Women's reflections and actions regarding working after breast cancer surgery - a focus group study.

BACKGROUND: To better understand processes affecting return to work (RTW) after breast cancer, more knowledge from the perspective of sickness absentees is warranted. Still, research based on women's own reasoning and actions in RTW is very scarce. This study aims to elucidate how women with breast cancer reflect and act on work-related issues. MATERIAL AND METHODS: Thematic analyses of data from four focus group interviews with 23 women who had had breast cancer surgery in the previous 3-13 months were carried out. RESULTS: The five following themes of reflections regarding RTW were identified: 'health and functioning', 'self-esteem/integrity', 'value of work', 'relationships at work', and 'social circumstances'. These reflections were associated with the three identified themes of actions taken by the women: 'to work or to be sickness absent', 'to adjust work according to own needs or not', and 'to disclose or to hide one's cancer'. There was a distinct difference between women who experienced work as a source of well-being and those who needed a respite from work. CONCLUSION: This study adds knowledge to the process of RTW after breast cancer and focuses on factors that lead the women to an active role in this process. We point to the interplay between women's own preferences, perceived competence, outer opportunities, and the actions each woman take with regard to RTW, which need to be recognized by all stakeholders involved. Furthermore, it continues to be essential to address the specific issue of disclosure in the workplace because this may be distressing for women.

Fluoride-supplemented milk inhibits acid tolerance in root caries biofilms.

In this study we investigated the effect of fluoride on plaque acid tolerance. The test group consumed 200 ml of milk supplemented with 5 mg F/l as NaF once a day, the milk control group drank 200 ml of unsupplemented milk, and the no-milk control group did not consume milk in this manner. Plaque samples were taken at baseline and after 15 months. The proportion of acid-tolerant bacteria in plaque was estimated using LIVE/DEAD® BacLight™ staining after exposure to pH 3.5 for 2 h. The fluoride group showed a statistically significant decrease in plaque acid tolerance compared to baseline. This study shows that daily intake of fluoride in milk reduces plaque acid tolerance.

Health-related quality of life and distress in cancer patients: results from a large randomised study.

To compare the effectiveness of individual support, group rehabilitation and a combination of the two in improving health-related quality of life (HRQOL) and psychological well-being in cancer patients during 24 months after diagnosis, as compared with standard care (SC). Furthermore, to compare the study sample and a random sample of the Swedish population with regard to HRQOL. A total of 481 consecutive patients, newly diagnosed with cancer, were randomly assigned to one of the four alternatives. Data on HRQOL and psychological well-being were collected at baseline and after 3, 6, 12 and 24 months. The interventions did not improve HRQOL or psychological well-being, as compared with SC. At 3 months, the study sample reported an HRQOL comparable with the normal population. Many cancer patients are able to manage their cancer-related concerns with the support available from SC. However, it is reasonable to assume that the findings suffer from a lack of data from especially vulnerable patients and a possible Hawthorne effect. It cannot be concluded that cancer patients have no need for additional psychosocial interventions. Future projects should include screening and target interventions for those at risk for significant and prolonged psychological distress.

Magnetic susceptibility of laccases and ceruloplasmin.

1. Recent magnetic susceptibility measurements on laccase (monophenol,dihydroxyphenylalanine:oxygen oxidoreductase, EC 1.14.18.1) from the lacquer tree Rhus vernicifera showed a deviation from Curie behaviour above 50 K, which was taken as evidence for an antiferromagnetically coupled Cu(II)-Cu(II) pair in the oxidized enzyme. The magnetic susceptibility of this protein has been reinvestigated. Further measurements on laccase from the fungus Polyporus versicolor and human ceruloplasmin (iron(II):oxygen oxidoreductase, EC 1.16.3.1) are presented. 2. The magnetic susceptibility of fungal laccase and lacquer tree laccase can be accounted for by the EPR detectable copper ions in the temperature range 40--300 K. 3. If an antiferromagnetically coupled Cu(II)-Cu(II) pair exists in the laccases, then the coupling, expressed as --J, should be at least of the order of 300 cm-1, as deduced from the Curie dependence of the susceptibility and the sensitivity in our measurements. 4. If an analogy with the laccases is assumed for the EPR invisible copper in ceruloplasmin then a limiting value of the coupling may be deduced also in this case, with --J at least of the order of 200 cm-1.

Antiferromagnetic exchange interaction in the two-iron-two-sulphur ferredoxin from the blue-green alga Spirulina maxima studied with a highly sensitive magnetic balance.

1. A highly sensitive magnetic balance of the Faraday type is described. 2. The magnetic susceptibility of the oxidized and reduced forms of the two-iron-two-sulphur ferredoxin from the blue-green alga Spirulina maxima has been measured over a wide temperature range. 3. The results can be interpreted within a simple model involving antiferromagnetically coupled iron atoms at the active site. The coupling, expressed as --J, is estimated to be 182 +/- 20/cm and 98 +5/-10 /cm for the oxidized and reduced forms, respectively.

Soluble tyrosine hydroxylase (tyrosine 3-monooxygenase) from bovine adrenal medulla: large-scale purification and physicochemical properties.

A new procedure that permits large-scale purification of tyrosine 3-monooxygenase (tyrosine hydroxylase) (L-tyrosine,tetrahydropteridine:oxygen oxidoreductase (3-hydroxylating), EC 1.14.16.2) from the cytosolic fraction of bovine adrenal medulla is described. The homogenous enzyme revealed a subunit Mr of 60,000 and a specific activity of 425 nmol.min-1.mg-1. The N-terminal amino-acid sequence (27 residues) revealed 89% homology with the human pheochromocytoma enzyme as deduced from its cDNA sequence. The pure enzyme contained 0.66 +/- 0.09 mol iron, 0.13 mol zinc and 0.62 +/- 0.04 mol phosphate per mol subunit of Mr = 60,000. A broad light absorption band with its maximum around 700 nm (epsilon 700 nm = 1.3 (mM monomer)-1.cm-1) explains its blue-green color. EPR spectra at 3.6 K revealed high-spin Fe(III) (S = 5/2) in an environment of nearly axial symmetry (g values at 7.2-6.7, 4.7-5.3 and 1.9-2.0). A close correlation was observed between the absorbance at 700 nm and the intensity of the axial type of EPR spectrum. The absorption peak at 700 nm is compatible with a ligand-to-iron charge-transfer transition as a result of catecholate coordination to the iron. Physicochemical studies suggest that the enzyme does not undergo such major substrate- or cofactor-induced conformational changes as have been reported for the related enzyme, phenylalanine hydroxylase.

The iron electron-nuclear double resonance (ENDOR) of 4-Fe clusters in iron-sulfur proteins from Chromatium and Clostridium pasteurianum.

Iron electron-nuclear double resonance (ENDOR) measurements were made of the 4-Fe clusters in oxidized Chromatium high-potential iron-sulfur protein, dithionite-reduced high-potential iron-sulfur protein in 80% dimethylsulphoxide, fully reduced Clostridium pasteurianum ferredoxin in aqueous solution and in 80% dimethylsulfoxide. The hyperfine couplings determined show that: i) the electron distribution in each case is nearly symmetric; ii) there are two types of iron in oxidized high potential iron-sulfur protein; iii) only one type of iron is observed in each fully reduced 4-Fe cluster; iv) the data also suggest a greater electron delocalization onto the ligands as compared to the 2-Fe ferredoxins.

Adaptive behavior in stressful situations and stroke incidence in hypertensive men: results from prospective cohort study "men born in 1914" in Malmö, Sweden.

BACKGROUND AND PURPOSE: Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men. METHODS: Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence. RESULTS: Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81). CONCLUSIONS: The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.

Reduced cadmium levels in human kidney cortex in sweden.

Environmental pollution with the nephrotoxic metal cadmium is considered a potential health risk for the general population. In 1976 it was reported that the cadmium concentration in human kidney cortex in Sweden had increased in parallel with increasing levels in soil and grain during the twentieth century. Since the cadmium concentration in farming lands is still increasing, the present study was undertaken to further elucidate whether the cadmium concentration in the kidney is still increasing. Kidney cortex biopsies were collected at 171 autopsies of victims to sudden and accidental death during 1995 and 1996, and the cadmium concentrations were determined and compared with previously published Swedish data obtained from forensic autopsies. The geometric mean cadmium concentration in kidney cortex in subjects 40 years of age and younger was about 40% of the concentration found in the 1970s, while the reduction was less pronounced among older people. The highest individual concentration of cadmium was 41.5 microg/g wet weight (ww). The geometric mean concentration was less than 14 microg/g ww at ages around 50 years of age, when the cadmium concentration in kidney cortex is highest, as compared with approximately 20 microg/g ww in the 1970s. There was also a reduction in cadmium concentrations among nonsmokers; thus, a decrease in tobacco smoking in Sweden during the last decades is not the only explanation for the reduction of cadmium in the kidney cortex. Other reasons for this reduction could be changes in dietary habits and reduced cadmium contamination from Swedish industries.

Effect of delmopinol on the cohesion of glucan-containing plaque formed by Streptococcus mutans in a flow cell system.

Glucan-containing plaque was formed by Streptococcus mutans adhering to saliva-coated glass slides in flow cells thermostated at 37 degrees C. The substrate was Brain Heart Infusion broth containing 1% sucrose and 10% sterile saliva. During the build-up of the plaque, which lasted for 29 h, the plaque was subjected to three two-minute exposures to either 0.1 mol/L sodium acetate buffer, pH 6.0, or the same buffer containing 6.4 mmol/L (0.2%) of the surface-active anti-plaque substance delmopinol hydro-chloride. The glass slides carrying the plaque were weighed, and plaques subjected to delmopinol treatment weighed only seven percent of the control plaques. The glass slides were then mounted in a beaker containing buffer, subjected to ultrasonication, and re-weighed. The delmopinol-treated plaques lost 59% of their wet weight upon sonication, while the controls lost only 19%. Control plaques having the same weight as delmopinol-treated plaques were not different from the control plaques grown for 29 h with regard to reduction of plaque weight after sonication. Transmission electron micrographs (TEM) showed a plaque dominated by globular or fibrillar matrix components in controls, while the delmopinol-treated plaque showed empty or unordered matrix areas between more densely packed cells. The TEM results were confirmed by scanning electron micrographs, which showed amorphous material associated with the bacterial cells in the control but not in the delmopinol-treated plaque. In conclusion, delmopinol reduced surface-associated glucan synthesis and lowered the cohesion of the plaque, indicating that glucan-containing plaque formed during repeated rinsings with delmopinol may be easier to remove by mechanical means than a non-treated plaque of this type.

Ion probe study of fluorine gradients in outermost layers of human enamel.

F concentrations in the outermost layers of human tooth enamel were studied with the aid of a secondary ion microanalyzer. Concentration profiles were recorded in continuous sputtering analysis from the surface down to a depth of about 0.3 micrometer. Samples previously subjected to topical fluoride treatment were compared with reference specimens. In some samples, the results were compared with those obtained at greater depths by macroscopic etching analysis.

Group rehabilitation for cancer patients: satisfaction and perceived benefits.

Satisfaction with a group rehabilitation programme (GR) was evaluated in a heterogeneous group of cancer patients. Of the patients that were invited, 67% (N = 132) participated in the GR. The GR included eight sessions plus one booster-session, each including information and/or cognitive-behavioural techniques combined with physical training and relaxation and started approximately 4 months after diagnosis. Men and women participated to the same extent. A mailed questionnaire was used to assess patients' satisfaction, perceived benefits and level of difficulty of the GR components. The majority of patients stated that the number of sessions and timing of the GR was adequate. The usefulness of the GR components were rated in the following descending order: relaxation, physical training, encountering others in the same situation, breathing exercises, information and cognitive-behavioural skills. Patients were more satisfied with diagnosis-specific group meetings than with those including several diagnoses. Assessment of patient satisfaction seems appropriate to elucidate patient priorities.

Studies on metal content in the brown seaweed, Fucus vesiculosus, from the Archipelago of Stockholm.

Concentrations of eleven metals (Al, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, V and Zn) were determined in the brown seaweed Fucus vesiculosus collected from the Archipelago of Stockholm. Several factors which influence the metal content in the seaweed have been studied, including errors caused by epiphytes, sea exposure and differences depending on which part of the seaweed is analysed. It is concluded that, if all these factors are considered, Fucus vesiculosus plants are excellent bio-indicators of metal pollution. This is also demonstrated by a significant increase in metal content in transplanted Fucus vesiculosus near the city of Stockholm. The results from this investigation also indicate increasing metal concentrations, especially Cd, in samples from the northern parts of the Archipelago and the reason for this is discussed.

Vanadium poisoning of cattle with basic slag. Concentrations in tissues from poisoned animals and from a reference, slaughterhouse material.

In northern Sweden, 23 heifers out of 98 cattle died of acute vanadium toxicity in a 10-day period. Eight months earlier a pasture had been fertilized with basic slag, containing 3% vanadium. The fertilizer was laid on the surface without being ploughed in. Mainly heifers, and some cows, were fed with basic slag-contaminated fresh hay. The first signs of illness appeared 11 days later, and the first case of death appeared 14 days after the initial clinical signs. The signs were diffuse and difficult to interpret. Inappetence, black diarrhea, lethargy, dehydration and spontaneous abortions occurred. Further, pulmonary lesions, conjunctivitis, neurological disturbances such as depression, leg incoordination, and paralysis of the hind limbs and face were also noted. Although feeding with the contaminated hay was stopped at the outbreak of the toxicity, the 23 animals died or had to be slaughtered, and at necropsy of another heifer 4 weeks later, large amounts of basic slag were still found in the alimentary tract. High vanadium concentrations were found in the liver, kidneys, spleen and urine, 5.9, 5.5, 1.9 and 4.8 mg/kg w.w., respectively. In bone tissue (coccygeal vertebrae), the highest value in an acutely poisoned heifer was 0.680 mg/kd d.w., in the same range as that of an experimentally poisoned sheep. Surviving heifers were more affected than cows; the state of health of these heifers gradually deteriorated and, therefore, a few were slaughtered 3 months later. Because of residual neurological disturbances and decreased milk production, the rest of the herd was slaughtered 5 months after the outbreak, and samples were collected and analyzed. Elevated vanadium concentrations were found in the organs, especially in the spleen, where values of 1.40 and 1.42 mg/kg w.w. were found in 2 heifers at 3 months. The values in heifers (n = 6) were decreased 5 months after the outbreak. The median concentrations were somewhat higher in the liver than in the spleen, and lowest in the kidney (0.244, 0.213 and 0.058 mg/kg w.w., respectively). In the organs of the cows (n = 24), which were less exposed, the corresponding values were 0.012, 0.095 and 0.013 mg/kg w.w., respectively. Vanadium concentrations were also determined in livers of cows and calves at regular slaughter in four geographic regions of Sweden. In one of the regions, where basic slag (with 3% vanadium) had been used for many years, the values were significantly higher than those in the other regions. In a material of 293 specimens, an upper reference limit of 0.012 mg/kg liver w.w., with a 90% confidence interval of 0.011-0.019 mg/kg w.w., was found to be normal for cattle in Sweden. Concentrations above the Highest Swedish Reference Value, 0.019 mg/kg liver can be considered elevated. Vanadium-containing basic slag used as fertilizer caused poisoning in a herd of cattle and its regional use was detectable in livers from cattle at regular slaughter. Such fertilizer must be applied in a proper way. It should be ploughed in and any direct contact of grazing animals with the hazardous fertilizer should be prevented.

Caries preventive effect of a fluoride-containing varnish (Duraphat) after 1 year's study.

The caries prophylactic effect of semi-annual applications of a fluoride-containing varnish (Duraphat) was tested in 121 15-year-old children. The children were divided into a test (60 subjects). The teeth of the children in the test group were coated with fluoride varnish at the beginning of the experimental period and again 6 months later. A clinical and radiographic examination of all children was performed immediately prior to the first application of varnish and 1 year later. The mean caries increment was 0.9 new DMFS in the test group and 4.0 in the control group. The difference was statistically significant at the 0.1% level. The caries prophylactic effect on different tooth surfaces was statistically significant both on proximal and on occlusal surfaces at the 0.1% level. Analyzing the material with respect to the caries prophylactic effect against the background of caries prevalence at the start of the investigation showed a better effect in the group of children with low and medium initial DMFS values.

Dental caries, mutans streptococci, lactobacilli, and saliva secretion rate in adults.

In 718 Swedish patients, equally divided into four age groups (19-25, 26-45, 46-60, greater than 60 yr), salivary levels of mutans streptococci and lactobacilli, saliva secretion rate, and DMFS were registered. No significant differences were found between the various age groups either in salivary factors or in caries (D). Number of missing (M) and filled (F) surfaces increased with age. Prevalence of root caries, which increased with age, was significantly correlated to number of exposed root surfaces independent of age. Of the total study group, 50% had greater than or equal to 10(6) mutans streptococci and 40% had greater than or equal to 10(5) lactobacilli per mL saliva. Three percent had a saliva secretion rate of less than or equal to 0.5 mL/min. Correlation analyses showed that both mutans streptococci and lactobacilli significantly correlated to the caries prevalence but the r-value never exceeded 0.34.

Caries increment in primary teeth after application of Duraphat fluoride varnish.

In order to evaluate the possible cariostatic effect of a fluoride varnish in the primary dentition, Duraphat varnish was applied twice yearly for 2 years to the teeth of 195 3 1/2-year-old children of both sexes attending nine preparatory schools in the Warsaw area. A control group of 127 children attending nine other preparatory schools was also examined. For each child a dmfs1 index (including "caries without macroscopic defect") and a dmfs2 index ("caries without macroscopic defect" excluded) were determined as well as a dmft1 and a dmft2 index. After 2 years the difference between the test and the control groups regarding the mean dmfs1 and dmft2 index increments was 9.39% (P greater than 0.1) and 24.09% (P less than 0.05), respectively. No significant differences were found, however, concerning the dmft2 and dmfs2 indices, the percentage children with new gingival caries, the number of teeth extracted on account of caries and the number of remaining teeth. A test group of 46 children treated with fluoride varnish in which a complete radiological examination could be carried out before and after the experimental period and which was treated with fluoride varnish was compared with a similar group of 27 children, which was not treated with fluoride varnish. The differences in caries increments were small, less than 15%, and were not significant. Taking into consideration the great variation between the schools it was concluded that the cariostatic effect of Duraphat application twice yearly in the primary dentition of these children was slight.

Dietary zinc oxide in weaned pigs--effects on performance, tissue concentrations, morphology, neutrophil functions and faecal microflora.

The uptake and distribution of zinc in tissues and the effects of 2500 ppm dietary zinc oxide on health, faecal microflora, and the functions of circulating neutrophils were evaluated in weaned pigs. One group was fed a zinc supplement diet and another group was used as a control. All pigs remained healthy throughout the study, but the supplemented animals showed better performance than the controls. The serum zinc values rose rapidly. At autopsy, carried out at the age of 63 days, the zinc concentrations in liver tissue were 4.5 times higher, and in renal tissue two times higher in the supplemented group than in controls (P<0.001). Microscopic examination showed increased lipid accumulation in hepatocytes from supplemented pigs. No effect on the number of excreted Escherichia coli and enterococci per gram faeces or on the functions of circulating neutrophils was observed. Dietary supplementation with 2500 ppm ZnO for up to two weeks after weaning appears to be potentially beneficial in the prevention of postweaning diarrhoea in pigs.

The efficiency of semiannual silane fluoride varnish applications: a two-year clinical study in preschool children.

OBJECTIVE: The aim of this two-year community demonstration trial was to study the caries inhibitory effects of semiannual applications of a fluoride varnish in preschool children. METHODS: Twenty-four public dental health clinics in the county of Halland, Sweden, with 5,137 preschool children, 4 and 5 years of age, were matched and equally allocated to a fluoride varnish group (n = 2,535) and a reference group (n = 2,602). The children in the fluoride varnish group were treated every six months with topical applications of a silane fluoride varnish, Fluor Protector (0.1% F), while no fluoride varnish was used in the reference group. Both groups received a basic preventive program at annual checkups consisting of dietary counseling and instructions to parents to brush their children's teeth at least once daily with fluoridated dentifrice. Caries data were collected by clinical examinations at baseline and after one and two years. RESULTS: Caries prevalence at baseline did not differ significantly between the groups. After two years, the mean caries incidence was low and no statistical difference was found in the total number of carious and filled surfaces (dfs) between the two groups. However, the incidence of approximal lesions (dfsa) was significantly lower (P < .05) in the fluoride varnish group than the reference group. Children in the fluoride varnish group with dfs scores of 1-4 and > or = 5 at the start of the study exhibited a statistically significant (P < .05) reduction in approximal caries incidence of 19 percent and 25 percent, respectively, when compared with the reference group. CONCLUSION: Preschool children 4 and 5 years of age with clinical caries who receive semiannual applications of a silane fluoride varnish containing 0.1 percent F experience a reduced incidence of approximal caries over two years.

Lead poisoning in woodpeckers in Sweden.

Lead poisoning was demonstrated in two gray-headed woodpeckers (Picus canus) and one white-backed woodpecker (Dendrocopus leucotos) in Sweden; they had liver lead levels between 9.4 and 26.2 mg(-1) wet weight. At necropsy one gray-headed woodpecker showed signs of emaciation and the other one had severe traumatic injuries, caused by a cat. The white-backed woodpecker died in the transportation box during a translocation program. The source of the lead could not be determined, but it was suspected that it may have originated from lead pellets shot into trees and picked out by the woodpeckers during food search.