PSYCHOLOGICAL DISTRESS AMONG INFORMAL SUPPORTERS OF FRAIL OLDER PEOPLE AT HOME AND IN INSTITUTIONS

Objective. Investigate presence of psychiatric morbidity in informal carers using 30-item General Health Questionnaire (GHQ) and examine which factors best predict psychiatric morbidity. Design. Two-year longitudinal, panel survey of informal supporters of frail elderly subjects, using semi-structured interview schedules. Subjects were those defined as frail after screening stratified random sample of people aged 65 or over. Setting. Informal supporters of frail elderly subjects residing in private households or residential or nursing homes in four UK districts. Respondents. 623 informal supporters of subjects living at home, 129 regular visitors of those in long-term care. Measure. 30-item GHQ (cross-sectional analysis). Results. Stepwise multiple regression indicated main predictors of high GHQ scores in key supporters were: subjects had at least three problems of behaviour (b=1.56, 95% CI 1.25–1.94); supporters had to alter working hours (b=1.70, 95% CI 1.15–2.51); supporters were female (b=1.26, 95% CI 1.06–1.50). The following variables predicted low GHQ scores: supporters able to leave subject all day (b=0.71, 95% CI 0.64–0.80); subjects never wandered (b=0.78, 95% CI 0.62–0.99); supporters were ‘other relatives’ or friends of subject (b=0.74, 95% CI 0.59–0.91). For visitors, spouses were most likely to have high GHQ scores (b=2.46, 95% CI 1.32–4.57). Conclusions. Results suggest the need for greater collaboration between formal and informal care. Little work has been carried out to ascertain which interventions are most effective in alleviating carer stress: a series of randomized controlled trials to determine long-term effectiveness of various interventions for different groups of carers is required. © 1997 John Wiley & Sons, Ltd.     

USING SMOOTHING SPLINE ANOVA TO EXAMINE THE RELATION OF RISK FACTORS TO THE INCIDENCE AND PROGRESSION OF DIABETIC RETINOPATHY

Smoothing spline ANOVA (ANalysis Of VAriance) methods provide a flexible alternative to the standard parametric GLIM (generalized linear models) methods for analysing the relationship of predictor variables to outcomes with data from large epidemiologic studies. These methods allow the visualization of relationships not readily fit by simple GLIM models, and provide for the ability to visualize interactions between the variables. At the same time, they reduce to GLIM models if the data suggest that the added flexibility is unwarranted. Using this method, we investigate risk factors for incidence and progression of diabetic retinopathy in a group of patients with older onset diabetes from the Wisconsin Epidemiological Study of Diabetic Retinopathy. We carry out four analyses to illustrate various properties of this class of methods. Some of the results confirm previous findings with use of standard methods, while others allow the visualization of more complex relationships not evident from the application of parametric methods. © 1997 by John Wiley & Sons, Ltd.     

THE NANOMELIC MUTATION IN THE AGGRECAN GENE IS EXPRESSED IN CHICK CHONDROCYTES AND NEURONS

We have established the presence of at least two large chondroitin sulfate proteoglycans in the developing chick brain, one that reacts exclusively with HNK-1, a carbohydrate epitope found on several neural specific molecules, and one that reacts with S103L, a defined peptide epitope in the CS-2 domain of the cartilage-specific chondroitin sulfate proteoglycan (CSPG), aggrecan. In order to determine the relationships between the two distinct S103L-reactive CSPGs from cartilage (chondrocytes) and brain (neurons), as well as among the three large CSPGs expressed in brain, S103L, HNK-1 and versican, we studied the expression of these multiple proteoglycan species in the brain of nanomelic chicks. We have previously shown that homozygous embryos expressing the nanomelic phenotype exhibit a single point mutation in the aggrecan gene. In the present study, the S103L CSPG is not accumulated or synthesized by embryonic chick CNS tissue or E8CH neuronal cultures derived from nanomelic chick embryo cerebral hemispheres. In contrast, expression of both versican and the HNK-1 CSPG was normal in the mutant embryo CNS. Pulse chase experiments demonstrated the presence of the 380 kDa precursor in normal neurons and the 300 kDa truncated precursor in nanomelic neurons. Northern blot analysis revealed normal-sized mRNA but reduced levels of expression of the S103L CSPG message in nanomelic neurons, while expression of the versican message was comparable in normal and nanomelic neurons. Most conclusively, the point mutation previously identified in nanomelic cartilage mRNA was also identified in nanomelic brain mRNA. Together these results provide evidence that a single aggrecan gene is expressed in both cartilage and CNS tissue leading to the production of identical core proteins which then undergo differential and tissue-specific post-translation processing, resulting in the characteristic tissue-specific proteoglycans. Furthermore, versican and the HNK-1 CSPG, although structurally and chemically similar to the S103L CSPG, are the products of separate genes. Copyright © 1996 ISDN. Published by Elsevier Science Ltd.     

Using Amnioinfusion for the Relief of Repetitive Variable Decelerations during Labor

Amnioinfusion is a method of replacing intrauterine amniotic fluid volume through intrauterine infusion of a saline solution using a pressure catheter. This method simply and effectively relieves variable decelerations not alleviated by the conventional measures of maternal position change and oxygen administration. The mechanisms underlying variable decelerations, the technique for amnioinfusion administration, and two case studies are reported. Nursing responsibilities regarding amnioinfusion include pattern recognition, assisting with or initiation of amnioinfusion, and maintenance and evaluation of this intervention.     

The Effects of Birth Chair Delivery on Maternal Perceptions

A prospective quasi-experimental study was conducted to determine women's perceptions of their childbirth experiences using a birth chair. The sample consisted of 55 primiparas, from 37 to 41 gestational weeks, with normal pregnancy and labor; 22 women delivered on a traditional delivery table (DT), and 33 women used a birth chair (BC). A questionnaire consisting of 21 items on a five-point scale (the higher the score, the more positive the perception) was self-administered by subjects during postpartum hospitalization. No significant differences were found between groups on overall score. However, women using the birth chair had a significantly higher score on the comfort subscale, as did women who had attended prepared childbirth classes.     

The psychophysiology of crying

Two conflicting views have emerged as to why people cry when they are sad. One suggests that crying serves homeostasis by facilitating recovery; the other suggests that crying produces an aversive high-arousal state that motivates behavior aimed at ending the tears. To test hypotheses drawn from these views, we showed a short film known to elicit sadness to 150 women. During this film, 33 subjects spontaneously cried and 117 did not. Subjects who eried exhibited more expressive behavior and reported feeling more sadness and pain than did subjects who did not cry. Crying also was associated with increases in somatic and autonomic nervous system activity. The increases in autonomic activity could not be accounted for solely by the increases in somatic activity. Crying is thus associated with an aversive state, including negative emotion and a complex mixture of sympathetic, parasympathetic, and somatic activation, and we speculate about the functional implications of these findings.     

Initial Experience with Mode Switching in a Dual Sensor, Dual Chamher Pacemaker in Patients with Paroxysmal Atrial Tachyarrhythmias

Mode switching algorithms have been developed to avoid tracking of atrial fibrillation (AF) or flutter (AFL) during DDD(R) pacing. Upon recognition of AF or AFL, the mode is switched to a nontracking, sensor driven mode. The Vitatron Diamond model 800 pacemaker does this on a beat-to-beat basis. Atrial events occurring within a “physiological range” (± 15 beats/min) calculated from a running average of the atrial rate are tracked. When atrial events are not tracked the escape interval is either determined by the sensor(s) or by a fallback algorithm thereby preventing large increases in V-V interval during mode switching. Loss of atrioventricular (AV) synchrony by atrial premature beats and after an episode of AF or AFL is prevented by atrial synchronization pulses (ASP), which are delivered after a safe interval (timed out from the sensed premature atrial event) has expired and before delivery of the next ventricular stimulus. We implanted 26 such devices in 18 men and 8 women with symptomatic second- or third-degree AV block and paroxysmal AF or AFL. Their ages ranged from 18–84 years (mean 60), and the follow-up ranged from 2–13 months (mean 8). During pacemaker check-up, exercise testing or 24-hour Holter monitoring one or more episodes of mode switching was documented in 8 patients. In these 8 patients a smooth transition (ventricular rate) from sinus rhythm to AF or AFL was documented on one or more occasions, without inappropriate increase in ventricular rate in the DDDR mode. None of the patients complained of palpitations. Appropriate rate response was seen in all patients during Holter monitoring and exercise. Restoration of AV synchrony with ASP was documented many times. In 2 patients the DDIR mode was programmed due to intermittent synchronization of ventricular stimuli to near incessant supraventricular tachycardia, which sometimes gave rise to asymptomatic slightly irregular ventricular paced rhythms below WO beats/min. Recognition of AF or AFL was reliable. No inappropriate increases in ventricular pacing rate were seen at the onset of or during AF or AFL. ASP is an effective method of maintaining AV synchrony and avoiding competitive atrial pacing.     

Change in HIV-antibody seroprevalence rates in i.v. drug dependent prisoners

In 1985 a high HIV-seroprevalence (44.2%) was found in a cohort of parenteral drug addicted prisoners in Innsbruck, Austria. In a longitudinal study from March 1985 to March 1989 we investigated the epidemiology of HIV-infection as well as possible changes in the drug taking behaviour of this defined population at risk. During the study HIV-seroprevalence rates in drug dependent prisoners showed a statistical decrease to 30%. A concomitant increase in admission to any kind of therapy programmes as well as an increasing change from ‘heavy use’ (mainly taking heroin i.v.) to ‘non-heavy use’ (mainly taking drugs orally) could be noted. The influence of preventive measures, such as comprehensive AIDS-information, special therapy programmes including the methadone substitution programme, and the unrestricted availability of needles and syringes is discussed.     

Human circadian rhythms in constant dim light (8 lux) with knowledge of clock time

The light/dark (L/D) cycle is a major synchronizer of human circadian rhythms. In the absence of a strong L/D cycle, synchrony with 24 hours can nevertheless be maintained in a socially structured environment, as shown in Polar regions (Broadway et al . 1987) and by some blind subjects (Czeisler et al . 1995a). The relative contribution of other time cues to entrainment in dim light has not been fully explored. The present study investigated the behaviour of melatonin (assessed as 6-sulphatoxymelatonin); rectal temperature; activity and sleep (actigraphy and logs) in constant dim light (L/L) with access to a digital clock. 6 normal healthy males were maintained as a group in partial temporal isolation with attenuated sound and ambient temperature for 21 days. All 6 subjects showed free-running periodicity for 6-sulphatoxymelatonin and 5/6 subjects for temperature, activity and sleep offset. The average period (tau) was 24.26±0.049, substantially shorter than in previous experiments with a self selected L/D cycle but similar to a recent study conducted in very dim light. One subject maintained a rigid sleep/wake cycle throughout whilst his 6-sulphatoxymelatonin rhythm free-ran. Total sleep time, from actigraph data, did not change but sleep efficiency decreased during the experiment. The subjects did not show group synchronization. These results confirm previous data indicating the importance of the L/D cycle in human entrainment and underline the lesser role of social cues and knowledge of clock time. This particular approach will permit the administration of timed medication to sighted humans under free-running conditions.