Portrait of the Patient as a Young Man: An Exploration of the Use of Photographs in Hospital

The display of personal photographs in hospital is a common practice that has yet to be rigorously examined. The photographs displayed are subject to interpretation by the viewer and may lead to misunderstandings or miscommunication if clarification of meaning is not sought. This paper explores a range of possible meanings that the display of photographs in hospital may hold, based on a case study of a 15 year old boy hospitalised with a life threatening illness. Further research is needed into the actual meanings attributed to the display of photographs in hospital by patients and family members.     

Oral care of people with disability: a qualitative exploration of the views of nursing staff

This study aimed to identify influences, attitudes and actions of nursing staff in relation to oral care for people with disabilities. Individual in-depth interviews of twenty two nursing staff were conducted. Enabling and inhibiting factors in the reported attitudes, approaches and practices were identified. The main enabling factors were that nursing staff saw mouth care as part of their role and took an empathic and caring approach to its delivery. They aimed to make the residents socially acceptable, improve their self-esteem and make their mouths clean and breath fresher. Inhibiting factors were: a lack of training, time constraints associated with workload, and poor understanding of the processes causing dental disease. The study concludes that improvements in oral care by nursing staff can be encouraged by working with nurses'attitudes, values and beliefs. Once the desired behaviour change has occurred then the lack of knowledge can be addressed.     

Wild chamomile (Matricaria recutita L.) mouthwashes in methotrexate-induced oral mucositis

Oral mucositis is a known complication of methotrexate (MTX) therapy, but a single efficacious intervention or agent for prophylaxis or management of this side effect has not yet been identified. We report a case of MTX-induced oral mucositis in a patient with rheumatoid arthritis, who was successfully treated with Wild chamomile mouthwashes.     

Evolution of parental care in dart poison frogs (Amphibia: Anura: Dendrobatidae)

Dendrobatid frogs perform a unique mode of parental care, ranging from egg attendance and tadpole transport to tadpole feeding. It is hypothesized that a behaviour in which the egg attending parent remains with the cluch is the most primitive condition. In more advanced forms or parental care, the male is able to attend several clutches of eggs. Tadpole attendance and feeding, finally, started as deceit; the male induced the female to lay eggs into a bromeliad leaf axil already occupied by a larva. Costs and benefits of the different modes of parental care and possible alternative reproductive tactics are discussed.     

Social and reproductive behavior of three mouthbrooding cardinalfishes,Apogon doederleini,A. niger and A. notatus

Synopsis Social and reproductive behavior of three paternal mouthbrooding cardinalfishes (Apogonidae) were investigated in the shallow marine waters of Shirahama, Japan. The solitary species Apogon doederleini and A. niger bred in transient pairs, in which a male and female associated for only a few hours of each afternoon on less than 5 successive days. The prespawning behavior was the same as the courtship display on days prior to spawning. After spawning, egg-incubating males were usually left alone. The gregarious species Apogon notatus formed territorial lasting pairs, which resided at given sites from dawn to dusk on each day during a period of a month or more. After spawning, the egg-incubating male either continued to stay with his mate in the territory, or left it to enter into an aggregation. In the latter case, the female continued to reside in the territory, pairing with a new male whom she brought from an aggregation. It is suggested that in paternal apogonids the prolonged pair bond and territoriality should have developed only in gregarious species as secondary adaptation for reproductive success: to avoid conspecific interference during spawning.     

Epithelial differentiation at the edentulous alveolar ridge in man

Summary The epithelial lining of the mucosa of the edentulous, maxillary alveolar ridge was subjected to an ultrastructural and stereological analysis. Four biopsies collected from the non-inflamed crest, i.e., the center over former tooth sockets, in non-denture-wearing female patients 30 to 55 years of age were processed for light and electron microscopy. At the light-microscopic level, epithelial thickness was determined histometrically. Electron micrographs were sampled at two levels of magnification, from five strata in regions of epithelial ridges and from three strata over connective tissue papillae. Standardized stereological pointcounting techniques were employed to analyze a total of 990 electron micrographs. Observations and data revealed that at the alveolar ridge the oral epithelium is truly keratinizing and comprises four strata including a 40±5 m-thick stratum corneum, which displays the oral keratin pattern. The histoand cytodifferentiation were peculiar: (1) Compared to the neighbouring gingival and hard palate epithelium, that of the alveolar crest was markedly thicker, with elongated rete ridges indicating acanthosis. (2) The cytoarchitecture was identical neither to the gingival nor to the hard palate epithelium but revealed a mixture of features typical for either of these two epithelia. Reasons for this are explained on the basis of factors, possible genetic, inherent in epithelial cells that are possibly derived from both the gingival and the palatal environment.     

Functions and social consequences of infant–adult male interaction in a captive group of lowland gorillas (Gorilla gorilla gorilla)

The functions and social consequences of infant-adult male interaction in a captive group of lowland gorillas were evaluated. The two males repeatedly attempted to interact with the infant, the infant sometimes attempted to interact with the males, and the mother usually interrupted interactions between male and infant. Infant-directed actions by the two males frequently showed their interest in the infant and infrequently showed care giving toward her; their other infant-directed actions occurred near the time of excitement or of playful actions between adults. Male-directed actions by the infant frequently showed its interest in one male and infrequently showed care seeking from him. All infant-adult male interactions but one occurred in the less stimulating of the gorillas' two enclosures. Boredom and the mother's frequent thwarting of contact between a male and infant are suggested as influences on the males' interest in the infant. The data suggest that availability of interesting objects alleviated the boredom of captivity for males and thus dissuaded them from seeking stimulation which sometimes resulted in harmful behaviors toward the infant.     

The benefit to some minnows of spawning in the nests of other species

Synopsis Fishes that act as nest associates spawn simultaneously with nest-building hosts and then abandon their eggs. The proposed benefit for this behavior is increased brood survivorship, arising from the physical environment provided by the nest or the parental care provided by the host. Field and enclosure experiments indicated that associates benefit from the parental care provided by the host, and not from the physical environment provided by the nests of hosts. This information, along with the effect of nest association on host reproductive success, is necessary before the nature of this nesting symbiosis can be characterized.     

Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias

Background and objectiveMore than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission.MethodsRetrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48 h after admission, hospital discharge location) were collected.ResultsTwo hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p = 0.14. Hospital lenght of stay was 9.61 ± 6.01 days in direct admission, 11.22 ± 5.36 days in ED group, p = 0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48 h after admission.ConclusionsDirect admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.     

Substance use disorders: a comprehensive update of classification,epidemiology, neurobiology,clinical aspects,treatment and prevention

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.