 h in the gestational diabetic (P = 0.003) and pregnant control (P = 0.002) groups, with no difference between them. Heart rate variability, very-low-frequency and low-frequency power were lower in pregnant groups compared to the non-pregnant controls. Heart rate variability remained unchanged between specified sampling times in the gestational diabetic group, in contrast to fluctuation seen in the control groups. CONCLUSIONS: Gestational diabetes, compared with normal pregnancy, seems not to be a state of overall sympathetic nervous system activation. At the heart level, however, an inhibitory effect on autonomic nervous system modulation was seen. Plasma noradrenaline and heart rate variability correlated well, supporting the use of this function in future studies of overall sympathetic activity during pregnancy.

Effects on leg muscular performance from whole-body vibration exercise: a systematic review.

The purpose of this study was to investigate the effects on leg muscular performance from whole-body vibration exercise. Literature search was performed on the databases Pubmed, Cinahl, ISI web of science (Sci-expanded, SSCI) and Embase (Rehab & Physical Med). Rating of 19 relevant studies was performed (14 on long-term exercise and five on short-term exercise) using a score system for the methodological quality. Several randomized-controlled trial studies of high to moderate quality show similar improvements from long-term regimen on muscular performance in the legs after a period of whole-body vibration exercise. As there were few studies on short-term exercise and as they had no control groups, the same convincing improvements regarding muscular performance were not achieved. Preliminarily, there is strong to moderate evidence that long-term whole-body vibration exercise can have positive effects on the leg muscular performance among untrained people and elderly women. There is no clear evidence for effects on muscular performance after short-term vibration stimuli.

Transplanted children's experiences of daily living: children's narratives about their lives following transplantation.

Transplantation is often an appropriate choice of treatment for children with end-stage renal, liver, heart or lung disease. Over the last decade, mortality and morbidity figures have been relatively stable and quality of life fairly good in children who have undergone organ transplantation. Few studies however, have focused on the experiences of transplantation from the child's perspective. The child's view is an important factor when evaluating the 'true' outcome and quality of life after transplantation. The aim of the present study was to illuminate the meaning of transplanted children's experiences of daily living. Unstructured interviews were carried out with 18 children and adolescents, aged 4-18 yr, who had undergone organ transplantation. Their narratives were transcribed and interpreted using a phenomenologic-hermeneutic method inspired by the philosophy of Ricoeur. Two main themes emerged: Being satisfied with life, with the themes: being able to live a normal life; someone who cares; coping with one's new life; and being dissatisfied with life, with the themes: not being able to live a normal life; lacking someone who cares; not being respected; existential thoughts. Most of the children and adolescents were of the opinion that they lived a normal life while the rest strived to achieve a normal life. Social support and mental support were of great importance and, when lacking, had negative consequences. Multi-disciplinary co-operation between healthcare professionals and between the healthcare system, the school and the family is crucial in order to optimize the outcome and quality of life after organ transplantation in children.

Making healthy choices easy choices: the role of empowerment.

An important goal of health promotion is to make it easier for people to make healthy choices. However, this may be difficult if people do not feel control over their environment and their personal circumstances. An important concept in relation to this is empowerment. Health professionals are expected to facilitate and enable people moving towards empowerment. In this paper, we address the question what is meant by individual empowerment. In an attempt to provide a theoretical framework, we discuss individual empowerment from a salutogenic perspective. This perspective introduces two fundamental concepts: the general resistance resources, and the sense of coherence. In addition, in order to further clarify and operationalise the concept, some factors influencing individual empowerment are identified, that is, locus of control, learned helplessness, self-efficacy and outcome expectations. These concepts find common ground in feelings of (lack of) control, but they differ in stability and changeability. We provide some suggestions how these factors can be influenced, and we discuss the meaning of the identified factors for empowering interactions between professionals and their clients. Health professionals can facilitate people to see a correspondence between their efforts and the outcomes thereof, improve and facilitate health literacy, in a relationship which can be characterised as partnership.

Open-set speech perception in adult cochlear implant users with ossified cochleae.

This study describes open-set speech recognition in cochlear implant subjects with ossified cochleae and compares it to a control group with open cochleae. Twenty-one postlingually deafened adults with a Med-El Combi 40/40+GB split- electrode implant were matched to patients using a Med-El cochlear implant with a standard electrode. Speech recognition was assessed over an 18-month period. Split- electrode patients improved significantly over time, but their scores were significantly lower and increased significantly slower than those of controls. Of 14 patients with a duration of deafness less than 20 years, average sentence test scores were 50%, and average monosyllabic word test scores were 31%. This study provides evidence that cochlear implantation is beneficial to patients with ossified cochleae, but early implantation is advisable.

Introducing simulation technologies in nurse education: a nursing practice perspective.

Computer simulations have been widely used for training purposes and proliferate in nursing and medicine. To take account of the multifaceted nature of nursing, a participatory design approach was applied in which nursing practice was utilized as a point of departure for exploring the educational value of the new technologies. In an empirical study, nurses with different degrees of experience were interviewed about those tasks within nursing that they perceived as difficult to learn, and how simulation technologies might contribute to learning the management of these. Six aspects of expertise emerged:judging the patient's health status; monitoring care interventions; prioritizing and carrying out interventions efficiently; communicating with patients and their relatives; cooperating with other members of the staff; and managing complexity. Most aspects include dynamic and complex features, and simulations were judged to be useful for capturing these and, subsequently, for training. Other aspects, such as focusing on human interaction, were assessed to be less prolific. Compared to traditio nal teaching media, the dynamic featuresof simulations were judged to be most useful. Training with simulations was regarded as complementary to other forms of instruction, and the curricular integration of simulations decisive in determining their cont ribution to learning in nurse education.

The effects of preexercise stretching on muscular soreness, tenderness and force loss following heavy eccentric exercise.

The present study sought to investigate the effects of preexercise stretching on delayed onset muscle soreness (DOMS), i.e. soreness, tenderness and loss of muscle force, that usually occurs after strenuous or unaccustomed eccentric exercise. Ten female volunteers performed 10 sets of 10 maximal isokinetic eccentric contractions for knee flexion with both legs after a 5-min ergometer cycling warm-up. Prior to the exercise for one leg, randomly chosen, 4 x 20 s of static stretching for the hamstring muscle group was implemented. Rated soreness, tenderness on algometer pressure and loss of maximal eccentric contractile force was evaluated preexercise and 24, 48 and 96 h postexercise. The exercise bout produced severe DOMS, with parameters peaking and troughing at 48 h postexercise. However, no significant differences were found, regarding any of the parameters, when comparing stretched and nonstretched legs. The present study thus suggests that preexercise static stretching has no preventive effect on the muscular soreness, tenderness and force loss that follows heavy eccentric exercise.

Phase Equilibria and Structure of the 1-Dodecylpyridinium Bromide-Dodecane-Water System.

The isothermal ternary phase diagram for the 1-dodecylpyridinium bromide/dodecane/water system was determined at 40 degreesC by 2H NMR and polarizing microscopy methods. Two liquid crystalline phases, a large cubic area and a normal hexagonal phase, and one isotropic normal micellar solution phase were characterized, and their ranges of existence were determined. The micelles were found to be probably small and spherical at lower concentrations of surfactant, and were found to grow at higher concentrations and on addition of oil. The two-phase areas, L1 + HI and HI + I, are both very narrow. The comparatively large cubic area, containing 43-63 wt% surfactant and 3-10 wt% dodecane, is probably consistent of more than one structure. SAXS experiments indicate two different structures built of discrete micellar aggregates. Copyright 1998 Academic Press.

Repeated maximum reciprocal knee movements in patients with minimal overt symptoms after ischaemic stroke: an evaluation of mechanical performance and EMG.

The ability to perform reciprocal knee flexions and knee extensions was investigated in patients with minimal or no overt motor symptoms after stroke. Ten patients and 22 controls performed 10 maximal reciprocal knee extensions and knee flexions without intervening rest period using an isokinetic dynamometer (Cybex II). Peak torque (PT; Nm), signal amplitude (RMS) and mean frequency (fmean) of the electromyography were registered for each extension and flexion separately and as the ratio extension/flexion. The patients exhibited pronounced motor deficit despite no or minimal overt clinical symptoms. The reduced motor capacity in the knee muscles was shown as a decrease in the PT and in a different electromyographic pattern compared with the controls. A bilateral affection was found with the formerly hemiparetic side mostly affected. Repeated reciprocal contractions influenced the motor performance, shown as an increase of the PT ratio in the patients, which was especially pronounced with an increasing number of contractions.

Intraoperative electrical stimulation of the stapedius reflex in children.

OBJECTIVE: To describe the use of intraoperative electrical stimulation on the stapedius reflex in children. SETTING: Hospital cochlear implantation center. PATIENTS AND METHODS: Eighteen children under the age of 10 years, who have undergone cochlear implantation, have been examined during surgery with the electrically elicited stapedius reflex in the monopolar stimulation mode. RESULTS: A stapedius reflex could visually be detected for all subjects. CONCLUSION: The responses serve to test the implant, provide guidance in avoiding overstimulation of the child when the device is switched on, and estimate the optimal C-levels.

Some experiences with the nucleus 20 + 2 cochlear implant in adults and children.

OBJECTIVE: To evaluate the effectiveness of the Nucleus 20 + 2 implant in a group of patients. PATIENTS: Fifteen children and 11 adults who have received the Nucleus 20 + 2 implant since late 1993. RESULTS: The outcome in most patients has been favorable.

Quality of life in children with congenital heart defects.

Quality of life was measured in children with congenital heart defects (CHDs) registered in a total population of infants born live in the period 1982-91 (n = 22,810), using essential life spheres: external living conditions, interpersonal and personal conditions. In 200 children with CHD alive at the time the investigation was performed, 164 (82%) of the families answered a questionnaire addressing different dimensions of these quality of life spheres. Three subgroups of CHDs were investigated: CHDs spontaneously cured (n = 80), CHDs treated by surgery (n = 56), and CHDs with associated syndromes/malformations (n = 29). 301 (75%) out of 400 controls, matched for age and habitat (county), answered the same questionnaire. The children's ages at investigation were 2 y 2 months-12 y 2 months (median 6 y 1 month). There were no statistically significant differences between the CHD groups and the controls for overall quality of life for any of the three life spheres (p > 0.05). In children with operated CHDs and CHDs associated with syndromes/malformations, quality of life was influenced at some aspects of the external as well as at the interpersonal and personal levels. A trend existed for a higher subjective experience of quality of life in the total CHD group as well as in all the subgroups. It is speculated that this may represent development of coping mechanisms and recalibration of values of life.