Measuring the wellbeing of family caregivers using the time trade-off technique

In the absence of a quality of life instrument which is applicable to the caregivers of elderly relatives and amenable to a cost-utility analyses, the Caregiver Quality of Life Instrument (CQLI) was developed using Torrance's time trade-off technique. The CQLI was administered to 30 family caregivers and 10 relatives of well elderly. Utility scores were obtained for three standardized caregiver situations and the subject's own state. The CQLI could be completed by almost all subjects. Good test-retest reliability was established. The subjects were able to discriminate between degrees of caregiver wellbeing using standardized states and the CQLI scores discriminated among groups of subjects. The CQLI detected within-subject change in caregivers whose relatives received institutional respite care. The CQLI appears to be feasible, reliable, valid, and responsive to change. Further CQLI applications and research are recommended.     

Ibuprofen-induced meningitis in an elderly patient with systemic lupus erythematosus

The use of ibuprofen by patients with systemic lupus erythematosus poses a major threat of aseptic meningitis. Although previously reported cases have all been in young adults, our case of ibuprofen-induced meningitis occurred in a 73-year-old woman. This report greatly expands the age population that may suffer meningitis from this analgesic, now available over the counter, and emphasizes the importance of recognizing this causative relationship in patients with headache.     

Calcium antagonists and blood glucose in normal rabbits

The effects of the calcium antagonists verapamil and nifedipine on blood glucose levels, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic effect of tolbutamide were studied in normal nondiabetic rabbits. Daily dosage of 40 mg/kg verapamil and 5 mg/kg nifedipine given orally up to 7 days did not affect blood glucose level, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic activity of tolbutamide 250 mg/kg p.o.     

Auricular complication of acupuncture

Auricular chondritis occurred in a patient following a course of auricular acupuncture administered to help the patient give up smoking. Despite immediate treatment the condition pursued a long course resulting in considerable morbidity and some deformity of the ear. Twenty months after presentation the ear is not completely stable. Acupuncture should be considered a form of penetrating trauma which may induce perichondritis or chondritis in the auricle.     

Synaptic physiology of horizontal connections in the cat's visual cortex.

Horizontal connections are a principal component of intrinsic cortical circuitry. They arise mainly from pyramidal cells and course parallel to the brain's surface for distances as long as 8 mm, linking columns with shared orientation preference and allowing cells to integrate visual information from outside their receptive fields. We examined the synaptic physiology of the horizontal pathway in slices of the cat's striate cortex and found that activating lateral fibers produced both excitation and inhibition. We recorded the postsynaptic responses of identified pyramidal cells in layer 2 + 3 of area 17 to electrical shocks applied at three sites: in the home column of the impaled neuron either in layer 2 + 3 or 4, or at a lateral distance of 0.9-3 mm in layer 2 + 3. Within the home column, suprathreshold stimuli produced compound EPSPs with action potentials, followed by fast, GABAAergic IPSPs and a slower, GABABergic IPSP. For the distant stimulating site, the threshold response was an EPSP. Stronger shocks frequently evoked a disynaptic, GABAAergic IPSP that truncated the EPSP and could dominate the postsynaptic response. At the resting potential, the horizontally evoked EPSP was too small to elicit spikes. With depolarization of the membrane, however, it grew several hundred-fold. This amplification was blocked by N-(2,6-dimethylphenylcarbamoylmethyl)triethylammonium bromide (QX-314), but not by 2-amino-5-phosphonovalerate (APV), indicating that it was mediated by Na+ channels, rather than by NMDA receptors. We propose that the horizontal connections provide the means for stimuli outside the receptive field to modulate activity elicited within its confines. The voltage-dependent enhancement of the laterally evoked EPSP may explain why stimulating the surround by itself fails to drive cells but can facilitate their response to stimuli within the receptive field. The ability to initiate disynaptic inhibition from lateral sites shows that recruiting appropriate groups of horizontal fibers can also have a suppressive effect. Thus, the effect of horizontal input is state dependent, with the size and sign of the laterally evoked response changing according to the balance of converging inputs.     

Eligible Veterans'' Choice Between VA-covered and Non-VA-covered Dental Care

Veterans who were eligible for dental care in Department of Veterans Affairs (VA) facilities at no monetary cost responded to a mailed questionnaire. Seventy-one percent were aware that they were actually eligible for VA dental care. However, only 48 percent reported the VA as their only or primary source of dental care. Eligibility status, perceived quality of VA dental care, use of VA medical care, perception that one's income meets expenses, and perceived need for dental care were significant correlates of using the VA as one's current source of dental care. Level of formal education, perception that one's income meets expenses, transportation pattern, geographic distance from a VA facility, and eligibility status were significant correlates of using the VA as one's current medical care source. Research on VA utilization offers the opportunity to study issues of access to, and use of, a large public health care system whose patients largely receive care at no monetary cost. Veterans' use of VA dental and medical care is apparently influenced by a wide variety of factors, ranging from barriers to access to non-VA systems, to characteristics of the VA delivery system itself, to need for treatment.