Theory-driven guidelines for practical care of older people,based on the theory of gerotranscendence

INTRODUCTION: The theory of gerotranscendence states that human development is a process extending into old age. When optimized, this process ends in a new perspective. The developmental process towards gerotranscendence can be obstructed or accelerated by life crises and grief, but elements in the culture can also facilitate or impede the process. Similarly, the caring climate can obstruct or accelerate the process toward gerotranscendence. The view introduced by the theory may have several consequences for staff treatment of and actions towards older people, as it offers a new understanding of living into old age. AIM: The aim of the present study was to derive guidelines for practical use in the care of older people. The guidelines should be used to promote a development toward gerotranscendence and should also be of value for people who already have attained a state of gerotranscendence. METHODS: The method of deriving guidelines from the theory was focus group interviews. The theory of gerotranscendence was used as a foundation for stimulating the discussions in the focus groups as well as for organizing the proposals that emerged. FINDINGS: Concrete guidelines at three levels, focusing on the individual, activity and organization, were derived. The guidelines describe different ways to support older people in their process towards gerotranscendence. CONCLUSION: These guidelines could support staff in their practical care of older people and could be used as a supplement to enrich the present care.     

Identification of functional prolactin (PRL) receptor gene expression: PRL inhibits lipoprotein lipase activity in human white adipose tissue

During lactation serum levels of prolactin (PRL) are elevated, and the activity of lipoprotein lipase (LPL) is decreased in the adipose tissue and increased in the mammary gland. However, PRL has been suggested to affect the adipose tissue in an indirect fashion during lactation. In the present study, we demonstrated expression of four PRL receptor (PRLR) mRNA isoforms (L, I, S1(a), and S1(b)) in human sc abdominal adipose tissue and breast adipose tissue using RT-PCR/Southern blot analysis. In addition, L-PRLR [relative molecular mass (M(r)) 90,000] and I-PRLR (M(r) 50,000) protein expression was detected in human sc abdominal adipose tissue and breast adipose tissue using immunoblot analysis. Two additional protein bands with the molecular weight M(r) 40-35,000 were also detected. The direct effect of PRL on the regulation of LPL activity in human abdominal adipose tissue cultured in vitro was investigated. PRL (500 ng/ml) reduced the LPL activity in human adipose tissue to 31 +/- 7.7%, compared with control. GH (100 ng/ml) also reduced the LPL activity, to 45 +/- 8.6%, compared with control. In agreement with previous studies, cortisol increased the LPL activity and GH inhibited cortisol-induced LPL activity. Furthermore, we found that PRL also inhibited the cortisol-induced LPL activity. Taken together, these results demonstrate a direct effect of PRL, via functional PRLRs, in reducing the LPL activity in human adipose tissue, and these results suggest that LPL might also be regulated in this fashion during lactation.     

Effect of Surgery on the Outcome of Midgut Carcinoid Disease with Lymph Node and Liver Metastases

We have evaluated survival and tumor-related symptoms in the presence of mesenteric lymph node and liver metastases in relation to surgical procedures in 314 patients (148 women, mean age at diagnosis 61 years; 249 with liver metastases) treated for midgut carcinoid tumors. Of the operated patients, 46% presented with severe abdominal pain and intestinal obstruction and were operated on before the diagnosis. Medical treatment (somatostatin analogs, interferon-a) was initiated in 67% and 86%, respectively. Surgical attempts included small intestine or ileocecal/right-sided colon resection with excision of mesenteric lymph node metastases. Most of the patients (n = 286) had mesenteric lymph node metastases; 33% of them had unresectable mesenteric lymph node metastases and underwent surgery without mesenteric dissection. Patients who underwent resection for the primary tumor had a longer survival than those with no resection (median survival 7.4 vs. 4.0 years; p <0.01). Patients who underwent successful excision of mesenteric metastases had a significantly longer survival than those with remaining lymph node metastases. Patients operated on for a primary tumor but with remaining lymph nodes but no liver metastases and who subsequently received interferon and somatostatin analog treatment had a median survival of 7.4 years. Resection of the primary tumor and the mesenteric lymph node metastases led to a significant reduction in tumor-related symptoms. Surgery to remove the primary intestinal tumor including mesenteric lymph node metastases is supported by the present results, even in the presence of liver metastases. Liver metastases and significant preoperative weight loss are identified as major negative prognostic factors for survival.     

Vinyl sulfide cyclized analogues of angiotensin II with high affinity and full agonist activity at the AT(1) receptor

Vinyl sulfide cyclized analogues of the octapeptide angiotensin II that are structurally related to the cyclic disulfide agonist c[Hcy(3,5)]Ang II have been prepared. The synthesis relies on the reaction of the mercapto group of a cysteine residue in position 3 with the formyl group of allysine incorporated in position 5 of angiotensin II. A mixture of the cis and the trans isomers was formed, and these were separated and isolated by RP-HPLC. Thus, the three-atom CH(2)[bond]S[bond]S element of the AT(1) receptor agonist c[Hcy(3,5)]Ang II has been displaced by a bioisosteric three-atom S[bond]CH[double bond]CH element. A comparative conformational analysis of the 13-membered ring systems of c[Hcy(3,5)]Ang II and the 13-membered cyclic vinyl sulfides with cis and trans configuration, respectively, suggested that all three systems adopted very similar low-energy conformations. This similarity was also reflected in the bioactivity. Both of the compounds that contained the ring systems encompassing the cis or trans vinyl sulfide elements between positions 3 and 5 exhibited K(i) values less than 2 nM and exerted full agonism at the AT(1) receptor. In contrast, vinyl sulfide cyclization involving the amino acid residues 5 and 7 rendered inactive compounds. The cyclic vinyl sulfides that have agonist activity were both shown to possess low-energy conformers compatible with the previously proposed 3D model for the bioactive conformation of Ang II.     

Stress reactions in police officers after a disaster rescue operation

This study intended to determine the prevalence of posttraumatic stress disorder symptoms and to report subjective well-being, general distress, and social functioning among police officers 18 months after a rescue operation during a fire at a discotheque. Emotional responses, including self-reported reactions, recorded during and after the fire were analysed. Forty-one police officers participated in the study. They completed a questionnaire and a battery of self-report measures. Psychological distress was recorded using the PTSS-10, IES-R, and GHQ-28. The three scales had a high internal consistency. The police officers were not unaffected by their experiences, and a few officers were still under stress. One police officer had IES-R intrusion and an avoidance score greater than 20, suggesting a stress reaction of clinical significance. When compared with the PTSS-10 scale, two (5%) officers showed a high level of psychological distress. Measured with the GHQ-28, three officers (7%) still had a high level of psychological distress. On one of the four different subscales most of the officers show various degrees of reduced social functioning. Debriefing was carried out by the police department after the fire, and 75% thought debriefing was positive. Eighteen months after the disaster a few police officers are still under stress.     

Cooperation between gatekeepers in sickness insurance – the perspective of social insurance officers. A qualitative study

Background  

Objective was to describe variations in how social insurance officers conceive the cooperation with the health care in their daily work with sick leave.     

Why do young women continue to have sexual intercourse despite pain?

PURPOSE: Many young women suffer from pain and discomfort during sexual intercourse, and an increasing number of them seek help for their problems. It seems that some young women continue to have sexual intercourse despite pain. However, their motives are unclear. METHODS: A total of 16 women, aged 14 to 20 years, with variable degrees of coital pain were selected at a youth center in a city in southeastern Sweden, to explore why they continued to have sexual intercourse despite pain. The women participated in audiotaped qualitative individual interviews, which were analyzed using the constant comparative method from grounded theory. RESULTS: During the analysis we identified the core category striving to be affirmed in their image of an ideal woman and the categories resignation, sacrifice, and feeling guilt. The perceived ideal women had several distinct characteristics, such as willingness to have sexual intercourse, being perceptive of their partner's sexual needs, and being able to satisfy their partners. Having sexual intercourse per se was considered to be an affirmation of being a normal woman, irrespective of pain or discomfort. CONCLUSIONS: These young women's focus on a constructed ideal explains why they continue to have sexual intercourse despite pain. Greater awareness of these beliefs among gynecologists, sexologists, and other healthcare professionals involved in the management of young women with coital pain would be beneficial.