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Scand J Caring Sci; 2011; 25; 798-805 Holism in nursing and health promotion: distinct or related perspectives? - A literature review Background: The concept of holism is central in health promotion as well as in nursing. Holism or a holistic view on health was identified as one of the key principles of the Ottawa Charter for Health Promotion and is linked to social ecology and the determinants of health. Aims: To explore how the term holism was defined and/or described in Nordic articles with a health-promotion approach, and how holism aspects were related to nursing and health promotion, and to the other key principles of the Ottawa Charter. Methods: Abstracts were first identified by the search word 'health promotion' as a keyword. The search was limited to 1986-2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for this study were subsequently selected from these abstracts using the search words 'holism' and 'holistic' and analysed by quantitative and manifest qualitative content analysis. Findings: The sample included 23 articles: one theoretical, two reviews and 20 empirical studies. Sixteen articles included a hospital setting or nursing perspective. A holistic perspective could be extracted from most articles. No larger but several minor differences were identified in the way holism aspects were related to nursing and health promotion respectively. Conclusion: There is a risk that the individual patient perspective of holism in nursing may result in less chance of reaching larger groups of patients with chronic diseases and mental health problems, not least the most vulnerable ones. [ABSTRACT FROM AUTHOR]

Background and Aims The immune system is a major determinant of the pathophysiological inflammation, which may lead to gastrointestinal mucosal injury in patients with Crohn's disease. Cytokines such as tumour necrosis factor-alpha are well-known mediators of the immune system, and treatment with a chimeric anti-tumour necrosis factor-alpha antibody (infliximab) has been shown to be highly effective in patients with Crohn's disease. Recent evidence indicates that infliximab induces apoptosis in lamina propria T lymphocytes in these patients. To better understand the mechanisms of infliximab's effect on gastrointestinal inflammation, we investigated changes in the serum level of cytokines after treatment in these patients, and the effect of infliximab in inducing the apoptosis of T lymphocytes. Methods Thirteen patients with Crohn's disease were treated with infliximab at a dosage of 5-mg/kg body weight. Clinical response was evaluated using the Crohn's Disease Activity Index, and serum soluble interleukin-2 receptor, interleukin-6, tumour necrosis factor-alpha levels were analysed by enzyme-linked immunosorbent assay at 0 and 2 weeks after treatment. Apoptosis of peripheral and lamina propria T lymphocytes after culture with infliximab was detected by flow cytometry. Results Crohn's Disease Activity Index decreased in 12 of 13 patients, and serum soluble interleukin-2 receptor, interleukin-6 and tumour necrosis factor-alpha levels decreased in most patients after treatment with infliximab. Tumour necrosis factor-alpha level before treatment in the six patients in whom Crohn's Disease Activity Index decreased by more than 70 was <5 ng/mL. Infliximab induced the apoptosis of lamina propria but not of peripheral T lymphocytes. Conclusion These findings suggest that a low level of serum tumour necrosis factor-alpha is an indicator for infliximab treatment. The induction of apoptosis of lamina propria T lymphocytes by infliximab may be an important mechanism of its anti-inflammatory effect in patients with Crohn's disease. [ABSTRACT FROM AUTHOR]

Abstract: Dosage compensation involves fine-tuning of gene expression at the level of entire chromosomes. The principles that assure selective targeting of the male X chromosome in Drosophila and the mechanism by which transcription levels are adjusted in a twofold range are still mysterious. We discuss the prevalent models in the context of recent experimental observations. [Copyright &y& Elsevier]

Hayasaki N, Ito M, Suzuki T, Ina K, Ando T, Kusugami K&Goto H(2004)Histopathology45,377–383Neutrophilic phlebitis is characteristic of intestinal Behçet's disease and simple ulcer syndrome: To characterize the histological features of intestinal Behçet's disease and simple ulcer syndrome and to clarify the possible mechanisms involved in their development by analysing the type of inflammatory infiltrates in the diseased intestine and the expression of adhesion molecules on endothelial cells.: Tissue samples from 10 patients diagnosed as having intestinal Behçet's disease or simple ulcer syndrome were studied. Immunohistochemical studies were performed on paraffin-embedded tissue using a labelled streptavidin–biotin method. In all cases, phlebitis was remarkably seen in submucosal inflammatory lesions, but the adjacent arteries were not affected. Inflammatory infiltrates around the affected vessels consisted of neutrophils and mononuclear cells, and neutrophils predominated over CD68+ macrophages and lymphocytes. The majority of mononuclear cells were CD3+ T cells, and CD4+ cells were more frequent than CD8+ T cells. As for adhesion molecule expression, intercellular adhesion molecule-1, but not vascular cell adhesion molecule-1, was expressed in most endothelial cells of the vessels with phlebitis, some of which were also positive for HLA-DR.: Neutrophilic phlebitis may be involved in the pathogenesis of intestinal Behçet's disease and simple ulcer syndrome. [ABSTRACT FROM AUTHOR]

: Failure of Helicobacter pylori eradication occurs frequently despite use of multiple microbial agents. : We aimed to study differences between H. pylori strains isolated before and after eradication failure. : We treated 87 patients with peptic ulcer using triple therapy consisting of omeprazole plus combinations of clarithromycin, amoxicillin, or metronidazole. We studied the status of cagA, vacA, and iceA by PCR, and examined the differences in H. pylori isolates by pulsed-field gel electrophoresis and arbitrary primer polymerase chain reaction. The minimum inhibitory concentration of clarithromycin, amoxicillin, or metronidazole was determined by an agar dilution method. : Eradication therapy failed in 12 patients (14%); H. pylori isolates were obtained from all of these both before and after therapy. After eradication therapy, 10 patients were colonized with the same strain as before therapy, while the other two patients were colonized with different strains from those before therapy. In the former group, one isolate changed from metronidazole-sensitive to -resistant, one changed from clarithromycin- and metronidazole-sensitive to -resistant, and four were resistant to clarithromycin or metronidazole both before and after therapy. The other four isolates remained sensitive to clarithromycin and metronidazole after therapy. In the two patients who yielded apparently different isolates after therapy, they changed from clarithromycin- and metronidazole-sensitive to -resistant. : Eradication of H. pylori by first-line therapy is an important goal in the treatment of H. pylori-positive peptic ulcer, and that appropriate antimicrobial sensitivity testing should be conducted in patients with eradication failure. [ABSTRACT FROM AUTHOR]

Twofold differences in gene expression levels can be vital for an organism. This is beautifully illustrated by the process of `dosage compensation'' in Drosophila, which doubles transcription from the single male X chromosome to equal the mRNA levels originating from the two X chromosomes in female cells. Failure of the process leads to male-specific lethality. A number of recent publications have furthered our understanding of the ribonucleoprotein complex, which mediates dosage compensation and how it targets the male X chromosome. Deciphering the principles of X chromosome recognition and the nature of the chromatin configuration, that allows fine-tuning of transcription, remain the most interesting challenges. [Copyright &y& Elsevier]

Background: Clarithromycin (CAM) may have certain indirect effects on Helicobacter pylori (H. pylori ) other than its inhibitory activity on bacterial growth, as indicated in other infections with Gram-negative micro-organisms. In the present study, we examined the effects of lower concentrations of CAM on the release of heat shock protein B (HspB), one of the major antigenic proteins from H. pylori cells, as well as the changes in humoral immune response and histological degree of antral gastritis in patients who received eradication therapy with CAM. Methods: The H. pylori strain 26695 and three CAM-resistant clinical isolates were cultured in broth with and without CAM (2–500 ng/mL). Expression of H. pylori proteins was examined by two-dimensional (2D)-electrophoresis followed by N-terminal amino acid sequencing. Changes in host immune response and histological degree of antral gastritis were monitored in patients with peptic ulcer disease who received H. pylori eradication therapy. Results: 2D electrophoresis showed 26 spots in extracellularly released proteins with different profiles from those in cytoplasmic proteins. The release of HspB increased after incubation with CAM (30–500 ng/mL) in all three H. pylori clinical isolates tested. Patients with failed H. pylori eradication after triple therapy with CAM, but not those with failed eradication after dual therapy without CAM, showed an increase in serum IgG1 and IgG2 antibodies against HspB along with a decrease in the degree of neutrophil and H. pylori colonization density in tissue sections. Conclusions: CAM may induce a humoral immune response against H. pylori and a decrease in gastric mucosal inflammation through up-regulation of the release of HspB from the bacteria in infected patients. [ABSTRACT FROM AUTHOR]

Enhanced gastric mucosal chemokine activity has been demonstrated in patients with Helicobacter pylori infection. However, little is known about the mechanisms involved in this phenomenon. To examine whether in vivo chemokine activity is similar to in vitro response of gastric epithelial cells infected by H. pylori. In organ cultures of mucosal tissues, the levels of interleukin-8 and growth-related gene product α were elevated in patients with peptic ulcer disease compared with those with erosive gastritis or endoscopically normal mucosa. However, there were no significant differences in vitro cultures of MKN45 or KATO III cells that were infected with H. pylori isolated from these same patients. These in vivo and in vitro α-chemokine levels showed no significant association with the presence of cagA gene and CagA protein, ureB genotype, or binding capacity to MKN45 or KATO III cells in individual H. pylori isolates. In contrast, in vivo mucosal α-chemokine activity correlated with H. pylori colonization density. Mucosal chemokine profiles and inflammatory responses in H. pylori infection may be associated more closely with host factors, including those determining bacterial adhesiveness, than with differences in H. pylori strains. [ABSTRACT FROM AUTHOR]

This study describes and analyses the health dialogue on the basis of the pupils' experience and the association with background factors such as age, sex, geographical areas, family and social class. The theoretical framework is based on empowerment and health promotion, and on Kolb's theory of experiential learning. The study, conducted in 1991, is the Danish contribution to the WHO collaborative study 'Health Behaviour in School Children'. A nationwide random sample of pupils aged 11, 13 and 15 (n = 1860) answered a standardized questionnaire about perceived health, health behaviour, social situation and the health dialogue with the school health nurse. Among the pupils, 68% had participated in the annual health dialogue at the time of the survey (three quarters of the way through the school year). The youngest pupils, and the girls, often participated in groups and reported the greatest number of topics discussed. The health dialogue most frequently comprised 11–20 topics. Most topics discussed were related to health promotion, 31%–60% were related to prevention of illness and symptoms and the rest were related to psychosocial issues. Girls more often reported discussing personal relationships and boys more often discussed action-related topics. Pupils from lower social classes more frequently reported topics related to prevention of illness and symptoms and psychosocial issues. The discussions are the first step in a learning process as a Concrete Experience (CE). [ABSTRACT FROM AUTHOR]

We have cloned a 13 kb Escherichia coli DNA fragment which complemented the rfe mutation to recover the biosynthesis of E. coli O9 polysaccharide. Using Tn5 insertion inactivation, the rfe gene was localized at the 1.5kb HindIII-EcoRI region flanking the rho gene. We constructed an rfe-deficient E. coli K-12 mutant by site-directed inactivation using a DNA fragment of the cloned 1.5 kb rfe gene. This also confirmed the presence of the rfe gene in the 1.5kb region. By simultaneous introduction of both the rfe plasmid and the plasmid of our previously cloned E. coli 09 rfb into this rfe mutant, we succeeded in achieving in vivo reconstitution of O9 polysaccharide biosynthesis. From sequence analysis of the rfe gene, a putative promoter followed by an open reading frame (ORF) was identified downstream of the rho gene. This ORF coincided with the position of the rfe gene determined by Tn5 analysis and site-directed mutagenesis. Furthermore, we identified the rff genes in the 10.5kb DNA flanking the rfe gene. We recognized at least two functional domains on this cloned rff region. Region I complemented a newly found K-12 rff mutant, A238, to synthesize the enterobacterial common antigen (ECA). Deletion of region II resulted in the synthesis of ECAs with shorter sugar chains. When the 10.5kb rff genes of the plasmid were inactivated by either deletion or Tn5 insertion, the plasmid lost its ability to give rise to transformants of the rfe mutants. [ABSTRACT FROM AUTHOR]

Background: The long-term benefit of Helicobacter pylori eradication treatment that includes metronidazole on peptic ulcer disease in Japan is unclear. We investigated the rate of H. pylori re-infection and ulcer relapse after H. pylori eradication., Materials and Methods: A total of 266 patients with endoscopically confirmed peptic ulcer disease and H. pylori infection were treated with triple therapy of omeprazole 40 mg (20 mg b.i.d.), clarithromycin 800 mg (400 mg b.i.d.), and tinidazole 1000 mg (500 mg b.i.d.) for 7 days. Endoscopy with gastric biopsy was performed before and 1 month, 6 months, 1.5 years, and 3.5 years after therapy. H. pylori status was determined by H. pylori culture, rapid urease test, and histopathology. 13C-urea breath test was done at 6 months after eradication therapy. Treatment was deemed successful when all tests were negative at 6 months after therapy by endoscopic biopsy., Results: Successful H. pylori eradication was achieved in 262/266 (98.5%) patients with peptic ulcer. Total relapse of peptic ulcer occurred in 8/262 (3%) patients after eradication, with 3/262 (1.1%) occurring within 1.5 years after treatment and 5/262 (1.9%) within 3.5 years. All relapsed patients were found to be H. pylori-positive at the time of relapse. Of the 262 patients who experienced eradication, 20 (7.6%) were subsequently re-infected, six (2.3%) within 1.5 years and 14 (5.3%) within 3.5 years., Conclusion: Triple therapy with omeprazole, clarithromycin, and tinidazole (OCT) is useful for H. pylori eradication in Japan, but there is an appreciable re-infection rate in this population.

Background: The association between Helicobacter pylori infection and idiopathic thrombocytopenic purpura (ITP) has been reported widely. We investigated the prevalence of H. pylori infection, its virulence profile and the effectiveness of its eradication in patients with ITP., Materials and Methods: Twenty patients with ITP, 20 with peptic ulcer (10 gastric ulcer (GU), 10 duodenal ulcer (DU)) and 20 with NUD were studied. The virulence profile of the strains was assessed by genotyping for cagA, vacA, iceA, and hpyIIIR/hrgA and by assaying for IL-8 and DNA fragmentation after incubation with AGS cells. Infected patients and two uninfected ITP patients received triple therapy and platelets were counted before and 1 month, 6 months, 1 year, and 2 years after eradication therapy., Results: H. pylori infection was found in 17 ITP (85%), 20 ulcer (100%) and 13 NUD (65%) patients. Biopsies and strains were collected from five ITP, 20 ulcer and 13 NUD patients. The ITP patients had a pangastritis or corpus-predominant gastritis pattern. All H. pylori isolates, from ITP, ulcer and NUD patients, were cagA(+) and vacA s1/m1, and did not differ in levels of IL-8 induction or DNA fragmentation. Fifteen ITP (88%) and 17 ulcer (85%) patients had successful eradication of H. pylori. Ten of these 15 (67%) H. pylori-eradicated ITP patients had platelet recovery. There was no significant change in platelet count in the two ITP patients in whom eradication failed or in the two originally H. pylori-uninfected ITP patients, or in the treated ulcer patients. Age at onset of ITP was the main determinant of platelet recovery: 100% of patients diagnosed after the age of 60 recovered compared with only 22% of those diagnosed before 50., Conclusions: H. pylori-infected ITP patients have a corpus-predominant pattern of gastritis but the virulence profile of their strains does not differ from that of ulcer or NUD patients. Eradication of H. pylori infection is a good therapeutic option for some patients with chronic ITP, especially for those who develop ITP in older age.

Analysis of cytokine production and function is an indispensable tool to study Crohn's disease and ulcerative colitis. This analysis has generated a tremendous amount of data, but a clear interpretation of results has been hampered by limited attention paid to several patient- and sample-related pitfalls. These include: clinical parameters; the relative value of circulating vs. intestinal cytokine levels; the selection of tissue specimens and their processing method; the specific cellular source of each cytokine; the effect of cytokine inducers; and the technique utilized to obtain qualitative or quantitative data on cytokine protein or mRNA. Once all of these crucial variables are taken into proper perspective, a better understanding will emerge of the true role of cytokines in the pathogenesis of inflammatory bowel disease.