Corticosterone release in response to repeated, short episodes of neonatal isolation : evidence of sensitization

Repeated isolation of neonatal rats produces persistent changes in physiology and behavior. In Experiment 1, we examined changes in plasma corticosterone (CORT) levels as a possible mechanism for the effects of isolation. Pups that were isolated from their mother and the nest for 1 h per day on postnatal days (PND) 2–9 were compared to control litters of pups that were either nonhandled or handled but not isolated. On PND 2, compared to nonhandled pups, handled pups had elevated CORT levels that returned to baseline levels within 30 to 60 min of return to the home cage. No significant elevation of CORT levels were found in handled pups on PND 9. The CORT levels of isolated pups were over twice those of nonhandled pups on PND 2 and four times those of nonhandled pups on PND 9. In Experiment 2, we investigated whether the increased CORT release in response to isolation on PND 9 was the result of the pups treatment on the previous six days as against an effect of maturation. Plasma CORT levels were measured in rat pups that were either isolated, handled or nonhandled on PNDs 2–8 during the conditions of isolation, handling and nonhandling on PND 9. There were no differences among the groups in basal plasma levels of CORT. Handling on PND 9 did not result in elevated CORT levels in any of the groups. All three groups showed a significant increase in plasma CORT levels after isolation on PND 9. However, the CORT response to isolation of pups previously isolated on PND 2–8 were significantly higher than pups that were either handled or nonhandled on PNDs 2–8. Thus, daily episodes of isolation potentiate the hypothalamic-pituitary-adrenal response to stress.     

Critical reading using the READER acronym by experienced general practitioners (G.P.s) and by G.P. registrars in Southern and Northern Ireland

The READER acronym describes a simple easily applied method of critical reading, an important skill for general practitioners (GPs). The aim of the study was to evaluate an abstract using the READER method, and to compare the appraisal by GP registrars in Southern Ireland with those of GP registrars in Northern Ireland and those previously recorded by experienced GPs at the Conference of Teachers of the Irish College of General Practitioners. General practice registrars (n=41) in Southern Ireland participated in a critical reading workshop at which they appraised the abstract of a sample paper using the READER model for critical appraisal. A group of GP registrars (n=10) in Northern Ireland, and experienced GPs (n=35) at the Conference of Teachers of the Irish College of General Practitioners evaluated the complete paper using a similar methodology. There was no statistically significant difference between scores recorded by GP registrars in Southern Ireland and their Northern Irish counterparts, nor was there a statistically significant difference with experienced GP teachers. The READER model for critical reading provides GP registrars with a useful tool for critical evaluation of medical literature. GP registrars in Southern Ireland, Northern Ireland, and experienced GP’s from the Conference of Teachers in Ireland recorded similar results and the study appraised, while dealing with an intervention in one practice in south west England, appeared relevant and applicable to participants from other locations in a different health care system.     

The pharmacokinetics of isoxicam in elderly patients with rheumatoid arthritis

Nineteen patients, aged 60 years and over, with rheumatoid arthritis participated in a clinical trial to investigate the pharmacokinetics of isoxicam (a new non-steroidal anti-inflammatory drug) in this age group. The purpose of the study was to determine if the pharmacokinetics are different compared to a younger healthy population. The half-lives were independent of dosage, indicating linearity of pharmacokinetics. Furthermore, the half-lives after repeated dosing were not different from those found after single doses of 400 mg. This shows that there is neither undue accumulation of the drug nor induction of its own metabolism. These results are similar to the results obtained in other centres when isoxicam was administered to healthy subjects between 18 and 32 years.     

Diagnosis: Chronic kidney disease, now what!

The occupational health nurse can play an important role in supporting employees with CKD and ESRD by recognizing risk factors such as diabetes and hypertension associated with CKD. The occupational health nurse should encourage compliance with treatment regimens that retard or delay progression of kidney disease into the next stage, especially blood pressure and glucose control. When employees are in need of diagnostic testing, the occupational health nurse can describe the testing procedures such as laboratory values, ultrasounds, and biopsies, and explain the five stages of CKD. The occupational health nurse can assist employees in Stage 4 or 5 CKD in deciding on a treatment option modality that best suits their individual lifestyles, after they have seen a nephrologist and kidney patient educator. In addition, the occupational health nurse can guide employees with difficult lifestyle changes and provide support during the adjustment process. The occupational health nurse also can play a key role in facilitating and coordinating those changes with the renal social worker. Together they can explore available resources, such as the NKF, the American Association of Kidney Patients, and kidneydirections.com. See the Sidebar on pages 295 to 296 for other available resources. Kidney disease can be a devastating diagnosis. Support and education are key to a successful lifestyle transition. Employees who have CKD and work with an occupational health nurse who is informed about their disease and its stages of progression can benefit from educational processes that create informed choices to delay or retard the progression of their renal disease.     

Older people's assets: a contested site1

The management of the financial assets of older people is increasingly important in the current policy context. Competing interests from the state, the market and the family regarding the appropriate use of these assets suggest that non‐professional managers are assisting older people in a complex environment. This paper, based on a national prevalence study and an in‐depth study, explores the nature and extent of asset management on behalf of older people. It examines the role of legal provision for substitute decision‐making in these processes and concludes that the current provision is insufficient to protect older people from financial abuse and support carers to manage assets well. This paper proposes that more broadly based interventions are required in a complex environment of competing interests. Such interventions include attitudinal change, improved financial literacy, information and support for older people and informal asset managers and improved monitoring and support for substitute decision makers.