Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Argument omissions in preschool Catalan and Spanish speaking children with SLI

El presente artículo describe tres estudios sobre la producción del verbo y la estructura argumental en niños con Trastorno Específico del Lenguaje (TEL) usando diferentes metodologías. El primero es un estudio observacional que usa una muestra de habla espontánea. El segundo usa una tarea experimental de denominación de oraciones como resultado de la observación de videos de acciones. El tercero comprende la tarea de denominación de oraciones con imágenes estáticas en eventos con diferente complejidad argumental. Aunque los datos concretos varían en función de la metodología usada, hay una clara evidencia de que los niños de habla catalana y española con TEL presentan especiales dificultades en la producción de verbos con una alta complejidad en relación a la estructura argumental y cometen errores en la especificación de los argumentos obligatorios. Se concluye quetanto limitaciones en el procesamiento como déficits en la representación semántica de los verbos pueden estar implicados en estas dificultades

Caracterização do material particulado fino e grosso e composição da fração inorgânica solúvel em água em São José dos Campos (SP)

Air samples of fine (PM2,5) and coarse (PM2,5-10) particulate matter were collected in São José dos Campos from February 2004 to February 2005. Average PM10 mass concentrations was 31.2 ± 14.0 μg m-3, half of which belonging to the PM2.5 fraction. Ammonium and SO4(2-) were predominantly found in the fine fraction. Average (NH4)2SO4 concentration was estimated to be about 2.9 μg m-3. Chloride, Na+ and NO3- were mostly associated with PM2,5-10. Chloride deficits with respect to sea-salt Cl/Na ratio were found in both size fractions.

Basel III -vakavaraisuuskehikon vaikutus investointipankkiin ja sen luottoriskin hallintaan

Tutkielman tavoitteena oli analysoida Basel III -vakavaraisuuskehikon tuomia muutoksia ja niiden vaikutusta yksittäiseen investointipankkiin ja sen luottoriskin hallintaan. Tarkoituksena oli syventyä aiheeseen tarkastelemalla luottoriskin asemaa ja elementtejä, sekä pohtia Basel III -kehikon tuomia muutoksia Basel II -säännöstöön nähden. Empiirisessä osiossa tapaustutkimuksen aineistonkeruumenetelmänä käytettiin puolistrukturoitua haastattelua ja kohdeyrityksenä Evli Pankki Oyj:tä. Basel III -vakavaraisuuskehikon tarkoitus on vahvistaa pankkeja ja korjata sääntelyn puutteita, jotka tulivat esille finanssikriisissä 2007–2009. Luottoriski on pankkitoiminnan merkittävin riski ja sen hallinta on olennainen osa Basel III -kehikkoa. Basel III -säännöstön myötä pankeilla on oltava enemmän omia varoja suhteessa niiden riskipainotettuihin saamisiin. Lisäksi pankeille asetetaan uusia pääomapuskuri- ja maksuvalmiusvaatimuksia, sekä pankkien velkaantumista rajoitetaan uudella vähimmäisomavaraisuusasteella. Basel III -kehikon vaikutukset kohdeyritykseen jäävät vähäisiksi, koska kohdeyrityksen vakavaraisuus ja likviditeetti ovat erittäin hyvällä tasolla. Suurimmat vaikutukset kohdeyritykseen aiheutuvat maksuvalmiusvaatimuksesta (LCR) ja pysyvän varainhankinnan vaatimuksesta (NSFR).

Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

MS-potilaiden kognitiiviset häiriöt ja PASAT-testissä suoriutuminen

Eija Rosti-Otajärven väitöskirja Cognitive deficits and the Paced Auditory Serial Addition Test performance among patients with multiple sclerosis (Helsingin yliopisto 2009).

Regulated deficit irrigation and tommy atkins mango orchard productivity under microsprinkling in brazilian semi arid

This study aimed to test controlled levels of water deficiency in soil in mango trees, under microsprinkling irrigation, in semi-arid conditions, and to evaluate its effect in the productivity and fruits quality. The deficits were applied in the phases I, II and III of growth of the fruit, during the productive cycles of the mango tree in 2006 and 2007. The experiment in both cases was arranged in an entirely random design with 10 treatments and 3 repetitions, in the year I, and with 8 treatments and 3 repetitions in the year II. The values of soil water potential, of the treatments submitted to regulated deficit irrigation (RDI), were placed in the range of 0 to -0.011 MPa, showing that the soil humidity varied between the saturation and the field capacity, not characterizing deficit water condition. The average values of stem water potential (Ψstem) varied between -0.90 and -1.74 MPa, evidencing significant effect (p <0.05) just for T1 (without irrigation), T7 and T8 (RDI with 30% of the ETc in the phases II and III, respectively). Through the variance analysis, significant differences were not verified among productivity, number of fruits per plant and size of the fruit, in none of the experiments, what indicates the possibility of reduction of the water use in the irrigation of the mango tree without significant losses of productivity and fruit quality.

Cognitive Development of Very Low Birth Weight Children from Infancy to Pre-school Age

The survival of preterm born infants has increased but the prevalence of long-term morbidities has still remained high. Preterm born children are at an increased risk for various developmental impairments including both severe neurological deficits as well as deficits in cognitive development. According to the literature the developmental outcome perspective differs between countries, centers, and eras. Definitions of preterm infant vary between studies, and the follow-up has been carried out with diverse methods making the comparison less reliable. It is essential to offer parents upto-date information about the outcome of preterm infants born in the same area. A centralized follow-up of children at risk makes it possible to monitor the consequences of changes in the treatment practices of hospitals on developmental outcome. This thesis is part of a larger regional, prospective multidisciplinary follow-up project entitled “Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age” (PIeniPAinoisten RIskilasten käyttäytyminen ja toimintakyky imeväisiästä kouluikään, PIPARI). The thesis consists of four original studies that present data of very low birth weight (VLBW) infants born between 2001 and 2006, who are followed up from the neonatal period until the age of five years. The main outcome measure was cognitive development and secondary outcomes were significant neurological deficits (cerebral palsy, CP, deafness, and blindness). In Study I, the early crying and fussing behavior of preterm infants was studied using parental diaries, and the relation of crying behavior and cognitive and motor development at the age of two years was assessed. In Study II, the developmental outcome (cognitive, CP, deafness, and blindness) at the age of two years was studied in relation to demographic, antenatal, neonatal, and brain imaging data. Development was studied in relationship to a full-term born control group born in the same hospital. In Study III, the stability of cognitive development was studied in VLBW and full-term groups by comparing the outcomes at the ages of two and five years. Finally, in Study IV the precursors of reading skills (phonological processing, rapid automatized naming, and letter knowledge) were assessed for VLBW and full-term children at the age of five years. Pre-reading skills were studied in relation to demographic, antenatal, neonatal, and brain imaging data. The main findings of the thesis were that VLBW infants who fussed or cried more in the infancy were not at greater risk for problems in their cognitive development. However, crying was associated with poorer motor development. The developmental outcome of the present population was better that has been reported earlier and this improvement covered also cognitive development. However, the difference to fullterm born peers was still significant. Major brain pathology and intestinal perforation were independent significant risk factors for adverse outcome, also when several individual risk factors were controlled for. Cognitive development at the age of two years was strongly related with development at the age of five years, stressing the importance of the early assessment, and the possibility for early interventions. Finally, VLBW children had poorer pre-reading skills compared with their full-term born peers, but the IQ was an important mediator even when children with mental retardation were excluded from the analysis. The findings suggest that counseling parents about the developmental perspectives of their preterm infant should be based on data covering the same birth hospital. Neonatal brain imaging data and neonatal morbidity are important predictors for developmental outcome. The findings of the present study stress the importance of both short-term (two years) and long-term (five years) follow-ups for the individual, and for improving the quality of care.

Fetal alcohol spectrum disorders in Finnish children and adolescents : diagnosis, cognition, behavior, adaptation and brain metabolic alterations

Alcohol consumption during pregnancy can potentially affect the developing fetus in devastating ways, leading to a range of physical, neurological, and behavioral alterations most accurately termed Fetal Alcohol Spectrum Disorders (FASD). Despite the fact that it is a preventable disorder, prenatal alcohol exposure today constitutes a leading cause of intellectual disability in the Western world. In Western countries where prevalence studies have been performed the rates of FASD exceed, for example, autism spectrum disorders, Down’s syndrome and cerebral palsy. In addition to the direct effects of alcohol, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. However, children with FASD today remain remarkably underdiagnosed by the health care system. This thesis forms part of a larger multinational research project, The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (the CIFASD), initiated by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in the U.S.A. The general aim of the present thesis was to examine a cohort of children and adolescents growing up with fetal alcohol-related damage in Finland. The thesis consists of five studies with a broad focus on diagnosis, cognition, behavior, adaptation and brain metabolic alterations in children and adolescents with FASD. The participants consisted of four different groups: one group with histories of prenatal exposure to alcohol, the FASD group; one IQ matched contrast group mostly consisting of children with specific learning disorder (SLD); and two typically-developing control groups (CON1 and CON2). Participants were identified through medical records, random sampling from the Finnish national population registry and email alerts to students. Importantly, the participants in the present studies comprise a group of very carefully clinically characterized children with FASD as the studies were performed in close collaboration with leading experts in the field (Prof. Edward Riley and Prof. Sarah Mattson, Center for Behavioral Teratology, San Diego State University, U.S.A; Prof. Eugene Hoyme, Sanford School of Medicine, University of South Dakota, U.S.A.). In the present thesis, the revised Institute of Medicine diagnostic criteria for FASD were tested on a Finnish population and found to be a reliable tool for differentiating among the subgroups of FASD. A weighted dysmorphology scoring system proved to be a valuable additional adjunct in quantification of growth deficits and dysmorphic features in children with FASD (Study 1). The purpose of Study 2 was to clarify the relationship between alcohol-related dysmorphic features and general cognitive capacity. Results showed a significant correlation between dysmorphic features and cognitive capacity, suggesting that children with more severe growth deficiency and dysmorphic features have more cognitive limitations. This association was, however, only moderate, indicating that physical markers and cognitive capacity not always go hand in hand in individuals with FASD. Behavioral problems in the FASD group proved substantial compared to the typically developing control group. In Study 3 risk and protective factors associated with behavioral problems in the FASD group were explored further focusing on diagnostic and environmental factors. Two groups with elevated risks for behavioral problems emerged: length of time spent in residential care and a low dysmorphology score proved to be the most pervasive risk factor for behavioral problems. The results underscore the clinical importance of appropriate services and care for less visibly alcohol affected children and highlight the need to attend to children with FASD being raised in institutions. With their background of early biological and psychological impairment compounded with less opportunity for a close and continuous caregiver relationship, such children seem to run an especially great risk of adverse life outcomes. Study 4 focused on adaptive abilities such as communication, daily living skills and social skills, in other words skills that are important for gradually enabling an independent life, maintain social relationships and allow the individual to become integrated into society. The results showed that adaptive abilities of children and adolescents growing up with FASD were significantly compromised compared to both typically-developing peers and IQ-matched children with SLD. Clearly different adaptive profiles were revealed where the FASD group performed worse than the SLD group, who in turn performed worse than the CON1 group. Importantly, the SLD group outperformed the FASD group on adaptive behavior in spite of comparable cognitive levels. This is the first study to compare adaptive abilities in a group of children and adolescents with FASD relative to both a contrast group of IQ-matched children with SLD and to a group of typically-developing peers. Finally, in Study 5, through magnetic resonance spectroscopic imaging (MRS) evidence of longstanding neurochemical alterations were observed in adolescents and young adults with FASD related to alcohol exposure in utero 14-20 years earlier. Neurochemical alterations were seen in several brain areas: in frontal and parietal cortices, corpus callosum, thalamus and frontal white matter areas as well as in the cerebellar dentate nucleus. The findings are compatible with neuropsychological findings in FASD. Glial cells seemed to be more affected than neurons. In conclusion, more societal efforts and resources should be focused on recognizing and diagnosing FASD, and supporting subgroups with elevated risk of poor outcome. Without adequate intervention children and adolescents with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

Koulutusinflaatio. Koulutusekspansio ja koulutuksen arvo Suomessa 1970–2008

Sotienjälkeisenä aikana Suomessa jokainen sukupolvi on ollut edellistä korkeammin koulutettu ja kehitys näyttää yhä vain jatkuvan. Kun 1970-luvulla alle kolmanneksella väestöstä oli perusasteen jälkeinen koulutus, nykyään vähintään keskiasteen koulutuksen puuttuminen on lähes yhtä harvinaista. Koulutusinflaatio viittaa koulutuksen arvon laskuun työmarkkinoilla. Koulutuksen arvon inflatoituessa saman tasoisella koulutuksella päädytään yhä alempiin yhteiskunnallisiin asemiin. Väitöskirjassa tarkastellaan koulutuksen arvon muuttumista Suomessa vuosina 1970–2008. Empiirinen osuus muodostuu kolmesta referee-journaaleissa julkaistusta artikkelista. Ensimmäisessä artikkelissa tarkastellaan ylemmän toimihenkilön asemaan päätyneiden osuutta sekä suhteellista tulotasoa eri koulutusasteilla. Toinen artikkeli keskittyy koulutuksen ja huono-osaisuuden väliseen yhteyteen. Kolmannessa artikkelissa tarkastellaan koulutusekspansion ja koulutusinflaation välistä yhteyttä. Kahdessa ensimmäisessä artikkelissa käytetään samaa rekisteripohjaista otosaineistoa.Aineisto koostuu neljästä 4000 henkilön otoksesta, jotka edustavat 30–39-vuotiaita suomalaisia vuosina 1970, 1980, 1990 ja 2000. Kolmannessa artikkelissa käytetään aggregaattidataa vuosilta 1970, 1980, 1985, 1990, 1993, 1995, 2000, 2004, 2005, 2006, 2007 ja 2008. Viimeinen aineisto kattaa 30–39-vuotiaat työlliset suomalaiset mainituilta vuosilta, se ei siis ole otospohjainen. Tulosten perusteella koulutusinflaatio on ollut Suomessa vahvaa, erityisesti alimmalla korkea-asteella ja alemmalla korkeakouluasteella. Hyvinvointipuutteet lisääntyivät vähiten koulutettujen keskuudessa, mutta vähemmän kuin olisi voinut olettaa. Raja, jonka ylittävällä koulutuksella hyvinvointipuutteiden riski laskee huomattavasti, on noussut – perusasteen ja keskiasteen välistä keskiasteen ja alimman korkea-asteen väliin. Koulutusekspansion yhteys koulutusinflaatioon on ollut erittäin vahva, erityisesti alemmalla korkeakouluasteella.

Epidemiology, management and outcome of facial injuries

Dental injuries are common and the incidence of maxillofacial injuries has increased over the recent decades in Finland. Accidental injuries are the global leading cause of death among children over the age of one year and among adults under the age of 40 globally. Significant resources and costs are needed for the treatment of these patients. The prevention is the most economical way to reduce trauma rates and costs. For the prevention it is crucial to know the prevalences, incidences and risk factors related to injuries. To improve the quality of treatment, it is essential to explore the causes, trauma mechanisms and management of trauma. The above mentioned was the aim of this thesis. With a large epidemiological cohort study (5737 participants) it was possible to estimate lifetime prevalence of and risk factors for dental trauma in general population (Study I). The prevalence of dental fractures was 43% and the prevalence of dental luxations and avulsions was 14%. Male gender, a history of previous non-dental injuries, mental distress, overweight and high alcohol consumption were positively associated with the occurrence of dental injuries Study II was conducted to explore the differences in type and multiplicity of mandibular fractures in three different countries (Canada, Finland and Kuwait). This retrospective study showed that the differences in mandibular fracture multiplicity and location are based on different etiologies and demographic patterns. This data can be exploited for planning of measures to prevent traumatic facial fractures. The etiology, management and outcome of 63 pediatric skull base fracture (Study III) and 20 pediatric frontobasal fracture patients (Study IV) were explored. These retrospective studies showed that, both skull base fracture and frontobasa fracture are rare injuries in childhood and although intracranial injuries and morbidity are frequent, permanent neurological or neuropsychological deficits are infrequent. A systematic algorithm (Study V) for computer tomography (CT) image review was aimed at clinicians and radiologists to improve the assessment of patients with complex upper midface and cranial base trauma. The cohort study was cross sectional and data was collected in the Turku and Oulu University Hospitals. A novel image-reviewing algorithm was created to enhance the specificity of CT for the diagnosis of frontobasal fractures. The study showed that an image-viewing algorithm standardizes the frontobasal trauma detection procedure and leads to better control and assessment. The purpose of the retrospective subcranial craniotomy study (VI) was to review the types of frontobasal fractures and their management, complications and outcome when the fracture is approached subcranially. The subcranial approach appears to be successful and have a reasonably low complication rate. It may be recommended as the technique of choice in multiple and the most complicated frontal base fractures where the endoscopic endonasal approach is not feasible.

Water relations of tree species growing on a rock outcrop in the "Parque Estadual de Itapuã", RS

Water relations of the tree species Myrsine umbellata Mart. ex A. DC., Dodonaea viscosa Jacq. and Erythroxylum argentinum O. E. Schulz, growing on a rock outcrop in the "Parque Estadual de Itapuã" (RS), were studied. Environmental (precipitation, temperature, soil water) and plant (water potential, vapor pressure deficit, stomatal conductance, transpiration, leaf specific hydraulic conductance, osmotic potential and cell wall elasticity) parameters were collected in five periods and pooled into two sets of data: wet and dry periods. Myrsine umbellata showed great stability of the plant parameters, including the maintenance of high pre-dawn (psiwpd) and mid-day (psiwmd) water potentials in the dry period (-0.48 and -1.12 MPa, respectively), suggesting the presence of a deep root system. Dodonaea viscosa and E. argentinum reached lower psiwpd (-1.41 and -1.97 MPa, respectively) and a greater degree of stomatal closure in the dry period, suggesting a shallower root system. Differential exposure to soil drought was also corroborated by differential drought effects on the whole-plant leaf specific hydraulic conductance (Gt). Correlation analysis pointed to weak correlations between psiwpd and g s. Erythroxylum argentinum was the only species to show osmotic adjustment in response to drought. It is suggested that M. umbellata has low tolerance to water deficits, adopting an avoidance behavior. The much lower values of psiw reached by D. viscosa and E. argentinum suggest a greater tolerance to drought by these species.

Spreading depression is facilitated in adult rats previously submitted to short episodes of malnutrition during the lactation period

Lactating rat dams were submitted to short episodes (1, 2 or 3 weeks) of nutritional restriction by receiving the "regional basic diet" (RBD, with 8% protein) of low-income human populations of Northeast Brazil. Their pups were then studied regarding the developmental effects on body and brain weights. When the rats reached adulthood, cortical susceptibility to the phenomenon of spreading depression (SD) was evaluated by performing electrophysiological recordings on the surface of the cerebral cortex. SD was elicited at 20-min intervals by applying 2% KCl for 1 min to a site on the frontal cortex and its occurrence was monitored at 2 sites in the parietal region by recording the electrocorticogram and the slow potential change of SD. When compared to control rats fed a commercial diet with 23% protein, early malnourished rats showed deficits in body and brain weights (10% to 60% and 3% to 15%, respectively), as well as increases in velocity of SD propagation (10% to 20%). These effects were directly related to the duration of maternal dietary restriction, with pups malnourished for 2 or 3 weeks presenting more intense weight and SD changes than those malnourished for 1 week. The effects of 1-week restrictions on SD were less evident in the pups malnourished during the second week of lactation and were more evident in pups receiving the RBD during the third week. The results indicate that short episodes of early malnutrition during the suckling period can affect body and brain development, as well as the cortical susceptibility to SD during adulthood. The data also suggest that the third week of lactation is the period during which the brain is most sensitive to malnutrition, concerning the effects on SD

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.